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10|FH_F91575_0_0|0.00|14
10|FH_F91594_0_0|0.00|7
10|FH_F91898_0_0|0.00|34
10|FH_F91900_0_0|0.00|15
10|FH_F91933_0_0|0.00|9
10|FH_F91940_0_0|0.00|17
10|FH_F92119_0_0|0.00|12
10|FH_F92120_0_0|0.00|15
10|FH_F92493_0_0|0.00|79
10|FH_F92496_0_0|0.00|2
10|FH_F92516_0_0|0.00|14
10|FH_F92531_0_0|0.00|26
10|FH_F92614_0_0|0.00|2
10|FH_F92935_0_0|0.00|13
10|FH_F92972_0_0|0.00|5
10|FH_F93000_0_0|0.00|2
10|FH_F93138_0_0|0.00|4
10|FH_F93172_0_0|0.00|6
10|FH_F93212_0_0|0.00|15
10|FH_F93232_0_0|0.00|9
10|FH_F93237_0_0|0.00|3
10|FH_F93279_0_0|0.00|14
10|FH_F93281_0_0|0.00|14
10|FH_F93375_0_0|0.00|13
10|FH_F93381_0_0|0.00|2
10|FH_F93421_0_0|0.00|6
10|FH_F93592_0_0|0.00|15
10|FH_F94103_0_0|0.00|3
10|FH_F94165_0_0|0.00|36
10|FH_F94280_0_0|0.00|16
10|FH_F94403_0_0|0.00|15
10|FH_F94481_0_0|0.00|9
10|FH_F94502_0_0|0.00|8
10|FH_F94581_0_0|0.00|6
10|FH_F94665_0_0|0.00|16
10|FH_F95101_0_0|0.00|9
10|FH_F95284_0_0|0.00|3
10|FH_F95482_0_0|0.00|16
10|FH_F95629_0_0|0.00|13
10|FH_F95900_0_0|0.00|14
10|FH_F96780_0_0|0.00|29
10|FH_F97161_0_0|0.00|14
10|FH_F99441_0_0|0.00|18
10|FH_F99442_0_0|0.00|2
10|FH_F99520_0_0|0.00|2
10|FH_F99541_0_0|0.00|2
10|FH_F99760_0_0|0.00|2
10|FH_F99960_0_0|0.00|28
10|FH_F86717_0_0|0.00|5
10|FH_F87012_0_0|0.00|13
10|FH_F87114_0_0|0.00|2
10|FH_F87152_0_0|0.00|2
10|FH_F87272_0_0|0.00|2
10|FH_F87480_0_0|0.00|27
10|FH_F87482_0_0|0.00|2
10|FH_F87816_0_0|0.00|4
10|FH_F88357_0_0|0.00|15
10|FH_F88391_0_0|0.00|6
10|FH_F88451_0_0|0.00|12
10|FH_F88616_0_0|0.00|5
10|FH_F89340_0_0|0.00|27
10|FH_F89372_0_0|0.00|40
10|FH_F89495_0_0|0.00|20
10|FH_F89551_0_0|0.00|5
10|FH_F89580_0_0|0.00|31
10|FH_F89582_0_0|0.00|6
10|FH_F89760_0_0|0.00|3
10|FH_F89799_0_0|0.00|3
10|FH_F90173_0_0|0.00|4
10|FH_F90653_0_0|0.00|13
10|FH_F90714_0_0|0.00|14
10|FH_F90838_0_0|0.00|2
10|FH_F91034_0_0|0.00|4
10|FH_F91056_0_0|0.00|2
10|FH_F91077_0_0|0.00|2
10|FH_F91284_0_0|0.00|14
10|FH_F91451_0_0|0.00|3
10|FH_F91634_0_0|0.00|16
10|FH_F91636_0_0|0.00|2
10|FH_F91787_0_0|0.00|5
10|FH_F91819_0_0|0.00|16
10|FH_F91912_0_0|0.00|9
10|FH_F91973_0_0|0.00|17
10|FH_F91975_0_0|0.00|20
10|FH_F91994_0_0|0.00|27
10|FH_F92091_0_0|0.00|36
10|FH_F92477_0_0|0.00|10
10|FH_F92599_0_0|0.00|12
10|FH_F92659_0_0|0.00|28
10|FH_F92760_0_0|0.00|2
10|FH_F92792_0_0|0.00|33
10|FH_F92871_0_0|0.00|17
10|FH_F92971_0_0|0.00|2
10|FH_F92993_0_0|0.00|34
10|FH_F93119_0_0|0.00|6
10|FH_F93268_0_0|0.00|6
10|FH_F93275_0_0|0.00|17
10|FH_F93331_0_0|0.00|13
10|FH_F93354_0_0|0.00|3
10|FH_F93371_0_0|0.00|2
10|FH_F93377_0_0|0.00|8
10|FH_F93413_0_0|0.00|6
10|FH_F93517_0_0|0.00|12
10|FH_F93740_0_0|0.00|28
10|FH_F93786_0_0|0.00|2
10|FH_F93805_0_0|0.00|4
10|FH_F93909_0_0|0.00|2
10|FH_F93948_0_0|0.00|2
10|FH_F93961_0_0|0.00|23
10|FH_F94060_0_0|0.00|2
10|FH_F94101_0_0|0.00|2
10|FH_F94102_0_0|0.00|3
10|FH_F94340_0_0|0.00|2
10|FH_F95221_0_0|0.00|12
10|FH_F95641_0_0|0.00|9
10|FH_F95962_0_0|0.00|4
10|FH_F96902_0_0|0.00|12
10|FH_F98741_0_0|0.00|4
10|FH_F99161_0_0|0.00|15
10|FH_F99528_0_0|0.00|2
10|FH_F99720_0_0|0.00|31
20|FH_F100060_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F100060_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F100060_0_0|CSTM-ALL|CSTM-00|2020|PDM|1851.00|99|0.00|AEG 1 (NO REV)
20|FH_F100060_0_0|SrvcGrp|705|2022|PCT|0.50|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F100063_0_0|SrvcGrp|76501|2022|PDM|235.00|99|0.00|SUB-ACUTE - LEVEL I
20|FH_F100240_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F100320_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F100320_0_0|SrvcGrp|75485|2022|PDM|674.00|99|0.00|AEG 4
20|FH_F100320_0_0|SrvcGrp|75491|2022|PDM|1065.00|99|0.00|AEG 7
20|FH_F100320_0_0|SrvcGrp|86919|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH INCIDENTAL CODES
20|FH_F100320_0_0|SrvcGrp|93121|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F100460_0_0|CSTM-ALL|CSTM-00|2020|PDM|1104.00|99|0.00|AEG 5  (NO REV)
20|FH_F100460_0_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS
20|FH_F100540_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F100540_0_0|SrvcGrp|72994|2022|PDM|1104.75|99|0.00|AEG 3
20|FH_F100703_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F100703_0_0|CSTM-ALL|CSTM-00|2020|PDM|2035.00|99|0.00|AEG 3 (NO REV)
20|FH_F100703_0_0|CSTM-ALL|CSTM-00|2020|PDM|2625.00|99|0.00|AEG 5  (NO REV)
20|FH_F100703_0_0|CSTM-ALL|CSTM-00|2020|PDM|4391.00|99|0.00|AEG 9 (NO REV)
20|FH_F100703_0_0|SrvcGrp|16669|2022|PDM|3535.00|99|0.00|ACROMINOPLASTY OF SHOULDER
20|FH_F100703_0_0|SrvcGrp|16692|2022|PDM|3535.00|99|0.00|KNEE SCOPE
20|FH_F100703_0_0|SrvcGrp|19991|2022|PDM|7876.00|99|0.00|NERVOUS SYSTEM SERVICES
20|FH_F100703_0_0|SrvcGrp|93741|2022|PDM|8034.00|99|0.00|REVISE SPINE ELECTRODE PERCUTANEOUS ARRAY
20|FH_F100703_0_0|SrvcGrp|96353|2022|PDM|8034.00|99|0.00|RECONSTRUCT ANKLE JOINT
20|FH_F100703_0_0|SrvcGrp|96354|2022|PDM|7876.00|99|0.00|REMOVAL OF ANKLE JOINT
20|FH_F100703_0_0|SrvcGrp|96919|2022|PDM|4200.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F100703_0_0|SrvcGrp|97039|2022|PDM|3466.00|99|0.00|KNEE ARTHROSCOPY
20|FH_F100703_0_0|SrvcGrp|97059|2022|PDM|3466.00|99|0.00|MENISCUS REPAIR, MED OR LAT
20|FH_F100703_0_0|SrvcGrp|97079|2022|PDM|3466.00|99|0.00|MENISCUS REPAIR, MED OR LAT
20|FH_F100703_0_0|SrvcGrp|97139|2022|PDM|8034.00|99|0.00|LAMINECTOMY W/FACETECTOMY
20|FH_F100703_0_0|SrvcGrp|97159|2022|PDM|8034.00|99|0.00|TRANSPEDICULAR, 1 SEG, LUMBAR
20|FH_F100703_0_0|SrvcGrp|97179|2022|PDM|8034.00|99|0.00|DECOMPRESS SPINE CORD ADD-ON
20|FH_F100703_0_0|SrvcGrp|97219|2022|PDM|7876.00|99|0.00|DECOMPRESS SPINE CORD ADD-ON
20|FH_F100741_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F100741_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F100741_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F100741_0_0|SrvcGrp|72994|2022|PDM|703.00|99|0.00|AEG 3
20|FH_F100741_0_0|SrvcGrp|72996|2022|PDM|973.00|99|0.00|AEG 4
20|FH_F100741_0_0|SrvcGrp|73006|2022|PDM|1453.00|99|0.00|AEG 9
20|FH_F100789_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|AEG 10 (NO REV)
20|FH_F100789_0_0|CSTM-ALL|CSTM-00|2020|PDM|5041.00|99|0.00|AEG 7 (NO REV)
20|FH_F100789_0_0|CSTM-ALL|CSTM-00|2020|PDM|6786.00|99|0.00|AEG 9 (NO REV)
20|FH_F100841_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F100841_0_0|SrvcGrp|87077|2022|PDM|105.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F100904_0_0|CSTM-ALL|CSTM-00|2020|PDM|1070.00|99|0.00|AEG 8 (NO REV)
20|FH_F100904_0_0|CSTM-ALL|CSTM-00|2020|PDM|366.00|99|0.00|AEG 1 (NO REV)
20|FH_F100906_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F100906_0_0|SrvcGrp|63459|2022|PDM|1800.00|99|0.00|CPT 52601
20|FH_F100906_0_0|SrvcGrp|67072|2022|PDM|2000.00|99|0.00|CPT 22845
20|FH_F100906_0_0|SrvcGrp|72992|2022|PDM|643.00|99|0.00|AEG 2
20|FH_F100906_0_0|SrvcGrp|72994|2022|PDM|793.00|99|0.00|AEG 3
20|FH_F100906_0_0|SrvcGrp|72998|2022|PDM|1185.00|99|0.00|AEG 5
20|FH_F100906_0_0|SrvcGrp|73006|2022|PDM|1254.00|99|0.00|AEG 9
20|FH_F100906_0_0|SrvcGrp|92676|2022|PCT|0.00|99|0.00|IMAGING ENHANCED SUBSTANCE
20|FH_F100906_0_0|SrvcGrp|97499|2022|PDM|1020.00|99|0.00|AETNA BIOPSY OR EXCISION
20|FH_F100906_0_0|SrvcGrp|98661|2022|PDM|2016.00|99|0.00|AETNA AEG 7 WITHOUT HERNIA
20|FH_F100962_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F100962_0_0|SrvcGrp|72998|2022|PDM|1061.00|99|0.00|AEG 5
20|FH_F100962_0_0|SrvcGrp|73006|2022|PDM|1353.00|99|0.00|AEG 9
20|FH_F100984_0_0|CSTM-ALL|CSTM-00|2020|PDM|1061.00|99|0.00|AEG 8 (NO REV)
20|FH_F100984_0_0|CSTM-ALL|CSTM-00|2020|PDM|791.00|99|0.00|AEG 5  (NO REV)
20|FH_F101041_0_0|SrvcGrp|82981|2022|PDM|130.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F101063_0_0|CSTM-ALL|CSTM-00|2020|PCT|62.00|99|0.00|OP SVCS
20|FH_F101083_0_0|SrvcGrp|19923|2022|PDM|2625.00|99|0.00|HYSTEROSCOPY
20|FH_F101083_0_0|SrvcGrp|72990|2022|PDM|452.00|99|0.00|AEG 1
20|FH_F101083_0_0|SrvcGrp|73000|2022|PDM|1123.00|99|0.00|AEG 6
20|FH_F101083_0_0|SrvcGrp|74588|2022|PDM|2100.00|99|0.00|AETNA ARTHROSCOPY
20|FH_F101104_0_0|SrvcGrp|27969|2022|PDM|61.00|99|0.00|HOME HEALTH AIDE
20|FH_F101104_0_0|SrvcGrp|73524|2022|PDM|147.00|99|0.00|PHYSICAL THERAPY
20|FH_F101104_0_0|SrvcGrp|87393|2022|PDM|147.00|99|0.00|HCPCS G0151 (HCFA)
20|FH_F101104_0_0|SrvcGrp|88809|2022|PDM|61.00|99|0.00|HOME HEALTH AIDE (HCFA)
20|FH_F101104_0_0|SrvcGrp|90338|2022|PDM|125.00|99|0.00|SKILLED NURSING RN (HCFA)
20|FH_F101104_0_0|SrvcGrp|95761|2022|PDM|125.00|99|0.00|NURSING CARE (HCFA)
20|FH_F101161_0_0|SrvcGrp|4003|2022|PDM|2500.00|99|0.00|CPT CODE 99291- CRITICAL CARE
20|FH_F101164_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F101341_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F101360_0_0|CSTM-ALL|CSTM-00|2020|PDM|1040.00|99|0.00|AEG 5  (NO REV)
20|FH_F101360_0_0|CSTM-ALL|CSTM-00|2020|PDM|1197.00|99|0.00|AEG 6 (NO REV)
20|FH_F101360_0_0|CSTM-ALL|CSTM-00|2020|PDM|1410.00|99|0.00|AEG 8 (NO REV)
20|FH_F101360_0_0|CSTM-ALL|CSTM-00|2020|PDM|1942.00|99|0.00|AEG 9 (NO REV)
20|FH_F101360_0_0|CSTM-ALL|CSTM-00|2020|PDM|647.00|99|0.00|AEG 2 (NO REV)
20|FH_F101380_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F101380_0_0|CSTM-ALL|CSTM-00|2020|PDM|1313.00|99|0.00|AEG 1 (NO REV)
20|FH_F101406_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|GENERAL ACUTE CARE
20|FH_F101410_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|OP SVCS
20|FH_F101441_0_0|CSTM-ALL|CSTM-00|2020|PDM|3178.00|99|0.00|AEG 6 (NO REV)
20|FH_F101441_0_0|SrvcGrp|112026|2022|PDM|8105.00|99|0.00|TOTAL KNEE ARTHROPLASTY
20|FH_F101441_0_0|SrvcGrp|19920|2022|PDM|3567.00|99|0.00|ARTHROSCOPY OF SHOULDER
20|FH_F101441_0_0|SrvcGrp|38015|2022|PDM|7946.00|99|0.00|ARTHRODESIS
20|FH_F101441_0_0|SrvcGrp|93740|2022|PDM|8105.00|99|0.00|REVISE/REMOVE NEURO RECEIVER
20|FH_F101441_0_0|SrvcGrp|93741|2022|PDM|8105.00|99|0.00|REVISE SPINE ELECTRODE PERCUTANEOUS ARRAY
20|FH_F101441_0_0|SrvcGrp|96349|2022|PDM|7946.00|99|0.00|NECK SPINE FUSE
20|FH_F101441_0_0|SrvcGrp|96353|2022|PDM|8105.00|99|0.00|RECONSTRUCT ANKLE JOINT
20|FH_F101441_0_0|SrvcGrp|96999|2022|PDM|3567.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F101441_0_0|SrvcGrp|97019|2022|PDM|4323.00|99|0.00|ARTHROSCOPY BICEPS TENODESIS
20|FH_F101441_0_0|SrvcGrp|97219|2022|PDM|8105.00|99|0.00|DECOMPRESS SPINE CORD ADD-ON
20|FH_F101441_0_0|SrvcGrp|97259|2022|PDM|8105.00|99|0.00|INCISE SPINAL COLUMN NERVES
20|FH_F101441_0_0|SrvcGrp|97319|2022|PDM|7946.00|99|0.00|REVISE SPINE ELTRD PLATE
20|FH_F101441_0_0|SrvcGrp|99073|2022|PDM|1.40|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F101442_0_0|CSTM-ALL|CSTM-00|2020|PDM|1045.00|99|0.00|AEG 4 (NO REV)
20|FH_F101442_0_0|CSTM-ALL|CSTM-00|2020|PDM|552.00|99|0.00|AEG 1 (NO REV)
20|FH_F101442_0_0|CSTM-ALL|CSTM-00|2020|PDM|740.00|99|0.00|AEG 2 (NO REV)
20|FH_F101442_0_0|CSTM-ALL|CSTM-00|2020|PDM|847.00|99|0.00|AEG 3 (NO REV)
20|FH_F101442_0_0|SrvcGrp|41327|2022|PDM|926.81|99|0.00|OP SURGERY CPT 28308
20|FH_F101442_0_0|SrvcGrp|70746|2022|PDM|1494.63|99|0.00|CPT 28292
20|FH_F101442_0_0|SrvcGrp|89989|2022|PDM|1490.63|99|0.00|FUSION OF BIG TOE JOINT
20|FH_F101442_0_0|SrvcGrp|92197|2022|PDM|1501.22|99|0.00|CORRECTION OF BUNION
20|FH_F101442_0_0|SrvcGrp|98462|2022|PDM|1427.10|99|0.00|REVISON OF FOOT
20|FH_F101442_0_0|SrvcGrp|98463|2022|PDM|1347.69|99|0.00|CORRECTION OF BUNION
20|FH_F101442_0_0|SrvcGrp|98465|2022|PDM|1178.85|99|0.00|OPEN TXMT METATARSOPHALANGEAL
20|FH_F101442_0_0|SrvcGrp|98469|2022|PDM|1106.52|99|0.00|AMPUTATION METATARSAL
20|FH_F101442_0_0|SrvcGrp|98470|2022|PDM|1010.93|99|0.00|AMPUTATION TOE
20|FH_F101442_0_0|SrvcGrp|98471|2022|PDM|711.90|99|0.00|CLOSED TXMT TALOTARSAL JOINT
20|FH_F101562_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS
20|FH_F101564_0_0|CSTM-ALL|CSTM-00|2020|PCT|54.00|99|0.00|GENERAL ACUTE CARE
20|FH_F101566_0_0|CSTM-ALL|CSTM-00|2020|PCT|42.00|99|0.00|GENERAL ACUTE CARE
20|FH_F101568_0_0|CSTM-ALL|CSTM-00|2020|PCT|42.00|99|0.00|GENERAL ACUTE CARE
20|FH_F101568_0_0|CSTM-ALL|CSTM-00|2020|PCT|42.00|99|0.00|OP SVCS
20|FH_F101606_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F101607_0_0|CSTM-ALL|CSTM-00|2020|PDM|1942.00|99|0.00|AEG 9 (NO REV)
20|FH_F101607_0_0|CSTM-ALL|CSTM-00|2020|PDM|864.00|99|0.00|AEG 10 (NO REV)
20|FH_F101607_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 4 (NO REV)
20|FH_F101685_0_0|SrvcGrp|104021|2022|PDM|2450.00|99|0.00|CYSTOSCOPY PROSTATIC IMP 1-3
20|FH_F101685_0_0|SrvcGrp|72994|2022|PDM|646.00|99|0.00|AEG 3
20|FH_F101685_0_0|SrvcGrp|72998|2022|PDM|885.00|99|0.00|AEG 5
20|FH_F101685_0_0|SrvcGrp|73000|2022|PDM|962.00|99|0.00|AEG 6
20|FH_F101685_0_0|SrvcGrp|73004|2022|PDM|1205.00|99|0.00|AEG 8
20|FH_F101685_0_0|SrvcGrp|73008|2022|PDM|384.00|99|0.00|AEG 10
20|FH_F101700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F101700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F101700_0_0|CSTM-ALL|CSTM-00|2020|PDM|685.00|99|0.00|AEG 10 (NO REV) INTERVENTIONAL PAIN CTR
20|FH_F101700_0_0|SrvcGrp|35669|2022|PDM|4422.13|99|0.00|CPT 63650
20|FH_F101700_0_0|SrvcGrp|87677|2022|PDM|862.19|99|0.00|CERVICAL OR THORACIC SURGERY
20|FH_F101700_0_0|SrvcGrp|98103|2022|PDM|38.85|99|0.00|INJECTION TRIGGER POINTS >3
20|FH_F101709_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F101709_0_0|SrvcGrp|112025|2022|PDM|8441.00|99|0.00|TOTAL HIP ARTHROPLASTY
20|FH_F101709_0_0|SrvcGrp|112026|2022|PDM|8441.00|99|0.00|TOTAL KNEE ARTHROPLASTY
20|FH_F101709_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F101709_0_0|SrvcGrp|26275|2022|PDM|2985.00|99|0.00|CPT 29826
20|FH_F101709_0_0|SrvcGrp|72990|2022|PDM|1236.00|99|0.00|AEG 1
20|FH_F101709_0_0|SrvcGrp|72992|2022|PDM|1433.00|99|0.00|AEG 2
20|FH_F101709_0_0|SrvcGrp|73004|2022|PDM|2746.00|99|0.00|AEG 8
20|FH_F101709_0_0|SrvcGrp|73006|2022|PDM|2746.00|99|0.00|AEG 9
20|FH_F101709_0_0|SrvcGrp|73008|2022|PDM|1236.00|99|0.00|AEG 10
20|FH_F101709_0_0|SrvcGrp|97363|2022|PDM|2865.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F101711_0_0|SrvcGrp|46605|2022|PDM|75.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES
20|FH_F101711_0_0|SrvcGrp|48394|2022|PDM|50.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F101747_0_0|SrvcGrp|87077|2022|PDM|105.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F101752_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F101752_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F101752_0_0|SrvcGrp|11108|2022|PDM|712.00|99|0.00|NEWBORN NURSERY
20|FH_F101752_0_0|SrvcGrp|74584|2022|PCT|0.90|99|0.00|AETNA OBSERVATION SERVICES
20|FH_F101752_0_0|SrvcGrp|75506|2022|PCT|0.90|99|0.00|VASCULAR DIAGNOSTIC STUDIES
20|FH_F101752_0_0|SrvcGrp|80245|2022|PCT|0.00|99|0.00|AETNA STEP DOWN/TELEMETRY
20|FH_F101752_0_0|SrvcGrp|88977|2022|PDM|6401.00|99|0.00|C-SECTION DELIVERY
20|FH_F101752_0_0|SrvcGrp|92825|2022|PCT|0.90|99|0.00|AETNA CARDIAC CATHERTERIZATION
20|FH_F101755_0_0|CSTM-ALL|CSTM-00|2020|PCT|52.00|99|0.00|OP SVCS
20|FH_F101757_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|GENERAL ACUTE CARE
20|FH_F101806_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F101806_0_0|SrvcGrp|24714|2022|PCT|1.05|99|0.00|INTRAOCULAR LENS
20|FH_F101806_0_0|SrvcGrp|75489|2022|PDM|920.00|99|0.00|AEG 6
20|FH_F101806_0_0|SrvcGrp|75493|2022|PDM|1083.30|99|0.00|AEG 8
20|FH_F101806_0_0|SrvcGrp|93121|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F101824_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F101844_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F101844_0_0|CSTM-ALL|CSTM-00|2020|PDM|3577.00|99|0.00|AEG 1 (NO REV)
20|FH_F101844_0_0|CSTM-ALL|CSTM-00|2020|PDM|5962.00|99|0.00|AEG 5  (NO REV)
20|FH_F101844_0_0|SrvcGrp|85022|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F101844_0_0|SrvcGrp|89404|2022|PDM|8943.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F101844_0_0|SrvcGrp|93433|2022|PDM|8943.00|99|0.00|PARTIAL HIP REPLACEMENT
20|FH_F101844_0_0|SrvcGrp|97741|2022|PDM|8943.00|99|0.00|REVISE KNEE
20|FH_F101844_0_0|SrvcGrp|98325|2022|PDM|8943.00|99|0.00|TTE W/DOPPLER COMPLETE
20|FH_F101844_0_0|SrvcGrp|98327|2022|PDM|8943.00|99|0.00|LAMINECTOMY FOR MYELOTOMY
20|FH_F101854_0_0|CSTM-ALL|CSTM-00|2020|PDM|1057.00|99|0.00|AEG 7 (NO REV)
20|FH_F101854_0_0|CSTM-ALL|CSTM-00|2020|PDM|1061.00|99|0.00|AEG 8 (NO REV)
20|FH_F101854_0_0|CSTM-ALL|CSTM-00|2020|PDM|353.00|99|0.00|AEG 1 (NO REV)
20|FH_F101854_0_0|CSTM-ALL|CSTM-00|2020|PDM|474.00|99|0.00|AEG 2 (NO REV)
20|FH_F101854_0_0|CSTM-ALL|CSTM-00|2020|PDM|905.00|99|0.00|AEG 6 (NO REV)
20|FH_F101901_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|AEG 4 (NO REV)
20|FH_F101901_0_0|SrvcGrp|85022|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F101945_0_0|CSTM-ALL|CSTM-00|2020|PDM|1040.00|99|0.00|AEG 5  (NO REV)
20|FH_F101945_0_0|CSTM-ALL|CSTM-00|2020|PDM|1248.00|99|0.00|AEG 6 (NO REV)
20|FH_F101945_0_0|CSTM-ALL|CSTM-00|2020|PDM|1353.00|99|0.00|AEG 8 (NO REV)
20|FH_F101945_0_0|SrvcGrp|10986|2022|PDM|3967.00|99|0.00|ARTHROSCOPIC KNEE REPAIR
20|FH_F101945_0_0|SrvcGrp|26275|2022|PDM|2726.00|99|0.00|CPT 29826
20|FH_F101945_0_0|SrvcGrp|26276|2022|PDM|2726.00|99|0.00|CPT 29819
20|FH_F101945_0_0|SrvcGrp|34605|2022|PDM|2185.00|99|0.00|CPT 28299
20|FH_F101945_0_0|SrvcGrp|59705|2022|PDM|1025.00|99|0.00|SEPTOPLASTY
20|FH_F101945_0_0|SrvcGrp|83644|2022|PDM|2261.00|99|0.00|CPT 30465
20|FH_F101945_0_0|SrvcGrp|98402|2022|PDM|2261.00|99|0.00|RHINO INCL MJR SEPTAL RPR
20|FH_F102009_0_0|CSTM-ALL|CSTM-00|2020|PDM|1941.56|99|0.00|AEG 9 (NO REV)
20|FH_F102020_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F102020_0_0|SrvcGrp|22954|2022|PDM|214.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F102020_0_0|SrvcGrp|9828|2022|PDM|75.00|99|0.00|HOME HEALTH AIDE
20|FH_F102020_0_0|SrvcGrp|9830|2022|PDM|143.00|99|0.00|OT SVCS
20|FH_F102020_0_0|SrvcGrp|9832|2022|PDM|143.00|99|0.00|ST SVCS
20|FH_F102063_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F102063_0_0|SrvcGrp|27969|2022|PDM|55.00|99|0.00|HOME HEALTH AIDE
20|FH_F102063_0_0|SrvcGrp|48385|2022|PDM|140.00|99|0.00|SPEECH THERAPY
20|FH_F102063_0_0|SrvcGrp|48394|2022|PDM|40.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F102063_0_0|SrvcGrp|88621|2022|PDM|140.00|99|0.00|SKILLED NURSING LPN
20|FH_F102163_0_0|SrvcGrp|472|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F102163_0_0|SrvcGrp|473|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F102180_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F102180_0_0|SrvcGrp|472|2022|PCT|0.84|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F102184_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F102184_0_0|CSTM-ALL|CSTM-00|2020|PDM|2409.00|99|0.00|AEG 7 (NO REV)
20|FH_F102184_0_0|CSTM-ALL|CSTM-00|2020|PDM|2788.00|99|0.00|AEG 8 (NO REV)
20|FH_F102184_0_0|CSTM-ALL|CSTM-00|2020|PDM|2887.00|99|0.00|AEG 9 (NO REV)
20|FH_F102184_0_0|SrvcGrp|24714|2022|PCT|1.00|99|0.00|INTRAOCULAR LENS
20|FH_F102184_0_0|SrvcGrp|67279|2022|PDM|7699.00|99|0.00|CERVICAL SURGERY
20|FH_F102184_0_0|SrvcGrp|71666|2022|PDM|6737.00|99|0.00|CPT 63655
20|FH_F102184_0_0|SrvcGrp|72121|2022|PDM|2887.00|99|0.00|ARTHOSCOPY
20|FH_F102184_0_0|SrvcGrp|77021|2022|PDM|7215.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY
20|FH_F102184_0_0|SrvcGrp|79644|2022|PCT|1.00|99|0.00|AETNA IMPLANTS
20|FH_F102184_0_0|SrvcGrp|88157|2022|PDM|7215.00|99|0.00|TOTAL HIP ARTHROPLASTY
20|FH_F102184_0_0|SrvcGrp|88158|2022|PDM|7215.00|99|0.00|NECK SPINE DISK SURGERY
20|FH_F102184_0_0|SrvcGrp|88164|2022|PDM|7699.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR
20|FH_F102184_0_0|SrvcGrp|95559|2022|PDM|7215.00|99|0.00|HIP JOINT
20|FH_F102184_0_0|SrvcGrp|98496|2022|PDM|7699.00|99|0.00|ARTHRODESIS POSTERIOR ATLAS
20|FH_F102184_0_0|SrvcGrp|98498|2022|PDM|7215.00|99|0.00|TRANSPEDICULAR 1 SEG THORACIC
20|FH_F102185_0_0|SrvcGrp|473|2022|PDM|315.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F102185_0_0|SrvcGrp|96201|2022|PDM|45.00|99|0.00|PT/OT/ST
20|FH_F102188_0_0|SrvcGrp|26001|2022|PDM|136.42|99|0.00|HOSPICE RESPITE SVCS
20|FH_F102188_0_0|SrvcGrp|57968|2022|PDM|29.47|99|0.00|CONTINUOUS HOMECARE
20|FH_F102224_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F102224_0_0|CSTM-ALL|CSTM-00|2020|PDM|1120.00|99|0.00|AEG 4 (NO REV)
20|FH_F102224_0_0|CSTM-ALL|CSTM-00|2020|PDM|1612.00|99|0.00|AEG 7 (NO REV)
20|FH_F102224_0_0|CSTM-ALL|CSTM-00|2020|PDM|2120.00|99|0.00|AEG 3 (NO REV)
20|FH_F102224_0_0|SrvcGrp|106557|2022|PDM|11000.00|99|0.00|REVISE KNEE 2
20|FH_F102224_0_0|SrvcGrp|35669|2022|PDM|7000.00|99|0.00|CPT 63650
20|FH_F102224_0_0|SrvcGrp|58638|2022|PDM|4000.00|99|0.00|CPT 63688
20|FH_F102224_0_0|SrvcGrp|77021|2022|PDM|6000.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY
20|FH_F102224_0_0|SrvcGrp|84442|2022|PDM|9900.00|99|0.00|REVISION KNEE
20|FH_F102224_0_0|SrvcGrp|88159|2022|PDM|6000.00|99|0.00|LOW BACK DISK SURGERY
20|FH_F102224_0_0|SrvcGrp|90797|2022|PDM|6000.00|99|0.00|INSERT SPINAL INFUSION DEV16
20|FH_F102224_0_0|SrvcGrp|92409|2022|PDM|2400.00|99|0.00|PERQ CERVICOTHORACIC INJECT
20|FH_F102224_0_0|SrvcGrp|96839|2022|PDM|5000.00|99|0.00|REVISE SPINE ELTRD PLATE
20|FH_F102267_0_0|SrvcGrp|42782|2022|PDM|45.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F102267_0_0|SrvcGrp|471|2022|PDM|580.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F102267_0_0|SrvcGrp|473|2022|PDM|315.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F102302_0_0|SrvcGrp|44461|2022|PDM|18450.00|99|0.00|INSERTION / REPLACEMENT OF SPINAL NEUROSTIMULATOR GENERATOR
20|FH_F102302_0_0|SrvcGrp|73004|2022|PDM|1775.00|99|0.00|AEG 8
20|FH_F102302_0_0|SrvcGrp|80281|2022|PDM|14300.00|99|0.00|AETNA REVISE/REMOVE NEURORECEIVER
20|FH_F102302_0_0|SrvcGrp|97139|2022|PDM|10850.00|99|0.00|LAMINECTOMY W/FACETECTOMY
20|FH_F102302_0_0|SrvcGrp|97159|2022|PDM|10850.00|99|0.00|TRANSPEDICULAR, 1 SEG, LUMBAR
20|FH_F102302_0_0|SrvcGrp|98360|2022|PDM|10850.00|99|0.00|AETNA LAMINECTOMY W/FACE-LUMBAR
20|FH_F102302_0_0|SrvcGrp|98562|2022|PDM|39100.00|99|0.00|THORAX SPINE FUSION
20|FH_F102302_0_0|SrvcGrp|98569|2022|PDM|29900.00|99|0.00|POSTERIOR NON-SEGMENTAL INST
20|FH_F102302_0_0|SrvcGrp|98596|2022|PDM|10850.00|99|0.00|LOW BACK DISK SURGERY
20|FH_F102302_0_0|SrvcGrp|98600|2022|PDM|10850.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON
20|FH_F102302_0_0|SrvcGrp|98603|2022|PDM|10800.00|99|0.00|PERQ VERTEBRAL AUGMENTATION
20|FH_F102302_0_0|SrvcGrp|98607|2022|PDM|1817.00|99|0.00|REVISE ARM/LEG NERVE
20|FH_F102341_0_0|SrvcGrp|184|2022|PDM|1982.00|99|0.00|MEDICAL INTENSIVE CARE
20|FH_F102500_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F102500_0_0|CSTM-ALL|CSTM-00|2020|PDM|3668.00|99|0.00|OSSEOINTEGRATED IMPLANT REPL
20|FH_F102500_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F102500_0_0|SrvcGrp|36864|2022|PDM|29351.00|99|0.00|COCHLEAR IMPLANTS
20|FH_F102500_0_0|SrvcGrp|45583|2022|PDM|1863.00|99|0.00|CPT 65730
20|FH_F102500_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F102500_0_0|SrvcGrp|72992|2022|PDM|696.00|99|0.00|AEG 2
20|FH_F102500_0_0|SrvcGrp|73000|2022|PDM|1283.00|99|0.00|AEG 6
20|FH_F102500_0_0|SrvcGrp|73008|2022|PDM|1250.00|99|0.00|AEG 10
20|FH_F102500_0_0|SrvcGrp|85022|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F102542_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F102542_0_0|SrvcGrp|30089|2022|PDM|400.00|99|0.00|HEMODIALYSIS SERVICES
20|FH_F102542_0_0|SrvcGrp|75399|2022|PDM|0.10|99|0.00|MED RECORD COPY
20|FH_F102620_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F102620_0_0|SrvcGrp|37542|2022|PDM|569.25|99|0.00|RESIDENTIAL TREATMENT
20|FH_F102623_0_0|SrvcGrp|94501|2022|PDM|180.00|99|0.00|PERITONEAL/CAPD/CCPD
20|FH_F102641_0_0|SrvcGrp|72990|2022|PDM|561.00|99|0.00|AEG 1
20|FH_F102641_0_0|SrvcGrp|98779|2022|PDM|3096.00|99|0.00|INCISION OF TENDON SHEATH
20|FH_F102726_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING
20|FH_F102726_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|AETNA MRI/MRA
20|FH_F102760_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING
20|FH_F102760_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|DME PROSTHETICS AND ORTHOTICS
20|FH_F102760_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|ENTERAL & PARENTERAL THERAPY
20|FH_F102760_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|MEDICAL/SURGICAL SUPPLIES AND ADMINISTRATION
20|FH_F102844_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F102844_0_0|CSTM-ALL|CSTM-00|2020|PDM|411.00|99|0.00|AEG 1 (NO REV)
20|FH_F102844_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 2 (NO REV)
20|FH_F102881_0_0|CSTM-ALL|CSTM-00|2020|PDM|1298.00|99|0.00|AEG 2 (NO REV)
20|FH_F102881_0_0|CSTM-ALL|CSTM-00|2020|PDM|3893.00|99|0.00|AEG 9 (NO REV)
20|FH_F102881_0_0|CSTM-ALL|CSTM-00|2020|PDM|969.00|99|0.00|AEG 1 (NO REV)
20|FH_F102881_0_0|SrvcGrp|89939|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH INCIDENTAL CODES
20|FH_F102881_0_0|SrvcGrp|99084|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F102920_0_0|SrvcGrp|72990|2022|PDM|561.00|99|0.00|AEG 1
20|FH_F102920_0_0|SrvcGrp|72996|2022|PDM|1098.00|99|0.00|AEG 4
20|FH_F102920_0_0|SrvcGrp|73004|2022|PDM|1679.00|99|0.00|AEG 8
20|FH_F102920_0_0|SrvcGrp|77021|2022|PDM|3602.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY
20|FH_F102920_0_0|SrvcGrp|91528|2022|PDM|1295.00|99|0.00|SPINAL CORD IMPLANT
20|FH_F102943_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F102943_0_0|CSTM-ALL|CSTM-00|2020|PDM|1286.00|99|0.00|AEG 9 (NO REV)
20|FH_F102943_0_0|CSTM-ALL|CSTM-00|2020|PDM|463.61|99|0.00|AEG 1 (NO REV)
20|FH_F102943_0_0|CSTM-ALL|CSTM-00|2020|PDM|643.00|99|0.00|AEG 4 (NO REV)
20|FH_F102943_0_0|CSTM-ALL|CSTM-00|2020|PDM|851.00|99|0.00|AEG 6 (NO REV)
20|FH_F102943_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F103000_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F103060_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F103060_0_0|SrvcGrp|11673|2022|PDM|5202.00|99|0.00|CPT 29888
20|FH_F103060_0_0|SrvcGrp|34606|2022|PDM|3121.00|99|0.00|CPT 29827
20|FH_F103060_0_0|SrvcGrp|41334|2022|PDM|7803.00|99|0.00|TOTAL KNEE
20|FH_F103060_0_0|SrvcGrp|67068|2022|PDM|8323.00|99|0.00|LUMBAR SPINE FUSION COMBINED
20|FH_F103060_0_0|SrvcGrp|72121|2022|PDM|3121.00|99|0.00|ARTHOSCOPY
20|FH_F103060_0_0|SrvcGrp|72990|2022|PDM|1248.00|99|0.00|AEG 1
20|FH_F103060_0_0|SrvcGrp|73000|2022|PDM|2497.00|99|0.00|AEG 6
20|FH_F103060_0_0|SrvcGrp|73008|2022|PDM|1040.00|99|0.00|AEG 10
20|FH_F103060_0_0|SrvcGrp|88157|2022|PDM|7803.00|99|0.00|TOTAL HIP ARTHROPLASTY
20|FH_F103060_0_0|SrvcGrp|88159|2022|PDM|7803.00|99|0.00|LOW BACK DISK SURGERY
20|FH_F103060_0_0|SrvcGrp|89404|2022|PDM|7803.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F103060_0_0|SrvcGrp|90343|2022|PDM|7803.00|99|0.00|CERVICE CORPECTOMY 1 LEVEL
20|FH_F103060_0_0|SrvcGrp|98494|2022|PDM|8323.00|99|0.00|ARTHRODESIS PRE-SACRAL
20|FH_F103060_0_0|SrvcGrp|98498|2022|PDM|7803.00|99|0.00|TRANSPEDICULAR 1 SEG THORACIC
20|FH_F103060_0_0|SrvcGrp|98499|2022|PDM|7803.00|99|0.00|INCISE SPINAL COLUMN NERVES
20|FH_F103122_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F103122_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 1 (NO REV)
20|FH_F103122_0_0|CSTM-ALL|CSTM-00|2020|PDM|446.00|99|0.00|AEG 2 (NO REV)
20|FH_F103122_0_0|CSTM-ALL|CSTM-00|2020|PDM|973.00|99|0.00|AEG 8 (NO REV)
20|FH_F103220_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F103220_0_0|CSTM-ALL|CSTM-00|2020|PDM|1760.00|99|0.00|AEG 3 (NO REV)
20|FH_F103220_0_0|CSTM-ALL|CSTM-00|2020|PDM|1980.00|99|0.00|AEG 5  (NO REV)
20|FH_F103220_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|AEG 6 (NO REV)
20|FH_F103220_0_0|CSTM-ALL|CSTM-00|2020|PDM|671.00|99|0.00|AEG 1 (NO REV)
20|FH_F103220_0_0|SrvcGrp|111777|2022|PDM|3960.00|99|0.00|INT HRHC TRANAL DARTLZJ 2+
20|FH_F103220_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F103220_0_0|SrvcGrp|99150|2022|PDM|11000.00|99|0.00|LAP BAND SURGERY
20|FH_F103320_0_0|SrvcGrp|72990|2022|PDM|487.00|99|0.00|AEG 1
20|FH_F103320_0_0|SrvcGrp|73002|2022|PDM|1460.00|99|0.00|AEG 7
20|FH_F103320_0_0|SrvcGrp|73008|2022|PDM|1015.00|99|0.00|AEG 10
20|FH_F103440_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F103760_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F103760_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.23|99|0.00|HSS ASC
20|FH_F103781_0_0|SrvcGrp|48394|2022|PDM|25.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F103781_0_0|SrvcGrp|48398|2022|PDM|80.00|99|0.00|PT SERVICES
20|FH_F103781_0_0|SrvcGrp|88620|2022|PDM|85.00|99|0.00|SKILLED NURSING RN
20|FH_F103821_0_0|SrvcGrp|471|2022|PDM|703.31|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F104180_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F104180_0_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS
20|FH_F104180_0_0|SrvcGrp|471|2022|PDM|759.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F104340_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F104340_0_0|SrvcGrp|87077|2022|PDM|120.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F104520_0_0|SrvcGrp|63297|2022|PDM|90.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F104700_0_0|SrvcGrp|72992|2022|PDM|1245.00|99|0.00|AEG 2
20|FH_F104700_0_0|SrvcGrp|72994|2022|PDM|1245.00|99|0.00|AEG 3
20|FH_F104700_0_0|SrvcGrp|73008|2022|PDM|1245.00|99|0.00|AEG 10
20|FH_F104720_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F104740_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F104800_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F104800_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 7 (NO REV)
20|FH_F104800_0_0|CSTM-ALL|CSTM-00|2020|PDM|480.00|99|0.00|AEG 1 (NO REV)
20|FH_F104800_0_0|SrvcGrp|13990|2022|PCT|0.50|99|0.00|PACEMAKER
20|FH_F104802_0_0|SrvcGrp|10951|2022|PDM|350.00|99|0.00|PARTIAL HOSPITALIZATION PSYCH/CD
20|FH_F104802_0_0|SrvcGrp|23587|2022|PDM|425.00|99|0.00|RESIDENTIAL TREATMENT - PSYCH
20|FH_F104802_0_0|SrvcGrp|44858|2022|PDM|20.00|99|0.00|DAY TREATMENT
20|FH_F104802_0_0|SrvcGrp|9811|2022|PDM|425.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F105142_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F105142_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F105142_0_0|CSTM-ALL|CSTM-00|2020|PDM|551.91|99|0.00|AEG 1 (NO REV)
20|FH_F105142_0_0|CSTM-ALL|CSTM-00|2020|PDM|632.82|99|0.00|AEG 10 (NO REV)
20|FH_F105142_0_0|CSTM-ALL|CSTM-00|2020|PDM|632.82|99|0.00|AEG 4 (NO REV)
20|FH_F105142_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F105142_0_0|SrvcGrp|74585|2022|PCT|0.00|99|0.00|AETNA OP IMPLANTS
20|FH_F105301_0_0|CSTM-ALL|CSTM-00|2020|PCT|12000.00|99|0.00|TIMELY FILING
20|FH_F105320_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F105320_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F105593_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F105593_0_0|SrvcGrp|48396|2022|PDM|80.00|99|0.00|OT SERVICES
20|FH_F105593_0_0|SrvcGrp|48398|2022|PDM|80.00|99|0.00|PT SERVICES
20|FH_F105593_0_0|SrvcGrp|88621|2022|PDM|70.00|99|0.00|SKILLED NURSING LPN
20|FH_F105600_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F105600_0_0|CSTM-ALL|CSTM-00|2020|PDM|1425.00|99|0.00|AEG 8 (NO REV)
20|FH_F105600_0_0|CSTM-ALL|CSTM-00|2020|PDM|481.00|99|0.00|AEG 1 (NO REV)
20|FH_F105600_0_0|CSTM-ALL|CSTM-00|2020|PDM|646.00|99|0.00|AEG 2 (NO REV)
20|FH_F105680_0_0|SrvcGrp|75481|2022|PDM|1200.00|99|0.00|AEG 2
20|FH_F105680_0_0|SrvcGrp|75487|2022|PDM|1625.00|99|0.00|AEG 5
20|FH_F106020_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F106020_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F106020_0_0|CSTM-ALL|CSTM-00|2020|PDM|602.00|99|0.00|AEG 1 (NO REV)
20|FH_F106020_0_0|CSTM-ALL|CSTM-00|2020|PDM|944.00|99|0.00|AEG 6 (NO REV)
20|FH_F106020_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F106020_0_0|SrvcGrp|33967|2022|PDM|2364.00|99|0.00|CPT 47562
20|FH_F106020_0_0|SrvcGrp|39904|2022|PDM|2022.00|99|0.00|ARTHROSCOPY OF KNEE
20|FH_F106500_0_0|SrvcGrp|28221|2022|PDM|455.00|99|0.00|COMPUTED TOMOGRAPHY (CT)
20|FH_F106500_0_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS
20|FH_F106500_0_0|SrvcGrp|73485|2022|PDM|1017.00|99|0.00|AETNA REHAB
20|FH_F106822_0_0|SrvcGrp|100247|2022|PDM|24.30|99|0.00|NASAL FLU VACCINE
20|FH_F106822_0_0|SrvcGrp|100250|2022|PDM|57.00|99|0.00|REPAIR SUPERFICIAL WOUND(S) (2.5 CM OR LESS)
20|FH_F106822_0_0|SrvcGrp|100251|2022|PDM|57.00|99|0.00|REPAIR SUPERFICIAL WOUND(S) (2.6 - 7.5 CM)
20|FH_F106822_0_0|SrvcGrp|100255|2022|PDM|57.00|99|0.00|REPAIR SUPERFICIAL WOUND(S) (OVER 30.0 CM)
20|FH_F106822_0_0|SrvcGrp|100258|2022|PDM|57.00|99|0.00|REPAIR SUPERFICIAL WOUND(S) (12.6 - 20.0 CM)
20|FH_F106822_0_0|SrvcGrp|100259|2022|PDM|57.00|99|0.00|REPAIR SUPERFICIAL WOUND(S) (20.1 - 30.0 CM)
20|FH_F106822_0_0|SrvcGrp|100262|2022|PDM|57.00|99|0.00|TREAT DEHISCENCE W/ PACKING
20|FH_F106822_0_0|SrvcGrp|100268|2022|PDM|13.07|99|0.00|ADENOVIRUS ASSAY W/ OPTIC
20|FH_F106822_0_0|SrvcGrp|100269|2022|PDM|68.25|99|0.00|HEPA VACCINE ADULT IM
20|FH_F106822_0_0|SrvcGrp|100273|2022|PDM|62.50|99|0.00|MEASLES MUMPS&RUBELLA VAC LI
20|FH_F106822_0_0|SrvcGrp|100280|2022|PDM|1.47|99|0.00|NEBULIZER ADMINISTRATION SET
20|FH_F106822_0_0|SrvcGrp|100285|2022|PDM|3.00|99|0.00|IMMUN ADMIN ORAL/NASAL (HCFA)
20|FH_F106822_0_0|SrvcGrp|100286|2022|PDM|3.00|99|0.00|IMMUN ADMIN ORAL/NASAL ADDL (HCFA)
20|FH_F106822_0_0|SrvcGrp|100288|2022|PDM|45.00|99|0.00|NEW PATIENT OFF/OP VISIT (HCFA)
20|FH_F106822_0_0|SrvcGrp|101411|2022|PDM|45.00|99|0.00|NEW PATIENT OFFICE VISIT
20|FH_F106822_0_0|SrvcGrp|101741|2022|PDM|3.00|99|0.00|IMMUN ADMIN ORAL/NASAL
20|FH_F106822_0_0|SrvcGrp|101745|2022|PDM|14.10|99|0.00|IIV3 VACC NO PRSV 0.5 ML IM(HCFA)
20|FH_F106822_0_0|SrvcGrp|36668|2022|PDM|186.25|99|0.00|ZOSTER (SHINGLES VACCINE)
20|FH_F106822_0_0|SrvcGrp|36669|2022|PDM|7.95|99|0.00|IMMUNIZATION ADMIN
20|FH_F106822_0_0|SrvcGrp|53786|2022|PDM|17.20|99|0.00|BREATHING DEVICE
20|FH_F106822_0_0|SrvcGrp|82744|2022|PDM|9.58|99|0.00|URINE CULTURE COLONY COUNT
20|FH_F100060_0_0|CSTM-ALL|CSTM-00|2020|PDM|3501.00|99|0.00|AEG 4 (NO REV)
20|FH_F100060_0_0|CSTM-ALL|CSTM-00|2020|PDM|3982.00|99|0.00|AEG 5  (NO REV)
20|FH_F100060_0_0|CSTM-ALL|CSTM-00|2020|PDM|4590.00|99|0.00|AEG 6 (NO REV)
20|FH_F100060_0_0|CSTM-ALL|CSTM-00|2020|PDM|5404.00|99|0.00|AEG 8 (NO REV)
20|FH_F100060_0_0|CSTM-ALL|CSTM-00|2020|PDM|5537.00|99|0.00|AEG 7 (NO REV)
20|FH_F100060_0_0|SrvcGrp|12491|2022|PCT|0.50|99|0.00|PACEMAKER
20|FH_F100063_0_0|SrvcGrp|42782|2022|PDM|45.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F100063_0_0|SrvcGrp|471|2022|PDM|580.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F100240_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F100320_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F100320_0_0|SrvcGrp|75479|2022|PDM|356.00|99|0.00|AEG 1
20|FH_F100320_0_0|SrvcGrp|75487|2022|PDM|767.00|99|0.00|AEG 5
20|FH_F100320_0_0|SrvcGrp|75489|2022|PDM|884.00|99|0.00|AEG 6
20|FH_F100320_0_0|SrvcGrp|75495|2022|PDM|1433.00|99|0.00|AEG 9
20|FH_F100320_0_0|SrvcGrp|75497|2022|PDM|674.00|99|0.00|AEG 10
20|FH_F100320_0_0|SrvcGrp|86582|2022|PDM|1700.00|99|0.00|AETNA CARDIAC CATHERTERIZATION
20|FH_F100460_0_0|CSTM-ALL|CSTM-00|2020|PDM|1530.00|99|0.00|AEG 7 (NO REV)
20|FH_F100460_0_0|CSTM-ALL|CSTM-00|2020|PDM|817.00|99|0.00|AEG 2 (NO REV)
20|FH_F100460_0_0|CSTM-ALL|CSTM-00|2020|PDM|875.00|99|0.00|AEG 3 (NO REV)
20|FH_F100460_0_0|SrvcGrp|96104|2022|PCT|0.00|99|0.00|IMPLANTABLE NEUROSTIMULATOR
20|FH_F100540_0_0|SrvcGrp|12491|2022|PCT|1.05|99|0.00|PACEMAKER
20|FH_F100540_0_0|SrvcGrp|73002|2022|PDM|2153.25|99|0.00|AEG 7
20|FH_F100540_0_0|SrvcGrp|73008|2022|PDM|909.00|99|0.00|AEG 10
20|FH_F100703_0_0|CSTM-ALL|CSTM-00|2020|PDM|1365.00|99|0.00|AEG 1 (NO REV)
20|FH_F100703_0_0|SrvcGrp|112026|2022|PDM|8034.00|99|0.00|TOTAL KNEE ARTHROPLASTY
20|FH_F100703_0_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F100703_0_0|SrvcGrp|16693|2022|PDM|3466.00|99|0.00|KNEE SCOPE, MENISCECTOMY
20|FH_F100703_0_0|SrvcGrp|38015|2022|PDM|7876.00|99|0.00|ARTHRODESIS
20|FH_F100703_0_0|SrvcGrp|64761|2022|PDM|8034.00|99|0.00|DISCECTOMY
20|FH_F100703_0_0|SrvcGrp|96349|2022|PDM|8034.00|99|0.00|NECK SPINE FUSE
20|FH_F100703_0_0|SrvcGrp|96959|2022|PDM|3466.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F100703_0_0|SrvcGrp|96999|2022|PDM|3535.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F100741_0_0|SrvcGrp|73000|2022|PDM|1149.00|99|0.00|AEG 6
20|FH_F100741_0_0|SrvcGrp|73002|2022|PDM|1373.00|99|0.00|AEG 7
20|FH_F100741_0_0|SrvcGrp|88436|2022|PCT|1.00|99|0.00|HIGH COST DRUGS
20|FH_F100789_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F100789_0_0|CSTM-ALL|CSTM-00|2020|PDM|3630.00|99|0.00|AEG 5  (NO REV)
20|FH_F100789_0_0|CSTM-ALL|CSTM-00|2020|PDM|4951.00|99|0.00|AEG 8 (NO REV)
20|FH_F100841_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F100904_0_0|CSTM-ALL|CSTM-00|2020|PDM|1473.00|99|0.00|AEG 9 (NO REV)
20|FH_F100904_0_0|CSTM-ALL|CSTM-00|2020|PDM|491.00|99|0.00|AEG 2 (NO REV)
20|FH_F100904_0_0|CSTM-ALL|CSTM-00|2020|PDM|909.00|99|0.00|AEG 6 (NO REV)
20|FH_F100906_0_0|SrvcGrp|34606|2022|PDM|3000.00|99|0.00|CPT 29827
20|FH_F100906_0_0|SrvcGrp|68543|2022|PDM|1020.00|99|0.00|CPT 36561
20|FH_F100906_0_0|SrvcGrp|69964|2022|PDM|1750.00|99|0.00|CPT 23120
20|FH_F100906_0_0|SrvcGrp|73008|2022|PDM|793.00|99|0.00|AEG 10
20|FH_F100906_0_0|SrvcGrp|85022|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F100906_0_0|SrvcGrp|90061|2022|PDM|6000.00|99|0.00|AETNA RECONSTRUCT SHOULDER JOINT
20|FH_F100906_0_0|SrvcGrp|97463|2022|PDM|2250.00|99|0.00|KNEE ARTHROSCOPY
20|FH_F100906_0_0|SrvcGrp|98643|2022|PDM|557.00|99|0.00|AETNA AEG 1 WITHOUT LUMBER INJECTION
20|FH_F100962_0_0|SrvcGrp|72996|2022|PDM|1020.00|99|0.00|AEG 4
20|FH_F100984_0_0|CSTM-ALL|CSTM-00|2020|PDM|1057.00|99|0.00|AEG 7 (NO REV)
20|FH_F100984_0_0|CSTM-ALL|CSTM-00|2020|PDM|1433.00|99|0.00|AEG 9 (NO REV)
20|FH_F100984_0_0|CSTM-ALL|CSTM-00|2020|PDM|905.00|99|0.00|AEG 6 (NO REV)
20|FH_F100984_0_0|SrvcGrp|85022|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F100984_0_0|SrvcGrp|97440|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F101081_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F101083_0_0|SrvcGrp|72992|2022|PDM|693.00|99|0.00|AEG 2
20|FH_F101083_0_0|SrvcGrp|72994|2022|PDM|788.00|99|0.00|AEG 3
20|FH_F101083_0_0|SrvcGrp|73004|2022|PDM|1522.00|99|0.00|AEG 8
20|FH_F101104_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F101104_0_0|SrvcGrp|73700|2022|PDM|125.00|99|0.00|AETNA - SKILLED NURSING
20|FH_F101104_0_0|SrvcGrp|86825|2022|PDM|200.00|99|0.00|HCPCS S5523 (HCFA)
20|FH_F101104_0_0|SrvcGrp|87395|2022|PDM|160.00|99|0.00|HCPCS G0153 (HCFA)
20|FH_F101161_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F101161_0_0|SrvcGrp|15324|2022|PDM|310.00|99|0.00|ER LEVEL II
20|FH_F101161_0_0|SrvcGrp|98000|2022|PDM|190.00|99|0.00|HOSPITAL OBSERVATION
20|FH_F101184_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F101201_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F101201_0_0|SrvcGrp|43525|2022|PDM|275.00|99|0.00|INTENSIVE OUTPATIENT PROGRAM - PSYCHIATRIC
20|FH_F101246_0_0|CSTM-ALL|CSTM-00|2020|PCT|45.00|99|0.00|GENERAL ACUTE CARE
20|FH_F101281_0_0|CSTM-ALL|CSTM-00|2020|PCT|41.00|99|0.00|GENERAL ACUTE CARE
20|FH_F101341_0_0|CSTM-ALL|CSTM-00|2020|PDM|2237.00|99|0.00|GENERAL ACUTE CARE
20|FH_F101360_0_0|SrvcGrp|11306|2022|PCT|1.05|99|0.00|IMPLANTS
20|FH_F101380_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F101380_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AEG 10 (NO REV)
20|FH_F101380_0_0|CSTM-ALL|CSTM-00|2020|PDM|1757.00|99|0.00|AEG 2 (NO REV)
20|FH_F101386_0_0|CSTM-ALL|CSTM-00|2020|PCT|74.00|99|0.00|GENERAL ACUTE CARE
20|FH_F101410_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|GENERAL ACUTE CARE
20|FH_F101441_0_0|CSTM-ALL|CSTM-00|2020|PDM|1837.00|99|0.00|AEG 2 (NO REV)
20|FH_F101441_0_0|CSTM-ALL|CSTM-00|2020|PDM|2437.00|99|0.00|AEG 10 (NO REV)
20|FH_F101441_0_0|CSTM-ALL|CSTM-00|2020|PDM|3675.00|99|0.00|AEG 8 (NO REV)
20|FH_F101441_0_0|CSTM-ALL|CSTM-00|2020|PDM|4107.00|99|0.00|AEG 7 (NO REV)
20|FH_F106822_0_0|SrvcGrp|96499|2022|PDM|7.95|99|0.00|ADMIN OF PNEUMOCOCCAL VACCINE
20|FH_F106841_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F106841_0_0|CSTM-ALL|CSTM-00|2020|PDM|520.92|99|0.00|AEG 2 (NO REV)
20|FH_F106841_0_0|CSTM-ALL|CSTM-00|2020|PDM|735.85|99|0.00|AEG 4 (NO REV)
20|FH_F106940_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS
20|FH_F106964_0_0|CSTM-ALL|CSTM-00|2020|PDM|1502.00|99|0.00|AEG 6 (NO REV)
20|FH_F106980_0_0|SrvcGrp|73000|2022|PDM|1250.00|99|0.00|AEG 6
20|FH_F106980_0_0|SrvcGrp|73006|2022|PDM|1481.00|99|0.00|AEG 9
20|FH_F107200_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F107200_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F107200_0_0|CSTM-ALL|CSTM-00|2020|PDM|832.00|99|0.00|AEG 3 (NO REV)
20|FH_F107200_0_0|SrvcGrp|101521|2022|PDM|6242.00|99|0.00|T1H UTERUS (>250G)
20|FH_F107200_0_0|SrvcGrp|101524|2022|PDM|1665.00|99|0.00|MISSED ABORTION SECOND TRIMESTER
20|FH_F107200_0_0|SrvcGrp|101525|2022|PDM|5722.00|99|0.00|MYOMECTOMY
20|FH_F107200_0_0|SrvcGrp|101527|2022|PDM|2289.00|99|0.00|HYSTEROSCOPY LYSIS
20|FH_F107200_0_0|SrvcGrp|27346|2022|PDM|4162.00|99|0.00|REPAIR BLADDER DEFECT
20|FH_F107200_0_0|SrvcGrp|30076|2022|PCT|1.00|99|0.00|IMPLANTS, PROSTHETICS, OR SUPPLIES
20|FH_F107200_0_0|SrvcGrp|33965|2022|PDM|5202.00|99|0.00|CPT 58552
20|FH_F107200_0_0|SrvcGrp|33977|2022|PDM|1665.00|99|0.00|CPT 59820
20|FH_F107261_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F107360_0_0|SrvcGrp|10391|2022|PDM|1566.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F107360_0_0|SrvcGrp|30089|2022|PDM|467.00|99|0.00|HEMODIALYSIS SERVICES
20|FH_F107400_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F107400_0_0|SrvcGrp|73700|2022|PDM|60.00|99|0.00|AETNA - SKILLED NURSING
20|FH_F107400_0_0|SrvcGrp|73701|2022|PDM|43.00|99|0.00|AETNA - SKILLED NURSING
20|FH_F107400_0_0|SrvcGrp|88620|2022|PDM|127.00|99|0.00|SKILLED NURSING RN
20|FH_F107600_0_0|CSTM-ALL|CSTM-00|2020|PDM|362.00|99|0.00|AEG 1 (NO REV)
20|FH_F107600_0_0|CSTM-ALL|CSTM-00|2020|PDM|485.00|99|0.00|AEG 2 (NO REV)
20|FH_F107600_0_0|CSTM-ALL|CSTM-00|2020|PDM|780.00|99|0.00|AEG 5  (NO REV)
20|FH_F107600_0_0|CSTM-ALL|CSTM-00|2020|PDM|891.00|99|0.00|AEG 6 (NO REV)
20|FH_F107782_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F107782_0_0|CSTM-ALL|CSTM-00|2020|PDM|2450.00|99|0.00|AEG 8 (NO REV)
20|FH_F107782_0_0|CSTM-ALL|CSTM-00|2020|PDM|2450.00|99|0.00|AEG 9 (NO REV)
20|FH_F107782_0_0|SrvcGrp|102521|2022|PDM|2600.00|99|0.00|PENILE PROSTHESIS
20|FH_F107782_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F107782_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F107782_0_0|SrvcGrp|22780|2022|PDM|2600.00|99|0.00|CPT 55875
20|FH_F107922_0_0|SrvcGrp|471|2022|PDM|575.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F107922_0_0|SrvcGrp|472|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F107922_0_0|SrvcGrp|76501|2022|PDM|350.00|99|0.00|SUB-ACUTE - LEVEL I
20|FH_F107926_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F107926_0_0|CSTM-ALL|CSTM-00|2020|PDM|1068.00|99|0.00|AEG 6 (NO REV)
20|FH_F107926_0_0|CSTM-ALL|CSTM-00|2020|PDM|1280.00|99|0.00|AEG 7 (NO REV)
20|FH_F107926_0_0|CSTM-ALL|CSTM-00|2020|PDM|417.00|99|0.00|AEG 1 (NO REV)
20|FH_F107926_0_0|CSTM-ALL|CSTM-00|2020|PDM|612.00|99|0.00|AEG 3 (NO REV)
20|FH_F107926_0_0|SrvcGrp|104719|2022|PDM|1875.00|99|0.00|RELIEVE INNER EYE PRESSURE
20|FH_F107926_0_0|SrvcGrp|68283|2022|PDM|1875.00|99|0.00|CPT 67043
20|FH_F108420_0_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|AEG 10 (NO REV)
20|FH_F108420_0_0|CSTM-ALL|CSTM-00|2020|PDM|2275.00|99|0.00|AEG 6 (NO REV)
20|FH_F108420_0_0|CSTM-ALL|CSTM-00|2020|PDM|2600.00|99|0.00|AEG 7 (NO REV)
20|FH_F108420_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|AEG 2 (NO REV)
20|FH_F108680_0_0|CSTM-ALL|CSTM-00|2020|PDM|1410.00|99|0.00|AEG 8 (NO REV)
20|FH_F108680_0_0|CSTM-ALL|CSTM-00|2020|PDM|739.00|99|0.00|AEG 3 (NO REV)
20|FH_F108680_0_0|SrvcGrp|102725|2022|PCT|0.00|99|0.00|DESTROY C/TH FACET JNT ADDL
20|FH_F108680_0_0|SrvcGrp|71666|2022|PDM|24750.00|99|0.00|CPT 63655
20|FH_F108680_0_0|SrvcGrp|74039|2022|PDM|5720.00|99|0.00|LAMINECTOMY
20|FH_F108680_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F108680_0_0|SrvcGrp|87679|2022|PDM|1595.00|99|0.00|LUMBAR OR SACRAL SURGERY
20|FH_F108680_0_0|SrvcGrp|93069|2022|PDM|11000.00|99|0.00|POSTERIOR NON-SEGMENTAL INST
20|FH_F108680_0_0|SrvcGrp|96799|2022|PDM|1595.00|99|0.00|DESTROY C/TH FACET JNT ADDL
20|FH_F108762_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F108762_0_0|SrvcGrp|76501|2022|PDM|235.00|99|0.00|SUB-ACUTE - LEVEL I
20|FH_F108800_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|AEG 3 (NO REV)
20|FH_F108800_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|AEG 8 (NO REV)
20|FH_F108800_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F108800_0_0|SrvcGrp|35669|2022|PDM|5000.00|99|0.00|CPT 63650
20|FH_F108800_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|ANTI-SPASMOTIC THERAPY
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|BILIRUBIN TOTAL
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|HOME HEALTH AIDE
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|HOME HEALTH AIDE VISIT
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|HOME HEALTH LPN SERVICE
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|HOME HEALTH THERAPY VISITS OP
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|MEDICAL SOCIAL WORKER VISIT
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|NURSING CARE
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F109000_0_0|CSTM-ALL|CSTM-00|2020|PDM|2292.00|99|0.00|AEG 4 (NO REV)
20|FH_F109000_0_0|CSTM-ALL|CSTM-00|2020|PDM|2640.00|99|0.00|AEG 5  (NO REV)
20|FH_F109000_0_0|CSTM-ALL|CSTM-00|2020|PDM|3161.00|99|0.00|AEG 9 (NO REV)
20|FH_F109000_0_0|SrvcGrp|102959|2022|PDM|7260.00|99|0.00|NECK SPINE FUSE
20|FH_F109000_0_0|SrvcGrp|96350|2022|PDM|11110.00|99|0.00|SHOULDER JOINT
20|FH_F109040_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F109040_0_0|SrvcGrp|28787|2022|PDM|30.00|99|0.00|CPT CODE 90993
20|FH_F109040_0_0|SrvcGrp|29428|2022|PDM|420.00|99|0.00|HOME/CHRONIC HEMODIALYSIS TREATMENT
20|FH_F109248_0_0|CSTM-ALL|CSTM-00|2020|PDM|747.00|99|0.00|AEG 3 (NO REV)
20|FH_F109248_0_0|CSTM-ALL|CSTM-00|2020|PDM|901.00|99|0.00|AEG 4 (NO REV)
20|FH_F109248_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F109248_0_0|SrvcGrp|71666|2022|PDM|2200.00|99|0.00|CPT 63655
20|FH_F109260_0_0|CSTM-ALL|CSTM-00|2020|PDM|1642.75|99|0.00|AEG 4 (NO REV)
20|FH_F109260_0_0|CSTM-ALL|CSTM-00|2020|PDM|2671.13|99|0.00|AEG 7 (NO REV)
20|FH_F109260_0_0|CSTM-ALL|CSTM-00|2020|PDM|867.52|99|0.00|AEG 1 (NO REV)
20|FH_F109277_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F109277_0_0|SrvcGrp|60132|2022|PDM|378.00|99|0.00|DIALYSIS - PERITONEAL (NON-CAPD)
20|FH_F109277_0_0|SrvcGrp|9460|2022|PDM|1597.00|99|0.00|ACUTE REHABILITATION
20|FH_F109279_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F109279_0_0|CSTM-ALL|CSTM-00|2020|PDM|402.00|99|0.00|AEG 1 (NO REV)
20|FH_F109279_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F109279_0_0|SrvcGrp|79589|2022|PDM|600.00|99|0.00|UPPER GI
20|FH_F109279_0_0|SrvcGrp|79594|2022|PDM|600.00|99|0.00|CPT 45380
20|FH_F109279_0_0|SrvcGrp|79595|2022|PDM|600.00|99|0.00|CPT 45385
20|FH_F109281_0_0|CSTM-ALL|CSTM-00|2020|PDM|1375.00|99|0.00|AEG 10 (NO REV)
20|FH_F109281_0_0|CSTM-ALL|CSTM-00|2020|PDM|1375.00|99|0.00|AEG 5  (NO REV)
20|FH_F109281_0_0|CSTM-ALL|CSTM-00|2020|PDM|1610.00|99|0.00|AEG 6 (NO REV)
20|FH_F109281_0_0|CSTM-ALL|CSTM-00|2020|PDM|949.00|99|0.00|AEG 3 (NO REV)
20|FH_F109282_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F109346_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F109346_0_0|SrvcGrp|103605|2022|PCT|0.00|99|0.00|BIRTHING CENTER
20|FH_F109462_0_0|CSTM-ALL|CSTM-00|2020|PCT|64.00|99|0.00|GENERAL ACUTE CARE
20|FH_F109462_0_0|CSTM-ALL|CSTM-00|2020|PCT|64.00|99|0.00|OP SVCS
20|FH_F109484_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F109484_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F109484_0_0|SrvcGrp|72996|2022|PDM|630.00|99|0.00|AEG 4
20|FH_F109484_0_0|SrvcGrp|73000|2022|PDM|826.00|99|0.00|AEG 6
20|FH_F109484_0_0|SrvcGrp|73008|2022|PDM|333.00|99|0.00|AEG 10
20|FH_F109501_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.79|99|0.00|OP SVCS
20|FH_F109503_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 5  (NO REV)
20|FH_F109503_0_0|CSTM-ALL|CSTM-00|2020|PDM|790.00|99|0.00|AEG 6 (NO REV)
20|FH_F109513_0_0|SrvcGrp|72994|2022|PDM|765.00|99|0.00|AEG 3
20|FH_F109513_0_0|SrvcGrp|72996|2022|PDM|958.50|99|0.00|AEG 4
20|FH_F109513_0_0|SrvcGrp|73004|2022|PDM|1233.00|99|0.00|AEG 8
20|FH_F109513_0_0|SrvcGrp|73006|2022|PDM|1954.00|99|0.00|AEG 9
20|FH_F109513_0_0|SrvcGrp|85022|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F109513_0_0|SrvcGrp|88748|2022|PDM|2500.00|99|0.00|HIP ARTHROSCOPY
20|FH_F109513_0_0|SrvcGrp|90061|2022|PDM|10000.00|99|0.00|AETNA RECONSTRUCT SHOULDER JOINT
20|FH_F109513_0_0|SrvcGrp|90376|2022|PDM|10000.00|99|0.00|REVISION OF KNEE JOINTLANT
20|FH_F109513_0_0|SrvcGrp|90419|2022|PDM|4000.00|99|0.00|REPAIR HAND DISLOCATION
20|FH_F109513_0_0|SrvcGrp|90424|2022|PDM|2500.00|99|0.00|ANKLE ARTHROSCOPY SURGERY
20|FH_F109513_0_0|SrvcGrp|90427|2022|PDM|6500.00|99|0.00|CERVICAL SPINAL FUSION
20|FH_F109513_0_0|SrvcGrp|90431|2022|PDM|2500.00|99|0.00|HAND PROCEDURES
20|FH_F109513_0_0|SrvcGrp|90434|2022|PDM|2000.00|99|0.00|BREAST RECONSTRUCTION
20|FH_F109513_0_0|SrvcGrp|90438|2022|PDM|2500.00|99|0.00|ARM SURGICAL PROCEDURES
20|FH_F109538_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F109577_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F109577_0_0|SrvcGrp|103385|2022|PDM|123.00|99|0.00|MED NUTRITION, INDIV, INIT (HCFA)
20|FH_F109577_0_0|SrvcGrp|103609|2022|PDM|123.00|99|0.00|DIABETIC MGMT PROGRAM - FOLLOWUP
20|FH_F109577_0_0|SrvcGrp|103612|2022|PDM|123.00|99|0.00|DIABETIC MGMT PROGRAM - DIETICIAN
20|FH_F109577_0_0|SrvcGrp|73524|2022|PDM|135.00|99|0.00|PHYSICAL THERAPY
20|FH_F109577_0_0|SrvcGrp|73700|2022|PDM|65.00|99|0.00|AETNA - SKILLED NURSING
20|FH_F109577_0_0|SrvcGrp|87398|2022|PDM|135.00|99|0.00|CPT 99501 (HCFA)
20|FH_F109577_0_0|SrvcGrp|87399|2022|PDM|135.00|99|0.00|CPT 99502 (HCFA)
20|FH_F109577_0_0|SrvcGrp|90338|2022|PDM|135.00|99|0.00|SKILLED NURSING RN (HCFA)
20|FH_F109577_0_0|SrvcGrp|90340|2022|PDM|135.00|99|0.00|SKILLED NURSING LPN
20|FH_F109577_0_0|SrvcGrp|93147|2022|PDM|123.00|99|0.00|DIABETIC MANAGEMENT PROGRAM (HCFA)
20|FH_F109577_0_0|SrvcGrp|93338|2022|PDM|123.00|99|0.00|AETNA MED NUTRITION SEBSEQUENT
20|FH_F109577_0_0|SrvcGrp|98424|2022|PDM|123.00|99|0.00|DIABETES MANAGMENT INDIVIDUAL
20|FH_F109581_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F109581_0_0|SrvcGrp|75485|2022|PDM|716.00|99|0.00|AEG 4
20|FH_F109581_0_0|SrvcGrp|75489|2022|PDM|928.00|99|0.00|AEG 6
20|FH_F109581_0_0|SrvcGrp|75491|2022|PDM|1114.00|99|0.00|AEG 7
20|FH_F109601_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F109601_0_0|SrvcGrp|75479|2022|PDM|450.00|99|0.00|AEG 1
20|FH_F109601_0_0|SrvcGrp|75481|2022|PDM|550.00|99|0.00|AEG 2
20|FH_F109601_0_0|SrvcGrp|75485|2022|PDM|750.00|99|0.00|AEG 4
20|FH_F109601_0_0|SrvcGrp|75487|2022|PDM|800.00|99|0.00|AEG 5
20|FH_F109606_0_0|CSTM-ALL|CSTM-00|2020|PDM|749.00|99|0.00|AEG 10 (NO REV)
20|FH_F109630_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F109630_0_0|CSTM-ALL|CSTM-00|2020|PDM|1099.60|99|0.00|AEG 6 (NO REV)
20|FH_F109630_0_0|CSTM-ALL|CSTM-00|2020|PDM|1359.00|99|0.00|AEG 5  (NO REV)
20|FH_F109630_0_0|CSTM-ALL|CSTM-00|2020|PDM|1636.40|99|0.00|AEG 8 (NO REV)
20|FH_F109630_0_0|CSTM-ALL|CSTM-00|2020|PDM|597.80|99|0.00|AEG 1 (NO REV)
20|FH_F109632_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F109632_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F109632_0_0|SrvcGrp|36093|2022|PCT|0.00|99|0.00|ACUTE REHABILITATION
20|FH_F109632_0_0|SrvcGrp|43740|2022|PDM|900.00|99|0.00|REHABILITATION - PRIVATE
20|FH_F109632_0_0|SrvcGrp|74381|2022|PDM|80.00|99|0.00|PHYSICAL THERAPY
20|FH_F109632_0_0|SrvcGrp|74382|2022|PDM|80.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F109632_0_0|SrvcGrp|74383|2022|PDM|80.00|99|0.00|SPEECH THERAPY
20|FH_F109632_0_0|SrvcGrp|80258|2022|PCT|0.00|99|0.00|AETNA SKILLED CARE
20|FH_F109632_0_0|SrvcGrp|87536|2022|PDM|464.00|99|0.00|MED REHAB DAY PROGRAM (HALF)
20|FH_F109632_0_0|SrvcGrp|87537|2022|PDM|927.00|99|0.00|MED REHAB DAY PROGRAM (FULL)
20|FH_F109645_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F109645_0_0|SrvcGrp|103386|2022|PDM|42.00|99|0.00|ROUTINE VENIPUNCTURE FINGER/HEEL/EAR (HCFA)
20|FH_F109645_0_0|SrvcGrp|103683|2022|PDM|88.00|99|0.00|SPEECH THERAPY (HCFA)
20|FH_F109645_0_0|SrvcGrp|103684|2022|PDM|88.00|99|0.00|OCCUPATION THERAPY (HCFA)
20|FH_F109645_0_0|SrvcGrp|22384|2022|PDM|90.00|99|0.00|HOME VISIT PRENATAL
20|FH_F109645_0_0|SrvcGrp|87398|2022|PDM|95.00|99|0.00|CPT 99501 (HCFA)
20|FH_F109645_0_0|SrvcGrp|88808|2022|PDM|118.00|99|0.00|MEDICAL SOCIAL WORKER (HCFA)
20|FH_F109645_0_0|SrvcGrp|91677|2022|PDM|88.00|99|0.00|AETNA SKILLED NURSE IN HOME HEALTH SETTING
20|FH_F109648_0_0|CSTM-ALL|CSTM-00|2020|PDM|1339.00|99|0.00|AEG 9 (NO REV)
20|FH_F109648_0_0|CSTM-ALL|CSTM-00|2020|PDM|446.00|99|0.00|AEG 2 (NO REV)
20|FH_F109648_0_0|CSTM-ALL|CSTM-00|2020|PDM|973.00|99|0.00|AEG 8 (NO REV)
20|FH_F109648_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|AEG 7 (NO REV)
20|FH_F109762_0_0|SrvcGrp|72994|2022|PDM|510.00|99|0.00|AEG 3
20|FH_F109762_0_0|SrvcGrp|72996|2022|PDM|630.00|99|0.00|AEG 4
20|FH_F109762_0_0|SrvcGrp|72998|2022|PDM|717.00|99|0.00|AEG 5
20|FH_F109762_0_0|SrvcGrp|73002|2022|PDM|995.00|99|0.00|AEG 7
20|FH_F109762_0_0|SrvcGrp|73004|2022|PDM|973.00|99|0.00|AEG 8
20|FH_F109762_0_0|SrvcGrp|73006|2022|PDM|1339.00|99|0.00|AEG 9
20|FH_F109762_0_0|SrvcGrp|73008|2022|PDM|630.00|99|0.00|AEG 10
20|FH_F109803_0_0|CSTM-ALL|CSTM-00|2020|PDM|1155.00|99|0.00|AEG 8 (NO REV)
20|FH_F109803_0_0|SrvcGrp|98448|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F109810_0_0|CSTM-ALL|CSTM-00|2020|PCT|67.00|99|0.00|GENERAL ACUTE CARE
20|FH_F109821_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F109821_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|AEG 2 (NO REV)
20|FH_F109821_0_0|CSTM-ALL|CSTM-00|2020|PDM|877.00|99|0.00|AEG 5  (NO REV)
20|FH_F109821_0_0|SrvcGrp|13557|2022|PCT|1.02|99|0.00|CORNEAL TISSUE SVCS
20|FH_F109821_0_0|SrvcGrp|76847|2022|PDM|1836.00|99|0.00|AETNA ARTHROSCOPY
20|FH_F109821_0_0|SrvcGrp|78704|2022|PDM|3570.00|99|0.00|AETNA FRAGMENTING OF KIDNEY STONE
20|FH_F109821_0_0|SrvcGrp|86234|2022|PDM|1836.00|99|0.00|AETHA IMPLANT SPINAL CANAL CATH
20|FH_F109821_0_0|SrvcGrp|86236|2022|PDM|2550.00|99|0.00|AETNA SPINAL SURGERY
20|FH_F109843_0_0|CSTM-ALL|CSTM-00|2020|PDM|1595.00|99|0.00|AEG 3 (NO REV)
20|FH_F109843_0_0|CSTM-ALL|CSTM-00|2020|PDM|2530.00|99|0.00|AEG 5  (NO REV)
20|FH_F109848_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F109907_0_0|SrvcGrp|23683|2022|PDM|36.41|99|0.00|SKILLED NURSING RN
20|FH_F109907_0_0|SrvcGrp|27968|2022|PDM|31.21|99|0.00|SKILLED NURSING LPN
20|FH_F109907_0_0|SrvcGrp|48394|2022|PDM|54.10|99|0.00|SKILLED NURSING SERVICES
20|FH_F109907_0_0|SrvcGrp|88620|2022|PDM|92.60|99|0.00|SKILLED NURSING RN
20|FH_F109926_0_0|CSTM-ALL|CSTM-00|2020|PDM|1235.00|99|0.00|AEG 7 (NO REV)
20|FH_F109926_0_0|CSTM-ALL|CSTM-00|2020|PDM|1235.00|99|0.00|AEG 8 (NO REV)
20|FH_F109926_0_0|SrvcGrp|103786|2022|PCT|1.00|99|0.00|GANCICLOVIR IMPLANT/1UNIT MAX
20|FH_F109949_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F109949_0_0|CSTM-ALL|CSTM-00|2020|PDM|647.00|99|0.00|AEG 2 (NO REV)
20|FH_F109949_0_0|CSTM-ALL|CSTM-00|2020|PDM|690.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F109951_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F109951_0_0|CSTM-ALL|CSTM-00|2020|PDM|2920.00|99|0.00|COVENTRY ENHANCED GROUPER 6
20|FH_F109951_0_0|CSTM-ALL|CSTM-00|2020|PDM|3098.00|99|0.00|COVENTRY ENHANCED GROUPER 9
20|FH_F109951_0_0|SrvcGrp|11663|2022|PCT|0.45|99|0.00|IMPLANTS
20|FH_F109963_0_0|SrvcGrp|72990|2022|PDM|333.00|99|0.00|AEG 1
20|FH_F109963_0_0|SrvcGrp|73006|2022|PDM|834.00|99|0.00|AEG 9
20|FH_F109980_0_0|SrvcGrp|30089|2022|PDM|375.00|99|0.00|HEMODIALYSIS SERVICES
20|FH_F109980_0_0|SrvcGrp|73559|2022|PDM|1500.00|99|0.00|AETNA INTENSIVE CARE
20|FH_F109980_0_0|SrvcGrp|79804|2022|PDM|1200.00|99|0.00|AETNA MEDICAL/SURGICAL
20|FH_F110061_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F110061_0_0|SrvcGrp|58755|2022|PDM|4000.00|99|0.00|INJECTION PROC FOR JOINT
20|FH_F110061_0_0|SrvcGrp|75485|2022|PDM|667.00|99|0.00|AEG 4
20|FH_F110061_0_0|SrvcGrp|75489|2022|PDM|879.00|99|0.00|AEG 6
20|FH_F110061_0_0|SrvcGrp|75495|2022|PDM|1418.00|99|0.00|AEG 9
20|FH_F110061_0_0|SrvcGrp|96104|2022|PDM|350.00|99|0.00|IMPLANTABLE NEUROSTIMULATOR
20|FH_F110067_0_0|CSTM-ALL|CSTM-00|2020|PCT|69.00|99|0.00|OP SVCS
20|FH_F110102_0_0|SrvcGrp|104132|2022|PDM|650.00|99|0.00|INPATIENT PSYCH
20|FH_F110102_0_0|SrvcGrp|104232|2022|PDM|150.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F110102_0_0|SrvcGrp|95762|2022|PDM|150.00|99|0.00|HOSPICE CARE (HCFA)
20|FH_F110121_0_0|SrvcGrp|72994|2022|PDM|1943.00|99|0.00|AEG 3
20|FH_F110121_0_0|SrvcGrp|72998|2022|PDM|3360.00|99|0.00|AEG 5
20|FH_F110121_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F110140_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE
20|FH_F110160_0_0|SrvcGrp|72990|2022|PDM|580.00|99|0.00|AEG 1
20|FH_F110160_0_0|SrvcGrp|72994|2022|PDM|812.00|99|0.00|AEG 3
20|FH_F110160_0_0|SrvcGrp|73002|2022|PDM|1332.00|99|0.00|AEG 7
20|FH_F110160_0_0|SrvcGrp|73004|2022|PDM|1312.00|99|0.00|AEG 8
20|FH_F110180_0_0|SrvcGrp|29930|2022|PDM|400.00|99|0.00|DIALYSIS
20|FH_F110220_0_0|SrvcGrp|103928|2022|PDM|91.78|99|0.00|SLEEP STUDY UNATTENDED ANALYSIS(HCFA)
20|FH_F110220_0_0|SrvcGrp|103929|2022|PDM|193.54|99|0.00|SLEEP STUDY UNATTENDED RESPIRATORY EFFORT(HCFA)
20|FH_F110220_0_0|SrvcGrp|92190|2022|PDM|693.80|99|0.00|CPT 95810  (HCFA)
20|FH_F110233_0_0|SrvcGrp|73488|2022|PCT|0.94|99|0.00|AETNA HOSPITAL OP DIALYSIS
20|FH_F110233_0_0|SrvcGrp|89939|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH INCIDENTAL CODES
20|FH_F110236_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F110236_0_0|SrvcGrp|75481|2022|PDM|1200.00|99|0.00|AEG 2
20|FH_F110236_0_0|SrvcGrp|82137|2022|PDM|1350.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F110240_0_0|CSTM-ALL|CSTM-00|2020|PDM|435.00|99|0.00|AEG 1 (NO REV)
20|FH_F110263_0_0|CSTM-ALL|CSTM-00|2020|PDM|1368.00|99|0.00|AEG 10 (NO REV)
20|FH_F110263_0_0|CSTM-ALL|CSTM-00|2020|PDM|2361.00|99|0.00|AEG 6 (NO REV)
20|FH_F110263_0_0|SrvcGrp|111445|2022|PDM|12703.00|99|0.00|RECONSTRUCT ANKLE JOINT (HCFA)
20|FH_F110263_0_0|SrvcGrp|27402|2022|PDM|7575.00|99|0.00|LASER PROCEDURES
20|FH_F110263_0_0|SrvcGrp|38364|2022|PDM|8659.00|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F110263_0_0|SrvcGrp|80617|2022|PDM|13477.00|99|0.00|ARTHOPLASTY
20|FH_F110263_0_0|SrvcGrp|84939|2022|PDM|13084.00|99|0.00|SHOULDER JOINT
20|FH_F110263_0_0|SrvcGrp|93807|2022|PDM|9007.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY
20|FH_F110263_0_0|SrvcGrp|93980|2022|PDM|9277.00|99|0.00|IMPLANT NEUROELECTRODES 29 (HCFA)
20|FH_F110308_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F110308_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F110308_0_0|SrvcGrp|72990|2022|PDM|150.00|99|0.00|AEG 1
20|FH_F110308_0_0|SrvcGrp|72992|2022|PDM|350.00|99|0.00|AEG 2
20|FH_F110308_0_0|SrvcGrp|72996|2022|PDM|700.00|99|0.00|AEG 4
20|FH_F110308_0_0|SrvcGrp|73002|2022|PDM|800.00|99|0.00|AEG 7
20|FH_F110342_0_0|SrvcGrp|102419|2022|PDM|2200.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F110342_0_0|SrvcGrp|103965|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F110342_0_0|SrvcGrp|73000|2022|PDM|1900.00|99|0.00|AEG 6
20|FH_F110360_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F110360_0_0|CSTM-ALL|CSTM-00|2020|PDM|525.00|99|0.00|AEG 2 (NO REV)
20|FH_F110360_0_0|CSTM-ALL|CSTM-00|2020|PDM|949.50|99|0.00|AEG 4 (NO REV)
20|FH_F110360_0_0|CSTM-ALL|CSTM-00|2020|PDM|971.25|99|0.00|AEG 6 (NO REV)
20|FH_F110363_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F110381_0_0|SrvcGrp|41334|2022|PDM|15500.00|99|0.00|TOTAL KNEE
20|FH_F110381_0_0|SrvcGrp|73006|2022|PDM|3710.00|99|0.00|AEG 9
20|FH_F110381_0_0|SrvcGrp|89877|2022|PDM|5300.00|99|0.00|HIP ARTHROSCOPY/SURGERY
20|FH_F110381_0_0|SrvcGrp|89981|2022|PDM|2332.00|99|0.00|SHOULDER ARTHROSCOPY / SURGERY
20|FH_F110400_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F110448_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F110453_0_0|SrvcGrp|72992|2022|PDM|479.00|99|0.00|AEG 2
20|FH_F110453_0_0|SrvcGrp|72996|2022|PDM|677.00|99|0.00|AEG 4
20|FH_F110453_0_0|SrvcGrp|73006|2022|PDM|1434.00|99|0.00|AEG 9
20|FH_F110564_0_0|SrvcGrp|103974|2022|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES
20|FH_F110564_0_0|SrvcGrp|42550|2022|PDM|1000.00|99|0.00|OP SURGERY CPT 66984
20|FH_F110564_0_0|SrvcGrp|85966|2022|PDM|1000.00|99|0.00|EXTRACAPSULAR CATARACT
20|FH_F110564_0_0|SrvcGrp|91759|2022|PCT|1.00|99|0.00|OCULAR IMPLANT
20|FH_F110604_0_0|CSTM-ALL|CSTM-00|2020|PDM|1045.00|99|0.00|AEG 3 (NO REV)
20|FH_F110604_0_0|CSTM-ALL|CSTM-00|2020|PDM|880.00|99|0.00|AEG 2 (NO REV)
20|FH_F110604_0_0|SrvcGrp|113145|2022|PDM|1485.00|99|0.00|WRIST ARHROSCOPY
20|FH_F110604_0_0|SrvcGrp|63467|2022|PDM|2318.00|99|0.00|CPT 64585
20|FH_F110604_0_0|SrvcGrp|82110|2022|PDM|1485.00|99|0.00|KNEE ARTHROSCOPY DIAGNOSTIC
20|FH_F110604_0_0|SrvcGrp|87677|2022|PDM|1100.00|99|0.00|CERVICAL OR THORACIC SURGERY
20|FH_F110604_0_0|SrvcGrp|90797|2022|PDM|19800.00|99|0.00|INSERT SPINAL INFUSION DEV16
20|FH_F110604_0_0|SrvcGrp|90978|2022|PDM|1100.00|99|0.00|INJECTION CERVICAL OR THORACIC TRANSFORAMINAL EPIDURAL
20|FH_F110604_0_0|SrvcGrp|96799|2022|PDM|1100.00|99|0.00|DESTROY C/TH FACET JNT ADDL
20|FH_F110604_0_0|SrvcGrp|96819|2022|PDM|1100.00|99|0.00|DESTROY L/S FACET JNT ADDL
20|FH_F110621_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F110621_0_0|CSTM-ALL|CSTM-00|2020|PDM|655.00|99|0.00|AEG 4 (NO REV)
20|FH_F110621_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F110666_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F110702_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F110702_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F110720_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F110720_0_0|SrvcGrp|38015|2022|PDM|7322.00|99|0.00|ARTHRODESIS
20|FH_F110720_0_0|SrvcGrp|64761|2022|PDM|4882.00|99|0.00|DISCECTOMY
20|FH_F110720_0_0|SrvcGrp|72992|2022|PDM|1486.00|99|0.00|AEG 2
20|FH_F110720_0_0|SrvcGrp|72994|2022|PDM|2335.00|99|0.00|AEG 3
20|FH_F110720_0_0|SrvcGrp|73004|2022|PDM|3327.00|99|0.00|AEG 8
20|FH_F110720_0_0|SrvcGrp|96354|2022|PDM|2653.00|99|0.00|REMOVAL OF ANKLE JOINT
20|FH_F110720_0_0|SrvcGrp|96919|2022|PDM|4882.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F110900_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F110900_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F110900_0_0|SrvcGrp|87077|2022|PDM|120.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F110927_0_0|CSTM-ALL|CSTM-00|2020|PCT|64.00|99|0.00|OP SVCS
20|FH_F110967_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F110967_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F110967_0_0|CSTM-ALL|CSTM-00|2020|PDM|947.53|99|0.00|ASPG I
20|FH_F110971_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F110980_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F111001_0_0|CSTM-ALL|CSTM-00|2020|PDM|12.00|99|0.00|LVN HIGH TECH HOURLY
20|FH_F111044_0_0|CSTM-ALL|CSTM-00|2020|PDM|1012.00|99|0.00|AEG 3 (NO REV)
20|FH_F111044_0_0|CSTM-ALL|CSTM-00|2020|PDM|1298.00|99|0.00|AEG 5  (NO REV)
20|FH_F111044_0_0|SrvcGrp|104170|2022|PDM|1648.00|99|0.00|AETNA ARTHROSCOPY SURGERY
20|FH_F111044_0_0|SrvcGrp|26274|2022|PDM|2266.00|99|0.00|CPT 29877
20|FH_F111044_0_0|SrvcGrp|54962|2022|PDM|2987.00|99|0.00|RECONSTRUCTION OF SHOULDER CUFF (ROTATOR)
20|FH_F111044_0_0|SrvcGrp|69964|2022|PDM|2060.00|99|0.00|CPT 23120
20|FH_F111044_0_0|SrvcGrp|78282|2022|PDM|3296.00|99|0.00|CPT 47563
20|FH_F111044_0_0|SrvcGrp|82114|2022|PDM|2266.00|99|0.00|MENISCUS REPAIR MED OR LAT
20|FH_F111044_0_0|SrvcGrp|99155|2022|PDM|1648.00|99|0.00|WRST ARTHROS SURG
20|FH_F111046_0_0|SrvcGrp|13422|2022|PDM|436.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC
20|FH_F111046_0_0|SrvcGrp|2067|2022|PDM|906.00|99|0.00|SPECIALTY CARE TRANSPORT
20|FH_F111064_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F111163_0_0|CSTM-ALL|CSTM-00|2020|PDM|1043.00|99|0.00|AEG 8 (NO REV)
20|FH_F111163_0_0|CSTM-ALL|CSTM-00|2020|PDM|1069.00|99|0.00|AEG 6 (NO REV)
20|FH_F111163_0_0|CSTM-ALL|CSTM-00|2020|PDM|1961.00|99|0.00|AEG 9 (NO REV)
20|FH_F111163_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 1 (NO REV)
20|FH_F111163_0_0|CSTM-ALL|CSTM-00|2020|PDM|939.00|99|0.00|AEG 5  (NO REV)
20|FH_F111163_0_0|SrvcGrp|101320|2022|PDM|1000.00|99|0.00|PARAVERTEBRAL FACET JOINT NERVE
20|FH_F111189_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F111207_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F111207_0_0|SrvcGrp|58763|2022|PCT|0.70|99|0.00|IMMUNE ENHANCING/SUPPRESSANT PHARMACY
20|FH_F111207_0_0|SrvcGrp|58764|2022|PCT|0.70|99|0.00|PHYSICIANS FEES
20|FH_F111260_0_0|SrvcGrp|82981|2022|PDM|175.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F111263_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F111265_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F111269_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F111282_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F111288_0_0|SrvcGrp|27261|2022|PDM|21868.00|99|0.00|CPT 27446
20|FH_F111288_0_0|SrvcGrp|47142|2022|PDM|4866.00|99|0.00|CPT 49650
20|FH_F111288_0_0|SrvcGrp|67279|2022|PDM|18884.00|99|0.00|CERVICAL SURGERY
20|FH_F111288_0_0|SrvcGrp|70749|2022|PDM|2849.00|99|0.00|CPT 29823
20|FH_F111288_0_0|SrvcGrp|72121|2022|PDM|5724.00|99|0.00|ARTHOSCOPY
20|FH_F111288_0_0|SrvcGrp|82114|2022|PDM|2849.00|99|0.00|MENISCUS REPAIR MED OR LAT
20|FH_F111288_0_0|SrvcGrp|82298|2022|PDM|25500.00|99|0.00|AETNA LAP SLEEVE GASTRECTOMY
20|FH_F111288_0_0|SrvcGrp|88065|2022|PDM|29362.00|99|0.00|TOTAL DISC ARTHROPLASTY
20|FH_F111288_0_0|SrvcGrp|88599|2022|PDM|4069.00|99|0.00|ENDOSCOPY MAXILLARY SINUS
20|FH_F111300_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F111316_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F111316_0_0|SrvcGrp|86723|2022|PDM|400.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)
20|FH_F111320_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F111320_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 5  (NO REV)
20|FH_F111320_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|AEG 9 (NO REV)
20|FH_F111320_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 2 (NO REV)
20|FH_F111349_0_0|SrvcGrp|93274|2022|PDM|329.00|99|0.00|SKILLED CARE LEVEL I AND II
20|FH_F111589_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F111589_0_0|CSTM-ALL|CSTM-00|2020|PCT|12000.00|99|0.00|TIMELY FILING
20|FH_F111593_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F111593_0_0|SrvcGrp|103965|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F111593_0_0|SrvcGrp|38364|2022|PDM|6966.00|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F111593_0_0|SrvcGrp|72990|2022|PDM|841.50|99|0.00|AEG 1
20|FH_F111593_0_0|SrvcGrp|73004|2022|PDM|2344.10|99|0.00|AEG 8
20|FH_F111593_0_0|SrvcGrp|87053|2022|PDM|2145.00|99|0.00|CYSTOSCOPY AND TREATMENT
20|FH_F111594_0_0|CSTM-ALL|CSTM-00|2020|PDM|1155.00|99|0.00|AEG 1 (NO REV)
20|FH_F111594_0_0|CSTM-ALL|CSTM-00|2020|PDM|2346.00|99|0.00|AEG 6 (NO REV)
20|FH_F111594_0_0|SrvcGrp|11673|2022|PDM|4812.00|99|0.00|CPT 29888
20|FH_F111594_0_0|SrvcGrp|67279|2022|PDM|7699.00|99|0.00|CERVICAL SURGERY
20|FH_F111594_0_0|SrvcGrp|90343|2022|PDM|7215.00|99|0.00|CERVICE CORPECTOMY 1 LEVEL
20|FH_F111594_0_0|SrvcGrp|95559|2022|PDM|7215.00|99|0.00|HIP JOINT
20|FH_F111661_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F111826_0_0|SrvcGrp|35669|2022|PDM|6000.00|99|0.00|CPT 63650
20|FH_F111826_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F111826_0_0|SrvcGrp|72994|2022|PDM|990.00|99|0.00|AEG 3
20|FH_F111826_0_0|SrvcGrp|72996|2022|PDM|1045.00|99|0.00|AEG 4
20|FH_F111835_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F111835_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.49|99|0.00|ASPG X
20|FH_F111835_0_0|CSTM-ALL|CSTM-00|2020|PDM|725.00|99|0.00|ASPG II
20|FH_F111835_0_0|CSTM-ALL|CSTM-00|2020|PDM|809.92|99|0.00|ASPG III
20|FH_F111835_0_0|SrvcGrp|90318|2022|PCT|1.10|99|0.00|IMPLANTS/PROSTHETICS
20|FH_F111840_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F111840_0_0|SrvcGrp|75479|2022|PDM|333.00|99|0.00|AEG 1
20|FH_F111840_0_0|SrvcGrp|75481|2022|PDM|446.00|99|0.00|AEG 2
20|FH_F111840_0_0|SrvcGrp|75487|2022|PDM|717.00|99|0.00|AEG 5
20|FH_F111840_0_0|SrvcGrp|75493|2022|PDM|1339.00|99|0.00|AEG 8
20|FH_F111840_0_0|SrvcGrp|85022|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F111852_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|GENERAL ACUTE CARE
20|FH_F111862_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F111885_0_0|CSTM-ALL|CSTM-00|2020|PDM|1457.00|99|0.00|AEG 2 (NO REV)
20|FH_F111885_0_0|CSTM-ALL|CSTM-00|2020|PDM|624.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F111925_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F111925_0_0|CSTM-ALL|CSTM-00|2020|PDM|404.00|99|0.00|AEG 1 (NO REV)
20|FH_F111925_0_0|SrvcGrp|103965|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F111925_0_0|SrvcGrp|28551|2022|PDM|1602.00|99|0.00|REPAIR OF COMPLEX RETINAL DETACHMENT
20|FH_F111925_0_0|SrvcGrp|38909|2022|PDM|1602.00|99|0.00|CPT 67036 - VITRECTOMY, MECHANICAL
20|FH_F111925_0_0|SrvcGrp|62737|2022|PDM|1602.00|99|0.00|SURGERY CARVE OUTS
20|FH_F111925_0_0|SrvcGrp|74670|2022|PCT|1.00|99|0.00|AETNA OP INTRAOCULAR LENS
20|FH_F111986_0_0|SrvcGrp|104112|2022|PDM|2472.00|99|0.00|REPAIR OF ANKLE FRACTURE
20|FH_F111986_0_0|SrvcGrp|104119|2022|PDM|3399.00|99|0.00|LAP VENT/ABD HERNIA REPAIR
20|FH_F111986_0_0|SrvcGrp|11673|2022|PDM|3605.00|99|0.00|CPT 29888
20|FH_F111986_0_0|SrvcGrp|16732|2022|PDM|2266.00|99|0.00|HYSTEROSCOPY ABLATION
20|FH_F111986_0_0|SrvcGrp|27347|2022|PDM|1236.00|99|0.00|CPT 58558
20|FH_F111986_0_0|SrvcGrp|63459|2022|PDM|1854.00|99|0.00|CPT 52601
20|FH_F111986_0_0|SrvcGrp|72990|2022|PDM|477.00|99|0.00|AEG 1
20|FH_F111986_0_0|SrvcGrp|72994|2022|PDM|1030.00|99|0.00|AEG 3
20|FH_F111986_0_0|SrvcGrp|72996|2022|PDM|1030.00|99|0.00|AEG 4
20|FH_F111986_0_0|SrvcGrp|72998|2022|PDM|1133.00|99|0.00|AEG 5
20|FH_F111986_0_0|SrvcGrp|73000|2022|PDM|1339.00|99|0.00|AEG 6
20|FH_F111986_0_0|SrvcGrp|73006|2022|PDM|2015.00|99|0.00|AEG 9
20|FH_F111986_0_0|SrvcGrp|77444|2022|PDM|1236.00|99|0.00|VASECTOMY
20|FH_F111986_0_0|SrvcGrp|77461|2022|PDM|3296.00|99|0.00|CPT 52356
20|FH_F111986_0_0|SrvcGrp|82115|2022|PDM|2060.00|99|0.00|REPAIR UMBIL HERNIA
20|FH_F111986_0_0|SrvcGrp|87679|2022|PDM|721.00|99|0.00|LUMBAR OR SACRAL SURGERY
20|FH_F111986_0_0|SrvcGrp|90417|2022|PDM|2472.00|99|0.00|TREATMENT OF JOINT
20|FH_F111986_0_0|SrvcGrp|92007|2022|PDM|3605.00|99|0.00|PROXIMAL HUMERAL
20|FH_F111986_0_0|SrvcGrp|94904|2022|PDM|2472.00|99|0.00|REPAIR/REVISE WRIST JOINT
20|FH_F111986_0_0|SrvcGrp|98448|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F112024_0_0|SrvcGrp|72990|2022|PDM|1613.00|99|0.00|AEG 1
20|FH_F112024_0_0|SrvcGrp|72992|2022|PDM|2055.00|99|0.00|AEG 2
20|FH_F112064_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F112064_0_0|SrvcGrp|103896|2022|PDM|140.00|99|0.00|HOSPICE ROUTINE HOME CARE
20|FH_F112064_0_0|SrvcGrp|103898|2022|PDM|160.00|99|0.00|CONTINUOUS HOME CARE
20|FH_F112064_0_0|SrvcGrp|103902|2022|PDM|641.00|99|0.00|GENERAL INPATIENT CARE
20|FH_F112064_0_0|SrvcGrp|103904|2022|PCT|0.00|99|0.00|HOSPICE INPT RESPITE CARE
20|FH_F112064_0_0|SrvcGrp|84185|2022|PCT|0.00|99|0.00|RESPITE CARE
20|FH_F112080_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F112080_0_0|SrvcGrp|73000|2022|PDM|1197.00|99|0.00|AEG 6
20|FH_F112089_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F112089_0_0|CSTM-ALL|CSTM-00|2020|PDM|1866.00|99|0.00|AEG 6 (NO REV)
20|FH_F112133_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|AEG 5  (NO REV)
20|FH_F112153_0_0|CSTM-ALL|CSTM-00|2020|PDM|1020.00|99|0.00|AEG 7 (NO REV)
20|FH_F112153_0_0|CSTM-ALL|CSTM-00|2020|PDM|1089.00|99|0.00|AEG 8 (NO REV)
20|FH_F112153_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|AEG 1 (NO REV)
20|FH_F112153_0_0|CSTM-ALL|CSTM-00|2020|PDM|610.00|99|0.00|AEG 3 (NO REV)
20|FH_F112153_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F112163_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F112163_0_0|SrvcGrp|104621|2022|PDM|893.00|99|0.00|HOSPICE CARE PROVIDED IN INPATIENT HOSPICE FACILITY
20|FH_F112163_0_0|SrvcGrp|104713|2022|PDM|236.00|99|0.00|HOSPICE RESPITE CARE
20|FH_F112163_0_0|SrvcGrp|104746|2022|PDM|590.20|99|0.00|HOSPICE R & B NURSING FACIL
20|FH_F112165_0_0|SrvcGrp|72992|2022|PDM|2500.00|99|0.00|AEG 2
20|FH_F112165_0_0|SrvcGrp|73000|2022|PDM|2415.00|99|0.00|AEG 6
20|FH_F112165_0_0|SrvcGrp|73004|2022|PDM|2600.00|99|0.00|AEG 8
20|FH_F112165_0_0|SrvcGrp|86088|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F112263_0_0|CSTM-ALL|CSTM-00|2020|PDM|1040.00|99|0.00|AEG 5  (NO REV)
20|FH_F112263_0_0|CSTM-ALL|CSTM-00|2020|PDM|1442.00|99|0.00|AEG 7 (NO REV)
20|FH_F112263_0_0|CSTM-ALL|CSTM-00|2020|PDM|647.00|99|0.00|AEG 2 (NO REV)
20|FH_F112263_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AEG 1 (NO REV)
20|FH_F112263_0_0|CSTM-ALL|CSTM-00|2020|PDM|739.00|99|0.00|AEG 3 (NO REV)
20|FH_F112263_0_0|SrvcGrp|74585|2022|PCT|0.00|99|0.00|AETNA OP IMPLANTS
20|FH_F112272_0_0|SrvcGrp|73483|2022|PDM|832.00|99|0.00|AETNA SUBACUTE III
20|FH_F112325_0_0|SrvcGrp|73656|2022|PDM|475.00|99|0.00|AETNA HOSPICE SVCS
20|FH_F112325_0_0|SrvcGrp|80317|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F112325_0_0|SrvcGrp|95441|2022|PDM|100.00|99|0.00|HOSPICE OR HOME CARE
20|FH_F112374_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F112374_0_0|SrvcGrp|16|2022|PDM|832.00|99|0.00|ACUTE REHABILITATION
20|FH_F112374_0_0|SrvcGrp|30089|2022|PDM|442.00|99|0.00|HEMODIALYSIS SERVICES
20|FH_F112377_0_0|SrvcGrp|87077|2022|PDM|164.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F112408_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F112446_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.86|99|0.00|OP SVCS
20|FH_F112448_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.69|99|0.00|OP SVCS
20|FH_F112448_0_0|SrvcGrp|11606|2022|PDM|1475.00|99|0.00|ACUTE CARE (MEDICAL & SURGICAL)
20|FH_F112448_0_0|SrvcGrp|14938|2022|PDM|1575.00|99|0.00|PROGRESSIVE TELEMETRY
20|FH_F112448_0_0|SrvcGrp|3142|2022|PDM|1775.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F112452_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F112452_0_0|CSTM-ALL|CSTM-00|2020|PDM|581.00|99|0.00|AEG 2 (NO REV)
20|FH_F112453_0_0|SrvcGrp|90707|2022|PDM|105.00|99|0.00|AETNA HOSPICE CARE
20|FH_F112468_0_0|SrvcGrp|38364|2022|PDM|1417.00|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F112468_0_0|SrvcGrp|93759|2022|PCT|0.00|99|0.00|CARDIAC CATH
20|FH_F112508_0_0|SrvcGrp|10393|2022|PDM|1560.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F112526_0_0|SrvcGrp|63297|2022|PDM|105.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F112568_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F112568_0_0|SrvcGrp|104229|2022|PDM|240.60|99|0.00|HOSPICE IN HOME (HCFA)
20|FH_F112568_0_0|SrvcGrp|104230|2022|PDM|240.60|99|0.00|RESPITE CARE (HCFA)
20|FH_F112568_0_0|SrvcGrp|104840|2022|PDM|240.60|99|0.00|HOSPICE CARE (HCFA)
20|FH_F112568_0_0|SrvcGrp|84185|2022|PDM|240.60|99|0.00|RESPITE CARE
20|FH_F112631_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F112631_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F112631_0_0|SrvcGrp|72994|2022|PDM|658.00|99|0.00|AEG 3
20|FH_F112631_0_0|SrvcGrp|73000|2022|PDM|928.00|99|0.00|AEG 6
20|FH_F112631_0_0|SrvcGrp|73004|2022|PDM|1114.00|99|0.00|AEG 8
20|FH_F112665_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F112665_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F112665_0_0|CSTM-ALL|CSTM-00|2020|PDM|2133.00|99|0.00|AEG 4 (NO REV)
20|FH_F112665_0_0|CSTM-ALL|CSTM-00|2020|PDM|2788.00|99|0.00|AEG 8 (NO REV)
20|FH_F112665_0_0|CSTM-ALL|CSTM-00|2020|PDM|962.00|99|0.00|AEG 10 (NO REV)
20|FH_F112665_0_0|SrvcGrp|11306|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F112665_0_0|SrvcGrp|58993|2022|PDM|7215.00|99|0.00|DISKECTOMY
20|FH_F112665_0_0|SrvcGrp|67068|2022|PDM|7699.00|99|0.00|LUMBAR SPINE FUSION COMBINED
20|FH_F112665_0_0|SrvcGrp|72121|2022|PDM|2887.00|99|0.00|ARTHOSCOPY
20|FH_F112665_0_0|SrvcGrp|88159|2022|PDM|7215.00|99|0.00|LOW BACK DISK SURGERY
20|FH_F112665_0_0|SrvcGrp|88163|2022|PDM|5296.00|99|0.00|LUMBAR SPINE FUSION
20|FH_F112665_0_0|SrvcGrp|88164|2022|PDM|7699.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR
20|FH_F112665_0_0|SrvcGrp|89840|2022|PDM|7699.00|99|0.00|THORAX SPINE FUSION
20|FH_F112665_0_0|SrvcGrp|98496|2022|PDM|7699.00|99|0.00|ARTHRODESIS POSTERIOR ATLAS
20|FH_F112668_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F112668_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F112704_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F112704_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F112704_0_0|CSTM-ALL|CSTM-00|2020|PDM|1133.00|99|0.00|AEG 10 (NO REV)
20|FH_F112704_0_0|CSTM-ALL|CSTM-00|2020|PDM|1571.90|99|0.00|AEG 7 (NO REV)
20|FH_F112704_0_0|CSTM-ALL|CSTM-00|2020|PDM|806.30|99|0.00|AEG 3 (NO REV)
20|FH_F112704_0_0|SrvcGrp|44132|2022|PDM|733.00|99|0.00|OP SURGERY CPT 64490-64495
20|FH_F112708_0_0|CSTM-ALL|CSTM-00|2020|PDM|1024.00|99|0.00|AEG 4 (NO REV)
20|FH_F112708_0_0|CSTM-ALL|CSTM-00|2020|PDM|1596.00|99|0.00|AEG 8 (NO REV)
20|FH_F112708_0_0|SrvcGrp|76847|2022|PDM|2223.00|99|0.00|AETNA ARTHROSCOPY
20|FH_F112717_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|GENERAL ACUTE CARE
20|FH_F112726_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|OP SVCS
20|FH_F112791_0_0|SrvcGrp|72992|2022|PDM|468.00|99|0.00|AEG 2
20|FH_F112823_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F112823_0_0|CSTM-ALL|CSTM-00|2020|PDM|1224.00|99|0.00|AEG 8 (NO REV)
20|FH_F112823_0_0|CSTM-ALL|CSTM-00|2020|PDM|560.00|99|0.00|AEG 2 (NO REV)
20|FH_F112823_0_0|SrvcGrp|42550|2022|PDM|2155.00|99|0.00|OP SURGERY CPT 66984
20|FH_F112823_0_0|SrvcGrp|85966|2022|PDM|1915.00|99|0.00|EXTRACAPSULAR CATARACT
20|FH_F112844_0_0|SrvcGrp|80317|2022|PDM|115.00|99|0.00|RESPITE CARE
20|FH_F112844_0_0|SrvcGrp|93098|2022|PDM|115.00|99|0.00|HOSPICE CARE
20|FH_F112863_0_0|CSTM-ALL|CSTM-00|2020|PDM|1294.00|99|0.00|AEG 7 (NO REV)
20|FH_F112863_0_0|SrvcGrp|104248|2022|PDM|2002.00|99|0.00|SKIN TISSUE REARRANGEMENT
20|FH_F112863_0_0|SrvcGrp|104252|2022|PDM|1141.00|99|0.00|SKIN TISSUE REARRANGEMENT
20|FH_F112863_0_0|SrvcGrp|104254|2022|PDM|1141.00|99|0.00|SKIN TISSUE REARRANGEMENT
20|FH_F112863_0_0|SrvcGrp|104260|2022|PDM|1141.00|99|0.00|SKIN FULL GRAFT PROCEDURE
20|FH_F112863_0_0|SrvcGrp|104262|2022|PDM|1141.00|99|0.00|COMPOSITE SKIN GRAFT
20|FH_F112863_0_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS
20|FH_F112908_0_0|SrvcGrp|27968|2022|PDM|23.00|99|0.00|SKILLED NURSING LPN
20|FH_F112908_0_0|SrvcGrp|48396|2022|PDM|85.00|99|0.00|OT SERVICES
20|FH_F112908_0_0|SrvcGrp|88620|2022|PDM|87.00|99|0.00|SKILLED NURSING RN
20|FH_F112943_0_0|CSTM-ALL|CSTM-00|2020|PDM|1181.40|99|0.00|AEG 6 (NO REV)
20|FH_F112943_0_0|CSTM-ALL|CSTM-00|2020|PDM|1423.40|99|0.00|AEG 7 (NO REV)
20|FH_F112943_0_0|CSTM-ALL|CSTM-00|2020|PDM|1915.10|99|0.00|AEG 9 (NO REV)
20|FH_F112943_0_0|CSTM-ALL|CSTM-00|2020|PDM|638.00|99|0.00|AEG 2 (NO REV)
20|FH_F112943_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|AEG 10 (NO REV)
20|FH_F112946_0_0|CSTM-ALL|CSTM-00|2020|PDM|640.00|99|0.00|COVENTRY ENHANCED GROUPER 4
20|FH_F112956_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F112956_0_0|SrvcGrp|75497|2022|PDM|363.00|99|0.00|AEG 10
20|FH_F112962_0_0|CSTM-ALL|CSTM-00|2020|PDM|377.00|99|0.00|AEG 1 (NO REV)
20|FH_F112962_0_0|CSTM-ALL|CSTM-00|2020|PDM|377.00|99|0.00|AEG 10 (NO REV)
20|FH_F112962_0_0|CSTM-ALL|CSTM-00|2020|PDM|505.00|99|0.00|AEG 2 (NO REV)
20|FH_F112967_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F112967_0_0|SrvcGrp|24739|2022|PDM|115.00|99|0.00|RESPITE CARE
20|FH_F112967_0_0|SrvcGrp|74546|2022|PDM|489.00|99|0.00|HOSPICE SERVICES
20|FH_F112967_0_0|SrvcGrp|89783|2022|PDM|115.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F112967_0_0|SrvcGrp|94781|2022|PDM|115.00|99|0.00|HOSPICE IN LTCH (HCFA)
20|FH_F112995_0_0|CSTM-ALL|CSTM-00|2020|PDM|759.35|99|0.00|AEG 10 (NO REV)
20|FH_F112995_0_0|CSTM-ALL|CSTM-00|2020|PDM|864.22|99|0.00|AEG 5  (NO REV)
20|FH_F112995_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.60|99|0.00|AEG 6 (NO REV)
20|FH_F113025_0_0|SrvcGrp|104960|2022|PDM|349.00|99|0.00|AEG 1 W/O CPT 65820
20|FH_F113025_0_0|SrvcGrp|104962|2022|PDM|661.00|99|0.00|AEG 4 W/O CPT 67903-67904
20|FH_F113025_0_0|SrvcGrp|75495|2022|PDM|1404.00|99|0.00|AEG 9
20|FH_F113074_0_0|CSTM-ALL|CSTM-00|2020|PDM|686.00|99|0.00|AEG 4 (NO REV)
20|FH_F113074_0_0|SrvcGrp|103261|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBTANCE
20|FH_F113074_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F113074_0_0|SrvcGrp|13187|2022|PCT|1.00|99|0.00|INTRAOCULAR LENSES
20|FH_F113115_0_0|CSTM-ALL|CSTM-00|2020|PDM|1587.00|99|0.00|COVENTRY ENHANCED GROUPER 9
20|FH_F113115_0_0|CSTM-ALL|CSTM-00|2020|PDM|529.00|99|0.00|COVENTRY ENHANCED GROUPER 2
20|FH_F113115_0_0|CSTM-ALL|CSTM-00|2020|PDM|747.00|99|0.00|COVENTRY ENHANCED GROUPER 4
20|FH_F113130_0_0|SrvcGrp|105034|2022|PDM|1200.00|99|0.00|GI PEGFILGRASTIM (HCFA)
20|FH_F113130_0_0|SrvcGrp|92597|2022|PDM|1200.00|99|0.00|GI PEGFILGRASTIM
20|FH_F113139_0_0|CSTM-ALL|CSTM-00|2020|PDM|1150.00|99|0.00|AEG 6 (NO REV)
20|FH_F113139_0_0|CSTM-ALL|CSTM-00|2020|PDM|520.00|99|0.00|AEG 1 (NO REV)
20|FH_F113139_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AEG 2 (NO REV)
20|FH_F113139_0_0|SrvcGrp|11306|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F113143_0_0|SrvcGrp|103391|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F113143_0_0|SrvcGrp|12664|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F113143_0_0|SrvcGrp|72994|2022|PDM|536.00|99|0.00|AEG 3
20|FH_F113143_0_0|SrvcGrp|72996|2022|PDM|662.00|99|0.00|AEG 4
20|FH_F113143_0_0|SrvcGrp|73004|2022|PDM|1103.00|99|0.00|AEG 8
20|FH_F113255_0_0|SrvcGrp|86424|2022|PDM|737.00|99|0.00|REMOVE INT/EXT HEM 1 GROUP
20|FH_F113390_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|AETNA AEG 4 W/O CPT 31254 (NO REV)
20|FH_F113390_0_0|CSTM-ALL|CSTM-00|2020|PDM|3135.00|99|0.00|AEG 9 (NO REV)
20|FH_F113390_0_0|CSTM-ALL|CSTM-00|2020|PDM|880.00|99|0.00|AEG 1 (NO REV)
20|FH_F113390_0_0|SrvcGrp|105242|2022|PDM|1320.00|99|0.00|ESOPHAGOSCP RIG TRNSO BIOPSY
20|FH_F113390_0_0|SrvcGrp|27316|2022|PDM|2200.00|99|0.00|TONSILS & ADENOIDS (42820)
20|FH_F113392_0_0|CSTM-ALL|CSTM-00|2020|PDM|2750.00|99|0.00|AETNA AEG 4 W/O CPTS 19350, 19370-19371
20|FH_F113392_0_0|CSTM-ALL|CSTM-00|2020|PDM|770.00|99|0.00|AEG 2 (NO REV)
20|FH_F113392_0_0|CSTM-ALL|CSTM-00|2020|PDM|911.93|99|0.00|AEG 6 (NO REV)
20|FH_F113392_0_0|SrvcGrp|104249|2022|PDM|1650.00|99|0.00|FULL GRAFT PROCEDURE
20|FH_F113392_0_0|SrvcGrp|105202|2022|PDM|1650.00|99|0.00|MUSCLE FLAP
20|FH_F113392_0_0|SrvcGrp|64517|2022|PDM|2750.00|99|0.00|REDUCE MANMMAPLASTY
20|FH_F113410_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F113410_0_0|CSTM-ALL|CSTM-00|2020|PDM|1681.00|99|0.00|AEG 10 (NO REV)
20|FH_F113410_0_0|SrvcGrp|105248|2022|PDM|3047.00|99|0.00|HYSTEROSCOPY/LAPAROSCOPY
20|FH_F113410_0_0|SrvcGrp|105257|2022|PDM|1786.00|99|0.00|CORRECTION HALLUX VALGUS
20|FH_F113410_0_0|SrvcGrp|105259|2022|PDM|814.00|99|0.00|COLONOSCOPY AND BIOPSY
20|FH_F113410_0_0|SrvcGrp|27344|2022|PDM|2101.00|99|0.00|OP SURGERY (CPT 42821)
20|FH_F113410_0_0|SrvcGrp|33984|2022|PDM|1786.00|99|0.00|HAMMERTOE CORRECTION
20|FH_F113410_0_0|SrvcGrp|36591|2022|PDM|3152.00|99|0.00|CPT 63685
20|FH_F113410_0_0|SrvcGrp|79589|2022|PDM|709.00|99|0.00|UPPER GI
20|FH_F113410_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F113410_0_0|SrvcGrp|81571|2022|PDM|1996.00|99|0.00|NASAL ENDOSCOPY W/ SINUS OSTIA DILATION
20|FH_F113410_0_0|SrvcGrp|96539|2022|PDM|2416.00|99|0.00|REVISION OF ANKLE LIGAMENT
20|FH_F113426_0_0|CSTM-ALL|CSTM-00|2020|PDM|1420.00|99|0.00|AEG 6 (NO REV)
20|FH_F113426_0_0|CSTM-ALL|CSTM-00|2020|PDM|2303.00|99|0.00|AEG 9 (NO REV)
20|FH_F113503_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.64|99|0.00|GENERAL ACUTE CARE
20|FH_F113524_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F113524_0_0|SrvcGrp|105219|2022|PDM|11000.00|99|0.00|CERVICAL SPINAL FUSION
20|FH_F113524_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F113541_0_0|CSTM-ALL|CSTM-00|2020|PDM|1431.00|99|0.00|AEG 5  (NO REV)
20|FH_F113541_0_0|CSTM-ALL|CSTM-00|2020|PDM|1955.00|99|0.00|MASTECTOMY, SUBCUTANEOUS
20|FH_F113541_0_0|CSTM-ALL|CSTM-00|2020|PDM|1984.00|99|0.00|AEG 7 (NO REV)
20|FH_F113541_0_0|CSTM-ALL|CSTM-00|2020|PDM|3295.00|99|0.00|ENLARGE BREAST
20|FH_F113541_0_0|SrvcGrp|104947|2022|PDM|1955.00|99|0.00|EXCISION ADDL BREAST LESION
20|FH_F113541_0_0|SrvcGrp|104951|2022|PDM|2580.00|99|0.00|BREAST RECON-INVERTED NIPPLE
20|FH_F113541_0_0|SrvcGrp|104954|2022|PDM|541.00|99|0.00|EXTENDED RECOVERY/OBSERVATION (5-7 HRS)
20|FH_F113541_0_0|SrvcGrp|104955|2022|PDM|1219.00|99|0.00|EXTENDED RECOVERY/OBSERVATION (8-15 HRS)
20|FH_F113541_0_0|SrvcGrp|86460|2022|PDM|6662.00|99|0.00|REVISE BREAST RECONSTRUCTION
20|FH_F113546_0_0|SrvcGrp|46605|2022|PDM|90.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES
20|FH_F113546_0_0|SrvcGrp|48385|2022|PDM|90.00|99|0.00|SPEECH THERAPY
20|FH_F113546_0_0|SrvcGrp|48394|2022|PDM|50.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F113546_0_0|SrvcGrp|88621|2022|PDM|90.00|99|0.00|SKILLED NURSING LPN
20|FH_F113586_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F113586_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F113586_0_0|SrvcGrp|75481|2022|PDM|984.00|99|0.00|AEG 2
20|FH_F113586_0_0|SrvcGrp|75485|2022|PDM|1379.00|99|0.00|AEG 4
20|FH_F113586_0_0|SrvcGrp|75489|2022|PDM|1224.00|99|0.00|AEG 6
20|FH_F113709_0_0|SrvcGrp|104351|2022|PDM|35.09|99|0.00|STREP A/DNA/AMP PROBE
20|FH_F113709_0_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA
20|FH_F113709_0_0|SrvcGrp|112891|2022|PDM|70.20|99|0.00|RSV DNA/MA AMP PROBE
20|FH_F113709_0_0|SrvcGrp|88246|2022|PDM|95.80|99|0.00|INFLUENZA DNA AMP PROBE
20|FH_F113715_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|OP SVCS
20|FH_F113765_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F113765_0_0|SrvcGrp|42971|2022|PDM|85.00|99|0.00|SKN RN
20|FH_F113765_0_0|SrvcGrp|44042|2022|PDM|60.00|99|0.00|SKILLED NURSING - LPN
20|FH_F113784_0_0|SrvcGrp|46605|2022|PDM|80.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES
20|FH_F113784_0_0|SrvcGrp|88620|2022|PDM|80.00|99|0.00|SKILLED NURSING RN
20|FH_F113792_0_0|SrvcGrp|44042|2022|PDM|70.00|99|0.00|SKILLED NURSING - LPN
20|FH_F113792_0_0|SrvcGrp|45924|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE
20|FH_F113792_0_0|SrvcGrp|48396|2022|PDM|85.00|99|0.00|OT SERVICES
20|FH_F113792_0_0|SrvcGrp|48398|2022|PDM|85.00|99|0.00|PT SERVICES
20|FH_F113792_0_0|SrvcGrp|88621|2022|PDM|70.00|99|0.00|SKILLED NURSING LPN
20|FH_F113794_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F113794_0_0|SrvcGrp|42971|2022|PDM|85.00|99|0.00|SKN RN
20|FH_F113794_0_0|SrvcGrp|88621|2022|PDM|80.00|99|0.00|SKILLED NURSING LPN
20|FH_F113815_0_0|SrvcGrp|72994|2022|PDM|233.00|99|0.00|AEG 3
20|FH_F113866_0_0|SrvcGrp|90477|2022|PDM|100.00|99|0.00|HOSPICE
20|FH_F113866_0_0|SrvcGrp|93098|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F113885_0_0|SrvcGrp|3809|2022|PDM|721.60|99|0.00|HOSPICE CARE
20|FH_F113906_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F113906_0_0|SrvcGrp|72994|2022|PDM|665.00|99|0.00|AEG 3
20|FH_F113906_0_0|SrvcGrp|72998|2022|PDM|665.00|99|0.00|AEG 5
20|FH_F113906_0_0|SrvcGrp|73000|2022|PDM|665.00|99|0.00|AEG 6
20|FH_F113926_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F113926_0_0|SrvcGrp|87077|2022|PDM|100.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F113985_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F114002_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F114002_0_0|SrvcGrp|88620|2022|PDM|80.00|99|0.00|SKILLED NURSING RN
20|FH_F114024_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F114024_0_0|SrvcGrp|75479|2022|PDM|425.00|99|0.00|AEG 1
20|FH_F114024_0_0|SrvcGrp|75489|2022|PDM|851.00|99|0.00|AEG 6
20|FH_F114064_0_0|SrvcGrp|103391|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F114064_0_0|SrvcGrp|72992|2022|PDM|563.00|99|0.00|AEG 2
20|FH_F114064_0_0|SrvcGrp|72994|2022|PDM|1000.00|99|0.00|AEG 3
20|FH_F114064_0_0|SrvcGrp|72998|2022|PDM|906.00|99|0.00|AEG 5
20|FH_F114064_0_0|SrvcGrp|73002|2022|PDM|1257.00|99|0.00|AEG 7
20|FH_F114145_0_0|CSTM-ALL|CSTM-00|2020|PDM|593.00|99|0.00|AEG 3 (NO REV)
20|FH_F114145_0_0|SrvcGrp|114518|2022|PDM|1114.00|99|0.00|INSERTION DRAINAGE DEVICE
20|FH_F114151_0_0|SrvcGrp|24739|2022|PDM|90.00|99|0.00|RESPITE CARE
20|FH_F114151_0_0|SrvcGrp|80317|2022|PDM|90.00|99|0.00|RESPITE CARE
20|FH_F114151_0_0|SrvcGrp|83519|2022|PDM|90.00|99|0.00|HOSPICE CARE (ALL OTHER)
20|FH_F114166_0_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING
20|FH_F114171_0_0|CSTM-ALL|CSTM-00|2020|PDM|527.00|99|0.00|AEG 3 (NO REV)
20|FH_F114267_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F114267_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F114267_0_0|CSTM-ALL|CSTM-00|2020|PDM|542.00|99|0.00|AEG 2 (NO REV)
20|FH_F114267_0_0|CSTM-ALL|CSTM-00|2020|PDM|823.00|99|0.00|AEG 5  (NO REV)
20|FH_F114267_0_0|SrvcGrp|103671|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F114267_0_0|SrvcGrp|105550|2022|PDM|1800.00|99|0.00|AETNA SPINAL SURGERY
20|FH_F114310_0_0|CSTM-ALL|CSTM-00|2020|PDM|1585.00|99|0.00|AEG 7 (NO REV)
20|FH_F114310_0_0|CSTM-ALL|CSTM-00|2020|PDM|710.00|99|0.00|AEG 2 (NO REV)
20|FH_F114310_0_0|CSTM-ALL|CSTM-00|2020|PDM|795.00|99|0.00|AEG 10 (NO REV)
20|FH_F114310_0_0|CSTM-ALL|CSTM-00|2020|PDM|807.00|99|0.00|AEG 3 (NO REV)
20|FH_F114310_0_0|SrvcGrp|105489|2022|PDM|2050.00|99|0.00|SHOULDER ARTHOSCOPY PROCEDURES
20|FH_F114310_0_0|SrvcGrp|105490|2022|PDM|2050.00|99|0.00|KNEE ARTHROSCOPY PROCEDURES
20|FH_F114310_0_0|SrvcGrp|14614|2022|PDM|3500.00|99|0.00|LITHOTRIPSY
20|FH_F114310_0_0|SrvcGrp|34606|2022|PDM|3200.00|99|0.00|CPT 29827
20|FH_F114326_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F114326_0_0|SrvcGrp|87077|2022|PDM|125.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F114416_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F114416_0_0|SrvcGrp|65720|2022|PDM|120.00|99|0.00|RESPITE CARE
20|FH_F114416_0_0|SrvcGrp|93098|2022|PDM|120.00|99|0.00|HOSPICE CARE
20|FH_F114503_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F114511_0_0|SrvcGrp|46903|2022|PDM|624.00|99|0.00|RESIDENTIAL TREATMENT
20|FH_F114519_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F114519_0_0|SrvcGrp|12491|2022|PCT|0.50|99|0.00|PACEMAKER
20|FH_F114519_0_0|SrvcGrp|72990|2022|PDM|457.00|99|0.00|AEG 1
20|FH_F114519_0_0|SrvcGrp|72996|2022|PDM|1299.00|99|0.00|AEG 4
20|FH_F114519_0_0|SrvcGrp|73000|2022|PDM|1398.00|99|0.00|AEG 6
20|FH_F114519_0_0|SrvcGrp|73002|2022|PDM|1527.00|99|0.00|AEG 7
20|FH_F114572_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F114572_0_0|CSTM-ALL|CSTM-00|2020|PDM|1442.00|99|0.00|AEG 7 (NO REV)
20|FH_F114572_0_0|CSTM-ALL|CSTM-00|2020|PDM|1942.00|99|0.00|AEG 9 (NO REV)
20|FH_F114572_0_0|CSTM-ALL|CSTM-00|2020|PDM|647.00|99|0.00|AEG 2 (NO REV) W/O NERVOUS SYSTEM
20|FH_F114572_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 10 (NO REV)
20|FH_F114606_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F114606_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F114606_0_0|SrvcGrp|65720|2022|PDM|131.76|99|0.00|RESPITE CARE
20|FH_F114683_0_0|SrvcGrp|104015|2022|PDM|4500.00|99|0.00|INSERT STABILIZATION DEVICE
20|FH_F114683_0_0|SrvcGrp|105731|2022|PDM|5000.00|99|0.00|LOW BACK DISK SURGERY
20|FH_F114683_0_0|SrvcGrp|11669|2022|PDM|2100.00|99|0.00|OP SURG
20|FH_F114683_0_0|SrvcGrp|79420|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F114683_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F114683_0_0|SrvcGrp|88065|2022|PDM|6000.00|99|0.00|TOTAL DISC ARTHROPLASTY
20|FH_F114683_0_0|SrvcGrp|88760|2022|PDM|7800.00|99|0.00|CERVICAL ARTHRODESIS
20|FH_F114683_0_0|SrvcGrp|89981|2022|PDM|1645.00|99|0.00|SHOULDER ARTHROSCOPY / SURGERY
20|FH_F114853_0_0|CSTM-ALL|CSTM-00|2020|PDM|1613.00|99|0.00|AEG 2 (NO REV)
20|FH_F114853_0_0|CSTM-ALL|CSTM-00|2020|PDM|2788.00|99|0.00|AEG 8 (NO REV)
20|FH_F114853_0_0|SrvcGrp|11306|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F114853_0_0|SrvcGrp|11673|2022|PDM|4812.00|99|0.00|CPT 29888
20|FH_F114853_0_0|SrvcGrp|35669|2022|PDM|4812.00|99|0.00|CPT 63650
20|FH_F114853_0_0|SrvcGrp|77021|2022|PDM|7215.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY
20|FH_F114853_0_0|SrvcGrp|88157|2022|PDM|7215.00|99|0.00|TOTAL HIP ARTHROPLASTY
20|FH_F114853_0_0|SrvcGrp|88159|2022|PDM|7215.00|99|0.00|LOW BACK DISK SURGERY
20|FH_F114853_0_0|SrvcGrp|89840|2022|PDM|7699.00|99|0.00|THORAX SPINE FUSION
20|FH_F114853_0_0|SrvcGrp|95559|2022|PDM|7215.00|99|0.00|HIP JOINT
20|FH_F114853_0_0|SrvcGrp|98496|2022|PDM|7699.00|99|0.00|ARTHRODESIS POSTERIOR ATLAS
20|FH_F114853_0_0|SrvcGrp|98497|2022|PDM|7699.00|99|0.00|ARTHRODESIS POSTERIOR TECH
20|FH_F114853_0_0|SrvcGrp|98498|2022|PDM|7215.00|99|0.00|TRANSPEDICULAR 1 SEG THORACIC
20|FH_F114853_0_0|SrvcGrp|98500|2022|PDM|7215.00|99|0.00|INCISE SPINAL COLUMN NERVES
20|FH_F114927_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F114931_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F114931_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F114931_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 4 (NO REV)
20|FH_F114931_0_0|CSTM-ALL|CSTM-00|2020|PDM|447.00|99|0.00|AEG 1 (NO REV)
20|FH_F114931_0_0|SrvcGrp|105755|2022|PDM|3200.00|99|0.00|RPR EPIGASTRIC HERN BLOCKED
20|FH_F114931_0_0|SrvcGrp|105759|2022|PDM|1850.00|99|0.00|EXCISE ANAL EXT TAG/PAPILLA
20|FH_F114931_0_0|SrvcGrp|35921|2022|PDM|5200.00|99|0.00|BARIATRIC SURGERY
20|FH_F114931_0_0|SrvcGrp|63472|2022|PDM|3200.00|99|0.00|CPT 64581
20|FH_F114931_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F114931_0_0|SrvcGrp|75885|2022|PDM|3200.00|99|0.00|AETNA CPT 49560
20|FH_F114931_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F114931_0_0|SrvcGrp|86426|2022|PDM|1850.00|99|0.00|REMOVE INT/EXT HEM GROUP 2
20|FH_F114931_0_0|SrvcGrp|90779|2022|PDM|3200.00|99|0.00|HERNIA PROCEDURES
20|FH_F114931_0_0|SrvcGrp|90799|2022|PDM|3200.00|99|0.00|REPAIR VENTRAL HERNIA INI BLOCK
20|FH_F114931_0_0|SrvcGrp|91568|2022|PDM|1850.00|99|0.00|REMOVE EXT HEM GROUPS = 2
20|FH_F114931_0_0|SrvcGrp|91569|2022|PDM|3200.00|99|0.00|REMOVE HEMMORRHOIDS AND FISSURE
20|FH_F114941_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F114952_0_0|SrvcGrp|11043|2022|PDM|1575.00|99|0.00|CARPAL TUNNEL RELEASE
20|FH_F114952_0_0|SrvcGrp|16693|2022|PDM|2625.00|99|0.00|KNEE SCOPE, MENISCECTOMY
20|FH_F114952_0_0|SrvcGrp|58755|2022|PDM|4200.00|99|0.00|INJECTION PROC FOR JOINT
20|FH_F114952_0_0|SrvcGrp|75485|2022|PDM|1575.00|99|0.00|AEG 4
20|FH_F114952_0_0|SrvcGrp|75495|2022|PDM|1890.00|99|0.00|AEG 9
20|FH_F114952_0_0|SrvcGrp|96355|2022|PDM|4725.00|99|0.00|SPINE FIXATION
20|FH_F114968_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F114968_0_0|SrvcGrp|75545|2022|PDM|615.96|99|0.00|SUB-ACUTE - LEVEL I AND II
20|FH_F114974_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 6 (NO REV)
20|FH_F114974_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|AEG 10 (NO REV)
20|FH_F114974_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 1 (NO REV)
20|FH_F114974_0_0|SrvcGrp|83824|2022|PCT|0.00|99|0.00|AETNA CADIAC CATH INCIDENTAL CODES
20|FH_F115010_20105_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F115010_20105_0|SrvcGrp|73485|2022|PDM|1134.00|99|0.00|AETNA REHAB
20|FH_F115045_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F115127_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F115127_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F115127_0_0|SrvcGrp|103550|2022|PDM|580.00|99|0.00|HEMODIALYSIS SVCS
20|FH_F115150_0_0|SrvcGrp|103927|2022|PDM|135.87|99|0.00|SLEEP STUDY UNATTENDED(HCFA)
20|FH_F115185_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F115204_0_0|SrvcGrp|75545|2022|PDM|615.96|99|0.00|SUB-ACUTE - LEVEL I AND II
20|FH_F115206_80923_0|SrvcGrp|106048|2022|PDM|1034.00|99|0.00|AETNA IP REHAB ALCOHOL DRUG
20|FH_F115206_80923_0|SrvcGrp|16069|2022|PDM|859.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT
20|FH_F115206_80923_0|SrvcGrp|3178|2022|PDM|1034.00|99|0.00|ACUTE PSYCH
20|FH_F115206_80923_0|SrvcGrp|72602|2022|PDM|859.00|99|0.00|ECT
20|FH_F115206_80923_0|SrvcGrp|73842|2022|PDM|258.00|99|0.00|AETNA INTENSIVE OUTPATIENT
20|FH_F115206_80923_0|SrvcGrp|86723|2022|PDM|463.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)
20|FH_F115206_80923_0|SrvcGrp|87441|2022|PDM|859.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY (HCFA)
20|FH_F115206_80923_0|SrvcGrp|89337|2022|PDM|1034.00|99|0.00|DETOXIFICATION
20|FH_F115208_0_0|CSTM-ALL|CSTM-00|2020|PDM|1273.00|99|0.00|AEG 6 (NO REV)
20|FH_F115208_0_0|CSTM-ALL|CSTM-00|2020|PDM|1485.00|99|0.00|AEG 7 (NO REV)
20|FH_F115208_0_0|SrvcGrp|104042|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATHERTERIZATION
20|FH_F115208_0_0|SrvcGrp|106169|2022|PDM|1061.00|99|0.00|FRACTURE NASAL INFERIOR
20|FH_F115208_0_0|SrvcGrp|106171|2022|PDM|2016.00|99|0.00|ENDOSCOPY MAXILLARY SINUS
20|FH_F115208_0_0|SrvcGrp|106181|2022|PDM|2652.00|99|0.00|PARTIAL REMOVAL OF THYROID
20|FH_F115208_0_0|SrvcGrp|106182|2022|PDM|2652.00|99|0.00|PARTIAL REMOVAL OF THYROID
20|FH_F115208_0_0|SrvcGrp|106183|2022|PDM|2546.00|99|0.00|REPAIR EARDRUM STRUCTURES
20|FH_F115208_0_0|SrvcGrp|22915|2022|PDM|2228.00|99|0.00|CPT CODE 42820
20|FH_F115208_0_0|SrvcGrp|22948|2022|PDM|2228.00|99|0.00|CPT CODE 42830
20|FH_F115208_0_0|SrvcGrp|64725|2022|PDM|716.00|99|0.00|CPT 45378
20|FH_F115208_0_0|SrvcGrp|77490|2022|PDM|1485.00|99|0.00|AETNA SEPTOPLASTY
20|FH_F115208_0_0|SrvcGrp|79794|2022|PDM|1485.00|99|0.00|EYE/OCULAR ADNEXA SURGERY
20|FH_F115208_0_0|SrvcGrp|97468|2022|PDM|2652.00|99|0.00|PARTIAL EXCISION THYROID
20|FH_F115208_0_0|SrvcGrp|98363|2022|PDM|2016.00|99|0.00|AETNA NASAL ENDOSCOPY SURG
20|FH_F115298_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F115347_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F115347_0_0|CSTM-ALL|CSTM-00|2020|PDM|1472.00|99|0.00|AEG 9 (NO REV)
20|FH_F115347_0_0|SrvcGrp|106101|2022|PDM|1125.00|99|0.00|ENDOSCOPY
20|FH_F115347_0_0|SrvcGrp|38364|2022|PDM|3000.00|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F115347_0_0|SrvcGrp|82648|2022|PDM|1550.00|99|0.00|ERCP LITHOTRIPSY
20|FH_F115430_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F115430_0_0|CSTM-ALL|CSTM-00|2020|PDM|739.00|99|0.00|AEG 3 (NO REV)
20|FH_F115443_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F115443_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F115464_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F115464_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F115464_0_0|CSTM-ALL|CSTM-00|2020|PDM|436.00|99|0.00|AEG 1 (NO REV)
20|FH_F115464_0_0|CSTM-ALL|CSTM-00|2020|PDM|940.00|99|0.00|AEG 5  (NO REV)
20|FH_F115464_0_0|SrvcGrp|98448|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F115490_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F115490_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F115491_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F115495_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F115543_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F115543_0_0|CSTM-ALL|CSTM-00|2020|PDM|647.00|99|0.00|AEG 2 (NO REV)
20|FH_F115543_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AEG 1 (NO REV)
20|FH_F115543_0_0|CSTM-ALL|CSTM-00|2020|PDM|739.00|99|0.00|AEG 3 (NO REV)
20|FH_F115543_0_0|SrvcGrp|103966|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F115616_0_0|CSTM-ALL|CSTM-00|2020|PDM|1665.00|99|0.00|AEG 2 (NO REV)
20|FH_F115616_0_0|CSTM-ALL|CSTM-00|2020|PDM|1977.00|99|0.00|AEG 3 (NO REV)
20|FH_F115616_0_0|CSTM-ALL|CSTM-00|2020|PDM|2601.00|99|0.00|AEG 5  (NO REV)
20|FH_F115616_0_0|CSTM-ALL|CSTM-00|2020|PDM|2861.00|99|0.00|AEG 9 (NO REV)
20|FH_F115616_0_0|SrvcGrp|27343|2022|PDM|3121.00|99|0.00|OP SURGERY (CPT 25607 - 25609)
20|FH_F115616_0_0|SrvcGrp|35672|2022|PDM|3121.00|99|0.00|CPT 23412
20|FH_F115616_0_0|SrvcGrp|89404|2022|PDM|6138.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F115616_0_0|SrvcGrp|98003|2022|PDM|3121.00|99|0.00|BIMALLEOLAR ANKLE FRACTURE
20|FH_F115625_63110_0|SrvcGrp|80258|2022|PCT|0.00|99|0.00|AETNA SKILLED CARE
20|FH_F115625_63110_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE
20|FH_F115674_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F115674_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F115674_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|AEG 5  (NO REV)
20|FH_F115674_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|AEG 6 (NO REV)
20|FH_F115674_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F115674_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F115705_0_0|SrvcGrp|57968|2022|PDM|30.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F115808_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F115823_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F115823_0_0|CSTM-ALL|CSTM-00|2020|PDM|1339.00|99|0.00|AEG 9 (NO REV)
20|FH_F115823_0_0|CSTM-ALL|CSTM-00|2020|PDM|446.00|99|0.00|AEG 2 (NO REV)
20|FH_F115823_0_0|CSTM-ALL|CSTM-00|2020|PDM|973.00|99|0.00|AEG 8 (NO REV)
20|FH_F115868_0_0|SrvcGrp|89822|2022|PDM|18.00|99|0.00|HOSPICE ROUTINE HOME CARE
20|FH_F115875_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F115875_0_0|CSTM-ALL|CSTM-00|2020|PDM|3348.00|99|0.00|AEG 10 (NO REV)
20|FH_F115875_0_0|CSTM-ALL|CSTM-00|2020|PDM|3348.00|99|0.00|AEG 4 (NO REV)
20|FH_F115884_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F115884_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F115884_0_0|SrvcGrp|90478|2022|PDM|111.00|99|0.00|HOSPICE
20|FH_F115884_0_0|SrvcGrp|90707|2022|PDM|111.00|99|0.00|AETNA HOSPICE CARE
20|FH_F115884_0_0|SrvcGrp|93098|2022|PDM|111.00|99|0.00|HOSPICE CARE
20|FH_F115889_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F115889_0_0|SrvcGrp|72992|2022|PDM|655.00|99|0.00|AEG 2
20|FH_F115889_0_0|SrvcGrp|72994|2022|PDM|819.00|99|0.00|AEG 3
20|FH_F115889_0_0|SrvcGrp|73486|2022|PCT|0.00|99|0.00|AETNA CONTRAST AGENT
20|FH_F115895_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F115895_0_0|CSTM-ALL|CSTM-00|2020|PDM|2295.00|99|0.00|AEG 2 (NO REV)
20|FH_F115895_0_0|SrvcGrp|41334|2022|PDM|10079.00|99|0.00|TOTAL KNEE
20|FH_F115895_0_0|SrvcGrp|67072|2022|PDM|4774.00|99|0.00|CPT 22845
20|FH_F115895_0_0|SrvcGrp|74670|2022|PCT|1.00|99|0.00|AETNA OP INTRAOCULAR LENS
20|FH_F115905_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F115905_0_0|CSTM-ALL|CSTM-00|2020|PDM|513.00|99|0.00|ASPG 1 HEARTLAND HEALTHCARE
20|FH_F115949_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F115954_0_0|CSTM-ALL|CSTM-00|2020|PDM|540.00|99|0.00|AEG 2 (NO REV)
20|FH_F115954_0_0|CSTM-ALL|CSTM-00|2020|PDM|618.00|99|0.00|AEG 10 (NO REV)
20|FH_F115954_0_0|CSTM-ALL|CSTM-00|2020|PDM|618.00|99|0.00|AEG 3 (NO REV)
20|FH_F115954_0_0|CSTM-ALL|CSTM-00|2020|PDM|618.00|99|0.00|AEG 4 (NO REV)
20|FH_F115954_0_0|CSTM-ALL|CSTM-00|2020|PDM|618.00|99|0.00|AEG 7 (NO REV)
20|FH_F115954_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F115971_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F115971_0_0|CSTM-ALL|CSTM-00|2020|PDM|2060.00|99|0.00|DEVICE INSERTION
20|FH_F115971_0_0|SrvcGrp|72992|2022|PDM|497.00|99|0.00|AEG 2
20|FH_F115974_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 1 (NO REV)
20|FH_F115974_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 10 (NO REV)
20|FH_F115974_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|AEG 6 (NO REV)
20|FH_F115982_0_0|SrvcGrp|11669|2022|PDM|2300.00|99|0.00|OP SURG
20|FH_F115982_0_0|SrvcGrp|72990|2022|PDM|420.00|99|0.00|AEG 1
20|FH_F115982_0_0|SrvcGrp|72992|2022|PDM|563.00|99|0.00|AEG 2
20|FH_F115982_0_0|SrvcGrp|73002|2022|PDM|1282.00|99|0.00|AEG 7
20|FH_F115982_0_0|SrvcGrp|73004|2022|PDM|1165.00|99|0.00|AEG 8
20|FH_F115982_0_0|SrvcGrp|80617|2022|PDM|5500.00|99|0.00|ARTHOPLASTY
20|FH_F115982_0_0|SrvcGrp|92366|2022|PDM|1200.00|99|0.00|REPAIR ACHILLES TENDON
20|FH_F115982_0_0|SrvcGrp|96799|2022|PDM|550.00|99|0.00|DESTROY C/TH FACET JNT ADDL
20|FH_F115982_0_0|SrvcGrp|96819|2022|PDM|550.00|99|0.00|DESTROY L/S FACET JNT ADDL
20|FH_F115985_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F115985_0_0|SrvcGrp|73601|2022|PDM|1585.00|99|0.00|AETNA INTERMEDIATE ICU/CCU
20|FH_F115985_0_0|SrvcGrp|78403|2022|PDM|0.10|99|0.00|AETNA MED RECORD
20|FH_F115990_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F115990_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F115990_0_0|SrvcGrp|72990|2022|PDM|550.00|99|0.00|AEG 1
20|FH_F115990_0_0|SrvcGrp|72998|2022|PDM|1235.00|99|0.00|AEG 5
20|FH_F115990_0_0|SrvcGrp|73006|2022|PDM|1750.00|99|0.00|AEG 9
20|FH_F116005_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|AEG 7 (NO REV)
20|FH_F116019_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F116019_0_0|SrvcGrp|82981|2022|PDM|100.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F116043_0_0|SrvcGrp|33722|2022|PDM|23.00|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F116097_0_0|SrvcGrp|57968|2022|PDM|31.35|99|0.00|CONTINUOUS HOMECARE
20|FH_F116100_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F116100_0_0|SrvcGrp|26001|2022|PDM|133.35|99|0.00|HOSPICE RESPITE SVCS
20|FH_F116100_0_0|SrvcGrp|57968|2022|PDM|31.35|99|0.00|CONTINUOUS HOMECARE
20|FH_F116108_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F116108_0_0|SrvcGrp|26001|2022|PDM|133.35|99|0.00|HOSPICE RESPITE SVCS
20|FH_F116108_0_0|SrvcGrp|57968|2022|PDM|31.35|99|0.00|CONTINUOUS HOMECARE
20|FH_F116108_0_0|SrvcGrp|76531|2022|PDM|148.79|99|0.00|HOSPICE IN HOME
20|FH_F116126_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F116126_0_0|SrvcGrp|3809|2022|PDM|573.47|99|0.00|HOSPICE CARE
20|FH_F116126_0_0|SrvcGrp|57968|2022|PDM|31.35|99|0.00|CONTINUOUS HOMECARE
20|FH_F116143_0_0|SrvcGrp|76579|2022|PCT|1.00|99|0.00|IMPLANTS W/ HCPC
20|FH_F116145_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F116145_0_0|SrvcGrp|57968|2022|PDM|31.35|99|0.00|CONTINUOUS HOMECARE
20|FH_F116159_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F116159_0_0|CSTM-ALL|CSTM-00|2020|PDM|1030.00|99|0.00|AEG 8 (NO REV)
20|FH_F116159_0_0|CSTM-ALL|CSTM-00|2020|PDM|478.00|99|0.00|AEG 2 (NO REV)
20|FH_F116159_0_0|CSTM-ALL|CSTM-00|2020|PDM|839.00|99|0.00|AEG 5  (NO REV)
20|FH_F116159_0_0|SrvcGrp|115762|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F116207_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.49|99|0.00|OP SVCS
20|FH_F116245_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F116245_0_0|SrvcGrp|3809|2022|PDM|573.47|99|0.00|HOSPICE CARE
20|FH_F116245_0_0|SrvcGrp|57968|2022|PDM|31.35|99|0.00|CONTINUOUS HOMECARE
20|FH_F116275_0_0|SrvcGrp|105356|2022|PCT|0.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD - INCL CODES
20|FH_F116323_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F116323_0_0|CSTM-ALL|CSTM-00|2020|PDM|2141.00|99|0.00|AEG 4 (NO REV)
20|FH_F116323_0_0|CSTM-ALL|CSTM-00|2020|PDM|3650.00|99|0.00|AEG 10 (NO REV)
20|FH_F116323_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F116323_0_0|SrvcGrp|106667|2022|PDM|13383.00|99|0.00|AETNA LOW BACK DISK SURGERY
20|FH_F116323_0_0|SrvcGrp|106668|2022|PDM|26766.00|99|0.00|AETNA LUMBAR SPINE FUSION
20|FH_F116323_0_0|SrvcGrp|11663|2022|PCT|0.00|99|0.00|IMPLANTS
20|FH_F116323_0_0|SrvcGrp|27261|2022|PDM|28954.00|99|0.00|CPT 27446
20|FH_F116323_0_0|SrvcGrp|35669|2022|PDM|13383.00|99|0.00|CPT 63650
20|FH_F116323_0_0|SrvcGrp|41334|2022|PDM|30112.00|99|0.00|TOTAL KNEE
20|FH_F116323_0_0|SrvcGrp|97462|2022|PDM|24747.00|99|0.00|ARTHRODESIS SACROILIAC JOINT
20|FH_F116324_0_0|SrvcGrp|75481|2022|PDM|550.00|99|0.00|AEG 2
20|FH_F116324_0_0|SrvcGrp|75483|2022|PDM|550.00|99|0.00|AEG 3
20|FH_F116324_0_0|SrvcGrp|75485|2022|PDM|550.00|99|0.00|AEG 4
20|FH_F116324_0_0|SrvcGrp|75495|2022|PDM|550.00|99|0.00|AEG 9
20|FH_F116324_0_0|SrvcGrp|75497|2022|PDM|550.00|99|0.00|AEG 10
20|FH_F116332_0_0|CSTM-ALL|CSTM-00|2020|PDM|2173.00|99|0.00|AEG 3 (NO REV)
20|FH_F116332_0_0|CSTM-ALL|CSTM-00|2020|PDM|2763.00|99|0.00|AEG 4 (NO REV)
20|FH_F116332_0_0|CSTM-ALL|CSTM-00|2020|PDM|3427.00|99|0.00|AEG 6 (NO REV)
20|FH_F116332_0_0|CSTM-ALL|CSTM-00|2020|PDM|3978.00|99|0.00|AEG 8 (NO REV)
20|FH_F116332_0_0|CSTM-ALL|CSTM-00|2020|PDM|4058.00|99|0.00|AEG 7 (NO REV)
20|FH_F116332_0_0|CSTM-ALL|CSTM-00|2020|PDM|5991.00|99|0.00|AEG 9 (NO REV)
20|FH_F116332_0_0|SrvcGrp|111810|2022|PDM|16737.00|99|0.00|REVISION OF KNEE JOINT
20|FH_F116332_0_0|SrvcGrp|115364|2022|PDM|8144.00|99|0.00|NPS SURG DILAT EUST TUBE UNI
20|FH_F116332_0_0|SrvcGrp|11673|2022|PDM|8054.00|99|0.00|CPT 29888
20|FH_F116332_0_0|SrvcGrp|12491|2022|PCT|0.80|99|0.00|PACEMAKER
20|FH_F116332_0_0|SrvcGrp|25518|2022|PDM|4248.00|99|0.00|LAPAROSCOPY SURGICAL CHOLECYSTECTOMY
20|FH_F116332_0_0|SrvcGrp|27261|2022|PDM|16079.00|99|0.00|CPT 27446
20|FH_F116332_0_0|SrvcGrp|80617|2022|PDM|16730.00|99|0.00|ARTHOPLASTY
20|FH_F116332_0_0|SrvcGrp|89404|2022|PDM|17274.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F116346_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F116346_0_0|SrvcGrp|103550|2022|PDM|435.00|99|0.00|HEMODIALYSIS SVCS
20|FH_F116346_0_0|SrvcGrp|103551|2022|PDM|186.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS
20|FH_F116370_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F116370_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F116370_0_0|SrvcGrp|103552|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER
20|FH_F116373_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F116390_0_0|CSTM-ALL|CSTM-00|2020|PCT|71.00|99|0.00|OP SVCS
20|FH_F116428_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F116428_0_0|SrvcGrp|92501|2022|PDM|133.35|99|0.00|HOSPICE IP RESPITE CARE
20|FH_F116430_0_0|CSTM-ALL|CSTM-00|2020|PDM|1747.00|99|0.00|AEG 9 (NO REV)
20|FH_F116430_0_0|CSTM-ALL|CSTM-00|2020|PDM|843.00|99|0.00|AEG 10 (NO REV)
20|FH_F116430_0_0|SrvcGrp|106704|2022|PDM|2440.00|99|0.00|CYSTOURETHROSCOPY
20|FH_F116430_0_0|SrvcGrp|106705|2022|PDM|1353.00|99|0.00|ENT SURGERY
20|FH_F116430_0_0|SrvcGrp|106713|2022|PDM|7957.00|99|0.00|NECK & SPINE FUSION
20|FH_F116430_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F116430_0_0|SrvcGrp|36591|2022|PDM|4244.00|99|0.00|CPT 63685
20|FH_F116430_0_0|SrvcGrp|37317|2022|PDM|3713.00|99|0.00|LITHOTRIPSY
20|FH_F116430_0_0|SrvcGrp|88824|2022|PDM|2864.00|99|0.00|CPT 69631
20|FH_F116430_0_0|SrvcGrp|89989|2022|PDM|2652.00|99|0.00|FUSION OF BIG TOE JOINT
20|FH_F116437_0_0|CSTM-ALL|CSTM-00|2020|PDM|1304.60|99|0.00|AEG 6 (NO REV)
20|FH_F116437_0_0|CSTM-ALL|CSTM-00|2020|PDM|1535.60|99|0.00|AEG 8 (NO REV)
20|FH_F116437_0_0|CSTM-ALL|CSTM-00|2020|PDM|1870.00|99|0.00|AEG 7 W/O OCULAR SERVICES (NO REV)
20|FH_F116437_0_0|CSTM-ALL|CSTM-00|2020|PDM|2116.40|99|0.00|AEG 9 (NO REV)
20|FH_F116437_0_0|CSTM-ALL|CSTM-00|2020|PDM|705.10|99|0.00|AEG 2 (NO REV)
20|FH_F116437_0_0|CSTM-ALL|CSTM-00|2020|PDM|806.30|99|0.00|AEG 3 W/O SCLERAL REINFORCEMENT (NO REV)
20|FH_F116437_0_0|SrvcGrp|38909|2022|PDM|1757.00|99|0.00|CPT 67036 - VITRECTOMY, MECHANICAL
20|FH_F116437_0_0|SrvcGrp|78045|2022|PCT|1.10|99|0.00|AETNA AMNIOTIC MEMBRANE
20|FH_F116437_0_0|SrvcGrp|78046|2022|PCT|1.10|99|0.00|AETNA AQUEOUS SHUNT
20|FH_F116437_0_0|SrvcGrp|88149|2022|PDM|1757.00|99|0.00|RELEASE OF EYE FLUID
20|FH_F116437_0_0|SrvcGrp|88150|2022|PDM|1757.00|99|0.00|IMPLANT EYE DRUG SYSTEM
20|FH_F116440_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F116440_0_0|SrvcGrp|73606|2022|PDM|500.00|99|0.00|AETNA SKILLED NURSING CARE
20|FH_F116440_0_0|SrvcGrp|87536|2022|PDM|200.00|99|0.00|MED REHAB DAY PROGRAM (HALF)
20|FH_F116443_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F116443_0_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|AEG 10 (NO REV)
20|FH_F116443_0_0|CSTM-ALL|CSTM-00|2020|PDM|2800.00|99|0.00|AEG 8 (NO REV)
20|FH_F116443_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F116473_0_0|CSTM-ALL|CSTM-00|2020|PDM|1450.00|99|0.00|AEG 7 (NO REV)
20|FH_F116473_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|AEG 3 (NO REV)
20|FH_F116473_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|AEG 4 (NO REV)
20|FH_F116473_0_0|SrvcGrp|106717|2022|PDM|2000.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F116473_0_0|SrvcGrp|11673|2022|PDM|2200.00|99|0.00|CPT 29888
20|FH_F116485_17033_0|SrvcGrp|110057|2022|PDM|30.55|99|0.00|BEHAVIOR ID ASSESSMENT 15 MINS
20|FH_F116485_17033_0|SrvcGrp|110060|2022|PDM|18.57|99|0.00|GROUP BH TREATMENT 15 MINS
20|FH_F116485_17033_0|SrvcGrp|110063|2022|PDM|31.83|99|0.00|MULTIPLE FAMILY ADAPTIVE BH TREATMENT 15 MINS
20|FH_F116485_17033_0|SrvcGrp|110064|2022|PDM|31.83|99|0.00|GROUP BH TREATMENT 15 MINS
20|FH_F116485_17033_0|SrvcGrp|114752|2022|PDM|369.77|99|0.00|EDUCATIONALLY BEHAVIORAL SUPPORTS LEVEL 1
20|FH_F116492_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F116492_0_0|CSTM-ALL|CSTM-00|2020|PDM|1498.00|99|0.00|AEG 7 (NO REV)
20|FH_F116492_0_0|CSTM-ALL|CSTM-00|2020|PDM|501.00|99|0.00|AEG 1 (NO REV)
20|FH_F116492_0_0|CSTM-ALL|CSTM-00|2020|PDM|672.00|99|0.00|AEG 2 (NO REV)
20|FH_F116506_0_0|SrvcGrp|103671|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F116506_0_0|SrvcGrp|75489|2022|PDM|925.00|99|0.00|AEG 6
20|FH_F116506_0_0|SrvcGrp|75491|2022|PDM|1020.00|99|0.00|AEG 7
20|FH_F116549_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F116563_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F116563_0_0|CSTM-ALL|CSTM-00|2020|PDM|1242.45|99|0.00|AEG 2 (NO REV)
20|FH_F116563_0_0|CSTM-ALL|CSTM-00|2020|PDM|929.39|99|0.00|AEG 1 (NO REV)
20|FH_F116572_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|GENERAL ACUTE CARE
20|FH_F116575_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 4 (NO REV)
20|FH_F116575_0_0|SrvcGrp|105235|2022|PDM|2500.00|99|0.00|PARTIAL REMOVAL OF THYROID
20|FH_F116575_0_0|SrvcGrp|27344|2022|PDM|1600.00|99|0.00|OP SURGERY (CPT 42821)
20|FH_F116575_0_0|SrvcGrp|77582|2022|PDM|1800.00|99|0.00|CPT 31255
20|FH_F116575_0_0|SrvcGrp|78098|2022|PDM|1600.00|99|0.00|AETNA REMOVAL OF TONSILS
20|FH_F116575_0_0|SrvcGrp|88824|2022|PDM|2500.00|99|0.00|CPT 69631
20|FH_F116575_0_0|SrvcGrp|89853|2022|PDM|1250.00|99|0.00|NASAL/SINUS ENDOSCOPY-SURG
20|FH_F116575_0_0|SrvcGrp|90822|2022|PDM|1800.00|99|0.00|NASAL/SINUS ENDOSCOPY SURGERY
20|FH_F116581_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F116581_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F116583_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F116583_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F116583_0_0|SrvcGrp|103900|2022|PDM|150.00|99|0.00|HOSPICE/HOME HLTH IN ASST LVG
20|FH_F116583_0_0|SrvcGrp|104327|2022|PDM|150.00|99|0.00|HOSPICE HOME CARE
20|FH_F116583_0_0|SrvcGrp|104842|2022|PDM|650.00|99|0.00|HOSPICE CARE PROVIDED IP HOSPICE FAC (HCFA)
20|FH_F116583_0_0|SrvcGrp|106929|2022|PDM|150.00|99|0.00|HOSPICE IN LT NON-SNF (HCFA)
20|FH_F116583_0_0|SrvcGrp|106933|2022|PDM|650.00|99|0.00|HOSPICE IN LTCH
20|FH_F116583_0_0|SrvcGrp|95661|2022|PDM|150.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F116600_0_0|CSTM-ALL|CSTM-00|2020|PCT|69.00|99|0.00|GENERAL ACUTE CARE
20|FH_F116642_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE
20|FH_F116642_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|HSS ASC
20|FH_F116647_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F116647_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F116657_0_0|SrvcGrp|472|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F116664_0_0|SrvcGrp|103550|2022|PDM|1265.00|99|0.00|HEMODIALYSIS SVCS
20|FH_F116727_0_0|CSTM-ALL|CSTM-00|2020|PDM|1197.00|99|0.00|AEG 6 (NO REV)
20|FH_F116727_0_0|CSTM-ALL|CSTM-00|2020|PDM|1410.00|99|0.00|AEG 8 (NO REV)
20|FH_F116727_0_0|CSTM-ALL|CSTM-00|2020|PDM|1942.00|99|0.00|AEG 9 (NO REV)
20|FH_F116727_0_0|CSTM-ALL|CSTM-00|2020|PDM|647.00|99|0.00|AEG 2 (NO REV)
20|FH_F116727_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 4 (NO REV)
20|FH_F116727_0_0|SrvcGrp|103329|2022|PDM|2500.00|99|0.00|INSJ STABLJ DEV W/ DCMPRN
20|FH_F116731_0_0|SrvcGrp|63297|2022|PDM|100.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F116731_0_0|SrvcGrp|65720|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F116731_0_0|SrvcGrp|90707|2022|PDM|100.00|99|0.00|AETNA HOSPICE CARE
20|FH_F116731_0_0|SrvcGrp|97507|2022|PDM|100.00|99|0.00|AETNA HOSPICE
20|FH_F116747_0_0|SrvcGrp|27968|2022|PCT|0.00|99|0.00|SKILLED NURSING LPN
20|FH_F116747_0_0|SrvcGrp|46605|2022|PDM|91.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES
20|FH_F116793_0_0|SrvcGrp|472|2022|PDM|315.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F116793_0_0|SrvcGrp|75545|2022|PDM|245.00|99|0.00|SUB-ACUTE - LEVEL I AND II
20|FH_F116806_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F116806_0_0|CSTM-ALL|CSTM-00|2020|PDM|530.00|99|0.00|AEG 1 (NO REV) W/O CPT 41899
20|FH_F116806_0_0|CSTM-ALL|CSTM-00|2020|PDM|860.00|99|0.00|AEG 3 (NO REV)
20|FH_F116806_0_0|SrvcGrp|103965|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F116806_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F116806_0_0|SrvcGrp|107007|2022|PDM|2499.85|99|0.00|ADJUST BONE FIXATION DEVICE
20|FH_F116806_0_0|SrvcGrp|107014|2022|PDM|1923.16|99|0.00|REDUCTION OF FOREHEAD
20|FH_F116806_0_0|SrvcGrp|107018|2022|PDM|1923.16|99|0.00|OSTEOTOMY
20|FH_F116806_0_0|SrvcGrp|107022|2022|PDM|1923.16|99|0.00|FACE BONE GRAFT
20|FH_F116806_0_0|SrvcGrp|107023|2022|PDM|1923.16|99|0.00|LOWER JAW BONE GRAFT
20|FH_F116806_0_0|SrvcGrp|107025|2022|PDM|1923.16|99|0.00|RECONSTRUCTION OF MANDIBLE W/ TRANSOSTEAL BONE PLATE
20|FH_F116806_0_0|SrvcGrp|107034|2022|PDM|1923.16|99|0.00|REPAIR NASOETHMOID FRACTURE
20|FH_F116806_0_0|SrvcGrp|107038|2022|PDM|1923.16|99|0.00|REPAIR EYE SOCKET FRACTURE
20|FH_F116806_0_0|SrvcGrp|107040|2022|PDM|1923.16|99|0.00|PERCUTANEOUS OF MANDIBULAR FRACTURE W/ EXTERNAL FIXATION
20|FH_F116806_0_0|SrvcGrp|107042|2022|PDM|1923.16|99|0.00|REPAIR MOUTH/NOSE FISTULA
20|FH_F116806_0_0|SrvcGrp|107044|2022|PDM|1923.16|99|0.00|RECONSTRUCTION OF MANDIBLE/MAXILLA-PARTIAL ENDOSTEAL IMPLANT
20|FH_F116806_0_0|SrvcGrp|107047|2022|PDM|1923.16|99|0.00|EXCISION OF BONE-MANDIBLE
20|FH_F116806_0_0|SrvcGrp|107049|2022|PDM|1923.16|99|0.00|REMOVAL OF FACE BONE LESION
20|FH_F116806_0_0|SrvcGrp|107050|2022|PDM|1923.16|99|0.00|REPAIR CLEFT LIP
20|FH_F116806_0_0|SrvcGrp|107051|2022|PDM|1923.16|99|0.00|REPAIR CLEFT LIP
20|FH_F116806_0_0|SrvcGrp|107053|2022|PDM|1923.16|99|0.00|RECONSTRUCTION OF MOUTH
20|FH_F116806_0_0|SrvcGrp|107056|2022|PDM|1923.16|99|0.00|RECONSTRUCTION OF MOUTH
20|FH_F116806_0_0|SrvcGrp|107057|2022|PDM|887.26|99|0.00|EXCIS TONGUE LESION
20|FH_F116806_0_0|SrvcGrp|107059|2022|PDM|1923.16|99|0.00|REMOVE PALATE/LESION
20|FH_F116806_0_0|SrvcGrp|107083|2022|PDM|1923.16|99|0.00|TREATMENT OF MANDIBULAR FRACTURE W/O INTERDENTAL FIXATION
20|FH_F116806_0_0|SrvcGrp|107084|2022|PDM|1923.16|99|0.00|OPEN TREATMENT OF MANDIBULAR CONDYLAR FRACTURE
20|FH_F116806_0_0|SrvcGrp|107089|2022|PDM|1149.97|99|0.00|ARTHROSCOPY TEMPOROMANDIBULAR JOINT
20|FH_F116806_0_0|SrvcGrp|107098|2022|PDM|887.26|99|0.00|PREPARE FACE/ORAL PROSTHESIS
20|FH_F116806_0_0|SrvcGrp|107105|2022|PDM|887.26|99|0.00|CONTOUR OF FACE BONE LESION
20|FH_F116806_0_0|SrvcGrp|107113|2022|PDM|887.26|99|0.00|PARTIAL EXCISION OF LIP
20|FH_F116806_0_0|SrvcGrp|107122|2022|PDM|887.26|99|0.00|EXCISION OF UVULA
20|FH_F116806_0_0|SrvcGrp|107125|2022|PDM|887.26|99|0.00|BIOPSY OF SALIVARY GLAND
20|FH_F116806_0_0|SrvcGrp|107126|2022|PDM|887.26|99|0.00|CLOSURE OF SALIVARY FISTULA
20|FH_F116806_0_0|SrvcGrp|107127|2022|PDM|887.26|99|0.00|DRAINAGE OF THROAT ABSCESS
20|FH_F116806_0_0|SrvcGrp|107129|2022|PDM|887.26|99|0.00|CONTROL THROAT BLEEDING
20|FH_F116806_0_0|SrvcGrp|107130|2022|PDM|887.26|99|0.00|EXCISION OF MOUTH LESION
20|FH_F116806_0_0|SrvcGrp|107132|2022|PDM|887.26|99|0.00|EXCIS TONGUE LESION POSTR 1/3
20|FH_F116806_0_0|SrvcGrp|107137|2022|PDM|807.12|99|0.00|PREPARE FACE/ORAL PROSTHESIS
20|FH_F116806_0_0|SrvcGrp|44144|2022|PDM|1923.16|99|0.00|CPT 42440
20|FH_F116806_0_0|SrvcGrp|93642|2022|PDM|949.60|99|0.00|BIOPSY REMOVAL LYMPH NODES
20|FH_F116809_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F116809_0_0|CSTM-ALL|CSTM-00|2020|PDM|1006.00|99|0.00|AEG 8 (NO REV)
20|FH_F116809_0_0|CSTM-ALL|CSTM-00|2020|PDM|344.00|99|0.00|AEG 1 (NO REV)
20|FH_F116809_0_0|CSTM-ALL|CSTM-00|2020|PDM|527.00|99|0.00|AEG 3 (NO REV)
20|FH_F116809_0_0|SrvcGrp|79589|2022|PDM|461.00|99|0.00|UPPER GI
20|FH_F116825_0_0|SrvcGrp|23130|2022|PDM|26.50|99|0.00|1:1 SUPERVISION
20|FH_F116825_0_0|SrvcGrp|472|2022|PDM|1113.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F116828_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F116828_0_0|SrvcGrp|57968|2022|PDM|31.35|99|0.00|CONTINUOUS HOMECARE
20|FH_F116849_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F116849_0_0|SrvcGrp|44012|2022|PDM|789.70|99|0.00|RESIDENTIAL REHABILITATION
20|FH_F116956_0_0|CSTM-ALL|CSTM-00|2020|PDM|1110.23|99|0.00|2005 ASPG GROUPER VIII
20|FH_F116956_0_0|CSTM-ALL|CSTM-00|2020|PDM|1135.34|99|0.00|2005 ASPG GROUPER VII
20|FH_F116956_0_0|CSTM-ALL|CSTM-00|2020|PDM|718.86|99|0.00|2005 ASPG GROUPER IV
20|FH_F116959_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F116959_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 8 (NO REV)
20|FH_F116959_0_0|SrvcGrp|19922|2022|PDM|5000.00|99|0.00|ARTHROSCOPY OF SHOULDER
20|FH_F117001_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F117001_0_0|SrvcGrp|106596|2022|PDM|650.00|99|0.00|HEARING AID, PROG, MON, ITC
20|FH_F117009_0_0|CSTM-ALL|CSTM-00|2020|PDM|1043.00|99|0.00|AEG 4 (NO REV)
20|FH_F117009_0_0|CSTM-ALL|CSTM-00|2020|PDM|1163.00|99|0.00|AEG 10 (NO REV)
20|FH_F117009_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F117009_0_0|SrvcGrp|42427|2022|PDM|980.00|99|0.00|OP SURGERY CPT 65420
20|FH_F117009_0_0|SrvcGrp|56453|2022|PDM|2348.00|99|0.00|VITRECTOMY
20|FH_F117023_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F117023_0_0|SrvcGrp|107291|2022|PDM|8000.00|99|0.00|AETNA SPINE PROCEDURES
20|FH_F117023_0_0|SrvcGrp|11663|2022|PCT|1.10|99|0.00|IMPLANTS
20|FH_F117023_0_0|SrvcGrp|72990|2022|PDM|548.00|99|0.00|AEG 1
20|FH_F117023_0_0|SrvcGrp|73000|2022|PDM|1362.00|99|0.00|AEG 6
20|FH_F117027_0_0|CSTM-ALL|CSTM-00|2020|PDM|1012.00|99|0.00|AEG 9 (NO REV)
20|FH_F117027_0_0|CSTM-ALL|CSTM-00|2020|PDM|412.00|99|0.00|AEG 2 (NO REV)
20|FH_F117027_0_0|CSTM-ALL|CSTM-00|2020|PDM|919.00|99|0.00|AEG 7 (NO REV)
20|FH_F117027_0_0|CSTM-ALL|CSTM-00|2020|PDM|985.00|99|0.00|AEG 8 (NO REV)
20|FH_F117072_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F117087_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F117087_0_0|CSTM-ALL|CSTM-00|2020|PDM|1433.00|99|0.00|AEG 5  (NO REV)
20|FH_F117087_0_0|CSTM-ALL|CSTM-00|2020|PDM|1657.00|99|0.00|REMOVAL OF TISSUE FOR GRAFT
20|FH_F117087_0_0|CSTM-ALL|CSTM-00|2020|PDM|3276.00|99|0.00|AEG 9 (NO REV)
20|FH_F117087_0_0|CSTM-ALL|CSTM-00|2020|PDM|839.00|99|0.00|AEG 10 (NO REV)
20|FH_F117087_0_0|SrvcGrp|106266|2022|PDM|4185.00|99|0.00|NSL/SINS NDSC TOT W/ SPHENDT
20|FH_F117087_0_0|SrvcGrp|107167|2022|PDM|2494.00|99|0.00|RHINOPLASTY
20|FH_F117087_0_0|SrvcGrp|107169|2022|PDM|2494.00|99|0.00|SPHENOID SINUSOTOMY W/WO BIO
20|FH_F117087_0_0|SrvcGrp|107173|2022|PDM|2494.00|99|0.00|REMOVE EAR CANAL LESIONS
20|FH_F117087_0_0|SrvcGrp|107174|2022|PDM|2494.00|99|0.00|REBUILD OUTER EAR CANAL
20|FH_F117087_0_0|SrvcGrp|107180|2022|PDM|2494.00|99|0.00|REBUILD EARDRUM STRUCTURES
20|FH_F117087_0_0|SrvcGrp|107190|2022|PDM|1153.00|99|0.00|EARDRUM REVISION
20|FH_F117087_0_0|SrvcGrp|14320|2022|PCT|1.00|99|0.00|OP IMPLANTS/PROSTHETICS/DEVICES
20|FH_F117087_0_0|SrvcGrp|88599|2022|PDM|2093.00|99|0.00|ENDOSCOPY MAXILLARY SINUS
20|FH_F117087_0_0|SrvcGrp|90822|2022|PDM|2093.00|99|0.00|NASAL/SINUS ENDOSCOPY SURGERY
20|FH_F117087_0_0|SrvcGrp|98402|2022|PDM|2494.00|99|0.00|RHINO INCL MJR SEPTAL RPR
20|FH_F117132_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F117132_0_0|CSTM-ALL|CSTM-00|2020|PDM|1134.00|99|0.00|AEG 10 (NO REV)
20|FH_F117132_0_0|CSTM-ALL|CSTM-00|2020|PDM|1291.00|99|0.00|AEG 5  (NO REV)
20|FH_F117132_0_0|CSTM-ALL|CSTM-00|2020|PDM|1487.00|99|0.00|AEG 6 (NO REV)
20|FH_F117132_0_0|CSTM-ALL|CSTM-00|2020|PDM|1751.00|99|0.00|AEG 7 (NO REV)
20|FH_F117132_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|DEVICE INSERTION
20|FH_F117147_0_0|SrvcGrp|87077|2022|PDM|148.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F117195_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F117195_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.59|99|0.00|GENERAL ACUTE CARE
20|FH_F117202_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F117202_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F117202_0_0|SrvcGrp|82981|2022|PDM|100.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F117206_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F117206_0_0|SrvcGrp|104449|2022|PDM|1500.00|99|0.00|CYSTOURETHRO W/ IMPLANT
20|FH_F117206_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F117206_0_0|SrvcGrp|107322|2022|PDM|1970.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F117206_0_0|SrvcGrp|11673|2022|PDM|2884.00|99|0.00|CPT 29888
20|FH_F117206_0_0|SrvcGrp|35669|2022|PDM|1500.00|99|0.00|CPT 63650
20|FH_F117206_0_0|SrvcGrp|67065|2022|PDM|4326.00|99|0.00|CERVICAL SURGERY
20|FH_F117206_0_0|SrvcGrp|67066|2022|PDM|4326.00|99|0.00|CERVICAL SURGERY
20|FH_F117206_0_0|SrvcGrp|72990|2022|PDM|416.00|99|0.00|AEG 1
20|FH_F117206_0_0|SrvcGrp|72998|2022|PDM|1090.00|99|0.00|AEG 5
20|FH_F117206_0_0|SrvcGrp|73006|2022|PDM|3880.00|99|0.00|AEG 9
20|FH_F117206_0_0|SrvcGrp|79588|2022|PDM|824.00|99|0.00|CPT 43235
20|FH_F117206_0_0|SrvcGrp|85000|2022|PDM|721.00|99|0.00|CPT 45384
20|FH_F117206_0_0|SrvcGrp|88162|2022|PDM|3605.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON
20|FH_F117206_0_0|SrvcGrp|90604|2022|PDM|1485.00|99|0.00|EXTRACTION OF LENS
20|FH_F117206_0_0|SrvcGrp|90605|2022|PDM|1485.00|99|0.00|REMOVE CATARACT INSERT LENS
20|FH_F117208_0_0|CSTM-ALL|CSTM-00|2020|PDM|1870.00|99|0.00|AEG 3 (NO REV)
20|FH_F117208_0_0|CSTM-ALL|CSTM-00|2020|PDM|2090.00|99|0.00|AEG 10 (NO REV)
20|FH_F117208_0_0|CSTM-ALL|CSTM-00|2020|PDM|3850.00|99|0.00|AEG 7 (NO REV)
20|FH_F117208_0_0|CSTM-ALL|CSTM-00|2020|PDM|6050.00|99|0.00|AEG 9 (NO REV)
20|FH_F117208_0_0|SrvcGrp|106267|2022|PDM|4015.00|99|0.00|NSL/SINS NDSC SPHN TISS RMVL
20|FH_F117208_0_0|SrvcGrp|107357|2022|PDM|4015.00|99|0.00|HYOID MYOTOMY AND SUSPENSION
20|FH_F117225_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F117225_0_0|CSTM-ALL|CSTM-00|2020|PDM|1744.00|99|0.00|AEG 9 (NO REV)
20|FH_F117225_0_0|CSTM-ALL|CSTM-00|2020|PDM|2195.00|99|0.00|AEG 4 (NO REV)
20|FH_F117225_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F117230_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F117230_0_0|CSTM-ALL|CSTM-00|2020|PDM|1160.00|99|0.00|AEG 5  (NO REV)
20|FH_F117230_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 6 (NO REV)
20|FH_F117230_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F117230_0_0|SrvcGrp|103974|2022|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES
20|FH_F117245_0_0|SrvcGrp|72990|2022|PDM|550.00|99|0.00|AEG 1
20|FH_F117245_0_0|SrvcGrp|72994|2022|PDM|842.00|99|0.00|AEG 3
20|FH_F117245_0_0|SrvcGrp|72996|2022|PDM|1040.00|99|0.00|AEG 4
20|FH_F117245_0_0|SrvcGrp|73006|2022|PDM|2210.00|99|0.00|AEG 9
20|FH_F117299_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F117299_0_0|CSTM-ALL|CSTM-00|2020|PDM|1572.00|99|0.00|AEG 5  (NO REV)
20|FH_F117299_0_0|CSTM-ALL|CSTM-00|2020|PDM|556.00|99|0.00|AEG 1 (NO REV)
20|FH_F117299_0_0|SrvcGrp|104021|2022|PDM|2809.00|99|0.00|CYSTOSCOPY PROSTATIC IMP 1-3
20|FH_F117299_0_0|SrvcGrp|104022|2022|PDM|6867.00|99|0.00|CYSTOSCOPY IMPLANT 4 OR MORE
20|FH_F117299_0_0|SrvcGrp|47529|2022|PDM|976.00|99|0.00|CYSTOURETHROSCOPY, WITH REMOVAL OF FOREIGN BODY
20|FH_F117300_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F117300_0_0|CSTM-ALL|CSTM-00|2020|PDM|1645.00|99|0.00|AEG 2 (NO REV)
20|FH_F117300_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F117300_0_0|SrvcGrp|27261|2022|PDM|8835.00|99|0.00|CPT 27446
20|FH_F117300_0_0|SrvcGrp|54943|2022|PDM|2945.00|99|0.00|REPAIR OF SLAP LESION
20|FH_F117300_0_0|SrvcGrp|77021|2022|PDM|7360.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY
20|FH_F117300_0_0|SrvcGrp|78096|2022|PDM|2945.00|99|0.00|AETNA ARTHROSCOPY BICEPS
20|FH_F117300_0_0|SrvcGrp|88164|2022|PDM|7853.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR
20|FH_F117300_0_0|SrvcGrp|89840|2022|PDM|7853.00|99|0.00|THORAX SPINE FUSION
20|FH_F117300_0_0|SrvcGrp|89842|2022|PDM|7853.00|99|0.00|LUMBAR
20|FH_F117300_0_0|SrvcGrp|98495|2022|PDM|7853.00|99|0.00|ARTHRODESIS POSTERIOR TECH
20|FH_F117300_0_0|SrvcGrp|98497|2022|PDM|7853.00|99|0.00|ARTHRODESIS POSTERIOR TECH
20|FH_F117335_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS
20|FH_F117382_0_0|SrvcGrp|103550|2022|PDM|400.00|99|0.00|HEMODIALYSIS SVCS
20|FH_F117382_0_0|SrvcGrp|105357|2022|PDM|400.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD
20|FH_F117437_0_0|SrvcGrp|83857|2022|PDM|761.00|99|0.00|IP HOSPICE SVCS
20|FH_F117437_0_0|SrvcGrp|84185|2022|PDM|180.00|99|0.00|RESPITE CARE
20|FH_F117440_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F117442_0_0|SrvcGrp|57967|2022|PDM|148.79|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F117442_0_0|SrvcGrp|82222|2022|PDM|148.79|99|0.00|HOSPICE CARE
20|FH_F117442_0_0|SrvcGrp|92502|2022|PDM|573.47|99|0.00|HOSPICE GENERAL IP CARE
20|FH_F117465_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F117465_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F117465_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F117465_0_0|SrvcGrp|107472|2022|PDM|6000.00|99|0.00|AETNA CERV ARTIFIC DISKECTOMY
20|FH_F117465_0_0|SrvcGrp|64761|2022|PDM|4000.00|99|0.00|DISCECTOMY
20|FH_F117465_0_0|SrvcGrp|75479|2022|PDM|475.00|99|0.00|AEG 1
20|FH_F117465_0_0|SrvcGrp|75485|2022|PDM|1500.00|99|0.00|AEG 4
20|FH_F117465_0_0|SrvcGrp|75493|2022|PDM|1200.00|99|0.00|AEG 8
20|FH_F117465_0_0|SrvcGrp|98360|2022|PDM|4000.00|99|0.00|AETNA LAMINECTOMY W/FACE-LUMBAR
20|FH_F117485_0_0|CSTM-ALL|CSTM-00|2020|PDM|2344.00|99|0.00|AEG 9 (NO REV)
20|FH_F117485_0_0|CSTM-ALL|CSTM-00|2020|PDM|956.00|99|0.00|AEG 3 (NO REV)
20|FH_F117485_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F117485_0_0|SrvcGrp|14614|2022|PDM|5515.00|99|0.00|LITHOTRIPSY
20|FH_F117486_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F117509_0_0|SrvcGrp|57967|2022|PDM|148.79|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F117512_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|AEG 10 (NO REV)
20|FH_F117512_0_0|CSTM-ALL|CSTM-00|2020|PDM|1129.00|99|0.00|AEG 3 (NO REV)
20|FH_F117512_0_0|CSTM-ALL|CSTM-00|2020|PDM|1640.00|99|0.00|AEG 8 (NO REV)
20|FH_F117512_0_0|CSTM-ALL|CSTM-00|2020|PDM|2112.00|99|0.00|AEG 7 (NO REV)
20|FH_F117512_0_0|CSTM-ALL|CSTM-00|2020|PDM|638.00|99|0.00|AEG 1 (NO REV)
20|FH_F117525_0_0|SrvcGrp|72990|2022|PDM|500.00|99|0.00|AEG 1
20|FH_F117525_0_0|SrvcGrp|72994|2022|PDM|1900.00|99|0.00|AEG 3
20|FH_F117525_0_0|SrvcGrp|73004|2022|PDM|1400.00|99|0.00|AEG 8
20|FH_F117525_0_0|SrvcGrp|83817|2022|PDM|1900.00|99|0.00|LAPAROSCOPY LYSIS ADHESIONS
20|FH_F117531_0_0|SrvcGrp|105357|2022|PDM|525.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD
20|FH_F117531_0_0|SrvcGrp|68641|2022|PDM|700.00|99|0.00|HOME HEMODIALYSIS
20|FH_F117550_0_0|SrvcGrp|106521|2022|PDM|34.00|99|0.00|PT RE-EVAL
20|FH_F117550_0_0|SrvcGrp|106536|2022|PDM|22.40|99|0.00|GROUP THERAPEUTIC PROCEDURES
20|FH_F117550_0_0|SrvcGrp|17100|2022|PDM|800.00|99|0.00|SKILLED NURSING
20|FH_F117550_0_0|SrvcGrp|72379|2022|PDM|37.60|99|0.00|SPEECH THERAPY
20|FH_F117550_0_0|SrvcGrp|79720|2022|PDM|1100.00|99|0.00|ACUTE REHAB II
20|FH_F117550_0_0|SrvcGrp|83057|2022|PDM|28.00|99|0.00|AETNA THERAPEUTIC EXERCISES
20|FH_F117550_0_0|SrvcGrp|85963|2022|PDM|28.00|99|0.00|SELF CARE MANGEMENT TRAINING
20|FH_F117550_0_0|SrvcGrp|87537|2022|PDM|350.00|99|0.00|MED REHAB DAY PROGRAM (FULL)
20|FH_F117552_0_0|SrvcGrp|103645|2022|PDM|9500.00|99|0.00|AETNA TIB/ PER REVASE W/ STENT
20|FH_F117552_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F117552_0_0|SrvcGrp|58634|2022|PDM|4400.00|99|0.00|NEUROELECTRODES IMPLANT
20|FH_F117552_0_0|SrvcGrp|63471|2022|PDM|15400.00|99|0.00|CPT 64590
20|FH_F117552_0_0|SrvcGrp|72992|2022|PDM|536.00|99|0.00|AEG 2
20|FH_F117552_0_0|SrvcGrp|72996|2022|PDM|758.00|99|0.00|AEG 4
20|FH_F117552_0_0|SrvcGrp|73000|2022|PDM|1000.00|99|0.00|AEG 6
20|FH_F117552_0_0|SrvcGrp|73006|2022|PDM|1610.00|99|0.00|AEG 9
20|FH_F117552_0_0|SrvcGrp|73008|2022|PDM|825.00|99|0.00|AEG 10
20|FH_F117552_0_0|SrvcGrp|90061|2022|PDM|8500.00|99|0.00|AETNA RECONSTRUCT SHOULDER JOINT
20|FH_F117559_08619_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F117559_08619_0|SrvcGrp|100277|2022|PDM|45.00|99|0.00|HEPB VACCINE ADULT
20|FH_F117559_08619_0|SrvcGrp|104054|2022|PDM|20.00|99|0.00|INFLUENZA VACCINE - PRESERVATIVE FREE
20|FH_F117559_08619_0|SrvcGrp|104056|2022|PDM|131.00|99|0.00|PNEUMOCOCCAL VACCINE - INTRAMUSCULAR
20|FH_F117559_08619_0|SrvcGrp|111060|2022|PDM|20.00|99|0.00|TOXOIDS VACCINES
20|FH_F117559_08619_0|SrvcGrp|113297|2022|PDM|40.00|99|0.00|COVID-19 IMMUN ADMIN 1ST DOSE - PFIZER
20|FH_F117559_08619_0|SrvcGrp|114540|2022|PDM|40.00|99|0.00|ADM SARS COV2 10MCG TRS-SUCR 2
20|FH_F117559_08619_0|SrvcGrp|45307|2022|PDM|15.00|99|0.00|ADMIN OF INFLUENZA VIRUS VACCINE
20|FH_F117559_08619_0|SrvcGrp|96499|2022|PDM|15.00|99|0.00|ADMIN OF PNEUMOCOCCAL VACCINE
20|FH_F117575_0_0|CSTM-ALL|CSTM-00|2020|PDM|830.00|99|0.00|AEG 3 (NO REV)
20|FH_F117611_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F117626_0_0|CSTM-ALL|CSTM-00|2020|PDM|1311.00|99|0.00|AEG 7 (NO REV)
20|FH_F117626_0_0|CSTM-ALL|CSTM-00|2020|PDM|1765.00|99|0.00|AEG 9 (NO REV)
20|FH_F117626_0_0|CSTM-ALL|CSTM-00|2020|PDM|831.00|99|0.00|AEG 4 (NO REV)
20|FH_F117627_0_0|CSTM-ALL|CSTM-00|2020|PDM|1245.00|99|0.00|AEG 6 (NO REV)
20|FH_F117627_0_0|CSTM-ALL|CSTM-00|2020|PDM|1466.00|99|0.00|AEG 8 (NO REV)
20|FH_F117627_0_0|CSTM-ALL|CSTM-00|2020|PDM|673.00|99|0.00|AEG 2 (NO REV)
20|FH_F117644_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING
20|FH_F117644_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|AETNA CARDIAC CATHERTERIZATION
20|FH_F117644_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|CARDIAC STUDIES
20|FH_F117647_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 1 (NO REV)
20|FH_F117715_0_0|SrvcGrp|38364|2022|PDM|5234.92|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F117715_0_0|SrvcGrp|74585|2022|PCT|0.50|99|0.00|AETNA OP IMPLANTS
20|FH_F117715_0_0|SrvcGrp|75479|2022|PDM|572.00|99|0.00|AEG 1
20|FH_F117715_0_0|SrvcGrp|75495|2022|PDM|1957.00|99|0.00|AEG 9
20|FH_F117728_0_0|SrvcGrp|82498|2022|PDM|175.00|99|0.00|DIALYSIS PROCEDURE OTHER THAN HEMODIALYSIS
20|FH_F117762_0_0|CSTM-ALL|CSTM-00|2020|PDM|1075.00|99|0.00|AEG 10 (NO REV)
20|FH_F117762_0_0|CSTM-ALL|CSTM-00|2020|PDM|1077.00|99|0.00|AEG 5  (NO REV)
20|FH_F117762_0_0|CSTM-ALL|CSTM-00|2020|PDM|692.00|99|0.00|AEG 2 (NO REV)
20|FH_F117762_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F117762_0_0|SrvcGrp|11673|2022|PDM|5511.00|99|0.00|CPT 29888
20|FH_F117762_0_0|SrvcGrp|27261|2022|PDM|14560.00|99|0.00|CPT 27446
20|FH_F117762_0_0|SrvcGrp|27345|2022|PDM|3016.00|99|0.00|OP SURGERY (CPT 49650)
20|FH_F117762_0_0|SrvcGrp|33984|2022|PDM|1248.00|99|0.00|HAMMERTOE CORRECTION
20|FH_F117762_0_0|SrvcGrp|59705|2022|PDM|1352.00|99|0.00|SEPTOPLASTY
20|FH_F117762_0_0|SrvcGrp|67068|2022|PDM|8840.00|99|0.00|LUMBAR SPINE FUSION COMBINED
20|FH_F117762_0_0|SrvcGrp|67072|2022|PDM|8840.00|99|0.00|CPT 22845
20|FH_F117762_0_0|SrvcGrp|74039|2022|PDM|4992.00|99|0.00|LAMINECTOMY
20|FH_F117762_0_0|SrvcGrp|77021|2022|PDM|4992.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY
20|FH_F117762_0_0|SrvcGrp|81571|2022|PDM|2497.00|99|0.00|NASAL ENDOSCOPY W/ SINUS OSTIA DILATION
20|FH_F117762_0_0|SrvcGrp|88158|2022|PDM|4992.00|99|0.00|NECK SPINE DISK SURGERY
20|FH_F117762_0_0|SrvcGrp|88160|2022|PDM|4992.00|99|0.00|LAMINECTOMY W/FACETECTOMY
20|FH_F117762_0_0|SrvcGrp|88163|2022|PDM|9360.00|99|0.00|LUMBAR SPINE FUSION
20|FH_F117762_0_0|SrvcGrp|97730|2022|PDM|14560.00|99|0.00|REVERSE HIP JOINT
20|FH_F117762_0_0|SrvcGrp|98497|2022|PDM|4836.00|99|0.00|ARTHRODESIS POSTERIOR TECH
20|FH_F117762_0_0|SrvcGrp|99158|2022|PDM|1872.00|99|0.00|KNEE ARTHROSCOPY/DIAGNOSTIC
20|FH_F117762_0_0|SrvcGrp|99159|2022|PDM|2577.00|99|0.00|KNEE ARTHROSCOPY/SURGICAL
20|FH_F117762_0_0|SrvcGrp|99166|2022|PDM|2184.00|99|0.00|CPT 63005
20|FH_F117762_0_0|SrvcGrp|99173|2022|PDM|5144.00|99|0.00|HIP ARTHRO ACETABULOPLASTY
20|FH_F117783_0_0|CSTM-ALL|CSTM-00|2020|PDM|1545.00|99|0.00|AEG 7 (NO REV)
20|FH_F117783_0_0|CSTM-ALL|CSTM-00|2020|PDM|824.00|99|0.00|AEG 10 (NO REV)
20|FH_F117783_0_0|CSTM-ALL|CSTM-00|2020|PDM|979.00|99|0.00|AEG 4 (NO REV)
20|FH_F117783_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F117783_0_0|SrvcGrp|107611|2022|PCT|1.00|99|0.00|IMPLTJ NTRSTRML CRNL RNG SEGMENTS
20|FH_F117783_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F117784_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F117784_0_0|SrvcGrp|100961|2022|PDM|194.92|99|0.00|AMB SRVC NEONAT TRNSPRT BS RATE EMERG 1 WAY
20|FH_F117784_0_0|SrvcGrp|106291|2022|PDM|147.90|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT LEVEL 1 (HCFA)
20|FH_F117784_0_0|SrvcGrp|106294|2022|PDM|155.47|99|0.00|AMBULANCE SERVICE EMERGENCY TRANSPORT LEVEL 1 (HFCA)
20|FH_F117784_0_0|SrvcGrp|13683|2022|PDM|370.45|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2
20|FH_F117799_0_0|CSTM-ALL|CSTM-00|2020|PDM|1260.00|99|0.00|AEG 10 (NO REV)
20|FH_F117799_0_0|CSTM-ALL|CSTM-00|2020|PDM|1331.00|99|0.00|AEG 5  (NO REV)
20|FH_F117799_0_0|CSTM-ALL|CSTM-00|2020|PDM|2111.00|99|0.00|AEG 8 (NO REV)
20|FH_F117799_0_0|CSTM-ALL|CSTM-00|2020|PDM|875.00|99|0.00|AEG 2 (NO REV)
20|FH_F117799_0_0|SrvcGrp|104857|2022|PDM|23499.00|99|0.00|LUMBAR FUSION
20|FH_F117799_0_0|SrvcGrp|107662|2022|PDM|2565.00|99|0.00|NASAL/SINUS PROCEDURES
20|FH_F117799_0_0|SrvcGrp|77585|2022|PDM|3130.00|99|0.00|CPT 58558 - 58563
20|FH_F117799_0_0|SrvcGrp|84939|2022|PDM|11935.00|99|0.00|SHOULDER JOINT
20|FH_F117799_0_0|SrvcGrp|88163|2022|PDM|14396.00|99|0.00|LUMBAR SPINE FUSION
20|FH_F117816_0_0|SrvcGrp|82222|2022|PDM|148.79|99|0.00|HOSPICE CARE
20|FH_F117816_0_0|SrvcGrp|92502|2022|PDM|573.47|99|0.00|HOSPICE GENERAL IP CARE
20|FH_F117820_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F117820_0_0|SrvcGrp|80317|2022|PDM|82.34|99|0.00|RESPITE CARE
20|FH_F117820_0_0|SrvcGrp|89781|2022|PDM|82.34|99|0.00|RESPITE CARE (HCFA)
20|FH_F117820_0_0|SrvcGrp|94780|2022|PDM|105.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)
20|FH_F117831_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F117831_0_0|CSTM-ALL|CSTM-00|2020|PDM|1043.00|99|0.00|AEG 8 (NO REV)
20|FH_F117831_0_0|CSTM-ALL|CSTM-00|2020|PDM|564.00|99|0.00|AEG 2 (NO REV)
20|FH_F117831_0_0|CSTM-ALL|CSTM-00|2020|PDM|939.00|99|0.00|AEG 5  (NO REV)
20|FH_F117831_0_0|SrvcGrp|88494|2022|PDM|3200.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION
20|FH_F117858_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F117887_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F117896_0_0|SrvcGrp|57967|2022|PDM|140.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F117896_0_0|SrvcGrp|92502|2022|PDM|500.00|99|0.00|HOSPICE GENERAL IP CARE
20|FH_F117902_0_0|CSTM-ALL|CSTM-00|2020|PDM|805.00|99|0.00|AEG 3 (NO REV)
20|FH_F117902_0_0|SrvcGrp|107656|2022|PDM|1300.00|99|0.00|AETNA CARVE OUT CODES SERIES A
20|FH_F117902_0_0|SrvcGrp|15473|2022|PDM|900.00|99|0.00|CPT CODE 42820
20|FH_F117905_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F118165_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|AETNA CARDIAC CATHERTERIZATION
20|FH_F118165_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP DIALYSIS
20|FH_F118165_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F118168_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|CARDIAC STUDIES
20|FH_F118168_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F118168_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OBSERVATION SERVICES
20|FH_F118173_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|AEG 6 (NO REV)
20|FH_F118173_0_0|SrvcGrp|103974|2022|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES
20|FH_F118180_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING
20|FH_F118184_0_0|SrvcGrp|112812|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER
20|FH_F118196_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F118196_0_0|SrvcGrp|73004|2022|PDM|1201.00|99|0.00|AEG 8
20|FH_F118243_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F118249_0_0|CSTM-ALL|CSTM-00|2020|PDM|438.00|99|0.00|AEG 2 (NO REV)
20|FH_F118249_0_0|CSTM-ALL|CSTM-00|2020|PDM|814.00|99|0.00|AEG 6 (NO REV)
20|FH_F118249_0_0|SrvcGrp|108063|2022|PDM|4300.00|99|0.00|IMPLANT NEUROELECTRODES 29
20|FH_F118249_0_0|SrvcGrp|108065|2022|PDM|21000.00|99|0.00|IMPLANT NEUROELECTRODES 23
20|FH_F118249_0_0|SrvcGrp|96104|2022|PCT|1.10|99|0.00|IMPLANTABLE NEUROSTIMULATOR
20|FH_F118275_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE
20|FH_F118275_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F118300_0_0|SrvcGrp|14494|2022|PDM|31.35|99|0.00|CONTINUOUS HOMECARE
20|FH_F118303_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F118303_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F118303_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 10 (NO REV)
20|FH_F118303_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|AEG 5  (NO REV)
20|FH_F118303_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|AEG 6 (NO REV)
20|FH_F118303_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F118309_0_0|CSTM-ALL|CSTM-00|2020|PDM|912.15|99|0.00|AEG 6 (NO REV)
20|FH_F118309_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F118309_0_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS
20|FH_F118446_0_0|SrvcGrp|82223|2022|PDM|150.00|99|0.00|HOSPICE CARE
20|FH_F118446_0_0|SrvcGrp|84185|2022|PDM|150.00|99|0.00|RESPITE CARE
20|FH_F118459_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA CARDIAC CATH INCIDENTAL CODES
20|FH_F118459_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING
20|FH_F118459_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|CARDIAC STUDIES
20|FH_F118459_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OBSERVATION SERVICES
20|FH_F118459_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F118459_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|VASCULAR DIAGNOSTIC STUDIES
20|FH_F118469_0_0|CSTM-ALL|CSTM-00|2020|PDM|2031.00|99|0.00|AEG 5  (NO REV)
20|FH_F118469_0_0|SrvcGrp|103974|2022|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES
20|FH_F118469_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F118473_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F118488_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|CARDIAC STUDIES
20|FH_F118555_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F118555_0_0|CSTM-ALL|CSTM-00|2020|PDM|645.00|99|0.00|AEG 6 (NO REV)
20|FH_F118555_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 10 (NO REV)
20|FH_F118555_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F118555_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F118651_0_0|CSTM-ALL|CSTM-00|2020|PDM|2015.71|99|0.00|AEG 7 (NO REV)
20|FH_F118651_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F118651_0_0|SrvcGrp|107866|2022|PDM|6259.31|99|0.00|AETNA LAPAROSCOPY SURGICAL
20|FH_F118651_0_0|SrvcGrp|107869|2022|PDM|4349.69|99|0.00|AETNA EXC ABD TUM OVER 10 CM
20|FH_F118651_0_0|SrvcGrp|41547|2022|PDM|4376.21|99|0.00|OP LAPAROSCOPIC HYSTERECTOMY
20|FH_F118651_0_0|SrvcGrp|93637|2022|PDM|4959.71|99|0.00|LAPAROSCOPY SURGICAL
20|FH_F118651_0_0|SrvcGrp|97901|2022|PCT|0.00|99|0.00|LIGATION OF ABDOMEN ARTERY
20|FH_F118693_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F118699_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F118703_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F118703_0_0|SrvcGrp|72994|2022|PDM|583.00|99|0.00|AEG 3
20|FH_F118703_0_0|SrvcGrp|72998|2022|PDM|820.00|99|0.00|AEG 5
20|FH_F118703_0_0|SrvcGrp|73002|2022|PDM|1138.00|99|0.00|AEG 7
20|FH_F118720_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F118720_0_0|CSTM-ALL|CSTM-00|2020|PDM|531.00|99|0.00|AEG 1 (NO REV)
20|FH_F118741_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F118742_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F118783_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING
20|FH_F118783_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP DIALYSIS
20|FH_F118803_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F118803_0_0|CSTM-ALL|CSTM-00|2020|PDM|346.45|99|0.00|AEG 10 (NO REV)
20|FH_F118803_0_0|CSTM-ALL|CSTM-00|2020|PDM|464.02|99|0.00|AEG 2 (NO REV) W/O CARDIAC SERVICES
20|FH_F118803_0_0|CSTM-ALL|CSTM-00|2020|PDM|655.45|99|0.00|AEG 4 NO REV W/O CARDIOVASCULAR SURGERY
20|FH_F118803_0_0|SrvcGrp|104883|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F118803_0_0|SrvcGrp|107873|2022|PDM|349.70|99|0.00|SELECTIVE CATHETER PLACEMENT
20|FH_F118803_0_0|SrvcGrp|107874|2022|PDM|349.70|99|0.00|SELECTIVE CATHETER PLACEMENT
20|FH_F118803_0_0|SrvcGrp|107875|2022|PDM|349.70|99|0.00|SELECTIVE CATHETER PLACEMENT
20|FH_F118803_0_0|SrvcGrp|77278|2022|PDM|1156.98|99|0.00|AETNA REPL TUNNLD CNTRL CVC W/O PORT/PUMP
20|FH_F118848_0_0|CSTM-ALL|CSTM-00|2020|PDM|1900.00|99|0.00|AEG 2 (NO REV)
20|FH_F118848_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|AEG 7 (NO REV)
20|FH_F118848_0_0|CSTM-ALL|CSTM-00|2020|PDM|3100.00|99|0.00|AEG 3 (NO REV)
20|FH_F118907_0_0|SrvcGrp|107722|2022|PDM|603.56|99|0.00|SLEEP STUDIES
20|FH_F118907_0_0|SrvcGrp|107899|2022|PDM|663.75|99|0.00|SLEEP STUDIES (HCFA)
20|FH_F118907_0_0|SrvcGrp|42724|2022|PDM|171.01|99|0.00|SLEEP STUDY
20|FH_F118909_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F118909_0_0|SrvcGrp|63297|2022|PDM|133.90|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F118909_0_0|SrvcGrp|80920|2022|PDM|566.50|99|0.00|HOSPICE SERVICES
20|FH_F118909_0_0|SrvcGrp|89781|2022|PDM|123.60|99|0.00|RESPITE CARE (HCFA)
20|FH_F118909_0_0|SrvcGrp|94781|2022|PDM|123.60|99|0.00|HOSPICE IN LTCH (HCFA)
20|FH_F118909_0_0|SrvcGrp|97506|2022|PDM|133.90|99|0.00|AETNA HOSPICE ALL OTHER CARE
20|FH_F118909_0_0|SrvcGrp|97507|2022|PDM|123.60|99|0.00|AETNA HOSPICE
20|FH_F118910_0_0|SrvcGrp|89783|2022|PDM|126.18|99|0.00|RESPITE CARE (HCFA)
20|FH_F118910_0_0|SrvcGrp|90707|2022|PDM|126.18|99|0.00|AETNA HOSPICE CARE
20|FH_F118910_0_0|SrvcGrp|93098|2022|PDM|113.30|99|0.00|HOSPICE CARE
20|FH_F118910_0_0|SrvcGrp|97506|2022|PDM|126.18|99|0.00|AETNA HOSPICE ALL OTHER CARE
20|FH_F118957_0_0|CSTM-ALL|CSTM-00|2020|PDM|1430.00|99|0.00|AEG 2 (NO REV)
20|FH_F118957_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|AEG 3 (NO REV)
20|FH_F118957_0_0|CSTM-ALL|CSTM-00|2020|PDM|3300.00|99|0.00|AEG 4 (NO REV)
20|FH_F118957_0_0|CSTM-ALL|CSTM-00|2020|PDM|5500.00|99|0.00|AEG 7 (NO REV)
20|FH_F118957_0_0|CSTM-ALL|CSTM-00|2020|PDM|6930.00|99|0.00|AEG 9 (NO REV)
20|FH_F118957_0_0|SrvcGrp|110784|2022|PDM|3300.00|99|0.00|HAND OR FOOT NERVE GRAFT
20|FH_F118962_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F118962_0_0|CSTM-ALL|CSTM-00|2020|PDM|1357.60|99|0.00|AEG 8 (NO REV)
20|FH_F118962_0_0|CSTM-ALL|CSTM-00|2020|PDM|879.62|99|0.00|AEG 4 (NO REV)
20|FH_F118964_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F118964_0_0|CSTM-ALL|CSTM-00|2020|PDM|788.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F118964_0_0|CSTM-ALL|CSTM-00|2020|PDM|983.00|99|0.00|AEG 2 (NO REV)
20|FH_F118986_0_0|SrvcGrp|75491|2022|PDM|1409.23|99|0.00|AEG 7
20|FH_F118986_0_0|SrvcGrp|75493|2022|PDM|1419.37|99|0.00|AEG 8
20|FH_F119007_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F119007_0_0|CSTM-ALL|CSTM-00|2020|PDM|1016.00|99|0.00|AEG 5  (NO REV)
20|FH_F119007_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 10 (NO REV)
20|FH_F119007_0_0|CSTM-ALL|CSTM-00|2020|PDM|1452.00|99|0.00|AEG 8 (NO REV)
20|FH_F119007_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F119007_0_0|SrvcGrp|87677|2022|PDM|785.00|99|0.00|CERVICAL OR THORACIC SURGERY
20|FH_F119007_0_0|SrvcGrp|96799|2022|PDM|393.00|99|0.00|DESTROY C/TH FACET JNT ADDL
20|FH_F119008_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F119008_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F119008_0_0|SrvcGrp|82223|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F119029_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F119029_0_0|CSTM-ALL|CSTM-00|2020|PDM|1061.00|99|0.00|AEG 8 (NO REV)
20|FH_F119029_0_0|CSTM-ALL|CSTM-00|2020|PDM|1433.00|99|0.00|AEG 9 (NO REV)
20|FH_F119029_0_0|CSTM-ALL|CSTM-00|2020|PDM|582.00|99|0.00|AEG 3 (NO REV)
20|FH_F119029_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F119064_01581_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F119064_01581_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F119064_01581_0|SrvcGrp|108484|2022|PDM|482.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY
20|FH_F119064_01581_0|SrvcGrp|90854|2022|PDM|695.00|99|0.00|AETNA IP DETOXIFICATION SERVICES
20|FH_F119070_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F119070_0_0|CSTM-ALL|CSTM-00|2020|PDM|1750.00|99|0.00|AEG 3 (NO REV)
20|FH_F119070_0_0|CSTM-ALL|CSTM-00|2020|PDM|2300.00|99|0.00|AEG 6 (NO REV)
20|FH_F119070_0_0|CSTM-ALL|CSTM-00|2020|PDM|3300.00|99|0.00|AEG 9 (NO REV)
20|FH_F119070_0_0|SrvcGrp|104098|2022|PDM|4100.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT
20|FH_F119070_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F119072_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F119072_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|HSS ASC
20|FH_F119074_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F119074_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|OP SVCS
20|FH_F119125_0_0|SrvcGrp|10708|2022|PDM|200.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F119125_0_0|SrvcGrp|13705|2022|PDM|2197.00|99|0.00|ACUTE PHYSICAL REHAB
20|FH_F119125_0_0|SrvcGrp|8960|2022|PDM|200.00|99|0.00|SPEECH THERAPY
20|FH_F119130_0_0|SrvcGrp|108082|2022|PDM|75.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER
20|FH_F119203_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F119203_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F119203_0_0|SrvcGrp|108021|2022|PDM|435.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD
20|FH_F119214_0_0|SrvcGrp|75479|2022|PDM|552.00|99|0.00|AEG 1
20|FH_F119214_0_0|SrvcGrp|75481|2022|PDM|737.00|99|0.00|AEG 2
20|FH_F119266_0_0|SrvcGrp|103552|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER
20|FH_F119266_0_0|SrvcGrp|105357|2022|PDM|500.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD
20|FH_F119285_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F119285_0_0|CSTM-ALL|CSTM-00|2020|PDM|1884.00|99|0.00|AEG 9 (NO REV)
20|FH_F119285_0_0|CSTM-ALL|CSTM-00|2020|PDM|420.00|99|0.00|AEG 1 (NO REV)
20|FH_F119285_0_0|CSTM-ALL|CSTM-00|2020|PDM|888.00|99|0.00|AEG 4 (NO REV)
20|FH_F119285_0_0|SrvcGrp|108057|2022|PDM|1751.00|99|0.00|REPAIR RETINAL DETACHMENT
20|FH_F119285_0_0|SrvcGrp|38909|2022|PDM|1751.00|99|0.00|CPT 67036 - VITRECTOMY, MECHANICAL
20|FH_F119285_0_0|SrvcGrp|73486|2022|PCT|0.00|99|0.00|AETNA CONTRAST AGENT
20|FH_F119285_0_0|SrvcGrp|88154|2022|PDM|1751.00|99|0.00|LASER TREATMENT OLD RETINA
20|FH_F119291_0_0|SrvcGrp|103552|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER
20|FH_F119291_0_0|SrvcGrp|108041|2022|PDM|435.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME
20|FH_F119352_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F119355_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F119355_0_0|CSTM-ALL|CSTM-00|2020|PDM|50.00|99|0.00|GROUP BEHAVIOR TREATMENT (HCFA)
20|FH_F119376_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F119376_0_0|SrvcGrp|103391|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F119376_0_0|SrvcGrp|108114|2022|PDM|2500.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT
20|FH_F119376_0_0|SrvcGrp|108116|2022|PDM|1698.78|99|0.00|AV FUSION / UPPER ARM VEIN
20|FH_F119376_0_0|SrvcGrp|14162|2022|PDM|1500.00|99|0.00|VNUS CLOSURE
20|FH_F119376_0_0|SrvcGrp|72994|2022|PDM|612.00|99|0.00|AEG 3
20|FH_F119376_0_0|SrvcGrp|73000|2022|PDM|991.00|99|0.00|AEG 6
20|FH_F119379_0_0|CSTM-ALL|CSTM-00|2020|PDM|1060.00|99|0.00|AEG 7 (NO REV)
20|FH_F119379_0_0|CSTM-ALL|CSTM-00|2020|PDM|355.00|99|0.00|AEG 1 (NO REV)
20|FH_F119379_0_0|CSTM-ALL|CSTM-00|2020|PDM|475.00|99|0.00|AEG 2 (NO REV)
20|FH_F119379_0_0|CSTM-ALL|CSTM-00|2020|PDM|672.00|99|0.00|AEG 4 (NO REV)
20|FH_F119379_0_0|SrvcGrp|103563|2022|PDM|764.00|99|0.00|REPAIR HAND TENDON
20|FH_F119379_0_0|SrvcGrp|107008|2022|PDM|1428.00|99|0.00|REMOVAL OF BONE FOR GRAFT
20|FH_F119379_0_0|SrvcGrp|107830|2022|PDM|1428.00|99|0.00|REPAIR FOREARM TENDON/MUSCLE
20|FH_F119379_0_0|SrvcGrp|107835|2022|PDM|1350.00|99|0.00|NERVE REPAIR
20|FH_F119379_0_0|SrvcGrp|107841|2022|PDM|885.00|99|0.00|FORMATION OF SKIN PEDICLE
20|FH_F119379_0_0|SrvcGrp|107843|2022|PDM|885.00|99|0.00|NEUROVASCULAR PEDICLE GRAFT
20|FH_F119379_0_0|SrvcGrp|107845|2022|PDM|764.00|99|0.00|REVISE FINGER/TOE NERVE
20|FH_F119379_0_0|SrvcGrp|107850|2022|PDM|672.00|99|0.00|EXC HAND LES SC < 1.5 CM
20|FH_F119379_0_0|SrvcGrp|82720|2022|PDM|1298.00|99|0.00|WRIST ENDOSCOPY/SURGERY
20|FH_F119379_0_0|SrvcGrp|92010|2022|PDM|672.00|99|0.00|LESION OF TENDON SHEATH OR JOINT CAPSULE
20|FH_F119379_0_0|SrvcGrp|92367|2022|PDM|1280.00|99|0.00|TRANSPLANT HAND TENDON
20|FH_F119379_0_0|SrvcGrp|92822|2022|PDM|1428.00|99|0.00|REPAIR OF RUPTURED TENDON
20|FH_F119383_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F119383_0_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F119384_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F119384_0_0|SrvcGrp|107749|2022|PDM|280.00|99|0.00|CAPD/CCPD
20|FH_F119384_0_0|SrvcGrp|108043|2022|PDM|280.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD
20|FH_F119400_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F119435_0_0|CSTM-ALL|CSTM-00|2020|PDM|1295.00|99|0.00|AEG 4 (NO REV)
20|FH_F119435_0_0|CSTM-ALL|CSTM-00|2020|PDM|1775.00|99|0.00|AEG 6 (NO REV)
20|FH_F119435_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|AEG 10 (NO REV)
20|FH_F119435_0_0|CSTM-ALL|CSTM-00|2020|PDM|2750.00|99|0.00|AEG 9 (NO REV)
20|FH_F119435_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F119435_0_0|SrvcGrp|107880|2022|PDM|543.00|99|0.00|BALO ANGIOP CTR DIALYSIS SEG
20|FH_F119435_0_0|SrvcGrp|77276|2022|PDM|543.00|99|0.00|AETNA REP CV ACSS CATH W/O PORT/PUMP
20|FH_F101441_0_0|CSTM-ALL|CSTM-00|2020|PDM|4431.00|99|0.00|AEG 9 (NO REV)
20|FH_F101441_0_0|SrvcGrp|16692|2022|PDM|3567.00|99|0.00|KNEE SCOPE
20|FH_F101441_0_0|SrvcGrp|19921|2022|PDM|4862.00|99|0.00|ARTHROSCOPICALLY LIGAMENT REPAIR
20|FH_F101441_0_0|SrvcGrp|19991|2022|PDM|8105.00|99|0.00|NERVOUS SYSTEM SERVICES
20|FH_F101441_0_0|SrvcGrp|44461|2022|PDM|7946.00|99|0.00|INSERTION / REPLACEMENT OF SPINAL NEUROSTIMULATOR GENERATOR
20|FH_F101441_0_0|SrvcGrp|96899|2022|PDM|8105.00|99|0.00|LUMBAR ARTIF DISCECTOMY
20|FH_F101441_0_0|SrvcGrp|96919|2022|PDM|4323.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F101441_0_0|SrvcGrp|96979|2022|PDM|3567.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F101441_0_0|SrvcGrp|97079|2022|PDM|3497.00|99|0.00|MENISCUS REPAIR, MED OR LAT
20|FH_F101441_0_0|SrvcGrp|97099|2022|PDM|7946.00|99|0.00|SPINAL DISK SURGERY ADD-ON
20|FH_F101441_0_0|SrvcGrp|97299|2022|PDM|7946.00|99|0.00|REMOVE SPINE ELTRD PLATE
20|FH_F101441_0_0|SrvcGrp|97362|2022|PDM|8105.00|99|0.00|INCISE SPINAL COLUMN NERVES
20|FH_F101442_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F101442_0_0|CSTM-ALL|CSTM-00|2020|PDM|1613.00|99|0.00|AEG 8 (NO REV)
20|FH_F101442_0_0|CSTM-ALL|CSTM-00|2020|PDM|2222.00|99|0.00|AEG 9 (NO REV)
20|FH_F101442_0_0|SrvcGrp|33980|2022|PDM|1278.37|99|0.00|CPT 28298
20|FH_F101442_0_0|SrvcGrp|33982|2022|PDM|1327.08|99|0.00|CPT 28296
20|FH_F101442_0_0|SrvcGrp|36873|2022|PDM|3252.48|99|0.00|HAMMERTOE
20|FH_F101442_0_0|SrvcGrp|89988|2022|PDM|1373.81|99|0.00|REPAIR HALLUX RIGIDUS
20|FH_F101442_0_0|SrvcGrp|98457|2022|PDM|1503.05|99|0.00|TREAT FOOT BONE LESION
20|FH_F101442_0_0|SrvcGrp|98458|2022|PDM|2393.85|99|0.00|RESECT FOOT
20|FH_F101442_0_0|SrvcGrp|98467|2022|PDM|1218.19|99|0.00|REPAIR BIG TOE FRACTURE
20|FH_F101607_0_0|CSTM-ALL|CSTM-00|2020|PDM|1040.00|99|0.00|AEG 5  (NO REV)
20|FH_F101607_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AEG 1 (NO REV)
20|FH_F101607_0_0|CSTM-ALL|CSTM-00|2020|PDM|739.00|99|0.00|AEG 3 (NO REV)
20|FH_F101607_0_0|SrvcGrp|74587|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F101685_0_0|SrvcGrp|104022|2022|PDM|4400.00|99|0.00|CYSTOSCOPY IMPLANT 4 OR MORE
20|FH_F101685_0_0|SrvcGrp|73006|2022|PDM|1268.00|99|0.00|AEG 9
20|FH_F101700_0_0|CSTM-ALL|CSTM-00|2020|PDM|1080.00|99|0.00|AEG 7 (NO REV) INTERVENTIONAL PAIN CTR
20|FH_F101700_0_0|CSTM-ALL|CSTM-00|2020|PDM|365.00|99|0.00|AEG 1 (NO REV) INTERVENTIONAL PAIN CTR
20|FH_F101700_0_0|SrvcGrp|100660|2022|PDM|362.31|99|0.00|AETNA SURGERY
20|FH_F101700_0_0|SrvcGrp|104588|2022|PDM|362.31|99|0.00|EPIDURAL OR SUBARACHNOID; CERVICAL OR THORACIC
20|FH_F101700_0_0|SrvcGrp|45063|2022|PDM|509.00|99|0.00|CPT 64493  INJECTION CARVE OUT
20|FH_F101700_0_0|SrvcGrp|90976|2022|PDM|509.00|99|0.00|INJECTION PARAVERTEBRAL FACET JOINT
20|FH_F101700_0_0|SrvcGrp|98102|2022|PDM|42.41|99|0.00|DRAIN INJ JOING/BURSA W/US
20|FH_F101700_0_0|SrvcGrp|98604|2022|PDM|1700.00|99|0.00|IMPLANT SPINAL CANAL
20|FH_F101709_0_0|SrvcGrp|21978|2022|PDM|496.00|99|0.00|CPT 77003
20|FH_F101709_0_0|SrvcGrp|72121|2022|PDM|3045.00|99|0.00|ARTHOSCOPY
20|FH_F101709_0_0|SrvcGrp|73002|2022|PDM|2617.00|99|0.00|AEG 7
20|FH_F101709_0_0|SrvcGrp|82113|2022|PDM|3045.00|99|0.00|KNEE ARTHROSCOPY SURGERY
20|FH_F101709_0_0|SrvcGrp|85022|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F101709_0_0|SrvcGrp|96350|2022|PDM|8610.00|99|0.00|SHOULDER JOINT
20|FH_F101709_0_0|SrvcGrp|99073|2022|PDM|1.42|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F101711_0_0|SrvcGrp|23683|2022|PCT|0.00|99|0.00|SKILLED NURSING RN
20|FH_F101711_0_0|SrvcGrp|48385|2022|PDM|75.00|99|0.00|SPEECH THERAPY
20|FH_F101711_0_0|SrvcGrp|48396|2022|PDM|75.00|99|0.00|OT SERVICES
20|FH_F101711_0_0|SrvcGrp|88620|2022|PDM|85.00|99|0.00|SKILLED NURSING RN
20|FH_F101711_0_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN
20|FH_F101747_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F101752_0_0|SrvcGrp|75505|2022|PCT|0.90|99|0.00|CARDIAC STUDIES
20|FH_F101752_0_0|SrvcGrp|78579|2022|PDM|2618.00|99|0.00|AETNA ACUTE IP MEDICAL SVCS
20|FH_F101752_0_0|SrvcGrp|88978|2022|PDM|2561.00|99|0.00|VAGINAL DELIVERY
20|FH_F101752_0_0|SrvcGrp|90356|2022|PCT|0.90|99|0.00|OP DIALYSIS
20|FH_F101755_0_0|CSTM-ALL|CSTM-00|2020|PCT|52.00|99|0.00|GENERAL ACUTE CARE
20|FH_F101759_0_0|CSTM-ALL|CSTM-00|2020|PCT|61.00|99|0.00|OP SVCS
20|FH_F101806_0_0|SrvcGrp|75483|2022|PDM|564.65|99|0.00|AEG 3
20|FH_F101806_0_0|SrvcGrp|75487|2022|PDM|793.50|99|0.00|AEG 5
20|FH_F101806_0_0|SrvcGrp|75491|2022|PDM|1100.55|99|0.00|AEG 7
20|FH_F101806_0_0|SrvcGrp|75497|2022|PDM|696.60|99|0.00|AEG 10
20|FH_F101807_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F101844_0_0|CSTM-ALL|CSTM-00|2020|PDM|5962.00|99|0.00|AEG 4 (NO REV)
20|FH_F101844_0_0|CSTM-ALL|CSTM-00|2020|PDM|5962.00|99|0.00|AEG 6 (NO REV)
20|FH_F101844_0_0|SrvcGrp|89842|2022|PDM|8943.00|99|0.00|LUMBAR
20|FH_F101844_0_0|SrvcGrp|89856|2022|PDM|8943.00|99|0.00|LAMIN EXCIS EXTRADURAL LUMB
20|FH_F101844_0_0|SrvcGrp|93121|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F101847_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F101854_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F101854_0_0|CSTM-ALL|CSTM-00|2020|PDM|1433.00|99|0.00|AEG 9 (NO REV)
20|FH_F101854_0_0|CSTM-ALL|CSTM-00|2020|PDM|761.00|99|0.00|AEG 5  (NO REV)
20|FH_F101901_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F101901_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|AEG 5  (NO REV)
20|FH_F101901_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|AEG 6 (NO REV)
20|FH_F101901_0_0|CSTM-ALL|CSTM-00|2020|PDM|973.00|99|0.00|AEG 8 (NO REV)
20|FH_F101901_0_0|SrvcGrp|93121|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F101945_0_0|CSTM-ALL|CSTM-00|2020|PDM|1353.00|99|0.00|AEG 10 (NO REV)
20|FH_F101945_0_0|CSTM-ALL|CSTM-00|2020|PDM|1353.00|99|0.00|AEG 7 (NO REV)
20|FH_F101945_0_0|CSTM-ALL|CSTM-00|2020|PDM|1873.00|99|0.00|AEG 9 (NO REV)
20|FH_F101945_0_0|CSTM-ALL|CSTM-00|2020|PDM|884.00|99|0.00|AEG 2 (NO REV)
20|FH_F101945_0_0|CSTM-ALL|CSTM-00|2020|PDM|988.00|99|0.00|AEG 4 (NO REV)
20|FH_F101945_0_0|SrvcGrp|35668|2022|PDM|2726.00|99|0.00|CPT 29824
20|FH_F101945_0_0|SrvcGrp|54943|2022|PDM|2726.00|99|0.00|REPAIR OF SLAP LESION
20|FH_F101945_0_0|SrvcGrp|90366|2022|PDM|2261.00|99|0.00|RHINOPLASTY COMPLETE EXT PRT
20|FH_F101945_0_0|SrvcGrp|98401|2022|PDM|2261.00|99|0.00|RIB CARTILAGE GRAFT
20|FH_F101945_0_0|SrvcGrp|98403|2022|PDM|2261.00|99|0.00|RHINOPLASTY MAJOR REVISION
20|FH_F101945_0_0|SrvcGrp|98405|2022|PDM|1025.00|99|0.00|REPAIR OF NOSE FRACTURE
20|FH_F101945_0_0|SrvcGrp|98407|2022|PDM|2185.00|99|0.00|CORRECTION OF BUNION
20|FH_F102009_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F102009_0_0|CSTM-ALL|CSTM-00|2020|PDM|1196.58|99|0.00|AEG 6 (NO REV)
20|FH_F102009_0_0|CSTM-ALL|CSTM-00|2020|PDM|1442.60|99|0.00|AEG 7 (NO REV)
20|FH_F102009_0_0|CSTM-ALL|CSTM-00|2020|PDM|483.79|99|0.00|AEG 1 (NO REV)
20|FH_F102009_0_0|CSTM-ALL|CSTM-00|2020|PDM|646.80|99|0.00|AEG 2 (NO REV)
20|FH_F102009_0_0|CSTM-ALL|CSTM-00|2020|PDM|739.20|99|0.00|AEG 3 (NO REV)
20|FH_F102009_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F102020_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F102020_0_0|SrvcGrp|12401|2022|PDM|135.00|99|0.00|RN VISIT
20|FH_F102020_0_0|SrvcGrp|57968|2022|PDM|60.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F102063_0_0|SrvcGrp|48396|2022|PDM|140.00|99|0.00|OT SERVICES
20|FH_F102126_0_0|CSTM-ALL|CSTM-00|2020|PDM|248.00|99|0.00|AEG OUTPATIENT SURGERY
20|FH_F102163_0_0|SrvcGrp|42622|2022|PCT|0.00|99|0.00|SUBACUTE - LEVEL IV
20|FH_F102180_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F102180_0_0|SrvcGrp|75545|2022|PCT|0.84|99|0.00|SUB-ACUTE - LEVEL I AND II
20|FH_F102184_0_0|CSTM-ALL|CSTM-00|2020|PDM|1613.00|99|0.00|AEG 2 (NO REV)
20|FH_F102184_0_0|CSTM-ALL|CSTM-00|2020|PDM|2133.00|99|0.00|AEG 4 (NO REV)
20|FH_F102184_0_0|CSTM-ALL|CSTM-00|2020|PDM|2336.00|99|0.00|AEG 5  (NO REV)
20|FH_F102184_0_0|CSTM-ALL|CSTM-00|2020|PDM|2346.00|99|0.00|AEG 6 (NO REV)
20|FH_F102184_0_0|CSTM-ALL|CSTM-00|2020|PDM|962.00|99|0.00|AEG 10 (NO REV)
20|FH_F102184_0_0|SrvcGrp|36591|2022|PDM|7699.00|99|0.00|CPT 63685
20|FH_F102184_0_0|SrvcGrp|58993|2022|PDM|7215.00|99|0.00|DISKECTOMY
20|FH_F102184_0_0|SrvcGrp|74039|2022|PDM|7215.00|99|0.00|LAMINECTOMY
20|FH_F102184_0_0|SrvcGrp|78096|2022|PDM|2887.00|99|0.00|AETNA ARTHROSCOPY BICEPS
20|FH_F102184_0_0|SrvcGrp|89842|2022|PDM|7699.00|99|0.00|LUMBAR
20|FH_F102184_0_0|SrvcGrp|98493|2022|PDM|7699.00|99|0.00|THORACIC
20|FH_F102184_0_0|SrvcGrp|98499|2022|PDM|7215.00|99|0.00|INCISE SPINAL COLUMN NERVES
20|FH_F102184_0_0|SrvcGrp|98500|2022|PDM|7215.00|99|0.00|INCISE SPINAL COLUMN NERVES
20|FH_F102185_0_0|SrvcGrp|76501|2022|PDM|235.00|99|0.00|SUB-ACUTE - LEVEL I
20|FH_F102224_0_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|AEG 1 (NO REV)
20|FH_F102224_0_0|SrvcGrp|101282|2022|PDM|11000.00|99|0.00|REVISE HIP JOINT COMPONENT
20|FH_F102224_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F102224_0_0|SrvcGrp|108269|2022|PDM|11000.00|99|0.00|REVISE HIP JOINT COMPONENT
20|FH_F102224_0_0|SrvcGrp|108270|2022|PDM|11000.00|99|0.00|REVISE TOTAL KNEE REPAIR
20|FH_F102224_0_0|SrvcGrp|36591|2022|PDM|7000.00|99|0.00|CPT 63685
20|FH_F102224_0_0|SrvcGrp|40002|2022|PDM|11000.00|99|0.00|TOTAL HIP
20|FH_F102224_0_0|SrvcGrp|67065|2022|PDM|4500.00|99|0.00|CERVICAL SURGERY
20|FH_F102224_0_0|SrvcGrp|87677|2022|PDM|2080.00|99|0.00|CERVICAL OR THORACIC SURGERY
20|FH_F102224_0_0|SrvcGrp|88487|2022|PDM|4000.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION
20|FH_F102224_0_0|SrvcGrp|88493|2022|PDM|2120.00|99|0.00|AETNA VERTEBROPLASTY ADDL INJECT
20|FH_F102224_0_0|SrvcGrp|92416|2022|PDM|6000.00|99|0.00|CERVICAL LAMINOTOMY
20|FH_F102224_0_0|SrvcGrp|93069|2022|PDM|2300.00|99|0.00|POSTERIOR NON-SEGMENTAL INST
20|FH_F102224_0_0|SrvcGrp|93730|2022|PDM|2640.00|99|0.00|INJ PERIPHERAL NERVE
20|FH_F102224_0_0|SrvcGrp|96350|2022|PDM|9900.00|99|0.00|SHOULDER JOINT
20|FH_F102224_0_0|SrvcGrp|96819|2022|PDM|3000.00|99|0.00|DESTROY L/S FACET JNT ADDL
20|FH_F102224_0_0|SrvcGrp|99067|2022|PDM|2300.00|99|0.00|SPINE PROSTH DEVICE
20|FH_F102267_0_0|SrvcGrp|42784|2022|PDM|45.00|99|0.00|OCCUPATIONAL THERAPY  SRVCS
20|FH_F102267_0_0|SrvcGrp|42785|2022|PDM|45.00|99|0.00|SPEECH THERAPY  SRVCS
20|FH_F102267_0_0|SrvcGrp|76501|2022|PDM|235.00|99|0.00|SUB-ACUTE - LEVEL I
20|FH_F102302_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F102302_0_0|SrvcGrp|11043|2022|PDM|1817.00|99|0.00|CARPAL TUNNEL RELEASE
20|FH_F102302_0_0|SrvcGrp|38015|2022|PDM|29900.00|99|0.00|ARTHRODESIS
20|FH_F102302_0_0|SrvcGrp|72992|2022|PDM|901.00|99|0.00|AEG 2
20|FH_F102302_0_0|SrvcGrp|72998|2022|PDM|1484.00|99|0.00|AEG 5
20|FH_F102302_0_0|SrvcGrp|73000|2022|PDM|1537.00|99|0.00|AEG 6
20|FH_F102302_0_0|SrvcGrp|73006|2022|PDM|1934.00|99|0.00|AEG 9
20|FH_F102302_0_0|SrvcGrp|80136|2022|PDM|14750.00|99|0.00|IMPLANT SPINAL INFUSION
20|FH_F102302_0_0|SrvcGrp|80139|2022|PDM|18450.00|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F102302_0_0|SrvcGrp|85022|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F102302_0_0|SrvcGrp|87119|2022|PDM|8250.00|99|0.00|PERQ VERTEBRAL AUGMENTATION
20|FH_F102302_0_0|SrvcGrp|97179|2022|PDM|10850.00|99|0.00|DECOMPRESS SPINE CORD ADD-ON
20|FH_F102302_0_0|SrvcGrp|98561|2022|PDM|39100.00|99|0.00|ARTHRODESIS POSTERIOR TECH
20|FH_F102302_0_0|SrvcGrp|98565|2022|PDM|39100.00|99|0.00|LUMBAR SPINE FUSION COMBINED
20|FH_F102302_0_0|SrvcGrp|98568|2022|PDM|29900.00|99|0.00|EXPLORATION SPINAL FUSION
20|FH_F102302_0_0|SrvcGrp|98571|2022|PDM|29900.00|99|0.00|REMOVAL OF POSTERIOR SEGMENTAL INSTRUMENTATION
20|FH_F102302_0_0|SrvcGrp|98577|2022|PDM|29900.00|99|0.00|REMOVE VERTEBRAL BODY ADD-ON
20|FH_F102302_0_0|SrvcGrp|98580|2022|PDM|29900.00|99|0.00|ARTHRODESIS SACROILIAC JOINT
20|FH_F102302_0_0|SrvcGrp|98584|2022|PDM|25500.00|99|0.00|TOTAL DISC ARTHROPLASTY
20|FH_F102302_0_0|SrvcGrp|98585|2022|PDM|18450.00|99|0.00|INC FOR VAGUS N ELECT IMPL
20|FH_F102302_0_0|SrvcGrp|98588|2022|PDM|14750.00|99|0.00|REMOVE SPINE INFUSION DEVI16
20|FH_F102302_0_0|SrvcGrp|98589|2022|PDM|14300.00|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F102302_0_0|SrvcGrp|98590|2022|PDM|14300.00|99|0.00|NEUROELECTRODES IMPLANT
20|FH_F102302_0_0|SrvcGrp|98592|2022|PDM|10850.00|99|0.00|SPINAL CORD DECOMPRESS LUMBAR
20|FH_F102302_0_0|SrvcGrp|98595|2022|PDM|10850.00|99|0.00|SPINAL CRD DECOMP->2 LUMBAR
20|FH_F102302_0_0|SrvcGrp|98598|2022|PDM|10850.00|99|0.00|LUMBAR LAMINOTOMY
20|FH_F102302_0_0|SrvcGrp|98599|2022|PDM|10850.00|99|0.00|LAMINECTOMY W/FACE-THORACIC
20|FH_F102302_0_0|SrvcGrp|98604|2022|PDM|4550.00|99|0.00|IMPLANT SPINAL CANAL
20|FH_F102302_0_0|SrvcGrp|98605|2022|PDM|2550.00|99|0.00|TREAT TRIGEMINAL NERVE
20|FH_F102302_0_0|SrvcGrp|98608|2022|PDM|1817.00|99|0.00|REVISE ULNAR NERVE AT WRIST
20|FH_F102302_0_0|SrvcGrp|98639|2022|PDM|1817.00|99|0.00|REVISION OF ARM NERVE(S)
20|FH_F102341_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.69|99|0.00|OP SVCS
20|FH_F102341_0_0|SrvcGrp|1259|2022|PDM|1742.00|99|0.00|INTERMEDIATE INTENSIVE CARE UNIT
20|FH_F102341_0_0|SrvcGrp|73485|2022|PDM|1379.00|99|0.00|AETNA REHAB
20|FH_F102500_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F102500_0_0|SrvcGrp|72998|2022|PDM|1116.00|99|0.00|AEG 5
20|FH_F102500_0_0|SrvcGrp|73004|2022|PDM|1511.00|99|0.00|AEG 8
20|FH_F102500_0_0|SrvcGrp|84285|2022|PDM|2348.00|99|0.00|REVISE CORNEA WITH IMPLANT
20|FH_F102542_0_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE
20|FH_F102620_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|GENERAL ACUTE CARE
20|FH_F102620_0_0|SrvcGrp|58122|2022|PDM|170.78|99|0.00|IOP / MENTAL HEALTH / SUBSTANCE ABUSE
20|FH_F102623_0_0|SrvcGrp|78065|2022|PDM|180.00|99|0.00|DIALYSIS W/O HEMODIALYSIS W/1 DOC EVAL
20|FH_F102623_0_0|SrvcGrp|94502|2022|PDM|180.00|99|0.00|PERITONEAL/CAPD/CCPD
20|FH_F102641_0_0|SrvcGrp|16289|2022|PDM|1182.00|99|0.00|CARPAL TUNNEL RELEASE
20|FH_F102641_0_0|SrvcGrp|72994|2022|PDM|985.00|99|0.00|AEG 3
20|FH_F102641_0_0|SrvcGrp|72996|2022|PDM|1098.00|99|0.00|AEG 4
20|FH_F102641_0_0|SrvcGrp|73002|2022|PDM|1679.00|99|0.00|AEG 7
20|FH_F102641_0_0|SrvcGrp|73004|2022|PDM|1679.00|99|0.00|AEG 8
20|FH_F102641_0_0|SrvcGrp|77021|2022|PDM|3602.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY
20|FH_F102641_0_0|SrvcGrp|87677|2022|PDM|2026.00|99|0.00|CERVICAL OR THORACIC SURGERY
20|FH_F102641_0_0|SrvcGrp|87679|2022|PDM|2026.00|99|0.00|LUMBAR OR SACRAL SURGERY
20|FH_F102704_0_0|CSTM-ALL|CSTM-00|2020|PCT|40.00|99|0.00|GENERAL ACUTE CARE
20|FH_F102726_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|DIAGNOSTIC RADIOLOGY SERVICES
20|FH_F102726_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|PET SCAN FOR ER AND OP SERVICES
20|FH_F102760_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F102844_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F102881_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F102881_0_0|CSTM-ALL|CSTM-00|2020|PDM|1831.00|99|0.00|AEG 4 (NO REV)
20|FH_F102881_0_0|CSTM-ALL|CSTM-00|2020|PDM|2402.00|99|0.00|AEG 6 (NO REV)
20|FH_F102881_0_0|SrvcGrp|92825|2022|PCT|0.80|99|0.00|AETNA CARDIAC CATHERTERIZATION
20|FH_F102881_0_0|SrvcGrp|98721|2022|PCT|0.00|99|0.00|AETNA IMPLANTS DENIAL
20|FH_F102920_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F102920_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F102920_0_0|SrvcGrp|16289|2022|PDM|1182.00|99|0.00|CARPAL TUNNEL RELEASE
20|FH_F102920_0_0|SrvcGrp|72994|2022|PDM|985.00|99|0.00|AEG 3
20|FH_F102920_0_0|SrvcGrp|73000|2022|PDM|1394.00|99|0.00|AEG 6
20|FH_F102920_0_0|SrvcGrp|73002|2022|PDM|1679.00|99|0.00|AEG 7
20|FH_F102920_0_0|SrvcGrp|74039|2022|PDM|3602.00|99|0.00|LAMINECTOMY
20|FH_F102920_0_0|SrvcGrp|76847|2022|PDM|3152.00|99|0.00|AETNA ARTHROSCOPY
20|FH_F102920_0_0|SrvcGrp|96799|2022|PDM|2026.00|99|0.00|DESTROY C/TH FACET JNT ADDL
20|FH_F102943_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F102943_0_0|CSTM-ALL|CSTM-00|2020|PDM|573.00|99|0.00|AEG 3 (NO REV)
20|FH_F102943_0_0|CSTM-ALL|CSTM-00|2020|PDM|732.00|99|0.00|AEG 5  (NO REV)
20|FH_F102943_0_0|SrvcGrp|79577|2022|PDM|1044.65|99|0.00|CPT 43244
20|FH_F103060_0_0|SrvcGrp|36591|2022|PDM|8323.00|99|0.00|CPT 63685
20|FH_F103060_0_0|SrvcGrp|67065|2022|PDM|8323.00|99|0.00|CERVICAL SURGERY
20|FH_F103060_0_0|SrvcGrp|77021|2022|PDM|7803.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY
20|FH_F103060_0_0|SrvcGrp|88158|2022|PDM|7803.00|99|0.00|NECK SPINE DISK SURGERY
20|FH_F103060_0_0|SrvcGrp|88160|2022|PDM|7803.00|99|0.00|LAMINECTOMY W/FACETECTOMY
20|FH_F103060_0_0|SrvcGrp|89840|2022|PDM|8323.00|99|0.00|THORAX SPINE FUSION
20|FH_F103060_0_0|SrvcGrp|98495|2022|PDM|8323.00|99|0.00|ARTHRODESIS POSTERIOR TECH
20|FH_F103060_0_0|SrvcGrp|98496|2022|PDM|8323.00|99|0.00|ARTHRODESIS POSTERIOR ATLAS
20|FH_F103060_0_0|SrvcGrp|98500|2022|PDM|7803.00|99|0.00|INCISE SPINAL COLUMN NERVES
20|FH_F103122_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|AEG 4 (NO REV)
20|FH_F103122_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|AEG 6 (NO REV)
20|FH_F103122_0_0|CSTM-ALL|CSTM-00|2020|PDM|992.00|99|0.00|AEG 7 (NO REV)
20|FH_F103122_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F103122_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F103140_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|ACUTE REHABILITATION
20|FH_F103140_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|ICU
20|FH_F103220_0_0|CSTM-ALL|CSTM-00|2020|PDM|2420.00|99|0.00|AEG 10 (NO REV)
20|FH_F103220_0_0|CSTM-ALL|CSTM-00|2020|PDM|3410.00|99|0.00|AEG 9 (NO REV)
20|FH_F103220_0_0|SrvcGrp|41546|2022|PDM|6600.00|99|0.00|LAPAROSCOPIC APPENDECTOMY
20|FH_F103220_0_0|SrvcGrp|79757|2022|PDM|2805.00|99|0.00|ESOPHAGUS ENDOSCOPY REPAIR
20|FH_F103220_0_0|SrvcGrp|99144|2022|PDM|2310.00|99|0.00|BIOPSY OR EXC AXILLARY
20|FH_F103220_0_0|SrvcGrp|99145|2022|PDM|2750.00|99|0.00|HEMORRHOIDECTOMY
20|FH_F103220_0_0|SrvcGrp|99146|2022|PDM|3300.00|99|0.00|LIFEPORT 5 YEARS OR OLDER
20|FH_F103220_0_0|SrvcGrp|99148|2022|PDM|4510.00|99|0.00|HERNIA
20|FH_F103220_0_0|SrvcGrp|99149|2022|PDM|6600.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F103320_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F103320_0_0|SrvcGrp|72992|2022|PDM|655.00|99|0.00|AEG 2
20|FH_F103821_0_0|SrvcGrp|75545|2022|PDM|703.31|99|0.00|SUB-ACUTE - LEVEL I AND II
20|FH_F104180_0_0|SrvcGrp|75545|2022|PDM|440.00|99|0.00|SUB-ACUTE - LEVEL I AND II
20|FH_F104340_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F104700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F104700_0_0|SrvcGrp|72998|2022|PDM|1245.00|99|0.00|AEG 5
20|FH_F104700_0_0|SrvcGrp|73000|2022|PDM|1130.00|99|0.00|AEG 6
20|FH_F104800_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F104800_0_0|CSTM-ALL|CSTM-00|2020|PDM|575.00|99|0.00|AEG 10 (NO REV)
20|FH_F104800_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|AEG 5  (NO REV)
20|FH_F104800_0_0|SrvcGrp|23585|2022|PCT|0.50|99|0.00|IMPLANTS
20|FH_F104802_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F104802_0_0|SrvcGrp|100560|2022|PDM|90.00|99|0.00|FAMILY/COUPLES THERAPY
20|FH_F104941_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F105142_0_0|CSTM-ALL|CSTM-00|2020|PDM|720.21|99|0.00|AEG 5  (NO REV)
20|FH_F105142_0_0|CSTM-ALL|CSTM-00|2020|PDM|829.03|99|0.00|AEG 6 (NO REV)
20|FH_F105301_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F105301_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F105320_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING
20|FH_F105421_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F105421_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F105421_0_0|SrvcGrp|100950|2022|PDM|825.00|99|0.00|CHEMICAL DEPENDENCY DETOX
20|FH_F105593_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F105593_0_0|SrvcGrp|48385|2022|PDM|80.00|99|0.00|SPEECH THERAPY
20|FH_F105593_0_0|SrvcGrp|48394|2022|PDM|25.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F105600_0_0|CSTM-ALL|CSTM-00|2020|PDM|740.00|99|0.00|AEG 3 (NO REV)
20|FH_F105680_0_0|SrvcGrp|75479|2022|PDM|920.00|99|0.00|AEG 1
20|FH_F105680_0_0|SrvcGrp|75483|2022|PDM|1257.00|99|0.00|AEG 3
20|FH_F105680_0_0|SrvcGrp|75491|2022|PDM|1920.00|99|0.00|AEG 7
20|FH_F105680_0_0|SrvcGrp|75497|2022|PDM|1200.00|99|0.00|AEG 10
20|FH_F106020_0_0|CSTM-ALL|CSTM-00|2020|PDM|1012.00|99|0.00|AEG 3 (NO REV)
20|FH_F106020_0_0|CSTM-ALL|CSTM-00|2020|PDM|771.00|99|0.00|AEG 2 (NO REV)
20|FH_F106020_0_0|CSTM-ALL|CSTM-00|2020|PDM|899.00|99|0.00|AEG 10 (NO REV)
20|FH_F106020_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F106020_0_0|SrvcGrp|27261|2022|PDM|3047.00|99|0.00|CPT 27446
20|FH_F106020_0_0|SrvcGrp|27347|2022|PDM|1366.00|99|0.00|CPT 58558
20|FH_F106020_0_0|SrvcGrp|77582|2022|PDM|2101.00|99|0.00|CPT 31255
20|FH_F106500_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F106500_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F106500_0_0|SrvcGrp|101501|2022|PDM|96.41|99|0.00|PT/OT/ST
20|FH_F106500_0_0|SrvcGrp|10391|2022|PDM|1510.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F106500_0_0|SrvcGrp|472|2022|PDM|734.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F106500_0_0|SrvcGrp|82037|2022|PDM|1955.00|99|0.00|AETNA ICU
20|FH_F106822_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F106822_0_0|SrvcGrp|100248|2022|PDM|57.00|99|0.00|REMOVAL OF SKIN TAGS
20|FH_F106822_0_0|SrvcGrp|100249|2022|PDM|14.75|99|0.00|REMOVAL OF SKIN TAGS
20|FH_F106822_0_0|SrvcGrp|100263|2022|PDM|57.00|99|0.00|DESTRUCT LESION, 15 OR MORE
20|FH_F106822_0_0|SrvcGrp|100272|2022|PDM|9.50|99|0.00|IIV3 VACCINE SPLT 0.25 ML IM
20|FH_F106822_0_0|SrvcGrp|100274|2022|PDM|40.50|99|0.00|TETANUS DIPHTHERIA TOXOI
20|FH_F106822_0_0|SrvcGrp|100277|2022|PDM|59.71|99|0.00|HEPB VACCINE ADULT
20|FH_F106822_0_0|SrvcGrp|100279|2022|PDM|0.21|99|0.00|ALBUTEROL NON-COMPOUNDED
20|FH_F106822_0_0|SrvcGrp|101743|2022|PDM|7.95|99|0.00|IM ADMIN 1ST/ONLY COMPONENT
20|FH_F106822_0_0|SrvcGrp|22379|2022|PDM|30.00|99|0.00|CPT CODE 94010
20|FH_F106822_0_0|SrvcGrp|22380|2022|PDM|44.95|99|0.00|CPT CODE 94060
20|FH_F106822_0_0|SrvcGrp|25385|2022|PDM|30.00|99|0.00|CPT 10060
20|FH_F106822_0_0|SrvcGrp|68240|2022|PDM|57.00|99|0.00|DESTRUCTION WARTS - 1ST LESION
20|FH_F106822_0_0|SrvcGrp|68241|2022|PDM|2.13|99|0.00|DESTRUCTION WARTS - 2ND - 4TH LESIONS
20|FH_F106822_0_0|SrvcGrp|73362|2022|PDM|7.95|99|0.00|VACCINE SERVICES
20|FH_F106822_0_0|SrvcGrp|82745|2022|PDM|10.22|99|0.00|CULT BACT NO URINE/BLD/STOOL
20|FH_F106822_0_0|SrvcGrp|82757|2022|PDM|5.45|99|0.00|ASSAY BLOOD CREATININE
20|FH_F106841_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F106841_0_0|CSTM-ALL|CSTM-00|2020|PDM|1168.57|99|0.00|AEG 7 (NO REV)
20|FH_F106941_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE
20|FH_F106942_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F106961_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F106964_0_0|CSTM-ALL|CSTM-00|2020|PDM|1771.00|99|0.00|AEG 8 (NO REV)
20|FH_F106964_0_0|CSTM-ALL|CSTM-00|2020|PDM|328.00|99|0.00|AEG 10 (NO REV)
20|FH_F106964_0_0|CSTM-ALL|CSTM-00|2020|PDM|929.00|99|0.00|AEG 3 (NO REV)
20|FH_F106980_0_0|SrvcGrp|72994|2022|PDM|800.00|99|0.00|AEG 3
20|FH_F107200_0_0|CSTM-ALL|CSTM-00|2020|PDM|1405.00|99|0.00|AEG 6 (NO REV)
20|FH_F107200_0_0|CSTM-ALL|CSTM-00|2020|PDM|1457.00|99|0.00|AEG 5  (NO REV)
20|FH_F107200_0_0|CSTM-ALL|CSTM-00|2020|PDM|1457.00|99|0.00|AEG 8 (NO REV)
20|FH_F107200_0_0|SrvcGrp|101519|2022|PDM|6242.00|99|0.00|T1H UTERUS (<250G)
20|FH_F107200_0_0|SrvcGrp|101520|2022|PDM|6242.00|99|0.00|T1H W/T/O (<250G)
20|FH_F107200_0_0|SrvcGrp|27347|2022|PDM|1509.00|99|0.00|CPT 58558
20|FH_F107200_0_0|SrvcGrp|68000|2022|PDM|3641.00|99|0.00|CPT 58561
20|FH_F107200_0_0|SrvcGrp|73495|2022|PDM|5202.00|99|0.00|AETNA MYOMECTOMY
20|FH_F107200_0_0|SrvcGrp|89869|2022|PDM|1561.00|99|0.00|SPONTANEOUS ABORTION
20|FH_F107360_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F107480_0_0|SrvcGrp|75497|2022|PDM|500.00|99|0.00|AEG 10
20|FH_F107600_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F107600_0_0|CSTM-ALL|CSTM-00|2020|PDM|1083.00|99|0.00|AEG 7 (NO REV)
20|FH_F107600_0_0|CSTM-ALL|CSTM-00|2020|PDM|555.00|99|0.00|AEG 3 (NO REV)
20|FH_F107600_0_0|CSTM-ALL|CSTM-00|2020|PDM|780.00|99|0.00|AEG 10 (NO REV)
20|FH_F107782_0_0|CSTM-ALL|CSTM-00|2020|PDM|2400.00|99|0.00|AEG 3 (NO REV)
20|FH_F107782_0_0|CSTM-ALL|CSTM-00|2020|PDM|2450.00|99|0.00|AEG 4 (NO REV)
20|FH_F107782_0_0|CSTM-ALL|CSTM-00|2020|PDM|2450.00|99|0.00|AEG 6 (NO REV)
20|FH_F107782_0_0|SrvcGrp|102522|2022|PDM|2600.00|99|0.00|BARIATRIC SURGERY
20|FH_F107922_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F107922_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F107926_0_0|CSTM-ALL|CSTM-00|2020|PDM|556.00|99|0.00|AEG 10 (NO REV)
20|FH_F107926_0_0|CSTM-ALL|CSTM-00|2020|PDM|556.00|99|0.00|AEG 2 (NO REV)
20|FH_F107926_0_0|CSTM-ALL|CSTM-00|2020|PDM|889.00|99|0.00|AEG 5  (NO REV)
20|FH_F107926_0_0|SrvcGrp|103544|2022|PDM|1875.00|99|0.00|LASER TREATMENT RETINA
20|FH_F107926_0_0|SrvcGrp|112862|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F107926_0_0|SrvcGrp|11663|2022|PCT|0.80|99|0.00|IMPLANTS
20|FH_F107926_0_0|SrvcGrp|68280|2022|PDM|1875.00|99|0.00|CPT 67040
20|FH_F107926_0_0|SrvcGrp|68284|2022|PDM|1875.00|99|0.00|CPT 67113
20|FH_F108160_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F108420_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F108420_0_0|CSTM-ALL|CSTM-00|2020|PDM|1600.00|99|0.00|AEG 4 (NO REV)
20|FH_F108420_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F108680_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F108680_0_0|CSTM-ALL|CSTM-00|2020|PDM|1942.00|99|0.00|AEG 9 (NO REV)
20|FH_F108680_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 10 (NO REV)
20|FH_F108680_0_0|SrvcGrp|102723|2022|PDM|3850.00|99|0.00|NECK SPINE DISK SURGERY
20|FH_F108680_0_0|SrvcGrp|102726|2022|PCT|0.00|99|0.00|DESTROY CERV/THOR FACET JNT
20|FH_F108680_0_0|SrvcGrp|67066|2022|PDM|8800.00|99|0.00|CERVICAL SURGERY
20|FH_F108680_0_0|SrvcGrp|88487|2022|PDM|7700.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION
20|FH_F108680_0_0|SrvcGrp|92408|2022|PDM|7700.00|99|0.00|PERQ VERTEBRAL AUGMENTATION
20|FH_F108762_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F108762_0_0|SrvcGrp|42782|2022|PDM|45.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F108762_0_0|SrvcGrp|42785|2022|PDM|45.00|99|0.00|SPEECH THERAPY  SRVCS
20|FH_F108762_0_0|SrvcGrp|471|2022|PDM|580.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F108800_0_0|CSTM-ALL|CSTM-00|2020|PDM|1150.00|99|0.00|AEG 1 (NO REV)
20|FH_F108800_0_0|CSTM-ALL|CSTM-00|2020|PDM|3250.00|99|0.00|AEG 9 (NO REV)
20|FH_F108800_0_0|SrvcGrp|101180|2022|PDM|1000.00|99|0.00|AETNA HIP AND KNEE
20|FH_F108800_0_0|SrvcGrp|101184|2022|PDM|4000.00|99|0.00|AETNA SPINE
20|FH_F108800_0_0|SrvcGrp|101186|2022|PDM|9000.00|99|0.00|AETNA COMPLEX SPINE
20|FH_F108800_0_0|SrvcGrp|36591|2022|PDM|8000.00|99|0.00|CPT 63685
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|ALL DRUGS/AGENTS/INJ DRUG
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|BILIRUBIN DIRECT
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|ENTERAL NUTRITION VIA BOLUS
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|HOME HEALTH RN SERVICE
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|HOME INFUSION THERAPY
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|HOME THERAPY
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|HOME VISIT - PRENATAL
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|HORMONAL THERAPY (LEUPROLIDE/GOSERLINE)
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|IMMUNOMODULATING AGENTS VIG
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|IV SERVICES
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|ROUTINE VENIPUNCTURE
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|UNCLASSIFIED HOME INJECTABLES
20|FH_F109000_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F109000_0_0|CSTM-ALL|CSTM-00|2020|PDM|2483.00|99|0.00|AEG 8 (NO REV)
20|FH_F109000_0_0|CSTM-ALL|CSTM-00|2020|PDM|3080.00|99|0.00|AEG 6 (NO REV)
20|FH_F109000_0_0|SrvcGrp|19921|2022|PDM|4600.20|99|0.00|ARTHROSCOPICALLY LIGAMENT REPAIR
20|FH_F109000_0_0|SrvcGrp|19922|2022|PDM|4600.20|99|0.00|ARTHROSCOPY OF SHOULDER
20|FH_F109040_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F109040_0_0|SrvcGrp|26470|2022|PDM|180.00|99|0.00|SELF DIALYSIS TRAINING CAPD
20|FH_F109248_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F109248_0_0|CSTM-ALL|CSTM-00|2020|PDM|1107.00|99|0.00|AEG 6 (NO REV)
20|FH_F109248_0_0|CSTM-ALL|CSTM-00|2020|PDM|670.00|99|0.00|AEG 2 (NO REV)
20|FH_F109248_0_0|CSTM-ALL|CSTM-00|2020|PDM|901.00|99|0.00|AEG 10 (NO REV)
20|FH_F109248_0_0|SrvcGrp|35670|2022|PDM|3350.00|99|0.00|SPINAL NEUROSTIMULATORS PROCEDURE
20|FH_F109260_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F109260_0_0|CSTM-ALL|CSTM-00|2020|PDM|2124.97|99|0.00|AEG 6 (NO REV)
20|FH_F109260_0_0|CSTM-ALL|CSTM-00|2020|PDM|3492.01|99|0.00|AEG 9 (NO REV)
20|FH_F109260_0_0|SrvcGrp|85022|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F109277_0_0|SrvcGrp|9861|2022|PDM|1597.00|99|0.00|ACUTE REHABILITATION
20|FH_F109279_0_0|SrvcGrp|79588|2022|PDM|600.00|99|0.00|CPT 43235
20|FH_F109279_0_0|SrvcGrp|79593|2022|PDM|600.00|99|0.00|CPT 45378
20|FH_F109281_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F109281_0_0|CSTM-ALL|CSTM-00|2020|PDM|1950.00|99|0.00|AEG 7 (NO REV)
20|FH_F109281_0_0|SrvcGrp|85022|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F109281_0_0|SrvcGrp|98448|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F109320_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F109320_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F109343_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F109343_0_0|SrvcGrp|103604|2022|PCT|0.00|99|0.00|TRANSFER TO HOSPITAL
20|FH_F109394_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F109472_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F109472_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.79|99|0.00|GENERAL ACUTE CARE
20|FH_F109472_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.79|99|0.00|OP SVCS
20|FH_F109484_0_0|SrvcGrp|72990|2022|PDM|333.00|99|0.00|AEG 1
20|FH_F109501_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F109503_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F109513_0_0|SrvcGrp|64517|2022|PDM|2700.00|99|0.00|REDUCE MANMMAPLASTY
20|FH_F109513_0_0|SrvcGrp|65350|2022|PDM|2500.00|99|0.00|KNEE ARTHRO/ANTER
20|FH_F109513_0_0|SrvcGrp|72998|2022|PDM|1071.00|99|0.00|AEG 5
20|FH_F109513_0_0|SrvcGrp|83839|2022|PDM|2800.00|99|0.00|BREAST RECONSTRUCTION
20|FH_F119437_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F119437_0_0|SrvcGrp|35670|2022|PDM|4160.00|99|0.00|SPINAL NEUROSTIMULATORS PROCEDURE
20|FH_F119437_0_0|SrvcGrp|75479|2022|PDM|850.00|99|0.00|AEG 1
20|FH_F119437_0_0|SrvcGrp|75483|2022|PDM|1450.00|99|0.00|AEG 3
20|FH_F119437_0_0|SrvcGrp|75485|2022|PDM|1625.00|99|0.00|AEG 4
20|FH_F119437_0_0|SrvcGrp|75489|2022|PDM|2000.00|99|0.00|AEG 6
20|FH_F119437_0_0|SrvcGrp|88162|2022|PDM|4750.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON
20|FH_F119437_0_0|SrvcGrp|88163|2022|PDM|4000.00|99|0.00|LUMBAR SPINE FUSION
20|FH_F119437_0_0|SrvcGrp|93057|2022|PDM|4750.00|99|0.00|SPINAL BONE AUTOGRAFT
20|FH_F119437_0_0|SrvcGrp|93071|2022|PDM|4750.00|99|0.00|POSTERIOR SEGMENTAL INSTRU
20|FH_F119493_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA SUBACUTE CARE
20|FH_F119511_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|HSS ASC
20|FH_F119530_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F119530_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F119535_0_0|SrvcGrp|3142|2022|PDM|1550.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F119535_0_0|SrvcGrp|48085|2022|PDM|90.00|99|0.00|SPEECH PATHOLOGY VISIT
20|FH_F119544_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F119544_0_0|SrvcGrp|108082|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER
20|FH_F119544_0_0|SrvcGrp|108180|2022|PDM|500.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD
20|FH_F119555_0_0|CSTM-ALL|CSTM-00|2020|PDM|2830.00|99|0.00|GENERAL ACUTE CARE
20|FH_F119559_0_0|SrvcGrp|82981|2022|PDM|128.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F119575_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F119575_0_0|SrvcGrp|108081|2022|PDM|186.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS
20|FH_F119575_0_0|SrvcGrp|108082|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER
20|FH_F119578_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F119578_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F119578_0_0|SrvcGrp|108041|2022|PDM|435.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME
20|FH_F119581_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F119581_0_0|CSTM-ALL|CSTM-00|2020|PDM|424.00|99|0.00|AEG 1 (NO REV)
20|FH_F119581_0_0|CSTM-ALL|CSTM-00|2020|PDM|546.00|99|0.00|AEG 2 (NO REV)
20|FH_F119581_0_0|CSTM-ALL|CSTM-00|2020|PDM|764.00|99|0.00|AEG 4 (NO REV)
20|FH_F119581_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F119581_0_0|SrvcGrp|108191|2022|PDM|2646.00|99|0.00|ILIAC REVASC
20|FH_F119581_0_0|SrvcGrp|108193|2022|PDM|4697.00|99|0.00|TIB/PER REVASC W/TLA
20|FH_F119581_0_0|SrvcGrp|108194|2022|PDM|1273.00|99|0.00|INSERT TUN IP CATH PERC
20|FH_F119581_0_0|SrvcGrp|68546|2022|PDM|1361.00|99|0.00|CPT 36558
20|FH_F119588_0_0|CSTM-ALL|CSTM-00|2020|PDM|1117.00|99|0.00|AEG 7 W/O CARDIAC SVCS (NO REV)
20|FH_F119588_0_0|CSTM-ALL|CSTM-00|2020|PDM|1214.00|99|0.00|AEG 8 W/O CATHETER SVCS (NO REV)
20|FH_F119588_0_0|SrvcGrp|102419|2022|PDM|707.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F119588_0_0|SrvcGrp|102420|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATHETERIZATION INCIDENTAL CODES
20|FH_F119588_0_0|SrvcGrp|110853|2022|PCT|0.50|99|0.00|IMPLANTS
20|FH_F119594_0_0|CSTM-ALL|CSTM-00|2020|PDM|2072.00|99|0.00|GENERAL ACUTE CARE
20|FH_F119595_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F119595_0_0|CSTM-ALL|CSTM-00|2020|PCT|36500.00|99|0.00|TIMELY FILING
20|FH_F119601_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|OP SVCS
20|FH_F119602_0_0|CSTM-ALL|CSTM-00|2020|PDM|1088.00|99|0.00|AEG 6 (NO REV)
20|FH_F119602_0_0|CSTM-ALL|CSTM-00|2020|PDM|1282.00|99|0.00|AEG 8 (NO REV)
20|FH_F119602_0_0|CSTM-ALL|CSTM-00|2020|PDM|831.00|99|0.00|AEG 10 (NO REV)
20|FH_F119602_0_0|CSTM-ALL|CSTM-00|2020|PDM|945.00|99|0.00|AEG 5  (NO REV)
20|FH_F119602_0_0|SrvcGrp|11663|2022|PCT|1.05|99|0.00|IMPLANTS
20|FH_F119627_27288_0|SrvcGrp|102419|2022|PCT|0.75|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F119627_27288_0|SrvcGrp|103391|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F119627_27288_0|SrvcGrp|103913|2022|PCT|0.75|99|0.00|OP DIALYSIS
20|FH_F119627_27288_0|SrvcGrp|75505|2022|PCT|0.75|99|0.00|CARDIAC STUDIES
20|FH_F119635_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 4 (NO REV)
20|FH_F119635_0_0|CSTM-ALL|CSTM-00|2020|PDM|685.00|99|0.00|AEG 5  (NO REV)
20|FH_F119635_0_0|CSTM-ALL|CSTM-00|2020|PDM|934.00|99|0.00|AEG 8 (NO REV)
20|FH_F119635_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F119650_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F119650_0_0|SrvcGrp|101280|2022|PDM|25151.00|99|0.00|TOTAL HIP ARTHROPLASTY
20|FH_F119652_0_0|SrvcGrp|82037|2022|PDM|1600.00|99|0.00|AETNA ICU
20|FH_F119729_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F119760_0_0|SrvcGrp|63297|2022|PDM|105.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F119760_0_0|SrvcGrp|80920|2022|PDM|475.00|99|0.00|HOSPICE SERVICES
20|FH_F119760_0_0|SrvcGrp|89783|2022|PDM|105.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F119760_0_0|SrvcGrp|90707|2022|PDM|105.00|99|0.00|AETNA HOSPICE CARE
20|FH_F119760_0_0|SrvcGrp|97703|2022|PDM|105.00|99|0.00|HOSPICE IN LTCH (HCFA)
20|FH_F119775_0_0|SrvcGrp|103503|2022|PDM|1517.00|99|0.00|AETNA CARDIAC CATHERTERIZATION
20|FH_F119775_0_0|SrvcGrp|72990|2022|PDM|371.00|99|0.00|AEG 1
20|FH_F119775_0_0|SrvcGrp|72998|2022|PDM|872.00|99|0.00|AEG 5
20|FH_F119775_0_0|SrvcGrp|73000|2022|PDM|887.00|99|0.00|AEG 6
20|FH_F119775_0_0|SrvcGrp|73002|2022|PDM|1056.00|99|0.00|AEG 7
20|FH_F119775_0_0|SrvcGrp|73006|2022|PDM|1517.00|99|0.00|AEG 9
20|FH_F119784_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F119784_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AEG 2 (NO REV)
20|FH_F119784_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|AEG 4 (NO REV)
20|FH_F119795_0_0|CSTM-ALL|CSTM-00|2020|PDM|1860.00|99|0.00|AEG 5  (NO REV)
20|FH_F119795_0_0|CSTM-ALL|CSTM-00|2020|PDM|2825.00|99|0.00|AEG 8 (NO REV)
20|FH_F109513_0_0|SrvcGrp|86462|2022|PDM|1500.00|99|0.00|AREOLA RECONSTRUCTION
20|FH_F109513_0_0|SrvcGrp|90365|2022|PDM|2700.00|99|0.00|REPAIR METACARPAL FRACTURE
20|FH_F109513_0_0|SrvcGrp|90417|2022|PDM|2700.00|99|0.00|TREATMENT OF JOINT
20|FH_F109513_0_0|SrvcGrp|90420|2022|PDM|4000.00|99|0.00|REPAIR CLAVICLE FRACTURE
20|FH_F109513_0_0|SrvcGrp|90422|2022|PDM|3500.00|99|0.00|REPAIR GRAFT RADIUS OR ULNA
20|FH_F109513_0_0|SrvcGrp|90423|2022|PDM|3500.00|99|0.00|FUSION GRAFT OF WRIST JOINT
20|FH_F109513_0_0|SrvcGrp|90425|2022|PDM|2500.00|99|0.00|SHOULDER ARTHROSCOPY SURGERY
20|FH_F109513_0_0|SrvcGrp|90430|2022|PDM|2500.00|99|0.00|REPAIR ACHILLES TENDON
20|FH_F109513_0_0|SrvcGrp|90439|2022|PDM|2500.00|99|0.00|SHOULDER ARTHROSCOPY SURGERY
20|FH_F109526_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F109577_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F109577_0_0|SrvcGrp|103611|2022|PDM|123.00|99|0.00|DIABETIC MGMT PROGRAM - GROUP
20|FH_F109577_0_0|SrvcGrp|23681|2022|PDM|135.00|99|0.00|HOME VISIT - POSTNATAL
20|FH_F109577_0_0|SrvcGrp|29347|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE
20|FH_F109577_0_0|SrvcGrp|29464|2022|PDM|135.00|99|0.00|HOME HEALTH VISIT NEWBORN CARE
20|FH_F109577_0_0|SrvcGrp|53145|2022|PDM|133.00|99|0.00|SOCIAL WORKER
20|FH_F109577_0_0|SrvcGrp|53987|2022|PDM|35.00|99|0.00|PHOTOTHERAPY
20|FH_F109577_0_0|SrvcGrp|63119|2022|PDM|47.00|99|0.00|BASIC HOME HOSPICE CARE
20|FH_F109577_0_0|SrvcGrp|80716|2022|PDM|123.00|99|0.00|AETNA G0109
20|FH_F109577_0_0|SrvcGrp|87395|2022|PDM|133.00|99|0.00|HCPCS G0153 (HCFA)
20|FH_F109577_0_0|SrvcGrp|87396|2022|PDM|133.00|99|0.00|HCPCS G0155 (HCFA)
20|FH_F109577_0_0|SrvcGrp|89783|2022|PDM|195.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F109577_0_0|SrvcGrp|90339|2022|PDM|135.00|99|0.00|SKILLED NURSING RN
20|FH_F109581_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F109581_0_0|SrvcGrp|75487|2022|PDM|822.00|99|0.00|AEG 5
20|FH_F109581_0_0|SrvcGrp|75497|2022|PDM|886.00|99|0.00|AEG 10
20|FH_F109601_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F109601_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F109601_0_0|SrvcGrp|75491|2022|PDM|1096.00|99|0.00|AEG 7
20|FH_F109601_0_0|SrvcGrp|75497|2022|PDM|624.00|99|0.00|AEG 10
20|FH_F109606_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F109606_0_0|CSTM-ALL|CSTM-00|2020|PDM|808.00|99|0.00|AEG 2 (NO REV)
20|FH_F109607_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F109630_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F109630_0_0|CSTM-ALL|CSTM-00|2020|PDM|1193.60|99|0.00|AEG 3 (NO REV)
20|FH_F109630_0_0|CSTM-ALL|CSTM-00|2020|PDM|1540.60|99|0.00|AEG 7 (NO REV)
20|FH_F109645_0_0|SrvcGrp|103387|2022|PDM|85.00|99|0.00|NURSING ASSESSMENT/EVAL (HCFA)
20|FH_F109645_0_0|SrvcGrp|23683|2022|PDM|30.00|99|0.00|SKILLED NURSING RN
20|FH_F109645_0_0|SrvcGrp|34388|2022|PDM|88.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F109645_0_0|SrvcGrp|34390|2022|PDM|70.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F109648_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F109648_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|AEG 4 (NO REV)
20|FH_F109648_0_0|SrvcGrp|89569|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F109762_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F109762_0_0|SrvcGrp|72992|2022|PDM|500.00|99|0.00|AEG 2
20|FH_F109762_0_0|SrvcGrp|73000|2022|PDM|826.00|99|0.00|AEG 6
20|FH_F109762_0_0|SrvcGrp|86863|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F109803_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F109803_0_0|CSTM-ALL|CSTM-00|2020|PDM|778.00|99|0.00|AEG 4 (NO REV)
20|FH_F109821_0_0|CSTM-ALL|CSTM-00|2020|PDM|1173.00|99|0.00|AETNA AEG 7 NO REV WITHOUT CARV OUT SURGERY
20|FH_F109821_0_0|CSTM-ALL|CSTM-00|2020|PDM|1581.00|99|0.00|AETNA AEG 9 NO REV WITHOUT CARVEOUT SURGERY
20|FH_F109821_0_0|CSTM-ALL|CSTM-00|2020|PDM|663.00|99|0.00|AEG 10 (NO REV)
20|FH_F109821_0_0|SrvcGrp|102259|2022|PDM|2550.00|99|0.00|AETNA INSERTION OF HEART ELECTRODE
20|FH_F109821_0_0|SrvcGrp|103080|2022|PDM|1122.00|99|0.00|ORAL SURGERY
20|FH_F109821_0_0|SrvcGrp|103082|2022|PDM|714.00|99|0.00|GASTROENTEROLOGY
20|FH_F109821_0_0|SrvcGrp|11663|2022|PCT|1.02|99|0.00|IMPLANTS
20|FH_F109821_0_0|SrvcGrp|55084|2022|PDM|3264.00|99|0.00|CPT 52648
20|FH_F109821_0_0|SrvcGrp|58542|2022|PDM|4080.00|99|0.00|BARIATRIC SURGERY
20|FH_F109821_0_0|SrvcGrp|85022|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F109821_0_0|SrvcGrp|86235|2022|PDM|1020.00|99|0.00|AETHA HAND SURGERY
20|FH_F109843_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F109843_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F109843_0_0|CSTM-ALL|CSTM-00|2020|PDM|4950.00|99|0.00|AEG 8 (NO REV)
20|FH_F109843_0_0|CSTM-ALL|CSTM-00|2020|PDM|7150.00|99|0.00|AEG 9 (NO REV)
20|FH_F109843_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.50|99|0.00|AEG 2 (NO REV)
20|FH_F109907_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F109907_0_0|SrvcGrp|27969|2022|PDM|27.05|99|0.00|HOME HEALTH AIDE
20|FH_F109907_0_0|SrvcGrp|48396|2022|PDM|92.60|99|0.00|OT SERVICES
20|FH_F109926_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F109926_0_0|CSTM-ALL|CSTM-00|2020|PDM|593.00|99|0.00|AEG 3 (NO REV)
20|FH_F109926_0_0|CSTM-ALL|CSTM-00|2020|PDM|960.00|99|0.00|AEG 6 (NO REV)
20|FH_F109926_0_0|SrvcGrp|77507|2022|PCT|1.00|99|0.00|AETNA CORNEAL TISSUE HANDLING
20|FH_F109926_0_0|SrvcGrp|78046|2022|PCT|1.00|99|0.00|AETNA AQUEOUS SHUNT
20|FH_F109941_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F109949_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F109951_0_0|CSTM-ALL|CSTM-00|2020|PDM|1490.00|99|0.00|COVENTRY ENHANCED GROUPER 2
20|FH_F109951_0_0|CSTM-ALL|CSTM-00|2020|PDM|2106.00|99|0.00|COVENTRY ENHANCED GROUPER 10
20|FH_F109963_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F109963_0_0|SrvcGrp|72994|2022|PDM|615.00|99|0.00|AEG 3
20|FH_F109963_0_0|SrvcGrp|72998|2022|PDM|738.00|99|0.00|AEG 5
20|FH_F109963_0_0|SrvcGrp|73002|2022|PDM|1117.00|99|0.00|AEG 7
20|FH_F109963_0_0|SrvcGrp|73004|2022|PDM|981.00|99|0.00|AEG 8
20|FH_F100060_0_0|CSTM-ALL|CSTM-00|2020|PDM|2750.00|99|0.00|AEG 3 (NO REV)
20|FH_F100060_0_0|CSTM-ALL|CSTM-00|2020|PDM|7441.00|99|0.00|AEG 9 (NO REV)
20|FH_F100063_0_0|SrvcGrp|42785|2022|PDM|45.00|99|0.00|SPEECH THERAPY  SRVCS
20|FH_F100320_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F100320_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F100320_0_0|SrvcGrp|75481|2022|PDM|477.00|99|0.00|AEG 2
20|FH_F100320_0_0|SrvcGrp|75483|2022|PDM|546.00|99|0.00|AEG 3
20|FH_F100320_0_0|SrvcGrp|75493|2022|PDM|1041.00|99|0.00|AEG 8
20|FH_F100460_0_0|CSTM-ALL|CSTM-00|2020|PDM|970.00|99|0.00|AEG 4 (NO REV)
20|FH_F100460_0_0|SrvcGrp|105319|2022|PCT|0.00|99|0.00|IMPLT NROSTM PLS GEN DUA REC
20|FH_F100460_0_0|SrvcGrp|19991|2022|PDM|20428.00|99|0.00|NERVOUS SYSTEM SERVICES
20|FH_F100460_0_0|SrvcGrp|87526|2022|PDM|58366.00|99|0.00|AETNA PERMANENT NEUROSTIMULATOR
20|FH_F100520_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F100540_0_0|SrvcGrp|72990|2022|PDM|480.00|99|0.00|AEG 1
20|FH_F100540_0_0|SrvcGrp|73000|2022|PDM|1200.00|99|0.00|AEG 6
20|FH_F100540_0_0|SrvcGrp|73006|2022|PDM|909.00|99|0.00|AEG 9
20|FH_F100703_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F100703_0_0|CSTM-ALL|CSTM-00|2020|PDM|1785.00|99|0.00|AEG 2 (NO REV)
20|FH_F100703_0_0|CSTM-ALL|CSTM-00|2020|PDM|2415.00|99|0.00|AEG 4 (NO REV)
20|FH_F100703_0_0|CSTM-ALL|CSTM-00|2020|PDM|3151.00|99|0.00|AEG 6 (NO REV)
20|FH_F100703_0_0|CSTM-ALL|CSTM-00|2020|PDM|3642.00|99|0.00|AEG 8 (NO REV)
20|FH_F100703_0_0|SrvcGrp|113576|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F100703_0_0|SrvcGrp|113594|2022|PDM|8034.00|99|0.00|SPINE PROSTH DEVICE
20|FH_F100703_0_0|SrvcGrp|19922|2022|PDM|4200.00|99|0.00|ARTHROSCOPY OF SHOULDER
20|FH_F100703_0_0|SrvcGrp|3932|2022|PDM|4410.00|99|0.00|LITHOTRIPSY
20|FH_F100703_0_0|SrvcGrp|93740|2022|PDM|7876.00|99|0.00|REVISE/REMOVE NEURO RECEIVER
20|FH_F100703_0_0|SrvcGrp|96352|2022|PDM|6144.00|99|0.00|ANKLE JOINT
20|FH_F100703_0_0|SrvcGrp|96355|2022|PDM|8034.00|99|0.00|SPINE FIXATION
20|FH_F100703_0_0|SrvcGrp|97019|2022|PDM|4284.00|99|0.00|ARTHROSCOPY BICEPS TENODESIS
20|FH_F100703_0_0|SrvcGrp|97099|2022|PDM|8034.00|99|0.00|SPINAL DISK SURGERY ADD-ON
20|FH_F100703_0_0|SrvcGrp|97119|2022|PDM|8034.00|99|0.00|NECK SPINE DISK SURGERY
20|FH_F100703_0_0|SrvcGrp|97239|2022|PDM|7876.00|99|0.00|DISKECTOMY CERVICAL SINGLE
20|FH_F100703_0_0|SrvcGrp|97279|2022|PDM|8034.00|99|0.00|REMOVE SPINE ELTRD PERQ ARAY
20|FH_F100703_0_0|SrvcGrp|97319|2022|PDM|8034.00|99|0.00|REVISE SPINE ELTRD PLATE
20|FH_F100741_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F100741_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS
20|FH_F100741_0_0|SrvcGrp|72998|2022|PDM|1087.00|99|0.00|AEG 5
20|FH_F100741_0_0|SrvcGrp|73004|2022|PDM|1352.00|99|0.00|AEG 8
20|FH_F100741_0_0|SrvcGrp|90726|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F100789_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F100789_0_0|CSTM-ALL|CSTM-00|2020|PDM|1684.00|99|0.00|AEG 1 (NO REV)
20|FH_F100789_0_0|CSTM-ALL|CSTM-00|2020|PDM|2259.00|99|0.00|AEG 2 (NO REV)
20|FH_F100789_0_0|CSTM-ALL|CSTM-00|2020|PDM|2581.00|99|0.00|AEG 3 (NO REV)
20|FH_F100789_0_0|CSTM-ALL|CSTM-00|2020|PDM|3190.00|99|0.00|AEG 4 (NO REV)
20|FH_F100904_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F100904_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F100904_0_0|CSTM-ALL|CSTM-00|2020|PDM|789.00|99|0.00|AEG 5  (NO REV)
20|FH_F100904_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F100906_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F100906_0_0|SrvcGrp|14614|2022|PDM|2500.00|99|0.00|LITHOTRIPSY
20|FH_F100906_0_0|SrvcGrp|33967|2022|PDM|2500.00|99|0.00|CPT 47562
20|FH_F100906_0_0|SrvcGrp|36591|2022|PDM|4500.00|99|0.00|CPT 63685
20|FH_F100906_0_0|SrvcGrp|37984|2022|PDM|500.00|99|0.00|LUMBAR INJECTIONS PROCEDURE
20|FH_F100906_0_0|SrvcGrp|72996|2022|PDM|1007.00|99|0.00|AEG 4
20|FH_F100906_0_0|SrvcGrp|73000|2022|PDM|1316.00|99|0.00|AEG 6
20|FH_F100906_0_0|SrvcGrp|94682|2022|PDM|1500.00|99|0.00|SPINE OSTEOTOMY POSTERIOR
20|FH_F100906_0_0|SrvcGrp|97461|2022|PDM|6000.00|99|0.00|REVISON OF KNEE JOINT
20|FH_F100906_0_0|SrvcGrp|97464|2022|PDM|2000.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F100962_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F100962_0_0|SrvcGrp|72994|2022|PDM|884.00|99|0.00|AEG 3
20|FH_F100962_0_0|SrvcGrp|73000|2022|PDM|1144.00|99|0.00|AEG 6
20|FH_F100962_0_0|SrvcGrp|73002|2022|PDM|1248.00|99|0.00|AEG 7
20|FH_F100962_0_0|SrvcGrp|73008|2022|PDM|832.00|99|0.00|AEG 10
20|FH_F100962_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F100984_0_0|CSTM-ALL|CSTM-00|2020|PDM|474.00|99|0.00|AEG 2 (NO REV)
20|FH_F101083_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F101083_0_0|SrvcGrp|72996|2022|PDM|998.00|99|0.00|AEG 4
20|FH_F101083_0_0|SrvcGrp|73008|2022|PDM|997.00|99|0.00|AEG 10
20|FH_F101083_0_0|SrvcGrp|85980|2022|PDM|1575.00|99|0.00|CPT 58670
20|FH_F101104_0_0|SrvcGrp|14892|2022|PDM|175.00|99|0.00|HOME INFUSION NURSING SVCS
20|FH_F101104_0_0|SrvcGrp|53144|2022|PDM|160.00|99|0.00|SPEECH THERAPY
20|FH_F101104_0_0|SrvcGrp|86824|2022|PDM|175.00|99|0.00|CPT CODE 99601 (HCFA)
20|FH_F101104_0_0|SrvcGrp|87394|2022|PDM|148.00|99|0.00|HCPCS G0152 (HCFA)
20|FH_F101104_0_0|SrvcGrp|87396|2022|PDM|195.00|99|0.00|HCPCS G0155 (HCFA)
20|FH_F101104_0_0|SrvcGrp|90339|2022|PDM|125.00|99|0.00|SKILLED NURSING RN
20|FH_F101161_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F101161_0_0|SrvcGrp|15323|2022|PDM|168.00|99|0.00|ER LEVEL I
20|FH_F101161_0_0|SrvcGrp|15325|2022|PDM|700.00|99|0.00|ER LEVEL III
20|FH_F101184_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F101184_0_0|SrvcGrp|87077|2022|PDM|110.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F101201_0_0|SrvcGrp|86723|2022|PDM|275.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)
20|FH_F101246_0_0|CSTM-ALL|CSTM-00|2020|PCT|45.00|99|0.00|OP SVCS
20|FH_F101360_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F100060_0_0|CSTM-ALL|CSTM-00|2020|PDM|2480.00|99|0.00|AEG 2 (NO REV)
20|FH_F100060_0_0|SrvcGrp|11663|2022|PCT|0.50|99|0.00|IMPLANTS
20|FH_F100063_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F100063_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F100063_0_0|SrvcGrp|42784|2022|PDM|45.00|99|0.00|OCCUPATIONAL THERAPY  SRVCS
20|FH_F100063_0_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F100063_0_0|SrvcGrp|473|2022|PDM|315.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F100460_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F100460_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F100460_0_0|CSTM-ALL|CSTM-00|2020|PDM|1270.00|99|0.00|AEG 6 (NO REV)
20|FH_F100460_0_0|CSTM-ALL|CSTM-00|2020|PDM|1496.00|99|0.00|AEG 8 (NO REV)
20|FH_F100460_0_0|CSTM-ALL|CSTM-00|2020|PDM|2061.00|99|0.00|AEG 9 (NO REV)
20|FH_F100460_0_0|CSTM-ALL|CSTM-00|2020|PDM|788.00|99|0.00|AEG 1 (NO REV)
20|FH_F100460_0_0|CSTM-ALL|CSTM-00|2020|PDM|970.00|99|0.00|AEG 10 (NO REV)
20|FH_F100460_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F100520_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F100540_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F100540_0_0|SrvcGrp|11663|2022|PCT|1.05|99|0.00|IMPLANTS
20|FH_F100540_0_0|SrvcGrp|13187|2022|PCT|1.05|99|0.00|INTRAOCULAR LENSES
20|FH_F100540_0_0|SrvcGrp|72992|2022|PDM|969.25|99|0.00|AEG 2
20|FH_F100540_0_0|SrvcGrp|72996|2022|PDM|1363.50|99|0.00|AEG 4
20|FH_F100540_0_0|SrvcGrp|72998|2022|PDM|1035.00|99|0.00|AEG 5
20|FH_F100540_0_0|SrvcGrp|73004|2022|PDM|1413.00|99|0.00|AEG 8
20|FH_F100540_0_0|SrvcGrp|93121|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F100703_0_0|CSTM-ALL|CSTM-00|2020|PDM|2415.00|99|0.00|AEG 10 (NO REV)
20|FH_F100703_0_0|CSTM-ALL|CSTM-00|2020|PDM|4070.00|99|0.00|AEG 7 (NO REV)
20|FH_F100703_0_0|SrvcGrp|112025|2022|PDM|7876.00|99|0.00|TOTAL HIP ARTHROPLASTY
20|FH_F100703_0_0|SrvcGrp|12309|2022|PDM|8034.00|99|0.00|MICRODISKETOMY
20|FH_F100703_0_0|SrvcGrp|16694|2022|PDM|3535.00|99|0.00|KNEE SCOPE, CHONDROPLASTY
20|FH_F100703_0_0|SrvcGrp|19920|2022|PDM|3466.00|99|0.00|ARTHROSCOPY OF SHOULDER
20|FH_F100703_0_0|SrvcGrp|19921|2022|PDM|4821.00|99|0.00|ARTHROSCOPICALLY LIGAMENT REPAIR
20|FH_F100703_0_0|SrvcGrp|44461|2022|PDM|7876.00|99|0.00|INSERTION / REPLACEMENT OF SPINAL NEUROSTIMULATOR GENERATOR
20|FH_F100703_0_0|SrvcGrp|80139|2022|PDM|8034.00|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F100703_0_0|SrvcGrp|84442|2022|PDM|9977.00|99|0.00|REVISION KNEE
20|FH_F100703_0_0|SrvcGrp|96350|2022|PDM|8034.00|99|0.00|SHOULDER JOINT
20|FH_F100703_0_0|SrvcGrp|96899|2022|PDM|8034.00|99|0.00|LUMBAR ARTIF DISCECTOMY
20|FH_F100703_0_0|SrvcGrp|96939|2022|PDM|4200.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F100703_0_0|SrvcGrp|96979|2022|PDM|3535.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F100703_0_0|SrvcGrp|97199|2022|PDM|7876.00|99|0.00|THORAX SPINE DISK SURGERY
20|FH_F100703_0_0|SrvcGrp|97259|2022|PDM|8034.00|99|0.00|INCISE SPINAL COLUMN NERVES
20|FH_F100703_0_0|SrvcGrp|97299|2022|PDM|8034.00|99|0.00|REMOVE SPINE ELTRD PLATE
20|FH_F100703_0_0|SrvcGrp|97362|2022|PDM|7876.00|99|0.00|INCISE SPINAL COLUMN NERVES
20|FH_F100703_0_0|SrvcGrp|99073|2022|PDM|1.39|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F100741_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F100741_0_0|SrvcGrp|63469|2022|PDM|904.00|99|0.00|CPT 55700
20|FH_F100741_0_0|SrvcGrp|72990|2022|PDM|460.00|99|0.00|AEG 1
20|FH_F100741_0_0|SrvcGrp|72992|2022|PDM|616.00|99|0.00|AEG 2
20|FH_F100741_0_0|SrvcGrp|73008|2022|PDM|969.00|99|0.00|AEG 10
20|FH_F100789_0_0|CSTM-ALL|CSTM-00|2020|PDM|4205.00|99|0.00|AEG 6 (NO REV)
20|FH_F100789_0_0|SrvcGrp|11306|2022|PCT|0.74|99|0.00|IMPLANTS
20|FH_F100904_0_0|CSTM-ALL|CSTM-00|2020|PDM|1095.00|99|0.00|AEG 7 (NO REV)
20|FH_F100904_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|AEG 10 (NO REV)
20|FH_F100904_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|AEG 3 (NO REV)
20|FH_F100904_0_0|CSTM-ALL|CSTM-00|2020|PDM|693.00|99|0.00|AEG 4 (NO REV)
20|FH_F100906_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F100906_0_0|SrvcGrp|11673|2022|PDM|3500.00|99|0.00|CPT 29888
20|FH_F100906_0_0|SrvcGrp|35669|2022|PDM|3500.00|99|0.00|CPT 63650
20|FH_F100906_0_0|SrvcGrp|67073|2022|PDM|2000.00|99|0.00|CPT 22851
20|FH_F100906_0_0|SrvcGrp|73004|2022|PDM|2203.00|99|0.00|AEG 8
20|FH_F100906_0_0|SrvcGrp|78709|2022|PDM|6000.00|99|0.00|AETNA SPINE SURGERY
20|FH_F100906_0_0|SrvcGrp|84320|2022|PDM|2000.00|99|0.00|SPINE SURGERY
20|FH_F100906_0_0|SrvcGrp|97460|2022|PDM|6000.00|99|0.00|TOTAL HIP ARTHROPLASTY
20|FH_F100906_0_0|SrvcGrp|97462|2022|PDM|5000.00|99|0.00|ARTHRODESIS SACROILIAC JOINT
20|FH_F100906_0_0|SrvcGrp|97465|2022|PDM|1800.00|99|0.00|REMOVE PROSTATE REGROWTH
20|FH_F100906_0_0|SrvcGrp|97466|2022|PDM|1530.00|99|0.00|REPAIR INITIAL INGUINAL HERNIA
20|FH_F100962_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F100962_0_0|SrvcGrp|72990|2022|PDM|676.00|99|0.00|AEG 1
20|FH_F100962_0_0|SrvcGrp|72992|2022|PDM|832.00|99|0.00|AEG 2
20|FH_F100962_0_0|SrvcGrp|73004|2022|PDM|1301.00|99|0.00|AEG 8
20|FH_F100962_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F100984_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F100984_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F100984_0_0|CSTM-ALL|CSTM-00|2020|PDM|415.00|99|0.00|AEG 1 (NO REV)
20|FH_F100984_0_0|CSTM-ALL|CSTM-00|2020|PDM|542.00|99|0.00|AEG 3 (NO REV)
20|FH_F100984_0_0|CSTM-ALL|CSTM-00|2020|PDM|669.00|99|0.00|AEG 4 (NO REV)
20|FH_F100984_0_0|CSTM-ALL|CSTM-00|2020|PDM|761.00|99|0.00|AEG 10 (NO REV)
20|FH_F101041_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F101041_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F101041_0_0|SrvcGrp|87077|2022|PDM|130.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F101063_0_0|CSTM-ALL|CSTM-00|2020|PCT|62.00|99|0.00|GENERAL ACUTE CARE
20|FH_F101081_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F101083_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F109963_0_0|SrvcGrp|73008|2022|PDM|615.00|99|0.00|AEG 10
20|FH_F109980_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F110061_0_0|SrvcGrp|75479|2022|PDM|352.00|99|0.00|AEG 1
20|FH_F110061_0_0|SrvcGrp|75481|2022|PDM|473.00|99|0.00|AEG 2
20|FH_F110061_0_0|SrvcGrp|75497|2022|PDM|540.00|99|0.00|AEG 10
20|FH_F110061_0_0|SrvcGrp|93741|2022|PDM|4000.00|99|0.00|REVISE SPINE ELECTRODE PERCUTANEOUS ARRAY
20|FH_F110102_0_0|CSTM-ALL|CSTM-00|2020|PDM|150.00|99|0.00|HCFA HOSPICE HOME CARE
20|FH_F110102_0_0|SrvcGrp|104188|2022|PDM|650.00|99|0.00|IP HOSPICE
20|FH_F110102_0_0|SrvcGrp|104268|2022|PDM|150.00|99|0.00|HOSPICE HOME CARE
20|FH_F110121_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F110121_0_0|SrvcGrp|72992|2022|PDM|1155.00|99|0.00|AEG 2
20|FH_F110121_0_0|SrvcGrp|73002|2022|PDM|3885.00|99|0.00|AEG 7
20|FH_F110121_0_0|SrvcGrp|73004|2022|PDM|2625.00|99|0.00|AEG 8
20|FH_F110160_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F110160_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F110160_0_0|SrvcGrp|103301|2022|PDM|1500.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F110160_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F110160_0_0|SrvcGrp|73008|2022|PDM|928.00|99|0.00|AEG 10
20|FH_F110180_0_0|SrvcGrp|21975|2022|PDM|1575.00|99|0.00|INPATIENT SERVICES
20|FH_F110180_0_0|SrvcGrp|32703|2022|PDM|1900.00|99|0.00|ICU
20|FH_F110180_0_0|SrvcGrp|8950|2022|PDM|1730.00|99|0.00|INTERMEDIATE ICU/CCU
20|FH_F110184_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F110184_0_0|SrvcGrp|9875|2022|PDM|1100.00|99|0.00|ACUTE IP MEDICAL SERVICES
20|FH_F110220_0_0|SrvcGrp|92189|2022|PDM|701.23|99|0.00|CPT 95808  (HCFA)
20|FH_F110232_0_0|CSTM-ALL|CSTM-00|2020|PCT|64.00|99|0.00|GENERAL ACUTE CARE
20|FH_F110232_0_0|CSTM-ALL|CSTM-00|2020|PCT|64.00|99|0.00|OP SVCS
20|FH_F110233_0_0|SrvcGrp|74584|2022|PCT|0.94|99|0.00|AETNA OBSERVATION SERVICES
20|FH_F110233_0_0|SrvcGrp|75505|2022|PCT|0.94|99|0.00|CARDIAC STUDIES
20|FH_F110233_0_0|SrvcGrp|92825|2022|PCT|0.94|99|0.00|AETNA CARDIAC CATHERTERIZATION
20|FH_F110236_0_0|SrvcGrp|75479|2022|PDM|900.00|99|0.00|AEG 1
20|FH_F110240_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F110240_0_0|CSTM-ALL|CSTM-00|2020|PDM|716.00|99|0.00|AEG 2 (NO REV)
20|FH_F110240_0_0|SrvcGrp|79593|2022|PDM|743.00|99|0.00|CPT 45378
20|FH_F110240_0_0|SrvcGrp|91468|2022|PDM|743.00|99|0.00|DIAGNOSTIC COLONOSCOPY (HCFA)
20|FH_F110240_0_0|SrvcGrp|91475|2022|PDM|743.00|99|0.00|UPPER GI ENDOSCOPY BIOPSY (HCFA)
20|FH_F110240_0_0|SrvcGrp|91478|2022|PDM|743.00|99|0.00|COLONOSCOPY AND BIOPSY (HCFA)
20|FH_F110263_0_0|CSTM-ALL|CSTM-00|2020|PDM|1409.00|99|0.00|AEG 3 (NO REV)
20|FH_F110263_0_0|CSTM-ALL|CSTM-00|2020|PDM|2198.00|99|0.00|AEG 5  (NO REV)
20|FH_F110263_0_0|SrvcGrp|113462|2022|PDM|7140.00|99|0.00|LITHOTRIPSY ESWL
20|FH_F110263_0_0|SrvcGrp|113463|2022|PCT|0.00|99|0.00|LITHOTRIPSY ESWL INCIDENTAL CODES
20|FH_F110263_0_0|SrvcGrp|115582|2022|PDM|7140.00|99|0.00|CYSTO/URETERO LITHOTRIPSY (HCFA)
20|FH_F110263_0_0|SrvcGrp|115584|2022|PDM|8659.00|99|0.00|NEUROELECTRODES IMPLANTS (HCFA)
20|FH_F110263_0_0|SrvcGrp|115585|2022|PDM|20785.00|99|0.00|NEUROSTIMU INSERTION/REPLACE (HCFA)
20|FH_F110263_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F110263_0_0|SrvcGrp|27261|2022|PDM|8084.00|99|0.00|CPT 27446
20|FH_F110263_0_0|SrvcGrp|36591|2022|PDM|29402.00|99|0.00|CPT 63685
20|FH_F110308_0_0|SrvcGrp|73000|2022|PDM|700.00|99|0.00|AEG 6
20|FH_F110308_0_0|SrvcGrp|73004|2022|PDM|900.00|99|0.00|AEG 8
20|FH_F110342_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F110342_0_0|SrvcGrp|102420|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATHETERIZATION INCIDENTAL CODES
20|FH_F110342_0_0|SrvcGrp|11663|2022|PCT|1.05|99|0.00|IMPLANTS
20|FH_F110342_0_0|SrvcGrp|72990|2022|PDM|840.00|99|0.00|AEG 1
20|FH_F110342_0_0|SrvcGrp|72992|2022|PDM|1040.00|99|0.00|AEG 2
20|FH_F110342_0_0|SrvcGrp|72994|2022|PDM|1140.00|99|0.00|AEG 3
20|FH_F110342_0_0|SrvcGrp|72998|2022|PDM|1560.00|99|0.00|AEG 5
20|FH_F110342_0_0|SrvcGrp|73002|2022|PDM|2200.00|99|0.00|AEG 7
20|FH_F110342_0_0|SrvcGrp|73006|2022|PDM|2886.00|99|0.00|AEG 9
20|FH_F110342_0_0|SrvcGrp|73008|2022|PDM|1500.00|99|0.00|AEG 10
20|FH_F110342_0_0|SrvcGrp|89404|2022|PDM|8323.20|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F110360_0_0|CSTM-ALL|CSTM-00|2020|PDM|857.50|99|0.00|AEG 10 (NO REV)
20|FH_F110363_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F110363_0_0|SrvcGrp|103946|2022|PDM|168.00|99|0.00|HOSPICE OR HOME HLTH IN HOME
20|FH_F110363_0_0|SrvcGrp|103948|2022|PDM|168.00|99|0.00|HOSPICE IN LT/NON-SKILLED NF
20|FH_F110381_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F110381_0_0|SrvcGrp|103971|2022|PDM|2332.00|99|0.00|AETNA KNEE ARTHROSCOPY & REPAIR
20|FH_F110381_0_0|SrvcGrp|103972|2022|PDM|5872.00|99|0.00|AETNA NECK & SPINE SURGERY INCLUDING
20|FH_F110381_0_0|SrvcGrp|705|2022|PCT|0.50|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F110381_0_0|SrvcGrp|72990|2022|PDM|615.00|99|0.00|AEG 1
20|FH_F110381_0_0|SrvcGrp|72992|2022|PDM|901.00|99|0.00|AEG 2
20|FH_F110381_0_0|SrvcGrp|89942|2022|PDM|10335.00|99|0.00|PERCUTANEOUS INTRADISCAL
20|FH_F110448_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS
20|FH_F110453_0_0|SrvcGrp|73008|2022|PDM|677.00|99|0.00|AEG 10
20|FH_F110564_0_0|SrvcGrp|72990|2022|PDM|333.00|99|0.00|AEG 1
20|FH_F110564_0_0|SrvcGrp|73002|2022|PDM|995.00|99|0.00|AEG 7
20|FH_F110604_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F110604_0_0|CSTM-ALL|CSTM-00|2020|PDM|1375.00|99|0.00|AEG 4 (NO REV)
20|FH_F110604_0_0|CSTM-ALL|CSTM-00|2020|PDM|2090.00|99|0.00|AEG 7 (NO REV)
20|FH_F110604_0_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS
20|FH_F110604_0_0|SrvcGrp|113144|2022|PDM|6050.00|99|0.00|REMOVE VAGUS NERVE
20|FH_F110604_0_0|SrvcGrp|53066|2022|PDM|1100.00|99|0.00|INJECTION(S), LUMBAR OR SACRAL, EACH ADDITIONAL LEVEL
20|FH_F110604_0_0|SrvcGrp|55071|2022|PDM|1650.00|99|0.00|ARTHROSCOPY SHOULDER
20|FH_F110604_0_0|SrvcGrp|63462|2022|PDM|2318.00|99|0.00|CPT 64595
20|FH_F110604_0_0|SrvcGrp|63471|2022|PDM|43560.00|99|0.00|CPT 64590
20|FH_F110604_0_0|SrvcGrp|88163|2022|PDM|18150.00|99|0.00|LUMBAR SPINE FUSION
20|FH_F110604_0_0|SrvcGrp|90798|2022|PDM|18150.00|99|0.00|IMPLANT SPINE INFUSION PUMP19
20|FH_F110604_0_0|SrvcGrp|93724|2022|PDM|1650.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY
20|FH_F110604_0_0|SrvcGrp|98268|2022|PDM|6050.00|99|0.00|HIP ARTHROSCOPY DX
20|FH_F110606_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F110609_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F110621_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F110621_0_0|CSTM-ALL|CSTM-00|2020|PDM|1021.00|99|0.00|AEG 8 (NO REV)
20|FH_F110621_0_0|CSTM-ALL|CSTM-00|2020|PDM|1025.00|99|0.00|AEG 10 (NO REV)
20|FH_F110621_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 9 (NO REV)
20|FH_F110621_0_0|CSTM-ALL|CSTM-00|2020|PDM|346.00|99|0.00|AEG 1 (NO REV)
20|FH_F110621_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F110661_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F110720_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F110720_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F110720_0_0|SrvcGrp|104096|2022|PDM|4882.00|99|0.00|ANKLE ARTHROSCOPY/SURGERY
20|FH_F110720_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F110720_0_0|SrvcGrp|13187|2022|PCT|1.00|99|0.00|INTRAOCULAR LENSES
20|FH_F110720_0_0|SrvcGrp|85198|2022|PDM|4882.00|99|0.00|AETNA KNEE ARTHROSCOPY
20|FH_F110720_0_0|SrvcGrp|97119|2022|PDM|4882.00|99|0.00|NECK SPINE DISK SURGERY
20|FH_F110720_0_0|SrvcGrp|97139|2022|PDM|4882.00|99|0.00|LAMINECTOMY W/FACETECTOMY
20|FH_F110940_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F110940_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 9 (NO REV)
20|FH_F110940_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|AEG 8 (NO REV)
20|FH_F110940_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|AEG 1 (NO REV)
20|FH_F110940_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|AEG 4 (NO REV)
20|FH_F110940_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F110940_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F110940_0_0|SrvcGrp|13187|2022|PCT|1.00|99|0.00|INTRAOCULAR LENSES
20|FH_F110967_0_0|CSTM-ALL|CSTM-00|2020|PDM|1965.09|99|0.00|ASPG VI
20|FH_F110967_0_0|SrvcGrp|84721|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F111001_0_0|CSTM-ALL|CSTM-00|2020|PDM|11.00|99|0.00|LVN HOURLY
20|FH_F111001_0_0|CSTM-ALL|CSTM-00|2020|PDM|15.00|99|0.00|RESPITE CARE (MOD TD)
20|FH_F111001_0_0|CSTM-ALL|CSTM-00|2020|PDM|15.00|99|0.00|RN HOURLY
20|FH_F111001_0_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN
20|FH_F111001_0_0|SrvcGrp|27968|2022|PDM|40.00|99|0.00|SKILLED NURSING LPN
20|FH_F111044_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F111044_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F111044_0_0|CSTM-ALL|CSTM-00|2020|PDM|1178.00|99|0.00|AEG 4 (NO REV)
20|FH_F111044_0_0|CSTM-ALL|CSTM-00|2020|PDM|1442.00|99|0.00|AEG 6 (NO REV)
20|FH_F111044_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F111044_0_0|SrvcGrp|11673|2022|PDM|3090.00|99|0.00|CPT 29888
20|FH_F111044_0_0|SrvcGrp|26273|2022|PDM|2266.00|99|0.00|CPT 29880
20|FH_F111044_0_0|SrvcGrp|26278|2022|PDM|2266.00|99|0.00|CPT 29881
20|FH_F111044_0_0|SrvcGrp|27310|2022|PDM|1648.00|99|0.00|ENDOSCOPIC PLANTAR FASCIOTOMY
20|FH_F111044_0_0|SrvcGrp|35668|2022|PDM|2060.00|99|0.00|CPT 29824
20|FH_F111044_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F111044_0_0|SrvcGrp|77582|2022|PDM|2266.00|99|0.00|CPT 31255
20|FH_F111044_0_0|SrvcGrp|88597|2022|PDM|1648.00|99|0.00|INTERNAL FIX FOR FRACT/INSTA
20|FH_F111044_0_0|SrvcGrp|88600|2022|PDM|1648.00|99|0.00|WRIST ARTHROS DIAG W/WO BIO
20|FH_F111046_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F111046_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F111046_0_0|SrvcGrp|13595|2022|PDM|595.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC
20|FH_F111046_0_0|SrvcGrp|84284|2022|PDM|595.00|99|0.00|AMBULANCE SVC NEONATAL EMERG TRANSPORT
20|FH_F111064_0_0|CSTM-ALL|CSTM-00|2020|PCT|12000.00|99|0.00|TIMELY FILING
20|FH_F111141_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F111163_0_0|CSTM-ALL|CSTM-00|2020|PDM|939.00|99|0.00|AEG 10 (NO REV)
20|FH_F111163_0_0|SrvcGrp|88494|2022|PDM|3200.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION
20|FH_F111189_0_0|SrvcGrp|89337|2022|PDM|750.00|99|0.00|DETOXIFICATION
20|FH_F111207_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F111207_0_0|SrvcGrp|11199|2022|PCT|0.70|99|0.00|HYPERBARIC CHAMBER
20|FH_F111207_0_0|SrvcGrp|15659|2022|PCT|0.70|99|0.00|CHEMOTHERAPY
20|FH_F111207_0_0|SrvcGrp|17990|2022|PCT|0.70|99|0.00|CT / MRI
20|FH_F111207_0_0|SrvcGrp|471|2022|PDM|1800.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F111263_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F111288_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F111288_0_0|SrvcGrp|113482|2022|PDM|8670.00|99|0.00|LAPAROSCOPY
20|FH_F111288_0_0|SrvcGrp|11669|2022|PDM|5724.00|99|0.00|OP SURG
20|FH_F111288_0_0|SrvcGrp|53065|2022|PDM|1029.00|99|0.00|INJECTION(S), LUMBAR OR SACRAL, SINGLE LEVEL
20|FH_F111288_0_0|SrvcGrp|65625|2022|PDM|2488.00|99|0.00|CPT 30520
20|FH_F111288_0_0|SrvcGrp|84939|2022|PDM|22187.00|99|0.00|SHOULDER JOINT
20|FH_F111288_0_0|SrvcGrp|93057|2022|PDM|1034.00|99|0.00|SPINAL BONE AUTOGRAFT
20|FH_F111288_0_0|SrvcGrp|99067|2022|PDM|2527.00|99|0.00|SPINE PROSTH DEVICE
20|FH_F111300_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F111316_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F111316_0_0|SrvcGrp|73841|2022|PDM|400.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP
20|FH_F111316_0_0|SrvcGrp|89417|2022|PDM|400.00|99|0.00|PARTIAL HOSPITALIZATION
20|FH_F111320_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|AEG 8 (NO REV)
20|FH_F111320_0_0|SrvcGrp|46890|2022|PDM|2100.00|99|0.00|IMPLANT EYE SHUNT
20|FH_F111320_0_0|SrvcGrp|90795|2022|PDM|1200.00|99|0.00|EXCISION INFERIOR TURBINATE
20|FH_F111349_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F111349_0_0|SrvcGrp|471|2022|PDM|605.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F111349_0_0|SrvcGrp|472|2022|PDM|496.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F111589_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F111589_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F111589_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)
20|FH_F111593_0_0|SrvcGrp|103834|2022|PDM|2145.00|99|0.00|AETNA REMOVE BLADDER STONE
20|FH_F111593_0_0|SrvcGrp|63466|2022|PDM|2090.00|99|0.00|CPT 52005
20|FH_F111593_0_0|SrvcGrp|73000|2022|PDM|2043.80|99|0.00|AEG 6
20|FH_F111593_0_0|SrvcGrp|73006|2022|PDM|3822.50|99|0.00|AEG 9
20|FH_F111593_0_0|SrvcGrp|87054|2022|PDM|3025.00|99|0.00|CYSTOSCOPY CHEMODENERVATION
20|FH_F111594_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F111594_0_0|CSTM-ALL|CSTM-00|2020|PDM|2096.00|99|0.00|AEG 3 (NO REV)
20|FH_F111594_0_0|SrvcGrp|41335|2022|PDM|7215.00|99|0.00|TOTAL HIP
20|FH_F111594_0_0|SrvcGrp|54943|2022|PDM|2887.00|99|0.00|REPAIR OF SLAP LESION
20|FH_F111594_0_0|SrvcGrp|72121|2022|PDM|2887.00|99|0.00|ARTHOSCOPY
20|FH_F111594_0_0|SrvcGrp|74039|2022|PDM|7215.00|99|0.00|LAMINECTOMY
20|FH_F111594_0_0|SrvcGrp|77021|2022|PDM|7215.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY
20|FH_F111594_0_0|SrvcGrp|88160|2022|PDM|7215.00|99|0.00|LAMINECTOMY W/FACETECTOMY
20|FH_F111594_0_0|SrvcGrp|88164|2022|PDM|7699.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR
20|FH_F111594_0_0|SrvcGrp|88491|2022|PDM|7215.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR
20|FH_F111594_0_0|SrvcGrp|98493|2022|PDM|7699.00|99|0.00|THORACIC
20|FH_F111594_0_0|SrvcGrp|98494|2022|PDM|7699.00|99|0.00|ARTHRODESIS PRE-SACRAL
20|FH_F111594_0_0|SrvcGrp|98496|2022|PDM|7699.00|99|0.00|ARTHRODESIS POSTERIOR ATLAS
20|FH_F111594_0_0|SrvcGrp|98497|2022|PDM|7699.00|99|0.00|ARTHRODESIS POSTERIOR TECH
20|FH_F111594_0_0|SrvcGrp|98500|2022|PDM|7215.00|99|0.00|INCISE SPINAL COLUMN NERVES
20|FH_F111625_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F111661_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F111661_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 1 (NO REV)
20|FH_F111826_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F111826_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F111826_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F111826_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F111826_0_0|SrvcGrp|73000|2022|PDM|1320.00|99|0.00|AEG 6
20|FH_F111826_0_0|SrvcGrp|73002|2022|PDM|1430.00|99|0.00|AEG 7
20|FH_F111826_0_0|SrvcGrp|73006|2022|PDM|1870.00|99|0.00|AEG 9
20|FH_F111826_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F111835_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F111835_0_0|CSTM-ALL|CSTM-00|2020|PDM|1545.19|99|0.00|ASPG VIII
20|FH_F111835_0_0|CSTM-ALL|CSTM-00|2020|PDM|1580.13|99|0.00|ASPG VII
20|FH_F111835_0_0|CSTM-ALL|CSTM-00|2020|PDM|2126.43|99|0.00|ASPG IX
20|FH_F111840_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F111840_0_0|SrvcGrp|75483|2022|PDM|510.00|99|0.00|AEG 3
20|FH_F111840_0_0|SrvcGrp|75485|2022|PDM|630.00|99|0.00|AEG 4
20|FH_F111840_0_0|SrvcGrp|75489|2022|PDM|826.00|99|0.00|AEG 6
20|FH_F111852_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F111852_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING
20|FH_F111925_0_0|CSTM-ALL|CSTM-00|2020|PDM|1208.00|99|0.00|AEG 9 (NO REV)
20|FH_F111925_0_0|CSTM-ALL|CSTM-00|2020|PDM|1253.00|99|0.00|AEG 6 (NO REV)
20|FH_F111925_0_0|CSTM-ALL|CSTM-00|2020|PDM|814.00|99|0.00|AEG 10 (NO REV)
20|FH_F111925_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F111925_0_0|SrvcGrp|104562|2022|PDM|1602.00|99|0.00|AETNA ENCIRCLING MATERIAL
20|FH_F111925_0_0|SrvcGrp|88154|2022|PDM|1602.00|99|0.00|LASER TREATMENT OLD RETINA
20|FH_F111986_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F111986_0_0|SrvcGrp|104115|2022|PDM|1236.00|99|0.00|DESTRUCTION, ANAL LESION(S)
20|FH_F111986_0_0|SrvcGrp|104116|2022|PDM|1236.00|99|0.00|EXC RECT TUM TRANSANAL PART
20|FH_F111986_0_0|SrvcGrp|104124|2022|PDM|2060.00|99|0.00|ARTHROSCOPY SERVICES
20|FH_F111986_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F111986_0_0|SrvcGrp|16289|2022|PDM|1133.00|99|0.00|CARPAL TUNNEL RELEASE
20|FH_F111986_0_0|SrvcGrp|27261|2022|PDM|7725.00|99|0.00|CPT 27446
20|FH_F111986_0_0|SrvcGrp|35670|2022|PDM|3605.00|99|0.00|SPINAL NEUROSTIMULATORS PROCEDURE
20|FH_F111986_0_0|SrvcGrp|39909|2022|PDM|1545.00|99|0.00|PARTIAL MASTECTOMY
20|FH_F111986_0_0|SrvcGrp|67990|2022|PDM|2472.00|99|0.00|CPT 58660 58661 58662
20|FH_F111986_0_0|SrvcGrp|68543|2022|PDM|1854.00|99|0.00|CPT 36561
20|FH_F111986_0_0|SrvcGrp|73002|2022|PDM|1725.00|99|0.00|AEG 7
20|FH_F111986_0_0|SrvcGrp|73004|2022|PDM|1607.00|99|0.00|AEG 8
20|FH_F111986_0_0|SrvcGrp|73008|2022|PDM|1133.00|99|0.00|AEG 10
20|FH_F111986_0_0|SrvcGrp|78283|2022|PDM|2060.00|99|0.00|CPT 49505
20|FH_F111986_0_0|SrvcGrp|83835|2022|PDM|2472.00|99|0.00|REPLACE TISSUE EXPANDER
20|FH_F111986_0_0|SrvcGrp|83839|2022|PDM|3811.00|99|0.00|BREAST RECONSTRUCTION
20|FH_F111986_0_0|SrvcGrp|88594|2022|PDM|1854.00|99|0.00|OPERATIVE LARYNGOSCOPY
20|FH_F111986_0_0|SrvcGrp|89982|2022|PDM|3605.00|99|0.00|SHOULDER ARTHROSCOPY / SURGERY
20|FH_F111986_0_0|SrvcGrp|90420|2022|PDM|3605.00|99|0.00|REPAIR CLAVICLE FRACTURE
20|FH_F111986_0_0|SrvcGrp|92197|2022|PDM|1854.00|99|0.00|CORRECTION OF BUNION
20|FH_F111986_0_0|SrvcGrp|92369|2022|PDM|1854.00|99|0.00|REPAIR OF ANKLE LIGAMENTS
20|FH_F112024_0_0|SrvcGrp|82138|2022|PDM|1711.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F112064_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F112064_0_0|SrvcGrp|103897|2022|PDM|641.00|99|0.00|HOSPICE CONTINUOUS HOME CARE
20|FH_F112064_0_0|SrvcGrp|103899|2022|PDM|165.00|99|0.00|HOSPICE OR HOME HLTH IN HOME
20|FH_F112064_0_0|SrvcGrp|103900|2022|PDM|641.00|99|0.00|HOSPICE/HOME HLTH IN ASST LVG
20|FH_F112080_0_0|SrvcGrp|36591|2022|PDM|26000.00|99|0.00|CPT 63685
20|FH_F112080_0_0|SrvcGrp|72992|2022|PDM|647.00|99|0.00|AEG 2
20|FH_F112080_0_0|SrvcGrp|73006|2022|PDM|1942.00|99|0.00|AEG 9
20|FH_F112089_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F112089_0_0|CSTM-ALL|CSTM-00|2020|PDM|1388.00|99|0.00|AEG 2 (NO REV)
20|FH_F112089_0_0|CSTM-ALL|CSTM-00|2020|PDM|1866.00|99|0.00|AEG 10 (NO REV)
20|FH_F112089_0_0|CSTM-ALL|CSTM-00|2020|PDM|2033.00|99|0.00|AEG 7 (NO REV)
20|FH_F112089_0_0|CSTM-ALL|CSTM-00|2020|PDM|2126.00|99|0.00|AEG 8 (NO REV)
20|FH_F112089_0_0|CSTM-ALL|CSTM-00|2020|PDM|980.00|99|0.00|AEG 1 (NO REV)
20|FH_F112133_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 10 (NO REV)
20|FH_F112133_0_0|CSTM-ALL|CSTM-00|2020|PDM|446.00|99|0.00|AEG 2 (NO REV)
20|FH_F112133_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|AEG 3 (NO REV)
20|FH_F112153_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F112153_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F112153_0_0|CSTM-ALL|CSTM-00|2020|PDM|825.00|99|0.00|AEG 5  (NO REV)
20|FH_F112153_0_0|CSTM-ALL|CSTM-00|2020|PDM|925.00|99|0.00|AEG 6 (NO REV)
20|FH_F112163_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F112163_0_0|SrvcGrp|104745|2022|PDM|236.00|99|0.00|HOSPICE
20|FH_F112165_0_0|SrvcGrp|12664|2022|PCT|0.41|99|0.00|IMPLANTS
20|FH_F112165_0_0|SrvcGrp|72996|2022|PDM|3200.00|99|0.00|AEG 4
20|FH_F112165_0_0|SrvcGrp|73006|2022|PDM|2600.00|99|0.00|AEG 9
20|FH_F112263_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F112263_0_0|CSTM-ALL|CSTM-00|2020|PDM|1197.00|99|0.00|AEG 6 (NO REV)
20|FH_F112263_0_0|CSTM-ALL|CSTM-00|2020|PDM|1942.00|99|0.00|AEG 9 (NO REV)
20|FH_F112263_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 4 (NO REV)
20|FH_F112272_0_0|SrvcGrp|73485|2022|PDM|832.00|99|0.00|AETNA REHAB
20|FH_F112325_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F112325_0_0|SrvcGrp|24739|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F112374_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F112374_0_0|SrvcGrp|17100|2022|PDM|832.00|99|0.00|SKILLED NURSING
20|FH_F112408_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F112408_0_0|SrvcGrp|472|2022|PDM|315.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F112453_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F112453_0_0|SrvcGrp|61577|2022|PDM|498.75|99|0.00|HOSPICE
20|FH_F112453_0_0|SrvcGrp|80317|2022|PDM|105.00|99|0.00|RESPITE CARE
20|FH_F112468_0_0|SrvcGrp|73006|2022|PDM|1153.00|99|0.00|AEG 9
20|FH_F112468_0_0|SrvcGrp|74587|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F112508_0_0|SrvcGrp|10391|2022|PDM|1456.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F112526_0_0|SrvcGrp|90707|2022|PDM|105.00|99|0.00|AETNA HOSPICE CARE
20|FH_F112568_0_0|SrvcGrp|104841|2022|PDM|1047.73|99|0.00|HOSPICE CARE PROVIDED IP HOSPICE FAC
20|FH_F112568_0_0|SrvcGrp|104842|2022|PDM|1047.73|99|0.00|HOSPICE CARE PROVIDED IP HOSPICE FAC (HCFA)
20|FH_F112568_0_0|SrvcGrp|29155|2022|PDM|240.60|99|0.00|HOSPICE SVCS
20|FH_F112568_0_0|SrvcGrp|80918|2022|PDM|240.60|99|0.00|RESPITE CARE
20|FH_F112568_0_0|SrvcGrp|95661|2022|PDM|240.60|99|0.00|RESPITE CARE (HCFA)
20|FH_F112631_0_0|SrvcGrp|38364|2022|PDM|1417.00|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F112631_0_0|SrvcGrp|72990|2022|PDM|530.00|99|0.00|AEG 1
20|FH_F112631_0_0|SrvcGrp|72996|2022|PDM|727.00|99|0.00|AEG 4
20|FH_F112631_0_0|SrvcGrp|72998|2022|PDM|817.00|99|0.00|AEG 5
20|FH_F112631_0_0|SrvcGrp|73006|2022|PDM|1153.00|99|0.00|AEG 9
20|FH_F112631_0_0|SrvcGrp|73008|2022|PDM|796.00|99|0.00|AEG 10
20|FH_F112665_0_0|CSTM-ALL|CSTM-00|2020|PDM|1613.00|99|0.00|AEG 2 (NO REV)
20|FH_F112665_0_0|CSTM-ALL|CSTM-00|2020|PDM|2346.00|99|0.00|AEG 6 (NO REV)
20|FH_F112665_0_0|CSTM-ALL|CSTM-00|2020|PDM|2887.00|99|0.00|AEG 9 (NO REV)
20|FH_F112665_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F112665_0_0|SrvcGrp|35670|2022|PDM|7699.00|99|0.00|SPINAL NEUROSTIMULATORS PROCEDURE
20|FH_F112665_0_0|SrvcGrp|41334|2022|PDM|7215.00|99|0.00|TOTAL KNEE
20|FH_F112665_0_0|SrvcGrp|67279|2022|PDM|7699.00|99|0.00|CERVICAL SURGERY
20|FH_F112665_0_0|SrvcGrp|71666|2022|PDM|6737.00|99|0.00|CPT 63655
20|FH_F112665_0_0|SrvcGrp|78096|2022|PDM|2887.00|99|0.00|AETNA ARTHROSCOPY BICEPS
20|FH_F112665_0_0|SrvcGrp|88157|2022|PDM|7215.00|99|0.00|TOTAL HIP ARTHROPLASTY
20|FH_F112665_0_0|SrvcGrp|89404|2022|PDM|7215.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F112665_0_0|SrvcGrp|89842|2022|PDM|7699.00|99|0.00|LUMBAR
20|FH_F112665_0_0|SrvcGrp|98493|2022|PDM|7699.00|99|0.00|THORACIC
20|FH_F112665_0_0|SrvcGrp|98494|2022|PDM|7699.00|99|0.00|ARTHRODESIS PRE-SACRAL
20|FH_F112665_0_0|SrvcGrp|98498|2022|PDM|7215.00|99|0.00|TRANSPEDICULAR 1 SEG THORACIC
20|FH_F112704_0_0|CSTM-ALL|CSTM-00|2020|PDM|2116.40|99|0.00|AEG 9 (NO REV)
20|FH_F112704_0_0|CSTM-ALL|CSTM-00|2020|PDM|525.80|99|0.00|AEG 1 (NO REV)
20|FH_F112705_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|GENERAL ACUTE CARE
20|FH_F112705_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|OP SVCS
20|FH_F112708_0_0|CSTM-ALL|CSTM-00|2020|PDM|1548.00|99|0.00|AEG 7 (NO REV)
20|FH_F112708_0_0|CSTM-ALL|CSTM-00|2020|PDM|558.00|99|0.00|AEG 1 (NO REV)
20|FH_F112708_0_0|CSTM-ALL|CSTM-00|2020|PDM|882.00|99|0.00|AEG 3 (NO REV)
20|FH_F112708_0_0|SrvcGrp|11663|2022|PCT|1.10|99|0.00|IMPLANTS
20|FH_F112708_0_0|SrvcGrp|93121|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F112722_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.00|99|0.00|OP SVCS
20|FH_F112729_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|GENERAL ACUTE CARE
20|FH_F112729_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|OP SVCS
20|FH_F112791_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F112791_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F112791_0_0|SrvcGrp|73000|2022|PDM|945.00|99|0.00|AEG 6
20|FH_F112823_0_0|CSTM-ALL|CSTM-00|2020|PDM|1675.00|99|0.00|DEVICE INSERTION
20|FH_F112823_0_0|CSTM-ALL|CSTM-00|2020|PDM|1683.00|99|0.00|AEG 9 (NO REV)
20|FH_F112823_0_0|SrvcGrp|74587|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F112844_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F112844_0_0|SrvcGrp|65720|2022|PDM|115.00|99|0.00|RESPITE CARE
20|FH_F112844_0_0|SrvcGrp|74546|2022|PDM|545.00|99|0.00|HOSPICE SERVICES
20|FH_F112844_0_0|SrvcGrp|90477|2022|PDM|115.00|99|0.00|HOSPICE
20|FH_F112863_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F112863_0_0|CSTM-ALL|CSTM-00|2020|PDM|933.00|99|0.00|AEG 5  (NO REV)
20|FH_F112863_0_0|CSTM-ALL|CSTM-00|2020|PDM|997.00|99|0.00|AEG 3 (NO REV)
20|FH_F112863_0_0|SrvcGrp|104255|2022|PDM|1141.00|99|0.00|SKIN TISSUE REARRANGEMENT
20|FH_F112863_0_0|SrvcGrp|104261|2022|PDM|1141.00|99|0.00|FORMATION OF SKIN PEDICLE
20|FH_F112863_0_0|SrvcGrp|92547|2022|PDM|1141.00|99|0.00|SKIN FULL GRAFT PROCEDURE
20|FH_F112908_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F112908_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F112908_0_0|SrvcGrp|46605|2022|PDM|85.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES
20|FH_F112908_0_0|SrvcGrp|48398|2022|PDM|85.00|99|0.00|PT SERVICES
20|FH_F112943_0_0|CSTM-ALL|CSTM-00|2020|PDM|476.30|99|0.00|AEG 1 (NO REV)
20|FH_F112946_0_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|COVENTRY ENHANCED GROUPER 9
20|FH_F112946_0_0|CSTM-ALL|CSTM-00|2020|PDM|520.00|99|0.00|COVENTRY ENHANCED GROUPER 2
20|FH_F112946_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|COVENTRY ENHANCED GROUPER 3
20|FH_F112946_0_0|CSTM-ALL|CSTM-00|2020|PDM|730.00|99|0.00|COVENTRY ENHANCED GROUPER 5
20|FH_F112956_0_0|SrvcGrp|75479|2022|PDM|363.00|99|0.00|AEG 1
20|FH_F112956_0_0|SrvcGrp|75483|2022|PDM|612.00|99|0.00|AEG 3
20|FH_F112956_0_0|SrvcGrp|75491|2022|PDM|1087.00|99|0.00|AEG 7
20|FH_F112962_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F112962_0_0|CSTM-ALL|CSTM-00|2020|PDM|1102.00|99|0.00|AEG 8 (NO REV)
20|FH_F112962_0_0|CSTM-ALL|CSTM-00|2020|PDM|578.00|99|0.00|AEG 3 (NO REV)
20|FH_F112962_0_0|CSTM-ALL|CSTM-00|2020|PDM|813.00|99|0.00|AEG 5  (NO REV)
20|FH_F112967_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F112967_0_0|SrvcGrp|94780|2022|PDM|115.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)
20|FH_F112995_0_0|CSTM-ALL|CSTM-00|2020|PDM|537.57|99|0.00|AEG 2 (NO REV)
20|FH_F112995_0_0|CSTM-ALL|CSTM-00|2020|PDM|759.35|99|0.00|AEG 4 (NO REV)
20|FH_F112995_0_0|SrvcGrp|90318|2022|PCT|1.10|99|0.00|IMPLANTS/PROSTHETICS
20|FH_F113025_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F113025_0_0|SrvcGrp|104720|2022|PDM|485.00|99|0.00|BLEPHAROPLASTY UPPER EYELID
20|FH_F113025_0_0|SrvcGrp|104723|2022|PDM|719.00|99|0.00|REPAIR EYELID DEFECT
20|FH_F113025_0_0|SrvcGrp|75481|2022|PDM|468.00|99|0.00|AEG 2
20|FH_F113025_0_0|SrvcGrp|75497|2022|PDM|752.00|99|0.00|AEG 10
20|FH_F113033_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS
20|FH_F113041_0_0|CSTM-ALL|CSTM-00|2020|PCT|66.00|99|0.00|OP SVCS
20|FH_F113074_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F113074_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F113074_0_0|CSTM-ALL|CSTM-00|2020|PDM|686.00|99|0.00|AEG 9 (NO REV)
20|FH_F113074_0_0|CSTM-ALL|CSTM-00|2020|PDM|781.00|99|0.00|AEG 5  (NO REV)
20|FH_F113115_0_0|CSTM-ALL|CSTM-00|2020|PDM|1152.00|99|0.00|COVENTRY ENHANCED GROUPER 8
20|FH_F113115_0_0|CSTM-ALL|CSTM-00|2020|PDM|604.00|99|0.00|COVENTRY ENHANCED GROUPER 3
20|FH_F113115_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|COVENTRY ENHANCED GROUPER 10
20|FH_F113130_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F113130_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|AETNA SURGERY DEFAULT WITHOUT GROUPER 1
20|FH_F113139_0_0|CSTM-ALL|CSTM-00|2020|PDM|1390.00|99|0.00|AEG 7 (NO REV)
20|FH_F113139_0_0|CSTM-ALL|CSTM-00|2020|PDM|2008.00|99|0.00|AEG 9 (NO REV)
20|FH_F113139_0_0|CSTM-ALL|CSTM-00|2020|PDM|2375.00|99|0.00|AEG 8 (NO REV)
20|FH_F113139_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|AEG 10 W/O CPT 92978 (NO REV)
20|FH_F113139_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|AEG 3 (NO REV)
20|FH_F113139_0_0|CSTM-ALL|CSTM-00|2020|PDM|920.00|99|0.00|AEG 4 (NO REV)
20|FH_F113139_0_0|SrvcGrp|104921|2022|PDM|400.00|99|0.00|HEART FLOW RESERVE MEASURE-CONCUR
20|FH_F113139_0_0|SrvcGrp|104924|2022|PCT|1.00|99|0.00|GUIDE WIRE
20|FH_F113143_0_0|SrvcGrp|72990|2022|PDM|350.00|99|0.00|AEG 1
20|FH_F113143_0_0|SrvcGrp|73002|2022|PDM|1045.00|99|0.00|AEG 7
20|FH_F113143_0_0|SrvcGrp|73008|2022|PDM|536.00|99|0.00|AEG 10
20|FH_F113255_0_0|SrvcGrp|72992|2022|PDM|663.00|99|0.00|AEG 2
20|FH_F113255_0_0|SrvcGrp|86425|2022|PDM|737.00|99|0.00|EGD LESION ABLATION
20|FH_F113255_0_0|SrvcGrp|86426|2022|PDM|737.00|99|0.00|REMOVE INT/EXT HEM GROUP 2
20|FH_F113305_0_0|SrvcGrp|87077|2022|PDM|125.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F113385_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F113385_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F113386_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F113390_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F113390_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F113390_0_0|CSTM-ALL|CSTM-00|2020|PDM|1320.00|99|0.00|AEG 2 (NO REV)
20|FH_F113390_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|AEG 10 (NO REV)
20|FH_F113390_0_0|CSTM-ALL|CSTM-00|2020|PDM|2475.00|99|0.00|AEG 5  (NO REV)
20|FH_F113390_0_0|CSTM-ALL|CSTM-00|2020|PDM|2750.00|99|0.00|AEG 6 (NO REV)
20|FH_F113390_0_0|SrvcGrp|104907|2022|PDM|3135.00|99|0.00|EXCISE PAROTID GLAND/LESION
20|FH_F113390_0_0|SrvcGrp|105237|2022|PDM|1673.10|99|0.00|BIOPSY/REMOVAL LYMPH NODE(S)
20|FH_F113390_0_0|SrvcGrp|105238|2022|PDM|1320.00|99|0.00|INCISION OF TONGUE FOLD
20|FH_F113390_0_0|SrvcGrp|105244|2022|PDM|880.00|99|0.00|INCISION OF EARDRUM
20|FH_F113390_0_0|SrvcGrp|44144|2022|PDM|2200.00|99|0.00|CPT 42440
20|FH_F113390_0_0|SrvcGrp|59841|2022|PDM|1673.10|99|0.00|SUBMUCOUS RESECTION
20|FH_F113390_0_0|SrvcGrp|65403|2022|PDM|2200.00|99|0.00|CPT 42830
20|FH_F113390_0_0|SrvcGrp|78093|2022|PDM|1673.10|99|0.00|AETNA NASAL ENDOSCOPY SURG
20|FH_F113390_0_0|SrvcGrp|84910|2022|PDM|2475.00|99|0.00|ENDOSCOPY
20|FH_F113390_0_0|SrvcGrp|89884|2022|PDM|1673.10|99|0.00|AETNA ABLATE TURBINATE SUBMUC
20|FH_F113390_0_0|SrvcGrp|93642|2022|PDM|1673.10|99|0.00|BIOPSY REMOVAL LYMPH NODES
20|FH_F113390_0_0|SrvcGrp|94989|2022|PDM|2475.00|99|0.00|SINUS ENDO W/ BALLOON DILATION
20|FH_F113392_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F113392_0_0|CSTM-ALL|CSTM-00|2020|PDM|1479.50|99|0.00|AEG 9 (NO REV)
20|FH_F113392_0_0|CSTM-ALL|CSTM-00|2020|PDM|2750.00|99|0.00|AEG 10 (NO REV)
20|FH_F113392_0_0|SrvcGrp|103974|2022|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES
20|FH_F113392_0_0|SrvcGrp|105201|2022|PDM|1650.00|99|0.00|MUSCLE FLAP
20|FH_F113392_0_0|SrvcGrp|105203|2022|PDM|1650.00|99|0.00|MUSCLE FLAP
20|FH_F113392_0_0|SrvcGrp|74587|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F113392_0_0|SrvcGrp|84183|2022|PDM|1177.00|99|0.00|AETNA SURGERY OF BREAST CAPSULE
20|FH_F113392_0_0|SrvcGrp|86460|2022|PDM|2750.00|99|0.00|REVISE BREAST RECONSTRUCTION
20|FH_F113392_0_0|SrvcGrp|86462|2022|PDM|1177.00|99|0.00|AREOLA RECONSTRUCTION
20|FH_F113410_0_0|CSTM-ALL|CSTM-00|2020|PDM|1245.00|99|0.00|AEG 4 (NO REV)
20|FH_F113410_0_0|CSTM-ALL|CSTM-00|2020|PDM|1366.00|99|0.00|AEG 5  (NO REV)
20|FH_F113410_0_0|CSTM-ALL|CSTM-00|2020|PDM|1576.00|99|0.00|AEG 6 (NO REV)
20|FH_F113410_0_0|CSTM-ALL|CSTM-00|2020|PDM|1628.00|99|0.00|AEG 7 (NO REV)
20|FH_F113410_0_0|CSTM-ALL|CSTM-00|2020|PDM|1786.00|99|0.00|AEG 8 (NO REV)
20|FH_F113410_0_0|CSTM-ALL|CSTM-00|2020|PDM|814.00|99|0.00|AETNA AEG 2 W/O SURG CARVEOUT (NO REV)
20|FH_F113410_0_0|CSTM-ALL|CSTM-00|2020|PDM|946.00|99|0.00|AEG 3 (NO REV)
20|FH_F113410_0_0|SrvcGrp|101820|2022|PDM|3152.00|99|0.00|HYSTEROSCOPY RESECT SEPTUM
20|FH_F113410_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F113410_0_0|SrvcGrp|104555|2022|PDM|2101.00|99|0.00|HYSTEROSCOPY REMOVE FB
20|FH_F113410_0_0|SrvcGrp|104948|2022|PDM|1681.00|99|0.00|MASTECTOMY FOR GYNECOMASTIA
20|FH_F113410_0_0|SrvcGrp|105249|2022|PDM|2627.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F113410_0_0|SrvcGrp|105251|2022|PDM|2311.00|99|0.00|RPR I/HERNIA INIT REDUCTION
20|FH_F113410_0_0|SrvcGrp|105252|2022|PDM|1996.00|99|0.00|COLLARBONE REMOVAL
20|FH_F113410_0_0|SrvcGrp|105254|2022|PDM|1996.00|99|0.00|EXPLORE/TREAT ELBOW JOINT
20|FH_F113410_0_0|SrvcGrp|105255|2022|PDM|1996.00|99|0.00|ELBOW REPAIR
20|FH_F113410_0_0|SrvcGrp|105258|2022|PDM|946.00|99|0.00|UPPR GI SCOPE DILATE
20|FH_F113410_0_0|SrvcGrp|27343|2022|PDM|3677.00|99|0.00|OP SURGERY (CPT 25607 - 25609)
20|FH_F113410_0_0|SrvcGrp|63471|2022|PDM|3677.00|99|0.00|CPT 64590
20|FH_F113410_0_0|SrvcGrp|63472|2022|PDM|2364.00|99|0.00|CPT 64581
20|FH_F113410_0_0|SrvcGrp|64517|2022|PDM|3257.00|99|0.00|REDUCE MANMMAPLASTY
20|FH_F113410_0_0|SrvcGrp|65350|2022|PDM|3572.00|99|0.00|KNEE ARTHRO/ANTER
20|FH_F113410_0_0|SrvcGrp|65625|2022|PDM|1891.00|99|0.00|CPT 30520
20|FH_F113410_0_0|SrvcGrp|79588|2022|PDM|630.00|99|0.00|CPT 43235
20|FH_F113410_0_0|SrvcGrp|84181|2022|PDM|2837.00|99|0.00|AETNA IMMEDIATE BREAST PROSTHESIS
20|FH_F113410_0_0|SrvcGrp|84972|2022|PDM|709.00|99|0.00|CPT 43247
20|FH_F113410_0_0|SrvcGrp|86462|2022|PDM|1786.00|99|0.00|AREOLA RECONSTRUCTION
20|FH_F113410_0_0|SrvcGrp|88155|2022|PDM|4728.00|99|0.00|REVISE KNEECAP WITH IMPLANT
20|FH_F113410_0_0|SrvcGrp|89982|2022|PDM|2942.00|99|0.00|SHOULDER ARTHROSCOPY / SURGERY
20|FH_F113410_0_0|SrvcGrp|96559|2022|PDM|4833.00|99|0.00|TOTAL HYSTERCECTOMY
20|FH_F113426_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F113426_0_0|CSTM-ALL|CSTM-00|2020|PDM|1083.00|99|0.00|AEG 4 (NO REV)
20|FH_F113426_0_0|SrvcGrp|105282|2022|PCT|1.10|99|0.00|PROSTHETICS/IMPLANTS
20|FH_F113524_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F113524_0_0|SrvcGrp|105218|2022|PDM|12700.00|99|0.00|LUMBAR OR THORACIC SPINAL FUSION
20|FH_F113524_0_0|SrvcGrp|105220|2022|PDM|7000.00|99|0.00|SPINAL DECOMPRESSION
20|FH_F113537_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.64|99|0.00|GENERAL ACUTE CARE
20|FH_F113541_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F113541_0_0|CSTM-ALL|CSTM-00|2020|PDM|1018.00|99|0.00|AEG 10 (NO REV)
20|FH_F113541_0_0|CSTM-ALL|CSTM-00|2020|PDM|1946.00|99|0.00|AEG 8 (NO REV)
20|FH_F113541_0_0|CSTM-ALL|CSTM-00|2020|PDM|3606.00|99|0.00|BREAST RECONSTRUCTION
20|FH_F113541_0_0|SrvcGrp|104970|2022|PDM|1219.00|99|0.00|EXTENDED RECOVERY/OBSERVATION (8-15 HRS)(HCFA)
20|FH_F113541_0_0|SrvcGrp|23585|2022|PCT|1.10|99|0.00|IMPLANTS
20|FH_F113541_0_0|SrvcGrp|33985|2022|PDM|1955.00|99|0.00|CPT 19120
20|FH_F113541_0_0|SrvcGrp|39906|2022|PDM|1955.00|99|0.00|MASTECTOMY, SIMPLE, COMPLETE
20|FH_F113541_0_0|SrvcGrp|83839|2022|PDM|6662.00|99|0.00|BREAST RECONSTRUCTION
20|FH_F113541_0_0|SrvcGrp|84182|2022|PDM|2580.00|99|0.00|AETNA REMOVAL OF BREAST CAPSULE
20|FH_F113541_0_0|SrvcGrp|84183|2022|PDM|2580.00|99|0.00|AETNA SURGERY OF BREAST CAPSULE
20|FH_F113541_0_0|SrvcGrp|86462|2022|PDM|1956.00|99|0.00|AREOLA RECONSTRUCTION
20|FH_F113541_0_0|SrvcGrp|99073|2022|PDM|1.35|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F113546_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F113546_0_0|SrvcGrp|27968|2022|PDM|40.00|99|0.00|SKILLED NURSING LPN
20|FH_F113586_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F113586_0_0|SrvcGrp|75479|2022|PDM|816.00|99|0.00|AEG 1
20|FH_F113677_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F113677_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F113677_0_0|SrvcGrp|82981|2022|PDM|165.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F113682_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F113682_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F113682_0_0|SrvcGrp|45184|2022|PDM|247.23|99|0.00|OCCUPATIONAL THERAPY
20|FH_F113682_0_0|SrvcGrp|95360|2022|PDM|247.23|99|0.00|SPEECH THERAPY
20|FH_F113709_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F113709_0_0|SrvcGrp|87077|2022|PDM|122.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F113715_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F113765_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F113765_0_0|SrvcGrp|45924|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE
20|FH_F113765_0_0|SrvcGrp|48396|2022|PDM|85.00|99|0.00|OT SERVICES
20|FH_F113784_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F113784_0_0|SrvcGrp|48394|2022|PDM|25.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F113784_0_0|SrvcGrp|48396|2022|PDM|80.00|99|0.00|OT SERVICES
20|FH_F113784_0_0|SrvcGrp|48398|2022|PDM|80.00|99|0.00|PT SERVICES
20|FH_F101360_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AEG 1 (NO REV)
20|FH_F101360_0_0|CSTM-ALL|CSTM-00|2020|PDM|864.00|99|0.00|AEG 10 (NO REV)
20|FH_F101360_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 4 (NO REV)
20|FH_F101386_0_0|CSTM-ALL|CSTM-00|2020|PCT|74.00|99|0.00|OP SVCS
20|FH_F101441_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F101441_0_0|SrvcGrp|112025|2022|PDM|8105.00|99|0.00|TOTAL HIP ARTHROPLASTY
20|FH_F101441_0_0|SrvcGrp|113576|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F101441_0_0|SrvcGrp|19922|2022|PDM|4323.00|99|0.00|ARTHROSCOPY OF SHOULDER
20|FH_F101441_0_0|SrvcGrp|3932|2022|PDM|4450.00|99|0.00|LITHOTRIPSY
20|FH_F101441_0_0|SrvcGrp|64761|2022|PDM|8105.00|99|0.00|DISCECTOMY
20|FH_F101441_0_0|SrvcGrp|96350|2022|PDM|7946.00|99|0.00|SHOULDER JOINT
20|FH_F101441_0_0|SrvcGrp|96351|2022|PDM|8105.00|99|0.00|SPINE PROSTHESIS DEVICE
20|FH_F101441_0_0|SrvcGrp|96939|2022|PDM|4238.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F101441_0_0|SrvcGrp|96959|2022|PDM|3497.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F101441_0_0|SrvcGrp|97039|2022|PDM|3497.00|99|0.00|KNEE ARTHROSCOPY
20|FH_F101441_0_0|SrvcGrp|97119|2022|PDM|8105.00|99|0.00|NECK SPINE DISK SURGERY
20|FH_F101441_0_0|SrvcGrp|97139|2022|PDM|8105.00|99|0.00|LAMINECTOMY W/FACETECTOMY
20|FH_F101441_0_0|SrvcGrp|97179|2022|PDM|8105.00|99|0.00|DECOMPRESS SPINE CORD ADD-ON
20|FH_F101441_0_0|SrvcGrp|97199|2022|PDM|7946.00|99|0.00|THORAX SPINE DISK SURGERY
20|FH_F101441_0_0|SrvcGrp|97239|2022|PDM|8105.00|99|0.00|DISKECTOMY CERVICAL SINGLE
20|FH_F101442_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F101442_0_0|CSTM-ALL|CSTM-00|2020|PDM|1188.00|99|0.00|AEG 10 (NO REV)
20|FH_F101442_0_0|CSTM-ALL|CSTM-00|2020|PDM|1370.00|99|0.00|AEG 6 (NO REV)
20|FH_F101442_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|AEG 7 (NO REV)
20|FH_F101442_0_0|SrvcGrp|98461|2022|PDM|1825.25|99|0.00|OPEN TXMT TALOTARSAL DISLOCATION
20|FH_F101442_0_0|SrvcGrp|98464|2022|PDM|1295.50|99|0.00|RELEASE OF MIDFOOT JOINT
20|FH_F101442_0_0|SrvcGrp|98466|2022|PDM|1253.58|99|0.00|PARTIAL REMOVAL OF FOOT BONE
20|FH_F101442_0_0|SrvcGrp|98468|2022|PDM|1136.00|99|0.00|EXC FOOT/TOE TUM DEEP
20|FH_F101564_0_0|CSTM-ALL|CSTM-00|2020|PCT|54.00|99|0.00|OP SVCS
20|FH_F101606_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.66|99|0.00|OP SVCS
20|FH_F101607_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F101607_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F101607_0_0|CSTM-ALL|CSTM-00|2020|PDM|1197.00|99|0.00|AEG 6 (NO REV)
20|FH_F101607_0_0|CSTM-ALL|CSTM-00|2020|PDM|1410.00|99|0.00|AEG 8 (NO REV)
20|FH_F101607_0_0|CSTM-ALL|CSTM-00|2020|PDM|1442.00|99|0.00|AEG 7 (NO REV)
20|FH_F101607_0_0|SrvcGrp|73610|2022|PCT|1.05|99|0.00|AETNA IMPLANTS
20|FH_F101685_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F101685_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F101685_0_0|SrvcGrp|72996|2022|PDM|784.00|99|0.00|AEG 4
20|FH_F101685_0_0|SrvcGrp|73002|2022|PDM|1151.00|99|0.00|AEG 7
20|FH_F101700_0_0|CSTM-ALL|CSTM-00|2020|PDM|555.00|99|0.00|AEG 3 (NO REV) INTERVENTIONAL PAIN CTR
20|FH_F101700_0_0|CSTM-ALL|CSTM-00|2020|PDM|780.00|99|0.00|AEG 5 (NO REV) INTERVENTIONAL PAIN CTR
20|FH_F101700_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|AEG 6 (NO REV) INTERVENTIONAL PAIN CTR
20|FH_F101700_0_0|SrvcGrp|110443|2022|PDM|1476.00|99|0.00|REMOVE SPINAL CANAL CATHET
20|FH_F101700_0_0|SrvcGrp|44461|2022|PDM|1700.00|99|0.00|INSERTION / REPLACEMENT OF SPINAL NEUROSTIMULATOR GENERATOR
20|FH_F101700_0_0|SrvcGrp|53065|2022|PDM|362.31|99|0.00|INJECTION(S), LUMBAR OR SACRAL, SINGLE LEVEL
20|FH_F101700_0_0|SrvcGrp|74585|2022|PCT|1.00|99|0.00|AETNA OP IMPLANTS
20|FH_F101700_0_0|SrvcGrp|80137|2022|PDM|1300.00|99|0.00|IMPLANT SPINAL INFUSION
20|FH_F101700_0_0|SrvcGrp|87679|2022|PDM|862.19|99|0.00|LUMBAR OR SACRAL SURGERY
20|FH_F101700_0_0|SrvcGrp|93741|2022|PDM|1476.00|99|0.00|REVISE SPINE ELECTRODE PERCUTANEOUS ARRAY
20|FH_F101700_0_0|SrvcGrp|97279|2022|PDM|1200.00|99|0.00|REMOVE SPINE ELTRD PERQ ARAY
20|FH_F101700_0_0|SrvcGrp|98105|2022|PDM|32.11|99|0.00|DRAIN INJ JOINT/BURSA W/O U
20|FH_F101700_0_0|SrvcGrp|98580|2022|PDM|2600.00|99|0.00|ARTHRODESIS SACROILIAC JOINT
20|FH_F101709_0_0|SrvcGrp|11673|2022|PDM|3104.00|99|0.00|CPT 29888
20|FH_F101709_0_0|SrvcGrp|26274|2022|PDM|2985.00|99|0.00|CPT 29877
20|FH_F101709_0_0|SrvcGrp|26278|2022|PDM|2985.00|99|0.00|CPT 29881
20|FH_F101709_0_0|SrvcGrp|72996|2022|PDM|2681.00|99|0.00|AEG 4
20|FH_F101709_0_0|SrvcGrp|82107|2022|PDM|2865.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F101709_0_0|SrvcGrp|93121|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F101709_0_0|SrvcGrp|96352|2022|PDM|6584.00|99|0.00|ANKLE JOINT
20|FH_F101709_0_0|SrvcGrp|97364|2022|PDM|8610.00|99|0.00|SPINE CODES
20|FH_F101711_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F101711_0_0|SrvcGrp|27969|2022|PCT|0.00|99|0.00|HOME HEALTH AIDE
20|FH_F101711_0_0|SrvcGrp|29346|2022|PCT|0.00|99|0.00|SKILLED NURSING- LPN
20|FH_F101752_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F101752_0_0|SrvcGrp|10393|2022|PDM|5600.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F101752_0_0|SrvcGrp|36204|2022|PCT|0.00|99|0.00|ACUTE PSYCH
20|FH_F101752_0_0|SrvcGrp|75943|2022|PDM|5600.00|99|0.00|AETNA INPATIENT SURGICAL CARE
20|FH_F101752_0_0|SrvcGrp|79099|2022|PDM|2618.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS
20|FH_F101752_0_0|SrvcGrp|80258|2022|PCT|0.00|99|0.00|AETNA SKILLED CARE
20|FH_F101752_0_0|SrvcGrp|89939|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH INCIDENTAL CODES
20|FH_F101759_0_0|CSTM-ALL|CSTM-00|2020|PCT|61.00|99|0.00|GENERAL ACUTE CARE
20|FH_F101806_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F101806_0_0|SrvcGrp|13990|2022|PCT|1.05|99|0.00|PACEMAKER
20|FH_F101806_0_0|SrvcGrp|75479|2022|PDM|368.00|99|0.00|AEG 1
20|FH_F101806_0_0|SrvcGrp|75485|2022|PDM|696.60|99|0.00|AEG 4
20|FH_F101806_0_0|SrvcGrp|86863|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F101814_0_0|CSTM-ALL|CSTM-00|2020|PCT|37.00|99|0.00|GENERAL ACUTE CARE
20|FH_F101814_0_0|CSTM-ALL|CSTM-00|2020|PCT|37.00|99|0.00|OP SVCS
20|FH_F101819_0_0|CSTM-ALL|CSTM-00|2020|PCT|45.00|99|0.00|OP SVCS
20|FH_F101824_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F101824_0_0|SrvcGrp|16|2022|PDM|1050.00|99|0.00|ACUTE REHABILITATION
20|FH_F101844_0_0|CSTM-ALL|CSTM-00|2020|PDM|3577.00|99|0.00|AEG 10 (NO REV)
20|FH_F101844_0_0|CSTM-ALL|CSTM-00|2020|PDM|5962.00|99|0.00|AEG 3 (NO REV)
20|FH_F101844_0_0|CSTM-ALL|CSTM-00|2020|PDM|5962.00|99|0.00|AEG 8 (NO REV)
20|FH_F101844_0_0|SrvcGrp|41334|2022|PDM|8943.00|99|0.00|TOTAL KNEE
20|FH_F101844_0_0|SrvcGrp|98326|2022|PDM|8943.00|99|0.00|PERQ LAMOT/LAM LUMBAR
20|FH_F101847_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS
20|FH_F101901_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F101901_0_0|CSTM-ALL|CSTM-00|2020|PDM|1339.00|99|0.00|AEG 9 (NO REV)
20|FH_F101901_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|AEG 2 (NO REV)
20|FH_F101925_0_0|CSTM-ALL|CSTM-00|2020|PCT|86.00|99|0.00|OP SVCS
20|FH_F101945_0_0|CSTM-ALL|CSTM-00|2020|PDM|520.00|99|0.00|AEG 1 (NO REV)
20|FH_F101945_0_0|CSTM-ALL|CSTM-00|2020|PDM|936.00|99|0.00|AEG 3 (NO REV)
20|FH_F101945_0_0|SrvcGrp|11669|2022|PDM|2726.00|99|0.00|OP SURG
20|FH_F101945_0_0|SrvcGrp|55071|2022|PDM|2081.00|99|0.00|ARTHROSCOPY SHOULDER
20|FH_F101945_0_0|SrvcGrp|59841|2022|PDM|1025.00|99|0.00|SUBMUCOUS RESECTION
20|FH_F101945_0_0|SrvcGrp|98406|2022|PDM|2289.00|99|0.00|KNEE ARTHROSCOPY
20|FH_F102009_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AEG 10 (NO REV)
20|FH_F102009_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F102020_0_0|SrvcGrp|26001|2022|PDM|214.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F102020_0_0|SrvcGrp|3809|2022|PDM|802.00|99|0.00|HOSPICE CARE
20|FH_F102020_0_0|SrvcGrp|8962|2022|PDM|135.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F102020_0_0|SrvcGrp|9829|2022|PDM|143.00|99|0.00|PT SVCS
20|FH_F102063_0_0|SrvcGrp|23683|2022|PDM|50.00|99|0.00|SKILLED NURSING RN
20|FH_F102063_0_0|SrvcGrp|27968|2022|PDM|40.00|99|0.00|SKILLED NURSING LPN
20|FH_F102063_0_0|SrvcGrp|48398|2022|PDM|140.00|99|0.00|PT SERVICES
20|FH_F102063_0_0|SrvcGrp|88620|2022|PDM|140.00|99|0.00|SKILLED NURSING RN
20|FH_F102126_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F102126_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F102126_0_0|CSTM-ALL|CSTM-00|2020|PDM|580.00|99|0.00|AEG 2 (NO REV)
20|FH_F102163_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F102163_0_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I
20|FH_F102180_0_0|SrvcGrp|471|2022|PCT|0.84|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F102184_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F102184_0_0|CSTM-ALL|CSTM-00|2020|PDM|2096.00|99|0.00|AEG 3 (NO REV)
20|FH_F102184_0_0|SrvcGrp|11673|2022|PDM|4812.00|99|0.00|CPT 29888
20|FH_F102184_0_0|SrvcGrp|27261|2022|PDM|8661.00|99|0.00|CPT 27446
20|FH_F102184_0_0|SrvcGrp|67065|2022|PDM|7699.00|99|0.00|CERVICAL SURGERY
20|FH_F102184_0_0|SrvcGrp|67068|2022|PDM|7699.00|99|0.00|LUMBAR SPINE FUSION COMBINED
20|FH_F102184_0_0|SrvcGrp|88163|2022|PDM|5296.00|99|0.00|LUMBAR SPINE FUSION
20|FH_F102184_0_0|SrvcGrp|88491|2022|PDM|7215.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR
20|FH_F102184_0_0|SrvcGrp|89840|2022|PDM|7699.00|99|0.00|THORAX SPINE FUSION
20|FH_F102184_0_0|SrvcGrp|98494|2022|PDM|7699.00|99|0.00|ARTHRODESIS PRE-SACRAL
20|FH_F102184_0_0|SrvcGrp|98495|2022|PDM|7699.00|99|0.00|ARTHRODESIS POSTERIOR TECH
20|FH_F102184_0_0|SrvcGrp|98497|2022|PDM|7699.00|99|0.00|ARTHRODESIS POSTERIOR TECH
20|FH_F102185_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F102185_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F102185_0_0|SrvcGrp|471|2022|PDM|580.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F102185_0_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F102188_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F102188_0_0|SrvcGrp|22954|2022|PDM|139.71|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F102188_0_0|SrvcGrp|3809|2022|PDM|544.72|99|0.00|HOSPICE CARE
20|FH_F102224_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F102224_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 9 (NO REV)
20|FH_F102224_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 10 (NO REV)
20|FH_F102224_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|AEG 6 (NO REV)
20|FH_F102224_0_0|SrvcGrp|101114|2022|PDM|9900.00|99|0.00|ARTHOPLASTY
20|FH_F102224_0_0|SrvcGrp|58636|2022|PDM|6000.00|99|0.00|CPT 62362
20|FH_F102224_0_0|SrvcGrp|67072|2022|PDM|2300.00|99|0.00|CPT 22845
20|FH_F102224_0_0|SrvcGrp|71666|2022|PDM|6000.00|99|0.00|CPT 63655
20|FH_F102224_0_0|SrvcGrp|74039|2022|PDM|6000.00|99|0.00|LAMINECTOMY
20|FH_F102224_0_0|SrvcGrp|87679|2022|PDM|2080.00|99|0.00|LUMBAR OR SACRAL SURGERY
20|FH_F102224_0_0|SrvcGrp|88162|2022|PDM|4300.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON
20|FH_F102224_0_0|SrvcGrp|88492|2022|PDM|2300.00|99|0.00|AETNA SPINAL BONE AUTOGRAFT
20|FH_F102224_0_0|SrvcGrp|88739|2022|PDM|4000.00|99|0.00|IMPLANT SPINAL CANAL
20|FH_F102224_0_0|SrvcGrp|92365|2022|PDM|6800.00|99|0.00|FUSION OF SACROILIAC JOINT
20|FH_F102224_0_0|SrvcGrp|92408|2022|PDM|4000.00|99|0.00|PERQ VERTEBRAL AUGMENTATION
20|FH_F102224_0_0|SrvcGrp|93071|2022|PDM|5000.00|99|0.00|POSTERIOR SEGMENTAL INSTRU
20|FH_F102224_0_0|SrvcGrp|96779|2022|PDM|2300.00|99|0.00|SPINE OSTEOTOMY POST LUMBAR
20|FH_F102224_0_0|SrvcGrp|96780|2022|PDM|2300.00|99|0.00|REVISE EXTRA SPINE SEGMENT
20|FH_F102267_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F102267_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F102302_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F102302_0_0|SrvcGrp|64761|2022|PDM|10850.00|99|0.00|DISCECTOMY
20|FH_F102302_0_0|SrvcGrp|68742|2022|PDM|14300.00|99|0.00|CRANIAL DEVICE INSERTION/REPLACEMENT
20|FH_F102302_0_0|SrvcGrp|72996|2022|PDM|1272.00|99|0.00|AEG 4
20|FH_F102302_0_0|SrvcGrp|73002|2022|PDM|1644.00|99|0.00|AEG 7
20|FH_F102302_0_0|SrvcGrp|80135|2022|PDM|14750.00|99|0.00|INSERT SPINAL INFUSION
20|FH_F102302_0_0|SrvcGrp|80137|2022|PDM|14750.00|99|0.00|IMPLANT SPINAL INFUSION
20|FH_F102302_0_0|SrvcGrp|80283|2022|PDM|14300.00|99|0.00|AETNA REVISE/REMOVE NEUROELECTRODE
20|FH_F102302_0_0|SrvcGrp|87120|2022|PDM|8250.00|99|0.00|PERQ VERTEBRAL AUGMENTATION
20|FH_F102302_0_0|SrvcGrp|96355|2022|PDM|29900.00|99|0.00|SPINE FIXATION
20|FH_F102302_0_0|SrvcGrp|97119|2022|PDM|10850.00|99|0.00|NECK SPINE DISK SURGERY
20|FH_F102302_0_0|SrvcGrp|97299|2022|PDM|14300.00|99|0.00|REMOVE SPINE ELTRD PLATE
20|FH_F102302_0_0|SrvcGrp|98560|2022|PDM|39100.00|99|0.00|LUMBAR
20|FH_F102302_0_0|SrvcGrp|98564|2022|PDM|39100.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR
20|FH_F102302_0_0|SrvcGrp|98567|2022|PDM|29900.00|99|0.00|ARTHRODESIS ANTERIOR TRANS
20|FH_F102302_0_0|SrvcGrp|98572|2022|PDM|29900.00|99|0.00|SPINE INFUSION
20|FH_F102302_0_0|SrvcGrp|98575|2022|PDM|29900.00|99|0.00|CERVICE CORPECTOMY 1 LEVEL
20|FH_F102302_0_0|SrvcGrp|98576|2022|PDM|29900.00|99|0.00|REMOVE VERTEBRAL BODY ADD-ON
20|FH_F102302_0_0|SrvcGrp|98578|2022|PDM|29900.00|99|0.00|VERT CORP THORACOLUMBAR SING
20|FH_F102302_0_0|SrvcGrp|98579|2022|PDM|29900.00|99|0.00|REMOVE VERTEBRAL BODY ADD-ON
20|FH_F102302_0_0|SrvcGrp|98593|2022|PDM|10850.00|99|0.00|REMOVAL OF SPINAL LAMINA
20|FH_F102302_0_0|SrvcGrp|98597|2022|PDM|10850.00|99|0.00|CERVICAL LAMINOTOMY
20|FH_F102341_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F102341_0_0|SrvcGrp|79720|2022|PDM|1379.00|99|0.00|ACUTE REHAB II
20|FH_F102500_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F102500_0_0|SrvcGrp|72996|2022|PDM|982.00|99|0.00|AEG 4
20|FH_F102500_0_0|SrvcGrp|83646|2022|PDM|1780.00|99|0.00|CPT 31276
20|FH_F102500_0_0|SrvcGrp|92084|2022|PDM|1863.00|99|0.00|CORNEAL TRANSPLANT
20|FH_F102500_0_0|SrvcGrp|98684|2022|PDM|2582.00|99|0.00|OSSEOINTEGRATED IMPLANT REPL
20|FH_F102500_0_0|SrvcGrp|98686|2022|PDM|8189.00|99|0.00|OSSEOINTEGRATED IMPLANT
20|FH_F102500_0_0|SrvcGrp|98687|2022|PDM|2088.00|99|0.00|PARTIAL EXCISION THYROID
20|FH_F102542_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|GENERAL ACUTE CARE
20|FH_F102542_0_0|SrvcGrp|16|2022|PDM|900.00|99|0.00|ACUTE REHABILITATION
20|FH_F102542_0_0|SrvcGrp|8950|2022|PDM|1450.00|99|0.00|INTERMEDIATE ICU/CCU
20|FH_F102620_0_0|CSTM-ALL|CSTM-00|2020|PDM|496.80|99|0.00|OP OBSERVATION <=23 HRS
20|FH_F102623_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F102641_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F102641_0_0|SrvcGrp|72998|2022|PDM|1250.00|99|0.00|AEG 5
20|FH_F102641_0_0|SrvcGrp|73000|2022|PDM|1394.00|99|0.00|AEG 6
20|FH_F102641_0_0|SrvcGrp|73006|2022|PDM|2184.00|99|0.00|AEG 9
20|FH_F102641_0_0|SrvcGrp|74039|2022|PDM|3602.00|99|0.00|LAMINECTOMY
20|FH_F102641_0_0|SrvcGrp|76847|2022|PDM|3152.00|99|0.00|AETNA ARTHROSCOPY
20|FH_F102641_0_0|SrvcGrp|85022|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F102641_0_0|SrvcGrp|93121|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F102641_0_0|SrvcGrp|96799|2022|PDM|2026.00|99|0.00|DESTROY C/TH FACET JNT ADDL
20|FH_F102641_0_0|SrvcGrp|96819|2022|PDM|2026.00|99|0.00|DESTROY L/S FACET JNT ADDL
20|FH_F102704_0_0|CSTM-ALL|CSTM-00|2020|PCT|40.00|99|0.00|OP SVCS
20|FH_F102726_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F102726_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|MAMMOGRAPHY
20|FH_F102760_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|DME
20|FH_F102842_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F102842_0_0|CSTM-ALL|CSTM-00|2020|PCT|30.00|99|0.00|OP SVCS
20|FH_F102881_0_0|CSTM-ALL|CSTM-00|2020|PDM|1482.00|99|0.00|AEG 3 (NO REV)
20|FH_F102881_0_0|CSTM-ALL|CSTM-00|2020|PDM|2082.00|99|0.00|AEG 5  (NO REV)
20|FH_F102881_0_0|CSTM-ALL|CSTM-00|2020|PDM|2896.00|99|0.00|AEG 7 (NO REV)
20|FH_F102881_0_0|SrvcGrp|83960|2022|PCT|0.80|99|0.00|CARDIAC CATHETERIZATION
20|FH_F102920_0_0|SrvcGrp|72998|2022|PDM|1250.00|99|0.00|AEG 5
20|FH_F102920_0_0|SrvcGrp|73006|2022|PDM|2184.00|99|0.00|AEG 9
20|FH_F102920_0_0|SrvcGrp|87677|2022|PDM|2026.00|99|0.00|CERVICAL OR THORACIC SURGERY
20|FH_F102920_0_0|SrvcGrp|87679|2022|PDM|2026.00|99|0.00|LUMBAR OR SACRAL SURGERY
20|FH_F102920_0_0|SrvcGrp|96819|2022|PDM|2026.00|99|0.00|DESTROY L/S FACET JNT ADDL
20|FH_F102943_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F102943_0_0|SrvcGrp|71221|2022|PDM|729.94|99|0.00|EGD W/BALLOON DIALATION CPT 43249
20|FH_F102943_0_0|SrvcGrp|84974|2022|PDM|797.69|99|0.00|CPT 43255
20|FH_F103060_0_0|SrvcGrp|27261|2022|PDM|9364.00|99|0.00|CPT 27446
20|FH_F103060_0_0|SrvcGrp|35669|2022|PDM|5202.00|99|0.00|CPT 63650
20|FH_F103060_0_0|SrvcGrp|67279|2022|PDM|8323.00|99|0.00|CERVICAL SURGERY
20|FH_F103060_0_0|SrvcGrp|71666|2022|PDM|7283.00|99|0.00|CPT 63655
20|FH_F103060_0_0|SrvcGrp|72994|2022|PDM|2263.00|99|0.00|AEG 3
20|FH_F103060_0_0|SrvcGrp|73004|2022|PDM|3017.00|99|0.00|AEG 8
20|FH_F103060_0_0|SrvcGrp|73006|2022|PDM|3121.00|99|0.00|AEG 9
20|FH_F103060_0_0|SrvcGrp|74039|2022|PDM|7803.00|99|0.00|LAMINECTOMY
20|FH_F103060_0_0|SrvcGrp|78096|2022|PDM|3121.00|99|0.00|AETNA ARTHROSCOPY BICEPS
20|FH_F103060_0_0|SrvcGrp|88163|2022|PDM|5722.00|99|0.00|LUMBAR SPINE FUSION
20|FH_F103060_0_0|SrvcGrp|88164|2022|PDM|8323.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR
20|FH_F103060_0_0|SrvcGrp|88491|2022|PDM|7803.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR
20|FH_F103060_0_0|SrvcGrp|98497|2022|PDM|8323.00|99|0.00|ARTHRODESIS POSTERIOR TECH
20|FH_F103122_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F103122_0_0|CSTM-ALL|CSTM-00|2020|PDM|1339.00|99|0.00|AEG 9 (NO REV)
20|FH_F103122_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 10 (NO REV)
20|FH_F103122_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|AEG 3 (NO REV)
20|FH_F103140_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F103140_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING
20|FH_F103140_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|ACUTE REHAB II
20|FH_F103140_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|AETNA PT EVALUATION
20|FH_F103220_0_0|CSTM-ALL|CSTM-00|2020|PDM|2420.00|99|0.00|AEG 7 (NO REV)
20|FH_F103220_0_0|CSTM-ALL|CSTM-00|2020|PDM|2860.00|99|0.00|AEG 8 (NO REV)
20|FH_F103220_0_0|SrvcGrp|99147|2022|PDM|3850.00|99|0.00|BIOPSY BREAST MASTECTOMY
20|FH_F103220_0_0|SrvcGrp|99151|2022|PDM|12100.00|99|0.00|LAPS ESOPHGL SPHNCTR AGMNT
20|FH_F103320_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F103320_0_0|SrvcGrp|113695|2022|PDM|1998.00|99|0.00|COLONOSCOPY W/ RESECTION
20|FH_F103320_0_0|SrvcGrp|72998|2022|PDM|1051.00|99|0.00|AEG 5
20|FH_F103320_0_0|SrvcGrp|73006|2022|PDM|2158.00|99|0.00|AEG 9
20|FH_F103440_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F103760_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F103781_0_0|SrvcGrp|46605|2022|PDM|80.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES
20|FH_F103781_0_0|SrvcGrp|48385|2022|PDM|80.00|99|0.00|SPEECH THERAPY
20|FH_F103821_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F104180_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F104520_0_0|SrvcGrp|73656|2022|PDM|450.00|99|0.00|AETNA HOSPICE SVCS
20|FH_F104520_0_0|SrvcGrp|83519|2022|PDM|90.00|99|0.00|HOSPICE CARE (ALL OTHER)
20|FH_F104520_0_0|SrvcGrp|95441|2022|PDM|90.00|99|0.00|HOSPICE OR HOME CARE
20|FH_F104700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F104700_0_0|SrvcGrp|72990|2022|PDM|1245.00|99|0.00|AEG 1
20|FH_F104700_0_0|SrvcGrp|73006|2022|PDM|1245.00|99|0.00|AEG 9
20|FH_F104720_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F104720_0_0|SrvcGrp|82981|2022|PDM|125.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F104740_0_0|SrvcGrp|82981|2022|PDM|125.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F104800_0_0|CSTM-ALL|CSTM-00|2020|PDM|575.00|99|0.00|AEG 2 (NO REV)
20|FH_F104800_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 4 (NO REV)
20|FH_F104800_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|AEG 6 (NO REV)
20|FH_F104802_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F104802_0_0|SrvcGrp|12682|2022|PDM|45.00|99|0.00|GROUP THERAPY
20|FH_F104802_0_0|SrvcGrp|15157|2022|PDM|80.00|99|0.00|INDIVIDUAL THERAPY
20|FH_F104802_0_0|SrvcGrp|33812|2022|PDM|200.00|99|0.00|IOP / MENTAL HEALTH / SUBSTANCE ABUSE
20|FH_F104941_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F105142_0_0|CSTM-ALL|CSTM-00|2020|PDM|1345.00|99|0.00|AEG 9 (NO REV)
20|FH_F105142_0_0|CSTM-ALL|CSTM-00|2020|PDM|979.69|99|0.00|AEG 8 (NO REV)
20|FH_F105142_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F105301_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F105320_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F105421_0_0|SrvcGrp|73841|2022|PDM|325.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP
20|FH_F105481_80120_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F105481_80120_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F105593_0_0|SrvcGrp|88620|2022|PDM|85.00|99|0.00|SKILLED NURSING RN
20|FH_F105600_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F105600_0_0|CSTM-ALL|CSTM-00|2020|PDM|1041.00|99|0.00|AEG 5  (NO REV)
20|FH_F105600_0_0|CSTM-ALL|CSTM-00|2020|PDM|1443.00|99|0.00|AEG 7 (NO REV)
20|FH_F105600_0_0|CSTM-ALL|CSTM-00|2020|PDM|481.00|99|0.00|AEG 10 (NO REV)
20|FH_F105680_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F105680_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F106020_0_0|CSTM-ALL|CSTM-00|2020|PDM|1065.00|99|0.00|AEG 4 (NO REV)
20|FH_F106020_0_0|CSTM-ALL|CSTM-00|2020|PDM|1145.00|99|0.00|AEG 5  (NO REV)
20|FH_F106020_0_0|CSTM-ALL|CSTM-00|2020|PDM|1311.00|99|0.00|AEG 7 (NO REV)
20|FH_F106020_0_0|CSTM-ALL|CSTM-00|2020|PDM|1957.00|99|0.00|AEG 9 (NO REV)
20|FH_F106020_0_0|SrvcGrp|35669|2022|PDM|2311.00|99|0.00|CPT 63650
20|FH_F106020_0_0|SrvcGrp|36591|2022|PDM|3152.00|99|0.00|CPT 63685
20|FH_F106500_0_0|SrvcGrp|12845|2022|PDM|322.00|99|0.00|SUPPLIES
20|FH_F106500_0_0|SrvcGrp|471|2022|PDM|926.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F106500_0_0|SrvcGrp|73601|2022|PDM|1682.00|99|0.00|AETNA INTERMEDIATE ICU/CCU
20|FH_F106822_0_0|SrvcGrp|100257|2022|PDM|57.00|99|0.00|REPAIR SUPERFICIAL WOUND(S) (5.1 -7.5 CM)
20|FH_F106822_0_0|SrvcGrp|100261|2022|PDM|57.00|99|0.00|TREAT WOUND DEHISCENCE
20|FH_F106822_0_0|SrvcGrp|100265|2022|PDM|3.01|99|0.00|CHEMISTRY
20|FH_F106822_0_0|SrvcGrp|100266|2022|PDM|7.07|99|0.00|TB INTRADERMAL TEST
20|FH_F106822_0_0|SrvcGrp|100270|2022|PDM|16.30|99|0.00|IIV3 VACC NO PRSV 0.25 ML IM
20|FH_F106822_0_0|SrvcGrp|100271|2022|PDM|14.10|99|0.00|IIV3 VACC NO PRSV 0.5 ML IM
20|FH_F106822_0_0|SrvcGrp|100284|2022|PDM|7.95|99|0.00|2+ IMMUNIZATION ADMIN (HCFA)
20|FH_F106822_0_0|SrvcGrp|100287|2022|PDM|45.00|99|0.00|NEW PATIENT OFF/OP VISIT (HCFA)
20|FH_F106822_0_0|SrvcGrp|101742|2022|PDM|3.00|99|0.00|IMMUN ADMIN ORAL/NASAL ADDL
20|FH_F106822_0_0|SrvcGrp|90489|2022|PDM|77.85|99|0.00|PNEUMOCOCCAL VACCINE
20|FH_F106822_0_0|SrvcGrp|95103|2022|PDM|57.00|99|0.00|LASER SURGERY
20|FH_F106841_0_0|CSTM-ALL|CSTM-00|2020|PDM|596.21|99|0.00|AEG 3 (NO REV)
20|FH_F106841_0_0|CSTM-ALL|CSTM-00|2020|PDM|735.85|99|0.00|AMBULATORY SURGERY DEFAULT (NO REV) W/O AEG 1-8
20|FH_F106941_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS
20|FH_F106960_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS
20|FH_F106963_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.50|99|0.00|GENERAL ACUTE CARE
20|FH_F106963_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.50|99|0.00|OP SVCS
20|FH_F106964_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F106964_0_0|CSTM-ALL|CSTM-00|2020|PDM|1340.00|99|0.00|AEG 5  (NO REV)
20|FH_F106964_0_0|CSTM-ALL|CSTM-00|2020|PDM|1811.00|99|0.00|AEG 7 (NO REV)
20|FH_F106980_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F106980_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F106980_0_0|SrvcGrp|11663|2022|PCT|1.05|99|0.00|IMPLANTS
20|FH_F106980_0_0|SrvcGrp|72990|2022|PDM|600.00|99|0.00|AEG 1
20|FH_F106980_0_0|SrvcGrp|72992|2022|PDM|725.00|99|0.00|AEG 2
20|FH_F106980_0_0|SrvcGrp|72996|2022|PDM|925.00|99|0.00|AEG 4
20|FH_F106980_0_0|SrvcGrp|72998|2022|PDM|1000.00|99|0.00|AEG 5
20|FH_F106980_0_0|SrvcGrp|73002|2022|PDM|1250.00|99|0.00|AEG 7
20|FH_F106980_0_0|SrvcGrp|73008|2022|PDM|696.90|99|0.00|AEG 10
20|FH_F106980_0_0|SrvcGrp|74670|2022|PCT|1.05|99|0.00|AETNA OP INTRAOCULAR LENS
20|FH_F113792_0_0|SrvcGrp|88620|2022|PDM|85.00|99|0.00|SKILLED NURSING RN
20|FH_F113794_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F113794_0_0|SrvcGrp|48394|2022|PDM|25.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F113794_0_0|SrvcGrp|48398|2022|PDM|80.00|99|0.00|PT SERVICES
20|FH_F113815_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F113815_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F113815_0_0|SrvcGrp|72990|2022|PDM|426.00|99|0.00|AEG 1
20|FH_F113815_0_0|SrvcGrp|73006|2022|PDM|233.00|99|0.00|AEG 9
20|FH_F113866_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F113866_0_0|SrvcGrp|24739|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F113866_0_0|SrvcGrp|47411|2022|PDM|100.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F113885_0_0|SrvcGrp|26001|2022|PDM|154.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F113903_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F113906_0_0|SrvcGrp|73002|2022|PDM|665.00|99|0.00|AEG 7
20|FH_F114024_0_0|SrvcGrp|75481|2022|PDM|565.00|99|0.00|AEG 2
20|FH_F114024_0_0|SrvcGrp|75483|2022|PDM|573.00|99|0.00|AEG 3
20|FH_F114024_0_0|SrvcGrp|75485|2022|PDM|643.00|99|0.00|AEG 4
20|FH_F114024_0_0|SrvcGrp|75493|2022|PDM|1001.00|99|0.00|AEG 8
20|FH_F114024_0_0|SrvcGrp|75495|2022|PDM|1286.00|99|0.00|AEG 9
20|FH_F114064_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F114064_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F114064_0_0|SrvcGrp|72996|2022|PDM|1200.00|99|0.00|AEG 4
20|FH_F114064_0_0|SrvcGrp|73000|2022|PDM|1051.00|99|0.00|AEG 6
20|FH_F114064_0_0|SrvcGrp|73006|2022|PDM|1566.00|99|0.00|AEG 9
20|FH_F114064_0_0|SrvcGrp|77461|2022|PDM|1250.00|99|0.00|CPT 52356
20|FH_F114145_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F114145_0_0|CSTM-ALL|CSTM-00|2020|PDM|1097.00|99|0.00|AEG 8 (NO REV)
20|FH_F114145_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F114151_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F114151_0_0|SrvcGrp|73656|2022|PDM|450.00|99|0.00|AETNA HOSPICE SVCS
20|FH_F114166_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F114171_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F114171_0_0|CSTM-ALL|CSTM-00|2020|PDM|1028.00|99|0.00|AEG 7 (NO REV)
20|FH_F114171_0_0|CSTM-ALL|CSTM-00|2020|PDM|1114.00|99|0.00|AEG 9 (NO REV)
20|FH_F114171_0_0|CSTM-ALL|CSTM-00|2020|PDM|343.00|99|0.00|AEG 1 (NO REV)
20|FH_F114171_0_0|CSTM-ALL|CSTM-00|2020|PDM|862.00|99|0.00|AEG 6 (NO REV)
20|FH_F114171_0_0|SrvcGrp|77507|2022|PCT|1.00|99|0.00|AETNA CORNEAL TISSUE HANDLING
20|FH_F114267_0_0|CSTM-ALL|CSTM-00|2020|PDM|1141.00|99|0.00|AEG 7 (NO REV)
20|FH_F114267_0_0|CSTM-ALL|CSTM-00|2020|PDM|397.00|99|0.00|AEG 1 (NO REV)
20|FH_F114267_0_0|SrvcGrp|88242|2022|PDM|2300.00|99|0.00|LAPAROSCOPY
20|FH_F114310_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F114310_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F114310_0_0|CSTM-ALL|CSTM-00|2020|PDM|1569.00|99|0.00|AEG 8 (NO REV)
20|FH_F114310_0_0|CSTM-ALL|CSTM-00|2020|PDM|1647.00|99|0.00|AEG 9 (NO REV)
20|FH_F114310_0_0|SrvcGrp|11673|2022|PDM|2600.00|99|0.00|CPT 29888
20|FH_F114326_0_0|SrvcGrp|82981|2022|PDM|125.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F114416_0_0|SrvcGrp|63297|2022|PDM|120.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F114416_0_0|SrvcGrp|74546|2022|PDM|573.00|99|0.00|HOSPICE SERVICES
20|FH_F114416_0_0|SrvcGrp|80317|2022|PDM|120.00|99|0.00|RESPITE CARE
20|FH_F114416_0_0|SrvcGrp|90707|2022|PDM|120.00|99|0.00|AETNA HOSPICE CARE
20|FH_F114511_0_0|SrvcGrp|89337|2022|PDM|770.00|99|0.00|DETOXIFICATION
20|FH_F114519_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F114519_0_0|SrvcGrp|11663|2022|PCT|0.50|99|0.00|IMPLANTS
20|FH_F114519_0_0|SrvcGrp|73006|2022|PDM|1747.00|99|0.00|AEG 9
20|FH_F114519_0_0|SrvcGrp|73008|2022|PDM|1083.00|99|0.00|AEG 10
20|FH_F114572_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F114572_0_0|CSTM-ALL|CSTM-00|2020|PDM|1410.00|99|0.00|AEG 8 (NO REV)
20|FH_F114572_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AEG 1 (NO REV)
20|FH_F114606_0_0|SrvcGrp|63297|2022|PDM|120.14|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F114606_0_0|SrvcGrp|89822|2022|PDM|120.14|99|0.00|HOSPICE ROUTINE HOME CARE
20|FH_F114606_0_0|SrvcGrp|90707|2022|PDM|120.14|99|0.00|AETNA HOSPICE CARE
20|FH_F114683_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F114683_0_0|SrvcGrp|105730|2022|PDM|5000.00|99|0.00|LOW BACK & NECK DISK SURGERY
20|FH_F114683_0_0|SrvcGrp|41335|2022|PDM|8500.00|99|0.00|TOTAL HIP
20|FH_F114683_0_0|SrvcGrp|67279|2022|PDM|7000.00|99|0.00|CERVICAL SURGERY
20|FH_F114683_0_0|SrvcGrp|72990|2022|PDM|644.00|99|0.00|AEG 1
20|FH_F114683_0_0|SrvcGrp|72992|2022|PDM|920.00|99|0.00|AEG 2
20|FH_F114683_0_0|SrvcGrp|73002|2022|PDM|2239.00|99|0.00|AEG 7
20|FH_F114683_0_0|SrvcGrp|88158|2022|PDM|5000.00|99|0.00|NECK SPINE DISK SURGERY
20|FH_F114853_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F114853_0_0|CSTM-ALL|CSTM-00|2020|PDM|1155.00|99|0.00|AEG 1 (NO REV)
20|FH_F114853_0_0|CSTM-ALL|CSTM-00|2020|PDM|2336.00|99|0.00|AEG 5  (NO REV)
20|FH_F114853_0_0|CSTM-ALL|CSTM-00|2020|PDM|2887.00|99|0.00|AEG 9 (NO REV)
20|FH_F114853_0_0|CSTM-ALL|CSTM-00|2020|PDM|962.00|99|0.00|AEG 10 (NO REV)
20|FH_F114853_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F114853_0_0|SrvcGrp|13187|2022|PCT|1.00|99|0.00|INTRAOCULAR LENSES
20|FH_F114853_0_0|SrvcGrp|27261|2022|PDM|8661.00|99|0.00|CPT 27446
20|FH_F114853_0_0|SrvcGrp|74039|2022|PDM|7215.00|99|0.00|LAMINECTOMY
20|FH_F114853_0_0|SrvcGrp|78096|2022|PDM|2887.00|99|0.00|AETNA ARTHROSCOPY BICEPS
20|FH_F114853_0_0|SrvcGrp|88158|2022|PDM|7215.00|99|0.00|NECK SPINE DISK SURGERY
20|FH_F114853_0_0|SrvcGrp|88160|2022|PDM|7215.00|99|0.00|LAMINECTOMY W/FACETECTOMY
20|FH_F114853_0_0|SrvcGrp|88163|2022|PDM|5296.00|99|0.00|LUMBAR SPINE FUSION
20|FH_F114853_0_0|SrvcGrp|88164|2022|PDM|7699.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR
20|FH_F114853_0_0|SrvcGrp|89842|2022|PDM|7699.00|99|0.00|LUMBAR
20|FH_F107200_0_0|CSTM-ALL|CSTM-00|2020|PDM|1561.00|99|0.00|AEG 7 (NO REV)
20|FH_F107200_0_0|CSTM-ALL|CSTM-00|2020|PDM|676.00|99|0.00|AEG 1 (NO REV)
20|FH_F107200_0_0|CSTM-ALL|CSTM-00|2020|PDM|780.00|99|0.00|AEG 2 (NO REV)
20|FH_F107200_0_0|CSTM-ALL|CSTM-00|2020|PDM|988.00|99|0.00|AEG 4 (NO REV)
20|FH_F107200_0_0|SrvcGrp|69502|2022|PDM|1665.00|99|0.00|CPT 54150
20|FH_F107200_0_0|SrvcGrp|73610|2022|PCT|1.00|99|0.00|AETNA IMPLANTS
20|FH_F107200_0_0|SrvcGrp|88147|2022|PDM|4422.00|99|0.00|LAPAROSCOPY REMOVE ADNEXA
20|FH_F107261_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F107360_0_0|SrvcGrp|73601|2022|PDM|1693.00|99|0.00|AETNA INTERMEDIATE ICU/CCU
20|FH_F107360_0_0|SrvcGrp|82037|2022|PDM|1807.00|99|0.00|AETNA ICU
20|FH_F107400_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F107400_0_0|SrvcGrp|48394|2022|PDM|55.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F107480_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F107600_0_0|CSTM-ALL|CSTM-00|2020|PDM|1052.00|99|0.00|AEG 8 (NO REV)
20|FH_F107600_0_0|CSTM-ALL|CSTM-00|2020|PDM|1457.00|99|0.00|AEG 9 (NO REV)
20|FH_F107600_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F107782_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F107782_0_0|CSTM-ALL|CSTM-00|2020|PDM|2450.00|99|0.00|AEG 5  (NO REV)
20|FH_F107922_0_0|SrvcGrp|473|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F107926_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F107926_0_0|CSTM-ALL|CSTM-00|2020|PDM|1280.00|99|0.00|AEG 9 (NO REV)
20|FH_F107926_0_0|SrvcGrp|68281|2022|PDM|1875.00|99|0.00|CPT 67041
20|FH_F107926_0_0|SrvcGrp|68282|2022|PDM|1875.00|99|0.00|CPT 67042
20|FH_F107926_0_0|SrvcGrp|86033|2022|PDM|1875.00|99|0.00|CPT 67107
20|FH_F108160_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F108160_0_0|SrvcGrp|29428|2022|PDM|500.00|99|0.00|HOME/CHRONIC HEMODIALYSIS TREATMENT
20|FH_F108160_0_0|SrvcGrp|82498|2022|PDM|200.00|99|0.00|DIALYSIS PROCEDURE OTHER THAN HEMODIALYSIS
20|FH_F108420_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F108420_0_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|AEG 3 (NO REV)
20|FH_F108420_0_0|CSTM-ALL|CSTM-00|2020|PDM|1900.00|99|0.00|AEG 5  (NO REV)
20|FH_F108420_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|AEG 9 (NO REV)
20|FH_F108680_0_0|CSTM-ALL|CSTM-00|2020|PDM|1040.00|99|0.00|AEG 5  (NO REV)
20|FH_F108680_0_0|CSTM-ALL|CSTM-00|2020|PDM|1197.00|99|0.00|AEG 6 (NO REV)
20|FH_F108680_0_0|CSTM-ALL|CSTM-00|2020|PDM|1442.00|99|0.00|AEG 7 (NO REV)
20|FH_F108680_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AEG 1 (NO REV)
20|FH_F108680_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 4 (NO REV)
20|FH_F108680_0_0|SrvcGrp|100921|2022|PDM|4400.00|99|0.00|SPI  PROSTH DEVICE
20|FH_F108680_0_0|SrvcGrp|102724|2022|PCT|0.00|99|0.00|DESTROY LUMB/SAC FACET JNT
20|FH_F108680_0_0|SrvcGrp|35669|2022|PDM|6050.00|99|0.00|CPT 63650
20|FH_F108680_0_0|SrvcGrp|67065|2022|PDM|12100.00|99|0.00|CERVICAL SURGERY
20|FH_F108680_0_0|SrvcGrp|67068|2022|PDM|19800.00|99|0.00|LUMBAR SPINE FUSION COMBINED
20|FH_F108680_0_0|SrvcGrp|67072|2022|PDM|4400.00|99|0.00|CPT 22845
20|FH_F108680_0_0|SrvcGrp|87677|2022|PDM|1595.00|99|0.00|CERVICAL OR THORACIC SURGERY
20|FH_F108680_0_0|SrvcGrp|88163|2022|PDM|6710.00|99|0.00|LUMBAR SPINE FUSION
20|FH_F108680_0_0|SrvcGrp|89842|2022|PDM|19800.00|99|0.00|LUMBAR
20|FH_F108762_0_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F108800_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 10 (NO REV)
20|FH_F108800_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|AEG 2 (NO REV)
20|FH_F108800_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|AEG 6 (NO REV)
20|FH_F108800_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|AEG 7 (NO REV)
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|HOME ADMNSTRTN DRUG THERAPY - AEROSOLIZED
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|HOME HEALTH (NEWBORN CARE)
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|HOME INFUSION
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|HOME TRANSFUSION
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|HYDRATION THERAPY
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|PICC LINE INSERTION KIT
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|PICC LINE INSERTION NURSING
20|FH_F109000_0_0|CSTM-ALL|CSTM-00|2020|PDM|982.00|99|0.00|AEG 2 (NO REV)
20|FH_F109000_0_0|SrvcGrp|101114|2022|PDM|9592.00|99|0.00|ARTHOPLASTY
20|FH_F109000_0_0|SrvcGrp|11663|2022|PCT|0.40|99|0.00|IMPLANTS
20|FH_F109000_0_0|SrvcGrp|40002|2022|PDM|11110.00|99|0.00|TOTAL HIP
20|FH_F109000_0_0|SrvcGrp|84442|2022|PDM|9592.00|99|0.00|REVISION KNEE
20|FH_F109248_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F109248_0_0|CSTM-ALL|CSTM-00|2020|PDM|1313.00|99|0.00|AEG 7 (NO REV)
20|FH_F109248_0_0|CSTM-ALL|CSTM-00|2020|PDM|1313.00|99|0.00|AEG 8 (NO REV)
20|FH_F109248_0_0|SrvcGrp|35669|2022|PDM|1791.00|99|0.00|CPT 63650
20|FH_F109252_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F109260_0_0|CSTM-ALL|CSTM-00|2020|PDM|1330.12|99|0.00|AEG 3 (NO REV)
20|FH_F109260_0_0|CSTM-ALL|CSTM-00|2020|PDM|1865.40|99|0.00|AEG 5  (NO REV)
20|FH_F109260_0_0|CSTM-ALL|CSTM-00|2020|PDM|2583.21|99|0.00|AEG 8 (NO REV)
20|FH_F109260_0_0|CSTM-ALL|CSTM-00|2020|PDM|3890.26|99|0.00|AEG 10 (NO REV)
20|FH_F109260_0_0|SrvcGrp|27261|2022|PDM|22278.90|99|0.00|CPT 27446
20|FH_F109260_0_0|SrvcGrp|89404|2022|PDM|23339.80|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F109260_0_0|SrvcGrp|93433|2022|PDM|21630.00|99|0.00|PARTIAL HIP REPLACEMENT
20|FH_F109277_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.74|99|0.00|OP SVCS
20|FH_F109277_0_0|SrvcGrp|102100|2022|PDM|141.00|99|0.00|X-RAY/OTHER
20|FH_F109279_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|AEG 2 (NO REV)
20|FH_F109281_0_0|CSTM-ALL|CSTM-00|2020|PDM|1193.00|99|0.00|AEG 4 (NO REV)
20|FH_F109281_0_0|CSTM-ALL|CSTM-00|2020|PDM|1912.00|99|0.00|AEG 8 (NO REV)
20|FH_F114853_0_0|SrvcGrp|98493|2022|PDM|7699.00|99|0.00|THORACIC
20|FH_F114853_0_0|SrvcGrp|98494|2022|PDM|7699.00|99|0.00|ARTHRODESIS PRE-SACRAL
20|FH_F114853_0_0|SrvcGrp|98499|2022|PDM|7215.00|99|0.00|INCISE SPINAL COLUMN NERVES
20|FH_F114931_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 6 (NO REV)
20|FH_F114931_0_0|CSTM-ALL|CSTM-00|2020|PDM|597.00|99|0.00|AEG 2 (NO REV)
20|FH_F114931_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|AEG 3 (NO REV)
20|FH_F114931_0_0|SrvcGrp|104115|2022|PDM|1850.00|99|0.00|DESTRUCTION, ANAL LESION(S)
20|FH_F114931_0_0|SrvcGrp|104617|2022|PDM|1850.00|99|0.00|INCISION OF RECTAL ABSCESS
20|FH_F114931_0_0|SrvcGrp|105283|2022|PDM|3200.00|99|0.00|LAP INC HERN REPAIR COMP
20|FH_F114931_0_0|SrvcGrp|105286|2022|PDM|3200.00|99|0.00|LAP VENT/ABD HERN PROC COMP
20|FH_F114931_0_0|SrvcGrp|105754|2022|PDM|3200.00|99|0.00|RPR I/HERN INIT BLOCK >5 YR
20|FH_F114931_0_0|SrvcGrp|105762|2022|PDM|1850.00|99|0.00|REMOVE BY LIGAT INT HEM GRP
20|FH_F114931_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F114931_0_0|SrvcGrp|78283|2022|PDM|3200.00|99|0.00|CPT 49505
20|FH_F114931_0_0|SrvcGrp|78285|2022|PDM|3200.00|99|0.00|CPT 58671
20|FH_F114931_0_0|SrvcGrp|78911|2022|PDM|3200.00|99|0.00|LAPARO HERNIA REPAIR RECUR
20|FH_F114931_0_0|SrvcGrp|82115|2022|PDM|3200.00|99|0.00|REPAIR UMBIL HERNIA
20|FH_F114931_0_0|SrvcGrp|82298|2022|PDM|19000.00|99|0.00|AETNA LAP SLEEVE GASTRECTOMY
20|FH_F114931_0_0|SrvcGrp|86461|2022|PDM|3200.00|99|0.00|AREOLA RECONSTRUCTION
20|FH_F114931_0_0|SrvcGrp|90778|2022|PDM|3200.00|99|0.00|HEMIOPLASTY
20|FH_F114941_0_0|SrvcGrp|82981|2022|PDM|124.84|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F114952_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F114952_0_0|SrvcGrp|16242|2022|PDM|5250.00|99|0.00|ROTATOR CUFF
20|FH_F114952_0_0|SrvcGrp|19922|2022|PDM|3675.00|99|0.00|ARTHROSCOPY OF SHOULDER
20|FH_F114952_0_0|SrvcGrp|40003|2022|PDM|7560.00|99|0.00|TOTAL KNEE
20|FH_F114952_0_0|SrvcGrp|75489|2022|PDM|1627.50|99|0.00|AEG 6
20|FH_F114952_0_0|SrvcGrp|75493|2022|PDM|1470.00|99|0.00|AEG 8
20|FH_F114952_0_0|SrvcGrp|83624|2022|PDM|2625.00|99|0.00|REPAIR BICEPS TENDON RUPTURE
20|FH_F114952_0_0|SrvcGrp|96349|2022|PDM|7560.00|99|0.00|NECK SPINE FUSE
20|FH_F114952_0_0|SrvcGrp|96939|2022|PDM|2100.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F114968_0_0|SrvcGrp|30089|2022|PDM|455.28|99|0.00|HEMODIALYSIS SERVICES
20|FH_F114974_0_0|CSTM-ALL|CSTM-00|2020|PDM|1040.00|99|0.00|AEG 4 (NO REV)
20|FH_F114974_0_0|CSTM-ALL|CSTM-00|2020|PDM|1160.00|99|0.00|AEG 5  (NO REV)
20|FH_F114974_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|AEG 7 (NO REV)
20|FH_F114974_0_0|CSTM-ALL|CSTM-00|2020|PDM|1750.00|99|0.00|AEG 8 (NO REV)
20|FH_F114974_0_0|CSTM-ALL|CSTM-00|2020|PDM|2160.00|99|0.00|AEG 9 (NO REV)
20|FH_F114974_0_0|CSTM-ALL|CSTM-00|2020|PDM|730.00|99|0.00|AEG 2 (NO REV)
20|FH_F115010_20105_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F115010_20105_0|SrvcGrp|79720|2022|PDM|1311.00|99|0.00|ACUTE REHAB II
20|FH_F115010_20105_0|SrvcGrp|80258|2022|PCT|0.00|99|0.00|AETNA SKILLED CARE
20|FH_F115045_0_0|SrvcGrp|55677|2022|PDM|3500.00|99|0.00|VAGINAL DELIVERY ONLY
20|FH_F115127_0_0|SrvcGrp|103551|2022|PDM|265.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS
20|FH_F115127_0_0|SrvcGrp|105357|2022|PDM|580.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD
20|FH_F115150_0_0|SrvcGrp|93688|2022|PDM|594.62|99|0.00|POLYSOMNOGRAPHY (HCFA)
20|FH_F115185_0_0|SrvcGrp|82981|2022|PDM|157.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F115204_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F115204_0_0|SrvcGrp|30089|2022|PDM|455.28|99|0.00|HEMODIALYSIS SERVICES
20|FH_F115204_0_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS
20|FH_F115204_0_0|SrvcGrp|471|2022|PDM|856.98|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F115204_0_0|SrvcGrp|472|2022|PDM|696.30|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F115206_80923_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F115206_80923_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F115206_80923_0|SrvcGrp|89149|2022|PDM|258.00|99|0.00|OP INTENSIVE
20|FH_F115208_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F115208_0_0|CSTM-ALL|CSTM-00|2020|PDM|2016.00|99|0.00|AEG 9 (NO REV)
20|FH_F115208_0_0|CSTM-ALL|CSTM-00|2020|PDM|504.00|99|0.00|AEG 1 (NO REV)
20|FH_F115208_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F115208_0_0|SrvcGrp|106174|2022|PDM|2016.00|99|0.00|NASAL/SINUS ENDOSCOPY
20|FH_F115208_0_0|SrvcGrp|106176|2022|PDM|2546.00|99|0.00|EXCISE PAROTID GLAND/LESION
20|FH_F115208_0_0|SrvcGrp|106180|2022|PDM|2652.00|99|0.00|PARTIAL THYROID EXCISION
20|FH_F115208_0_0|SrvcGrp|57864|2022|PDM|1273.00|99|0.00|SUBMUCOUS RESECTION
20|FH_F115208_0_0|SrvcGrp|64723|2022|PDM|716.00|99|0.00|CPT 45380
20|FH_F115208_0_0|SrvcGrp|64732|2022|PDM|716.00|99|0.00|CPT 43239
20|FH_F115208_0_0|SrvcGrp|70062|2022|PDM|2652.00|99|0.00|THYROIDECTOMY
20|FH_F115208_0_0|SrvcGrp|98364|2022|PDM|1591.00|99|0.00|AETNA NASAL/SINUS ENDO W/MAXILLARY ANTROSTOMY
20|FH_F115347_0_0|CSTM-ALL|CSTM-00|2020|PDM|1070.00|99|0.00|AEG 8 (NO REV)
20|FH_F115347_0_0|CSTM-ALL|CSTM-00|2020|PDM|366.00|99|0.00|AEG 1 (NO REV)
20|FH_F115347_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 2 (NO REV)
20|FH_F115430_0_0|CSTM-ALL|CSTM-00|2020|PDM|1040.00|99|0.00|AEG 5  (NO REV)
20|FH_F115430_0_0|CSTM-ALL|CSTM-00|2020|PDM|1197.00|99|0.00|AEG 6 (NO REV)
20|FH_F115430_0_0|CSTM-ALL|CSTM-00|2020|PDM|1442.00|99|0.00|AEG 7 (NO REV)
20|FH_F115430_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AEG 1 (NO REV)
20|FH_F115430_0_0|SrvcGrp|73486|2022|PCT|0.00|99|0.00|AETNA CONTRAST AGENT
20|FH_F115443_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|AETNA SURGERY DEFAULT WITHOUT GROUPER 1 & 2
20|FH_F115464_0_0|CSTM-ALL|CSTM-00|2020|PDM|1277.00|99|0.00|AEG 8 (NO REV)
20|FH_F115464_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F115485_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F115488_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F115489_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F115495_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F119795_0_0|CSTM-ALL|CSTM-00|2020|PDM|3105.00|99|0.00|AEG 9 (NO REV)
20|FH_F119795_0_0|SrvcGrp|33986|2022|PDM|3019.00|99|0.00|CPT 26055
20|FH_F119795_0_0|SrvcGrp|35667|2022|PDM|3019.00|99|0.00|CPT 20680
20|FH_F119795_0_0|SrvcGrp|53065|2022|PDM|1685.00|99|0.00|INJECTION(S), LUMBAR OR SACRAL, SINGLE LEVEL
20|FH_F119795_0_0|SrvcGrp|71666|2022|PDM|5202.00|99|0.00|CPT 63655
20|FH_F119795_0_0|SrvcGrp|75002|2022|PDM|7263.00|99|0.00|ARTHOSCOPY
20|FH_F119795_0_0|SrvcGrp|92820|2022|PDM|7263.00|99|0.00|HIP ARTHOSCOPY ACETABULOPLASTY
20|FH_F119824_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F119824_0_0|SrvcGrp|108042|2022|PDM|424.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD
20|FH_F119824_0_0|SrvcGrp|108043|2022|PDM|164.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD
20|FH_F119824_0_0|SrvcGrp|108152|2022|PDM|424.00|99|0.00|HEMODIALYSIS INCLUDES TRAINING
20|FH_F119824_0_0|SrvcGrp|29428|2022|PDM|424.00|99|0.00|HOME/CHRONIC HEMODIALYSIS TREATMENT
20|FH_F119824_0_0|SrvcGrp|82498|2022|PDM|164.00|99|0.00|DIALYSIS PROCEDURE OTHER THAN HEMODIALYSIS
20|FH_F119825_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F119825_0_0|SrvcGrp|104226|2022|PDM|100.00|99|0.00|HOSPICE CARE (HCFA)
20|FH_F119825_0_0|SrvcGrp|95661|2022|PDM|100.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F119838_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F119838_0_0|CSTM-ALL|CSTM-00|2020|PDM|3180.00|99|0.00|AETNA AEG 6 WITHOUT 66985-66986
20|FH_F119838_0_0|SrvcGrp|11000|2022|PCT|1.00|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F119888_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F119888_0_0|SrvcGrp|13262|2022|PDM|7.45|99|0.00|GROUND MILEAGE, PER STATUTE MILE
20|FH_F119888_0_0|SrvcGrp|13595|2022|PDM|418.57|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC
20|FH_F119888_0_0|SrvcGrp|13597|2022|PDM|220.30|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT
20|FH_F119888_0_0|SrvcGrp|13683|2022|PDM|605.83|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2
20|FH_F119937_0_0|SrvcGrp|65720|2022|PDM|65.00|99|0.00|RESPITE CARE
20|FH_F119999_0_0|CSTM-ALL|CSTM-00|2020|PDM|2780.00|99|0.00|AEG 3 (NO REV)
20|FH_F119999_0_0|CSTM-ALL|CSTM-00|2020|PDM|3530.00|99|0.00|AEG 5  (NO REV)
20|FH_F119999_0_0|CSTM-ALL|CSTM-00|2020|PDM|5885.00|99|0.00|AEG 9 (NO REV)
20|FH_F119999_0_0|CSTM-ALL|CSTM-00|2020|PDM|855.00|99|0.00|AEG 1 (NO REV)
20|FH_F119999_0_0|SrvcGrp|11663|2022|PCT|0.50|99|0.00|IMPLANTS
20|FH_F120001_0_0|SrvcGrp|73485|2022|PDM|873.00|99|0.00|AETNA REHAB
20|FH_F120001_0_0|SrvcGrp|79720|2022|PDM|995.00|99|0.00|ACUTE REHAB II
20|FH_F120032_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F120032_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F120032_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AMBULATORY SURGERY W/O AEG 1 & 2
20|FH_F120032_0_0|SrvcGrp|79589|2022|PDM|580.00|99|0.00|UPPER GI
20|FH_F120032_0_0|SrvcGrp|85000|2022|PDM|580.00|99|0.00|CPT 45384
20|FH_F120057_0_0|SrvcGrp|107793|2022|PDM|6000.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE
20|FH_F120057_0_0|SrvcGrp|108076|2022|PDM|1698.78|99|0.00|AV FUSION / FOREARM VEIN
20|FH_F120057_0_0|SrvcGrp|108219|2022|PDM|4300.00|99|0.00|VASC EMBOLIZE/OCCLUDE ORGAN
20|FH_F120057_0_0|SrvcGrp|35664|2022|PDM|1500.00|99|0.00|VNUS CLOSURE
20|FH_F120057_0_0|SrvcGrp|72990|2022|PDM|400.00|99|0.00|AEG 1
20|FH_F120057_0_0|SrvcGrp|73008|2022|PDM|612.00|99|0.00|AEG 10
20|FH_F120058_0_0|CSTM-ALL|CSTM-00|2020|PDM|447.00|99|0.00|AEG 1 (NO REV)
20|FH_F120058_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AETNA SURGERY DEFAULT WITHOUT GROUPER 1 & 2
20|FH_F120058_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F120059_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 3 (NO REV)
20|FH_F120059_0_0|CSTM-ALL|CSTM-00|2020|PDM|1600.00|99|0.00|AEG 6 (NO REV)
20|FH_F120059_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|AEG 2 (NO REV)
20|FH_F120059_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F120059_0_0|SrvcGrp|108116|2022|PDM|1700.00|99|0.00|AV FUSION / UPPER ARM VEIN
20|FH_F120089_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F120112_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F120112_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F120112_0_0|SrvcGrp|80920|2022|PDM|446.25|99|0.00|HOSPICE SERVICES
20|FH_F120112_0_0|SrvcGrp|90707|2022|PDM|94.50|99|0.00|AETNA HOSPICE CARE
20|FH_F120112_0_0|SrvcGrp|93098|2022|PDM|94.50|99|0.00|HOSPICE CARE
20|FH_F120112_0_0|SrvcGrp|95661|2022|PDM|100.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F120118_0_0|CSTM-ALL|CSTM-00|2020|PCT|62.00|99|0.00|OP SVCS
20|FH_F120152_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F120152_0_0|CSTM-ALL|CSTM-00|2020|PDM|1320.00|99|0.00|AEG 2 (NO REV)
20|FH_F120152_0_0|CSTM-ALL|CSTM-00|2020|PDM|2090.00|99|0.00|AEG 5  (NO REV)
20|FH_F120152_0_0|SrvcGrp|101320|2022|PDM|1650.00|99|0.00|PARAVERTEBRAL FACET JOINT NERVE
20|FH_F120152_0_0|SrvcGrp|101800|2022|PDM|2420.00|99|0.00|SKELETAL FIXATION
20|FH_F120152_0_0|SrvcGrp|103563|2022|PDM|2420.00|99|0.00|REPAIR HAND TENDON
20|FH_F120152_0_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS
20|FH_F120152_0_0|SrvcGrp|16289|2022|PDM|4400.00|99|0.00|CARPAL TUNNEL RELEASE
20|FH_F120152_0_0|SrvcGrp|33986|2022|PDM|2420.00|99|0.00|CPT 26055
20|FH_F120152_0_0|SrvcGrp|35669|2022|PDM|8800.00|99|0.00|CPT 63650
20|FH_F120152_0_0|SrvcGrp|67069|2022|PDM|22000.00|99|0.00|CPT 22634
20|FH_F120152_0_0|SrvcGrp|72121|2022|PDM|6600.00|99|0.00|ARTHOSCOPY
20|FH_F120152_0_0|SrvcGrp|82109|2022|PDM|4400.00|99|0.00|REVISE ULNAR NERVE ELBOW
20|FH_F120152_0_0|SrvcGrp|85778|2022|PDM|3850.00|99|0.00|REPAIR OF ANKLE FRACTURE
20|FH_F120152_0_0|SrvcGrp|88065|2022|PDM|19800.00|99|0.00|TOTAL DISC ARTHROPLASTY
20|FH_F120152_0_0|SrvcGrp|89980|2022|PDM|6050.00|99|0.00|OPEN TREATMENT OF DISTAL
20|FH_F120152_0_0|SrvcGrp|91567|2022|PDM|2420.00|99|0.00|REPAIR OF KNEECAP TENDON
20|FH_F120152_0_0|SrvcGrp|92007|2022|PDM|11000.00|99|0.00|PROXIMAL HUMERAL
20|FH_F120152_0_0|SrvcGrp|92010|2022|PDM|2420.00|99|0.00|LESION OF TENDON SHEATH OR JOINT CAPSULE
20|FH_F115543_0_0|CSTM-ALL|CSTM-00|2020|PDM|1410.00|99|0.00|AEG 8 (NO REV)
20|FH_F115543_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 4 (NO REV)
20|FH_F115543_0_0|SrvcGrp|106235|2022|PDM|1600.00|99|0.00|CYPASS
20|FH_F115616_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F115616_0_0|CSTM-ALL|CSTM-00|2020|PDM|2601.00|99|0.00|AEG 6 (NO REV)
20|FH_F115616_0_0|CSTM-ALL|CSTM-00|2020|PDM|3069.00|99|0.00|AEG 8 (NO REV)
20|FH_F115616_0_0|SrvcGrp|104015|2022|PDM|4474.00|99|0.00|INSERT STABILIZATION DEVICE
20|FH_F115616_0_0|SrvcGrp|106226|2022|PDM|4474.00|99|0.00|CERV ARTIFIC DISC
20|FH_F115616_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F115625_63110_0|SrvcGrp|79720|2022|PDM|1008.00|99|0.00|ACUTE REHAB II
20|FH_F115674_0_0|CSTM-ALL|CSTM-00|2020|PDM|1339.00|99|0.00|AEG 9 (NO REV)
20|FH_F115674_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|AEG 7 (NO REV)
20|FH_F115705_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F115705_0_0|SrvcGrp|22954|2022|PDM|130.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F115705_0_0|SrvcGrp|26001|2022|PDM|120.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F115735_0_0|SrvcGrp|471|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F115808_0_0|SrvcGrp|87077|2022|PDM|100.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F115823_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|AEG 5  (NO REV)
20|FH_F115823_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|AEG 6 (NO REV)
20|FH_F115868_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F115868_0_0|SrvcGrp|80317|2022|PDM|135.00|99|0.00|RESPITE CARE
20|FH_F115868_0_0|SrvcGrp|89781|2022|PDM|100.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F115868_0_0|SrvcGrp|94781|2022|PDM|100.00|99|0.00|HOSPICE IN LTCH (HCFA)
20|FH_F115875_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F115875_0_0|CSTM-ALL|CSTM-00|2020|PDM|1185.00|99|0.00|AEG 1 (NO REV)
20|FH_F115875_0_0|CSTM-ALL|CSTM-00|2020|PDM|3348.00|99|0.00|AEG 6 (NO REV)
20|FH_F115875_0_0|CSTM-ALL|CSTM-00|2020|PDM|3348.00|99|0.00|AEG 8 (NO REV)
20|FH_F115875_0_0|SrvcGrp|103974|2022|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES
20|FH_F115875_0_0|SrvcGrp|94479|2022|PDM|412.00|99|0.00|AETNA SCAN PROC CRANIAL EXTRA
20|FH_F115884_0_0|SrvcGrp|29353|2022|PDM|111.00|99|0.00|HOSPICE SVCS
20|FH_F115884_0_0|SrvcGrp|65720|2022|PDM|111.00|99|0.00|RESPITE CARE
20|FH_F115884_0_0|SrvcGrp|80317|2022|PDM|125.00|99|0.00|RESPITE CARE
20|FH_F115884_0_0|SrvcGrp|89781|2022|PDM|111.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F115884_0_0|SrvcGrp|89822|2022|PDM|111.00|99|0.00|HOSPICE ROUTINE HOME CARE
20|FH_F115889_0_0|SrvcGrp|73000|2022|PDM|1311.00|99|0.00|AEG 6
20|FH_F115889_0_0|SrvcGrp|73002|2022|PDM|1434.00|99|0.00|AEG 7
20|FH_F115889_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F115895_0_0|CSTM-ALL|CSTM-00|2020|PDM|2758.00|99|0.00|AEG 3 (NO REV)
20|FH_F115895_0_0|CSTM-ALL|CSTM-00|2020|PDM|4098.00|99|0.00|AEG 6 (NO REV)
20|FH_F115895_0_0|CSTM-ALL|CSTM-00|2020|PDM|5136.00|99|0.00|AEG 9 (NO REV)
20|FH_F115895_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F115895_0_0|SrvcGrp|103974|2022|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES
20|FH_F115895_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F115895_0_0|SrvcGrp|67068|2022|PDM|7532.00|99|0.00|LUMBAR SPINE FUSION COMBINED
20|FH_F115895_0_0|SrvcGrp|84939|2022|PDM|8487.00|99|0.00|SHOULDER JOINT
20|FH_F115895_0_0|SrvcGrp|89404|2022|PDM|10079.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F115895_0_0|SrvcGrp|93432|2022|PDM|9548.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT
20|FH_F115895_0_0|SrvcGrp|97741|2022|PDM|7002.00|99|0.00|REVISE KNEE
20|FH_F115905_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F115905_0_0|CSTM-ALL|CSTM-00|2020|PDM|1540.00|99|0.00|ASPG 6 HEARTLAND HEALTHCARE
20|FH_F115905_0_0|CSTM-ALL|CSTM-00|2020|PDM|2370.00|99|0.00|ASPG 9 HEARTLAND HEALTHCARE
20|FH_F115943_0_0|SrvcGrp|106488|2022|PDM|977.00|99|0.00|ANESTHESIA SERVICES (HCFA)
20|FH_F115949_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F115954_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F115954_0_0|CSTM-ALL|CSTM-00|2020|PDM|618.00|99|0.00|AEG 9 (NO REV)
20|FH_F115971_0_0|SrvcGrp|11663|2022|PCT|0.33|99|0.00|IMPLANTS
20|FH_F115971_0_0|SrvcGrp|12491|2022|PCT|0.33|99|0.00|PACEMAKER
20|FH_F115971_0_0|SrvcGrp|42427|2022|PDM|670.00|99|0.00|OP SURGERY CPT 65420
20|FH_F115971_0_0|SrvcGrp|72994|2022|PDM|569.00|99|0.00|AEG 3
20|FH_F115971_0_0|SrvcGrp|73004|2022|PDM|1085.00|99|0.00|AEG 8
20|FH_F115974_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F115974_0_0|CSTM-ALL|CSTM-00|2020|PDM|1339.00|99|0.00|AEG 9 (NO REV)
20|FH_F115974_0_0|CSTM-ALL|CSTM-00|2020|PDM|446.00|99|0.00|AEG 2 (NO REV)
20|FH_F115974_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|AEG 5  (NO REV)
20|FH_F115974_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|AEG 7 (NO REV)
20|FH_F115982_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F115982_0_0|SrvcGrp|26274|2022|PDM|1250.00|99|0.00|CPT 29877
20|FH_F115982_0_0|SrvcGrp|26278|2022|PDM|1350.00|99|0.00|CPT 29881
20|FH_F115982_0_0|SrvcGrp|26432|2022|PDM|1800.00|99|0.00|OP SURGICAL SERVICES
20|FH_F115982_0_0|SrvcGrp|41335|2022|PDM|7000.00|99|0.00|TOTAL HIP
20|FH_F115982_0_0|SrvcGrp|72121|2022|PDM|1200.00|99|0.00|ARTHOSCOPY
20|FH_F115982_0_0|SrvcGrp|72994|2022|PDM|720.00|99|0.00|AEG 3
20|FH_F115982_0_0|SrvcGrp|73006|2022|PDM|1411.00|99|0.00|AEG 9
20|FH_F115982_0_0|SrvcGrp|87677|2022|PDM|550.00|99|0.00|CERVICAL OR THORACIC SURGERY
20|FH_F115982_0_0|SrvcGrp|87679|2022|PDM|550.00|99|0.00|LUMBAR OR SACRAL SURGERY
20|FH_F115985_0_0|SrvcGrp|79804|2022|PDM|1585.00|99|0.00|AETNA MEDICAL/SURGICAL
20|FH_F115990_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F115990_0_0|SrvcGrp|73000|2022|PDM|1250.00|99|0.00|AEG 6
20|FH_F115990_0_0|SrvcGrp|73002|2022|PDM|1525.00|99|0.00|AEG 7
20|FH_F116005_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|AEG 1 (NO REV)
20|FH_F116005_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|AEG 5  (NO REV)
20|FH_F116005_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|AEG 9 (NO REV)
20|FH_F116043_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F116043_0_0|SrvcGrp|29353|2022|PDM|100.00|99|0.00|HOSPICE SVCS
20|FH_F116043_0_0|SrvcGrp|90707|2022|PDM|100.00|99|0.00|AETNA HOSPICE CARE
20|FH_F116049_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F116049_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F116049_0_0|SrvcGrp|104745|2022|PDM|148.79|99|0.00|HOSPICE
20|FH_F116049_0_0|SrvcGrp|26001|2022|PDM|133.35|99|0.00|HOSPICE RESPITE SVCS
20|FH_F116049_0_0|SrvcGrp|57968|2022|PDM|31.35|99|0.00|CONTINUOUS HOMECARE
20|FH_F116049_0_0|SrvcGrp|80285|2022|PDM|148.79|99|0.00|HOSPICE ROUTINE HOME CARE
20|FH_F116097_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F116097_0_0|SrvcGrp|3809|2022|PDM|573.47|99|0.00|HOSPICE CARE
20|FH_F116097_0_0|SrvcGrp|80285|2022|PDM|148.79|99|0.00|HOSPICE ROUTINE HOME CARE
20|FH_F116100_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F116108_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F116126_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F116136_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F116136_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F116143_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F116143_0_0|SrvcGrp|104003|2022|PCT|1.00|99|0.00|INSERT AQUEOUS DRAIN DEVICES
20|FH_F116143_0_0|SrvcGrp|73000|2022|PDM|1425.00|99|0.00|AEG 6
20|FH_F116159_0_0|CSTM-ALL|CSTM-00|2020|PDM|2575.00|99|0.00|AEG 9 (NO REV)
20|FH_F116159_0_0|SrvcGrp|114443|2022|PDM|3245.00|99|0.00|EXTRACAPSULAR CATARACT REMOVAL, INSERT LENS
20|FH_F116169_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F116176_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F116245_0_0|SrvcGrp|26001|2022|PDM|133.35|99|0.00|HOSPICE RESPITE SVCS
20|FH_F116275_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F116279_0_0|CSTM-ALL|CSTM-00|2020|PCT|71.00|99|0.00|OP SVCS
20|FH_F116323_0_0|CSTM-ALL|CSTM-00|2020|PDM|1271.00|99|0.00|AEG 1 (NO REV)
20|FH_F116323_0_0|CSTM-ALL|CSTM-00|2020|PDM|1606.00|99|0.00|AEG 2 (NO REV)
20|FH_F116323_0_0|CSTM-ALL|CSTM-00|2020|PDM|2445.00|99|0.00|AEG 5  (NO REV)
20|FH_F116323_0_0|SrvcGrp|88740|2022|PDM|19303.00|99|0.00|SP BONE ALGRFT
20|FH_F116323_0_0|SrvcGrp|89404|2022|PDM|28954.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F116323_0_0|SrvcGrp|99073|2022|PDM|404.00|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F116324_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F116324_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F116324_0_0|SrvcGrp|75493|2022|PDM|550.00|99|0.00|AEG 8
20|FH_F116332_0_0|CSTM-ALL|CSTM-00|2020|PDM|1094.00|99|0.00|AEG 1 (NO REV)
20|FH_F116332_0_0|CSTM-ALL|CSTM-00|2020|PDM|6031.00|99|0.00|AEG 10 (NO REV)
20|FH_F116332_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F116332_0_0|SrvcGrp|113480|2022|PDM|16907.00|99|0.00|GASTRIC RESTRICTIVE
20|FH_F116332_0_0|SrvcGrp|115365|2022|PDM|2832.00|99|0.00|SHOULDER SURGERY
20|FH_F116332_0_0|SrvcGrp|27918|2022|PDM|5256.00|99|0.00|CPT 23410, 23412
20|FH_F116332_0_0|SrvcGrp|36591|2022|PDM|4512.00|99|0.00|CPT 63685
20|FH_F116332_0_0|SrvcGrp|705|2022|PCT|0.80|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F116332_0_0|SrvcGrp|82298|2022|PDM|17481.00|99|0.00|AETNA LAP SLEEVE GASTRECTOMY
20|FH_F116332_0_0|SrvcGrp|87842|2022|PDM|14551.00|99|0.00|LAPAROSCOPY - GASTRIC
20|FH_F116346_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F116370_0_0|SrvcGrp|105357|2022|PDM|400.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD
20|FH_F116390_0_0|CSTM-ALL|CSTM-00|2020|PCT|71.00|99|0.00|GENERAL ACUTE CARE
20|FH_F116430_0_0|CSTM-ALL|CSTM-00|2020|PDM|1665.00|99|0.00|AEG 8 (NO REV)
20|FH_F116430_0_0|CSTM-ALL|CSTM-00|2020|PDM|1682.00|99|0.00|AEG 7 (NO REV)
20|FH_F116430_0_0|CSTM-ALL|CSTM-00|2020|PDM|964.00|99|0.00|AEG 3 (NO REV)
20|FH_F116430_0_0|SrvcGrp|106706|2022|PDM|2122.00|99|0.00|PAIN STIM SURGERY
20|FH_F116430_0_0|SrvcGrp|106707|2022|PDM|1655.00|99|0.00|OTHER UROLOGY SURGERY
20|FH_F116430_0_0|SrvcGrp|106712|2022|PDM|10609.00|99|0.00|JOINT & HIP SURGERY
20|FH_F116430_0_0|SrvcGrp|106714|2022|PDM|1114.00|99|0.00|UROLOGY SURGERY
20|FH_F116430_0_0|SrvcGrp|55084|2022|PDM|2440.00|99|0.00|CPT 52648
20|FH_F116430_0_0|SrvcGrp|77445|2022|PDM|2042.00|99|0.00|REMOVAL OF HYDROCELE
20|FH_F116430_0_0|SrvcGrp|82720|2022|PDM|2175.00|99|0.00|WRIST ENDOSCOPY/SURGERY
20|FH_F116437_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F116437_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F116437_0_0|SrvcGrp|106768|2022|PDM|906.00|99|0.00|TREATMENT OF RETINAL LESION
20|FH_F116437_0_0|SrvcGrp|11663|2022|PCT|1.10|99|0.00|IMPLANTS
20|FH_F116437_0_0|SrvcGrp|84122|2022|PCT|1.10|99|0.00|VASCULAR GRAFT MATERIAL SYN
20|FH_F116437_0_0|SrvcGrp|87385|2022|PDM|1757.00|99|0.00|PARTIAL REMOVAL OF EYE FLUID
20|FH_F116437_0_0|SrvcGrp|87387|2022|PDM|1757.00|99|0.00|REMOVE EYE IMPLANT MATERIAL
20|FH_F116437_0_0|SrvcGrp|91759|2022|PCT|1.10|99|0.00|OCULAR IMPLANT
20|FH_F116440_0_0|SrvcGrp|79720|2022|PDM|1000.00|99|0.00|ACUTE REHAB II
20|FH_F116440_0_0|SrvcGrp|87537|2022|PDM|350.00|99|0.00|MED REHAB DAY PROGRAM (FULL)
20|FH_F116443_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F116443_0_0|CSTM-ALL|CSTM-00|2020|PDM|1450.00|99|0.00|AEG 2 (NO REV)
20|FH_F116443_0_0|CSTM-ALL|CSTM-00|2020|PDM|2425.00|99|0.00|AEG 6 (NO REV)
20|FH_F116443_0_0|CSTM-ALL|CSTM-00|2020|PDM|2585.00|99|0.00|AEG 7 (NO REV)
20|FH_F116443_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F116443_0_0|SrvcGrp|106799|2022|PDM|3500.00|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT
20|FH_F116443_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F116473_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F116473_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|AEG 2 (NO REV)
20|FH_F116473_0_0|SrvcGrp|80617|2022|PDM|15000.00|99|0.00|ARTHOPLASTY
20|FH_F116485_17033_0|SrvcGrp|110042|2022|PDM|31.83|99|0.00|BEHAVIOR IDENTIFICATION ASSESSMENT 15 MINS
20|FH_F116485_17033_0|SrvcGrp|110058|2022|PDM|21.22|99|0.00|BEHAVIOR ASSESSMENT 15 MINS
20|FH_F116485_17033_0|SrvcGrp|110059|2022|PDM|26.52|99|0.00|ADAPTIVE BH 15 MINS
20|FH_F116492_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F116492_0_0|CSTM-ALL|CSTM-00|2020|PDM|2018.00|99|0.00|AEG 9 (NO REV)
20|FH_F116492_0_0|CSTM-ALL|CSTM-00|2020|PDM|768.00|99|0.00|AEG 10 (NO REV)
20|FH_F116492_0_0|CSTM-ALL|CSTM-00|2020|PDM|768.00|99|0.00|AEG 3 (NO REV)
20|FH_F116506_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F116506_0_0|SrvcGrp|44461|2022|PDM|20471.00|99|0.00|INSERTION / REPLACEMENT OF SPINAL NEUROSTIMULATOR GENERATOR
20|FH_F116506_0_0|SrvcGrp|75481|2022|PDM|480.00|99|0.00|AEG 2
20|FH_F116506_0_0|SrvcGrp|75483|2022|PDM|610.00|99|0.00|AEG 3
20|FH_F116549_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F116549_0_0|SrvcGrp|103550|2022|PDM|425.00|99|0.00|HEMODIALYSIS SVCS
20|FH_F116549_0_0|SrvcGrp|103552|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER
20|FH_F116554_0_0|CSTM-ALL|CSTM-00|2020|PDM|1033.00|99|0.00|AETNA SURGERY DEFAULT W/O GROUPER 6 (NO REV)
20|FH_F116575_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 10 (NO REV)
20|FH_F116575_0_0|CSTM-ALL|CSTM-00|2020|PDM|1705.00|99|0.00|AEG 6 (NO REV)
20|FH_F116575_0_0|SrvcGrp|88823|2022|PDM|1250.00|99|0.00|REPAIR OF EARDRUM
20|FH_F116575_0_0|SrvcGrp|94989|2022|PDM|1525.00|99|0.00|SINUS ENDO W/ BALLOON DILATION
20|FH_F116583_0_0|SrvcGrp|103899|2022|PDM|150.00|99|0.00|HOSPICE OR HOME HLTH IN HOME
20|FH_F116583_0_0|SrvcGrp|104230|2022|PDM|150.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F116583_0_0|SrvcGrp|106928|2022|PDM|150.00|99|0.00|HOSPICE/HH IN ASST LVG (HCFA)
20|FH_F116583_0_0|SrvcGrp|106930|2022|PDM|150.00|99|0.00|HOSPICE IN LT NON-SNF
20|FH_F116583_0_0|SrvcGrp|106931|2022|PDM|150.00|99|0.00|HOSPICE IN SNF (HCFA)
20|FH_F116583_0_0|SrvcGrp|106950|2022|PDM|650.00|99|0.00|HOSPICE IN INPT PSYCH
20|FH_F116637_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F116642_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F116642_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F116644_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F116647_0_0|SrvcGrp|28787|2022|PDM|26.52|99|0.00|CPT CODE 90993
20|FH_F116657_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F116664_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F116664_0_0|SrvcGrp|103552|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER
20|FH_F116664_0_0|SrvcGrp|105357|2022|PDM|1265.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD
20|FH_F116703_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|OP SVCS
20|FH_F116727_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F116727_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AEG 1 (NO REV)
20|FH_F116727_0_0|CSTM-ALL|CSTM-00|2020|PDM|739.00|99|0.00|AEG 3 (NO REV)
20|FH_F116727_0_0|CSTM-ALL|CSTM-00|2020|PDM|814.00|99|0.00|AEG 10 (NO REV)
20|FH_F116727_0_0|SrvcGrp|103236|2022|PDM|5000.00|99|0.00|AETNA INSJ STABLJ DEV
20|FH_F116727_0_0|SrvcGrp|35670|2022|PDM|6500.00|99|0.00|SPINAL NEUROSTIMULATORS PROCEDURE
20|FH_F116731_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F116731_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F116731_0_0|SrvcGrp|97506|2022|PDM|100.00|99|0.00|AETNA HOSPICE ALL OTHER CARE
20|FH_F116747_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F116747_0_0|SrvcGrp|48398|2022|PDM|91.00|99|0.00|PT SERVICES
20|FH_F116747_0_0|SrvcGrp|88621|2022|PDM|91.00|99|0.00|SKILLED NURSING LPN
20|FH_F116793_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F116806_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 5  (NO REV)
20|FH_F116806_0_0|CSTM-ALL|CSTM-00|2020|PDM|1277.00|99|0.00|REMOVAL OF TISSUE FOR GRAFT
20|FH_F116806_0_0|CSTM-ALL|CSTM-00|2020|PDM|530.00|99|0.00|AEG 10 (NO REV)
20|FH_F116806_0_0|CSTM-ALL|CSTM-00|2020|PDM|760.00|99|0.00|AEG 2 (NO REV)
20|FH_F116806_0_0|SrvcGrp|104387|2022|PDM|2499.85|99|0.00|REMOVAL OF BONE FOR GRAFT
20|FH_F116806_0_0|SrvcGrp|104907|2022|PDM|1923.16|99|0.00|EXCISE PAROTID GLAND/LESION
20|FH_F116806_0_0|SrvcGrp|105237|2022|PDM|949.60|99|0.00|BIOPSY/REMOVAL LYMPH NODE(S)
20|FH_F116806_0_0|SrvcGrp|107011|2022|PDM|1923.16|99|0.00|REMOVE CORONOID PROCESS
20|FH_F116806_0_0|SrvcGrp|107013|2022|PDM|1923.16|99|0.00|AUGMENTATION LOWER JAW BONE
20|FH_F116806_0_0|SrvcGrp|107015|2022|PDM|1923.16|99|0.00|REDUCTION OF FOREHEAD
20|FH_F116806_0_0|SrvcGrp|107020|2022|PDM|1923.16|99|0.00|OSTEOPLASTY FACIAL-AUGMENT
20|FH_F116806_0_0|SrvcGrp|107021|2022|PDM|1923.16|99|0.00|OSTEOPLASTY FACIAL-REDUCT
20|FH_F116806_0_0|SrvcGrp|107026|2022|PDM|1923.16|99|0.00|RECONSTRUCTION OF MANDIBLE/MAXILLA-PARTIAL SUBPERIOSTEAL IMP
20|FH_F116806_0_0|SrvcGrp|107027|2022|PDM|1923.16|99|0.00|RECONSTRUCTION OF MANDIBLE/MAXILLA-COMPLETE SUBPERIOSTEAL IM
20|FH_F116806_0_0|SrvcGrp|107029|2022|PDM|1923.16|99|0.00|REVISE EYE SOCKETS
20|FH_F116806_0_0|SrvcGrp|107039|2022|PDM|1923.16|99|0.00|REPAIR DENTAL RIDGE FRACTURE
20|FH_F116806_0_0|SrvcGrp|107045|2022|PDM|1923.16|99|0.00|RECONSTUCTION OF CHIN
20|FH_F116806_0_0|SrvcGrp|107054|2022|PDM|1923.16|99|0.00|RECONSTRUCTION OF MOUTH
20|FH_F116806_0_0|SrvcGrp|107060|2022|PDM|1923.16|99|0.00|RECONSTRUCT CLEFT PALATE
20|FH_F116806_0_0|SrvcGrp|107061|2022|PDM|1923.16|99|0.00|RECONSTRUCT CLEFT PALATE
20|FH_F116806_0_0|SrvcGrp|107062|2022|PDM|1923.16|99|0.00|RECONSTRUCT CLEFT PALATE
20|FH_F116806_0_0|SrvcGrp|107063|2022|PDM|1923.16|99|0.00|RECONSTRUCT CLEFT PALATE
20|FH_F116806_0_0|SrvcGrp|107064|2022|PDM|1923.16|99|0.00|RECONSTRUCT CLEFT PALATE
20|FH_F116806_0_0|SrvcGrp|107066|2022|PDM|1923.16|99|0.00|LENGTHENING OF PALATE
20|FH_F116806_0_0|SrvcGrp|107072|2022|PDM|1923.16|99|0.00|DRAINAGE OF THROAT ABSCESS
20|FH_F116806_0_0|SrvcGrp|107074|2022|PDM|1923.16|99|0.00|EXCISION OF JAW JOINT
20|FH_F116806_0_0|SrvcGrp|107077|2022|PDM|1923.16|99|0.00|EXCISION OF LESION OR TUMOR W/ COMPLEX REPAIR
20|FH_F116806_0_0|SrvcGrp|107079|2022|PDM|1923.16|99|0.00|REPAIR PALATE
20|FH_F116806_0_0|SrvcGrp|107080|2022|PDM|1923.16|99|0.00|EXCISION SUBLINGUAL GLAND
20|FH_F116806_0_0|SrvcGrp|107087|2022|PDM|1277.00|99|0.00|SPLIT-THICKNESS AUTOGRAFT
20|FH_F116806_0_0|SrvcGrp|107088|2022|PDM|1149.97|99|0.00|JAW ARTHROSCOPY/TMJ SURG
20|FH_F116806_0_0|SrvcGrp|107090|2022|PDM|1149.97|99|0.00|INSERT AND REMOVE BONE PIN
20|FH_F116806_0_0|SrvcGrp|107094|2022|PDM|973.15|99|0.00|REMOVAL OF SKIN LESION
20|FH_F116806_0_0|SrvcGrp|107096|2022|PDM|949.60|99|0.00|BIOPSY/REMOVAL LYMPH NODE(S)
20|FH_F116806_0_0|SrvcGrp|107100|2022|PDM|887.26|99|0.00|REPAIR NASAL SEPTAL FRACTURE
20|FH_F116806_0_0|SrvcGrp|107101|2022|PDM|887.26|99|0.00|DRAINAGE OF MOUTH LESION
20|FH_F116806_0_0|SrvcGrp|107133|2022|PDM|887.26|99|0.00|GUM GRAFT
20|FH_F116806_0_0|SrvcGrp|107134|2022|PDM|875.13|99|0.00|SPEECH AID PROSTHESIS
20|FH_F116806_0_0|SrvcGrp|107135|2022|PDM|836.56|99|0.00|AURICULAR PROSTHESIS
20|FH_F116806_0_0|SrvcGrp|27311|2022|PDM|1923.16|99|0.00|EXCISION PAROTID GLAND/LESION
20|FH_F116806_0_0|SrvcGrp|33972|2022|PDM|1923.16|99|0.00|CPT 21048
20|FH_F116806_0_0|SrvcGrp|65402|2022|PDM|1923.16|99|0.00|CPT 42145
20|FH_F116806_0_0|SrvcGrp|90796|2022|PDM|1923.16|99|0.00|RHINOPLASTY SECONDARY - MINOR
20|FH_F116809_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F116809_0_0|CSTM-ALL|CSTM-00|2020|PDM|1385.00|99|0.00|AEG 9 (NO REV)
20|FH_F116809_0_0|CSTM-ALL|CSTM-00|2020|PDM|652.00|99|0.00|AEG 4 (NO REV)
20|FH_F116825_0_0|SrvcGrp|11258|2022|PCT|0.45|99|0.00|DRUGS
20|FH_F116825_0_0|SrvcGrp|471|2022|PDM|1219.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F116825_0_0|SrvcGrp|74382|2022|PDM|33.13|99|0.00|OCCUPATIONAL THERAPY
20|FH_F116828_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F116828_0_0|SrvcGrp|82222|2022|PDM|148.79|99|0.00|HOSPICE CARE
20|FH_F116828_0_0|SrvcGrp|92502|2022|PDM|573.47|99|0.00|HOSPICE GENERAL IP CARE
20|FH_F116849_0_0|SrvcGrp|23130|2022|PDM|23.32|99|0.00|1:1 SUPERVISION
20|FH_F116956_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F116956_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F116956_0_0|CSTM-ALL|CSTM-00|2020|PDM|818.13|99|0.00|2005 ASPG GROUPER V
20|FH_F116956_0_0|SrvcGrp|90318|2022|PCT|1.10|99|0.00|IMPLANTS/PROSTHETICS
20|FH_F116959_0_0|CSTM-ALL|CSTM-00|2020|PDM|1150.00|99|0.00|AEG 5  (NO REV)
20|FH_F116959_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|AEG 6 (NO REV)
20|FH_F116959_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|AEG 1 (NO REV)
20|FH_F116959_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|AEG 3 (NO REV)
20|FH_F116959_0_0|SrvcGrp|16669|2022|PDM|3000.00|99|0.00|ACROMINOPLASTY OF SHOULDER
20|FH_F116959_0_0|SrvcGrp|96999|2022|PDM|2500.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F116988_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F116988_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F116988_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F116988_0_0|SrvcGrp|75479|2022|PDM|446.00|99|0.00|AEG 1
20|FH_F116988_0_0|SrvcGrp|75481|2022|PDM|599.00|99|0.00|AEG 2
20|FH_F116988_0_0|SrvcGrp|75489|2022|PDM|1103.00|99|0.00|AEG 6
20|FH_F116988_0_0|SrvcGrp|75491|2022|PDM|1328.00|99|0.00|AEG 7
20|FH_F116988_0_0|SrvcGrp|75495|2022|PDM|1785.00|99|0.00|AEG 9
20|FH_F117001_0_0|SrvcGrp|106597|2022|PDM|1600.00|99|0.00|HEARING AID, PROG, BIN, CIC
20|FH_F117001_0_0|SrvcGrp|106602|2022|PDM|1300.00|99|0.00|HEARING AID, DIGIT, BIN, ITC
20|FH_F117001_0_0|SrvcGrp|24404|2022|PDM|450.00|99|0.00|HEARING AIDE
20|FH_F117001_0_0|SrvcGrp|49103|2022|PDM|400.00|99|0.00|HEARING AID
20|FH_F117001_0_0|SrvcGrp|49109|2022|PDM|400.00|99|0.00|HEARING AID
20|FH_F117006_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F117006_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F117006_0_0|SrvcGrp|57967|2022|PDM|148.79|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F117006_0_0|SrvcGrp|82222|2022|PDM|148.79|99|0.00|HOSPICE CARE
20|FH_F117006_0_0|SrvcGrp|92502|2022|PDM|573.47|99|0.00|HOSPICE GENERAL IP CARE
20|FH_F117009_0_0|CSTM-ALL|CSTM-00|2020|PDM|1351.00|99|0.00|AEG 6 (NO REV)
20|FH_F117009_0_0|CSTM-ALL|CSTM-00|2020|PDM|1657.00|99|0.00|AEG 8 (NO REV)
20|FH_F117009_0_0|CSTM-ALL|CSTM-00|2020|PDM|549.00|99|0.00|AEG 1 (NO REV)
20|FH_F117009_0_0|CSTM-ALL|CSTM-00|2020|PDM|983.00|99|0.00|AEG 3 (NO REV)
20|FH_F117009_0_0|SrvcGrp|88154|2022|PDM|2146.00|99|0.00|LASER TREATMENT OLD RETINA
20|FH_F117023_0_0|SrvcGrp|107290|2022|PDM|3928.00|99|0.00|AETNA IMPLANT NEUROELECTRODES
20|FH_F117023_0_0|SrvcGrp|72996|2022|PDM|1038.00|99|0.00|AEG 4
20|FH_F117023_0_0|SrvcGrp|72998|2022|PDM|1180.00|99|0.00|AEG 5
20|FH_F117023_0_0|SrvcGrp|73006|2022|PDM|2205.00|99|0.00|AEG 9
20|FH_F117023_0_0|SrvcGrp|89404|2022|PDM|5500.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F117027_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F117027_0_0|CSTM-ALL|CSTM-00|2020|PDM|307.00|99|0.00|AEG 1 (NO REV)
20|FH_F117027_0_0|CSTM-ALL|CSTM-00|2020|PDM|468.00|99|0.00|AEG 10 (NO REV)
20|FH_F117027_0_0|CSTM-ALL|CSTM-00|2020|PDM|468.00|99|0.00|AEG 3 (NO REV)
20|FH_F117027_0_0|CSTM-ALL|CSTM-00|2020|PDM|662.00|99|0.00|AEG 5  (NO REV)
20|FH_F117072_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F117087_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F117087_0_0|CSTM-ALL|CSTM-00|2020|PDM|2033.00|99|0.00|AEG 6 (NO REV)
20|FH_F117087_0_0|CSTM-ALL|CSTM-00|2020|PDM|2368.00|99|0.00|AEG 8 (NO REV)
20|FH_F117087_0_0|CSTM-ALL|CSTM-00|2020|PDM|773.00|99|0.00|AEG 1 (NO REV)
20|FH_F117087_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F117087_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F117087_0_0|SrvcGrp|106264|2022|PDM|4185.00|99|0.00|NSL/SINS NDSC W/ SINS DILATION
20|FH_F117087_0_0|SrvcGrp|107176|2022|PDM|2494.00|99|0.00|REMOVE EAR LESION
20|FH_F117087_0_0|SrvcGrp|107181|2022|PDM|2494.00|99|0.00|REVISE MIDDLE EAR & MASTOID
20|FH_F117087_0_0|SrvcGrp|107189|2022|PDM|1153.00|99|0.00|BIOPSY OF UPPER NOSE/THROAT
20|FH_F117113_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F117113_0_0|SrvcGrp|472|2022|PDM|367.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F117132_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F117132_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 2 (NO REV)
20|FH_F117132_0_0|SrvcGrp|107320|2022|PDM|2101.00|99|0.00|REPAIR RETINAL DETACHMENT
20|FH_F117132_0_0|SrvcGrp|107321|2022|PDM|2000.00|99|0.00|FISTULIZATION AND TRANSLUMINAL DILATION
20|FH_F117132_0_0|SrvcGrp|11663|2022|PCT|1.10|99|0.00|IMPLANTS
20|FH_F117132_0_0|SrvcGrp|80618|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBTANCE
20|FH_F117147_0_0|SrvcGrp|82981|2022|PDM|148.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F117195_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.59|99|0.00|OP SVCS
20|FH_F117195_0_0|SrvcGrp|66561|2022|PCT|0.90|99|0.00|DME/ORTHOTICS/PROSTHETICS/IMPLANTS
20|FH_F117199_0_0|CSTM-ALL|CSTM-00|2020|PDM|733.22|99|0.00|AEG 1 (NO REV)
20|FH_F117199_0_0|CSTM-ALL|CSTM-00|2020|PDM|733.22|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F117199_0_0|CSTM-ALL|CSTM-00|2020|PDM|947.39|99|0.00|AEG 2 (NO REV)
20|FH_F117206_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F117206_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F117206_0_0|SrvcGrp|36591|2022|PDM|1500.00|99|0.00|CPT 63685
20|FH_F117206_0_0|SrvcGrp|63471|2022|PDM|1500.00|99|0.00|CPT 64590
20|FH_F117206_0_0|SrvcGrp|71666|2022|PDM|2500.00|99|0.00|CPT 63655
20|FH_F117206_0_0|SrvcGrp|72996|2022|PDM|860.00|99|0.00|AEG 4
20|FH_F117206_0_0|SrvcGrp|73008|2022|PDM|914.00|99|0.00|AEG 10
20|FH_F117206_0_0|SrvcGrp|77021|2022|PDM|3605.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY
20|FH_F117206_0_0|SrvcGrp|82310|2022|PDM|600.00|99|0.00|COLORECTAL CANCER SCREENING
20|FH_F117206_0_0|SrvcGrp|84999|2022|PDM|721.00|99|0.00|CPT 45379
20|FH_F117206_0_0|SrvcGrp|88487|2022|PDM|1000.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION
20|FH_F117206_0_0|SrvcGrp|88494|2022|PDM|700.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION
20|FH_F117206_0_0|SrvcGrp|90601|2022|PDM|1485.00|99|0.00|REMOVAL OF LENS MATERIAL
20|FH_F117206_0_0|SrvcGrp|90602|2022|PDM|1485.00|99|0.00|EXTRACTION OF LENS
20|FH_F117206_0_0|SrvcGrp|90607|2022|PDM|619.00|99|0.00|SMALL BOWEL ENDOSCOPY
20|FH_F117206_0_0|SrvcGrp|92408|2022|PDM|1000.00|99|0.00|PERQ VERTEBRAL AUGMENTATION
20|FH_F117208_0_0|CSTM-ALL|CSTM-00|2020|PDM|2750.00|99|0.00|AEG 5  (NO REV)
20|FH_F117208_0_0|CSTM-ALL|CSTM-00|2020|PDM|742.50|99|0.00|AEG 1 (NO REV)
20|FH_F117208_0_0|SrvcGrp|106916|2022|PDM|3410.00|99|0.00|NASAL/SINUS ENDOSCPOY - W/ARTERY LIGAMENT
20|FH_F117208_0_0|SrvcGrp|11663|2022|PCT|1.05|99|0.00|IMPLANTS
20|FH_F117208_0_0|SrvcGrp|81571|2022|PDM|3410.00|99|0.00|NASAL ENDOSCOPY W/ SINUS OSTIA DILATION
20|FH_F117208_0_0|SrvcGrp|88599|2022|PDM|3410.00|99|0.00|ENDOSCOPY MAXILLARY SINUS
20|FH_F117208_0_0|SrvcGrp|90822|2022|PDM|4015.00|99|0.00|NASAL/SINUS ENDOSCOPY SURGERY
20|FH_F117210_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F117210_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F117216_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F117216_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|HSS ASC
20|FH_F117224_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F117225_0_0|CSTM-ALL|CSTM-00|2020|PDM|210.00|99|0.00|AEG 1 (NO REV)
20|FH_F117225_0_0|CSTM-ALL|CSTM-00|2020|PDM|481.00|99|0.00|AEG 2 (NO REV)
20|FH_F117225_0_0|CSTM-ALL|CSTM-00|2020|PDM|6353.00|99|0.00|AEG 7 (NO REV)
20|FH_F117230_0_0|CSTM-ALL|CSTM-00|2020|PDM|1040.00|99|0.00|AEG 4 (NO REV)
20|FH_F117230_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|AEG 10 (NO REV)
20|FH_F117230_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|AEG 7 (NO REV)
20|FH_F117230_0_0|CSTM-ALL|CSTM-00|2020|PDM|1750.00|99|0.00|AEG 8 (NO REV)
20|FH_F117230_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 1 (NO REV)
20|FH_F117245_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F117245_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F117245_0_0|SrvcGrp|72992|2022|PDM|736.00|99|0.00|AEG 2
20|FH_F117245_0_0|SrvcGrp|72998|2022|PDM|1183.00|99|0.00|AEG 5
20|FH_F117245_0_0|SrvcGrp|73000|2022|PDM|1363.00|99|0.00|AEG 6
20|FH_F117287_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F117299_0_0|CSTM-ALL|CSTM-00|2020|PDM|1688.00|99|0.00|AEG 6 (NO REV)
20|FH_F117299_0_0|CSTM-ALL|CSTM-00|2020|PDM|1756.00|99|0.00|AEG 9 (NO REV)
20|FH_F117299_0_0|CSTM-ALL|CSTM-00|2020|PDM|968.00|99|0.00|AEG 2 (NO REV)
20|FH_F117299_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F117299_0_0|SrvcGrp|107498|2022|PDM|1144.00|99|0.00|AETNA VASECTOMY, UNILAT OR BILAT
20|FH_F117299_0_0|SrvcGrp|107500|2022|PDM|976.00|99|0.00|AETNA - CYSTOSCOPY AND TREATMENT
20|FH_F117299_0_0|SrvcGrp|68053|2022|PDM|1701.00|99|0.00|CPT 52234
20|FH_F117299_0_0|SrvcGrp|68056|2022|PDM|2601.00|99|0.00|CPT 55700
20|FH_F117300_0_0|CSTM-ALL|CSTM-00|2020|PDM|2175.00|99|0.00|AEG 4 (NO REV)
20|FH_F117300_0_0|CSTM-ALL|CSTM-00|2020|PDM|2393.00|99|0.00|AEG 6 (NO REV)
20|FH_F117300_0_0|CSTM-ALL|CSTM-00|2020|PDM|2456.00|99|0.00|AEG 7 (NO REV)
20|FH_F117300_0_0|CSTM-ALL|CSTM-00|2020|PDM|2844.00|99|0.00|AEG 8 (NO REV)
20|FH_F117300_0_0|CSTM-ALL|CSTM-00|2020|PDM|2945.00|99|0.00|AEG 9 (NO REV)
20|FH_F117300_0_0|CSTM-ALL|CSTM-00|2020|PDM|982.00|99|0.00|AEG 10 (NO REV)
20|FH_F117300_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F117300_0_0|SrvcGrp|11306|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F117300_0_0|SrvcGrp|34606|2022|PDM|2945.00|99|0.00|CPT 29827
20|FH_F117300_0_0|SrvcGrp|67065|2022|PDM|7853.00|99|0.00|CERVICAL SURGERY
20|FH_F117300_0_0|SrvcGrp|72121|2022|PDM|2945.00|99|0.00|ARTHOSCOPY
20|FH_F117300_0_0|SrvcGrp|74039|2022|PDM|7360.00|99|0.00|LAMINECTOMY
20|FH_F117300_0_0|SrvcGrp|88158|2022|PDM|7360.00|99|0.00|NECK SPINE DISK SURGERY
20|FH_F117300_0_0|SrvcGrp|88491|2022|PDM|7360.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR
20|FH_F117300_0_0|SrvcGrp|89404|2022|PDM|7360.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F117300_0_0|SrvcGrp|98496|2022|PDM|7853.00|99|0.00|ARTHRODESIS POSTERIOR ATLAS
20|FH_F117335_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F117335_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F117335_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F117335_0_0|SrvcGrp|42550|2022|PDM|1485.00|99|0.00|OP SURGERY CPT 66984
20|FH_F117335_0_0|SrvcGrp|72990|2022|PDM|424.00|99|0.00|AEG 1
20|FH_F117335_0_0|SrvcGrp|72998|2022|PDM|854.00|99|0.00|AEG 5
20|FH_F117335_0_0|SrvcGrp|73000|2022|PDM|997.00|99|0.00|AEG 6
20|FH_F117335_0_0|SrvcGrp|73008|2022|PDM|833.00|99|0.00|AEG 10
20|FH_F117335_0_0|SrvcGrp|85966|2022|PDM|1485.00|99|0.00|EXTRACAPSULAR CATARACT
20|FH_F117382_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F117382_0_0|SrvcGrp|103551|2022|PDM|171.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS
20|FH_F117382_0_0|SrvcGrp|103552|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER
20|FH_F117387_0_0|CSTM-ALL|CSTM-00|2020|PCT|74.00|99|0.00|GENERAL ACUTE CARE
20|FH_F117392_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|AETNA SURGERY DEFAULT W/O GROUPER 1
20|FH_F117392_0_0|SrvcGrp|75479|2022|PDM|385.00|99|0.00|AEG 1
20|FH_F117399_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F117401_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F117401_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F117426_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F117426_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F117426_0_0|SrvcGrp|471|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F117437_0_0|SrvcGrp|104226|2022|PDM|180.00|99|0.00|HOSPICE CARE (HCFA)
20|FH_F117437_0_0|SrvcGrp|95661|2022|PDM|180.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F117442_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F117442_0_0|SrvcGrp|92501|2022|PDM|133.35|99|0.00|HOSPICE IP RESPITE CARE
20|FH_F117465_0_0|SrvcGrp|107493|2022|PDM|3000.00|99|0.00|AETNA - ARTHROSCOPY OF JOINT
20|FH_F117465_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F117465_0_0|SrvcGrp|40002|2022|PDM|10000.00|99|0.00|TOTAL HIP
20|FH_F117465_0_0|SrvcGrp|75495|2022|PDM|1500.00|99|0.00|AEG 9
20|FH_F117465_0_0|SrvcGrp|85198|2022|PDM|5000.00|99|0.00|AETNA KNEE ARTHROSCOPY
20|FH_F117465_0_0|SrvcGrp|96350|2022|PDM|10000.00|99|0.00|SHOULDER JOINT
20|FH_F117465_0_0|SrvcGrp|98580|2022|PDM|6000.00|99|0.00|ARTHRODESIS SACROILIAC JOINT
20|FH_F117485_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F117485_0_0|CSTM-ALL|CSTM-00|2020|PDM|1481.00|99|0.00|AEG 6 (NO REV)
20|FH_F117485_0_0|CSTM-ALL|CSTM-00|2020|PDM|593.00|99|0.00|AEG 1 (NO REV)
20|FH_F117486_0_0|SrvcGrp|105357|2022|PDM|400.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD
20|FH_F117509_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F117509_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F117509_0_0|SrvcGrp|57968|2022|PDM|31.35|99|0.00|CONTINUOUS HOMECARE
20|FH_F117509_0_0|SrvcGrp|92502|2022|PDM|573.47|99|0.00|HOSPICE GENERAL IP CARE
20|FH_F117512_0_0|CSTM-ALL|CSTM-00|2020|PDM|1418.00|99|0.00|AEG 4 (NO REV)
20|FH_F117512_0_0|CSTM-ALL|CSTM-00|2020|PDM|1699.00|99|0.00|AEG 9 (NO REV)
20|FH_F117512_0_0|SrvcGrp|75189|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F117525_0_0|SrvcGrp|73006|2022|PDM|1950.00|99|0.00|AEG 9
20|FH_F117531_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F117531_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F117531_0_0|SrvcGrp|103552|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER
20|FH_F117550_0_0|SrvcGrp|73485|2022|PDM|1100.00|99|0.00|AETNA REHAB
20|FH_F117550_0_0|SrvcGrp|88858|2022|PDM|102.00|99|0.00|EVALUATION OF SPEECH FLUENCY
20|FH_F117550_0_0|SrvcGrp|98688|2022|PDM|25.60|99|0.00|GROUP THERAPY 2 OR MORE
20|FH_F117550_0_0|SrvcGrp|99459|2022|PDM|46.00|99|0.00|PHYSICAL THERAPY EVALUATION
20|FH_F117552_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F117552_0_0|SrvcGrp|73002|2022|PDM|1196.00|99|0.00|AEG 7
20|FH_F117552_0_0|SrvcGrp|73004|2022|PDM|1178.00|99|0.00|AEG 8
20|FH_F117552_0_0|SrvcGrp|88739|2022|PDM|2200.00|99|0.00|IMPLANT SPINAL CANAL
20|FH_F117559_08619_0|SrvcGrp|112230|2022|PDM|20.00|99|0.00|CCIIV4 VACCINE IM CULT PRSV FREE 0.5 ML
20|FH_F117559_08619_0|SrvcGrp|114532|2022|PDM|40.00|99|0.00|ADM SARS COV2 30MCG/0.3 ML (3RD)
20|FH_F117559_08619_0|SrvcGrp|114536|2022|PDM|40.00|99|0.00|ADM SARS COV2 30MCG/0.3 ML BST
20|FH_F117559_08619_0|SrvcGrp|114537|2022|PDM|40.00|99|0.00|ADM SARS COV2 VAC AD26 .5ML B
20|FH_F117559_08619_0|SrvcGrp|114539|2022|PDM|40.00|99|0.00|ADM SARS COV2 10MCG TRS-SUCR 1
20|FH_F117559_08619_0|SrvcGrp|115658|2022|PDM|65.00|99|0.00|INFLUENZA VACCINE AIIV4
20|FH_F117559_08619_0|SrvcGrp|64580|2022|PDM|264.00|99|0.00|CAPD/CCPD SUPPLEMENT
20|FH_F117559_08619_0|SrvcGrp|68641|2022|PDM|648.00|99|0.00|HOME HEMODIALYSIS
20|FH_F117559_08619_0|SrvcGrp|74422|2022|PDM|15.00|99|0.00|IMMUNIZATION ADMIN
20|FH_F117559_08619_0|SrvcGrp|94423|2022|PDM|15.00|99|0.00|IMMUNIZATIONS
20|FH_F117575_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F117575_0_0|CSTM-ALL|CSTM-00|2020|PDM|1565.00|99|0.00|AEG 9 (NO REV)
20|FH_F117611_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F117626_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F117626_0_0|CSTM-ALL|CSTM-00|2020|PDM|1088.00|99|0.00|AEG 6 (NO REV)
20|FH_F117626_0_0|CSTM-ALL|CSTM-00|2020|PDM|675.00|99|0.00|AEG 3 (NO REV)
20|FH_F117626_0_0|SrvcGrp|35669|2022|PDM|5200.00|99|0.00|CPT 63650
20|FH_F117626_0_0|SrvcGrp|35670|2022|PDM|6500.00|99|0.00|SPINAL NEUROSTIMULATORS PROCEDURE
20|FH_F117627_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F117627_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 4 (NO REV)
20|FH_F117644_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA CARDIAC CATH INCIDENTAL CODES
20|FH_F117644_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F117644_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F117647_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|AEG 8 (NO REV)
20|FH_F117647_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 5  (NO REV)
20|FH_F117647_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F117715_0_0|SrvcGrp|107642|2022|PDM|2041.91|99|0.00|CYSTOURETHROSCOPY SERVICES
20|FH_F117715_0_0|SrvcGrp|107643|2022|PDM|929.68|99|0.00|CYSTOURETHROSCOPY/MALE GENITAL SERVICES
20|FH_F117715_0_0|SrvcGrp|2784|2022|PDM|7053.99|99|0.00|PROSTATE CRYOABLATION
20|FH_F117715_0_0|SrvcGrp|75481|2022|PDM|652.00|99|0.00|AEG 2
20|FH_F117715_0_0|SrvcGrp|75489|2022|PDM|1048.00|99|0.00|AEG 6
20|FH_F117715_0_0|SrvcGrp|75493|2022|PDM|1048.00|99|0.00|AEG 8
20|FH_F117715_0_0|SrvcGrp|80523|2022|PDM|14745.39|99|0.00|PENILE PROSTHESIS IMPLANTATION
20|FH_F117728_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F117762_0_0|CSTM-ALL|CSTM-00|2020|PDM|1725.00|99|0.00|AEG 9 (NO REV)
20|FH_F117762_0_0|CSTM-ALL|CSTM-00|2020|PDM|762.00|99|0.00|AEG 3 (NO REV)
20|FH_F117762_0_0|SrvcGrp|10985|2022|PDM|2891.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F117762_0_0|SrvcGrp|36864|2022|PDM|13520.00|99|0.00|COCHLEAR IMPLANTS
20|FH_F117762_0_0|SrvcGrp|58776|2022|PDM|5928.00|99|0.00|DISKECTOMY
20|FH_F117762_0_0|SrvcGrp|67064|2022|PDM|4836.00|99|0.00|MUSCULOSKELETAL SYSTEM
20|FH_F117762_0_0|SrvcGrp|73486|2022|PCT|0.00|99|0.00|AETNA CONTRAST AGENT
20|FH_F117762_0_0|SrvcGrp|75885|2022|PDM|2132.00|99|0.00|AETNA CPT 49560
20|FH_F117762_0_0|SrvcGrp|77582|2022|PDM|3120.00|99|0.00|CPT 31255
20|FH_F117762_0_0|SrvcGrp|83641|2022|PDM|1872.00|99|0.00|CPT 29889
20|FH_F117762_0_0|SrvcGrp|84307|2022|PDM|3640.00|99|0.00|TENDON REPAIR
20|FH_F117762_0_0|SrvcGrp|84939|2022|PDM|14560.00|99|0.00|SHOULDER JOINT
20|FH_F117762_0_0|SrvcGrp|85778|2022|PDM|3640.00|99|0.00|REPAIR OF ANKLE FRACTURE
20|FH_F117762_0_0|SrvcGrp|86233|2022|PDM|1430.00|99|0.00|AETNA RECONSTRUCT ANKLE JOINT
20|FH_F117762_0_0|SrvcGrp|88162|2022|PDM|4992.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON
20|FH_F117762_0_0|SrvcGrp|88491|2022|PDM|4992.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR
20|FH_F117762_0_0|SrvcGrp|89860|2022|PDM|4992.00|99|0.00|SPINAL DISK SURGERY ADD-ON
20|FH_F117762_0_0|SrvcGrp|89982|2022|PDM|3620.00|99|0.00|SHOULDER ARTHROSCOPY / SURGERY
20|FH_F117762_0_0|SrvcGrp|92415|2022|PDM|4992.00|99|0.00|NECK SPINE DISK SURGERY
20|FH_F117762_0_0|SrvcGrp|92819|2022|PDM|3620.00|99|0.00|HIP ARTHOSCOPY
20|FH_F117762_0_0|SrvcGrp|93071|2022|PDM|7280.00|99|0.00|POSTERIOR SEGMENTAL INSTRU
20|FH_F117762_0_0|SrvcGrp|95462|2022|PDM|1976.00|99|0.00|REPAIR OF ANKLE LIGAMENT
20|FH_F117762_0_0|SrvcGrp|95559|2022|PDM|14560.00|99|0.00|HIP JOINT
20|FH_F117762_0_0|SrvcGrp|98003|2022|PDM|3640.00|99|0.00|BIMALLEOLAR ANKLE FRACTURE
20|FH_F117762_0_0|SrvcGrp|99161|2022|PDM|14560.00|99|0.00|CPT 27138
20|FH_F117762_0_0|SrvcGrp|99172|2022|PDM|5144.00|99|0.00|CPT 28740
20|FH_F117762_0_0|SrvcGrp|99176|2022|PDM|1279.00|99|0.00|REMOVE TONSILS AND ADENOIDS
20|FH_F117783_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F117783_0_0|CSTM-ALL|CSTM-00|2020|PDM|1236.00|99|0.00|AEG 6 (NO REV)
20|FH_F117783_0_0|CSTM-ALL|CSTM-00|2020|PDM|1545.00|99|0.00|AEG 8 (NO REV)
20|FH_F117783_0_0|CSTM-ALL|CSTM-00|2020|PDM|824.00|99|0.00|AEG 1 (NO REV)
20|FH_F117783_0_0|CSTM-ALL|CSTM-00|2020|PDM|876.00|99|0.00|AEG 3 (NO REV)
20|FH_F117783_0_0|SrvcGrp|104003|2022|PCT|1.00|99|0.00|INSERT AQUEOUS DRAIN DEVICES
20|FH_F117783_0_0|SrvcGrp|13187|2022|PCT|1.00|99|0.00|INTRAOCULAR LENSES
20|FH_F117783_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS
20|FH_F117784_0_0|SrvcGrp|106300|2022|PDM|134.93|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT (HCFA)
20|FH_F117784_0_0|SrvcGrp|13262|2022|PDM|2.88|99|0.00|GROUND MILEAGE, PER STATUTE MILE
20|FH_F117784_0_0|SrvcGrp|13597|2022|PDM|130.07|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT
20|FH_F117799_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F117799_0_0|CSTM-ALL|CSTM-00|2020|PDM|2203.00|99|0.00|AEG 9 (NO REV)
20|FH_F117799_0_0|SrvcGrp|104856|2022|PDM|5570.00|99|0.00|PERCUTANEIOUS VERTEBROPLASY
20|FH_F117799_0_0|SrvcGrp|67065|2022|PDM|19627.00|99|0.00|CERVICAL SURGERY
20|FH_F117799_0_0|SrvcGrp|67066|2022|PDM|9018.00|99|0.00|CERVICAL SURGERY
20|FH_F117799_0_0|SrvcGrp|67279|2022|PDM|10609.00|99|0.00|CERVICAL SURGERY
20|FH_F117799_0_0|SrvcGrp|84357|2022|PDM|11935.00|99|0.00|HIP SURGERY
20|FH_F117799_0_0|SrvcGrp|84932|2022|PDM|1891.00|99|0.00|VITRECTOMY
20|FH_F117799_0_0|SrvcGrp|89721|2022|PDM|9813.00|99|0.00|SPINAL NEUROSTIMULATION
20|FH_F117799_0_0|SrvcGrp|89949|2022|PDM|5623.00|99|0.00|HIP ARTHOSCOPY
20|FH_F117802_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F117802_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F117802_0_0|SrvcGrp|59368|2022|PDM|188.00|99|0.00|PERITONEAL DIALYSIS
20|FH_F117816_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F117816_0_0|SrvcGrp|57968|2022|PDM|31.35|99|0.00|CONTINUOUS HOMECARE
20|FH_F117820_0_0|SrvcGrp|47411|2022|PDM|62.60|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F117820_0_0|SrvcGrp|94781|2022|PDM|105.00|99|0.00|HOSPICE IN LTCH (HCFA)
20|FH_F117831_0_0|CSTM-ALL|CSTM-00|2020|PDM|1110.00|99|0.00|AEG 7 (NO REV)
20|FH_F117831_0_0|CSTM-ALL|CSTM-00|2020|PDM|683.00|99|0.00|AEG 3 (NO REV)
20|FH_F117831_0_0|CSTM-ALL|CSTM-00|2020|PDM|848.00|99|0.00|AEG 4 (NO REV)
20|FH_F117831_0_0|CSTM-ALL|CSTM-00|2020|PDM|939.00|99|0.00|AEG 10 (NO REV)
20|FH_F117831_0_0|SrvcGrp|101320|2022|PDM|1000.00|99|0.00|PARAVERTEBRAL FACET JOINT NERVE
20|FH_F117831_0_0|SrvcGrp|35669|2022|PDM|6375.00|99|0.00|CPT 63650
20|FH_F117858_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F117887_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F117896_0_0|SrvcGrp|57968|2022|PDM|30.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F117902_0_0|CSTM-ALL|CSTM-00|2020|PDM|1845.00|99|0.00|AEG 9 (NO REV)
20|FH_F117902_0_0|CSTM-ALL|CSTM-00|2020|PDM|525.00|99|0.00|AEG 1 (NO REV)
20|FH_F117902_0_0|CSTM-ALL|CSTM-00|2020|PDM|825.00|99|0.00|AEG 10 (NO REV)
20|FH_F117905_0_0|SrvcGrp|103551|2022|PDM|180.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS
20|FH_F118028_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.50|99|0.00|OP SVCS
20|FH_F118165_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F118165_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|CARDIAC STUDIES
20|FH_F118168_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F118168_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING
20|FH_F118168_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|VASCULAR DIAGNOSTIC STUDIES
20|FH_F118173_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F118173_0_0|CSTM-ALL|CSTM-00|2020|PDM|1339.00|99|0.00|AEG 9 (NO REV)
20|FH_F118173_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 1 (NO REV)
20|FH_F118173_0_0|CSTM-ALL|CSTM-00|2020|PDM|446.00|99|0.00|AEG 2 (NO REV)
20|FH_F118173_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|AEG 3 (NO REV)
20|FH_F118184_0_0|SrvcGrp|111931|2022|PDM|35.91|99|0.00|COVID-19 CDC TESTING LAB
20|FH_F118184_0_0|SrvcGrp|111934|2022|PDM|51.31|99|0.00|COVID-19 NUCLEIC ACID
20|FH_F118184_0_0|SrvcGrp|112813|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER
20|FH_F118196_0_0|SrvcGrp|73000|2022|PDM|894.00|99|0.00|AEG 6
20|FH_F118243_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F118243_0_0|SrvcGrp|107639|2022|PDM|450.00|99|0.00|HEMODIALYSIS
20|FH_F118249_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F118249_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F118249_0_0|CSTM-ALL|CSTM-00|2020|PDM|1314.00|99|0.00|AEG 9 (NO REV)
20|FH_F118249_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F118249_0_0|SrvcGrp|108064|2022|PDM|4300.00|99|0.00|IMPLANT NEUROELECTRODES 29
20|FH_F118275_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F118275_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|OP SVCS
20|FH_F118275_0_0|CSTM-ALL|CSTM-00|2020|PCT|2.00|99|0.00|HSS ASC
20|FH_F118300_0_0|SrvcGrp|92501|2022|PDM|133.35|99|0.00|HOSPICE IP RESPITE CARE
20|FH_F118303_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 1 (NO REV)
20|FH_F118303_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|AEG 3 (NO REV)
20|FH_F118303_0_0|CSTM-ALL|CSTM-00|2020|PDM|973.00|99|0.00|AEG 8 (NO REV)
20|FH_F118309_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F118309_0_0|CSTM-ALL|CSTM-00|2020|PDM|792.23|99|0.00|AEG 10 (NO REV)
20|FH_F118386_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F118446_0_0|SrvcGrp|29155|2022|PDM|150.00|99|0.00|HOSPICE SVCS
20|FH_F118446_0_0|SrvcGrp|82222|2022|PDM|150.00|99|0.00|HOSPICE CARE
20|FH_F118459_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|AETNA CARDIAC CATHERTERIZATION
20|FH_F118459_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F118459_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP DIALYSIS
20|FH_F118469_0_0|CSTM-ALL|CSTM-00|2020|PDM|1492.00|99|0.00|AEG 3 (NO REV)
20|FH_F118469_0_0|CSTM-ALL|CSTM-00|2020|PDM|2425.00|99|0.00|AEG 6 (NO REV)
20|FH_F118469_0_0|CSTM-ALL|CSTM-00|2020|PDM|3455.00|99|0.00|AEG 9 (NO REV)
20|FH_F118469_0_0|SrvcGrp|107793|2022|PDM|3500.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE
20|FH_F118469_0_0|SrvcGrp|74587|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F118473_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F118488_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OBSERVATION SERVICES
20|FH_F118488_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP DIALYSIS
20|FH_F118555_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 7 (NO REV)
20|FH_F118555_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F118651_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F118651_0_0|CSTM-ALL|CSTM-00|2020|PDM|1273.08|99|0.00|AEG 2 (NO REV)
20|FH_F118651_0_0|CSTM-ALL|CSTM-00|2020|PDM|1591.35|99|0.00|AEG 10 (NO REV)
20|FH_F118651_0_0|CSTM-ALL|CSTM-00|2020|PDM|2015.71|99|0.00|AEG 6 (NO REV)
20|FH_F118651_0_0|SrvcGrp|101520|2022|PDM|4959.71|99|0.00|T1H W/T/O (<250G)
20|FH_F118651_0_0|SrvcGrp|101526|2022|PDM|5092.32|99|0.00|LAPARO-ASST VAG HYSTERECTOMY
20|FH_F118651_0_0|SrvcGrp|104554|2022|PCT|0.00|99|0.00|RELEASE OF URETER
20|FH_F118651_0_0|SrvcGrp|107867|2022|PDM|4959.71|99|0.00|AETNA REMOVAL OF UTERUS LESION
20|FH_F118651_0_0|SrvcGrp|107870|2022|PDM|3713.15|99|0.00|AETNA EXC ABD TUM OVER 5 CM
20|FH_F118651_0_0|SrvcGrp|107871|2022|PDM|3182.70|99|0.00|AETNA EXC ABD TUM 5 CM OR LESS
20|FH_F118651_0_0|SrvcGrp|33965|2022|PDM|4959.71|99|0.00|CPT 58552
20|FH_F118651_0_0|SrvcGrp|83817|2022|PDM|2652.25|99|0.00|LAPAROSCOPY LYSIS ADHESIONS
20|FH_F118661_0_0|SrvcGrp|79589|2022|PDM|998.00|99|0.00|UPPER GI
20|FH_F118661_0_0|SrvcGrp|82307|2022|PDM|903.00|99|0.00|COLORECTAL CANCER SCREENING
20|FH_F118693_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA CARDIAC CATH INCIDENTAL CODES
20|FH_F118693_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F118693_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OBSERVATION SERVICES
20|FH_F118693_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|VASCULAR DIAGNOSTIC STUDIES
20|FH_F118699_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|AEG 9 (NO REV)
20|FH_F118699_0_0|CSTM-ALL|CSTM-00|2020|PDM|433.00|99|0.00|AEG 10 (NO REV)
20|FH_F118699_0_0|CSTM-ALL|CSTM-00|2020|PDM|433.00|99|0.00|AEG 2 (NO REV)
20|FH_F118699_0_0|CSTM-ALL|CSTM-00|2020|PDM|495.00|99|0.00|AEG 3 (NO REV)
20|FH_F118699_0_0|CSTM-ALL|CSTM-00|2020|PDM|696.00|99|0.00|AEG 5  (NO REV)
20|FH_F118699_0_0|CSTM-ALL|CSTM-00|2020|PDM|966.00|99|0.00|AEG 7 (NO REV)
20|FH_F118699_0_0|SrvcGrp|103503|2022|PDM|433.00|99|0.00|AETNA CARDIAC CATHERTERIZATION
20|FH_F118703_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F118703_0_0|SrvcGrp|72990|2022|PDM|380.00|99|0.00|AEG 1
20|FH_F118703_0_0|SrvcGrp|72992|2022|PDM|508.00|99|0.00|AEG 2
20|FH_F118703_0_0|SrvcGrp|73004|2022|PDM|1134.00|99|0.00|AEG 8
20|FH_F118703_0_0|SrvcGrp|73006|2022|PDM|1513.00|99|0.00|AEG 9
20|FH_F118703_0_0|SrvcGrp|73008|2022|PDM|583.00|99|0.00|AEG 10
20|FH_F118742_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F118783_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|AETNA CARDIAC CATHERTERIZATION
20|FH_F118783_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS
20|FH_F118783_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|VASCULAR DIAGNOSTIC STUDIES
20|FH_F118786_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.33|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE
20|FH_F118803_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F118803_0_0|CSTM-ALL|CSTM-00|2020|PDM|1035.20|99|0.00|AEG 7 (NO REV)
20|FH_F118803_0_0|CSTM-ALL|CSTM-00|2020|PDM|745.97|99|0.00|AEG 5  (NO REV)
20|FH_F118803_0_0|SrvcGrp|103638|2022|PDM|3818.57|99|0.00|AETNA OPEN/PERQ PLACE STENT 1ST
20|FH_F118803_0_0|SrvcGrp|103640|2022|PDM|5555.43|99|0.00|AETNA OPEN/PERQ PLACE STENT SAME
20|FH_F118803_0_0|SrvcGrp|103974|2022|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES
20|FH_F118803_0_0|SrvcGrp|107794|2022|PDM|4993.92|99|0.00|DIALYSIS CIRCUIT PROCEDURE
20|FH_F118803_0_0|SrvcGrp|107876|2022|PDM|504.97|99|0.00|MECH REMV PERICATH MATL SEP
20|FH_F118803_0_0|SrvcGrp|107882|2022|PDM|2162.15|99|0.00|DIALYSIS CIRCUIT EMBOLJ
20|FH_F118803_0_0|SrvcGrp|107883|2022|PDM|1705.04|99|0.00|SEC ART THROMBECTOMY ADD-ON
20|FH_F118848_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F118848_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F118848_0_0|CSTM-ALL|CSTM-00|2020|PDM|2400.00|99|0.00|AEG 8 (NO REV)
20|FH_F118848_0_0|CSTM-ALL|CSTM-00|2020|PDM|2800.00|99|0.00|AEG 9 (NO REV)
20|FH_F118848_0_0|CSTM-ALL|CSTM-00|2020|PDM|3600.00|99|0.00|AEG 4 (NO REV)
20|FH_F118848_0_0|SrvcGrp|28548|2022|PDM|4800.00|99|0.00|VITRECTOMY
20|FH_F118884_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE
20|FH_F118907_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F118907_0_0|SrvcGrp|103927|2022|PDM|172.21|99|0.00|SLEEP STUDY UNATTENDED(HCFA)
20|FH_F118907_0_0|SrvcGrp|107720|2022|PDM|333.89|99|0.00|SLEEP STUDIES
20|FH_F118907_0_0|SrvcGrp|107721|2022|PDM|508.10|99|0.00|SLEEP STUDIES
20|FH_F118907_0_0|SrvcGrp|107723|2022|PDM|663.75|99|0.00|SLEEP STUDIES
20|FH_F118907_0_0|SrvcGrp|107896|2022|PDM|333.89|99|0.00|SLEEP STUDIES (HCFA)
20|FH_F118907_0_0|SrvcGrp|107898|2022|PDM|603.56|99|0.00|SLEEP STUDIES (HCFA)
20|FH_F118909_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F118909_0_0|SrvcGrp|89783|2022|PDM|133.90|99|0.00|RESPITE CARE (HCFA)
20|FH_F118909_0_0|SrvcGrp|90707|2022|PDM|133.90|99|0.00|AETNA HOSPICE CARE
20|FH_F118909_0_0|SrvcGrp|93098|2022|PDM|123.60|99|0.00|HOSPICE CARE
20|FH_F118909_0_0|SrvcGrp|95660|2022|PDM|566.50|99|0.00|HOSPICE SERVICES (HCFA)
20|FH_F118909_0_0|SrvcGrp|97703|2022|PDM|123.60|99|0.00|HOSPICE IN LTCH (HCFA)
20|FH_F118910_0_0|SrvcGrp|80920|2022|PDM|540.75|99|0.00|HOSPICE SERVICES
20|FH_F118910_0_0|SrvcGrp|89781|2022|PDM|113.30|99|0.00|RESPITE CARE (HCFA)
20|FH_F118910_0_0|SrvcGrp|97507|2022|PDM|113.30|99|0.00|AETNA HOSPICE
20|FH_F118957_0_0|CSTM-ALL|CSTM-00|2020|PDM|6270.00|99|0.00|AEG 8 (NO REV)
20|FH_F118957_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F118957_0_0|SrvcGrp|83838|2022|PDM|3300.00|99|0.00|SUSPENSION OF BREAST
20|FH_F118962_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F118962_0_0|CSTM-ALL|CSTM-00|2020|PDM|1001.09|99|0.00|AEG 5  (NO REV)
20|FH_F118962_0_0|CSTM-ALL|CSTM-00|2020|PDM|1389.25|99|0.00|AEG 7 (NO REV)
20|FH_F118962_0_0|CSTM-ALL|CSTM-00|2020|PDM|1869.55|99|0.00|AEG 9 (NO REV)
20|FH_F118962_0_0|CSTM-ALL|CSTM-00|2020|PDM|464.94|99|0.00|AEG 1 (NO REV)
20|FH_F118962_0_0|SrvcGrp|103671|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F118986_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F118986_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F118986_0_0|SrvcGrp|75481|2022|PDM|640.76|99|0.00|AEG 2
20|FH_F118986_0_0|SrvcGrp|75485|2022|PDM|903.37|99|0.00|AEG 4
20|FH_F118986_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F119007_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F119007_0_0|CSTM-ALL|CSTM-00|2020|PDM|1124.00|99|0.00|AEG 6 (NO REV)
20|FH_F119007_0_0|CSTM-ALL|CSTM-00|2020|PDM|760.00|99|0.00|AEG 2 (NO REV)
20|FH_F119007_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 3 (NO REV)
20|FH_F119007_0_0|CSTM-ALL|CSTM-00|2020|PDM|960.00|99|0.00|AEG 4 (NO REV)
20|FH_F119007_0_0|SrvcGrp|103329|2022|PDM|11876.00|99|0.00|INSJ STABLJ DEV W/ DCMPRN
20|FH_F119007_0_0|SrvcGrp|35669|2022|PDM|3692.00|99|0.00|CPT 63650
20|FH_F119007_0_0|SrvcGrp|87679|2022|PDM|785.00|99|0.00|LUMBAR OR SACRAL SURGERY
20|FH_F119008_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F119008_0_0|SrvcGrp|83857|2022|PDM|475.00|99|0.00|IP HOSPICE SVCS
20|FH_F119029_0_0|CSTM-ALL|CSTM-00|2020|PDM|761.00|99|0.00|AEG 10 (NO REV)
20|FH_F119070_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F119070_0_0|SrvcGrp|106799|2022|PDM|3500.00|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT
20|FH_F119070_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F119096_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F119096_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|AEG 10 (NO REV)
20|FH_F119130_0_0|SrvcGrp|108041|2022|PDM|400.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME
20|FH_F119203_0_0|SrvcGrp|103550|2022|PDM|435.00|99|0.00|HEMODIALYSIS SVCS
20|FH_F119203_0_0|SrvcGrp|103552|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER
20|FH_F119203_0_0|SrvcGrp|105357|2022|PDM|435.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD
20|FH_F119203_0_0|SrvcGrp|108019|2022|PDM|435.00|99|0.00|HEMODIALYSIS SVCS
20|FH_F119214_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F119214_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F119214_0_0|SrvcGrp|11663|2022|PCT|1.02|99|0.00|IMPLANTS
20|FH_F119214_0_0|SrvcGrp|75483|2022|PDM|1100.00|99|0.00|AEG 3
20|FH_F119214_0_0|SrvcGrp|75489|2022|PDM|1366.00|99|0.00|AEG 6
20|FH_F119214_0_0|SrvcGrp|75491|2022|PDM|1366.00|99|0.00|AEG 7
20|FH_F119262_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F119262_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F119262_0_0|SrvcGrp|87077|2022|PDM|120.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F119266_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F119266_0_0|SrvcGrp|103551|2022|PDM|214.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS
20|FH_F119285_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F119285_0_0|CSTM-ALL|CSTM-00|2020|PDM|1298.00|99|0.00|AEG 7 (NO REV)
20|FH_F119285_0_0|CSTM-ALL|CSTM-00|2020|PDM|687.00|99|0.00|AEG 3 (NO REV)
20|FH_F119285_0_0|CSTM-ALL|CSTM-00|2020|PDM|965.00|99|0.00|AEG 5  (NO REV)
20|FH_F119285_0_0|SrvcGrp|106235|2022|PDM|3050.00|99|0.00|CYPASS
20|FH_F119285_0_0|SrvcGrp|108058|2022|PDM|1751.00|99|0.00|VITRECTOMY PARS PLANA APPROACH
20|FH_F119285_0_0|SrvcGrp|93759|2022|PCT|0.00|99|0.00|CARDIAC CATH
20|FH_F119291_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F119291_0_0|SrvcGrp|103551|2022|PDM|186.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS
20|FH_F119352_0_0|SrvcGrp|26470|2022|PDM|200.00|99|0.00|SELF DIALYSIS TRAINING CAPD
20|FH_F119352_0_0|SrvcGrp|28787|2022|PDM|60.00|99|0.00|CPT CODE 90993
20|FH_F119352_0_0|SrvcGrp|29428|2022|PDM|185.00|99|0.00|HOME/CHRONIC HEMODIALYSIS TREATMENT
20|FH_F119352_0_0|SrvcGrp|82498|2022|PDM|135.00|99|0.00|DIALYSIS PROCEDURE OTHER THAN HEMODIALYSIS
20|FH_F119355_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F119355_0_0|CSTM-ALL|CSTM-00|2020|PDM|120.00|99|0.00|MULT FAM BEHAV TREAT GUIDE (HCFA)
20|FH_F119355_0_0|CSTM-ALL|CSTM-00|2020|PDM|50.00|99|0.00|OBSERV BEHAVIORAL ASSESSMENT 1ST 30 MINS (HCFA)
20|FH_F119355_0_0|SrvcGrp|107550|2022|PDM|50.00|99|0.00|EXPOSE BEHAV ASSESSMENT (HCFA)
20|FH_F119376_0_0|SrvcGrp|104098|2022|PDM|4370.06|99|0.00|INTRO CATH DIALYSIS CIRCUIT
20|FH_F119376_0_0|SrvcGrp|106799|2022|PDM|6000.00|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT
20|FH_F119379_0_0|CSTM-ALL|CSTM-00|2020|PDM|1428.00|99|0.00|AEG 9 (NO REV)
20|FH_F119379_0_0|SrvcGrp|103564|2022|PDM|764.00|99|0.00|REPAIR FINGER TENDON
20|FH_F119379_0_0|SrvcGrp|107827|2022|PDM|1428.00|99|0.00|EXPLORE/TREAT WRIST JOINT
20|FH_F119379_0_0|SrvcGrp|107829|2022|PDM|1428.00|99|0.00|REMOVAL OF WRIST BONES
20|FH_F119379_0_0|SrvcGrp|107833|2022|PDM|1428.00|99|0.00|FUSION/GRAFT OF FINGER JOINT
20|FH_F119379_0_0|SrvcGrp|107837|2022|PDM|1060.00|99|0.00|REPAIR FINGER/HAND TENDON
20|FH_F119379_0_0|SrvcGrp|107839|2022|PDM|1026.00|99|0.00|INCISE FLEXOR CARPI RADIALIS
20|FH_F119379_0_0|SrvcGrp|107840|2022|PDM|911.00|99|0.00|TREAT WRIST FRACTURE
20|FH_F119379_0_0|SrvcGrp|107847|2022|PDM|764.00|99|0.00|REVISE ULNAR NERVE AT ELBOW
20|FH_F119379_0_0|SrvcGrp|76602|2022|PDM|885.00|99|0.00|CPT 25000
20|FH_F119379_0_0|SrvcGrp|88596|2022|PDM|1428.00|99|0.00|EXC OF TRIANG FIBROCARTILAGE
20|FH_F119379_0_0|SrvcGrp|88597|2022|PDM|1428.00|99|0.00|INTERNAL FIX FOR FRACT/INSTA
20|FH_F119379_0_0|SrvcGrp|92011|2022|PDM|672.00|99|0.00|REMOVAL OF IMPLANT
20|FH_F119379_0_0|SrvcGrp|92014|2022|PDM|1428.00|99|0.00|PHALANGEAL SHAFT FRACTURE
20|FH_F119379_0_0|SrvcGrp|98007|2022|PDM|1113.00|99|0.00|FINGER/THUMB AMPUTATION
20|FH_F119400_0_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F119400_0_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F119400_0_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II
20|FH_F119435_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F119435_0_0|CSTM-ALL|CSTM-00|2020|PDM|1060.00|99|0.00|AEG 3 (NO REV)
20|FH_F119435_0_0|SrvcGrp|107794|2022|PDM|7630.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE
20|FH_F119435_0_0|SrvcGrp|107877|2022|PDM|543.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT
20|FH_F119435_0_0|SrvcGrp|107879|2022|PDM|4300.00|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT
20|FH_F119435_0_0|SrvcGrp|108087|2022|PDM|875.00|99|0.00|INSERT NON-TUNNL CNTRL CVC
20|FH_F119435_0_0|SrvcGrp|77278|2022|PDM|2212.00|99|0.00|AETNA REPL TUNNLD CNTRL CVC W/O PORT/PUMP
20|FH_F119435_0_0|SrvcGrp|77290|2022|PDM|543.00|99|0.00|AETNA REMV TUNNLD CVC W/O SUBQ PORT
20|FH_F119437_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F119437_0_0|SrvcGrp|108091|2022|PDM|5000.00|99|0.00|DISKECTOMY THORACIC SINGLE
20|FH_F119437_0_0|SrvcGrp|67072|2022|PDM|4750.00|99|0.00|CPT 22845
20|FH_F119437_0_0|SrvcGrp|75487|2022|PDM|1775.00|99|0.00|AEG 5
20|FH_F119437_0_0|SrvcGrp|75493|2022|PDM|2400.00|99|0.00|AEG 8
20|FH_F119437_0_0|SrvcGrp|77021|2022|PDM|4750.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY
20|FH_F119437_0_0|SrvcGrp|88491|2022|PDM|4750.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR
20|FH_F119437_0_0|SrvcGrp|89848|2022|PDM|4000.00|99|0.00|SPINE FUSION EXTRA SEGMENT
20|FH_F119437_0_0|SrvcGrp|89860|2022|PDM|4750.00|99|0.00|SPINAL DISK SURGERY ADD-ON
20|FH_F119437_0_0|SrvcGrp|93069|2022|PDM|4750.00|99|0.00|POSTERIOR NON-SEGMENTAL INST
20|FH_F119437_0_0|SrvcGrp|99167|2022|PDM|4750.00|99|0.00|CPT 63057
20|FH_F119493_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|ACUTE REHABILITATION
20|FH_F119493_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F119493_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING
20|FH_F119530_0_0|SrvcGrp|75481|2022|PDM|725.00|99|0.00|AEG 2
20|FH_F119535_0_0|SrvcGrp|35058|2022|PDM|400.00|99|0.00|MRI - IP
20|FH_F119535_0_0|SrvcGrp|45883|2022|PDM|90.00|99|0.00|OT
20|FH_F119544_0_0|SrvcGrp|108081|2022|PDM|214.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS
20|FH_F119555_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F119555_0_0|SrvcGrp|473|2022|PDM|2710.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F119575_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F119575_0_0|SrvcGrp|108041|2022|PDM|435.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME
20|FH_F119578_0_0|SrvcGrp|108082|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER
20|FH_F119581_0_0|CSTM-ALL|CSTM-00|2020|PDM|1247.00|99|0.00|AEG 8 (NO REV)
20|FH_F119581_0_0|CSTM-ALL|CSTM-00|2020|PDM|1273.00|99|0.00|AEG 7 (NO REV)
20|FH_F119581_0_0|CSTM-ALL|CSTM-00|2020|PDM|764.00|99|0.00|AEG 10 (NO REV)
20|FH_F119581_0_0|CSTM-ALL|CSTM-00|2020|PDM|928.00|99|0.00|AEG 5  (NO REV)
20|FH_F119581_0_0|SrvcGrp|103638|2022|PDM|4694.00|99|0.00|AETNA OPEN/PERQ PLACE STENT 1ST
20|FH_F119581_0_0|SrvcGrp|103640|2022|PDM|6578.00|99|0.00|AETNA OPEN/PERQ PLACE STENT SAME
20|FH_F119581_0_0|SrvcGrp|103642|2022|PDM|7320.00|99|0.00|AETNA FEM/POPL REVASE W/ATHER
20|FH_F119581_0_0|SrvcGrp|107792|2022|PDM|4774.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE
20|FH_F119581_0_0|SrvcGrp|107793|2022|PDM|7638.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE
20|FH_F119581_0_0|SrvcGrp|108190|2022|PDM|2334.00|99|0.00|ARTERY-VEIN GRAFT
20|FH_F119581_0_0|SrvcGrp|108192|2022|PDM|2646.00|99|0.00|FEM/POPL REVAS W/TLA
20|FH_F119588_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F119588_0_0|CSTM-ALL|CSTM-00|2020|PDM|1011.00|99|0.00|AEG 5  (NO REV)
20|FH_F119588_0_0|CSTM-ALL|CSTM-00|2020|PDM|1112.00|99|0.00|AEG 6 (NO REV)
20|FH_F119588_0_0|CSTM-ALL|CSTM-00|2020|PDM|1496.00|99|0.00|AEG 9 (NO REV)
20|FH_F119588_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F119593_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F119599_0_0|SrvcGrp|82981|2022|PDM|135.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F119599_0_0|SrvcGrp|87077|2022|PDM|135.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F119602_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F119602_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F119602_0_0|CSTM-ALL|CSTM-00|2020|PDM|1311.00|99|0.00|AEG 7 (NO REV)
20|FH_F119602_0_0|CSTM-ALL|CSTM-00|2020|PDM|675.00|99|0.00|AEG 3 (NO REV)
20|FH_F119602_0_0|CSTM-ALL|CSTM-00|2020|PDM|831.00|99|0.00|AEG 4 (NO REV)
20|FH_F119602_0_0|SrvcGrp|35669|2022|PDM|5200.00|99|0.00|CPT 63650
20|FH_F119602_0_0|SrvcGrp|93807|2022|PDM|3500.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY
20|FH_F119603_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F119603_0_0|SrvcGrp|82981|2022|PDM|185.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F119604_0_0|CSTM-ALL|CSTM-00|2020|PDM|2072.00|99|0.00|GENERAL ACUTE CARE
20|FH_F119627_27288_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|GENERAL ACUTE CARE
20|FH_F119627_27288_0|SrvcGrp|75506|2022|PCT|0.75|99|0.00|VASCULAR DIAGNOSTIC STUDIES
20|FH_F119635_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F119635_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 9 (NO REV)
20|FH_F119635_0_0|CSTM-ALL|CSTM-00|2020|PDM|425.00|99|0.00|AEG 2 (NO REV)
20|FH_F119635_0_0|CSTM-ALL|CSTM-00|2020|PDM|645.00|99|0.00|AEG 6 (NO REV)
20|FH_F119635_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 7 (NO REV)
20|FH_F119635_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F119650_0_0|SrvcGrp|40002|2022|PDM|25151.00|99|0.00|TOTAL HIP
20|FH_F119652_0_0|SrvcGrp|108224|2022|PDM|300.00|99|0.00|AETNA RESPIRATORY SERVICES
20|FH_F119652_0_0|SrvcGrp|73601|2022|PDM|1450.00|99|0.00|AETNA INTERMEDIATE ICU/CCU
20|FH_F119725_0_0|SrvcGrp|106291|2022|PDM|260.67|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT LEVEL 1 (HCFA)
20|FH_F119725_0_0|SrvcGrp|106294|2022|PDM|412.72|99|0.00|AMBULANCE SERVICE EMERGENCY TRANSPORT LEVEL 1 (HFCA)
20|FH_F119725_0_0|SrvcGrp|106297|2022|PDM|217.22|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT (HCFA)
20|FH_F119725_0_0|SrvcGrp|106314|2022|PDM|597.36|99|0.00|ADVANCED LIFE SUPPORT LEVEL 2 (ALS2) (HCFA)
20|FH_F119725_0_0|SrvcGrp|13422|2022|PDM|260.67|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC
20|FH_F119725_0_0|SrvcGrp|13683|2022|PDM|597.36|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2
20|FH_F119760_0_0|SrvcGrp|94780|2022|PDM|105.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)
20|FH_F119760_0_0|SrvcGrp|95660|2022|PDM|475.00|99|0.00|HOSPICE SERVICES (HCFA)
20|FH_F119760_0_0|SrvcGrp|97506|2022|PDM|105.00|99|0.00|AETNA HOSPICE ALL OTHER CARE
20|FH_F119775_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F119775_0_0|SrvcGrp|103391|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F119775_0_0|SrvcGrp|72992|2022|PDM|496.00|99|0.00|AEG 2
20|FH_F119775_0_0|SrvcGrp|72994|2022|PDM|564.00|99|0.00|AEG 3
20|FH_F119784_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F119784_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 10 (NO REV)
20|FH_F119784_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 1 (NO REV)
20|FH_F119784_0_0|SrvcGrp|102420|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATHETERIZATION INCIDENTAL CODES
20|FH_F119795_0_0|CSTM-ALL|CSTM-00|2020|PDM|1345.00|99|0.00|AEG 3 (NO REV)
20|FH_F119795_0_0|CSTM-ALL|CSTM-00|2020|PDM|2459.00|99|0.00|AEG 6 (NO REV)
20|FH_F119795_0_0|CSTM-ALL|CSTM-00|2020|PDM|3105.00|99|0.00|AEG 10 (NO REV)
20|FH_F119795_0_0|SrvcGrp|105401|2022|PDM|21590.00|99|0.00|TOTAL HIP ARTHROPLASTY
20|FH_F119795_0_0|SrvcGrp|108072|2022|PDM|21590.00|99|0.00|SPINE PROCEDURE
20|FH_F119795_0_0|SrvcGrp|108073|2022|PDM|7231.00|99|0.00|SPINE STIMULATORS
20|FH_F119795_0_0|SrvcGrp|11669|2022|PDM|5202.00|99|0.00|OP SURG
20|FH_F119795_0_0|SrvcGrp|11673|2022|PDM|7263.00|99|0.00|CPT 29888
20|FH_F119795_0_0|SrvcGrp|36865|2022|PDM|3106.00|99|0.00|NUCLEOPLASTY
20|FH_F119795_0_0|SrvcGrp|67073|2022|PDM|3019.00|99|0.00|CPT 22851
20|FH_F119795_0_0|SrvcGrp|70749|2022|PDM|5202.00|99|0.00|CPT 29823
20|FH_F119795_0_0|SrvcGrp|90376|2022|PDM|20453.00|99|0.00|REVISION OF KNEE JOINTLANT
20|FH_F119795_0_0|SrvcGrp|92819|2022|PDM|7263.00|99|0.00|HIP ARTHOSCOPY
20|FH_F119795_0_0|SrvcGrp|92821|2022|PDM|7263.00|99|0.00|HIP ARTHROSCOPY W/ LABRAL REPAIR
20|FH_F119795_0_0|SrvcGrp|92822|2022|PDM|4474.00|99|0.00|REPAIR OF RUPTURED TENDON
20|FH_F119795_0_0|SrvcGrp|99073|2022|PDM|1.38|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F119824_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F119825_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F119825_0_0|SrvcGrp|104228|2022|PDM|100.00|99|0.00|HOSPICE CARE (HCFA)
20|FH_F119825_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F119825_0_0|SrvcGrp|82223|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F119825_0_0|SrvcGrp|83857|2022|PDM|475.00|99|0.00|IP HOSPICE SVCS
20|FH_F119838_0_0|CSTM-ALL|CSTM-00|2020|PDM|1484.00|99|0.00|AEG 2 (NO REV)
20|FH_F119838_0_0|CSTM-ALL|CSTM-00|2020|PDM|3817.00|99|0.00|AEG 9 (NO REV)
20|FH_F119838_0_0|SrvcGrp|78702|2022|PDM|1350.00|99|0.00|AETNA EXTRACAPSULAR CATARAC
20|FH_F119888_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F119888_0_0|SrvcGrp|100961|2022|PDM|250.61|99|0.00|AMB SRVC NEONAT TRNSPRT BS RATE EMERG 1 WAY
20|FH_F119888_0_0|SrvcGrp|106291|2022|PDM|264.36|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT LEVEL 1 (HCFA)
20|FH_F119888_0_0|SrvcGrp|106314|2022|PDM|605.83|99|0.00|ADVANCED LIFE SUPPORT LEVEL 2 (ALS2) (HCFA)
20|FH_F119937_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F119937_0_0|SrvcGrp|63297|2022|PDM|127.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F119937_0_0|SrvcGrp|80920|2022|PDM|500.00|99|0.00|HOSPICE SERVICES
20|FH_F119999_0_0|CSTM-ALL|CSTM-00|2020|PDM|2990.00|99|0.00|AEG 4 (NO REV)
20|FH_F119999_0_0|SrvcGrp|12491|2022|PCT|0.50|99|0.00|PACEMAKER
20|FH_F120001_0_0|SrvcGrp|87536|2022|PDM|204.00|99|0.00|MED REHAB DAY PROGRAM (HALF)
20|FH_F120032_0_0|CSTM-ALL|CSTM-00|2020|PDM|402.00|99|0.00|AEG 1 (NO REV)
20|FH_F120032_0_0|CSTM-ALL|CSTM-00|2020|PDM|570.00|99|0.00|AEG 2 (NO REV)
20|FH_F120032_0_0|SrvcGrp|79593|2022|PDM|580.00|99|0.00|CPT 45378
20|FH_F120032_0_0|SrvcGrp|79594|2022|PDM|580.00|99|0.00|CPT 45380
20|FH_F120057_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F120057_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F120057_0_0|SrvcGrp|107879|2022|PDM|1969.74|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT
20|FH_F120057_0_0|SrvcGrp|12664|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F120057_0_0|SrvcGrp|72992|2022|PDM|535.00|99|0.00|AEG 2
20|FH_F120057_0_0|SrvcGrp|73000|2022|PDM|991.00|99|0.00|AEG 6
20|FH_F120057_0_0|SrvcGrp|73002|2022|PDM|1194.00|99|0.00|AEG 7
20|FH_F120057_0_0|SrvcGrp|77278|2022|PDM|1115.00|99|0.00|AETNA REPL TUNNLD CNTRL CVC W/O PORT/PUMP
20|FH_F120058_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F120058_0_0|CSTM-ALL|CSTM-00|2020|PDM|626.00|99|0.00|AEG 2 (NO REV)
20|FH_F120059_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F120059_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 4 (NO REV)
20|FH_F120059_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|AEG 9 (NO REV)
20|FH_F120059_0_0|SrvcGrp|104098|2022|PDM|4800.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT
20|FH_F120059_0_0|SrvcGrp|106798|2022|PDM|4200.00|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT
20|FH_F120059_0_0|SrvcGrp|108120|2022|PDM|1650.00|99|0.00|REPL TUNNLD CNTRL CVC W/O PORT/PUMP
20|FH_F120089_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F120089_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F120089_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F120089_0_0|SrvcGrp|75481|2022|PDM|444.00|99|0.00|AEG 2
20|FH_F120089_0_0|SrvcGrp|75485|2022|PDM|629.00|99|0.00|AEG 4
20|FH_F120089_0_0|SrvcGrp|75495|2022|PDM|1440.00|99|0.00|AEG 9
20|FH_F120112_0_0|SrvcGrp|89783|2022|PDM|94.50|99|0.00|RESPITE CARE (HCFA)
20|FH_F120112_0_0|SrvcGrp|94781|2022|PDM|94.50|99|0.00|HOSPICE IN LTCH (HCFA)
20|FH_F120118_0_0|CSTM-ALL|CSTM-00|2020|PCT|62.00|99|0.00|GENERAL ACUTE CARE
20|FH_F120119_0_0|CSTM-ALL|CSTM-00|2020|PDM|1479.00|99|0.00|AEG 9 (NO REV)
20|FH_F120119_0_0|CSTM-ALL|CSTM-00|2020|PDM|368.00|99|0.00|AEG 1 (NO REV)
20|FH_F120119_0_0|CSTM-ALL|CSTM-00|2020|PDM|564.00|99|0.00|AEG 3 (NO REV)
20|FH_F120119_0_0|CSTM-ALL|CSTM-00|2020|PDM|792.00|99|0.00|AEG 5  (NO REV)
20|FH_F120119_0_0|SrvcGrp|85966|2022|PDM|1057.00|99|0.00|EXTRACAPSULAR CATARACT
20|FH_F120152_0_0|CSTM-ALL|CSTM-00|2020|PDM|1045.00|99|0.00|AEG 1 (NO REV)
20|FH_F120152_0_0|CSTM-ALL|CSTM-00|2020|PDM|1540.00|99|0.00|AEG 3 (NO REV)
20|FH_F120152_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|AEG 6 (NO REV)
20|FH_F120152_0_0|SrvcGrp|100059|2022|PDM|7700.00|99|0.00|REPAIR ULNA FRACTURE
20|FH_F120152_0_0|SrvcGrp|103570|2022|PDM|6600.00|99|0.00|ARTHROSCOPIC FRACTURE
20|FH_F120152_0_0|SrvcGrp|108348|2022|PDM|2750.00|99|0.00|TREAT FRACTURE RADIUS/ULNA
20|FH_F120152_0_0|SrvcGrp|108350|2022|PDM|16500.00|99|0.00|REPAIR OF DURAL/CSF LEAK
20|FH_F120152_0_0|SrvcGrp|108351|2022|PDM|16500.00|99|0.00|REPAIR RADIUS FRACTURE
20|FH_F120152_0_0|SrvcGrp|27330|2022|PDM|2200.00|99|0.00|CPT 27096
20|FH_F120152_0_0|SrvcGrp|35672|2022|PDM|4400.00|99|0.00|CPT 23412
20|FH_F120152_0_0|SrvcGrp|71666|2022|PDM|22000.00|99|0.00|CPT 63655
20|FH_F120152_0_0|SrvcGrp|77021|2022|PDM|11000.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY
20|FH_F120152_0_0|SrvcGrp|84939|2022|PDM|24750.00|99|0.00|SHOULDER JOINT
20|FH_F120152_0_0|SrvcGrp|88024|2022|PDM|5500.00|99|0.00|REMOVAL OF POSTERIOR SEGMENTAL INSTRUMENTATION
20|FH_F120152_0_0|SrvcGrp|89404|2022|PDM|24750.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F120152_0_0|SrvcGrp|90063|2022|PDM|3300.00|99|0.00|REPAIR BICEPS TENDON RUPTURE
20|FH_F120152_0_0|SrvcGrp|90365|2022|PDM|2420.00|99|0.00|REPAIR METACARPAL FRACTURE
20|FH_F120152_0_0|SrvcGrp|99073|2022|PDM|1.22|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F120207_0_0|CSTM-ALL|CSTM-00|2020|PDM|1109.68|99|0.00|AEG 10 (NO REV)
20|FH_F120207_0_0|CSTM-ALL|CSTM-00|2020|PDM|1644.00|99|0.00|AEG 7 (NO REV)
20|FH_F120207_0_0|SrvcGrp|103643|2022|PDM|2870.00|99|0.00|AETNA FEM/POPL REVASE W/ STENT
20|FH_F120207_0_0|SrvcGrp|108191|2022|PDM|2898.00|99|0.00|ILIAC REVASC
20|FH_F120207_0_0|SrvcGrp|108192|2022|PDM|2985.00|99|0.00|FEM/POPL REVAS W/TLA
20|FH_F120207_0_0|SrvcGrp|11663|2022|PCT|0.40|99|0.00|IMPLANTS
20|FH_F120207_0_0|SrvcGrp|12491|2022|PCT|0.40|99|0.00|PACEMAKER
20|FH_F120207_0_0|SrvcGrp|78282|2022|PDM|2921.36|99|0.00|CPT 47563
20|FH_F120207_0_0|SrvcGrp|84908|2022|PDM|2786.00|99|0.00|LAPAROSCOPY
20|FH_F120207_0_0|SrvcGrp|86460|2022|PDM|3399.00|99|0.00|REVISE BREAST RECONSTRUCTION
20|FH_F120210_0_0|CSTM-ALL|CSTM-00|2020|PDM|394.00|99|0.00|AEG 1 (NO REV)
20|FH_F120210_0_0|CSTM-ALL|CSTM-00|2020|PDM|394.00|99|0.00|AETNA SURGERY DEFAULT WITHOUT GROUPER 1 & 2
20|FH_F120268_0_0|CSTM-ALL|CSTM-00|2020|PCT|40.00|99|0.00|GENERAL ACUTE CARE
20|FH_F120268_0_0|CSTM-ALL|CSTM-00|2020|PCT|40.00|99|0.00|OP SVCS
20|FH_F120290_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F120291_0_0|SrvcGrp|108433|2022|PDM|1053.00|99|0.00|HOSPICE SERVICES
20|FH_F120291_0_0|SrvcGrp|24739|2022|PDM|242.00|99|0.00|RESPITE CARE
20|FH_F120291_0_0|SrvcGrp|30609|2022|PDM|59.00|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F120291_0_0|SrvcGrp|47411|2022|PDM|236.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F120291_0_0|SrvcGrp|53746|2022|PDM|242.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F120300_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F120332_0_0|SrvcGrp|29347|2022|PCT|0.00|99|0.00|HOME HEALTH AIDE
20|FH_F120332_0_0|SrvcGrp|87799|2022|PDM|112.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)
20|FH_F120374_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F120408_0_0|SrvcGrp|23587|2022|PDM|731.50|99|0.00|RESIDENTIAL TREATMENT - PSYCH
20|FH_F120408_0_0|SrvcGrp|90573|2022|PDM|287.38|99|0.00|INTENSIVE OP PSYCH
20|FH_F120435_0_0|SrvcGrp|103552|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER
20|FH_F120435_0_0|SrvcGrp|105357|2022|PDM|400.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD
20|FH_F120435_0_0|SrvcGrp|108041|2022|PDM|400.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME
20|FH_F120448_0_0|CSTM-ALL|CSTM-00|2020|PCT|57.00|99|0.00|GENERAL ACUTE CARE
20|FH_F120448_0_0|CSTM-ALL|CSTM-00|2020|PCT|57.00|99|0.00|OP SVCS
20|FH_F120512_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F120512_0_0|SrvcGrp|82981|2022|PDM|125.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F120512_0_0|SrvcGrp|87077|2022|PDM|125.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F120531_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F120531_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F120531_0_0|CSTM-ALL|CSTM-00|2020|PDM|1530.00|99|0.00|AEG 8 (NO REV)
20|FH_F120531_0_0|CSTM-ALL|CSTM-00|2020|PDM|1574.00|99|0.00|AEG 7 (NO REV)
20|FH_F120605_0_0|SrvcGrp|25518|2022|PDM|2520.00|99|0.00|LAPAROSCOPY SURGICAL CHOLECYSTECTOMY
20|FH_F120605_0_0|SrvcGrp|72992|2022|PDM|712.00|99|0.00|AEG 2
20|FH_F120626_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.43|99|0.00|OP SVCS
20|FH_F120666_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|OP SVCS
20|FH_F120666_0_0|CSTM-ALL|CSTM-00|2020|PDM|2072.00|99|0.00|GENERAL ACUTE CARE
20|FH_F120670_0_0|CSTM-ALL|CSTM-00|2020|PDM|1850.00|99|0.00|AEG 8 (NO REV)
20|FH_F120670_0_0|CSTM-ALL|CSTM-00|2020|PDM|2600.00|99|0.00|AEG 6 (NO REV)
20|FH_F120670_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F120670_0_0|SrvcGrp|106684|2022|PDM|17000.00|99|0.00|RECONSTRUCT ANKLE JOINT
20|FH_F120670_0_0|SrvcGrp|108912|2022|PDM|7800.00|99|0.00|LOW BACK DISK SURGERY
20|FH_F120670_0_0|SrvcGrp|11673|2022|PDM|4700.00|99|0.00|CPT 29888
20|FH_F120670_0_0|SrvcGrp|67065|2022|PDM|19000.00|99|0.00|CERVICAL SURGERY
20|FH_F120670_0_0|SrvcGrp|67072|2022|PDM|6500.00|99|0.00|CPT 22845
20|FH_F120670_0_0|SrvcGrp|89404|2022|PDM|16000.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F120670_0_0|SrvcGrp|93071|2022|PDM|6500.00|99|0.00|POSTERIOR SEGMENTAL INSTRU
20|FH_F120670_0_0|SrvcGrp|93431|2022|PDM|12000.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT
20|FH_F120672_0_0|SrvcGrp|102419|2022|PCT|0.87|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F120672_0_0|SrvcGrp|75505|2022|PCT|0.87|99|0.00|CARDIAC STUDIES
20|FH_F120677_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.51|99|0.00|OP SVCS
20|FH_F120693_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|GENERAL ACUTE CARE
20|FH_F120693_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.00|99|0.00|AETNA LABORATORY
20|FH_F120693_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.00|99|0.00|CARDIAC CATH LAB SVCS
20|FH_F120695_15017_0|SrvcGrp|108484|2022|PDM|583.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY
20|FH_F120695_15017_0|SrvcGrp|46903|2022|PDM|600.00|99|0.00|RESIDENTIAL TREATMENT
20|FH_F120707_0_0|SrvcGrp|3378|2022|PCT|0.89|99|0.00|OBSERVATION SVCS
20|FH_F120721_0_0|CSTM-ALL|CSTM-00|2020|PDM|2237.00|99|0.00|GENERAL ACUTE CARE
20|FH_F120725_0_0|CSTM-ALL|CSTM-00|2020|PDM|2326.00|99|0.00|GENERAL ACUTE CARE
20|FH_F120745_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F120745_0_0|SrvcGrp|82137|2022|PCT|0.90|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F120767_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F120767_0_0|SrvcGrp|108042|2022|PDM|400.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD
20|FH_F120767_0_0|SrvcGrp|108043|2022|PDM|171.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD
20|FH_F120788_0_0|SrvcGrp|107746|2022|PCT|0.90|99|0.00|PARSABIV
20|FH_F120901_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F120901_0_0|CSTM-ALL|CSTM-00|2020|PDM|2273.00|99|0.00|AEG 2 (NO REV)
20|FH_F120901_0_0|CSTM-ALL|CSTM-00|2020|PDM|2513.00|99|0.00|AEG 3 (NO REV)
20|FH_F120901_0_0|CSTM-ALL|CSTM-00|2020|PDM|3230.00|99|0.00|AEG 5  (NO REV)
20|FH_F120901_0_0|SrvcGrp|27261|2022|PDM|4682.00|99|0.00|CPT 27446
20|FH_F120901_0_0|SrvcGrp|84939|2022|PDM|8973.00|99|0.00|SHOULDER JOINT
20|FH_F120924_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE
20|FH_F120930_0_0|CSTM-ALL|CSTM-00|2020|PDM|1683.00|99|0.00|AEG 8 (NO REV)
20|FH_F120930_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|DEVICE INSERTION
20|FH_F120930_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|EXTENSIVE HYSTERCTOMY
20|FH_F120930_0_0|CSTM-ALL|CSTM-00|2020|PDM|584.00|99|0.00|AEG 1 (NO REV)
20|FH_F120930_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|AEG 2 (NO REV)
20|FH_F120930_0_0|SrvcGrp|16732|2022|PDM|3000.00|99|0.00|HYSTEROSCOPY ABLATION
20|FH_F120930_0_0|SrvcGrp|27344|2022|PDM|2000.00|99|0.00|OP SURGERY (CPT 42821)
20|FH_F120930_0_0|SrvcGrp|34606|2022|PDM|3500.00|99|0.00|CPT 29827
20|FH_F120930_0_0|SrvcGrp|35668|2022|PDM|3500.00|99|0.00|CPT 29824
20|FH_F120930_0_0|SrvcGrp|38364|2022|PDM|4000.00|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F120930_0_0|SrvcGrp|41334|2022|PDM|6500.00|99|0.00|TOTAL KNEE
20|FH_F120930_0_0|SrvcGrp|58779|2022|PDM|2500.00|99|0.00|HERNIA REPAIR W/ MESH
20|FH_F120930_0_0|SrvcGrp|72121|2022|PDM|2000.00|99|0.00|ARTHOSCOPY
20|FH_F120930_0_0|SrvcGrp|79101|2022|PDM|2200.00|99|0.00|AETNA NASAL ENDOSCOPY
20|FH_F120930_0_0|SrvcGrp|82108|2022|PDM|2000.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F120930_0_0|SrvcGrp|84910|2022|PDM|2200.00|99|0.00|ENDOSCOPY
20|FH_F120930_0_0|SrvcGrp|91941|2022|PDM|2200.00|99|0.00|NASAL/SINUS ENDOSCOPY WITH DILATION
20|FH_F120930_0_0|SrvcGrp|94883|2022|PDM|2200.00|99|0.00|NASAL/SINUS ENDOSCOPY
20|FH_F120930_0_0|SrvcGrp|95462|2022|PDM|2500.00|99|0.00|REPAIR OF ANKLE LIGAMENT
20|FH_F120930_0_0|SrvcGrp|96542|2022|PDM|2500.00|99|0.00|REPAIR OF LEG TENDON
20|FH_F120930_0_0|SrvcGrp|96560|2022|PDM|3000.00|99|0.00|TOTAL HYSTERCECTOMY
20|FH_F101083_0_0|SrvcGrp|3932|2022|PDM|3780.00|99|0.00|LITHOTRIPSY
20|FH_F101083_0_0|SrvcGrp|56558|2022|PCT|1.02|99|0.00|AICD REV 278
20|FH_F101083_0_0|SrvcGrp|72998|2022|PDM|1102.00|99|0.00|AEG 5
20|FH_F101083_0_0|SrvcGrp|73002|2022|PDM|1344.00|99|0.00|AEG 7
20|FH_F101083_0_0|SrvcGrp|73006|2022|PDM|1806.00|99|0.00|AEG 9
20|FH_F101083_0_0|SrvcGrp|77486|2022|PDM|2415.00|99|0.00|AETNA REPAIR OF TENDON
20|FH_F101083_0_0|SrvcGrp|85540|2022|PDM|525.00|99|0.00|LOWER GI PROCEDURES
20|FH_F101083_0_0|SrvcGrp|86582|2022|PDM|4200.00|99|0.00|AETNA CARDIAC CATHERTERIZATION
20|FH_F101083_0_0|SrvcGrp|86606|2022|PDM|1260.00|99|0.00|INTRAOCULAR LENS
20|FH_F101104_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F101104_0_0|SrvcGrp|14949|2022|PDM|200.00|99|0.00|HOME INFUSION
20|FH_F101104_0_0|SrvcGrp|19742|2022|PDM|200.00|99|0.00|MID-LINE INSERTION
20|FH_F101104_0_0|SrvcGrp|53145|2022|PDM|195.00|99|0.00|SOCIAL WORKER
20|FH_F101104_0_0|SrvcGrp|73523|2022|PDM|148.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F101104_0_0|SrvcGrp|86828|2022|PDM|200.00|99|0.00|HCPCS S5521 (HCFA)
20|FH_F101104_0_0|SrvcGrp|95762|2022|PDM|142.50|99|0.00|HOSPICE CARE (HCFA)
20|FH_F101104_0_0|SrvcGrp|95779|2022|PDM|142.50|99|0.00|HOSPICE CARE
20|FH_F101161_0_0|SrvcGrp|15326|2022|PDM|1731.00|99|0.00|ER LEVEL IV
20|FH_F101161_0_0|SrvcGrp|20260|2022|PDM|2671.00|99|0.00|ER LEVEL V
20|FH_F101161_0_0|SrvcGrp|75499|2022|PDM|100.00|99|0.00|CRITICAL CARE
20|FH_F101164_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F101201_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F101201_0_0|SrvcGrp|46903|2022|PDM|412.00|99|0.00|RESIDENTIAL TREATMENT
20|FH_F101201_0_0|SrvcGrp|73849|2022|PDM|275.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP - REV 913
20|FH_F101201_0_0|SrvcGrp|89417|2022|PDM|275.00|99|0.00|PARTIAL HOSPITALIZATION
20|FH_F101201_0_0|SrvcGrp|93919|2022|PDM|412.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY
20|FH_F101281_0_0|CSTM-ALL|CSTM-00|2020|PCT|41.00|99|0.00|OP SVCS
20|FH_F101360_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F101360_0_0|CSTM-ALL|CSTM-00|2020|PDM|1442.00|99|0.00|AEG 7 (NO REV)
20|FH_F101360_0_0|CSTM-ALL|CSTM-00|2020|PDM|739.00|99|0.00|AEG 3 (NO REV)
20|FH_F101360_0_0|SrvcGrp|73486|2022|PCT|0.00|99|0.00|AETNA CONTRAST AGENT
20|FH_F101406_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|OP SVCS
20|FH_F101441_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F101441_0_0|CSTM-ALL|CSTM-00|2020|PDM|1405.00|99|0.00|AEG 1 (NO REV)
20|FH_F101441_0_0|CSTM-ALL|CSTM-00|2020|PDM|2053.00|99|0.00|AEG 3 (NO REV)
20|FH_F101441_0_0|CSTM-ALL|CSTM-00|2020|PDM|2486.00|99|0.00|AEG 4 (NO REV)
20|FH_F101441_0_0|CSTM-ALL|CSTM-00|2020|PDM|2702.00|99|0.00|AEG 5  (NO REV)
20|FH_F101441_0_0|SrvcGrp|113615|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F101441_0_0|SrvcGrp|12309|2022|PDM|8105.00|99|0.00|MICRODISKETOMY
20|FH_F101441_0_0|SrvcGrp|16669|2022|PDM|3497.00|99|0.00|ACROMINOPLASTY OF SHOULDER
20|FH_F101441_0_0|SrvcGrp|16693|2022|PDM|3497.00|99|0.00|KNEE SCOPE, MENISCECTOMY
20|FH_F101441_0_0|SrvcGrp|16694|2022|PDM|3497.00|99|0.00|KNEE SCOPE, CHONDROPLASTY
20|FH_F101441_0_0|SrvcGrp|80139|2022|PDM|7946.00|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F101441_0_0|SrvcGrp|84442|2022|PDM|10266.00|99|0.00|REVISION KNEE
20|FH_F101441_0_0|SrvcGrp|96352|2022|PDM|6077.00|99|0.00|ANKLE JOINT
20|FH_F101441_0_0|SrvcGrp|96354|2022|PDM|7946.00|99|0.00|REMOVAL OF ANKLE JOINT
20|FH_F101441_0_0|SrvcGrp|96355|2022|PDM|8105.00|99|0.00|SPINE FIXATION
20|FH_F101441_0_0|SrvcGrp|97059|2022|PDM|3567.00|99|0.00|MENISCUS REPAIR, MED OR LAT
20|FH_F101441_0_0|SrvcGrp|97159|2022|PDM|7946.00|99|0.00|TRANSPEDICULAR, 1 SEG, LUMBAR
20|FH_F101441_0_0|SrvcGrp|97279|2022|PDM|8105.00|99|0.00|REMOVE SPINE ELTRD PERQ ARAY
20|FH_F101442_0_0|CSTM-ALL|CSTM-00|2020|PDM|1188.00|99|0.00|AEG 5  (NO REV)
20|FH_F101442_0_0|SrvcGrp|74587|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F101442_0_0|SrvcGrp|98456|2022|PDM|1377.38|99|0.00|TREATMENT OF FOOT INFECTION
20|FH_F101442_0_0|SrvcGrp|98459|2022|PDM|1847.10|99|0.00|RESECT FOOT TOE TUMOR
20|FH_F101442_0_0|SrvcGrp|98460|2022|PDM|1909.05|99|0.00|AMPUTATION FOOT TRANSMETATARSAL
20|FH_F101562_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE
20|FH_F101566_0_0|CSTM-ALL|CSTM-00|2020|PCT|42.00|99|0.00|OP SVCS
20|FH_F101606_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.66|99|0.00|GENERAL ACUTE CARE
20|FH_F101607_0_0|CSTM-ALL|CSTM-00|2020|PDM|647.00|99|0.00|AEG 2 (NO REV)
20|FH_F101685_0_0|SrvcGrp|72990|2022|PDM|384.00|99|0.00|AEG 1
20|FH_F101685_0_0|SrvcGrp|72992|2022|PDM|550.00|99|0.00|AEG 2
20|FH_F101700_0_0|CSTM-ALL|CSTM-00|2020|PDM|1060.00|99|0.00|AEG 8 (NO REV) INTERVENTIONAL PAIN CTR
20|FH_F101700_0_0|CSTM-ALL|CSTM-00|2020|PDM|1450.00|99|0.00|AEG 9 (NO REV) INTERVENTIONAL PAIN CTR
20|FH_F101700_0_0|CSTM-ALL|CSTM-00|2020|PDM|485.00|99|0.00|AEG 2 (NO REV) INTERVENTIONAL PAIN CTR
20|FH_F101700_0_0|CSTM-ALL|CSTM-00|2020|PDM|685.00|99|0.00|AEG 4 (NO REV) INTERVENTIONAL PAIN CTR
20|FH_F101700_0_0|SrvcGrp|93740|2022|PDM|1250.00|99|0.00|REVISE/REMOVE NEURO RECEIVER
20|FH_F101700_0_0|SrvcGrp|98104|2022|PDM|33.30|99|0.00|INJ SINGLE/MX TRIGGER POINT1
20|FH_F101700_0_0|SrvcGrp|98588|2022|PDM|1476.00|99|0.00|REMOVE SPINE INFUSION DEVI16
20|FH_F101709_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F101709_0_0|SrvcGrp|26273|2022|PDM|3045.00|99|0.00|CPT 29880
20|FH_F101709_0_0|SrvcGrp|34606|2022|PDM|2985.00|99|0.00|CPT 29827
20|FH_F101709_0_0|SrvcGrp|54943|2022|PDM|2985.00|99|0.00|REPAIR OF SLAP LESION
20|FH_F101709_0_0|SrvcGrp|72994|2022|PDM|2088.00|99|0.00|AEG 3
20|FH_F101709_0_0|SrvcGrp|72998|2022|PDM|2497.00|99|0.00|AEG 5
20|FH_F101709_0_0|SrvcGrp|73000|2022|PDM|2617.00|99|0.00|AEG 6
20|FH_F101709_0_0|SrvcGrp|82112|2022|PDM|2985.00|99|0.00|KNEE ARTHROSCOPY SURGERY
20|FH_F101709_0_0|SrvcGrp|84442|2022|PDM|10691.00|99|0.00|REVISION KNEE
20|FH_F101709_0_0|SrvcGrp|96353|2022|PDM|8441.00|99|0.00|RECONSTRUCT ANKLE JOINT
20|FH_F101709_0_0|SrvcGrp|96354|2022|PDM|8610.00|99|0.00|REMOVAL OF ANKLE JOINT
20|FH_F101711_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F101711_0_0|SrvcGrp|48398|2022|PDM|75.00|99|0.00|PT SERVICES
20|FH_F101747_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F101752_0_0|SrvcGrp|36093|2022|PCT|0.00|99|0.00|ACUTE REHABILITATION
20|FH_F101752_0_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE
20|FH_F101752_0_0|SrvcGrp|80260|2022|PCT|0.00|99|0.00|AETNA IP DETOX (BHIPDETOX)
20|FH_F101757_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|OP SVCS
20|FH_F101806_0_0|SrvcGrp|75182|2022|PCT|1.05|99|0.00|AETNA IMPLANTS
20|FH_F101806_0_0|SrvcGrp|75481|2022|PDM|493.35|99|0.00|AEG 2
20|FH_F101806_0_0|SrvcGrp|75495|2022|PDM|1481.20|99|0.00|AEG 9
20|FH_F101807_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F101807_0_0|SrvcGrp|87077|2022|PDM|110.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F101819_0_0|CSTM-ALL|CSTM-00|2020|PCT|45.00|99|0.00|GENERAL ACUTE CARE
20|FH_F101844_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F101844_0_0|CSTM-ALL|CSTM-00|2020|PDM|3577.00|99|0.00|AEG 2 (NO REV)
20|FH_F101844_0_0|CSTM-ALL|CSTM-00|2020|PDM|5962.00|99|0.00|AEG 7 (NO REV)
20|FH_F101844_0_0|CSTM-ALL|CSTM-00|2020|PDM|5962.00|99|0.00|AEG 9 (NO REV)
20|FH_F101844_0_0|SrvcGrp|89861|2022|PDM|8943.00|99|0.00|LUMBAR LAMINOTOMY
20|FH_F101844_0_0|SrvcGrp|97895|2022|PDM|8943.00|99|0.00|REVISE KNEE 2
20|FH_F101844_0_0|SrvcGrp|98328|2022|PDM|8943.00|99|0.00|LAMIN BIO/EXC INTRA/EXT LUMB
20|FH_F101854_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F101854_0_0|CSTM-ALL|CSTM-00|2020|PDM|542.00|99|0.00|AEG 3 (NO REV)
20|FH_F101854_0_0|CSTM-ALL|CSTM-00|2020|PDM|669.00|99|0.00|AEG 4 (NO REV)
20|FH_F101854_0_0|CSTM-ALL|CSTM-00|2020|PDM|761.00|99|0.00|AEG 10 (NO REV)
20|FH_F101901_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 10 (NO REV)
20|FH_F101901_0_0|CSTM-ALL|CSTM-00|2020|PDM|425.00|99|0.00|AEG 1 (NO REV)
20|FH_F101901_0_0|CSTM-ALL|CSTM-00|2020|PDM|615.00|99|0.00|AEG 3 (NO REV)
20|FH_F101901_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|AEG 7 (NO REV)
20|FH_F101925_0_0|CSTM-ALL|CSTM-00|2020|PCT|86.00|99|0.00|GENERAL ACUTE CARE
20|FH_F101945_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F101945_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F101945_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F101945_0_0|SrvcGrp|16289|2022|PDM|1353.00|99|0.00|CARPAL TUNNEL RELEASE
20|FH_F101945_0_0|SrvcGrp|33984|2022|PDM|1095.00|99|0.00|HAMMERTOE CORRECTION
20|FH_F101945_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F101945_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F101945_0_0|SrvcGrp|98404|2022|PDM|2081.00|99|0.00|ARTHROSCOPIC FRACTURE TX
20|FH_F102009_0_0|CSTM-ALL|CSTM-00|2020|PDM|1410.26|99|0.00|AEG 8 (NO REV)
20|FH_F102009_0_0|CSTM-ALL|CSTM-00|2020|PDM|830.55|99|0.00|AEG 4 (NO REV)
20|FH_F102009_0_0|CSTM-ALL|CSTM-00|2020|PDM|954.50|99|0.00|AEG 5  (NO REV)
20|FH_F102063_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F102063_0_0|SrvcGrp|46605|2022|PDM|190.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES
20|FH_F102126_0_0|CSTM-ALL|CSTM-00|2020|PDM|414.00|99|0.00|AEG 1 (NO REV)
20|FH_F102163_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F102184_0_0|CSTM-ALL|CSTM-00|2020|PDM|1155.00|99|0.00|AEG 1 (NO REV)
20|FH_F102184_0_0|SrvcGrp|11669|2022|PDM|2887.00|99|0.00|OP SURG
20|FH_F102184_0_0|SrvcGrp|35669|2022|PDM|4812.00|99|0.00|CPT 63650
20|FH_F102184_0_0|SrvcGrp|41334|2022|PDM|7215.00|99|0.00|TOTAL KNEE
20|FH_F102184_0_0|SrvcGrp|54943|2022|PDM|2887.00|99|0.00|REPAIR OF SLAP LESION
20|FH_F102184_0_0|SrvcGrp|88159|2022|PDM|7215.00|99|0.00|LOW BACK DISK SURGERY
20|FH_F102184_0_0|SrvcGrp|88160|2022|PDM|7215.00|99|0.00|LAMINECTOMY W/FACETECTOMY
20|FH_F102184_0_0|SrvcGrp|89404|2022|PDM|7215.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F102184_0_0|SrvcGrp|90343|2022|PDM|7215.00|99|0.00|CERVICE CORPECTOMY 1 LEVEL
20|FH_F102188_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F102188_0_0|SrvcGrp|76531|2022|PDM|139.71|99|0.00|HOSPICE IN HOME
20|FH_F102224_0_0|CSTM-ALL|CSTM-00|2020|PDM|1445.00|99|0.00|AEG 8 (NO REV)
20|FH_F102224_0_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|AEG 2 (NO REV)
20|FH_F102224_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|AEG 5  (NO REV)
20|FH_F102224_0_0|SrvcGrp|101102|2022|PDM|10450.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT
20|FH_F102224_0_0|SrvcGrp|101103|2022|PDM|10450.00|99|0.00|REVIS SHOULDER JOINT
20|FH_F102224_0_0|SrvcGrp|106146|2022|PDM|11000.00|99|0.00|REVERSE HIP JOINT
20|FH_F102224_0_0|SrvcGrp|111966|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F102224_0_0|SrvcGrp|40003|2022|PDM|11000.00|99|0.00|TOTAL KNEE
20|FH_F102224_0_0|SrvcGrp|67066|2022|PDM|2300.00|99|0.00|CERVICAL SURGERY
20|FH_F102224_0_0|SrvcGrp|67068|2022|PDM|5514.95|99|0.00|LUMBAR SPINE FUSION COMBINED
20|FH_F102224_0_0|SrvcGrp|67069|2022|PDM|5514.95|99|0.00|CPT 22634
20|FH_F102224_0_0|SrvcGrp|73610|2022|PCT|0.54|99|0.00|AETNA IMPLANTS
20|FH_F102224_0_0|SrvcGrp|85084|2022|PDM|2300.00|99|0.00|MICROSURGERY ADD-ON CODE
20|FH_F102224_0_0|SrvcGrp|88160|2022|PDM|6000.00|99|0.00|LAMINECTOMY W/FACETECTOMY
20|FH_F102224_0_0|SrvcGrp|88161|2022|PDM|6000.00|99|0.00|LAMINECTOMY W/FACE-THORACIC
20|FH_F102224_0_0|SrvcGrp|88494|2022|PDM|2400.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION
20|FH_F102224_0_0|SrvcGrp|92405|2022|PDM|2400.00|99|0.00|PERQ LUMBOSACRAL INJECTION
20|FH_F102224_0_0|SrvcGrp|93057|2022|PDM|2300.00|99|0.00|SPINAL BONE AUTOGRAFT
20|FH_F102224_0_0|SrvcGrp|93724|2022|PDM|4000.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY
20|FH_F102224_0_0|SrvcGrp|93807|2022|PDM|6000.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY
20|FH_F102224_0_0|SrvcGrp|96781|2022|PDM|1800.00|99|0.00|INJECTION FOR NERVE BLOCK 5
20|FH_F102224_0_0|SrvcGrp|96799|2022|PDM|3600.00|99|0.00|DESTROY C/TH FACET JNT ADDL
20|FH_F102267_0_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F102302_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F102302_0_0|SrvcGrp|12309|2022|PDM|10850.00|99|0.00|MICRODISKETOMY
20|FH_F102302_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F102302_0_0|SrvcGrp|16470|2022|PDM|16000.00|99|0.00|ASPIRATION
20|FH_F120930_0_0|SrvcGrp|96561|2022|PDM|3000.00|99|0.00|VAGINAL HYSTERCTOMY
20|FH_F120930_0_0|SrvcGrp|96564|2022|PDM|3000.00|99|0.00|EXTENSIVE HYSTERCTOMY
20|FH_F120939_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F120954_0_0|SrvcGrp|108542|2022|PDM|281.40|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F120954_0_0|SrvcGrp|108543|2022|PDM|103.95|99|0.00|HOME HEALTH AIDE
20|FH_F121078_0_0|CSTM-ALL|CSTM-00|2020|PDM|422.00|99|0.00|AMBULATORY SURGERY W/O AEG 1 & 2
20|FH_F121111_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F121168_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F121168_0_0|SrvcGrp|65720|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F121168_0_0|SrvcGrp|89781|2022|PDM|100.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F121168_0_0|SrvcGrp|93098|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F121168_0_0|SrvcGrp|94780|2022|PDM|100.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)
20|FH_F121219_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F121219_0_0|SrvcGrp|114930|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F121219_0_0|SrvcGrp|115359|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F121223_0_0|SrvcGrp|108081|2022|PDM|186.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS
20|FH_F121335_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F121335_0_0|CSTM-ALL|CSTM-00|2020|PDM|2684.00|99|0.00|AEG 2 (NO REV)
20|FH_F121335_0_0|CSTM-ALL|CSTM-00|2020|PDM|2768.00|99|0.00|AEG 1 (NO REV)
20|FH_F121335_0_0|CSTM-ALL|CSTM-00|2020|PDM|3689.00|99|0.00|AEG 4 (NO REV)
20|FH_F121335_0_0|CSTM-ALL|CSTM-00|2020|PDM|6173.00|99|0.00|AEG 7 (NO REV)
20|FH_F121335_0_0|CSTM-ALL|CSTM-00|2020|PDM|6645.00|99|0.00|AEG 9 (NO REV)
20|FH_F121416_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING
20|FH_F121425_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F121426_0_0|CSTM-ALL|CSTM-00|2020|PDM|1828.00|99|0.00|ASPG VII
20|FH_F121426_0_0|CSTM-ALL|CSTM-00|2020|PDM|2460.00|99|0.00|ASPG IX
20|FH_F121426_0_0|CSTM-ALL|CSTM-00|2020|PDM|936.00|99|0.00|ASPG III
20|FH_F121426_0_0|SrvcGrp|10391|2022|PDM|2076.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F121426_0_0|SrvcGrp|11151|2022|PDM|2771.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F121427_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F121427_0_0|SrvcGrp|108042|2022|PDM|400.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD
20|FH_F121472_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 5  (NO REV)
20|FH_F121476_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F121476_0_0|CSTM-ALL|CSTM-00|2020|PDM|2449.00|99|0.00|MOMETASONE SINUS IMPLANT
20|FH_F121476_0_0|SrvcGrp|105317|2022|PDM|2061.00|99|0.00|ANCHOR/SCREW FOR OPPOSING
20|FH_F121476_0_0|SrvcGrp|105318|2022|PDM|1795.00|99|0.00|INTERPHALANGEAL JOINT REPL
20|FH_F121476_0_0|SrvcGrp|108827|2022|PDM|1443.00|99|0.00|REPLACEMENT IMPL PUMP CATHET
20|FH_F121476_0_0|SrvcGrp|108832|2022|PDM|16198.00|99|0.00|IMPLANTABLE INFUSION PUMP
20|FH_F121476_0_0|SrvcGrp|108833|2022|PDM|3695.00|99|0.00|PATIENT PROGRAMMER NEUROSTIM
20|FH_F121476_0_0|SrvcGrp|108834|2022|PDM|31575.00|99|0.00|IMPLT NROSTM PLS GEN SNG REC
20|FH_F121476_0_0|SrvcGrp|108844|2022|PDM|7041.00|99|0.00|CARDIAC EVENT RECORDER
20|FH_F121476_0_0|SrvcGrp|108845|2022|PDM|2100.00|99|0.00|STENT COATED/COVERED
20|FH_F121476_0_0|SrvcGrp|108850|2022|PDM|1656.00|99|0.00|IMPLANTABLE BREAST PROSTHESIS
20|FH_F121476_0_0|SrvcGrp|108858|2022|PDM|1492.00|99|0.00|CRYO PROBE/NEEDLE
20|FH_F121476_0_0|SrvcGrp|108862|2022|PDM|5533.00|99|0.00|NOS SKIN SUBSTITUTE
20|FH_F121476_0_0|SrvcGrp|108863|2022|PDM|199.00|99|0.00|PERMANENT/LONG TERM NON-DI
20|FH_F121476_0_0|SrvcGrp|108866|2022|PDM|995.99|99|0.00|LEAD PACEMAKER
20|FH_F121476_0_0|SrvcGrp|108893|2022|PDM|1232.00|99|0.00|IMPLANTABLE TISSUE MARKER
20|FH_F121476_0_0|SrvcGrp|58659|2022|PDM|4408.00|99|0.00|PROSTHETIC IMPLANTS
20|FH_F121476_0_0|SrvcGrp|77507|2022|PDM|6285.00|99|0.00|AETNA CORNEAL TISSUE HANDLING
20|FH_F121476_0_0|SrvcGrp|78045|2022|PDM|1064.00|99|0.00|AETNA AMNIOTIC MEMBRANE
20|FH_F121476_0_0|SrvcGrp|83895|2022|PDM|4932.00|99|0.00|IMPLANTABLE MESH
20|FH_F121476_0_0|SrvcGrp|84121|2022|PDM|3286.00|99|0.00|OCULAR IMPLANTS
20|FH_F121799_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F121799_0_0|SrvcGrp|80918|2022|PDM|110.00|99|0.00|RESPITE CARE
20|FH_F121799_0_0|SrvcGrp|82222|2022|PDM|103.00|99|0.00|HOSPICE CARE
20|FH_F121800_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE
20|FH_F121800_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC
20|FH_F121816_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F121819_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F121819_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F121925_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F121925_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F121925_0_0|CSTM-ALL|CSTM-00|2020|PDM|1001.00|99|0.00|AEG 8 (NO REV)
20|FH_F121925_0_0|CSTM-ALL|CSTM-00|2020|PDM|1017.00|99|0.00|AEG 7 (NO REV)
20|FH_F121925_0_0|CSTM-ALL|CSTM-00|2020|PDM|463.61|99|0.00|AEG 1 (NO REV)
20|FH_F121925_0_0|CSTM-ALL|CSTM-00|2020|PDM|732.00|99|0.00|AEG 5  (NO REV)
20|FH_F122067_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F122067_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 5  (NO REV)
20|FH_F122067_0_0|CSTM-ALL|CSTM-00|2020|PDM|1320.00|99|0.00|AEG 7 (NO REV)
20|FH_F122067_0_0|CSTM-ALL|CSTM-00|2020|PDM|770.00|99|0.00|AEG 3 (NO REV) W/O DRAINAGE DEVICE INSERTION
20|FH_F122067_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F122067_0_0|SrvcGrp|114518|2022|PCT|1.00|99|0.00|INSERTION DRAINAGE DEVICE
20|FH_F122067_0_0|SrvcGrp|46906|2022|PDM|1430.00|99|0.00|CORNEAL TISSUE
20|FH_F122130_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F122130_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE
20|FH_F122130_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F122200_0_0|SrvcGrp|29428|2022|PDM|670.00|99|0.00|HOME/CHRONIC HEMODIALYSIS TREATMENT
20|FH_F122240_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F122240_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F122245_0_0|SrvcGrp|106273|2022|PDM|1150.00|99|0.00|REMOVE TONSILS AND ADENOIDS
20|FH_F122245_0_0|SrvcGrp|55084|2022|PDM|8480.00|99|0.00|CPT 52648
20|FH_F122245_0_0|SrvcGrp|72990|2022|PDM|393.00|99|0.00|AEG 1
20|FH_F122245_0_0|SrvcGrp|72994|2022|PDM|650.00|99|0.00|AEG 3
20|FH_F122245_0_0|SrvcGrp|72996|2022|PDM|802.00|99|0.00|AEG 4
20|FH_F122245_0_0|SrvcGrp|72998|2022|PDM|846.00|99|0.00|AEG 5
20|FH_F122245_0_0|SrvcGrp|87055|2022|PDM|650.00|99|0.00|CYSTOURETHROSCOPY W/STENT INSERTION
20|FH_F122245_0_0|SrvcGrp|91342|2022|PDM|1750.00|99|0.00|INSERT TANDEM CUFF
20|FH_F122262_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F122262_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 2 (NO REV)
20|FH_F122262_0_0|CSTM-ALL|CSTM-00|2020|PDM|2315.00|99|0.00|AEG 10 (NO REV)
20|FH_F122262_0_0|CSTM-ALL|CSTM-00|2020|PDM|2990.00|99|0.00|AEG 4 (NO REV)
20|FH_F122262_0_0|CSTM-ALL|CSTM-00|2020|PDM|3745.00|99|0.00|AEG 6 (NO REV)
20|FH_F122262_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F122338_0_0|SrvcGrp|72992|2022|PDM|1485.00|99|0.00|AEG 2
20|FH_F122388_0_0|SrvcGrp|72992|2022|PDM|482.00|99|0.00|AEG 2
20|FH_F122433_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F122433_0_0|SrvcGrp|109082|2022|PDM|2000.00|99|0.00|SPINE FUSION
20|FH_F122433_0_0|SrvcGrp|58638|2022|PDM|1500.00|99|0.00|CPT 63688
20|FH_F122433_0_0|SrvcGrp|67073|2022|PDM|1100.00|99|0.00|CPT 22851
20|FH_F122433_0_0|SrvcGrp|72996|2022|PDM|630.00|99|0.00|AEG 4
20|FH_F122433_0_0|SrvcGrp|82109|2022|PDM|725.00|99|0.00|REVISE ULNAR NERVE ELBOW
20|FH_F122433_0_0|SrvcGrp|92759|2022|PCT|0.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)
20|FH_F122433_0_0|SrvcGrp|93807|2022|PDM|750.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY
20|FH_F122574_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|CARDIAC STUDIES
20|FH_F122574_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS
20|FH_F122627_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|GENERAL ACUTE CARE
20|FH_F122648_0_0|CSTM-ALL|CSTM-00|2020|PDM|631.00|99|0.00|AEG 9 (NO REV)
20|FH_F122648_0_0|SrvcGrp|107187|2022|PDM|1306.00|99|0.00|REVISE TWO EYE MUSCLES
20|FH_F122648_0_0|SrvcGrp|109176|2022|PDM|1739.00|99|0.00|EYE SERVICES
20|FH_F122649_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F122649_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F122649_0_0|SrvcGrp|100663|2022|PDM|632.50|99|0.00|HOSPICE IP CARE
20|FH_F122649_0_0|SrvcGrp|100664|2022|PDM|632.50|99|0.00|HOSPICE IP CARE (HCFA)
20|FH_F122649_0_0|SrvcGrp|24739|2022|PDM|112.00|99|0.00|RESPITE CARE
20|FH_F122649_0_0|SrvcGrp|53746|2022|PDM|112.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F122649_0_0|SrvcGrp|80920|2022|PDM|112.00|99|0.00|HOSPICE SERVICES
20|FH_F122649_0_0|SrvcGrp|87799|2022|PDM|112.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)
20|FH_F122649_0_0|SrvcGrp|93098|2022|PDM|112.00|99|0.00|HOSPICE CARE
20|FH_F122649_0_0|SrvcGrp|94780|2022|PDM|112.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)
20|FH_F122649_0_0|SrvcGrp|97507|2022|PDM|112.00|99|0.00|AETNA HOSPICE
20|FH_F122649_0_0|SrvcGrp|97703|2022|PDM|112.00|99|0.00|HOSPICE IN LTCH (HCFA)
20|FH_F122687_0_0|CSTM-ALL|CSTM-00|2020|PDM|856.00|99|0.00|AEG 2 (NO REV)
20|FH_F122687_0_0|CSTM-ALL|CSTM-00|2020|PDM|957.00|99|0.00|AEG 3 (NO REV)
20|FH_F122687_0_0|SrvcGrp|104112|2022|PDM|3825.00|99|0.00|REPAIR OF ANKLE FRACTURE
20|FH_F122687_0_0|SrvcGrp|105632|2022|PDM|2185.00|99|0.00|AMPUTATION OF TOE
20|FH_F122687_0_0|SrvcGrp|107001|2022|PDM|12381.00|99|0.00|REVISE/RECONSTRUCT/REMOVAL OF ANKLE IMPLANT
20|FH_F122687_0_0|SrvcGrp|109188|2022|PDM|4371.00|99|0.00|TIBIAL RODDING
20|FH_F122687_0_0|SrvcGrp|11663|2022|PCT|1.10|99|0.00|IMPLANTS
20|FH_F122687_0_0|SrvcGrp|11673|2022|PDM|3825.00|99|0.00|CPT 29888
20|FH_F122687_0_0|SrvcGrp|34606|2022|PDM|3825.00|99|0.00|CPT 29827
20|FH_F122687_0_0|SrvcGrp|35667|2022|PDM|1351.00|99|0.00|CPT 20680
20|FH_F122687_0_0|SrvcGrp|36591|2022|PDM|13113.00|99|0.00|CPT 63685
20|FH_F122687_0_0|SrvcGrp|54962|2022|PDM|3825.00|99|0.00|RECONSTRUCTION OF SHOULDER CUFF (ROTATOR)
20|FH_F122687_0_0|SrvcGrp|58773|2022|PDM|2732.00|99|0.00|ARTHROSCOPY KNEE
20|FH_F122687_0_0|SrvcGrp|72121|2022|PDM|3825.00|99|0.00|ARTHOSCOPY
20|FH_F122687_0_0|SrvcGrp|80617|2022|PDM|13413.00|99|0.00|ARTHOPLASTY
20|FH_F122687_0_0|SrvcGrp|82109|2022|PDM|1311.00|99|0.00|REVISE ULNAR NERVE ELBOW
20|FH_F122687_0_0|SrvcGrp|83641|2022|PDM|4371.00|99|0.00|CPT 29889
20|FH_F122687_0_0|SrvcGrp|84307|2022|PDM|3825.00|99|0.00|TENDON REPAIR
20|FH_F122687_0_0|SrvcGrp|88162|2022|PDM|8742.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON
20|FH_F122687_0_0|SrvcGrp|89848|2022|PDM|12020.00|99|0.00|SPINE FUSION EXTRA SEGMENT
20|FH_F122687_0_0|SrvcGrp|89979|2022|PDM|13413.00|99|0.00|RECONSTRUCT SHOULDER JOINT
20|FH_F122687_0_0|SrvcGrp|90361|2022|PDM|3825.00|99|0.00|REPAIR FRACTURE RADIUS/ULNA
20|FH_F122687_0_0|SrvcGrp|90420|2022|PDM|3825.00|99|0.00|REPAIR CLAVICLE FRACTURE
20|FH_F122687_0_0|SrvcGrp|92408|2022|PDM|7103.00|99|0.00|PERQ VERTEBRAL AUGMENTATION
20|FH_F122687_0_0|SrvcGrp|95560|2022|PDM|2185.00|99|0.00|REMOVAL OF SHOULDER BONE
20|FH_F122687_0_0|SrvcGrp|96539|2022|PDM|3825.00|99|0.00|REVISION OF ANKLE LIGAMENT
20|FH_F122841_0_0|CSTM-ALL|CSTM-00|2020|PDM|1107.00|99|0.00|AEG 3 W/O EYE AND OCULAR SERVICE
20|FH_F122841_0_0|CSTM-ALL|CSTM-00|2020|PDM|1391.00|99|0.00|AEG 10 (NO REV)
20|FH_F122841_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.49|99|0.00|AEG 1 (NO REV)
20|FH_F122841_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F122841_0_0|SrvcGrp|28549|2022|PDM|2497.00|99|0.00|VITRECTOMY
20|FH_F122841_0_0|SrvcGrp|42550|2022|PDM|1769.00|99|0.00|OP SURGERY CPT 66984
20|FH_F122841_0_0|SrvcGrp|90599|2022|PDM|1349.00|99|0.00|REMOVAL OF LENS LESION
20|FH_F122841_0_0|SrvcGrp|91456|2022|PDM|972.00|99|0.00|LAGOPHTHALMOS CORRECTION
20|FH_F122926_0_0|CSTM-ALL|CSTM-00|2020|PDM|685.00|99|0.00|AEG 5  (NO REV)
20|FH_F122926_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F122930_0_0|CSTM-ALL|CSTM-00|2020|PDM|3463.00|99|0.00|DEVICE INSERTION
20|FH_F120152_0_0|SrvcGrp|93433|2022|PDM|33000.00|99|0.00|PARTIAL HIP REPLACEMENT
20|FH_F120207_0_0|CSTM-ALL|CSTM-00|2020|PDM|1109.68|99|0.00|AEG 4 (NO REV)
20|FH_F120207_0_0|CSTM-ALL|CSTM-00|2020|PDM|1254.00|99|0.00|AEG 5  (NO REV)
20|FH_F120207_0_0|CSTM-ALL|CSTM-00|2020|PDM|2341.00|99|0.00|AEG 9 (NO REV)
20|FH_F120207_0_0|CSTM-ALL|CSTM-00|2020|PDM|757.12|99|0.00|AEG 2 (NO REV)
20|FH_F120207_0_0|SrvcGrp|105283|2022|PDM|3570.32|99|0.00|LAP INC HERN REPAIR COMP
20|FH_F120207_0_0|SrvcGrp|107878|2022|PDM|3787.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT
20|FH_F120207_0_0|SrvcGrp|82115|2022|PDM|2563.00|99|0.00|REPAIR UMBIL HERNIA
20|FH_F120207_0_0|SrvcGrp|83835|2022|PDM|4944.00|99|0.00|REPLACE TISSUE EXPANDER
20|FH_F120207_0_0|SrvcGrp|90802|2022|PDM|3787.00|99|0.00|LAP INC HERNIA REPAIR
20|FH_F120210_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F120290_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F120290_0_0|SrvcGrp|87077|2022|PDM|125.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F120291_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F120291_0_0|SrvcGrp|87799|2022|PDM|236.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)
20|FH_F120332_0_0|SrvcGrp|23683|2022|PCT|0.00|99|0.00|SKILLED NURSING RN
20|FH_F120332_0_0|SrvcGrp|46605|2022|PDM|76.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES
20|FH_F120332_0_0|SrvcGrp|48385|2022|PDM|75.00|99|0.00|SPEECH THERAPY
20|FH_F120332_0_0|SrvcGrp|63297|2022|PDM|112.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F120332_0_0|SrvcGrp|88621|2022|PDM|70.00|99|0.00|SKILLED NURSING LPN
20|FH_F120408_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F120408_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F120408_0_0|SrvcGrp|103669|2022|PDM|481.00|99|0.00|AETNA PARTIAL HOSP (HCFA)
20|FH_F120408_0_0|SrvcGrp|93337|2022|PDM|365.75|99|0.00|AETNA INTENSIVE OP EATING DISORDERS
20|FH_F120531_0_0|CSTM-ALL|CSTM-00|2020|PDM|2118.00|99|0.00|AEG 9 (NO REV)
20|FH_F120531_0_0|CSTM-ALL|CSTM-00|2020|PDM|526.00|99|0.00|AEG 1 (NO REV)
20|FH_F120531_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F120605_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F120605_0_0|SrvcGrp|11673|2022|PDM|2625.00|99|0.00|CPT 29888
20|FH_F120605_0_0|SrvcGrp|64517|2022|PDM|2625.00|99|0.00|REDUCE MANMMAPLASTY
20|FH_F120605_0_0|SrvcGrp|72990|2022|PDM|531.00|99|0.00|AEG 1
20|FH_F120605_0_0|SrvcGrp|72996|2022|PDM|1006.00|99|0.00|AEG 4
20|FH_F120605_0_0|SrvcGrp|72998|2022|PDM|1145.00|99|0.00|AEG 5
20|FH_F120605_0_0|SrvcGrp|73000|2022|PDM|1330.00|99|0.00|AEG 6
20|FH_F120605_0_0|SrvcGrp|73002|2022|PDM|1590.00|99|0.00|AEG 7
20|FH_F120605_0_0|SrvcGrp|73006|2022|PDM|2139.00|99|0.00|AEG 9
20|FH_F120626_0_0|CSTM-ALL|CSTM-00|2020|PDM|2072.00|99|0.00|GENERAL ACUTE CARE
20|FH_F120647_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F120647_0_0|SrvcGrp|108041|2022|PDM|400.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME
20|FH_F120665_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.46|99|0.00|OP SVCS
20|FH_F120670_0_0|CSTM-ALL|CSTM-00|2020|PDM|2800.00|99|0.00|AEG 9 (NO REV)
20|FH_F120670_0_0|CSTM-ALL|CSTM-00|2020|PDM|2850.00|99|0.00|AEG 7 (NO REV)
20|FH_F120670_0_0|SrvcGrp|100919|2022|PDM|6500.00|99|0.00|SPINE PROSTH DEVICE
20|FH_F120670_0_0|SrvcGrp|108911|2022|PDM|5500.00|99|0.00|DISK SURGERY/LAMINECTOMY
20|FH_F120670_0_0|SrvcGrp|14614|2022|PDM|4000.00|99|0.00|LITHOTRIPSY
20|FH_F120670_0_0|SrvcGrp|41334|2022|PDM|15000.00|99|0.00|TOTAL KNEE
20|FH_F120670_0_0|SrvcGrp|67279|2022|PDM|16000.00|99|0.00|CERVICAL SURGERY
20|FH_F120670_0_0|SrvcGrp|80617|2022|PDM|12000.00|99|0.00|ARTHOPLASTY
20|FH_F120670_0_0|SrvcGrp|88156|2022|PDM|15000.00|99|0.00|REVISION OF KNEE JOINT
20|FH_F120670_0_0|SrvcGrp|89848|2022|PDM|16000.00|99|0.00|SPINE FUSION EXTRA SEGMENT
20|FH_F120670_0_0|SrvcGrp|91528|2022|PDM|6500.00|99|0.00|SPINAL CORD IMPLANT
20|FH_F120670_0_0|SrvcGrp|99167|2022|PDM|6000.00|99|0.00|CPT 63057
20|FH_F120674_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.49|99|0.00|OP SVCS
20|FH_F120677_0_0|CSTM-ALL|CSTM-00|2020|PDM|2619.00|99|0.00|GENERAL ACUTE CARE
20|FH_F120679_0_0|CSTM-ALL|CSTM-00|2020|PDM|2619.00|99|0.00|GENERAL ACUTE CARE
20|FH_F120693_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F120707_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.89|99|0.00|GENERAL ACUTE CARE
20|FH_F120707_0_0|SrvcGrp|103913|2022|PCT|0.89|99|0.00|OP DIALYSIS
20|FH_F120714_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.60|99|0.00|OP SVCS
20|FH_F120718_0_0|CSTM-ALL|CSTM-00|2020|PCT|74.60|99|0.00|GENERAL ACUTE CARE
20|FH_F120767_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F120767_0_0|SrvcGrp|108081|2022|PDM|171.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS
20|FH_F120901_0_0|CSTM-ALL|CSTM-00|2020|PDM|4427.00|99|0.00|AEG 7 (NO REV)
20|FH_F120901_0_0|CSTM-ALL|CSTM-00|2020|PDM|5202.00|99|0.00|AEG 9 (NO REV)
20|FH_F120901_0_0|SrvcGrp|102420|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATHETERIZATION INCIDENTAL CODES
20|FH_F120901_0_0|SrvcGrp|12491|2022|PCT|0.40|99|0.00|PACEMAKER
20|FH_F120901_0_0|SrvcGrp|86233|2022|PDM|8973.00|99|0.00|AETNA RECONSTRUCT ANKLE JOINT
20|FH_F120901_0_0|SrvcGrp|92819|2022|PDM|4682.00|99|0.00|HIP ARTHOSCOPY
20|FH_F120901_0_0|SrvcGrp|92821|2022|PDM|4682.00|99|0.00|HIP ARTHROSCOPY W/ LABRAL REPAIR
20|FH_F120930_0_0|CSTM-ALL|CSTM-00|2020|PDM|1480.00|99|0.00|AEG 5  (NO REV)
20|FH_F120930_0_0|CSTM-ALL|CSTM-00|2020|PDM|983.00|99|0.00|AEG 3 (NO REV)
20|FH_F120930_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F120930_0_0|SrvcGrp|11306|2022|PCT|0.50|99|0.00|IMPLANTS
20|FH_F120930_0_0|SrvcGrp|11673|2022|PDM|3500.00|99|0.00|CPT 29888
20|FH_F120930_0_0|SrvcGrp|26275|2022|PDM|2000.00|99|0.00|CPT 29826
20|FH_F120930_0_0|SrvcGrp|26281|2022|PDM|3000.00|99|0.00|CPT 58353
20|FH_F120930_0_0|SrvcGrp|27261|2022|PDM|6500.00|99|0.00|CPT 27446
20|FH_F120930_0_0|SrvcGrp|33967|2022|PDM|3000.00|99|0.00|CPT 47562
20|FH_F120930_0_0|SrvcGrp|33982|2022|PDM|2500.00|99|0.00|CPT 28296
20|FH_F120930_0_0|SrvcGrp|38013|2022|PDM|3000.00|99|0.00|HYSTEROSCOPY
20|FH_F120930_0_0|SrvcGrp|63472|2022|PDM|4000.00|99|0.00|CPT 64581
20|FH_F120930_0_0|SrvcGrp|70749|2022|PDM|3500.00|99|0.00|CPT 29823
20|FH_F120930_0_0|SrvcGrp|83641|2022|PDM|3500.00|99|0.00|CPT 29889
20|FH_F120930_0_0|SrvcGrp|88157|2022|PDM|6500.00|99|0.00|TOTAL HIP ARTHROPLASTY
20|FH_F120930_0_0|SrvcGrp|90367|2022|PDM|2200.00|99|0.00|NASAL/SINUS ENDOSCOPY
20|FH_F120930_0_0|SrvcGrp|92820|2022|PDM|4500.00|99|0.00|HIP ARTHOSCOPY ACETABULOPLASTY
20|FH_F120930_0_0|SrvcGrp|95559|2022|PDM|6500.00|99|0.00|HIP JOINT
20|FH_F120930_0_0|SrvcGrp|96541|2022|PDM|3000.00|99|0.00|EXTENSIVE HYSTERCTOMY
20|FH_F120930_0_0|SrvcGrp|96543|2022|PDM|2500.00|99|0.00|REVISION OF CALF TENDON
20|FH_F120930_0_0|SrvcGrp|96559|2022|PDM|3000.00|99|0.00|TOTAL HYSTERCECTOMY
20|FH_F120930_0_0|SrvcGrp|96562|2022|PDM|3000.00|99|0.00|VAGINAL HYSTERCTOMY
20|FH_F120930_0_0|SrvcGrp|96563|2022|PDM|3000.00|99|0.00|HYSTERCTOMY AND VAGINA REPAIR
20|FH_F120930_0_0|SrvcGrp|96566|2022|PDM|3000.00|99|0.00|EXTENSIVE HYSTERCTOMY
20|FH_F120930_0_0|SrvcGrp|97741|2022|PDM|4000.00|99|0.00|REVISE KNEE
20|FH_F120930_0_0|SrvcGrp|97895|2022|PDM|4000.00|99|0.00|REVISE KNEE 2
20|FH_F120939_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F120954_0_0|SrvcGrp|108538|2022|PCT|0.00|99|0.00|HOSPICE ROUTINE HOME CARE
20|FH_F120954_0_0|SrvcGrp|108696|2022|PCT|0.00|99|0.00|HOSPICE IP/OP RESPITE CARE
20|FH_F120954_0_0|SrvcGrp|108697|2022|PCT|0.00|99|0.00|HOSPICE IP/OP RESPITE CARE
20|FH_F120954_0_0|SrvcGrp|57965|2022|PDM|997.50|99|0.00|HOSPICE RESPITE SVCS
20|FH_F121078_0_0|CSTM-ALL|CSTM-00|2020|PDM|731.00|99|0.00|AEG 2 (NO REV)
20|FH_F121111_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F121168_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F121168_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F121168_0_0|SrvcGrp|89783|2022|PDM|100.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F121168_0_0|SrvcGrp|97507|2022|PDM|100.00|99|0.00|AETNA HOSPICE
20|FH_F121168_0_0|SrvcGrp|97703|2022|PDM|100.00|99|0.00|HOSPICE IN LTCH (HCFA)
20|FH_F121168_0_0|SrvcGrp|97704|2022|PDM|100.00|99|0.00|HOSPICE IN HOME (HCFA)
20|FH_F121219_0_0|CSTM-ALL|CSTM-00|2020|PDM|4199.00|99|0.00|AEG 5  (NO REV)
20|FH_F121219_0_0|CSTM-ALL|CSTM-00|2020|PDM|4838.00|99|0.00|AEG 6 (NO REV)
20|FH_F121223_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F121223_0_0|SrvcGrp|108082|2022|PDM|75.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER
20|FH_F121335_0_0|CSTM-ALL|CSTM-00|2020|PDM|2984.00|99|0.00|AEG 3 (NO REV)
20|FH_F121335_0_0|CSTM-ALL|CSTM-00|2020|PDM|4838.00|99|0.00|AEG 6 (NO REV)
20|FH_F121402_0_0|CSTM-ALL|CSTM-00|2020|PCT|45.00|99|0.00|GENERAL ACUTE CARE
20|FH_F121416_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F121416_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F121425_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING
20|FH_F121426_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F121426_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ASPG V
20|FH_F121426_0_0|CSTM-ALL|CSTM-00|2020|PDM|611.00|99|0.00|ASPG I
20|FH_F121426_0_0|CSTM-ALL|CSTM-00|2020|PDM|820.00|99|0.00|ASPG II
20|FH_F121426_0_0|SrvcGrp|12995|2022|PDM|485.00|99|0.00|DIALYSIS
20|FH_F121426_0_0|SrvcGrp|3388|2022|PDM|969.00|99|0.00|SUBACUTE CARE
20|FH_F121427_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F121427_0_0|SrvcGrp|108043|2022|PDM|171.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD
20|FH_F121472_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 10 (NO REV)
20|FH_F121472_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 3 (NO REV)
20|FH_F121472_0_0|CSTM-ALL|CSTM-00|2020|PDM|1600.00|99|0.00|AEG 6 (NO REV)
20|FH_F121472_0_0|CSTM-ALL|CSTM-00|2020|PDM|1900.00|99|0.00|AEG 7 (NO REV)
20|FH_F121472_0_0|CSTM-ALL|CSTM-00|2020|PDM|2050.00|99|0.00|AEG 8 (NO REV)
20|FH_F121472_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F121472_0_0|SrvcGrp|103974|2022|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES
20|FH_F121476_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F121476_0_0|SrvcGrp|103865|2022|PDM|1848.00|99|0.00|PT PRGRM FOR IMPLT NEUROSTIM
20|FH_F121476_0_0|SrvcGrp|104448|2022|PDM|5628.00|99|0.00|CYSTOSCOPY IMPLANT 4 OR MORE
20|FH_F121476_0_0|SrvcGrp|108821|2022|PDM|156.00|99|0.00|GRAFTJACKET
20|FH_F121476_0_0|SrvcGrp|108822|2022|PDM|1723.00|99|0.00|NEUROMATRIX NERVE CUFF
20|FH_F121476_0_0|SrvcGrp|108826|2022|PDM|175.00|99|0.00|STENT NON-CORONARY
20|FH_F121476_0_0|SrvcGrp|108835|2022|PDM|55.00|99|0.00|LEAD NEUROSTIMULATOR
20|FH_F121476_0_0|SrvcGrp|108837|2022|PDM|8595.00|99|0.00|AUD OSSEO DEV INT/EXT COMP
20|FH_F121476_0_0|SrvcGrp|108840|2022|PDM|6695.00|99|0.00|LEAD CARDIOVERTER DEFIBRILLATOR
20|FH_F121476_0_0|SrvcGrp|108849|2022|PDM|2641.00|99|0.00|BON VOID FILLER-PUTTY IMPLNT
20|FH_F121476_0_0|SrvcGrp|108856|2022|PDM|8549.00|99|0.00|IMPLANTABLE JOINT DEVICE
20|FH_F121476_0_0|SrvcGrp|108859|2022|PDM|2627.00|99|0.00|METATARSAL JOINT IMPLANT
20|FH_F121476_0_0|SrvcGrp|108861|2022|PDM|2030.00|99|0.00|METACARPOPHALANGEAL JOINT
20|FH_F121476_0_0|SrvcGrp|108868|2022|PDM|23963.00|99|0.00|CARDIOVERTER DEFIBRILLATOR
20|FH_F121476_0_0|SrvcGrp|108869|2022|PDM|26565.00|99|0.00|CARDIOVERTER DEFIBRILLATOR
20|FH_F121476_0_0|SrvcGrp|11000|2022|PCT|1.00|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F121476_0_0|SrvcGrp|111249|2022|PDM|575.00|99|0.00|LEVONORGESTREL
20|FH_F121476_0_0|SrvcGrp|111253|2022|PDM|4340.00|99|0.00|CATHETER
20|FH_F121476_0_0|SrvcGrp|111428|2022|PDM|1770.00|99|0.00|CATHETER EXTRAVASCULAR TISSUE ABLATION
20|FH_F121476_0_0|SrvcGrp|36273|2022|PDM|299.00|99|0.00|INTRAOCULAR LENS
20|FH_F121476_0_0|SrvcGrp|78046|2022|PDM|1360.00|99|0.00|AETNA AQUEOUS SHUNT
20|FH_F121476_0_0|SrvcGrp|88269|2022|PDM|729.00|99|0.00|RETINAL TAMPONADE DEVICE
20|FH_F121799_0_0|SrvcGrp|82223|2022|PDM|103.00|99|0.00|HOSPICE CARE
20|FH_F121799_0_0|SrvcGrp|84185|2022|PDM|24.50|99|0.00|RESPITE CARE
20|FH_F121925_0_0|CSTM-ALL|CSTM-00|2020|PDM|1286.00|99|0.00|AEG 9 (NO REV)
20|FH_F121925_0_0|CSTM-ALL|CSTM-00|2020|PDM|643.00|99|0.00|AEG 4 (NO REV)
20|FH_F121925_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F121925_0_0|SrvcGrp|71221|2022|PDM|729.94|99|0.00|EGD W/BALLOON DIALATION CPT 43249
20|FH_F121925_0_0|SrvcGrp|79577|2022|PDM|1044.65|99|0.00|CPT 43244
20|FH_F122009_0_0|SrvcGrp|107746|2022|PCT|0.90|99|0.00|PARSABIV
20|FH_F122009_0_0|SrvcGrp|108041|2022|PDM|400.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME
20|FH_F122009_0_0|SrvcGrp|108043|2022|PDM|171.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD
20|FH_F122009_0_0|SrvcGrp|108081|2022|PDM|171.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS
20|FH_F122067_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DEVICE INSERTION
20|FH_F122067_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 6 (NO REV)
20|FH_F122067_0_0|CSTM-ALL|CSTM-00|2020|PDM|1320.00|99|0.00|AEG 8 (NO REV)
20|FH_F122067_0_0|CSTM-ALL|CSTM-00|2020|PDM|473.00|99|0.00|AEG 1 (NO REV)
20|FH_F122067_0_0|SrvcGrp|104003|2022|PCT|1.00|99|0.00|INSERT AQUEOUS DRAIN DEVICES
20|FH_F122067_0_0|SrvcGrp|92549|2022|PDM|550.00|99|0.00|REMOVAL OF EYE LESION
20|FH_F122200_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F122200_0_0|SrvcGrp|107746|2022|PCT|0.90|99|0.00|PARSABIV
20|FH_F122240_0_0|SrvcGrp|108153|2022|PCT|0.90|99|0.00|PARSABIV
20|FH_F122245_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F122245_0_0|SrvcGrp|103236|2022|PDM|7468.00|99|0.00|AETNA INSJ STABLJ DEV
20|FH_F122245_0_0|SrvcGrp|104448|2022|PDM|9902.25|99|0.00|CYSTOSCOPY IMPLANT 4 OR MORE
20|FH_F122245_0_0|SrvcGrp|107441|2022|PDM|6839.50|99|0.00|AETNA CYSTOSCOPY PROSTATIC IMPLANTS
20|FH_F122245_0_0|SrvcGrp|109039|2022|PDM|1356.77|99|0.00|PROSTATE SATURATION SAMPLING
20|FH_F122245_0_0|SrvcGrp|48160|2022|PDM|1741.70|99|0.00|BOTULINUM TOXIN TYPE A, PER UNIT
20|FH_F122245_0_0|SrvcGrp|56464|2022|PDM|8750.00|99|0.00|CPT 55873
20|FH_F122245_0_0|SrvcGrp|72992|2022|PDM|568.00|99|0.00|AEG 2
20|FH_F122245_0_0|SrvcGrp|73000|2022|PDM|975.00|99|0.00|AEG 6
20|FH_F122245_0_0|SrvcGrp|73004|2022|PDM|1148.00|99|0.00|AEG 8
20|FH_F122245_0_0|SrvcGrp|73006|2022|PDM|1580.00|99|0.00|AEG 9
20|FH_F122245_0_0|SrvcGrp|87054|2022|PDM|1899.70|99|0.00|CYSTOSCOPY CHEMODENERVATION
20|FH_F122245_0_0|SrvcGrp|91340|2022|PDM|1750.00|99|0.00|PENILE IMPLANT PROCEDURES
20|FH_F122245_0_0|SrvcGrp|91341|2022|PDM|1750.00|99|0.00|CORRECT BLADDER FUNCTION
20|FH_F122262_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F122262_0_0|CSTM-ALL|CSTM-00|2020|PDM|5885.00|99|0.00|AEG 8 (NO REV)
20|FH_F122262_0_0|SrvcGrp|12491|2022|PCT|0.50|99|0.00|PACEMAKER
20|FH_F122262_0_0|SrvcGrp|74587|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F122388_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F122433_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F122433_0_0|SrvcGrp|109084|2022|PDM|1200.00|99|0.00|NERVOUS SYSTEM
20|FH_F122433_0_0|SrvcGrp|109085|2022|PDM|1000.00|99|0.00|MUSCULOSKELETAL SYSTEM
20|FH_F122433_0_0|SrvcGrp|109086|2022|PDM|1150.00|99|0.00|CYSTOURETHROSCOPY
20|FH_F122433_0_0|SrvcGrp|27402|2022|PDM|1150.00|99|0.00|LASER PROCEDURES
20|FH_F122433_0_0|SrvcGrp|36591|2022|PDM|1500.00|99|0.00|CPT 63685
20|FH_F122433_0_0|SrvcGrp|37317|2022|PDM|1425.00|99|0.00|LITHOTRIPSY
20|FH_F122433_0_0|SrvcGrp|58671|2022|PDM|725.00|99|0.00|ASC CARVE OUT 64721
20|FH_F122433_0_0|SrvcGrp|72998|2022|PDM|717.00|99|0.00|AEG 5
20|FH_F122433_0_0|SrvcGrp|73002|2022|PDM|995.00|99|0.00|AEG 7
20|FH_F122433_0_0|SrvcGrp|87054|2022|PDM|700.00|99|0.00|CYSTOSCOPY CHEMODENERVATION
20|FH_F122433_0_0|SrvcGrp|88491|2022|PDM|2000.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR
20|FH_F122433_0_0|SrvcGrp|96839|2022|PDM|750.00|99|0.00|REVISE SPINE ELTRD PLATE
20|FH_F122533_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F122533_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F122574_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|AETNA CARDIAC CATHERTERIZATION
20|FH_F122648_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PHENYLEPHRINE KETOROLAC
20|FH_F122648_0_0|CSTM-ALL|CSTM-00|2020|PDM|631.00|99|0.00|AEG 10 (NO REV)
20|FH_F122648_0_0|SrvcGrp|77507|2022|PCT|1.00|99|0.00|AETNA CORNEAL TISSUE HANDLING
20|FH_F122648_0_0|SrvcGrp|91759|2022|PCT|1.00|99|0.00|OCULAR IMPLANT
20|FH_F122648_0_0|SrvcGrp|92545|2022|PDM|758.00|99|0.00|FOLLOW-UP SURGERY OF EYE
20|FH_F122649_0_0|SrvcGrp|90707|2022|PDM|112.00|99|0.00|AETNA HOSPICE CARE
20|FH_F122649_0_0|SrvcGrp|95661|2022|PDM|112.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F122649_0_0|SrvcGrp|97506|2022|PDM|112.00|99|0.00|AETNA HOSPICE ALL OTHER CARE
20|FH_F122687_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F122687_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F122687_0_0|CSTM-ALL|CSTM-00|2020|PDM|1182.00|99|0.00|AEG 4 (NO REV)
20|FH_F122687_0_0|CSTM-ALL|CSTM-00|2020|PDM|1351.00|99|0.00|AEG 5  (NO REV)
20|FH_F122687_0_0|CSTM-ALL|CSTM-00|2020|PDM|1576.00|99|0.00|AEG 6 (NO REV)
20|FH_F122687_0_0|CSTM-ALL|CSTM-00|2020|PDM|1913.00|99|0.00|AEG 7 (NO REV)
20|FH_F122687_0_0|CSTM-ALL|CSTM-00|2020|PDM|652.00|99|0.00|AEG 1 (NO REV)
20|FH_F122687_0_0|SrvcGrp|100014|2022|PDM|3825.00|99|0.00|REPAIR RADIUS OR ULNA
20|FH_F122687_0_0|SrvcGrp|102481|2022|PDM|2732.00|99|0.00|CPT 29898
20|FH_F122687_0_0|SrvcGrp|10985|2022|PDM|2732.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F122687_0_0|SrvcGrp|27261|2022|PDM|11474.00|99|0.00|CPT 27446
20|FH_F122687_0_0|SrvcGrp|63471|2022|PDM|8742.00|99|0.00|CPT 64590
20|FH_F122687_0_0|SrvcGrp|63472|2022|PDM|8742.00|99|0.00|CPT 64581
20|FH_F122687_0_0|SrvcGrp|74039|2022|PDM|8742.00|99|0.00|LAMINECTOMY
20|FH_F122687_0_0|SrvcGrp|78096|2022|PDM|2732.00|99|0.00|AETNA ARTHROSCOPY BICEPS
20|FH_F122687_0_0|SrvcGrp|82720|2022|PDM|1475.00|99|0.00|WRIST ENDOSCOPY/SURGERY
20|FH_F122687_0_0|SrvcGrp|88159|2022|PDM|8742.00|99|0.00|LOW BACK DISK SURGERY
20|FH_F122687_0_0|SrvcGrp|88163|2022|PDM|12020.00|99|0.00|LUMBAR SPINE FUSION
20|FH_F122687_0_0|SrvcGrp|88164|2022|PDM|12566.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR
20|FH_F122687_0_0|SrvcGrp|88493|2022|PDM|5464.00|99|0.00|AETNA VERTEBROPLASTY ADDL INJECT
20|FH_F122687_0_0|SrvcGrp|88494|2022|PDM|5464.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION
20|FH_F122687_0_0|SrvcGrp|92409|2022|PDM|5464.00|99|0.00|PERQ CERVICOTHORACIC INJECT
20|FH_F122687_0_0|SrvcGrp|99073|2022|PDM|1.38|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F122687_0_0|SrvcGrp|99171|2022|PDM|3825.00|99|0.00|CPT 28485
20|FH_F122841_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F122841_0_0|CSTM-ALL|CSTM-00|2020|PDM|2112.00|99|0.00|AEG 6 (NO REV)
20|FH_F122841_0_0|CSTM-ALL|CSTM-00|2020|PDM|2497.00|99|0.00|DEVICE INSERTION
20|FH_F122841_0_0|SrvcGrp|103671|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F122841_0_0|SrvcGrp|42551|2022|PDM|603.00|99|0.00|OP SURGERY
20|FH_F122841_0_0|SrvcGrp|87385|2022|PDM|2063.00|99|0.00|PARTIAL REMOVAL OF EYE FLUID
20|FH_F122841_0_0|SrvcGrp|90604|2022|PDM|1349.00|99|0.00|EXTRACTION OF LENS
20|FH_F122926_0_0|CSTM-ALL|CSTM-00|2020|PDM|315.00|99|0.00|AEG 1 (NO REV)
20|FH_F122926_0_0|CSTM-ALL|CSTM-00|2020|PDM|645.00|99|0.00|AEG 6 (NO REV)
20|FH_F122930_0_0|SrvcGrp|72990|2022|PDM|893.00|99|0.00|AEG 1
20|FH_F122930_0_0|SrvcGrp|73486|2022|PCT|0.00|99|0.00|AETNA CONTRAST AGENT
20|FH_F122933_0_0|SrvcGrp|72990|2022|PDM|500.00|99|0.00|AEG 1
20|FH_F122953_0_0|SrvcGrp|29155|2022|PDM|100.00|99|0.00|HOSPICE SVCS
20|FH_F123036_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F123036_0_0|SrvcGrp|107347|2022|PDM|6334.00|99|0.00|IMPLT NEUROSTIM RADIOFQ REC
20|FH_F123036_0_0|SrvcGrp|108836|2022|PDM|30000.00|99|0.00|COCHLEAR DEVICE/SYSTEM
20|FH_F123036_0_0|SrvcGrp|40003|2022|PDM|17750.00|99|0.00|TOTAL KNEE
20|FH_F123036_0_0|SrvcGrp|96104|2022|PDM|376.00|99|0.00|IMPLANTABLE NEUROSTIMULATOR
20|FH_F123036_0_0|SrvcGrp|96349|2022|PDM|17500.00|99|0.00|NECK SPINE FUSE
20|FH_F123064_0_0|CSTM-ALL|CSTM-00|2020|PDM|315.00|99|0.00|AEG 1 (NO REV)
20|FH_F123064_0_0|CSTM-ALL|CSTM-00|2020|PDM|425.00|99|0.00|AEG 2 (NO REV)
20|FH_F123064_0_0|CSTM-ALL|CSTM-00|2020|PDM|645.00|99|0.00|AEG 6 (NO REV)
20|FH_F123064_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 7 (NO REV)
20|FH_F123064_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F123083_0_0|CSTM-ALL|CSTM-00|2020|PDM|1013.00|99|0.00|AEG 10 (NO REV)
20|FH_F123083_0_0|CSTM-ALL|CSTM-00|2020|PDM|1490.00|99|0.00|AEG 9 (NO REV)
20|FH_F123083_0_0|SrvcGrp|28551|2022|PDM|1434.49|99|0.00|REPAIR OF COMPLEX RETINAL DETACHMENT
20|FH_F123144_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F123144_0_0|SrvcGrp|73006|2022|PDM|1405.00|99|0.00|AEG 9
20|FH_F123154_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F123154_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F123157_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F123157_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F123157_0_0|SrvcGrp|75481|2022|PDM|400.00|99|0.00|AEG 2
20|FH_F123157_0_0|SrvcGrp|75489|2022|PDM|794.00|99|0.00|AEG 6
20|FH_F123158_0_0|CSTM-ALL|CSTM-00|2020|PDM|645.00|99|0.00|AEG 6 (NO REV)
20|FH_F123158_0_0|CSTM-ALL|CSTM-00|2020|PDM|934.00|99|0.00|AEG 8 (NO REV)
20|FH_F123158_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 7 (NO REV)
20|FH_F123158_0_0|SrvcGrp|109307|2022|PDM|1200.00|99|0.00|DESTRUCTION ANAL LESION(S)
20|FH_F123158_0_0|SrvcGrp|29830|2022|PDM|1375.00|99|0.00|PERCUT NEEDLE INSERTION
20|FH_F123158_0_0|SrvcGrp|84704|2022|PDM|960.00|99|0.00|CYSTOURETHROSCOPY W/ REMOVAL OF FOREIGN BODY
20|FH_F123158_0_0|SrvcGrp|87026|2022|PDM|475.00|99|0.00|CYSTOSCOPY AND TREATMENT
20|FH_F123158_0_0|SrvcGrp|98526|2022|PDM|1300.00|99|0.00|CYSTOURETHROSCOPY
20|FH_F123162_0_0|CSTM-ALL|CSTM-00|2020|PDM|315.00|99|0.00|AEG 1 (NO REV)
20|FH_F123162_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 7 (NO REV)
20|FH_F123162_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F123170_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|AEG 1 (NO REV)
20|FH_F123170_0_0|CSTM-ALL|CSTM-00|2020|PDM|689.00|99|0.00|AEG 10 (NO REV)
20|FH_F123170_0_0|CSTM-ALL|CSTM-00|2020|PDM|689.00|99|0.00|AEG 3 (NO REV)
20|FH_F123185_0_0|SrvcGrp|72990|2022|PDM|340.00|99|0.00|AEG 1
20|FH_F123185_0_0|SrvcGrp|72994|2022|PDM|581.00|99|0.00|AEG 3
20|FH_F123185_0_0|SrvcGrp|72998|2022|PDM|979.00|99|0.00|AEG 5
20|FH_F123324_0_0|CSTM-ALL|CSTM-00|2020|PDM|1711.00|99|0.00|GENERAL ACUTE CARE
20|FH_F123324_0_0|SrvcGrp|20752|2022|PDM|2367.00|99|0.00|MSDRG 619-621 ONLY BARIATRIC SURGERY
20|FH_F123324_0_0|SrvcGrp|29817|2022|PDM|4548.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F123324_0_0|SrvcGrp|63|2022|PDM|1711.00|99|0.00|SUBACUTE CARE
20|FH_F123324_0_0|SrvcGrp|77348|2022|PDM|6557.00|99|0.00|CARDIAC CATH
20|FH_F123324_0_0|SrvcGrp|9537|2022|PDM|3249.00|99|0.00|CARDIAC CARE UNIT
20|FH_F123325_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING
20|FH_F123371_0_0|SrvcGrp|87799|2022|PDM|168.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)
20|FH_F123372_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.52|99|0.00|OP SVCS
20|FH_F123372_0_0|CSTM-ALL|CSTM-00|2020|PDM|837.00|99|0.00|CD ADULT REHAB
20|FH_F123372_0_0|SrvcGrp|10667|2022|PDM|657.00|99|0.00|BOARDER BABY SVCS
20|FH_F123372_0_0|SrvcGrp|15363|2022|PCT|0.52|99|0.00|DME/ORTHOTICS/PROSTHETICS/IMPLANTS
20|FH_F123372_0_0|SrvcGrp|3178|2022|PDM|837.00|99|0.00|ACUTE PSYCH
20|FH_F123373_0_0|CSTM-ALL|CSTM-00|2020|PDM|837.00|99|0.00|CD ADULT REHAB
20|FH_F123373_0_0|SrvcGrp|11259|2022|PCT|0.52|99|0.00|DRUGS
20|FH_F123373_0_0|SrvcGrp|12918|2022|PDM|2367.00|99|0.00|GYNECOLOGICAL MED/SURG
20|FH_F123373_0_0|SrvcGrp|20752|2022|PDM|2367.00|99|0.00|MSDRG 619-621 ONLY BARIATRIC SURGERY
20|FH_F123373_0_0|SrvcGrp|77348|2022|PDM|6557.00|99|0.00|CARDIAC CATH
20|FH_F123386_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F123386_0_0|SrvcGrp|10667|2022|PDM|450.00|99|0.00|BOARDER BABY SVCS
20|FH_F123386_0_0|SrvcGrp|3418|2022|PDM|2800.00|99|0.00|NEONATAL INTENSIVE CARE UNIT
20|FH_F123445_0_0|SrvcGrp|80920|2022|PDM|706.00|99|0.00|HOSPICE SERVICES
20|FH_F123445_0_0|SrvcGrp|89781|2022|PDM|198.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F123445_0_0|SrvcGrp|94781|2022|PDM|198.00|99|0.00|HOSPICE IN LTCH (HCFA)
20|FH_F123489_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 10 (NO REV)
20|FH_F123489_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 4 (NO REV)
20|FH_F122930_0_0|SrvcGrp|106235|2022|PDM|3463.00|99|0.00|CYPASS
20|FH_F122930_0_0|SrvcGrp|38907|2022|PDM|3274.00|99|0.00|CPT 66170 - FISTULIZATION OF SCLERA FOR GLAUCOMA
20|FH_F122930_0_0|SrvcGrp|72992|2022|PDM|1084.00|99|0.00|AEG 2
20|FH_F122930_0_0|SrvcGrp|72994|2022|PDM|1575.00|99|0.00|AEG 3
20|FH_F122930_0_0|SrvcGrp|73004|2022|PDM|3274.00|99|0.00|AEG 8
20|FH_F122930_0_0|SrvcGrp|73006|2022|PDM|4125.00|99|0.00|AEG 9
20|FH_F122930_0_0|SrvcGrp|73008|2022|PDM|1650.00|99|0.00|AEG 10
20|FH_F122930_0_0|SrvcGrp|87386|2022|PDM|3592.00|99|0.00|AMNIOTIC MEMBRANE TRANSPLANTATION
20|FH_F122933_0_0|SrvcGrp|106906|2022|PDM|700.00|99|0.00|AETNA SURGERY DEFAULT W/O GROUPER 1 & 2
20|FH_F122953_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F122953_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F122953_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F122953_0_0|SrvcGrp|82222|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F122953_0_0|SrvcGrp|82223|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F123036_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE
20|FH_F123036_0_0|SrvcGrp|101279|2022|PDM|17500.00|99|0.00|ADDL NECK SPINE FUSION
20|FH_F123036_0_0|SrvcGrp|105319|2022|PDM|21704.00|99|0.00|IMPLT NROSTM PLS GEN DUA REC
20|FH_F123036_0_0|SrvcGrp|108834|2022|PDM|22889.00|99|0.00|IMPLT NROSTM PLS GEN SNG REC
20|FH_F123036_0_0|SrvcGrp|108847|2022|PDM|14429.00|99|0.00|IMPLT NROSTM PLS GEN SNG NON
20|FH_F123036_0_0|SrvcGrp|11306|2022|PCT|1.10|99|0.00|IMPLANTS
20|FH_F123036_0_0|SrvcGrp|15052|2022|PCT|0.60|99|0.00|RADIOLOGY SVCS
20|FH_F123036_0_0|SrvcGrp|96350|2022|PDM|13393.00|99|0.00|SHOULDER JOINT
20|FH_F123036_0_0|SrvcGrp|96353|2022|PDM|19500.00|99|0.00|RECONSTRUCT ANKLE JOINT
20|FH_F123064_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F123064_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F123064_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 9 (NO REV)
20|FH_F123064_0_0|CSTM-ALL|CSTM-00|2020|PDM|485.00|99|0.00|AEG 3 (NO REV)
20|FH_F123064_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 4 (NO REV)
20|FH_F123064_0_0|CSTM-ALL|CSTM-00|2020|PDM|685.00|99|0.00|AEG 5  (NO REV)
20|FH_F123064_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 10 (NO REV)
20|FH_F123083_0_0|CSTM-ALL|CSTM-00|2020|PDM|1055.00|99|0.00|AEG 5  (NO REV)
20|FH_F123083_0_0|SrvcGrp|28548|2022|PDM|1233.94|99|0.00|VITRECTOMY
20|FH_F123144_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F123144_0_0|SrvcGrp|109383|2022|PCT|0.65|99|0.00|IMPLANTS/PROSTHETICS
20|FH_F123144_0_0|SrvcGrp|72990|2022|PDM|354.00|99|0.00|AEG 1
20|FH_F123144_0_0|SrvcGrp|72998|2022|PDM|762.00|99|0.00|AEG 5
20|FH_F123144_0_0|SrvcGrp|73000|2022|PDM|855.00|99|0.00|AEG 6
20|FH_F123144_0_0|SrvcGrp|73004|2022|PDM|1093.00|99|0.00|AEG 8
20|FH_F123157_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F123157_0_0|SrvcGrp|75497|2022|PDM|300.00|99|0.00|AEG 10
20|FH_F123158_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F123158_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 10 (NO REV)
20|FH_F123158_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F123158_0_0|SrvcGrp|63468|2022|PDM|850.00|99|0.00|CPT 52281
20|FH_F123158_0_0|SrvcGrp|63469|2022|PDM|2200.00|99|0.00|CPT 55700
20|FH_F123160_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.40|99|0.00|GENERAL ACUTE CARE
20|FH_F123160_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.40|99|0.00|OP SVCS
20|FH_F123162_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F123162_0_0|CSTM-ALL|CSTM-00|2020|PDM|645.00|99|0.00|AEG 6 (NO REV)
20|FH_F123162_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 10 (NO REV)
20|FH_F123170_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F123170_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F123185_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F123185_0_0|SrvcGrp|72996|2022|PDM|707.00|99|0.00|AEG 4
20|FH_F123185_0_0|SrvcGrp|73000|2022|PDM|1020.00|99|0.00|AEG 6
20|FH_F123185_0_0|SrvcGrp|73002|2022|PDM|1144.00|99|0.00|AEG 7
20|FH_F123317_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE
20|FH_F123324_0_0|SrvcGrp|16|2022|PDM|1711.00|99|0.00|ACUTE REHABILITATION
20|FH_F123324_0_0|SrvcGrp|22899|2022|PDM|2914.00|99|0.00|ICU
20|FH_F123371_0_0|SrvcGrp|104228|2022|PDM|168.00|99|0.00|HOSPICE CARE (HCFA)
20|FH_F123372_0_0|SrvcGrp|20752|2022|PDM|2367.00|99|0.00|MSDRG 619-621 ONLY BARIATRIC SURGERY
20|FH_F123372_0_0|SrvcGrp|30623|2022|PDM|6237.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788
20|FH_F123372_0_0|SrvcGrp|3418|2022|PDM|2914.00|99|0.00|NEONATAL INTENSIVE CARE UNIT
20|FH_F123372_0_0|SrvcGrp|62963|2022|PCT|0.52|99|0.00|SURGICAL
20|FH_F123372_0_0|SrvcGrp|77348|2022|PDM|6557.00|99|0.00|CARDIAC CATH
20|FH_F123373_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.52|99|0.00|OP SVCS
20|FH_F123373_0_0|SrvcGrp|10667|2022|PDM|657.00|99|0.00|BOARDER BABY SVCS
20|FH_F123373_0_0|SrvcGrp|15363|2022|PCT|0.52|99|0.00|DME/ORTHOTICS/PROSTHETICS/IMPLANTS
20|FH_F123373_0_0|SrvcGrp|16|2022|PDM|1711.00|99|0.00|ACUTE REHABILITATION
20|FH_F123373_0_0|SrvcGrp|22899|2022|PDM|2914.00|99|0.00|ICU
20|FH_F123373_0_0|SrvcGrp|62963|2022|PCT|0.52|99|0.00|SURGICAL
20|FH_F123377_0_0|CSTM-ALL|CSTM-00|2020|PDM|1904.00|99|0.00|GENERAL ACUTE CARE
20|FH_F123377_0_0|SrvcGrp|63|2022|PDM|1794.00|99|0.00|SUBACUTE CARE
20|FH_F123386_0_0|CSTM-ALL|CSTM-00|2020|PDM|1475.00|99|0.00|GENERAL ACUTE CARE
20|FH_F123386_0_0|SrvcGrp|11259|2022|PCT|0.50|99|0.00|DRUGS
20|FH_F123386_0_0|SrvcGrp|12918|2022|PDM|2300.00|99|0.00|GYNECOLOGICAL MED/SURG
20|FH_F123386_0_0|SrvcGrp|29817|2022|PDM|3400.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F123386_0_0|SrvcGrp|30623|2022|PDM|5400.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788
20|FH_F123386_0_0|SrvcGrp|3178|2022|PDM|650.00|99|0.00|ACUTE PSYCH
20|FH_F123386_0_0|SrvcGrp|63381|2022|PCT|0.50|99|0.00|OP SURGERY
20|FH_F123445_0_0|SrvcGrp|63297|2022|PDM|198.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F123489_0_0|CSTM-ALL|CSTM-00|2020|PDM|2295.00|99|0.00|AEG 9 (NO REV)
20|FH_F123489_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F123489_0_0|SrvcGrp|103974|2022|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES
20|FH_F123570_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F123570_0_0|SrvcGrp|41336|2022|PDM|3399.00|99|0.00|VAGINAL HYSTERECTOMY
20|FH_F123570_0_0|SrvcGrp|72998|2022|PDM|1014.18|99|0.00|AEG 5
20|FH_F123570_0_0|SrvcGrp|73002|2022|PDM|1407.40|99|0.00|AEG 7
20|FH_F123570_0_0|SrvcGrp|73006|2022|PDM|1893.97|99|0.00|AEG 9
20|FH_F123570_0_0|SrvcGrp|73008|2022|PDM|721.38|99|0.00|AEG 10
20|FH_F123620_0_0|SrvcGrp|106314|2022|PDM|624.00|99|0.00|ADVANCED LIFE SUPPORT LEVEL 2 (ALS2) (HCFA)
20|FH_F123620_0_0|SrvcGrp|107353|2022|PDM|336.00|99|0.00|AMB SRVC NEONAT TRNSPRT BS RATE EMERG 1 WAY (HCFA)
20|FH_F123620_0_0|SrvcGrp|13262|2022|PDM|5.00|99|0.00|GROUND MILEAGE, PER STATUTE MILE
20|FH_F123620_0_0|SrvcGrp|2067|2022|PDM|823.00|99|0.00|SPECIALTY CARE TRANSPORT
20|FH_F123638_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F123638_0_0|SrvcGrp|108041|2022|PDM|927.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME
20|FH_F123644_0_0|SrvcGrp|73841|2022|PDM|300.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP
20|FH_F123644_0_0|SrvcGrp|89149|2022|PDM|215.00|99|0.00|OP INTENSIVE
20|FH_F123726_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F123726_0_0|CSTM-ALL|CSTM-00|2020|PDM|1449.00|99|0.00|AEG 9 (NO REV)
20|FH_F123726_0_0|CSTM-ALL|CSTM-00|2020|PDM|366.00|99|0.00|AEG 1 (NO REV)
20|FH_F123726_0_0|CSTM-ALL|CSTM-00|2020|PDM|788.00|99|0.00|AEG 10 (NO REV)
20|FH_F123745_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 1 (NO REV)
20|FH_F123745_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 2 (NO REV)
20|FH_F123745_0_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|AEG 3 W/O EXCISION OF GANGLION (NO REV)
20|FH_F123745_0_0|CSTM-ALL|CSTM-00|2020|PDM|6300.00|99|0.00|AEG 9 (NO REV)
20|FH_F123745_0_0|SrvcGrp|100919|2022|PDM|3500.00|99|0.00|SPINE PROSTH DEVICE
20|FH_F123745_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F123745_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F123745_0_0|SrvcGrp|33986|2022|PDM|2500.00|99|0.00|CPT 26055
20|FH_F123745_0_0|SrvcGrp|67064|2022|PDM|2500.00|99|0.00|MUSCULOSKELETAL SYSTEM
20|FH_F123745_0_0|SrvcGrp|71666|2022|PDM|15000.00|99|0.00|CPT 63655
20|FH_F123745_0_0|SrvcGrp|88164|2022|PDM|9500.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR
20|FH_F123745_0_0|SrvcGrp|90417|2022|PDM|7500.00|99|0.00|TREATMENT OF JOINT
20|FH_F123745_0_0|SrvcGrp|90420|2022|PDM|6800.00|99|0.00|REPAIR CLAVICLE FRACTURE
20|FH_F123745_0_0|SrvcGrp|93431|2022|PDM|11000.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT
20|FH_F123745_0_0|SrvcGrp|97741|2022|PDM|16500.00|99|0.00|REVISE KNEE
20|FH_F123774_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F123774_0_0|SrvcGrp|72994|2022|PDM|770.00|99|0.00|AEG 3
20|FH_F123774_0_0|SrvcGrp|72996|2022|PDM|898.00|99|0.00|AEG 4
20|FH_F123774_0_0|SrvcGrp|73008|2022|PDM|700.00|99|0.00|AEG 10
20|FH_F123844_0_0|SrvcGrp|104226|2022|PDM|190.00|99|0.00|HOSPICE CARE (HCFA)
20|FH_F123844_0_0|SrvcGrp|90707|2022|PDM|194.00|99|0.00|AETNA HOSPICE CARE
20|FH_F123844_0_0|SrvcGrp|93098|2022|PDM|190.00|99|0.00|HOSPICE CARE
20|FH_F123850_0_0|SrvcGrp|30609|2022|PDM|43.86|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F123915_0_0|SrvcGrp|87799|2022|PDM|194.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)
20|FH_F123915_0_0|SrvcGrp|94780|2022|PDM|194.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)
20|FH_F123915_0_0|SrvcGrp|95660|2022|PDM|706.00|99|0.00|HOSPICE SERVICES (HCFA)
20|FH_F123926_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 10 (NO REV)
20|FH_F123926_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|AEG 5  (NO REV)
20|FH_F123926_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|AEG 6 (NO REV)
20|FH_F123926_0_0|CSTM-ALL|CSTM-00|2020|PDM|973.00|99|0.00|AEG 8 (NO REV)
20|FH_F123963_0_0|CSTM-ALL|CSTM-00|2020|PDM|1133.24|99|0.00|AEG 2 (NO REV)
20|FH_F123963_0_0|CSTM-ALL|CSTM-00|2020|PDM|1596.85|99|0.00|AEG 10 (NO REV)
20|FH_F123963_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F124017_0_0|CSTM-ALL|CSTM-00|2020|PDM|1275.00|99|0.00|AEG 9 (NO REV)
20|FH_F124017_0_0|CSTM-ALL|CSTM-00|2020|PDM|2300.00|99|0.00|AEG 4 (NO REV)
20|FH_F124017_0_0|SrvcGrp|40002|2022|PDM|12800.00|99|0.00|TOTAL HIP
20|FH_F124017_0_0|SrvcGrp|84442|2022|PDM|7800.00|99|0.00|REVISION KNEE
20|FH_F124112_0_0|SrvcGrp|82981|2022|PDM|130.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F124180_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|DEVICE INSERTION
20|FH_F124180_0_0|SrvcGrp|109733|2022|PDM|3796.50|99|0.00|NSL/SINS NDSC W/ SINS DILATION
20|FH_F124180_0_0|SrvcGrp|109734|2022|PDM|3475.50|99|0.00|OCULR RECNSTR;LMBL STEM CELL
20|FH_F124180_0_0|SrvcGrp|109736|2022|PDM|3364.00|99|0.00|NSL/SINS NDSC TOT W/ SPHENDT
20|FH_F124180_0_0|SrvcGrp|109739|2022|PDM|2724.00|99|0.00|NASAL/SINUS ENDOSCOPY WITH DILATION
20|FH_F124180_0_0|SrvcGrp|109740|2022|PDM|2490.00|99|0.00|SINUS ENDO W/ BALLOON DILATION
20|FH_F124180_0_0|SrvcGrp|109741|2022|PDM|2433.00|99|0.00|SINUS ENDO W/ BALLOON DILATION
20|FH_F124180_0_0|SrvcGrp|22948|2022|PDM|1800.00|99|0.00|CPT CODE 42830
20|FH_F124180_0_0|SrvcGrp|22949|2022|PDM|3860.00|99|0.00|CPT CODE 42825
20|FH_F124180_0_0|SrvcGrp|44461|2022|PDM|7132.00|99|0.00|INSERTION / REPLACEMENT OF SPINAL NEUROSTIMULATOR GENERATOR
20|FH_F124180_0_0|SrvcGrp|57863|2022|PDM|3215.50|99|0.00|NASAL/SINUS ENDOSCOPY
20|FH_F124180_0_0|SrvcGrp|72990|2022|PDM|795.00|99|0.00|AEG 1
20|FH_F124180_0_0|SrvcGrp|72994|2022|PDM|2300.00|99|0.00|AEG 3
20|FH_F124180_0_0|SrvcGrp|73000|2022|PDM|1700.00|99|0.00|AEG 6
20|FH_F124180_0_0|SrvcGrp|73004|2022|PDM|2000.00|99|0.00|AEG 8
20|FH_F124180_0_0|SrvcGrp|86034|2022|PDM|3500.00|99|0.00|REPAIR DETACHED RETINA
20|FH_F124180_0_0|SrvcGrp|91382|2022|PDM|1800.00|99|0.00|REMOVAL OF TONSILS
20|FH_F124180_0_0|SrvcGrp|97319|2022|PDM|8808.50|99|0.00|REVISE SPINE ELTRD PLATE
20|FH_F124219_0_0|SrvcGrp|87077|2022|PDM|150.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F124262_0_0|CSTM-ALL|CSTM-00|2020|PDM|736.00|99|0.00|AEG 1 (NO REV)
20|FH_F124262_0_0|CSTM-ALL|CSTM-00|2020|PDM|882.00|99|0.00|AEG 2 (NO REV)
20|FH_F124369_0_0|CSTM-ALL|CSTM-00|2020|PDM|1210.00|99|0.00|AEG 1 (NO REV)
20|FH_F124369_0_0|CSTM-ALL|CSTM-00|2020|PDM|2911.70|99|0.00|AEG 5  (NO REV)
20|FH_F124369_0_0|CSTM-ALL|CSTM-00|2020|PDM|3697.10|99|0.00|AEG 7 (NO REV)
20|FH_F124369_0_0|SrvcGrp|104008|2022|PDM|7480.00|99|0.00|CORRECTION HALUX RIDGUS W IMPLANTS
20|FH_F124369_0_0|SrvcGrp|107984|2022|PDM|9350.00|99|0.00|PARTIAL REMOVAL OF HEEL
20|FH_F124369_0_0|SrvcGrp|107987|2022|PDM|5610.00|99|0.00|REMOVAL OF SESAMOID BONE
20|FH_F124369_0_0|SrvcGrp|109790|2022|PDM|11220.00|99|0.00|FUSION OF FOOT BONES
20|FH_F124369_0_0|SrvcGrp|109792|2022|PDM|9350.00|99|0.00|FUSION OF BIG TOE JOINT
20|FH_F124369_0_0|SrvcGrp|27310|2022|PDM|2113.10|99|0.00|ENDOSCOPIC PLANTAR FASCIOTOMY
20|FH_F124369_0_0|SrvcGrp|33980|2022|PDM|7480.00|99|0.00|CPT 28298
20|FH_F124369_0_0|SrvcGrp|34605|2022|PDM|9350.00|99|0.00|CPT 28299
20|FH_F124369_0_0|SrvcGrp|70746|2022|PDM|7480.00|99|0.00|CPT 28292
20|FH_F124369_0_0|SrvcGrp|74587|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F124369_0_0|SrvcGrp|96543|2022|PDM|2750.00|99|0.00|REVISION OF CALF TENDON
20|FH_F124369_0_0|SrvcGrp|98466|2022|PDM|8415.00|99|0.00|PARTIAL REMOVAL OF FOOT BONE
20|FH_F124369_0_0|SrvcGrp|99169|2022|PDM|2113.10|99|0.00|CPT 28200
20|FH_F124371_0_0|SrvcGrp|106291|2022|PDM|217.36|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT LEVEL 1 (HCFA)
20|FH_F124371_0_0|SrvcGrp|106314|2022|PDM|498.38|99|0.00|ADVANCED LIFE SUPPORT LEVEL 2 (ALS2) (HCFA)
20|FH_F124371_0_0|SrvcGrp|106317|2022|PDM|588.69|99|0.00|SPECIALTY CARE TRANSPORT (HCFA)
20|FH_F124372_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F124372_0_0|SrvcGrp|108042|2022|PDM|437.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD
20|FH_F124388_0_0|CSTM-ALL|CSTM-00|2020|PDM|1613.00|99|0.00|AEG 8 (NO REV)
20|FH_F124388_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|AEG 7 (NO REV)
20|FH_F124388_0_0|CSTM-ALL|CSTM-00|2020|PDM|2222.00|99|0.00|AEG 9 (NO REV)
20|FH_F124388_0_0|SrvcGrp|103966|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F124388_0_0|SrvcGrp|63468|2022|PDM|1254.00|99|0.00|CPT 52281
20|FH_F124388_0_0|SrvcGrp|77444|2022|PDM|1254.00|99|0.00|VASECTOMY
20|FH_F124388_0_0|SrvcGrp|87054|2022|PDM|1254.00|99|0.00|CYSTOSCOPY CHEMODENERVATION
20|FH_F124388_0_0|SrvcGrp|87421|2022|PDM|1254.00|99|0.00|CYSTOURETHROSCOPY
20|FH_F124395_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F124438_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F124441_0_0|CSTM-ALL|CSTM-00|2020|PDM|1900.00|99|0.00|AEG 10 (NO REV)
20|FH_F124441_0_0|CSTM-ALL|CSTM-00|2020|PDM|2185.00|99|0.00|AEG 5  (NO REV)
20|FH_F124441_0_0|CSTM-ALL|CSTM-00|2020|PDM|3918.75|99|0.00|AEG 8 (NO REV)
20|FH_F124441_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F124441_0_0|SrvcGrp|106265|2022|PDM|3325.00|99|0.00|NSL/SINS NDSC TOTAL
20|FH_F124441_0_0|SrvcGrp|106267|2022|PDM|3325.00|99|0.00|NSL/SINS NDSC SPHN TISS RMVL
20|FH_F124441_0_0|SrvcGrp|109831|2022|PDM|6175.00|99|0.00|SPINE FUSION
20|FH_F124441_0_0|SrvcGrp|38364|2022|PDM|9500.00|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F124441_0_0|SrvcGrp|41334|2022|PDM|14250.00|99|0.00|TOTAL KNEE
20|FH_F124441_0_0|SrvcGrp|58638|2022|PDM|3325.00|99|0.00|CPT 63688
20|FH_F124441_0_0|SrvcGrp|59841|2022|PDM|1615.00|99|0.00|SUBMUCOUS RESECTION
20|FH_F124441_0_0|SrvcGrp|67068|2022|PDM|7125.00|99|0.00|LUMBAR SPINE FUSION COMBINED
20|FH_F124441_0_0|SrvcGrp|77444|2022|PDM|2185.00|99|0.00|VASECTOMY
20|FH_F124441_0_0|SrvcGrp|86505|2022|PDM|1425.00|99|0.00|DENTAL SURGERY
20|FH_F124441_0_0|SrvcGrp|89404|2022|PDM|14250.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F124441_0_0|SrvcGrp|90063|2022|PDM|3040.00|99|0.00|REPAIR BICEPS TENDON RUPTURE
20|FH_F124441_0_0|SrvcGrp|92410|2022|PDM|9025.00|99|0.00|SPINE FUSION EXTRA SEGMENT
20|FH_F124443_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F124443_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F124486_0_0|CSTM-ALL|CSTM-00|2020|PDM|2618.00|99|0.00|DEVICE INSERTION
20|FH_F124486_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 10 (NO REV)
20|FH_F124486_0_0|CSTM-ALL|CSTM-00|2020|PDM|446.00|99|0.00|AEG 2 (NO REV)
20|FH_F124486_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|AEG 4 (NO REV)
20|FH_F124486_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|AEG 5  (NO REV)
20|FH_F124486_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F124486_0_0|SrvcGrp|109846|2022|PDM|1803.00|99|0.00|RELIEVE INNER EYE PRESSURE (HCFA)
20|FH_F124486_0_0|SrvcGrp|84123|2022|PDM|1803.00|99|0.00|INSERT ANT SEGMENT DRAIN EXT
20|FH_F124486_0_0|SrvcGrp|87759|2022|PDM|1009.00|99|0.00|REINFORCE/GRAFT EYE WALL
20|FH_F124505_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F124505_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F124505_0_0|SrvcGrp|80538|2022|PDM|434.00|99|0.00|AETNA MEDICARE OUTPATIENT GROUPER 2
20|FH_F124505_0_0|SrvcGrp|80541|2022|PDM|698.00|99|0.00|AETNA MEDICARE OUTPATIENT GROUPER 5
20|FH_F124542_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F124542_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F124608_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F124608_0_0|CSTM-ALL|CSTM-00|2020|PDM|1928.00|99|0.00|AEG 10 (NO REV)
20|FH_F124608_0_0|CSTM-ALL|CSTM-00|2020|PDM|1928.00|99|0.00|AEG 5  (NO REV)
20|FH_F124608_0_0|CSTM-ALL|CSTM-00|2020|PDM|3059.00|99|0.00|AEG 9 (NO REV)
20|FH_F124608_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F124608_0_0|SrvcGrp|109909|2022|PDM|3060.00|99|0.00|LAPAROSCOPY
20|FH_F124608_0_0|SrvcGrp|109910|2022|PDM|2354.00|99|0.00|HYSTEROSCOPY BIOPSY
20|FH_F124608_0_0|SrvcGrp|11673|2022|PDM|4284.00|99|0.00|CPT 29888
20|FH_F124608_0_0|SrvcGrp|33987|2022|PDM|1224.00|99|0.00|CPT 57522
20|FH_F124608_0_0|SrvcGrp|35669|2022|PDM|4080.00|99|0.00|CPT 63650
20|FH_F124608_0_0|SrvcGrp|84939|2022|PDM|9149.00|99|0.00|SHOULDER JOINT
20|FH_F124608_0_0|SrvcGrp|86233|2022|PDM|9149.00|99|0.00|AETNA RECONSTRUCT ANKLE JOINT
20|FH_F123445_0_0|SrvcGrp|65720|2022|PDM|194.00|99|0.00|RESPITE CARE
20|FH_F123445_0_0|SrvcGrp|80918|2022|PDM|706.00|99|0.00|RESPITE CARE
20|FH_F123445_0_0|SrvcGrp|87799|2022|PDM|198.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)
20|FH_F123445_0_0|SrvcGrp|90707|2022|PDM|198.00|99|0.00|AETNA HOSPICE CARE
20|FH_F123445_0_0|SrvcGrp|93098|2022|PDM|198.00|99|0.00|HOSPICE CARE
20|FH_F123445_0_0|SrvcGrp|94780|2022|PDM|198.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)
20|FH_F123489_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F123489_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|AEG 6 (NO REV)
20|FH_F123489_0_0|CSTM-ALL|CSTM-00|2020|PDM|1935.00|99|0.00|AEG 7 (NO REV)
20|FH_F123489_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 1 (NO REV)
20|FH_F123489_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 2 (NO REV)
20|FH_F123570_0_0|SrvcGrp|103862|2022|PDM|1802.50|99|0.00|ARTHOSCOPY PROCEDURES
20|FH_F123570_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F123570_0_0|SrvcGrp|37317|2022|PDM|3914.00|99|0.00|LITHOTRIPSY
20|FH_F123570_0_0|SrvcGrp|41334|2022|PDM|3502.00|99|0.00|TOTAL KNEE
20|FH_F123570_0_0|SrvcGrp|65350|2022|PDM|2369.00|99|0.00|KNEE ARTHRO/ANTER
20|FH_F123570_0_0|SrvcGrp|73004|2022|PDM|1388.13|99|0.00|AEG 8
20|FH_F123620_0_0|SrvcGrp|100961|2022|PDM|336.00|99|0.00|AMB SRVC NEONAT TRNSPRT BS RATE EMERG 1 WAY
20|FH_F123620_0_0|SrvcGrp|106294|2022|PDM|285.00|99|0.00|AMBULANCE SERVICE EMERGENCY TRANSPORT LEVEL 1 (HFCA)
20|FH_F123620_0_0|SrvcGrp|13595|2022|PDM|285.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC
20|FH_F123627_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F123627_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F123638_0_0|SrvcGrp|108546|2022|PDM|398.00|99|0.00|PERITONEAL TREATMENTS W/ PATIENT TRAINING
20|FH_F123644_0_0|SrvcGrp|86648|2022|PCT|0.00|99|0.00|AETNA OP THERAPY SERVICE
20|FH_F123726_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F123726_0_0|CSTM-ALL|CSTM-00|2020|PDM|1093.00|99|0.00|AEG 7 (NO REV)
20|FH_F123726_0_0|CSTM-ALL|CSTM-00|2020|PDM|560.00|99|0.00|AEG 3 (NO REV)
20|FH_F123726_0_0|CSTM-ALL|CSTM-00|2020|PDM|788.00|99|0.00|AEG 5  (NO REV)
20|FH_F123726_0_0|SrvcGrp|79420|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F123745_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F123745_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F123745_0_0|CSTM-ALL|CSTM-00|2020|PDM|5100.00|99|0.00|AEG 6 (NO REV)
20|FH_F123745_0_0|CSTM-ALL|CSTM-00|2020|PDM|5900.00|99|0.00|AEG 8 (NO REV)
20|FH_F123745_0_0|SrvcGrp|109525|2022|PDM|6800.00|99|0.00|TREAT WRIST BONE FRACTURE
20|FH_F123745_0_0|SrvcGrp|109526|2022|PDM|7500.00|99|0.00|TREATMENT OF ANKLE FRACTURE
20|FH_F123745_0_0|SrvcGrp|109527|2022|PDM|7500.00|99|0.00|REPAIR ANKLE DISLOCATION
20|FH_F123745_0_0|SrvcGrp|109530|2022|PDM|4500.00|99|0.00|MENISCUS REPAIR MED OR LAT
20|FH_F123745_0_0|SrvcGrp|109571|2022|PDM|7500.00|99|0.00|REPAIR OF ANKLE FRACTURE
20|FH_F123745_0_0|SrvcGrp|26279|2022|PDM|4500.00|99|0.00|CPT 29884
20|FH_F123745_0_0|SrvcGrp|34606|2022|PDM|7500.00|99|0.00|CPT 29827
20|FH_F123745_0_0|SrvcGrp|36591|2022|PDM|22000.00|99|0.00|CPT 63685
20|FH_F123745_0_0|SrvcGrp|41334|2022|PDM|16500.00|99|0.00|TOTAL KNEE
20|FH_F123745_0_0|SrvcGrp|67072|2022|PDM|3600.00|99|0.00|CPT 22845
20|FH_F123745_0_0|SrvcGrp|85790|2022|PDM|6800.00|99|0.00|TREATMENT OF FRACTURE
20|FH_F123745_0_0|SrvcGrp|88492|2022|PDM|2500.00|99|0.00|AETNA SPINAL BONE AUTOGRAFT
20|FH_F123745_0_0|SrvcGrp|89404|2022|PDM|17000.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F123745_0_0|SrvcGrp|92358|2022|PDM|16500.00|99|0.00|REMOVAL OF KNEE PROSTHESIS
20|FH_F123745_0_0|SrvcGrp|93641|2022|PDM|4500.00|99|0.00|KNEE ARTHROSCOPIC SURGERY
20|FH_F123745_0_0|SrvcGrp|97730|2022|PDM|17000.00|99|0.00|REVERSE HIP JOINT
20|FH_F123774_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F123774_0_0|SrvcGrp|73000|2022|PDM|1118.00|99|0.00|AEG 6
20|FH_F123774_0_0|SrvcGrp|73006|2022|PDM|1338.00|99|0.00|AEG 9
20|FH_F123844_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F123844_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F123844_0_0|SrvcGrp|30609|2022|PDM|43.00|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F123844_0_0|SrvcGrp|80918|2022|PDM|678.00|99|0.00|RESPITE CARE
20|FH_F123844_0_0|SrvcGrp|89781|2022|PDM|190.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F123850_0_0|SrvcGrp|80918|2022|PDM|706.00|99|0.00|RESPITE CARE
20|FH_F123850_0_0|SrvcGrp|94781|2022|PDM|190.00|99|0.00|HOSPICE IN LTCH (HCFA)
20|FH_F123915_0_0|SrvcGrp|93098|2022|PDM|194.00|99|0.00|HOSPICE CARE
20|FH_F123915_0_0|SrvcGrp|95661|2022|PDM|706.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F123926_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|AEG 4 (NO REV)
20|FH_F123926_0_0|SrvcGrp|113576|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F123963_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F123963_0_0|CSTM-ALL|CSTM-00|2020|PDM|1287.78|99|0.00|AEG 3 (NO REV)
20|FH_F123963_0_0|CSTM-ALL|CSTM-00|2020|PDM|2060.45|99|0.00|AEG 6 (NO REV)
20|FH_F124017_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F124017_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 2 (NO REV)
20|FH_F124017_0_0|CSTM-ALL|CSTM-00|2020|PDM|2700.00|99|0.00|AEG 7 (NO REV)
20|FH_F124017_0_0|SrvcGrp|101114|2022|PDM|12800.00|99|0.00|ARTHOPLASTY
20|FH_F124017_0_0|SrvcGrp|102360|2022|PDM|3500.00|99|0.00|SHOULDER ARTHROSCOPY / SURGERY
20|FH_F124017_0_0|SrvcGrp|105524|2022|PDM|4500.00|99|0.00|INSJ BIOMECHANICAL DEVICE
20|FH_F124017_0_0|SrvcGrp|106145|2022|PDM|12800.00|99|0.00|PARTIAL HIP REPLACEMENT
20|FH_F124017_0_0|SrvcGrp|108265|2022|PDM|4100.00|99|0.00|AETNA INSJ BIOMECHANICAL DEVICE
20|FH_F124017_0_0|SrvcGrp|109666|2022|PDM|4100.00|99|0.00|INSJ STABLJ DEV W/DCMPRN
20|FH_F124017_0_0|SrvcGrp|109670|2022|PDM|9500.00|99|0.00|CERV ARTIFIC DISKECTOMY
20|FH_F124017_0_0|SrvcGrp|109672|2022|PDM|5200.00|99|0.00|LAMINOPLASTY, CERVICAL
20|FH_F124017_0_0|SrvcGrp|109673|2022|PDM|5200.00|99|0.00|LAMINOPLASTY, CERVICAL
20|FH_F124017_0_0|SrvcGrp|109674|2022|PDM|3500.00|99|0.00|SHOULDER ARTHROSCOPY/SURGERY
20|FH_F124608_0_0|SrvcGrp|88157|2022|PDM|7650.00|99|0.00|TOTAL HIP ARTHROPLASTY
20|FH_F124608_0_0|SrvcGrp|88491|2022|PDM|6452.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR
20|FH_F124608_0_0|SrvcGrp|93432|2022|PDM|8160.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT
20|FH_F124660_0_0|SrvcGrp|72992|2022|PDM|527.00|99|0.00|AEG 2
20|FH_F124660_0_0|SrvcGrp|72998|2022|PDM|847.00|99|0.00|AEG 5
20|FH_F124660_0_0|SrvcGrp|73000|2022|PDM|964.00|99|0.00|AEG 6
20|FH_F124711_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F124711_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F124711_0_0|CSTM-ALL|CSTM-00|2020|PDM|685.00|99|0.00|AEG 5  (NO REV)
20|FH_F124711_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F124727_0_0|SrvcGrp|108081|2022|PDM|182.14|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS
20|FH_F124727_0_0|SrvcGrp|108180|2022|PDM|425.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD
20|FH_F124738_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F124738_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F124738_0_0|SrvcGrp|72998|2022|PDM|710.00|99|0.00|AEG 5
20|FH_F124738_0_0|SrvcGrp|73002|2022|PDM|980.00|99|0.00|AEG 7
20|FH_F124743_0_0|SrvcGrp|29155|2022|PDM|125.00|99|0.00|HOSPICE SVCS
20|FH_F124743_0_0|SrvcGrp|82222|2022|PDM|125.00|99|0.00|HOSPICE CARE
20|FH_F124788_0_0|SrvcGrp|72992|2022|PDM|446.00|99|0.00|AEG 2
20|FH_F124788_0_0|SrvcGrp|73002|2022|PDM|995.00|99|0.00|AEG 7
20|FH_F124788_0_0|SrvcGrp|73006|2022|PDM|1339.00|99|0.00|AEG 9
20|FH_F124854_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F124854_0_0|SrvcGrp|65720|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F124854_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F124854_0_0|SrvcGrp|82223|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F124917_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F124917_0_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F124926_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F124927_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F124927_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F124965_0_0|SrvcGrp|72990|2022|PDM|540.00|99|0.00|AEG 1
20|FH_F124965_0_0|SrvcGrp|73004|2022|PDM|1500.00|99|0.00|AEG 8
20|FH_F124965_0_0|SrvcGrp|73008|2022|PCT|0.00|99|0.00|AEG 10
20|FH_F124976_0_0|SrvcGrp|72602|2022|PDM|651.00|99|0.00|ECT
20|FH_F124976_0_0|SrvcGrp|73842|2022|PDM|247.00|99|0.00|AETNA INTENSIVE OUTPATIENT
20|FH_F124976_0_0|SrvcGrp|86723|2022|PDM|531.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)
20|FH_F125053_0_0|SrvcGrp|72994|2022|PDM|549.00|99|0.00|AEG 3
20|FH_F125053_0_0|SrvcGrp|72996|2022|PDM|680.00|99|0.00|AEG 4
20|FH_F125053_0_0|SrvcGrp|73006|2022|PDM|1547.00|99|0.00|AEG 9
20|FH_F125053_0_0|SrvcGrp|79590|2022|PDM|1884.00|99|0.00|CPT 43248
20|FH_F125053_0_0|SrvcGrp|82301|2022|PDM|2233.50|99|0.00|HEMORRHOIDECTOMY
20|FH_F125069_0_0|SrvcGrp|72990|2022|PDM|683.00|99|0.00|AEG 1
20|FH_F125103_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F125110_0_0|CSTM-ALL|CSTM-00|2020|PDM|1080.00|99|0.00|AEG 10 (NO REV)
20|FH_F125110_0_0|CSTM-ALL|CSTM-00|2020|PDM|1080.00|99|0.00|AEG 5  (NO REV)
20|FH_F125110_0_0|CSTM-ALL|CSTM-00|2020|PDM|2020.00|99|0.00|AEG 9 (NO REV)
20|FH_F125110_0_0|CSTM-ALL|CSTM-00|2020|PDM|502.00|99|0.00|AEG 1 (NO REV)
20|FH_F125113_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F125113_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|AEG 3 (NO REV)
20|FH_F125113_0_0|CSTM-ALL|CSTM-00|2020|PDM|2062.00|99|0.00|AEG 8 (NO REV)
20|FH_F125113_0_0|CSTM-ALL|CSTM-00|2020|PDM|2250.00|99|0.00|AEG 4 (NO REV)
20|FH_F125115_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F125124_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F125124_0_0|SrvcGrp|110066|2022|PDM|768.00|99|0.00|ANOSCOPY CONTROL BLEEDING
20|FH_F125124_0_0|SrvcGrp|72990|2022|PDM|360.00|99|0.00|AEG 1
20|FH_F125124_0_0|SrvcGrp|79579|2022|PDM|3315.00|99|0.00|CPT 43251
20|FH_F125124_0_0|SrvcGrp|79588|2022|PDM|1783.50|99|0.00|CPT 43235
20|FH_F125124_0_0|SrvcGrp|79594|2022|PDM|2259.00|99|0.00|CPT 45380
20|FH_F125134_0_0|SrvcGrp|108041|2022|PDM|360.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME
20|FH_F125163_0_0|SrvcGrp|108041|2022|PDM|1300.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME
20|FH_F125173_0_0|SrvcGrp|108081|2022|PDM|171.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS
20|FH_F125173_0_0|SrvcGrp|108082|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER
20|FH_F125181_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F125182_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F125182_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F125182_0_0|SrvcGrp|79595|2022|PDM|2535.00|99|0.00|CPT 45385
20|FH_F125206_0_0|CSTM-ALL|CSTM-00|2020|PDM|1155.00|99|0.00|COVENTRY ENHANCED GROUPER 1
20|FH_F125206_0_0|CSTM-ALL|CSTM-00|2020|PDM|1795.00|99|0.00|COVENTRY ENHANCED GROUPER 3
20|FH_F125206_0_0|CSTM-ALL|CSTM-00|2020|PDM|2140.00|99|0.00|COVENTRY ENHANCED GROUPER 10
20|FH_F125206_0_0|SrvcGrp|705|2022|PCT|0.55|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F125244_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|AEG 1 (NO REV)
20|FH_F125244_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|AEG 3 (NO REV)
20|FH_F125244_0_0|SrvcGrp|101520|2022|PDM|5500.00|99|0.00|T1H W/T/O (<250G)
20|FH_F125244_0_0|SrvcGrp|104006|2022|PDM|6500.00|99|0.00|LAPS ABLATION UTERINE FIBROIDS
20|FH_F125244_0_0|SrvcGrp|107868|2022|PDM|5500.00|99|0.00|AETNA LAPAROSCOPY SURGICAL
20|FH_F125244_0_0|SrvcGrp|27348|2022|PDM|4000.00|99|0.00|OP SURGERY (CPT 58662)
20|FH_F125244_0_0|SrvcGrp|38364|2022|PDM|4900.00|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F125249_0_0|SrvcGrp|100005|2022|PDM|2100.00|99|0.00|FUSION RADIOULNAR JNT/ULNA
20|FH_F125249_0_0|SrvcGrp|100011|2022|PDM|1800.00|99|0.00|ANKLE ARTHROSCOPY
20|FH_F125249_0_0|SrvcGrp|100019|2022|PDM|1200.00|99|0.00|TREATMENT OF FRACTURE
20|FH_F125249_0_0|SrvcGrp|100044|2022|PDM|1200.00|99|0.00|INCISION OF HEEL BONE
20|FH_F125249_0_0|SrvcGrp|100071|2022|PDM|1200.00|99|0.00|REVISION OF THIGH MUSCLES
20|FH_F125249_0_0|SrvcGrp|108251|2022|PDM|2000.00|99|0.00|AETNA GRAFT INTO CARPAL BONE
20|FH_F125249_0_0|SrvcGrp|108254|2022|PDM|1700.00|99|0.00|AETNA CPT CODES 29828-29887
20|FH_F125249_0_0|SrvcGrp|108259|2022|PDM|1200.00|99|0.00|AETNA REPAIR LOWER LEG DISLOCATION
20|FH_F125249_0_0|SrvcGrp|108262|2022|PDM|1000.00|99|0.00|AETNA PARTIAL REMOVAL OF FIBULA
20|FH_F125249_0_0|SrvcGrp|108264|2022|PDM|700.00|99|0.00|AETNA DRAINAGE OF PALM BURSA
20|FH_F125249_0_0|SrvcGrp|11663|2022|PCT|0.60|99|0.00|IMPLANTS
20|FH_F125249_0_0|SrvcGrp|11673|2022|PDM|3200.00|99|0.00|CPT 29888
20|FH_F125249_0_0|SrvcGrp|26431|2022|PDM|9000.00|99|0.00|OP SURGICAL SERVICES
20|FH_F125249_0_0|SrvcGrp|27261|2022|PDM|11000.00|99|0.00|CPT 27446
20|FH_F125249_0_0|SrvcGrp|27315|2022|PDM|3300.00|99|0.00|TENDON REPAIR
20|FH_F125249_0_0|SrvcGrp|34603|2022|PDM|1200.00|99|0.00|CPT 24341
20|FH_F125249_0_0|SrvcGrp|67065|2022|PDM|11000.00|99|0.00|CERVICAL SURGERY
20|FH_F125249_0_0|SrvcGrp|67074|2022|PDM|1400.00|99|0.00|AC SURGERY
20|FH_F125249_0_0|SrvcGrp|70746|2022|PDM|1000.00|99|0.00|CPT 28292
20|FH_F125249_0_0|SrvcGrp|71666|2022|PDM|7000.00|99|0.00|CPT 63655
20|FH_F125249_0_0|SrvcGrp|82634|2022|PDM|1200.00|99|0.00|REPAIR OF KNEE LIGAMENTS
20|FH_F125249_0_0|SrvcGrp|85790|2022|PDM|1400.00|99|0.00|TREATMENT OF FRACTURE
20|FH_F125249_0_0|SrvcGrp|90361|2022|PDM|2000.00|99|0.00|REPAIR FRACTURE RADIUS/ULNA
20|FH_F125249_0_0|SrvcGrp|92007|2022|PDM|2000.00|99|0.00|PROXIMAL HUMERAL
20|FH_F125249_0_0|SrvcGrp|92009|2022|PDM|1200.00|99|0.00|CARPAL SCAPHOID FRACTURE
20|FH_F125249_0_0|SrvcGrp|92366|2022|PDM|1200.00|99|0.00|REPAIR ACHILLES TENDON
20|FH_F125259_0_0|CSTM-ALL|CSTM-00|2020|PDM|1640.00|99|0.00|AEG 7 (NO REV)
20|FH_F125259_0_0|SrvcGrp|106799|2022|PDM|4000.00|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT
20|FH_F125259_0_0|SrvcGrp|108114|2022|PDM|2500.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT
20|FH_F125259_0_0|SrvcGrp|110101|2022|PDM|2500.00|99|0.00|TRLUML BALO ANGIOP 1ST ART
20|FH_F125259_0_0|SrvcGrp|110102|2022|PDM|1750.00|99|0.00|ARTERY-VEIN GRAFT
20|FH_F125260_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F125260_0_0|SrvcGrp|23683|2022|PCT|0.00|99|0.00|SKILLED NURSING RN
20|FH_F125260_0_0|SrvcGrp|26160|2022|PDM|83.69|99|0.00|HOME HEALTH AIDE VISIT
20|FH_F125260_0_0|SrvcGrp|27969|2022|PCT|0.00|99|0.00|HOME HEALTH AIDE
20|FH_F125328_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F125328_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F125328_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F125328_0_0|SrvcGrp|42472|2022|PDM|11371.50|99|0.00|CPT 58670
20|FH_F125328_0_0|SrvcGrp|72992|2022|PDM|482.00|99|0.00|AEG 2
20|FH_F125328_0_0|SrvcGrp|72998|2022|PDM|889.00|99|0.00|AEG 5
20|FH_F125328_0_0|SrvcGrp|73002|2022|PDM|1077.00|99|0.00|AEG 7
20|FH_F125328_0_0|SrvcGrp|73006|2022|PDM|1547.00|99|0.00|AEG 9
20|FH_F125328_0_0|SrvcGrp|79583|2022|PDM|2028.00|99|0.00|CPT 45381
20|FH_F125328_0_0|SrvcGrp|82301|2022|PDM|2233.50|99|0.00|HEMORRHOIDECTOMY
20|FH_F125328_0_0|SrvcGrp|85000|2022|PDM|2410.50|99|0.00|CPT 45384
20|FH_F125473_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F125473_0_0|CSTM-ALL|CSTM-00|2020|PDM|2300.00|99|0.00|AEG 2 (NO REV)
20|FH_F125473_0_0|CSTM-ALL|CSTM-00|2020|PDM|2992.00|99|0.00|AEG 3 (NO REV)
20|FH_F125473_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F125473_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F125473_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F125677_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE
20|FH_F125772_0_0|CSTM-ALL|CSTM-00|2020|PDM|1600.00|99|0.00|AEG 4 (NO REV)
20|FH_F125772_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|AEG 6 (NO REV)
20|FH_F125772_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F125870_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F125870_0_0|SrvcGrp|104003|2022|PDM|3095.00|99|0.00|INSERT AQUEOUS DRAIN DEVICES
20|FH_F125870_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F125870_0_0|SrvcGrp|28547|2022|PDM|2445.00|99|0.00|VITRECTOMY
20|FH_F125870_0_0|SrvcGrp|72990|2022|PDM|375.00|99|0.00|AEG 1
20|FH_F125870_0_0|SrvcGrp|72998|2022|PDM|1495.00|99|0.00|AEG 5
20|FH_F125870_0_0|SrvcGrp|75182|2022|PCT|1.00|99|0.00|AETNA IMPLANTS
20|FH_F125870_0_0|SrvcGrp|90569|2022|PDM|1295.00|99|0.00|INCISION SECONDARY CATARACT
20|FH_F125910_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F125928_0_0|SrvcGrp|107353|2022|PDM|284.05|99|0.00|AMB SRVC NEONAT TRNSPRT BS RATE EMERG 1 WAY (HCFA)
20|FH_F125928_0_0|SrvcGrp|13262|2022|PDM|6.47|99|0.00|GROUND MILEAGE, PER STATUTE MILE
20|FH_F125938_0_0|SrvcGrp|16|2022|PCT|0.75|99|0.00|ACUTE REHABILITATION
20|FH_F125938_0_0|SrvcGrp|17100|2022|PCT|0.75|99|0.00|SKILLED NURSING
20|FH_F125940_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F125946_0_0|SrvcGrp|92501|2022|PDM|333.00|99|0.00|HOSPICE IP RESPITE CARE
20|FH_F126070_0_0|SrvcGrp|24954|2022|PDM|100.00|99|0.00|SIGMOIDOSCOPY
20|FH_F126073_0_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F126104_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F126104_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F126116_0_0|CSTM-ALL|CSTM-00|2020|PDM|1586.00|99|0.00|AEG 5 W/O LAPAROSCOPY
20|FH_F126116_0_0|CSTM-ALL|CSTM-00|2020|PDM|2152.00|99|0.00|AEG 8 (NO REV)
20|FH_F126116_0_0|CSTM-ALL|CSTM-00|2020|PDM|2958.00|99|0.00|AEG 9 (NO REV)
20|FH_F126116_0_0|SrvcGrp|104009|2022|PDM|6726.00|99|0.00|REMOVE AND REPLACE PM GEN SINGL
20|FH_F126116_0_0|SrvcGrp|107544|2022|PDM|6730.00|99|0.00|ILIAC REVASC W/ STENT
20|FH_F126116_0_0|SrvcGrp|108191|2022|PDM|2311.00|99|0.00|ILIAC REVASC
20|FH_F126116_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F126116_0_0|SrvcGrp|27347|2022|PDM|1125.00|99|0.00|CPT 58558
20|FH_F126249_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|GENERAL ACUTE CARE
20|FH_F126305_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F126339_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F126339_0_0|SrvcGrp|87077|2022|PDM|115.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F126345_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F126345_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F126345_0_0|SrvcGrp|27347|2022|PDM|3035.00|99|0.00|CPT 58558
20|FH_F126345_0_0|SrvcGrp|63471|2022|PDM|2899.00|99|0.00|CPT 64590
20|FH_F126345_0_0|SrvcGrp|72990|2022|PDM|453.00|99|0.00|AEG 1
20|FH_F126345_0_0|SrvcGrp|72994|2022|PDM|694.00|99|0.00|AEG 3
20|FH_F126345_0_0|SrvcGrp|73006|2022|PDM|1689.00|99|0.00|AEG 9
20|FH_F126345_0_0|SrvcGrp|73008|2022|PDM|979.00|99|0.00|AEG 10
20|FH_F126489_0_0|SrvcGrp|108041|2022|PDM|400.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME
20|FH_F126489_0_0|SrvcGrp|108081|2022|PDM|171.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS
20|FH_F126502_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F126523_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F126523_0_0|SrvcGrp|72994|2022|PDM|810.00|99|0.00|AEG 3
20|FH_F126523_0_0|SrvcGrp|73000|2022|PDM|1135.00|99|0.00|AEG 6
20|FH_F126523_0_0|SrvcGrp|73004|2022|PDM|1425.00|99|0.00|AEG 8
20|FH_F126525_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F126527_0_0|SrvcGrp|80918|2022|PDM|110.00|99|0.00|RESPITE CARE
20|FH_F126527_0_0|SrvcGrp|82222|2022|PDM|110.00|99|0.00|HOSPICE CARE
20|FH_F126527_0_0|SrvcGrp|83857|2022|PDM|500.00|99|0.00|IP HOSPICE SVCS
20|FH_F126554_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F126554_0_0|CSTM-ALL|CSTM-00|2020|PDM|1513.00|99|0.00|AEG 6 (NO REV)
20|FH_F126554_0_0|CSTM-ALL|CSTM-00|2020|PDM|1585.00|99|0.00|AEG 7 (NO REV)
20|FH_F126554_0_0|CSTM-ALL|CSTM-00|2020|PDM|726.00|99|0.00|AEG 1 (NO REV)
20|FH_F126554_0_0|SrvcGrp|104484|2022|PDM|39.00|99|0.00|THER/PROPH/DIAG IV INF ADDON
20|FH_F126554_0_0|SrvcGrp|49443|2022|PDM|121.00|99|0.00|INFUSION THERAPY
20|FH_F126647_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F126672_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F126672_0_0|CSTM-ALL|CSTM-00|2020|PDM|2649.00|99|0.00|DEVICE INSERTION
20|FH_F126672_0_0|CSTM-ALL|CSTM-00|2020|PDM|3621.00|99|0.00|IMPLANTS
20|FH_F126672_0_0|CSTM-ALL|CSTM-00|2020|PDM|944.00|99|0.00|AEG 5  (NO REV)
20|FH_F126672_0_0|SrvcGrp|104003|2022|PDM|2607.00|99|0.00|INSERT AQUEOUS DRAIN DEVICES
20|FH_F126698_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F126698_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F126882_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE
20|FH_F126904_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F126904_0_0|SrvcGrp|83857|2022|PDM|475.00|99|0.00|IP HOSPICE SVCS
20|FH_F126930_0_0|SrvcGrp|110599|2022|PDM|270.00|99|0.00|ORAL MEDICATION ADMIN
20|FH_F126990_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANESTHESIOLOGIST/CRNA (HAN5) SAME DOS
20|FH_F126990_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|GENERAL ACUTE CARE (ALL LINES-SAME DOS AS CURRENT LINE)
20|FH_F126990_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS (ALL LINES- SAME DOS AS CURRENT LINE)
20|FH_F127068_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F127105_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.20|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE
20|FH_F127105_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F127138_0_0|SrvcGrp|87077|2022|PDM|110.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F127188_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F127199_0_0|SrvcGrp|95661|2022|PDM|114.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F127207_0_0|SrvcGrp|104226|2022|PDM|90.00|99|0.00|HOSPICE CARE (HCFA)
20|FH_F127207_0_0|SrvcGrp|29155|2022|PDM|90.00|99|0.00|HOSPICE SVCS
20|FH_F127214_0_0|SrvcGrp|87077|2022|PDM|163.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F127324_0_0|CSTM-ALL|CSTM-00|2020|PDM|1320.00|99|0.00|AEG 5  (NO REV)
20|FH_F127324_0_0|CSTM-ALL|CSTM-00|2020|PDM|1660.00|99|0.00|AEG 8 (NO REV)
20|FH_F127324_0_0|CSTM-ALL|CSTM-00|2020|PDM|1744.00|99|0.00|AEG 7 (NO REV)
20|FH_F127324_0_0|SrvcGrp|93962|2022|PDM|11480.00|99|0.00|NEURO STIMULATOR
20|FH_F127325_0_0|SrvcGrp|72990|2022|PDM|318.00|99|0.00|AEG 1
20|FH_F127325_0_0|SrvcGrp|72994|2022|PDM|488.00|99|0.00|AEG 3
20|FH_F127325_0_0|SrvcGrp|72998|2022|PDM|687.00|99|0.00|AEG 5
20|FH_F127325_0_0|SrvcGrp|73004|2022|PDM|941.00|99|0.00|AEG 8
20|FH_F127325_0_0|SrvcGrp|73006|2022|PDM|1081.00|99|0.00|AEG 9
20|FH_F127328_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE
20|FH_F127328_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS
20|FH_F127343_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F127343_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F127343_0_0|CSTM-ALL|CSTM-00|2020|PDM|2750.00|99|0.00|AEG 10 (NO REV)
20|FH_F127343_0_0|CSTM-ALL|CSTM-00|2020|PDM|3520.00|99|0.00|AEG 9 (NO REV)
20|FH_F127343_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F127343_0_0|SrvcGrp|87059|2022|PDM|3105.00|99|0.00|REPAIR OF TENDON
20|FH_F127343_0_0|SrvcGrp|87062|2022|PDM|1725.00|99|0.00|REVISE ULNAR NERVE AT ELBOW
20|FH_F127399_0_0|SrvcGrp|100040|2022|PDM|4162.00|99|0.00|REPAIR HUMERUS FRACTURE
20|FH_F127399_0_0|SrvcGrp|101522|2022|PDM|4890.00|99|0.00|T1H W/T/O UTERUS (>250G)
20|FH_F127399_0_0|SrvcGrp|101523|2022|PDM|1665.00|99|0.00|CERCLAGE OF CERVIX
20|FH_F127399_0_0|SrvcGrp|110676|2022|PDM|2913.00|99|0.00|LAPAROSCOPIC TREAT OF ECTOP
20|FH_F127399_0_0|SrvcGrp|110679|2022|PDM|5202.00|99|0.00|REPAIR HUMERUS FRACTURE
20|FH_F127399_0_0|SrvcGrp|11673|2022|PDM|3954.00|99|0.00|CPT 29888
20|FH_F127399_0_0|SrvcGrp|33965|2022|PDM|4682.00|99|0.00|CPT 58552
20|FH_F127399_0_0|SrvcGrp|34603|2022|PDM|3121.00|99|0.00|CPT 24341
20|FH_F127399_0_0|SrvcGrp|54943|2022|PDM|3121.00|99|0.00|REPAIR OF SLAP LESION
20|FH_F127399_0_0|SrvcGrp|70749|2022|PDM|3121.00|99|0.00|CPT 29823
20|FH_F127399_0_0|SrvcGrp|72121|2022|PDM|3121.00|99|0.00|ARTHOSCOPY
20|FH_F127399_0_0|SrvcGrp|72992|2022|PDM|1873.00|99|0.00|AEG 2
20|FH_F127399_0_0|SrvcGrp|72998|2022|PDM|2705.00|99|0.00|AEG 5
20|FH_F127399_0_0|SrvcGrp|74039|2022|PDM|3849.00|99|0.00|LAMINECTOMY
20|FH_F127399_0_0|SrvcGrp|84181|2022|PDM|2185.00|99|0.00|AETNA IMMEDIATE BREAST PROSTHESIS
20|FH_F127399_0_0|SrvcGrp|88740|2022|PDM|2601.00|99|0.00|SP BONE ALGRFT
20|FH_F127399_0_0|SrvcGrp|89883|2022|PDM|2913.00|99|0.00|AETNA TREAT HUMERUS FRACTURE
20|FH_F127399_0_0|SrvcGrp|90357|2022|PDM|2913.00|99|0.00|REPAIR OF ANKLE FRACTURE
20|FH_F127399_0_0|SrvcGrp|90420|2022|PDM|2809.00|99|0.00|REPAIR CLAVICLE FRACTURE
20|FH_F127399_0_0|SrvcGrp|92367|2022|PDM|2913.00|99|0.00|TRANSPLANT HAND TENDON
20|FH_F127418_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F127418_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F127418_0_0|CSTM-ALL|CSTM-00|2020|PCT|3.00|99|0.00|HSS ASC
20|FH_F127418_0_0|SrvcGrp|100919|2022|PDM|5419.19|99|0.00|SPINE PROSTH DEVICE
20|FH_F127418_0_0|SrvcGrp|107361|2022|PDM|22312.11|99|0.00|SECOND LEVEL CER DISKECTOMY
20|FH_F127418_0_0|SrvcGrp|110757|2022|PDM|5529.43|99|0.00|CERVICAL VERTEBRAL CORPECTOMY
20|FH_F127418_0_0|SrvcGrp|37984|2022|PDM|7951.56|99|0.00|LUMBAR INJECTIONS PROCEDURE
20|FH_F127418_0_0|SrvcGrp|53066|2022|PDM|2800.00|99|0.00|INJECTION(S), LUMBAR OR SACRAL, EACH ADDITIONAL LEVEL
20|FH_F127418_0_0|SrvcGrp|67072|2022|PDM|15190.28|99|0.00|CPT 22845
20|FH_F127418_0_0|SrvcGrp|67119|2022|PDM|6830.78|99|0.00|ARTHODESIS
20|FH_F127418_0_0|SrvcGrp|88340|2022|PDM|16719.02|99|0.00|SPINAL FUSION
20|FH_F127418_0_0|SrvcGrp|89857|2022|PDM|24591.46|99|0.00|REMOVAL OF SPINAL LAMINA
20|FH_F127418_0_0|SrvcGrp|90343|2022|PDM|36330.72|99|0.00|CERVICE CORPECTOMY 1 LEVEL
20|FH_F127418_0_0|SrvcGrp|93730|2022|PDM|4195.19|99|0.00|INJ PERIPHERAL NERVE
20|FH_F127422_0_0|SrvcGrp|104003|2022|PDM|1400.00|99|0.00|INSERT AQUEOUS DRAIN DEVICES
20|FH_F127422_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F127422_0_0|SrvcGrp|28549|2022|PDM|1675.00|99|0.00|VITRECTOMY
20|FH_F127422_0_0|SrvcGrp|72992|2022|PDM|446.00|99|0.00|AEG 2
20|FH_F127422_0_0|SrvcGrp|72994|2022|PDM|510.00|99|0.00|AEG 3
20|FH_F127422_0_0|SrvcGrp|73002|2022|PDM|995.00|99|0.00|AEG 7
20|FH_F127448_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F127448_0_0|SrvcGrp|107879|2022|PDM|1900.00|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT
20|FH_F127448_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F127448_0_0|SrvcGrp|72996|2022|PDM|1000.00|99|0.00|AEG 4
20|FH_F127448_0_0|SrvcGrp|73006|2022|PDM|1800.00|99|0.00|AEG 9
20|FH_F127560_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F127571_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F127604_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F127711_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F127711_0_0|CSTM-ALL|CSTM-00|2020|PDM|1337.00|99|0.00|AEG 3 (NO REV)
20|FH_F128027_0_0|SrvcGrp|110954|2022|PDM|1050.00|99|0.00|UPPER GI ENDOSCOPY W/ SUBMUC INJ
20|FH_F128027_0_0|SrvcGrp|11663|2022|PCT|1.10|99|0.00|IMPLANTS
20|FH_F128027_0_0|SrvcGrp|64735|2022|PDM|1050.00|99|0.00|CPT 43235
20|FH_F128027_0_0|SrvcGrp|705|2022|PCT|1.10|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F128031_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F128031_0_0|SrvcGrp|110951|2022|PDM|18700.00|99|0.00|SHOULDER REPLACEMENT
20|FH_F128031_0_0|SrvcGrp|110953|2022|PDM|4950.00|99|0.00|DECOMPRESSIONS & ADDITIONAL LEVEL FUSIONS
20|FH_F128031_0_0|SrvcGrp|49544|2022|PDM|17600.00|99|0.00|ARTHROPLASTY
20|FH_F128031_0_0|SrvcGrp|72992|2022|PDM|567.00|99|0.00|AEG 2
20|FH_F128031_0_0|SrvcGrp|72994|2022|PDM|766.00|99|0.00|AEG 3
20|FH_F128031_0_0|SrvcGrp|73000|2022|PDM|1147.00|99|0.00|AEG 6
20|FH_F128031_0_0|SrvcGrp|73002|2022|PDM|1256.00|99|0.00|AEG 7
20|FH_F128031_0_0|SrvcGrp|73004|2022|PDM|1583.00|99|0.00|AEG 8
20|FH_F128031_0_0|SrvcGrp|73008|2022|PDM|820.00|99|0.00|AEG 10
20|FH_F128031_0_0|SrvcGrp|75659|2022|PDM|1980.00|99|0.00|ARTHRODESIS
20|FH_F128148_0_0|SrvcGrp|12079|2022|PCT|0.70|99|0.00|MED SURG SUPPLIES
20|FH_F128148_0_0|SrvcGrp|22596|2022|PDM|250.00|99|0.00|HOSPICE CARE
20|FH_F128148_0_0|SrvcGrp|29898|2022|PDM|135.00|99|0.00|RN VISIT
20|FH_F128185_0_0|CSTM-ALL|CSTM-00|2020|PDM|1054.00|99|0.00|AEG 10 (NO REV)
20|FH_F128185_0_0|CSTM-ALL|CSTM-00|2020|PDM|1057.00|99|0.00|AEG 8 (NO REV)
20|FH_F128185_0_0|CSTM-ALL|CSTM-00|2020|PDM|1714.00|99|0.00|AEG 3 (NO REV)
20|FH_F128185_0_0|CSTM-ALL|CSTM-00|2020|PDM|772.00|99|0.00|AEG 1 (NO REV)
20|FH_F128185_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F128237_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F128237_0_0|SrvcGrp|82222|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F128237_0_0|SrvcGrp|82223|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F128246_0_0|SrvcGrp|104722|2022|PDM|726.00|99|0.00|REPAIR EYELID DEFECT
20|FH_F128246_0_0|SrvcGrp|111036|2022|PDM|726.00|99|0.00|REPAIR ENTROPION
20|FH_F128246_0_0|SrvcGrp|111038|2022|PDM|726.00|99|0.00|REPAIR ENTROPION
20|FH_F128246_0_0|SrvcGrp|111046|2022|PDM|726.00|99|0.00|REVISE EYELASHES
20|FH_F128246_0_0|SrvcGrp|79794|2022|PDM|1176.00|99|0.00|EYE/OCULAR ADNEXA SURGERY
20|FH_F128246_0_0|SrvcGrp|85564|2022|PDM|841.00|99|0.00|REVISION OF IRIS
20|FH_F128274_81501_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F128274_81501_0|SrvcGrp|76321|2022|PCT|0.80|99|0.00|AETNA ALL INPATIENT SERVICES
20|FH_F128334_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F128360_0_0|CSTM-ALL|CSTM-00|2020|PDM|1088.00|99|0.00|AEG 6 (NO REV)
20|FH_F128360_0_0|CSTM-ALL|CSTM-00|2020|PDM|1311.00|99|0.00|AEG 7 (NO REV)
20|FH_F128360_0_0|CSTM-ALL|CSTM-00|2020|PDM|1765.00|99|0.00|AEG 9 (NO REV)
20|FH_F128360_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 1 (NO REV)
20|FH_F128360_0_0|CSTM-ALL|CSTM-00|2020|PDM|675.00|99|0.00|AEG 3 (NO REV)
20|FH_F128360_0_0|CSTM-ALL|CSTM-00|2020|PDM|831.00|99|0.00|AEG 4 (NO REV)
20|FH_F128360_0_0|CSTM-ALL|CSTM-00|2020|PDM|945.00|99|0.00|AEG 5  (NO REV)
20|FH_F128360_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F128378_0_0|SrvcGrp|80918|2022|PDM|175.00|99|0.00|RESPITE CARE
20|FH_F128379_0_0|CSTM-ALL|CSTM-00|2020|PDM|1373.00|99|0.00|AEG 4 (NO REV)
20|FH_F128379_0_0|CSTM-ALL|CSTM-00|2020|PDM|1488.00|99|0.00|AEG 5  (NO REV)
20|FH_F128379_0_0|CSTM-ALL|CSTM-00|2020|PDM|2174.00|99|0.00|AEG 8 (NO REV)
20|FH_F128379_0_0|SrvcGrp|100920|2022|PDM|3319.00|99|0.00|SPINE PRO DEVICE
20|FH_F128379_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F128379_0_0|SrvcGrp|111058|2022|PDM|7210.00|99|0.00|SPINAL CORD DECOMPRESS
20|FH_F128379_0_0|SrvcGrp|12491|2022|PCT|1.05|99|0.00|PACEMAKER
20|FH_F128379_0_0|SrvcGrp|67068|2022|PDM|14306.00|99|0.00|LUMBAR SPINE FUSION COMBINED
20|FH_F128390_0_0|SrvcGrp|65720|2022|PDM|115.00|99|0.00|RESPITE CARE
20|FH_F128390_0_0|SrvcGrp|80920|2022|PDM|591.00|99|0.00|HOSPICE SERVICES
20|FH_F128390_0_0|SrvcGrp|90707|2022|PDM|115.00|99|0.00|AETNA HOSPICE CARE
20|FH_F128390_0_0|SrvcGrp|93098|2022|PDM|115.00|99|0.00|HOSPICE CARE
20|FH_F128397_0_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F128446_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F128580_0_0|CSTM-ALL|CSTM-00|2020|PDM|1002.00|99|0.00|AEG 8 (NO REV)
20|FH_F128580_0_0|CSTM-ALL|CSTM-00|2020|PDM|1373.00|99|0.00|AEG 9 (NO REV)
20|FH_F128580_0_0|CSTM-ALL|CSTM-00|2020|PDM|342.00|99|0.00|AEG 1 (NO REV)
20|FH_F128580_0_0|CSTM-ALL|CSTM-00|2020|PDM|737.00|99|0.00|AEG 5  (NO REV)
20|FH_F128580_0_0|CSTM-ALL|CSTM-00|2020|PDM|849.00|99|0.00|AEG 6 (NO REV)
20|FH_F128580_0_0|SrvcGrp|107793|2022|PDM|9725.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE
20|FH_F128580_0_0|SrvcGrp|107794|2022|PDM|4058.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE
20|FH_F128580_0_0|SrvcGrp|107878|2022|PDM|2003.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT
20|FH_F128580_0_0|SrvcGrp|108075|2022|PDM|2248.00|99|0.00|AV FUSION / UPPER ARM VEIN
20|FH_F128580_0_0|SrvcGrp|109136|2022|PDM|2248.00|99|0.00|AV FISTULA REVISION
20|FH_F128698_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F128699_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F128699_0_0|SrvcGrp|80918|2022|PDM|90.00|99|0.00|RESPITE CARE
20|FH_F128804_0_0|CSTM-ALL|CSTM-00|2020|PDM|3300.00|99|0.00|AEG 7 (NO REV)
20|FH_F128804_0_0|CSTM-ALL|CSTM-00|2020|PDM|715.00|99|0.00|AEG 1 (NO REV)
20|FH_F128804_0_0|SrvcGrp|23585|2022|PCT|1.05|99|0.00|IMPLANTS
20|FH_F128804_0_0|SrvcGrp|77582|2022|PDM|4263.00|99|0.00|CPT 31255
20|FH_F128804_0_0|SrvcGrp|79101|2022|PDM|3520.00|99|0.00|AETNA NASAL ENDOSCOPY
20|FH_F128833_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F128833_0_0|SrvcGrp|108042|2022|PDM|400.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD
20|FH_F128833_0_0|SrvcGrp|108043|2022|PDM|171.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD
20|FH_F128833_0_0|SrvcGrp|108081|2022|PDM|171.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS
20|FH_F128839_0_0|SrvcGrp|73841|2022|PDM|304.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP
20|FH_F128839_0_0|SrvcGrp|89149|2022|PDM|200.00|99|0.00|OP INTENSIVE
20|FH_F128839_0_0|SrvcGrp|89417|2022|PDM|304.00|99|0.00|PARTIAL HOSPITALIZATION
20|FH_F128880_0_0|SrvcGrp|87077|2022|PDM|120.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F128893_0_0|SrvcGrp|89783|2022|PDM|150.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F128893_0_0|SrvcGrp|90707|2022|PDM|160.00|99|0.00|AETNA HOSPICE CARE
20|FH_F128893_0_0|SrvcGrp|94781|2022|PDM|160.00|99|0.00|HOSPICE IN LTCH (HCFA)
20|FH_F128924_0_0|SrvcGrp|29428|2022|PDM|424.00|99|0.00|HOME/CHRONIC HEMODIALYSIS TREATMENT
20|FH_F128927_0_0|SrvcGrp|87077|2022|PDM|148.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F128988_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F128988_0_0|SrvcGrp|84185|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F129046_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F129053_0_0|CSTM-ALL|CSTM-00|2020|PDM|1498.00|99|0.00|AEG 3 (NO REV)
20|FH_F129053_0_0|CSTM-ALL|CSTM-00|2020|PDM|884.00|99|0.00|AEG 10 (NO REV)
20|FH_F129053_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F129053_0_0|SrvcGrp|26275|2022|PDM|2861.00|99|0.00|CPT 29826
20|FH_F129175_0_0|CSTM-ALL|CSTM-00|2020|PDM|1466.00|99|0.00|AEG 9 (NO REV)
20|FH_F129175_0_0|CSTM-ALL|CSTM-00|2020|PDM|365.00|99|0.00|AEG 1 (NO REV) W/O SURGICAL/SPINE AND NERVE SERVICES
20|FH_F129175_0_0|CSTM-ALL|CSTM-00|2020|PDM|689.00|99|0.00|AEG 4 (NO REV)
20|FH_F129175_0_0|CSTM-ALL|CSTM-00|2020|PDM|745.00|99|0.00|AEG 10 (NO REV)
20|FH_F129175_0_0|SrvcGrp|105640|2022|PDM|285.03|99|0.00|NJX INTERLAMINAR CRV/THRC
20|FH_F129175_0_0|SrvcGrp|110766|2022|PDM|94.56|99|0.00|3RD LEVEL INJ PARAVERT F JNT C/T
20|FH_F129175_0_0|SrvcGrp|27330|2022|PDM|290.47|99|0.00|CPT 27096
20|FH_F129175_0_0|SrvcGrp|73486|2022|PCT|0.00|99|0.00|AETNA CONTRAST AGENT
20|FH_F129175_0_0|SrvcGrp|90976|2022|PDM|300.00|99|0.00|INJECTION PARAVERTEBRAL FACET JOINT
20|FH_F129175_0_0|SrvcGrp|93730|2022|PDM|135.58|99|0.00|INJ PERIPHERAL NERVE
20|FH_F129175_0_0|SrvcGrp|96799|2022|PDM|166.68|99|0.00|DESTROY C/TH FACET JNT ADDL
20|FH_F129225_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F129225_0_0|CSTM-ALL|CSTM-00|2020|PDM|1041.88|99|0.00|2005 ASPG GROUPER VI
20|FH_F129248_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F129248_0_0|CSTM-ALL|CSTM-00|2020|PDM|1376.11|99|0.00|2005 ASPG GROUPER VII
20|FH_F129248_0_0|CSTM-ALL|CSTM-00|2020|PDM|871.30|99|0.00|2005 ASPG GROUPER IV
20|FH_F129254_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F129254_0_0|CSTM-ALL|CSTM-00|2020|PDM|1255.05|99|0.00|ASPG VII
20|FH_F129254_0_0|CSTM-ALL|CSTM-00|2020|PDM|1688.96|99|0.00|ASPG IX
20|FH_F129254_0_0|CSTM-ALL|CSTM-00|2020|PDM|562.57|99|0.00|ASPG II
20|FH_F129254_0_0|CSTM-ALL|CSTM-00|2020|PDM|643.29|99|0.00|ASPG III
20|FH_F129260_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F129260_0_0|CSTM-ALL|CSTM-00|2020|PDM|6000.00|99|0.00|AEG 7 (NO REV)
20|FH_F129260_0_0|CSTM-ALL|CSTM-00|2020|PDM|640.00|99|0.00|AEG 2 (NO REV)
20|FH_F129260_0_0|CSTM-ALL|CSTM-00|2020|PDM|687.50|99|0.00|AEG 10 (NO REV)
20|FH_F129260_0_0|CSTM-ALL|CSTM-00|2020|PDM|920.00|99|0.00|AEG 4 (NO REV)
20|FH_F129364_0_0|SrvcGrp|107746|2022|PCT|0.90|99|0.00|PARSABIV
20|FH_F129364_0_0|SrvcGrp|108042|2022|PDM|424.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD
20|FH_F129472_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F129472_0_0|CSTM-ALL|CSTM-00|2020|PDM|740.00|99|0.00|AEG 10 (NO REV)
20|FH_F129472_0_0|CSTM-ALL|CSTM-00|2020|PDM|901.00|99|0.00|AEG 5  (NO REV)
20|FH_F129487_0_0|SrvcGrp|14614|2022|PDM|2800.00|99|0.00|LITHOTRIPSY
20|FH_F129487_0_0|SrvcGrp|33984|2022|PDM|2369.00|99|0.00|HAMMERTOE CORRECTION
20|FH_F129487_0_0|SrvcGrp|72998|2022|PDM|1934.00|99|0.00|AEG 5
20|FH_F129487_0_0|SrvcGrp|73000|2022|PDM|2205.00|99|0.00|AEG 6
20|FH_F129487_0_0|SrvcGrp|99073|2022|PDM|1.36|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F129500_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F129509_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F129509_0_0|SrvcGrp|69069|2022|PDM|5125.00|99|0.00|HAPA WPA ASC SURG IN ER SETTING 2012-13
20|FH_F129509_0_0|SrvcGrp|72996|2022|PDM|924.00|99|0.00|AEG 4
20|FH_F129509_0_0|SrvcGrp|73002|2022|PDM|1380.00|99|0.00|AEG 7
20|FH_F129509_0_0|SrvcGrp|77483|2022|PDM|610.00|99|0.00|AETNA OBSERVATION
20|FH_F129509_0_0|SrvcGrp|88065|2022|PDM|6319.00|99|0.00|TOTAL DISC ARTHROPLASTY
20|FH_F129509_0_0|SrvcGrp|88160|2022|PDM|3767.00|99|0.00|LAMINECTOMY W/FACETECTOMY
20|FH_F129509_0_0|SrvcGrp|88493|2022|PDM|5139.00|99|0.00|AETNA VERTEBROPLASTY ADDL INJECT
20|FH_F129509_0_0|SrvcGrp|89856|2022|PDM|5125.00|99|0.00|LAMIN EXCIS EXTRADURAL LUMB
20|FH_F129509_0_0|SrvcGrp|89861|2022|PDM|3767.00|99|0.00|LUMBAR LAMINOTOMY
20|FH_F129509_0_0|SrvcGrp|92408|2022|PDM|2846.00|99|0.00|PERQ VERTEBRAL AUGMENTATION
20|FH_F129509_0_0|SrvcGrp|92416|2022|PDM|3767.00|99|0.00|CERVICAL LAMINOTOMY
20|FH_F129526_0_0|CSTM-ALL|CSTM-00|2020|PDM|819.00|99|0.00|2005 ASPG GROUPER IV
20|FH_F129535_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F129535_0_0|SrvcGrp|75493|2022|PDM|934.00|99|0.00|AEG 8
20|FH_F129535_0_0|SrvcGrp|91989|2022|PDM|550.00|99|0.00|COLONOSCOPY LESION REMOVAL
20|FH_F129536_0_0|CSTM-ALL|CSTM-00|2020|PDM|438.00|99|0.00|AEG 2 (NO REV)
20|FH_F129536_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 6 (NO REV)
20|FH_F129536_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F129536_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F129536_0_0|SrvcGrp|23936|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS
20|FH_F129536_0_0|SrvcGrp|92552|2022|PCT|1.00|99|0.00|AMNIOTIC MEMBRANE
20|FH_F129576_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F129588_0_0|SrvcGrp|87077|2022|PDM|120.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F129596_0_0|SrvcGrp|29930|2022|PDM|400.00|99|0.00|DIALYSIS
20|FH_F129597_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F129597_0_0|SrvcGrp|29155|2022|PDM|100.00|99|0.00|HOSPICE SVCS
20|FH_F129597_0_0|SrvcGrp|82222|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F129638_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS
20|FH_F129638_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F129638_0_0|SrvcGrp|15323|2022|PDM|200.00|99|0.00|ER LEVEL I
20|FH_F129638_0_0|SrvcGrp|15325|2022|PDM|600.00|99|0.00|ER LEVEL III
20|FH_F129638_0_0|SrvcGrp|20260|2022|PDM|1800.00|99|0.00|ER LEVEL V
20|FH_F129638_0_0|SrvcGrp|537|2022|PCT|0.55|99|0.00|OBSERVATION SERVICES
20|FH_F129639_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F129639_0_0|SrvcGrp|87077|2022|PDM|154.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F129644_0_0|SrvcGrp|103550|2022|PDM|400.00|99|0.00|HEMODIALYSIS SVCS
20|FH_F129653_0_0|SrvcGrp|103590|2022|PDM|4000.00|99|0.00|CAROTID ART
20|FH_F129653_0_0|SrvcGrp|103593|2022|PDM|4000.00|99|0.00|XTRNL CAROTID
20|FH_F129653_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F129653_0_0|SrvcGrp|41334|2022|PDM|4000.00|99|0.00|TOTAL KNEE
20|FH_F129653_0_0|SrvcGrp|72994|2022|PDM|1365.00|99|0.00|AEG 3
20|FH_F129653_0_0|SrvcGrp|77021|2022|PDM|4000.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY
20|FH_F129653_0_0|SrvcGrp|90978|2022|PDM|2000.00|99|0.00|INJECTION CERVICAL OR THORACIC TRANSFORAMINAL EPIDURAL
20|FH_F129673_0_0|SrvcGrp|103608|2022|PDM|164.00|99|0.00|SKILLED NURSING
20|FH_F129754_0_0|CSTM-ALL|CSTM-00|2020|PDM|1030.15|99|0.00|2005 ASPG GROUPER VI
20|FH_F129754_0_0|CSTM-ALL|CSTM-00|2020|PDM|1213.48|99|0.00|2005 ASPG GROUPER VIII
20|FH_F129754_0_0|CSTM-ALL|CSTM-00|2020|PDM|1240.92|99|0.00|2005 ASPG GROUPER VII
20|FH_F129754_0_0|SrvcGrp|90318|2022|PCT|1.10|99|0.00|IMPLANTS/PROSTHETICS
20|FH_F129767_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F129793_0_0|CSTM-ALL|CSTM-00|2020|PDM|1413.23|99|0.00|2006 MEDICARE ASPG VIII
20|FH_F129793_0_0|CSTM-ALL|CSTM-00|2020|PDM|625.45|99|0.00|2006 MEDICARE ASPG II
20|FH_F129793_0_0|SrvcGrp|111415|2022|PCT|1.00|99|0.00|SURGICAL SERVICES
20|FH_F129810_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F129888_0_0|CSTM-ALL|CSTM-00|2020|PDM|1520.76|99|0.00|2005 ASPG GROUPER VIII
20|FH_F129892_0_0|CSTM-ALL|CSTM-00|2020|PDM|1305.00|99|0.00|AEG 8 (NO REV)
20|FH_F129892_0_0|CSTM-ALL|CSTM-00|2020|PDM|1331.00|99|0.00|AEG 7 (NO REV)
20|FH_F129892_0_0|CSTM-ALL|CSTM-00|2020|PDM|682.00|99|0.00|AEG 3 (NO REV)
20|FH_F129892_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F129892_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F129892_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F129892_0_0|SrvcGrp|33967|2022|PDM|1495.00|99|0.00|CPT 47562
20|FH_F129892_0_0|SrvcGrp|88610|2022|PDM|1495.00|99|0.00|NASAL ENDOSCOPY
20|FH_F129913_0_0|CSTM-ALL|CSTM-00|2020|PDM|1101.88|99|0.00|2005 ASPG GROUPER X
20|FH_F129913_0_0|CSTM-ALL|CSTM-00|2020|PDM|1444.69|99|0.00|2005 ASPG GROUPER VI
20|FH_F129913_0_0|CSTM-ALL|CSTM-00|2020|PDM|1740.27|99|0.00|2005 ASPG GROUPER VII
20|FH_F129913_0_0|CSTM-ALL|CSTM-00|2020|PDM|582.42|99|0.00|2005 ASPG GROUPER I
20|FH_F129941_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|GENERAL ACUTE CARE
20|FH_F130023_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F130023_0_0|SrvcGrp|111477|2022|PDM|279.00|99|0.00|WOUND CARE (HCFA)
20|FH_F130025_0_0|SrvcGrp|111477|2022|PDM|279.00|99|0.00|WOUND CARE (HCFA)
20|FH_F130025_0_0|SrvcGrp|11283|2022|PDM|580.00|99|0.00|HYPERBARIC CHAMBER
20|FH_F130025_0_0|SrvcGrp|16|2022|PDM|1102.00|99|0.00|ACUTE REHABILITATION
20|FH_F130035_0_0|SrvcGrp|108043|2022|PDM|203.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD
20|FH_F130035_0_0|SrvcGrp|108082|2022|PDM|37.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER
20|FH_F130035_0_0|SrvcGrp|111471|2022|PDM|141.75|99|0.00|HEPATITIS B VACCINE
20|FH_F130035_0_0|SrvcGrp|111472|2022|PDM|15.45|99|0.00|FLUZONE VACCINE
20|FH_F130108_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|ASPG X
20|FH_F130108_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 020-022
20|FH_F130108_0_0|CSTM-ALL|CSTM-00|2020|PDM|3400.00|99|0.00|ASPG VIII
20|FH_F130108_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|ASPG IX
20|FH_F130108_0_0|SrvcGrp|18200|2022|PCT|0.75|99|0.00|MS DRG 026
20|FH_F130108_0_0|SrvcGrp|9510|2022|PDM|575.00|99|0.00|SKILLED NURSING CARE
20|FH_F130108_0_0|SrvcGrp|9936|2022|PCT|0.75|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F130108_0_0|SrvcGrp|9937|2022|PCT|0.75|99|0.00|OCCUPATIONAL THERAPY
20|FH_F130112_0_0|CSTM-ALL|CSTM-00|2020|PDM|1273.00|99|0.00|AEG 10 (NO REV)
20|FH_F130112_0_0|CSTM-ALL|CSTM-00|2020|PDM|1406.00|99|0.00|AEG 6 (NO REV)
20|FH_F130112_0_0|CSTM-ALL|CSTM-00|2020|PDM|1804.00|99|0.00|AEG 4 (NO REV)
20|FH_F130146_0_0|SrvcGrp|107749|2022|PDM|175.00|99|0.00|CAPD/CCPD
20|FH_F130182_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F130182_0_0|CSTM-ALL|CSTM-00|2020|PDM|1040.00|99|0.00|AEG 5  (NO REV)
20|FH_F130182_0_0|CSTM-ALL|CSTM-00|2020|PDM|1410.00|99|0.00|AEG 8 (NO REV)
20|FH_F130182_0_0|CSTM-ALL|CSTM-00|2020|PDM|1446.00|99|0.00|AEG 7 (NO REV)
20|FH_F130182_0_0|CSTM-ALL|CSTM-00|2020|PDM|915.00|99|0.00|AEG 4 (NO REV)
20|FH_F130182_0_0|SrvcGrp|109445|2022|PDM|1457.00|99|0.00|LEFT HRT CATH W/ VENTRCLGRPHY
20|FH_F130182_0_0|SrvcGrp|109446|2022|PDM|1457.00|99|0.00|R&L HRT CATH W/ VENTRICLGRPHY
20|FH_F130182_0_0|SrvcGrp|109448|2022|PDM|1457.00|99|0.00|CORONARY ART/GRFT ANGIO S&I
20|FH_F130182_0_0|SrvcGrp|111515|2022|PDM|79.00|99|0.00|INJECT R VENTR/ATRIAL ANGIO
20|FH_F130182_0_0|SrvcGrp|111517|2022|PDM|79.00|99|0.00|INJECT PULM ART HRT CATH
20|FH_F130182_0_0|SrvcGrp|41334|2022|PDM|8323.00|99|0.00|TOTAL KNEE
20|FH_F130182_0_0|SrvcGrp|88155|2022|PDM|7803.00|99|0.00|REVISE KNEECAP WITH IMPLANT
20|FH_F130182_0_0|SrvcGrp|97741|2022|PDM|8323.00|99|0.00|REVISE KNEE
20|FH_F130302_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F130302_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F130302_0_0|SrvcGrp|73004|2022|PDM|2251.00|99|0.00|AEG 8
20|FH_F130317_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|OP SVCS
20|FH_F130317_0_0|SrvcGrp|473|2022|PDM|1872.63|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F130317_0_0|SrvcGrp|95664|2022|PDM|2276.20|99|0.00|POST- NEONATAL
20|FH_F130328_0_0|SrvcGrp|104228|2022|PDM|194.00|99|0.00|HOSPICE CARE (HCFA)
20|FH_F130328_0_0|SrvcGrp|104229|2022|PDM|194.00|99|0.00|HOSPICE IN HOME (HCFA)
20|FH_F130330_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F130330_0_0|SrvcGrp|82981|2022|PDM|114.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F130331_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F130350_0_0|CSTM-ALL|CSTM-00|2020|PDM|1170.00|99|0.00|AEG 6 (NO REV)
20|FH_F130350_0_0|CSTM-ALL|CSTM-00|2020|PDM|1301.00|99|0.00|AEG 8 (NO REV)
20|FH_F130350_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F130363_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F130468_0_0|CSTM-ALL|CSTM-00|2020|PDM|1980.40|99|0.00|AEG 4 (NO REV)
20|FH_F130468_0_0|CSTM-ALL|CSTM-00|2020|PDM|2221.10|99|0.00|AEG 6 (NO REV)
20|FH_F130468_0_0|CSTM-ALL|CSTM-00|2020|PDM|2390.00|99|0.00|AEG 7 (NO REV)
20|FH_F130468_0_0|CSTM-ALL|CSTM-00|2020|PDM|805.00|99|0.00|AEG 1 (NO REV)
20|FH_F130468_0_0|SrvcGrp|111433|2022|PDM|10503.00|99|0.00|REMOVAL OF HIP PROSTHESIS
20|FH_F130468_0_0|SrvcGrp|27261|2022|PDM|12602.50|99|0.00|CPT 27446
20|FH_F130468_0_0|SrvcGrp|88157|2022|PDM|11776.00|99|0.00|TOTAL HIP ARTHROPLASTY
20|FH_F130468_0_0|SrvcGrp|88220|2022|PDM|2847.40|99|0.00|SHOULDER ARTHROSCOPY/SURGERY
20|FH_F130468_0_0|SrvcGrp|97741|2022|PDM|21005.80|99|0.00|REVISE KNEE
20|FH_F130501_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F130619_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|OP SVCS
20|FH_F130619_0_0|CSTM-ALL|CSTM-00|2020|PDM|2117.00|99|0.00|GENERAL ACUTE CARE
20|FH_F130654_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F130654_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|VASCULAR DIAGNOSTIC STUDIES
20|FH_F130676_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F130676_0_0|SrvcGrp|87536|2022|PCT|0.00|99|0.00|MED REHAB DAY PROGRAM (HALF)
20|FH_F130682_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F130682_0_0|CSTM-ALL|CSTM-00|2020|PDM|1188.00|99|0.00|AEG 5  (NO REV)
20|FH_F130682_0_0|CSTM-ALL|CSTM-00|2020|PDM|2222.00|99|0.00|AEG 9 (NO REV)
20|FH_F130682_0_0|CSTM-ALL|CSTM-00|2020|PDM|552.00|99|0.00|AEG 1 (NO REV)
20|FH_F130682_0_0|CSTM-ALL|CSTM-00|2020|PDM|847.00|99|0.00|AEG 3 (NO REV)
20|FH_F130682_0_0|SrvcGrp|110204|2022|PDM|4980.00|99|0.00|UNLISTED PROC, MIDDLE EAR
20|FH_F130682_0_0|SrvcGrp|111552|2022|PDM|4980.00|99|0.00|REMOVAL OF INTRANASAL LESION
20|FH_F130682_0_0|SrvcGrp|65402|2022|PDM|11184.00|99|0.00|CPT 42145
20|FH_F130682_0_0|SrvcGrp|78097|2022|PDM|6068.00|99|0.00|AETNA NASAL ENDOSCOPY
20|FH_F130682_0_0|SrvcGrp|78098|2022|PDM|4980.00|99|0.00|AETNA REMOVAL OF TONSILS
20|FH_F130682_0_0|SrvcGrp|88823|2022|PDM|4980.00|99|0.00|REPAIR OF EARDRUM
20|FH_F130682_0_0|SrvcGrp|91422|2022|PDM|4980.00|99|0.00|REMOVAL OF ADENOIDS
20|FH_F130682_0_0|SrvcGrp|97480|2022|PDM|3110.00|99|0.00|BASAL/SINUS ENDOSCOPY
20|FH_F130723_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F130723_0_0|CSTM-ALL|CSTM-00|2020|PDM|611.00|99|0.00|AEG 4 (NO REV)
20|FH_F130723_0_0|CSTM-ALL|CSTM-00|2020|PDM|948.00|99|0.00|AEG 8 (NO REV)
20|FH_F130723_0_0|CSTM-ALL|CSTM-00|2020|PDM|964.00|99|0.00|AEG 7 (NO REV)
20|FH_F130747_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F130747_0_0|CSTM-ALL|CSTM-00|2020|PDM|1353.00|99|0.00|AEG 2 (NO REV)
20|FH_F130747_0_0|CSTM-ALL|CSTM-00|2020|PDM|4682.00|99|0.00|AEG 9 (NO REV)
20|FH_F130747_0_0|CSTM-ALL|CSTM-00|2020|PDM|936.00|99|0.00|AEG 1 (NO REV)
20|FH_F130747_0_0|SrvcGrp|100919|2022|PDM|8843.00|99|0.00|SPINE PROSTH DEVICE
20|FH_F130747_0_0|SrvcGrp|103329|2022|PDM|6242.00|99|0.00|INSJ STABLJ DEV W/ DCMPRN
20|FH_F130747_0_0|SrvcGrp|111587|2022|PDM|6763.00|99|0.00|CPTR-ASST DIR MS PX
20|FH_F130747_0_0|SrvcGrp|26275|2022|PDM|5202.00|99|0.00|CPT 29826
20|FH_F130747_0_0|SrvcGrp|27261|2022|PDM|26010.00|99|0.00|CPT 27446
20|FH_F130747_0_0|SrvcGrp|33986|2022|PDM|3121.00|99|0.00|CPT 26055
20|FH_F130747_0_0|SrvcGrp|35672|2022|PDM|6503.00|99|0.00|CPT 23412
20|FH_F130747_0_0|SrvcGrp|41335|2022|PDM|26010.00|99|0.00|TOTAL HIP
20|FH_F130747_0_0|SrvcGrp|54943|2022|PDM|5202.00|99|0.00|REPAIR OF SLAP LESION
20|FH_F130747_0_0|SrvcGrp|55071|2022|PDM|5202.00|99|0.00|ARTHROSCOPY SHOULDER
20|FH_F130747_0_0|SrvcGrp|67065|2022|PDM|20808.00|99|0.00|CERVICAL SURGERY
20|FH_F130747_0_0|SrvcGrp|67069|2022|PDM|36414.00|99|0.00|CPT 22634
20|FH_F130747_0_0|SrvcGrp|75002|2022|PDM|6763.00|99|0.00|ARTHOSCOPY
20|FH_F130747_0_0|SrvcGrp|76602|2022|PDM|4682.00|99|0.00|CPT 25000
20|FH_F130747_0_0|SrvcGrp|76603|2022|PDM|4682.00|99|0.00|CPT 25111
20|FH_F130747_0_0|SrvcGrp|82112|2022|PDM|5202.00|99|0.00|KNEE ARTHROSCOPY SURGERY
20|FH_F130747_0_0|SrvcGrp|84939|2022|PDM|26010.00|99|0.00|SHOULDER JOINT
20|FH_F130747_0_0|SrvcGrp|88156|2022|PDM|26010.00|99|0.00|REVISION OF KNEE JOINT
20|FH_F130747_0_0|SrvcGrp|88158|2022|PDM|14566.00|99|0.00|NECK SPINE DISK SURGERY
20|FH_F130747_0_0|SrvcGrp|88161|2022|PDM|8843.00|99|0.00|LAMINECTOMY W/FACE-THORACIC
20|FH_F130747_0_0|SrvcGrp|88162|2022|PDM|8843.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON
20|FH_F130747_0_0|SrvcGrp|88739|2022|PDM|4682.00|99|0.00|IMPLANT SPINAL CANAL
20|FH_F130747_0_0|SrvcGrp|89980|2022|PDM|6763.00|99|0.00|OPEN TREATMENT OF DISTAL
20|FH_F130747_0_0|SrvcGrp|90063|2022|PDM|5306.00|99|0.00|REPAIR BICEPS TENDON RUPTURE
20|FH_F130747_0_0|SrvcGrp|92013|2022|PDM|5202.00|99|0.00|REPAIR OF COLLATERAL LIGAMENT
20|FH_F130747_0_0|SrvcGrp|92821|2022|PDM|5202.00|99|0.00|HIP ARTHROSCOPY W/ LABRAL REPAIR
20|FH_F130747_0_0|SrvcGrp|93063|2022|PDM|24970.00|99|0.00|LUMBAR ARTIF DISKECTOMY
20|FH_F130747_0_0|SrvcGrp|93069|2022|PDM|8843.00|99|0.00|POSTERIOR NON-SEGMENTAL INST
20|FH_F130747_0_0|SrvcGrp|97741|2022|PDM|26010.00|99|0.00|REVISE KNEE
20|FH_F130747_0_0|SrvcGrp|98498|2022|PDM|8843.00|99|0.00|TRANSPEDICULAR 1 SEG THORACIC
20|FH_F130747_0_0|SrvcGrp|99162|2022|PDM|6242.00|99|0.00|CPT 24366
20|FH_F130747_0_0|SrvcGrp|99167|2022|PDM|8843.00|99|0.00|CPT 63057
20|FH_F130757_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|OP SVCS
20|FH_F130763_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F130763_0_0|CSTM-ALL|CSTM-00|2020|PDM|2420.00|99|0.00|AEG 3 (NO REV)
20|FH_F130763_0_0|CSTM-ALL|CSTM-00|2020|PDM|2744.00|99|0.00|AEG 5  (NO REV)
20|FH_F130763_0_0|CSTM-ALL|CSTM-00|2020|PDM|3137.00|99|0.00|AEG 7 (NO REV)
20|FH_F130763_0_0|CSTM-ALL|CSTM-00|2020|PDM|4169.00|99|0.00|AEG 9 (NO REV)
20|FH_F130763_0_0|SrvcGrp|100045|2022|PDM|3882.00|99|0.00|REVISION OF FOOT TENDON
20|FH_F130763_0_0|SrvcGrp|100920|2022|PDM|6239.00|99|0.00|SPINE PRO DEVICE
20|FH_F130763_0_0|SrvcGrp|104008|2022|PDM|3450.00|99|0.00|CORRECTION HALUX RIDGUS W IMPLANTS
20|FH_F130763_0_0|SrvcGrp|26278|2022|PDM|3450.00|99|0.00|CPT 29881
20|FH_F130763_0_0|SrvcGrp|26279|2022|PDM|3450.00|99|0.00|CPT 29884
20|FH_F130763_0_0|SrvcGrp|27316|2022|PDM|3258.00|99|0.00|TONSILS & ADENOIDS (42820)
20|FH_F130763_0_0|SrvcGrp|33984|2022|PDM|3450.00|99|0.00|HAMMERTOE CORRECTION
20|FH_F130763_0_0|SrvcGrp|34606|2022|PDM|4705.00|99|0.00|CPT 29827
20|FH_F130763_0_0|SrvcGrp|44066|2022|PDM|5823.00|99|0.00|CPT 57288
20|FH_F130763_0_0|SrvcGrp|44067|2022|PDM|4714.00|99|0.00|CPT 52240
20|FH_F130763_0_0|SrvcGrp|54943|2022|PDM|4705.00|99|0.00|REPAIR OF SLAP LESION
20|FH_F130763_0_0|SrvcGrp|59840|2022|PDM|2773.00|99|0.00|TYMPANOSTOMY
20|FH_F130763_0_0|SrvcGrp|65625|2022|PDM|3189.00|99|0.00|CPT 30520
20|FH_F130763_0_0|SrvcGrp|74039|2022|PDM|7319.00|99|0.00|LAMINECTOMY
20|FH_F130763_0_0|SrvcGrp|76604|2022|PDM|3895.00|99|0.00|CPT 25447
20|FH_F130763_0_0|SrvcGrp|77021|2022|PDM|7319.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY
20|FH_F130763_0_0|SrvcGrp|78093|2022|PDM|4714.00|99|0.00|AETNA NASAL ENDOSCOPY SURG
20|FH_F130763_0_0|SrvcGrp|82112|2022|PDM|3450.00|99|0.00|KNEE ARTHROSCOPY SURGERY
20|FH_F130763_0_0|SrvcGrp|83643|2022|PDM|3450.00|99|0.00|CPT 29885
20|FH_F130763_0_0|SrvcGrp|83646|2022|PDM|4367.00|99|0.00|CPT 31276
20|FH_F130763_0_0|SrvcGrp|85792|2022|PDM|5165.00|99|0.00|OPEN TREATMENT OF DISTAL
20|FH_F130763_0_0|SrvcGrp|86233|2022|PDM|11056.00|99|0.00|AETNA RECONSTRUCT ANKLE JOINT
20|FH_F130763_0_0|SrvcGrp|87054|2022|PDM|4714.00|99|0.00|CYSTOSCOPY CHEMODENERVATION
20|FH_F130763_0_0|SrvcGrp|89860|2022|PDM|7319.00|99|0.00|SPINAL DISK SURGERY ADD-ON
20|FH_F130763_0_0|SrvcGrp|93057|2022|PDM|5823.00|99|0.00|SPINAL BONE AUTOGRAFT
20|FH_F130763_0_0|SrvcGrp|96539|2022|PDM|5268.00|99|0.00|REVISION OF ANKLE LIGAMENT
20|FH_F130763_0_0|SrvcGrp|99163|2022|PDM|11056.00|99|0.00|CPT 27703
20|FH_F130770_0_0|CSTM-ALL|CSTM-00|2020|PCT|2.00|99|0.00|HSS ASC
20|FH_F130796_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F130826_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F130826_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|AEG 1 (NO REV)
20|FH_F130826_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|AEG 10 (NO REV)
20|FH_F130826_0_0|CSTM-ALL|CSTM-00|2020|PDM|533.00|99|0.00|AEG 2 (NO REV)
20|FH_F130826_0_0|CSTM-ALL|CSTM-00|2020|PDM|812.00|99|0.00|AEG 5  (NO REV)
20|FH_F130826_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F130826_0_0|SrvcGrp|111630|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F130844_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.53|99|0.00|OP SVCS
20|FH_F130920_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F130923_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F130923_0_0|SrvcGrp|29155|2022|PDM|100.00|99|0.00|HOSPICE SVCS
20|FH_F130923_0_0|SrvcGrp|82222|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F130923_0_0|SrvcGrp|83857|2022|PDM|475.00|99|0.00|IP HOSPICE SVCS
20|FH_F130928_0_0|CSTM-ALL|CSTM-00|2020|PDM|2278.00|99|0.00|GENERAL ACUTE CARE
20|FH_F130941_0_0|CSTM-ALL|CSTM-00|2020|PDM|2072.00|99|0.00|GENERAL ACUTE CARE
20|FH_F130970_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F130970_0_0|SrvcGrp|82981|2022|PDM|90.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F130978_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F130985_0_0|SrvcGrp|11606|2022|PDM|1450.00|99|0.00|ACUTE CARE (MEDICAL & SURGICAL)
20|FH_F130997_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F130997_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F131000_0_0|CSTM-ALL|CSTM-00|2020|PDM|1925.00|99|0.00|AEG 3 (NO REV)
20|FH_F131000_0_0|CSTM-ALL|CSTM-00|2020|PDM|1925.00|99|0.00|AEG 6 (NO REV)
20|FH_F131000_0_0|SrvcGrp|100044|2022|PDM|2971.00|99|0.00|INCISION OF HEEL BONE
20|FH_F131000_0_0|SrvcGrp|100067|2022|PDM|3183.00|99|0.00|ANKLE ARTHROSCOPY SURGERY
20|FH_F131000_0_0|SrvcGrp|106264|2022|PDM|5114.00|99|0.00|NSL/SINS NDSC W/ SINS DILATION
20|FH_F131000_0_0|SrvcGrp|26278|2022|PDM|3343.00|99|0.00|CPT 29881
20|FH_F131000_0_0|SrvcGrp|35668|2022|PDM|3343.00|99|0.00|CPT 29824
20|FH_F131000_0_0|SrvcGrp|36864|2022|PDM|13005.00|99|0.00|COCHLEAR IMPLANTS
20|FH_F131000_0_0|SrvcGrp|39909|2022|PDM|2494.00|99|0.00|PARTIAL MASTECTOMY
20|FH_F131000_0_0|SrvcGrp|41334|2022|PDM|15086.00|99|0.00|TOTAL KNEE
20|FH_F131000_0_0|SrvcGrp|54943|2022|PDM|3608.00|99|0.00|REPAIR OF SLAP LESION
20|FH_F131000_0_0|SrvcGrp|55084|2022|PDM|3096.00|99|0.00|CPT 52648
20|FH_F131000_0_0|SrvcGrp|63463|2022|PDM|3608.00|99|0.00|CPT 52204
20|FH_F131000_0_0|SrvcGrp|67064|2022|PDM|4457.00|99|0.00|MUSCULOSKELETAL SYSTEM
20|FH_F131000_0_0|SrvcGrp|67066|2022|PDM|15494.00|99|0.00|CERVICAL SURGERY
20|FH_F131000_0_0|SrvcGrp|76604|2022|PDM|2971.00|99|0.00|CPT 25447
20|FH_F131000_0_0|SrvcGrp|77021|2022|PDM|6450.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY
20|FH_F131000_0_0|SrvcGrp|77461|2022|PDM|3077.00|99|0.00|CPT 52356
20|FH_F131000_0_0|SrvcGrp|78096|2022|PDM|3608.00|99|0.00|AETNA ARTHROSCOPY BICEPS
20|FH_F131000_0_0|SrvcGrp|82108|2022|PDM|3343.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F131000_0_0|SrvcGrp|82113|2022|PDM|3343.00|99|0.00|KNEE ARTHROSCOPY SURGERY
20|FH_F131000_0_0|SrvcGrp|83839|2022|PDM|5098.00|99|0.00|BREAST RECONSTRUCTION
20|FH_F131000_0_0|SrvcGrp|88162|2022|PDM|6450.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON
20|FH_F131000_0_0|SrvcGrp|88599|2022|PDM|3343.00|99|0.00|ENDOSCOPY MAXILLARY SINUS
20|FH_F131000_0_0|SrvcGrp|88740|2022|PDM|4457.00|99|0.00|SP BONE ALGRFT
20|FH_F131000_0_0|SrvcGrp|89853|2022|PDM|3343.00|99|0.00|NASAL/SINUS ENDOSCOPY-SURG
20|FH_F131000_0_0|SrvcGrp|89860|2022|PDM|6450.00|99|0.00|SPINAL DISK SURGERY ADD-ON
20|FH_F131000_0_0|SrvcGrp|89861|2022|PDM|6155.00|99|0.00|LUMBAR LAMINOTOMY
20|FH_F131000_0_0|SrvcGrp|90418|2022|PDM|3608.00|99|0.00|ENLARGE BREAST WITH IMPLANT
20|FH_F131000_0_0|SrvcGrp|91879|2022|PDM|3096.00|99|0.00|PROSTATE LASER ENUCLEATION
20|FH_F131000_0_0|SrvcGrp|93057|2022|PDM|4457.00|99|0.00|SPINAL BONE AUTOGRAFT
20|FH_F131000_0_0|SrvcGrp|99167|2022|PDM|4994.00|99|0.00|CPT 63057
20|FH_F131087_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F131100_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F131100_0_0|SrvcGrp|111737|2022|PDM|1268.00|99|0.00|DRAIN THIGH/KNEE LESION
20|FH_F131100_0_0|SrvcGrp|35667|2022|PDM|1274.00|99|0.00|CPT 20680
20|FH_F131113_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F131127_0_0|CSTM-ALL|CSTM-00|2020|PDM|1581.00|99|0.00|AEG 2 (NO REV)
20|FH_F131127_0_0|CSTM-ALL|CSTM-00|2020|PDM|2870.00|99|0.00|AEG 5  (NO REV)
20|FH_F131127_0_0|CSTM-ALL|CSTM-00|2020|PDM|3338.00|99|0.00|AEG 6 (NO REV)
20|FH_F131127_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F131127_0_0|SrvcGrp|111745|2022|PCT|0.00|99|0.00|REVISE BREAST RECONSTRUCTION INCIDENTAL
20|FH_F131127_0_0|SrvcGrp|84182|2022|PDM|3060.00|99|0.00|AETNA REMOVAL OF BREAST CAPSULE
20|FH_F131127_0_0|SrvcGrp|86462|2022|PDM|3183.00|99|0.00|AREOLA RECONSTRUCTION
20|FH_F131128_0_0|CSTM-ALL|CSTM-00|2020|PDM|1136.00|99|0.00|AEG 4 (NO REV)
20|FH_F131128_0_0|CSTM-ALL|CSTM-00|2020|PDM|1330.00|99|0.00|AEG 10 (NO REV)
20|FH_F131128_0_0|CSTM-ALL|CSTM-00|2020|PDM|1684.00|99|0.00|AEG 8 (NO REV)
20|FH_F131128_0_0|SrvcGrp|107833|2022|PDM|1546.00|99|0.00|FUSION/GRAFT OF FINGER JOINT
20|FH_F131128_0_0|SrvcGrp|108348|2022|PDM|1273.00|99|0.00|TREAT FRACTURE RADIUS/ULNA
20|FH_F131128_0_0|SrvcGrp|112718|2022|PDM|2334.00|99|0.00|KNEE ARTHROSCOPY / SURGERY
20|FH_F131128_0_0|SrvcGrp|16289|2022|PDM|1311.00|99|0.00|CARPAL TUNNEL RELEASE
20|FH_F131128_0_0|SrvcGrp|73610|2022|PCT|0.00|99|0.00|AETNA IMPLANTS
20|FH_F131128_0_0|SrvcGrp|82881|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBTANCE
20|FH_F131187_0_0|SrvcGrp|108042|2022|PDM|400.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD
20|FH_F131208_0_0|SrvcGrp|106294|2022|PDM|594.00|99|0.00|AMBULANCE SERVICE EMERGENCY TRANSPORT LEVEL 1 (HFCA)
20|FH_F131208_0_0|SrvcGrp|106314|2022|PDM|686.40|99|0.00|ADVANCED LIFE SUPPORT LEVEL 2 (ALS2) (HCFA)
20|FH_F131208_0_0|SrvcGrp|13262|2022|PDM|13.20|99|0.00|GROUND MILEAGE, PER STATUTE MILE
20|FH_F131224_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F131282_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 7 (NO REV)
20|FH_F131282_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 8 (NO REV)
20|FH_F131282_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|AEG 9 (NO REV)
20|FH_F131282_0_0|SrvcGrp|111801|2022|PDM|400.00|99|0.00|TREATMENT OF RETINAL LESION
20|FH_F131282_0_0|SrvcGrp|92542|2022|PDM|817.00|99|0.00|REVISION OF EYELID
20|FH_F131286_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F131286_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F131315_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F131315_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F131315_0_0|SrvcGrp|87077|2022|PDM|148.50|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F131324_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F131324_0_0|CSTM-ALL|CSTM-00|2020|PDM|714.00|99|0.00|AEG 2 (NO REV)
20|FH_F131327_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F131327_0_0|CSTM-ALL|CSTM-00|2020|PDM|6364.00|99|0.00|AEG 7 (NO REV)
20|FH_F131331_0_0|SrvcGrp|104226|2022|PDM|55.66|99|0.00|HOSPICE CARE (HCFA)
20|FH_F131331_0_0|SrvcGrp|104229|2022|PDM|165.42|99|0.00|HOSPICE IN HOME (HCFA)
20|FH_F131331_0_0|SrvcGrp|80317|2022|PDM|190.00|99|0.00|RESPITE CARE
20|FH_F131371_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|AEG 10 (NO REV)
20|FH_F131371_0_0|SrvcGrp|101282|2022|PDM|17000.00|99|0.00|REVISE HIP JOINT COMPONENT
20|FH_F131371_0_0|SrvcGrp|108269|2022|PDM|17000.00|99|0.00|REVISE HIP JOINT COMPONENT
20|FH_F131371_0_0|SrvcGrp|40003|2022|PDM|17000.00|99|0.00|TOTAL KNEE
20|FH_F131371_0_0|SrvcGrp|80139|2022|PDM|31485.00|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F131379_0_0|SrvcGrp|107748|2022|PDM|400.00|99|0.00|HEMODIALYSIS IN CENTER
20|FH_F131412_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F131412_0_0|SrvcGrp|104227|2022|PDM|149.80|99|0.00|RESPITE CARE (HCFA)
20|FH_F131412_0_0|SrvcGrp|104229|2022|PDM|165.42|99|0.00|HOSPICE IN HOME (HCFA)
20|FH_F131412_0_0|SrvcGrp|104230|2022|PDM|165.42|99|0.00|RESPITE CARE (HCFA)
20|FH_F131412_0_0|SrvcGrp|29155|2022|PDM|165.42|99|0.00|HOSPICE SVCS
20|FH_F131412_0_0|SrvcGrp|80918|2022|PDM|149.80|99|0.00|RESPITE CARE
20|FH_F131412_0_0|SrvcGrp|82222|2022|PDM|34.91|99|0.00|HOSPICE CARE
20|FH_F131412_0_0|SrvcGrp|84185|2022|PDM|165.42|99|0.00|RESPITE CARE
20|FH_F131433_0_0|SrvcGrp|87077|2022|PDM|149.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F131464_0_0|SrvcGrp|82981|2022|PDM|125.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F131464_0_0|SrvcGrp|87077|2022|PDM|125.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F131472_0_0|SrvcGrp|82981|2022|PDM|125.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F131472_0_0|SrvcGrp|87077|2022|PDM|125.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F131494_0_0|CSTM-ALL|CSTM-00|2020|PDM|420.00|99|0.00|AEG 7 (NO REV)
20|FH_F131494_0_0|CSTM-ALL|CSTM-00|2020|PDM|526.00|99|0.00|AEG 4 (NO REV)
20|FH_F131494_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F131494_0_0|SrvcGrp|111848|2022|PDM|484.00|99|0.00|REVISION OF CERVIX
20|FH_F131501_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F131501_0_0|SrvcGrp|63297|2022|PDM|100.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F131501_0_0|SrvcGrp|73656|2022|PDM|475.00|99|0.00|AETNA HOSPICE SVCS
20|FH_F131505_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F131505_0_0|CSTM-ALL|CSTM-00|2020|PDM|210.00|99|0.00|AEG 1 (NO REV)
20|FH_F131505_0_0|CSTM-ALL|CSTM-00|2020|PDM|338.00|99|0.00|AEG 2 (NO REV)
20|FH_F131505_0_0|CSTM-ALL|CSTM-00|2020|PDM|420.00|99|0.00|AEG 6 (NO REV)
20|FH_F131505_0_0|CSTM-ALL|CSTM-00|2020|PDM|546.00|99|0.00|AEG 3 (NO REV)
20|FH_F131505_0_0|SrvcGrp|101523|2022|PDM|252.00|99|0.00|CERCLAGE OF CERVIX
20|FH_F131505_0_0|SrvcGrp|89869|2022|PDM|410.00|99|0.00|SPONTANEOUS ABORTION
20|FH_F131529_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F131529_0_0|SrvcGrp|24739|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F131529_0_0|SrvcGrp|73656|2022|PDM|475.00|99|0.00|AETNA HOSPICE SVCS
20|FH_F131529_0_0|SrvcGrp|80317|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F131529_0_0|SrvcGrp|83519|2022|PDM|100.00|99|0.00|HOSPICE CARE (ALL OTHER)
20|FH_F131608_0_0|SrvcGrp|89783|2022|PDM|165.42|99|0.00|RESPITE CARE (HCFA)
20|FH_F131609_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F131613_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F131613_0_0|SrvcGrp|79720|2022|PDM|1250.00|99|0.00|ACUTE REHAB II
20|FH_F131630_0_0|CSTM-ALL|CSTM-00|2020|PDM|2430.00|99|0.00|AEG 6 (NO REV)
20|FH_F131630_0_0|CSTM-ALL|CSTM-00|2020|PDM|2918.00|99|0.00|AEG 7 (NO REV)
20|FH_F131630_0_0|CSTM-ALL|CSTM-00|2020|PDM|3928.00|99|0.00|AEG 9 (NO REV)
20|FH_F131630_0_0|CSTM-ALL|CSTM-00|2020|PDM|884.00|99|0.00|AEG 10 (NO REV)
20|FH_F131630_0_0|SrvcGrp|11673|2022|PDM|2705.00|99|0.00|CPT 29888
20|FH_F131965_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F131982_0_0|SrvcGrp|57966|2022|PDM|556.00|99|0.00|HOSPICE CARE
20|FH_F131996_0_0|CSTM-ALL|CSTM-00|2020|PDM|1079.00|99|0.00|AEG 8 (NO REV)
20|FH_F131996_0_0|CSTM-ALL|CSTM-00|2020|PDM|2884.00|99|0.00|AEG 9 (NO REV)
20|FH_F131996_0_0|CSTM-ALL|CSTM-00|2020|PDM|824.00|99|0.00|AEG 2 (NO REV)
20|FH_F132016_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132032_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F132032_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F132032_0_0|SrvcGrp|82223|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F132073_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132073_0_0|SrvcGrp|57968|2022|PDM|30.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F132080_0_0|SrvcGrp|63297|2022|PDM|169.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F132080_0_0|SrvcGrp|65720|2022|PDM|169.00|99|0.00|RESPITE CARE
20|FH_F132080_0_0|SrvcGrp|83522|2022|PDM|169.00|99|0.00|RESPITE CARE
20|FH_F132080_0_0|SrvcGrp|83857|2022|PDM|675.00|99|0.00|IP HOSPICE SVCS
20|FH_F132080_0_0|SrvcGrp|90707|2022|PDM|169.00|99|0.00|AETNA HOSPICE CARE
20|FH_F132080_0_0|SrvcGrp|94780|2022|PDM|169.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)
20|FH_F132080_0_0|SrvcGrp|97506|2022|PDM|169.00|99|0.00|AETNA HOSPICE ALL OTHER CARE
20|FH_F132092_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F132092_0_0|SrvcGrp|65720|2022|PDM|169.00|99|0.00|RESPITE CARE
20|FH_F132092_0_0|SrvcGrp|80918|2022|PDM|169.00|99|0.00|RESPITE CARE
20|FH_F132092_0_0|SrvcGrp|90707|2022|PDM|169.00|99|0.00|AETNA HOSPICE CARE
20|FH_F132092_0_0|SrvcGrp|95661|2022|PDM|169.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F132092_0_0|SrvcGrp|97704|2022|PDM|169.00|99|0.00|HOSPICE IN HOME (HCFA)
20|FH_F132092_0_0|SrvcGrp|97705|2022|PDM|169.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F132125_0_0|SrvcGrp|473|2022|PDM|850.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F132130_0_0|CSTM-ALL|CSTM-00|2020|PDM|323.00|99|0.00|AEG 1 (NO REV)
20|FH_F132130_0_0|CSTM-ALL|CSTM-00|2020|PDM|494.00|99|0.00|AEG 3 (NO REV)
20|FH_F132130_0_0|CSTM-ALL|CSTM-00|2020|PDM|611.00|99|0.00|AEG 4 (NO REV)
20|FH_F132130_0_0|SrvcGrp|86505|2022|PDM|1500.00|99|0.00|DENTAL SURGERY
20|FH_F132133_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F132133_0_0|CSTM-ALL|CSTM-00|2020|PDM|713.00|99|0.00|AEG 4 (NO REV)
20|FH_F132160_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132160_0_0|CSTM-ALL|CSTM-00|2020|PDM|1499.00|99|0.00|AEG 5  (NO REV)
20|FH_F132160_0_0|CSTM-ALL|CSTM-00|2020|PDM|1916.00|99|0.00|AEG 6 (NO REV)
20|FH_F132160_0_0|SrvcGrp|106235|2022|PDM|6885.00|99|0.00|CYPASS
20|FH_F132160_0_0|SrvcGrp|109764|2022|PDM|4590.00|99|0.00|REPAIR EYELID DEFECT
20|FH_F132160_0_0|SrvcGrp|109766|2022|PDM|2869.00|99|0.00|COVER EYE W/ MEMBRANE
20|FH_F132160_0_0|SrvcGrp|109794|2022|PDM|11475.00|99|0.00|COLLAGEN CROSSLINKING CORNEA
20|FH_F132160_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS
20|FH_F132160_0_0|SrvcGrp|42550|2022|PDM|5738.00|99|0.00|OP SURGERY CPT 66984
20|FH_F132160_0_0|SrvcGrp|42551|2022|PDM|1721.00|99|0.00|OP SURGERY
20|FH_F132160_0_0|SrvcGrp|82570|2022|PDM|4590.00|99|0.00|REVISION EYELID/EXCESS SKIN
20|FH_F132160_0_0|SrvcGrp|92549|2022|PDM|5738.00|99|0.00|REMOVAL OF EYE LESION
20|FH_F132160_0_0|SrvcGrp|95819|2022|PDM|6885.00|99|0.00|GONIOTOMY
20|FH_F132190_0_0|CSTM-ALL|CSTM-00|2020|PDM|1269.00|99|0.00|AEG 8 (NO REV)
20|FH_F132190_0_0|CSTM-ALL|CSTM-00|2020|PDM|1743.00|99|0.00|AEG 9 (NO REV)
20|FH_F132190_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|DEVICE INSERTION
20|FH_F132190_0_0|CSTM-ALL|CSTM-00|2020|PDM|501.00|99|0.00|AEG 1 (NO REV)
20|FH_F132190_0_0|CSTM-ALL|CSTM-00|2020|PDM|876.00|99|0.00|AEG 4 (NO REV)
20|FH_F132190_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F132190_0_0|SrvcGrp|109619|2022|PDM|6000.00|99|0.00|NECK SPINE FUSE & REMOVE BEL C
20|FH_F132190_0_0|SrvcGrp|109620|2022|PDM|2600.00|99|0.00|RELIEVE SPINAL CORD PRESSURE
20|FH_F132190_0_0|SrvcGrp|109622|2022|PDM|6000.00|99|0.00|LUMBAR SPINE FUSION
20|FH_F132190_0_0|SrvcGrp|11043|2022|PDM|2500.00|99|0.00|CARPAL TUNNEL RELEASE
20|FH_F132190_0_0|SrvcGrp|111136|2022|PDM|600.00|99|0.00|PHENYLEPHRINE KETOROLAC INJECTION
20|FH_F132190_0_0|SrvcGrp|13187|2022|PCT|0.00|99|0.00|INTRAOCULAR LENSES
20|FH_F132190_0_0|SrvcGrp|16693|2022|PDM|2500.00|99|0.00|KNEE SCOPE, MENISCECTOMY
20|FH_F132190_0_0|SrvcGrp|80139|2022|PDM|2600.00|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F132190_0_0|SrvcGrp|94565|2022|PDM|2500.00|99|0.00|EXC OF TRIANG FIBROCARTILAGE
20|FH_F132190_0_0|SrvcGrp|96959|2022|PDM|2500.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F132193_0_0|SrvcGrp|101320|2022|PDM|2500.00|99|0.00|PARAVERTEBRAL FACET JOINT NERVE
20|FH_F132193_0_0|SrvcGrp|111966|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F132193_0_0|SrvcGrp|35669|2022|PDM|7500.00|99|0.00|CPT 63650
20|FH_F132199_0_0|CSTM-ALL|CSTM-00|2020|PDM|1392.85|99|0.00|OP SVCS
20|FH_F132212_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132212_0_0|SrvcGrp|83857|2022|PDM|425.00|99|0.00|IP HOSPICE SVCS
20|FH_F132212_0_0|SrvcGrp|89783|2022|PDM|90.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F132212_0_0|SrvcGrp|90707|2022|PDM|90.00|99|0.00|AETNA HOSPICE CARE
20|FH_F132235_0_0|SrvcGrp|65720|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F132235_0_0|SrvcGrp|83857|2022|PDM|475.00|99|0.00|IP HOSPICE SVCS
20|FH_F132247_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F132263_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132263_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F132275_0_0|SrvcGrp|82981|2022|PDM|158.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F132282_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132328_0_0|CSTM-ALL|CSTM-00|2020|PDM|1363.00|99|0.00|AEG 2 (NO REV)
20|FH_F132328_0_0|CSTM-ALL|CSTM-00|2020|PDM|1394.00|99|0.00|AEG 3 (NO REV)
20|FH_F132328_0_0|CSTM-ALL|CSTM-00|2020|PDM|2217.00|99|0.00|AEG 6 (NO REV)
20|FH_F132328_0_0|SrvcGrp|103642|2022|PDM|10862.00|99|0.00|AETNA FEM/POPL REVASE W/ATHER
20|FH_F132328_0_0|SrvcGrp|103646|2022|PDM|10592.00|99|0.00|AETNA TIB/ PER REVASE STENT & ATHER
20|FH_F132328_0_0|SrvcGrp|103834|2022|PDM|1259.00|99|0.00|AETNA REMOVE BLADDER STONE
20|FH_F132328_0_0|SrvcGrp|104170|2022|PDM|2049.00|99|0.00|AETNA ARTHROSCOPY SURGERY
20|FH_F132328_0_0|SrvcGrp|105638|2022|PDM|2143.00|99|0.00|HIP ARTHROSCOPY
20|FH_F132328_0_0|SrvcGrp|107187|2022|PDM|2685.00|99|0.00|REVISE TWO EYE MUSCLES
20|FH_F132328_0_0|SrvcGrp|111951|2022|PDM|2425.00|99|0.00|URINARY PROCEDURES
20|FH_F132328_0_0|SrvcGrp|111957|2022|PDM|5368.00|99|0.00|PERCUTANEOUS INTRADISCAL
20|FH_F132328_0_0|SrvcGrp|111959|2022|PDM|2383.00|99|0.00|ELBOW ARTHROSCOPY
20|FH_F132328_0_0|SrvcGrp|26278|2022|PDM|2195.00|99|0.00|CPT 29881
20|FH_F132328_0_0|SrvcGrp|26279|2022|PDM|2049.00|99|0.00|CPT 29884
20|FH_F132328_0_0|SrvcGrp|27261|2022|PDM|11257.00|99|0.00|CPT 27446
20|FH_F132328_0_0|SrvcGrp|27315|2022|PDM|2876.00|99|0.00|TENDON REPAIR
20|FH_F132328_0_0|SrvcGrp|28547|2022|PDM|4110.00|99|0.00|VITRECTOMY
20|FH_F132328_0_0|SrvcGrp|28548|2022|PDM|4110.00|99|0.00|VITRECTOMY
20|FH_F132328_0_0|SrvcGrp|28550|2022|PDM|4110.00|99|0.00|VITRECTOMY
20|FH_F132328_0_0|SrvcGrp|28551|2022|PDM|4110.00|99|0.00|REPAIR OF COMPLEX RETINAL DETACHMENT
20|FH_F132328_0_0|SrvcGrp|33966|2022|PDM|2049.00|99|0.00|CPT 29866
20|FH_F132328_0_0|SrvcGrp|35672|2022|PDM|2876.00|99|0.00|CPT 23412
20|FH_F132328_0_0|SrvcGrp|37984|2022|PDM|1498.00|99|0.00|LUMBAR INJECTIONS PROCEDURE
20|FH_F132328_0_0|SrvcGrp|38909|2022|PDM|3490.00|99|0.00|CPT 67036 - VITRECTOMY, MECHANICAL
20|FH_F132328_0_0|SrvcGrp|41334|2022|PDM|14566.00|99|0.00|TOTAL KNEE
20|FH_F132328_0_0|SrvcGrp|67066|2022|PDM|14566.00|99|0.00|CERVICAL SURGERY
20|FH_F132328_0_0|SrvcGrp|67073|2022|PDM|5826.00|99|0.00|CPT 22851
20|FH_F132328_0_0|SrvcGrp|67119|2022|PDM|14566.00|99|0.00|ARTHODESIS
20|FH_F132328_0_0|SrvcGrp|70749|2022|PDM|1800.00|99|0.00|CPT 29823
20|FH_F132328_0_0|SrvcGrp|77448|2022|PDM|2425.00|99|0.00|CYSTOSCOPY AND TREATMENT
20|FH_F132328_0_0|SrvcGrp|77582|2022|PDM|7117.00|99|0.00|CPT 31255
20|FH_F132328_0_0|SrvcGrp|79589|2022|PDM|1500.00|99|0.00|UPPER GI
20|FH_F132328_0_0|SrvcGrp|80617|2022|PDM|13245.00|99|0.00|ARTHOPLASTY
20|FH_F132328_0_0|SrvcGrp|83639|2022|PDM|2049.00|99|0.00|CPT 29886
20|FH_F132328_0_0|SrvcGrp|84279|2022|PDM|3839.00|99|0.00|CORNEAL TRANSPLANT
20|FH_F132328_0_0|SrvcGrp|85785|2022|PDM|2049.00|99|0.00|ARTHROSCOPY
20|FH_F132328_0_0|SrvcGrp|87386|2022|PDM|3839.00|99|0.00|AMNIOTIC MEMBRANE TRANSPLANTATION
20|FH_F132328_0_0|SrvcGrp|88154|2022|PDM|4110.00|99|0.00|LASER TREATMENT OLD RETINA
20|FH_F132328_0_0|SrvcGrp|88739|2022|PDM|1706.00|99|0.00|IMPLANT SPINAL CANAL
20|FH_F132328_0_0|SrvcGrp|89848|2022|PDM|14566.00|99|0.00|SPINE FUSION EXTRA SEGMENT
20|FH_F132328_0_0|SrvcGrp|90157|2022|PDM|2562.00|99|0.00|AETNA REMOVAL OF TONSILS
20|FH_F132328_0_0|SrvcGrp|90797|2022|PDM|3974.00|99|0.00|INSERT SPINAL INFUSION DEV16
20|FH_F132328_0_0|SrvcGrp|92365|2022|PDM|11257.00|99|0.00|FUSION OF SACROILIAC JOINT
20|FH_F132328_0_0|SrvcGrp|96819|2022|PDM|1746.00|99|0.00|DESTROY L/S FACET JNT ADDL
20|FH_F132328_0_0|SrvcGrp|97465|2022|PDM|2123.00|99|0.00|REMOVE PROSTATE REGROWTH
20|FH_F132328_0_0|SrvcGrp|99154|2022|PDM|2383.00|99|0.00|ELBOW ARTHROSCOPY/SURGERY
20|FH_F132328_0_0|SrvcGrp|99155|2022|PDM|2049.00|99|0.00|WRST ARTHROS SURG
20|FH_F132328_0_0|SrvcGrp|99174|2022|PDM|2289.00|99|0.00|CPT 30140
20|FH_F132374_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132374_0_0|CSTM-ALL|CSTM-00|2020|PDM|1753.71|99|0.00|AEG 5  (NO REV)
20|FH_F132374_0_0|CSTM-ALL|CSTM-00|2020|PDM|2019.49|99|0.00|AEG 6 (NO REV)
20|FH_F132374_0_0|CSTM-ALL|CSTM-00|2020|PDM|2378.41|99|0.00|AEG 8 (NO REV)
20|FH_F132374_0_0|SrvcGrp|112030|2022|PDM|1395.44|99|0.00|NASAL/SINUS ENDOSCOPY
20|FH_F132374_0_0|SrvcGrp|11663|2022|PCT|1.05|99|0.00|IMPLANTS
20|FH_F132439_0_0|SrvcGrp|22596|2022|PDM|178.17|99|0.00|HOSPICE CARE
20|FH_F132439_0_0|SrvcGrp|90707|2022|PDM|178.17|99|0.00|AETNA HOSPICE CARE
20|FH_F132442_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132487_0_0|SrvcGrp|30609|2022|PDM|23.00|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F132487_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F132501_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132501_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 7 (NO REV)
20|FH_F132501_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 2 (NO REV)
20|FH_F132512_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F132512_0_0|SrvcGrp|73841|2022|PDM|714.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP
20|FH_F132512_0_0|SrvcGrp|89149|2022|PDM|408.00|99|0.00|OP INTENSIVE
20|FH_F132544_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F132544_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F132544_0_0|CSTM-ALL|CSTM-00|2020|PDM|1361.00|99|0.00|AEG 1 (NO REV)
20|FH_F132544_0_0|CSTM-ALL|CSTM-00|2020|PDM|3140.00|99|0.00|AEG 6 (NO REV)
20|FH_F132544_0_0|CSTM-ALL|CSTM-00|2020|PDM|4057.00|99|0.00|AEG 7 (NO REV)
20|FH_F132544_0_0|SrvcGrp|106146|2022|PDM|8007.00|99|0.00|REVERSE HIP JOINT
20|FH_F132544_0_0|SrvcGrp|113576|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F132544_0_0|SrvcGrp|113594|2022|PDM|7850.00|99|0.00|SPINE PROSTH DEVICE
20|FH_F132544_0_0|SrvcGrp|16692|2022|PDM|3523.00|99|0.00|KNEE SCOPE
20|FH_F132544_0_0|SrvcGrp|84442|2022|PDM|8007.00|99|0.00|REVISION KNEE
20|FH_F132544_0_0|SrvcGrp|93741|2022|PDM|8007.00|99|0.00|REVISE SPINE ELECTRODE PERCUTANEOUS ARRAY
20|FH_F132544_0_0|SrvcGrp|96349|2022|PDM|7850.00|99|0.00|NECK SPINE FUSE
20|FH_F132544_0_0|SrvcGrp|96350|2022|PDM|7850.00|99|0.00|SHOULDER JOINT
20|FH_F132544_0_0|SrvcGrp|96353|2022|PDM|8007.00|99|0.00|RECONSTRUCT ANKLE JOINT
20|FH_F132544_0_0|SrvcGrp|97039|2022|PDM|3523.00|99|0.00|KNEE ARTHROSCOPY
20|FH_F132544_0_0|SrvcGrp|97179|2022|PDM|8007.00|99|0.00|DECOMPRESS SPINE CORD ADD-ON
20|FH_F132544_0_0|SrvcGrp|97259|2022|PDM|7850.00|99|0.00|INCISE SPINAL COLUMN NERVES
20|FH_F132544_0_0|SrvcGrp|97279|2022|PDM|7850.00|99|0.00|REMOVE SPINE ELTRD PERQ ARAY
20|FH_F132544_0_0|SrvcGrp|97362|2022|PDM|7850.00|99|0.00|INCISE SPINAL COLUMN NERVES
20|FH_F132545_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|CARDIAC CATHETERIZATION INJECTIONS
20|FH_F132559_0_0|CSTM-ALL|CSTM-00|2020|PDM|1442.00|99|0.00|AEG 3 (NO REV)
20|FH_F132559_0_0|CSTM-ALL|CSTM-00|2020|PDM|1545.00|99|0.00|AEG 5  (NO REV)
20|FH_F132559_0_0|SrvcGrp|106265|2022|PDM|2800.00|99|0.00|NSL/SINS NDSC TOTAL
20|FH_F132559_0_0|SrvcGrp|65625|2022|PDM|1635.00|99|0.00|CPT 30520
20|FH_F132559_0_0|SrvcGrp|88824|2022|PDM|3100.00|99|0.00|CPT 69631
20|FH_F132579_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F132585_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132595_0_0|CSTM-ALL|CSTM-00|2020|PDM|535.00|99|0.00|CD PARTIAL HOSPITALIZATION
20|FH_F132595_0_0|SrvcGrp|108|2022|PCT|0.75|99|0.00|EXTRA CORPOREAL MEMBRANE OXYGEN
20|FH_F132595_0_0|SrvcGrp|16679|2022|PDM|5335.00|99|0.00|LAPAROSCOPIC PROCEDURES
20|FH_F132595_0_0|SrvcGrp|22147|2022|PDM|142.00|99|0.00|PSYCH PARTIAL HOSP (HALF DAY)
20|FH_F132595_0_0|SrvcGrp|361|2022|PDM|2320.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F132606_0_0|CSTM-ALL|CSTM-00|2020|PDM|1321.31|99|0.00|AEG 8 (NO REV)
20|FH_F132606_0_0|CSTM-ALL|CSTM-00|2020|PDM|456.97|99|0.00|AEG 1 (NO REV)
20|FH_F132606_0_0|CSTM-ALL|CSTM-00|2020|PDM|707.47|99|0.00|AEG 3 (NO REV)
20|FH_F132606_0_0|CSTM-ALL|CSTM-00|2020|PDM|988.38|99|0.00|AEG 5  (NO REV)
20|FH_F132606_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F132606_0_0|SrvcGrp|16289|2022|PDM|780.30|99|0.00|CARPAL TUNNEL RELEASE
20|FH_F132606_0_0|SrvcGrp|26275|2022|PDM|1305.00|99|0.00|CPT 29826
20|FH_F132606_0_0|SrvcGrp|26278|2022|PDM|1305.00|99|0.00|CPT 29881
20|FH_F132606_0_0|SrvcGrp|74039|2022|PDM|2809.00|99|0.00|LAMINECTOMY
20|FH_F132606_0_0|SrvcGrp|80617|2022|PDM|3537.36|99|0.00|ARTHOPLASTY
20|FH_F132609_0_0|SrvcGrp|107734|2022|PDM|4090.00|99|0.00|VAGINAL DELIVERY
20|FH_F132609_0_0|SrvcGrp|12280|2022|PCT|0.67|99|0.00|IMPLANTS
20|FH_F132609_0_0|SrvcGrp|361|2022|PDM|1860.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F132609_0_0|SrvcGrp|413|2022|PCT|0.72|99|0.00|TRANSPLANT SVCS
20|FH_F132609_0_0|SrvcGrp|941|2022|PDM|2872.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F132611_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132612_0_0|SrvcGrp|107734|2022|PDM|4090.00|99|0.00|VAGINAL DELIVERY
20|FH_F132612_0_0|SrvcGrp|112077|2022|PDM|49727.00|99|0.00|CV SURGERY
20|FH_F132612_0_0|SrvcGrp|11663|2022|PCT|0.67|99|0.00|IMPLANTS
20|FH_F132612_0_0|SrvcGrp|360|2022|PDM|1520.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F132627_0_0|SrvcGrp|10580|2022|PDM|64.26|99|0.00|HYDRATION THERAPY - 3 LITERS
20|FH_F132627_0_0|SrvcGrp|14945|2022|PDM|18.36|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN
20|FH_F132627_0_0|SrvcGrp|14947|2022|PDM|18.36|99|0.00|HOME INFUSION
20|FH_F132627_0_0|SrvcGrp|14948|2022|PDM|291.00|99|0.00|HOME INFUSION THERAPY
20|FH_F132627_0_0|SrvcGrp|14949|2022|PDM|291.00|99|0.00|HOME INFUSION
20|FH_F132627_0_0|SrvcGrp|17001|2022|PDM|220.00|99|0.00|TOTAL PARENTERAL NUTRITION; ONE LITER PER DAY
20|FH_F132627_0_0|SrvcGrp|17005|2022|PDM|80.58|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 8HRS
20|FH_F132627_0_0|SrvcGrp|17006|2022|PDM|80.58|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 12HRS
20|FH_F132627_0_0|SrvcGrp|17011|2022|PDM|69.36|99|0.00|HOME INFUSION THERAPY
20|FH_F132627_0_0|SrvcGrp|17012|2022|PDM|6.12|99|0.00|HOME INFUSION THERAPY
20|FH_F132627_0_0|SrvcGrp|19742|2022|PDM|153.00|99|0.00|MID-LINE INSERTION
20|FH_F132627_0_0|SrvcGrp|21711|2022|PDM|220.00|99|0.00|TOTAL PARENTERAL NUTRITION; LESS THAN 2 LITERS
20|FH_F132627_0_0|SrvcGrp|22389|2022|PDM|43.86|99|0.00|HORMONAL INJECTION THERAPY
20|FH_F132627_0_0|SrvcGrp|22588|2022|PDM|84.66|99|0.00|CHEMOTHERAPY
20|FH_F132627_0_0|SrvcGrp|23683|2022|PDM|133.00|99|0.00|SKILLED NURSING RN
20|FH_F132627_0_0|SrvcGrp|24752|2022|PDM|43.86|99|0.00|HORMONE INJECTION THERAPY
20|FH_F132627_0_0|SrvcGrp|26868|2022|PDM|18.36|99|0.00|DIURETIC IV THERAPY
20|FH_F132627_0_0|SrvcGrp|26871|2022|PDM|80.58|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 3 HRS
20|FH_F132627_0_0|SrvcGrp|29023|2022|PDM|80.58|99|0.00|HOME INFUSION THERAPY
20|FH_F132627_0_0|SrvcGrp|44428|2022|PDM|144.00|99|0.00|OCCUPATIONAL THERAPY SVCS (VISIT LVL)
20|FH_F132627_0_0|SrvcGrp|81858|2022|PDM|43.86|99|0.00|LPN SERVICES
20|FH_F132672_0_0|CSTM-ALL|CSTM-00|2020|PDM|825.00|99|0.00|AEG 2 (NO REV)
20|FH_F132693_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F132693_0_0|CSTM-ALL|CSTM-00|2020|PDM|1339.00|99|0.00|AEG 9 (NO REV)
20|FH_F132694_0_0|SrvcGrp|11000|2022|PCT|0.49|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F132694_0_0|SrvcGrp|13724|2022|PCT|0.49|99|0.00|PHARMACY SVCS
20|FH_F132720_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.72|99|0.00|OP SVCS
20|FH_F132720_0_0|CSTM-ALL|CSTM-00|2020|PDM|2059.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132720_0_0|SrvcGrp|107733|2022|PDM|6266.00|99|0.00|CESAREAN SECTION
20|FH_F132720_0_0|SrvcGrp|112088|2022|PCT|0.65|99|0.00|CARDIAC ABLATION
20|FH_F132720_0_0|SrvcGrp|40820|2022|PDM|3088.00|99|0.00|ICU/CCU
20|FH_F132721_0_0|CSTM-ALL|CSTM-00|2020|PDM|2059.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132721_0_0|SrvcGrp|3409|2022|PDM|600.00|99|0.00|NEWBORN NURSERY
20|FH_F132721_0_0|SrvcGrp|51672|2022|PDM|7161.00|99|0.00|MS DRG 286-287 ONLY
20|FH_F132728_0_0|CSTM-ALL|CSTM-00|2020|PDM|2059.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132728_0_0|SrvcGrp|40820|2022|PDM|3088.00|99|0.00|ICU/CCU
20|FH_F132732_0_0|CSTM-ALL|CSTM-00|2020|PDM|2199.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132732_0_0|SrvcGrp|112077|2022|PDM|59209.00|99|0.00|CV SURGERY
20|FH_F132732_0_0|SrvcGrp|33793|2022|PDM|6734.00|99|0.00|MSDRG 246-251 ONLY ANGIOPLASTY
20|FH_F132733_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.63|99|0.00|OP SVCS
20|FH_F132733_0_0|CSTM-ALL|CSTM-00|2020|PDM|2306.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132733_0_0|SrvcGrp|112088|2022|PCT|0.65|99|0.00|CARDIAC ABLATION
20|FH_F132733_0_0|SrvcGrp|3409|2022|PDM|595.00|99|0.00|NEWBORN NURSERY
20|FH_F132733_0_0|SrvcGrp|51672|2022|PDM|6804.00|99|0.00|MS DRG 286-287 ONLY
20|FH_F132733_0_0|SrvcGrp|58|2022|PDM|9184.00|99|0.00|IP LITHOTRIPSY SVCS
20|FH_F132733_0_0|SrvcGrp|941|2022|PDM|4250.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F132736_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.63|99|0.00|OP SVCS
20|FH_F132736_0_0|SrvcGrp|112088|2022|PCT|0.65|99|0.00|CARDIAC ABLATION
20|FH_F132736_0_0|SrvcGrp|16|2022|PDM|1611.00|99|0.00|ACUTE REHABILITATION
20|FH_F132737_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.63|99|0.00|OP SVCS
20|FH_F132737_0_0|CSTM-ALL|CSTM-00|2020|PDM|1957.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132738_0_0|SrvcGrp|110|2022|PDM|846.00|99|0.00|CD - REHABILITATION
20|FH_F132739_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.51|99|0.00|OP SVCS
20|FH_F132768_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132772_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F132772_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F132772_0_0|SrvcGrp|112094|2022|PDM|465.00|99|0.00|DIALYSIS ULTRAFILTRATION
20|FH_F132779_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|OP SVCS
20|FH_F132779_0_0|SrvcGrp|38|2022|PDM|4837.00|99|0.00|NORMAL DELIVERY
20|FH_F132779_0_0|SrvcGrp|73602|2022|PDM|517.00|99|0.00|AETNA NEWBORN NURSERY I
20|FH_F132779_0_0|SrvcGrp|87310|2022|PDM|21351.00|99|0.00|MSDRG 273 ONLY
20|FH_F132779_0_0|SrvcGrp|89814|2022|PDM|18890.00|99|0.00|MS DRG 499 ONLY
20|FH_F132779_0_0|SrvcGrp|92622|2022|PDM|36134.00|99|0.00|AORTIC & HEART ASSIST PRECEDURE
20|FH_F132801_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.49|99|0.00|OP SVCS
20|FH_F132809_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F132809_0_0|SrvcGrp|82981|2022|PDM|120.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F132824_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132824_0_0|SrvcGrp|82981|2022|PDM|150.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F132824_0_0|SrvcGrp|87077|2022|PDM|150.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F132827_0_0|SrvcGrp|14494|2022|PDM|15.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F132849_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.66|99|0.00|OP SVCS
20|FH_F132849_0_0|CSTM-ALL|CSTM-00|2020|PDM|1515.00|99|0.00|ACUTE IP MED SVCS
20|FH_F132849_0_0|CSTM-ALL|CSTM-00|2020|PDM|797.00|99|0.00|ADOLESCENT PSYCHIATRIC
20|FH_F132849_0_0|SrvcGrp|3140|2022|PCT|0.63|99|0.00|PHARMACY SERVICES
20|FH_F132849_0_0|SrvcGrp|3493|2022|PCT|0.63|99|0.00|PHARMACY SVCS
20|FH_F132849_0_0|SrvcGrp|3499|2022|PCT|0.63|99|0.00|IMPLANTS
20|FH_F132849_0_0|SrvcGrp|361|2022|PDM|2233.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F132849_0_0|SrvcGrp|38|2022|PDM|3189.00|99|0.00|NORMAL DELIVERY
20|FH_F132849_0_0|SrvcGrp|701|2022|PDM|2233.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F132849_0_0|SrvcGrp|71083|2022|PDM|1275.00|99|0.00|RADIOLOGY SERVICES
20|FH_F132860_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.61|99|0.00|OP SVCS
20|FH_F132860_0_0|SrvcGrp|58|2022|PDM|6760.00|99|0.00|IP LITHOTRIPSY SVCS
20|FH_F132860_0_0|SrvcGrp|701|2022|PDM|2536.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F132860_0_0|SrvcGrp|88|2022|PDM|6760.00|99|0.00|OP LITHOTRIPSY
20|FH_F132878_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|IMPLANTS
20|FH_F132886_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F132886_0_0|SrvcGrp|13262|2022|PDM|10.92|99|0.00|GROUND MILEAGE, PER STATUTE MILE
20|FH_F132915_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 1 (NO REV)
20|FH_F132915_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|AEG 6 (NO REV)
20|FH_F132968_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132968_0_0|SrvcGrp|87077|2022|PDM|120.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F132988_0_0|CSTM-ALL|CSTM-00|2020|PDM|2457.00|99|0.00|AEG 5  (NO REV)
20|FH_F132988_0_0|CSTM-ALL|CSTM-00|2020|PDM|2750.00|99|0.00|AEG 7 (NO REV)
20|FH_F132988_0_0|CSTM-ALL|CSTM-00|2020|PDM|771.00|99|0.00|AEG 1 (NO REV)
20|FH_F132988_0_0|SrvcGrp|100010|2022|PDM|4493.01|99|0.00|KNEE RECONSTRUCTION
20|FH_F132988_0_0|SrvcGrp|100045|2022|PDM|4493.01|99|0.00|REVISION OF FOOT TENDON
20|FH_F132988_0_0|SrvcGrp|100063|2022|PDM|6031.49|99|0.00|REPAIR FOOT DISLOCATION
20|FH_F132988_0_0|SrvcGrp|100066|2022|PDM|4493.01|99|0.00|REPAIR RADIUS FRACTURE
20|FH_F132988_0_0|SrvcGrp|100069|2022|PDM|4493.01|99|0.00|REVISE LOWER LEG TENDON
20|FH_F132988_0_0|SrvcGrp|103568|2022|PDM|2057.62|99|0.00|PARTIAL REMOVAL OF TIBIA
20|FH_F132988_0_0|SrvcGrp|105000|2022|PDM|4493.01|99|0.00|REPAIR OF KNEECAP FRACTURE
20|FH_F132988_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F132988_0_0|SrvcGrp|107008|2022|PDM|4493.01|99|0.00|REMOVAL OF BONE FOR GRAFT
20|FH_F132988_0_0|SrvcGrp|108260|2022|PDM|1154.34|99|0.00|AETNA FIXATION OF KNEE JOINT
20|FH_F132988_0_0|SrvcGrp|111588|2022|PDM|4493.01|99|0.00|REPAIR OF THIGH MUSCLE
20|FH_F132988_0_0|SrvcGrp|112139|2022|PDM|11865.23|99|0.00|REPAIR OF TIBIA FRACTURE
20|FH_F132988_0_0|SrvcGrp|112144|2022|PDM|4493.01|99|0.00|FUSION OF KNUCKLE WITH GRAFT
20|FH_F132988_0_0|SrvcGrp|112150|2022|PDM|895.82|99|0.00|DRAINAGE OF FINGER ABSCESS
20|FH_F132988_0_0|SrvcGrp|112158|2022|PDM|2057.62|99|0.00|EXCISE THIGH TENDON & FASCIA
20|FH_F132988_0_0|SrvcGrp|112169|2022|PDM|4493.01|99|0.00|REPAIR WRIST DISLOCATION
20|FH_F132988_0_0|SrvcGrp|35670|2022|PDM|36969.87|99|0.00|SPINAL NEUROSTIMULATORS PROCEDURE
20|FH_F132988_0_0|SrvcGrp|41335|2022|PDM|17000.00|99|0.00|TOTAL HIP
20|FH_F132988_0_0|SrvcGrp|71666|2022|PDM|27385.00|99|0.00|CPT 63655
20|FH_F132988_0_0|SrvcGrp|87677|2022|PDM|1279.81|99|0.00|CERVICAL OR THORACIC SURGERY
20|FH_F132988_0_0|SrvcGrp|89980|2022|PDM|6410.83|99|0.00|OPEN TREATMENT OF DISTAL
20|FH_F132988_0_0|SrvcGrp|90422|2022|PDM|6088.16|99|0.00|REPAIR GRAFT RADIUS OR ULNA
20|FH_F132988_0_0|SrvcGrp|91567|2022|PDM|4717.66|99|0.00|REPAIR OF KNEECAP TENDON
20|FH_F132988_0_0|SrvcGrp|92197|2022|PDM|6219.68|99|0.00|CORRECTION OF BUNION
20|FH_F132988_0_0|SrvcGrp|92359|2022|PDM|2057.62|99|0.00|REMOVAL OF TAIL BONE
20|FH_F132988_0_0|SrvcGrp|92368|2022|PDM|2057.62|99|0.00|REPAIR OF LEG TENDON
20|FH_F132988_0_0|SrvcGrp|92408|2022|PDM|4493.01|99|0.00|PERQ VERTEBRAL AUGMENTATION
20|FH_F132988_0_0|SrvcGrp|93731|2022|PDM|771.00|99|0.00|INJEC PROC FOR SACROILIAC JOINT
20|FH_F132988_0_0|SrvcGrp|98003|2022|PDM|5929.57|99|0.00|BIMALLEOLAR ANKLE FRACTURE
20|FH_F132988_0_0|SrvcGrp|98347|2022|PDM|4493.01|99|0.00|HIP ARTHROSCOPY / SURGERY
20|FH_F132988_0_0|SrvcGrp|99172|2022|PDM|6468.75|99|0.00|CPT 28740
20|FH_F133002_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F133002_0_0|SrvcGrp|112173|2022|PDM|1716.00|99|0.00|SUBCONJUNCTIVE PLACEMENT
20|FH_F133002_0_0|SrvcGrp|28550|2022|PDM|1716.00|99|0.00|VITRECTOMY
20|FH_F133002_0_0|SrvcGrp|46887|2022|PDM|1716.00|99|0.00|REPAIR DETACHED RETINA
20|FH_F133002_0_0|SrvcGrp|46906|2022|PDM|1716.00|99|0.00|CORNEAL TISSUE
20|FH_F133002_0_0|SrvcGrp|84280|2022|PDM|1716.00|99|0.00|CORNEAL TRANSPLANT
20|FH_F133002_0_0|SrvcGrp|88154|2022|PDM|1716.00|99|0.00|LASER TREATMENT OLD RETINA
20|FH_F133011_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F133011_0_0|CSTM-ALL|CSTM-00|2020|PDM|1848.00|99|0.00|AEG 7 (NO REV)
20|FH_F133011_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|AEG 2 (NO REV)
20|FH_F133011_0_0|CSTM-ALL|CSTM-00|2020|PDM|952.00|99|0.00|AEG 10 (NO REV)
20|FH_F133011_0_0|CSTM-ALL|CSTM-00|2020|PDM|994.00|99|0.00|AEG 4 (NO REV)
20|FH_F133025_0_0|CSTM-ALL|CSTM-00|2020|PDM|1066.00|99|0.00|AEG 6 (NO REV)
20|FH_F133025_0_0|CSTM-ALL|CSTM-00|2020|PDM|1286.00|99|0.00|AEG 7 (NO REV)
20|FH_F133100_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F133100_0_0|CSTM-ALL|CSTM-00|2020|PDM|1180.00|99|0.00|AEG 6 (NO REV)
20|FH_F133100_0_0|CSTM-ALL|CSTM-00|2020|PDM|1420.00|99|0.00|AEG 7 (NO REV)
20|FH_F133100_0_0|CSTM-ALL|CSTM-00|2020|PDM|635.00|99|0.00|AEG 2 (NO REV)
20|FH_F133132_0_0|SrvcGrp|3178|2022|PDM|900.00|99|0.00|ACUTE PSYCH
20|FH_F133140_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F133140_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F133140_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 10 (NO REV)
20|FH_F133140_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 4 (NO REV)
20|FH_F133140_0_0|CSTM-ALL|CSTM-00|2020|PDM|758.00|99|0.00|AEG 6 (NO REV)
20|FH_F133140_0_0|CSTM-ALL|CSTM-00|2020|PDM|820.00|99|0.00|AEG 7 (NO REV)
20|FH_F133155_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F133155_0_0|SrvcGrp|83857|2022|PDM|475.00|99|0.00|IP HOSPICE SVCS
20|FH_F133155_0_0|SrvcGrp|93098|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F133155_0_0|SrvcGrp|97506|2022|PDM|100.00|99|0.00|AETNA HOSPICE ALL OTHER CARE
20|FH_F133178_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F133178_0_0|CSTM-ALL|CSTM-00|2020|PDM|1248.00|99|0.00|AEG 6 (NO REV)
20|FH_F133178_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|AEG 10 (NO REV)
20|FH_F133178_0_0|CSTM-ALL|CSTM-00|2020|PDM|670.00|99|0.00|AEG 3 (NO REV)
20|FH_F133178_0_0|CSTM-ALL|CSTM-00|2020|PDM|831.00|99|0.00|AEG 4 (NO REV)
20|FH_F133178_0_0|SrvcGrp|112205|2022|PDM|586.00|99|0.00|BIOPSY OF PENIS
20|FH_F133207_0_0|CSTM-ALL|CSTM-00|2020|PDM|1904.00|99|0.00|AEG 10 (NO REV)
20|FH_F133207_0_0|CSTM-ALL|CSTM-00|2020|PDM|2241.00|99|0.00|AEG 8 (NO REV)
20|FH_F133207_0_0|CSTM-ALL|CSTM-00|2020|PDM|2353.00|99|0.00|AEG 5  (NO REV)
20|FH_F133207_0_0|CSTM-ALL|CSTM-00|2020|PDM|2688.00|99|0.00|AEG 7 (NO REV)
20|FH_F133207_0_0|CSTM-ALL|CSTM-00|2020|PDM|3331.00|99|0.00|AEG 9 (NO REV)
20|FH_F133207_0_0|SrvcGrp|100044|2022|PDM|3136.00|99|0.00|INCISION OF HEEL BONE
20|FH_F133207_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F133207_0_0|SrvcGrp|106265|2022|PDM|5293.00|99|0.00|NSL/SINS NDSC TOTAL
20|FH_F133207_0_0|SrvcGrp|111602|2022|PDM|2464.00|99|0.00|LARYNGOSCOPY
20|FH_F133207_0_0|SrvcGrp|11673|2022|PDM|6161.00|99|0.00|CPT 29888
20|FH_F133207_0_0|SrvcGrp|26278|2022|PDM|3529.00|99|0.00|CPT 29881
20|FH_F133207_0_0|SrvcGrp|27316|2022|PDM|2632.00|99|0.00|TONSILS & ADENOIDS (42820)
20|FH_F133207_0_0|SrvcGrp|27344|2022|PDM|2632.00|99|0.00|OP SURGERY (CPT 42821)
20|FH_F133207_0_0|SrvcGrp|27402|2022|PDM|3809.00|99|0.00|LASER PROCEDURES
20|FH_F133207_0_0|SrvcGrp|64517|2022|PDM|5600.00|99|0.00|REDUCE MANMMAPLASTY
20|FH_F133207_0_0|SrvcGrp|77582|2022|PDM|3529.00|99|0.00|CPT 31255
20|FH_F133207_0_0|SrvcGrp|78093|2022|PDM|3809.00|99|0.00|AETNA NASAL ENDOSCOPY SURG
20|FH_F133207_0_0|SrvcGrp|79101|2022|PDM|3529.00|99|0.00|AETNA NASAL ENDOSCOPY
20|FH_F133207_0_0|SrvcGrp|82113|2022|PDM|3529.00|99|0.00|KNEE ARTHROSCOPY SURGERY
20|FH_F133207_0_0|SrvcGrp|83839|2022|PDM|5040.00|99|0.00|BREAST RECONSTRUCTION
20|FH_F133207_0_0|SrvcGrp|84180|2022|PDM|3809.00|99|0.00|AETNA DELAYED BREAST PROSTHESIS
20|FH_F133207_0_0|SrvcGrp|84939|2022|PDM|14004.00|99|0.00|SHOULDER JOINT
20|FH_F133207_0_0|SrvcGrp|85778|2022|PDM|3696.00|99|0.00|REPAIR OF ANKLE FRACTURE
20|FH_F133207_0_0|SrvcGrp|87054|2022|PDM|3809.00|99|0.00|CYSTOSCOPY CHEMODENERVATION
20|FH_F133207_0_0|SrvcGrp|90157|2022|PDM|2632.00|99|0.00|AETNA REMOVAL OF TONSILS
20|FH_F133207_0_0|SrvcGrp|99174|2022|PDM|2577.00|99|0.00|CPT 30140
20|FH_F133210_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F133210_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.76|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F133210_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.76|99|0.00|OP SVCS
20|FH_F133211_0_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING
20|FH_F133211_0_0|SrvcGrp|111927|2022|PDM|95.00|99|0.00|COVID-19 NON CDC
20|FH_F133211_0_0|SrvcGrp|112223|2022|PDM|95.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)
20|FH_F133215_0_0|SrvcGrp|83857|2022|PDM|475.00|99|0.00|IP HOSPICE SVCS
20|FH_F133223_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.91|99|0.00|GENERAL ACUTE CARE
20|FH_F133223_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.91|99|0.00|OP SVCS
20|FH_F133223_0_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING
20|FH_F133223_0_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB
20|FH_F133232_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F133403_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F133403_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F133403_0_0|SrvcGrp|87077|2022|PDM|156.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F133474_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F133474_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F133474_0_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING
20|FH_F133474_0_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC
20|FH_F133474_0_0|SrvcGrp|82981|2022|PDM|150.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F133485_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F133492_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F133492_0_0|SrvcGrp|72990|2022|PDM|758.00|99|0.00|AEG 1
20|FH_F133492_0_0|SrvcGrp|72992|2022|PDM|927.00|99|0.00|AEG 2
20|FH_F133492_0_0|SrvcGrp|79584|2022|PDM|1809.00|99|0.00|CPT 45386
20|FH_F133492_0_0|SrvcGrp|84974|2022|PDM|1809.00|99|0.00|CPT 43255
20|FH_F133519_0_0|CSTM-ALL|CSTM-00|2020|PDM|1040.00|99|0.00|AEG 5  (NO REV)
20|FH_F133519_0_0|CSTM-ALL|CSTM-00|2020|PDM|1248.00|99|0.00|AEG 6 (NO REV)
20|FH_F133519_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|AEG 1 (NO REV)
20|FH_F133519_0_0|CSTM-ALL|CSTM-00|2020|PDM|584.00|99|0.00|AEG 2 (NO REV)
20|FH_F133519_0_0|SrvcGrp|112206|2022|PDM|106.00|99|0.00|DESTROY VULVA LESIONS
20|FH_F133519_0_0|SrvcGrp|112207|2022|PDM|832.00|99|0.00|DESTROY VULVA LESIONS
20|FH_F133519_0_0|SrvcGrp|67994|2022|PDM|1255.00|99|0.00|CPT 58120
20|FH_F133529_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F133529_0_0|SrvcGrp|82138|2022|PDM|3786.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F133536_0_0|CSTM-ALL|CSTM-00|2020|PDM|2090.00|99|0.00|AEG 8 (NO REV)
20|FH_F133536_0_0|SrvcGrp|100011|2022|PDM|3145.00|99|0.00|ANKLE ARTHROSCOPY
20|FH_F133536_0_0|SrvcGrp|100661|2022|PDM|3215.00|99|0.00|AETNA OP SURGERY
20|FH_F133536_0_0|SrvcGrp|104739|2022|PDM|3000.00|99|0.00|REPAIR OF  TENDON(S)
20|FH_F133536_0_0|SrvcGrp|26273|2022|PDM|3000.00|99|0.00|CPT 29880
20|FH_F133536_0_0|SrvcGrp|71666|2022|PDM|8250.00|99|0.00|CPT 63655
20|FH_F133536_0_0|SrvcGrp|83642|2022|PDM|2400.00|99|0.00|CPT 29883
20|FH_F133536_0_0|SrvcGrp|98006|2022|PDM|3300.00|99|0.00|PHALANGEAL SHAFT FRACTURE
20|FH_F133536_0_0|SrvcGrp|99154|2022|PDM|2100.00|99|0.00|ELBOW ARTHROSCOPY/SURGERY
20|FH_F133579_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F133579_0_0|CSTM-ALL|CSTM-00|2020|PDM|1373.00|99|0.00|AEG 4 (NO REV)
20|FH_F133579_0_0|CSTM-ALL|CSTM-00|2020|PDM|2213.00|99|0.00|AEG 7 (NO REV)
20|FH_F133579_0_0|SrvcGrp|111966|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F133579_0_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS
20|FH_F133579_0_0|SrvcGrp|38909|2022|PDM|1624.00|99|0.00|CPT 67036 - VITRECTOMY, MECHANICAL
20|FH_F133579_0_0|SrvcGrp|53702|2022|PDM|2551.00|99|0.00|PREP CORNEAL ENDOTHELIAL ALLOGRAFT
20|FH_F133579_0_0|SrvcGrp|84278|2022|PDM|2551.00|99|0.00|CORNEAL TRANSPLANT
20|FH_F133579_0_0|SrvcGrp|93807|2022|PDM|3248.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY
20|FH_F133579_0_0|SrvcGrp|96839|2022|PDM|3248.00|99|0.00|REVISE SPINE ELTRD PLATE
20|FH_F124017_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F124017_0_0|SrvcGrp|64761|2022|PDM|5200.00|99|0.00|DISCECTOMY
20|FH_F124017_0_0|SrvcGrp|73616|2022|PDM|3500.00|99|0.00|AETNA WRIST ENDOSCOPY
20|FH_F124017_0_0|SrvcGrp|96349|2022|PDM|9000.00|99|0.00|NECK SPINE FUSE
20|FH_F124017_0_0|SrvcGrp|97159|2022|PDM|5200.00|99|0.00|TRANSPEDICULAR, 1 SEG, LUMBAR
20|FH_F124017_0_0|SrvcGrp|97179|2022|PDM|5200.00|99|0.00|DECOMPRESS SPINE CORD ADD-ON
20|FH_F124112_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F124180_0_0|SrvcGrp|104719|2022|PDM|2000.00|99|0.00|RELIEVE INNER EYE PRESSURE
20|FH_F124180_0_0|SrvcGrp|106216|2022|PDM|2824.50|99|0.00|CORNEAL TRANSPLANT ENDOTHELIAL
20|FH_F124180_0_0|SrvcGrp|109735|2022|PDM|3450.00|99|0.00|NSL/SINS NDSC TOTAL
20|FH_F124180_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F124180_0_0|SrvcGrp|47544|2022|PDM|2500.00|99|0.00|PERCUTANEOUS IMPLANT OF NEUROSTIMULATOR ELECTRODES
20|FH_F124180_0_0|SrvcGrp|58755|2022|PDM|3000.00|99|0.00|INJECTION PROC FOR JOINT
20|FH_F124180_0_0|SrvcGrp|68048|2022|PDM|6139.50|99|0.00|CPT 64581
20|FH_F124180_0_0|SrvcGrp|68282|2022|PDM|3500.00|99|0.00|CPT 67042
20|FH_F124180_0_0|SrvcGrp|68284|2022|PDM|3500.00|99|0.00|CPT 67113
20|FH_F124180_0_0|SrvcGrp|73006|2022|PDM|2500.00|99|0.00|AEG 9
20|FH_F124180_0_0|SrvcGrp|73008|2022|PDM|1000.00|99|0.00|AEG 10
20|FH_F124180_0_0|SrvcGrp|86037|2022|PDM|6672.50|99|0.00|REVISE CORNEA WITH IMPLANT
20|FH_F124180_0_0|SrvcGrp|91522|2022|PDM|3000.00|99|0.00|NASAL/SINUS ENDOSCOPY
20|FH_F124180_0_0|SrvcGrp|93741|2022|PDM|5929.00|99|0.00|REVISE SPINE ELECTRODE PERCUTANEOUS ARRAY
20|FH_F124219_0_0|SrvcGrp|82981|2022|PDM|150.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F124254_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F124254_0_0|SrvcGrp|82981|2022|PDM|120.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F124262_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F124262_0_0|SrvcGrp|109753|2022|PDM|138.00|99|0.00|PROCTOSIGMOIDOSCOPY DIAGNOSTIC
20|FH_F124369_0_0|CSTM-ALL|CSTM-00|2020|PDM|1815.00|99|0.00|AEG 2 (NO REV)
20|FH_F124369_0_0|CSTM-ALL|CSTM-00|2020|PDM|2911.70|99|0.00|AEG 10 (NO REV)
20|FH_F124369_0_0|CSTM-ALL|CSTM-00|2020|PDM|4087.60|99|0.00|AEG 8 (NO REV)
20|FH_F124369_0_0|CSTM-ALL|CSTM-00|2020|PDM|4958.80|99|0.00|AEG 9 (NO REV)
20|FH_F124369_0_0|SrvcGrp|107983|2022|PDM|11220.00|99|0.00|PART REMOVAL OF ANKLE/HEEL
20|FH_F124369_0_0|SrvcGrp|107988|2022|PDM|3740.00|99|0.00|PARTIAL REMOVAL OF TOE
20|FH_F124369_0_0|SrvcGrp|108095|2022|PDM|1815.00|99|0.00|PARTIAL REMOVAL FOOT FASCIA
20|FH_F124369_0_0|SrvcGrp|109787|2022|PDM|1815.00|99|0.00|EXC FOOT/TOE TUM SC < 1.5 CM
20|FH_F124369_0_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS
20|FH_F124369_0_0|SrvcGrp|41327|2022|PDM|6545.00|99|0.00|OP SURGERY CPT 28308
20|FH_F124369_0_0|SrvcGrp|92366|2022|PDM|13090.00|99|0.00|REPAIR ACHILLES TENDON
20|FH_F124369_0_0|SrvcGrp|96539|2022|PDM|16830.00|99|0.00|REVISION OF ANKLE LIGAMENT
20|FH_F124369_0_0|SrvcGrp|98523|2022|PDM|2750.00|99|0.00|CAPSULOTOMY
20|FH_F124369_0_0|SrvcGrp|99171|2022|PDM|12155.00|99|0.00|CPT 28485
20|FH_F124371_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F124371_0_0|SrvcGrp|13597|2022|PDM|181.13|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT
20|FH_F124371_0_0|SrvcGrp|2067|2022|PDM|588.69|99|0.00|SPECIALTY CARE TRANSPORT
20|FH_F124372_0_0|SrvcGrp|107748|2022|PDM|437.00|99|0.00|HEMODIALYSIS IN CENTER
20|FH_F124372_0_0|SrvcGrp|108043|2022|PDM|164.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD
20|FH_F124388_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F124388_0_0|CSTM-ALL|CSTM-00|2020|PDM|1045.00|99|0.00|AEG 4 (NO REV)
20|FH_F124388_0_0|CSTM-ALL|CSTM-00|2020|PDM|1188.00|99|0.00|AEG 5  (NO REV)
20|FH_F124388_0_0|SrvcGrp|14614|2022|PDM|3875.00|99|0.00|LITHOTRIPSY
20|FH_F124388_0_0|SrvcGrp|27402|2022|PDM|2755.50|99|0.00|LASER PROCEDURES
20|FH_F124388_0_0|SrvcGrp|63469|2022|PDM|1254.00|99|0.00|CPT 55700
20|FH_F124388_0_0|SrvcGrp|77450|2022|PDM|1254.00|99|0.00|CPT 54161
20|FH_F124388_0_0|SrvcGrp|87053|2022|PDM|1870.00|99|0.00|CYSTOSCOPY AND TREATMENT
20|FH_F124388_0_0|SrvcGrp|87055|2022|PDM|1870.00|99|0.00|CYSTOURETHROSCOPY W/STENT INSERTION
20|FH_F124395_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F124407_0_0|CSTM-ALL|CSTM-00|2020|PDM|255.00|99|0.00|AEG 1 (NO REV)
20|FH_F124438_0_0|SrvcGrp|82981|2022|PDM|140.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F124441_0_0|CSTM-ALL|CSTM-00|2020|PDM|1814.50|99|0.00|AEG 4 (NO REV)
20|FH_F124441_0_0|CSTM-ALL|CSTM-00|2020|PDM|3206.25|99|0.00|AEG 7 (NO REV)
20|FH_F124441_0_0|CSTM-ALL|CSTM-00|2020|PDM|4987.50|99|0.00|AEG 9 (NO REV)
20|FH_F124441_0_0|SrvcGrp|35669|2022|PDM|4512.50|99|0.00|CPT 63650
20|FH_F124441_0_0|SrvcGrp|63472|2022|PDM|6650.00|99|0.00|CPT 64581
20|FH_F124441_0_0|SrvcGrp|67065|2022|PDM|11400.00|99|0.00|CERVICAL SURGERY
20|FH_F124441_0_0|SrvcGrp|67066|2022|PDM|8550.00|99|0.00|CERVICAL SURGERY
20|FH_F124441_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F124441_0_0|SrvcGrp|74039|2022|PDM|5700.00|99|0.00|LAMINECTOMY
20|FH_F124441_0_0|SrvcGrp|77461|2022|PDM|2375.00|99|0.00|CPT 52356
20|FH_F124441_0_0|SrvcGrp|88159|2022|PDM|5700.00|99|0.00|LOW BACK DISK SURGERY
20|FH_F124441_0_0|SrvcGrp|88599|2022|PDM|2090.00|99|0.00|ENDOSCOPY MAXILLARY SINUS
20|FH_F124441_0_0|SrvcGrp|89842|2022|PDM|11400.00|99|0.00|LUMBAR
20|FH_F124441_0_0|SrvcGrp|89856|2022|PDM|2850.00|99|0.00|LAMIN EXCIS EXTRADURAL LUMB
20|FH_F124441_0_0|SrvcGrp|90420|2022|PDM|3040.00|99|0.00|REPAIR CLAVICLE FRACTURE
20|FH_F124441_0_0|SrvcGrp|92364|2022|PDM|13300.00|99|0.00|ARTHRODESIS SACROILIAC JOINT
20|FH_F124441_0_0|SrvcGrp|97730|2022|PDM|12825.00|99|0.00|REVERSE HIP JOINT
20|FH_F124441_0_0|SrvcGrp|98497|2022|PDM|9025.00|99|0.00|ARTHRODESIS POSTERIOR TECH
20|FH_F124444_0_0|SrvcGrp|87077|2022|PDM|130.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F124486_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F124486_0_0|CSTM-ALL|CSTM-00|2020|PDM|1339.00|99|0.00|AEG 9 (NO REV)
20|FH_F124505_0_0|SrvcGrp|80542|2022|PDM|813.00|99|0.00|AETNA MEDICARE OUTPATIENT GROUPER 6
20|FH_F133585_0_0|CSTM-ALL|CSTM-00|2020|PDM|1094.00|99|0.00|AEG 6 (NO REV)
20|FH_F133585_0_0|CSTM-ALL|CSTM-00|2020|PDM|1319.00|99|0.00|AEG 7 (NO REV)
20|FH_F133585_0_0|CSTM-ALL|CSTM-00|2020|PDM|1775.00|99|0.00|AEG 9 (NO REV)
20|FH_F133585_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 5  (NO REV)
20|FH_F133585_0_0|SrvcGrp|107544|2022|PDM|8230.00|99|0.00|ILIAC REVASC W/ STENT
20|FH_F133585_0_0|SrvcGrp|107793|2022|PDM|13560.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE
20|FH_F133585_0_0|SrvcGrp|107880|2022|PDM|211.00|99|0.00|BALO ANGIOP CTR DIALYSIS SEG
20|FH_F133585_0_0|SrvcGrp|108077|2022|PDM|3092.00|99|0.00|ARTERIOVENOUS ANASTOMOSIS
20|FH_F133585_0_0|SrvcGrp|109135|2022|PDM|3092.00|99|0.00|AV FISTULA EXCISION
20|FH_F133585_0_0|SrvcGrp|109468|2022|PDM|342.00|99|0.00|INS CATH ABD/L-EXT ART 2ND
20|FH_F133585_0_0|SrvcGrp|112388|2022|PDM|245.00|99|0.00|ARTERY XRAYS ARMS/LEGS (HCFA)
20|FH_F133585_0_0|SrvcGrp|12993|2022|PDM|121.00|99|0.00|ACTIVASE
20|FH_F133585_0_0|SrvcGrp|77278|2022|PDM|1786.00|99|0.00|AETNA REPL TUNNLD CNTRL CVC W/O PORT/PUMP
20|FH_F133585_0_0|SrvcGrp|77290|2022|PDM|424.00|99|0.00|AETNA REMV TUNNLD CVC W/O SUBQ PORT
20|FH_F133585_0_0|SrvcGrp|91577|2022|PDM|14572.00|99|0.00|FEM/POPL REVASC STNT & ATHER
20|FH_F133631_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F133631_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F133631_0_0|SrvcGrp|3499|2022|PCT|1.10|99|0.00|IMPLANTS
20|FH_F133632_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F133632_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 5  (NO REV)
20|FH_F133632_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|AEG 1 (NO REV)
20|FH_F133969_0_0|CSTM-ALL|CSTM-00|2020|PDM|1096.51|99|0.00|AEG 8 (NO REV)
20|FH_F133969_0_0|CSTM-ALL|CSTM-00|2020|PDM|373.88|99|0.00|AEG 1 (NO REV)
20|FH_F133969_0_0|CSTM-ALL|CSTM-00|2020|PDM|805.01|99|0.00|AEG 5  (NO REV)
20|FH_F133969_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F133990_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F133990_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F133990_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F133990_0_0|CSTM-ALL|CSTM-00|2020|PCT|41.00|99|0.00|AEG 1 (NO REV)
20|FH_F133990_0_0|CSTM-ALL|CSTM-00|2020|PCT|41.00|99|0.00|AEG 3 (NO REV)
20|FH_F133990_0_0|CSTM-ALL|CSTM-00|2020|PCT|41.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F134027_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F134027_0_0|CSTM-ALL|CSTM-00|2020|PDM|1024.00|99|0.00|AEG 4 (NO REV)
20|FH_F134027_0_0|CSTM-ALL|CSTM-00|2020|PDM|1173.00|99|0.00|AEG 5  (NO REV)
20|FH_F134027_0_0|CSTM-ALL|CSTM-00|2020|PDM|558.00|99|0.00|AEG 1 (NO REV)
20|FH_F134027_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F134027_0_0|SrvcGrp|99981|2022|PDM|2223.00|99|0.00|LAPAROSCOPY SERVICES
20|FH_F134087_0_0|CSTM-ALL|CSTM-00|2020|PDM|2885.00|99|0.00|AEG 6 (NO REV)
20|FH_F134087_0_0|SrvcGrp|111966|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F134087_0_0|SrvcGrp|11669|2022|PDM|2064.00|99|0.00|OP SURG
20|FH_F134087_0_0|SrvcGrp|11673|2022|PDM|4286.00|99|0.00|CPT 29888
20|FH_F134087_0_0|SrvcGrp|41335|2022|PDM|10455.00|99|0.00|TOTAL HIP
20|FH_F134087_0_0|SrvcGrp|58993|2022|PDM|5410.00|99|0.00|DISKECTOMY
20|FH_F134087_0_0|SrvcGrp|67064|2022|PDM|2195.00|99|0.00|MUSCULOSKELETAL SYSTEM
20|FH_F134087_0_0|SrvcGrp|67069|2022|PDM|6011.00|99|0.00|CPT 22634
20|FH_F134087_0_0|SrvcGrp|67119|2022|PDM|9017.00|99|0.00|ARTHODESIS
20|FH_F134087_0_0|SrvcGrp|67279|2022|PDM|9017.00|99|0.00|CERVICAL SURGERY
20|FH_F134087_0_0|SrvcGrp|74039|2022|PDM|6011.00|99|0.00|LAMINECTOMY
20|FH_F134087_0_0|SrvcGrp|95559|2022|PDM|10455.00|99|0.00|HIP JOINT
20|FH_F134087_0_0|SrvcGrp|97895|2022|PDM|10455.00|99|0.00|REVISE KNEE 2
20|FH_F134192_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F134192_0_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|AEG 10 (NO REV)
20|FH_F134192_0_0|CSTM-ALL|CSTM-00|2020|PDM|2585.00|99|0.00|AEG 7 (NO REV)
20|FH_F134192_0_0|CSTM-ALL|CSTM-00|2020|PDM|2800.00|99|0.00|AEG 8 (NO REV)
20|FH_F134192_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F134192_0_0|SrvcGrp|104098|2022|PDM|4100.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT
20|FH_F134192_0_0|SrvcGrp|106799|2022|PDM|3500.00|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT
20|FH_F134202_0_0|CSTM-ALL|CSTM-00|2020|PDM|1038.45|99|0.00|AEG 5  (NO REV)
20|FH_F134202_0_0|CSTM-ALL|CSTM-00|2020|PDM|584.85|99|0.00|AEG 2 (NO REV)
20|FH_F134202_0_0|SrvcGrp|63466|2022|PDM|842.10|99|0.00|CPT 52005
20|FH_F134202_0_0|SrvcGrp|63472|2022|PDM|4480.39|99|0.00|CPT 64581
20|FH_F134229_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F134270_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F134270_0_0|CSTM-ALL|CSTM-00|2020|PDM|2075.00|99|0.00|AEG 4 (NO REV)
20|FH_F134270_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F134270_0_0|SrvcGrp|111966|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F134270_0_0|SrvcGrp|67065|2022|PDM|18000.00|99|0.00|CERVICAL SURGERY
20|FH_F134270_0_0|SrvcGrp|74585|2022|PCT|0.00|99|0.00|AETNA OP IMPLANTS
20|FH_F134270_0_0|SrvcGrp|89404|2022|PDM|19000.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F134287_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F134287_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.20|99|0.00|OP SVCS
20|FH_F134368_0_0|SrvcGrp|87077|2022|PDM|110.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F134398_0_0|CSTM-ALL|CSTM-00|2020|PDM|530.00|99|0.00|AEG 3 (NO REV)
20|FH_F134398_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F134398_0_0|SrvcGrp|111966|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F134603_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F134603_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F134603_0_0|CSTM-ALL|CSTM-00|2020|PDM|2215.30|99|0.00|AEG 3 (NO REV)
20|FH_F134603_0_0|SrvcGrp|11663|2022|PCT|0.44|99|0.00|IMPLANTS
20|FH_F134603_0_0|SrvcGrp|705|2022|PCT|0.44|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F134603_0_0|SrvcGrp|99073|2022|PDM|1.38|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F134612_0_0|CSTM-ALL|CSTM-00|2020|PDM|579.00|99|0.00|AEG 2 (NO REV)
20|FH_F134612_0_0|SrvcGrp|106798|2022|PDM|4500.00|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT
20|FH_F134612_0_0|SrvcGrp|108114|2022|PDM|2300.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT
20|FH_F134612_0_0|SrvcGrp|108120|2022|PDM|1500.00|99|0.00|REPL TUNNLD CNTRL CVC W/O PORT/PUMP
20|FH_F134612_0_0|SrvcGrp|111994|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES
20|FH_F134651_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE
20|FH_F134654_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F134654_0_0|SrvcGrp|105425|2022|PDM|33.26|99|0.00|AETNA EXPOSURE ADAPTIVE BH TREATMENT 60 MINS
20|FH_F134654_0_0|SrvcGrp|110057|2022|PDM|1.63|99|0.00|BEHAVIOR ID ASSESSMENT 15 MINS
20|FH_F134676_0_0|SrvcGrp|107748|2022|PDM|424.00|99|0.00|HEMODIALYSIS IN CENTER
20|FH_F134676_0_0|SrvcGrp|108043|2022|PDM|164.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD
20|FH_F134707_0_0|CSTM-ALL|CSTM-00|2020|PDM|2016.00|99|0.00|AEG 2 (NO REV)
20|FH_F134707_0_0|CSTM-ALL|CSTM-00|2020|PDM|2663.00|99|0.00|AEG 4 (NO REV)
20|FH_F134707_0_0|CSTM-ALL|CSTM-00|2020|PDM|3604.00|99|0.00|AEG 10 (NO REV)
20|FH_F134707_0_0|SrvcGrp|705|2022|PCT|0.44|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F134707_0_0|SrvcGrp|99073|2022|PDM|1.38|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F134732_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F134732_0_0|CSTM-ALL|CSTM-00|2020|PDM|525.00|99|0.00|AEG 3 (NO REV)
20|FH_F134732_0_0|CSTM-ALL|CSTM-00|2020|PDM|649.00|99|0.00|AEG 4 (NO REV)
20|FH_F134732_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F134732_0_0|SrvcGrp|107878|2022|PDM|2003.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT
20|FH_F134732_0_0|SrvcGrp|109137|2022|PDM|2248.00|99|0.00|AV FISTULA REVISION
20|FH_F134732_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F134738_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F134738_0_0|CSTM-ALL|CSTM-00|2020|PDM|1675.00|99|0.00|AEG 3 (NO REV)
20|FH_F134738_0_0|SrvcGrp|27344|2022|PDM|3000.00|99|0.00|OP SURGERY (CPT 42821)
20|FH_F134738_0_0|SrvcGrp|59840|2022|PDM|2100.00|99|0.00|TYMPANOSTOMY
20|FH_F134738_0_0|SrvcGrp|90157|2022|PDM|2475.00|99|0.00|AETNA REMOVAL OF TONSILS
20|FH_F134797_0_0|SrvcGrp|112679|2022|PDM|1100.00|99|0.00|TRIGGER FINGER RELEASE
20|FH_F134797_0_0|SrvcGrp|112681|2022|PDM|1265.00|99|0.00|HUMERUS AND ELBOW REPAIR
20|FH_F134797_0_0|SrvcGrp|72990|2022|PDM|412.00|99|0.00|AEG 1
20|FH_F134797_0_0|SrvcGrp|72994|2022|PDM|1205.00|99|0.00|AEG 3
20|FH_F134797_0_0|SrvcGrp|73006|2022|PDM|1696.00|99|0.00|AEG 9
20|FH_F134809_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F134809_0_0|SrvcGrp|73485|2022|PDM|787.00|99|0.00|AETNA REHAB
20|FH_F134809_0_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE
20|FH_F134809_0_0|SrvcGrp|87537|2022|PDM|420.00|99|0.00|MED REHAB DAY PROGRAM (FULL)
20|FH_F134813_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS
20|FH_F134819_0_0|CSTM-ALL|CSTM-00|2020|PDM|1704.00|99|0.00|AEG 8 (NO REV)
20|FH_F134819_0_0|CSTM-ALL|CSTM-00|2020|PDM|774.00|99|0.00|AEG 2 (NO REV)
20|FH_F134819_0_0|SrvcGrp|109741|2022|PDM|2128.00|99|0.00|SINUS ENDO W/ BALLOON DILATION
20|FH_F134819_0_0|SrvcGrp|19923|2022|PDM|2241.00|99|0.00|HYSTEROSCOPY
20|FH_F134819_0_0|SrvcGrp|22949|2022|PDM|1773.00|99|0.00|CPT CODE 42825
20|FH_F134819_0_0|SrvcGrp|96979|2022|PDM|2481.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F134847_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F134847_0_0|CSTM-ALL|CSTM-00|2020|PDM|2149.00|99|0.00|AEG 5  (NO REV)
20|FH_F134847_0_0|CSTM-ALL|CSTM-00|2020|PDM|2398.00|99|0.00|AEG 6 (NO REV)
20|FH_F134847_0_0|CSTM-ALL|CSTM-00|2020|PDM|2944.00|99|0.00|AEG 7 (NO REV)
20|FH_F134847_0_0|CSTM-ALL|CSTM-00|2020|PDM|4414.00|99|0.00|AEG 9 W/O SPINE SERVICES (NO REV)
20|FH_F134847_0_0|SrvcGrp|102120|2022|PDM|2270.00|99|0.00|REVISE EYE MUSCLE
20|FH_F134847_0_0|SrvcGrp|112643|2022|PDM|5071.00|99|0.00|SHOULDER PROCEDURES
20|FH_F134847_0_0|SrvcGrp|112644|2022|PDM|4090.00|99|0.00|JOINT ARTHROSCOPY
20|FH_F134847_0_0|SrvcGrp|112646|2022|PDM|1698.00|99|0.00|FEMALE GENITAL PROCEDURES
20|FH_F134847_0_0|SrvcGrp|112647|2022|PDM|2684.00|99|0.00|JOINT ARTHROSCOPY
20|FH_F134847_0_0|SrvcGrp|11673|2022|PDM|5926.00|99|0.00|CPT 29888
20|FH_F134847_0_0|SrvcGrp|28551|2022|PDM|3486.00|99|0.00|REPAIR OF COMPLEX RETINAL DETACHMENT
20|FH_F134847_0_0|SrvcGrp|42472|2022|PDM|3258.00|99|0.00|CPT 58670
20|FH_F134847_0_0|SrvcGrp|44066|2022|PDM|4751.00|99|0.00|CPT 57288
20|FH_F134847_0_0|SrvcGrp|68000|2022|PDM|3054.00|99|0.00|CPT 58561
20|FH_F134847_0_0|SrvcGrp|78285|2022|PDM|3258.00|99|0.00|CPT 58671
20|FH_F134847_0_0|SrvcGrp|88161|2022|PDM|6110.00|99|0.00|LAMINECTOMY W/FACE-THORACIC
20|FH_F134847_0_0|SrvcGrp|88493|2022|PDM|6110.00|99|0.00|AETNA VERTEBROPLASTY ADDL INJECT
20|FH_F134847_0_0|SrvcGrp|92408|2022|PDM|5836.00|99|0.00|PERQ VERTEBRAL AUGMENTATION
20|FH_F134847_0_0|SrvcGrp|93059|2022|PDM|5135.00|99|0.00|SPINAL BONE AUTOGRAFT
20|FH_F134847_0_0|SrvcGrp|99067|2022|PDM|5135.00|99|0.00|SPINE PROSTH DEVICE
20|FH_F134876_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F134895_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F134895_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F134895_0_0|CSTM-ALL|CSTM-00|2020|PDM|425.00|99|0.00|AEG 1 (NO REV)
20|FH_F134895_0_0|CSTM-ALL|CSTM-00|2020|PDM|568.00|99|0.00|AEG 2 (NO REV)
20|FH_F134895_0_0|CSTM-ALL|CSTM-00|2020|PDM|644.00|99|0.00|AEG 4 (NO REV)
20|FH_F134904_0_0|CSTM-ALL|CSTM-00|2020|PDM|599.00|99|0.00|AEG 2 (NO REV)
20|FH_F134904_0_0|CSTM-ALL|CSTM-00|2020|PDM|840.00|99|0.00|AEG 4 (NO REV)
20|FH_F134904_0_0|SrvcGrp|111966|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F134917_0_0|CSTM-ALL|CSTM-00|2020|PDM|2117.50|99|0.00|AEG 10 (NO REV)
20|FH_F134917_0_0|CSTM-ALL|CSTM-00|2020|PDM|2117.50|99|0.00|AEG 5  (NO REV)
20|FH_F134917_0_0|CSTM-ALL|CSTM-00|2020|PDM|3294.50|99|0.00|AEG 8 (NO REV)
20|FH_F134917_0_0|CSTM-ALL|CSTM-00|2020|PDM|434.50|99|0.00|AEG 1 (NO REV)
20|FH_F134918_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE
20|FH_F134918_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS
20|FH_F134928_0_0|SrvcGrp|82037|2022|PDM|2300.00|99|0.00|AETNA ICU
20|FH_F134930_0_0|SrvcGrp|104330|2022|PDM|1200.00|99|0.00|AETNA ACUTE REHAB II
20|FH_F134968_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE
20|FH_F134968_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS
20|FH_F135027_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F135069_0_0|CSTM-ALL|CSTM-00|2020|PDM|315.00|99|0.00|AEG 1 (NO REV)
20|FH_F135069_0_0|CSTM-ALL|CSTM-00|2020|PDM|425.00|99|0.00|AEG 2 (NO REV)
20|FH_F135069_0_0|CSTM-ALL|CSTM-00|2020|PDM|485.00|99|0.00|AEG 3 (NO REV)
20|FH_F135069_0_0|CSTM-ALL|CSTM-00|2020|PDM|645.00|99|0.00|AEG 6 (NO REV)
20|FH_F135069_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 10 (NO REV)
20|FH_F135069_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F135093_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F135093_0_0|SrvcGrp|16|2022|PDM|890.00|99|0.00|ACUTE REHABILITATION
20|FH_F135093_0_0|SrvcGrp|80258|2022|PCT|0.00|99|0.00|AETNA SKILLED CARE
20|FH_F135149_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS
20|FH_F135179_0_0|SrvcGrp|108042|2022|PDM|424.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD
20|FH_F135239_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F135263_0_0|CSTM-ALL|CSTM-00|2020|PDM|1150.00|99|0.00|AEG 7 (NO REV)
20|FH_F135263_0_0|CSTM-ALL|CSTM-00|2020|PDM|755.00|99|0.00|AEG 4 (NO REV)
20|FH_F135263_0_0|CSTM-ALL|CSTM-00|2020|PDM|875.00|99|0.00|AEG 5  (NO REV)
20|FH_F135263_0_0|SrvcGrp|112581|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F135263_0_0|SrvcGrp|112742|2022|PDM|900.00|99|0.00|TOTAL HIP ARTHROPLASTY
20|FH_F135263_0_0|SrvcGrp|11306|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F135315_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F135327_0_0|CSTM-ALL|CSTM-00|2020|PDM|953.00|99|0.00|AEG 10 (NO REV)
20|FH_F135327_0_0|CSTM-ALL|CSTM-00|2020|PDM|953.00|99|0.00|AEG 9 (NO REV)
20|FH_F135351_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F135351_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AEG 1 (NO REV)
20|FH_F135351_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 10 (NO REV)
20|FH_F135351_0_0|SrvcGrp|27330|2022|PDM|809.00|99|0.00|CPT 27096
20|FH_F135351_0_0|SrvcGrp|58638|2022|PDM|2940.00|99|0.00|CPT 63688
20|FH_F135351_0_0|SrvcGrp|67065|2022|PDM|9900.00|99|0.00|CERVICAL SURGERY
20|FH_F135351_0_0|SrvcGrp|78096|2022|PDM|3850.00|99|0.00|AETNA ARTHROSCOPY BICEPS
20|FH_F135351_0_0|SrvcGrp|88487|2022|PDM|3630.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION
20|FH_F135351_0_0|SrvcGrp|92408|2022|PDM|3630.00|99|0.00|PERQ VERTEBRAL AUGMENTATION
20|FH_F135450_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F135450_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F135451_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.20|99|0.00|GENERAL ACUTE CARE
20|FH_F135451_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.20|99|0.00|OP SVCS
20|FH_F135466_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F135491_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F135491_0_0|CSTM-ALL|CSTM-00|2020|PDM|1143.00|99|0.00|AEG 7 (NO REV)
20|FH_F135491_0_0|CSTM-ALL|CSTM-00|2020|PDM|382.00|99|0.00|AEG 1 (NO REV)
20|FH_F135491_0_0|CSTM-ALL|CSTM-00|2020|PDM|605.00|99|0.00|AEG 10 (NO REV)
20|FH_F135491_0_0|CSTM-ALL|CSTM-00|2020|PDM|770.00|99|0.00|AEG 4 (NO REV)
20|FH_F135491_0_0|SrvcGrp|112755|2022|PDM|1980.00|99|0.00|CORNEAL TRANSPLANT ENDOTHELIAL
20|FH_F135491_0_0|SrvcGrp|112756|2022|PDM|892.00|99|0.00|EYELID REVISION
20|FH_F135491_0_0|SrvcGrp|114443|2022|PDM|5236.00|99|0.00|EXTRACAPSULAR CATARACT REMOVAL, INSERT LENS
20|FH_F135491_0_0|SrvcGrp|77507|2022|PCT|1.21|99|0.00|AETNA CORNEAL TISSUE HANDLING
20|FH_F135491_0_0|SrvcGrp|82570|2022|PDM|1980.00|99|0.00|REVISION EYELID/EXCESS SKIN
20|FH_F135491_0_0|SrvcGrp|84280|2022|PDM|1980.00|99|0.00|CORNEAL TRANSPLANT
20|FH_F135491_0_0|SrvcGrp|91759|2022|PCT|1.21|99|0.00|OCULAR IMPLANT
20|FH_F135491_0_0|SrvcGrp|95819|2022|PDM|1956.00|99|0.00|GONIOTOMY
20|FH_F135580_0_0|CSTM-ALL|CSTM-00|2020|PDM|794.00|99|0.00|AEG 6 (NO REV)
20|FH_F135580_0_0|CSTM-ALL|CSTM-00|2020|PDM|934.00|99|0.00|AEG 8 (NO REV)
20|FH_F135649_0_0|CSTM-ALL|CSTM-00|2020|PDM|507.00|99|0.00|AEG 1 (NO REV)
20|FH_F135649_0_0|CSTM-ALL|CSTM-00|2020|PDM|619.00|99|0.00|AEG 2 (NO REV)
20|FH_F135653_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F135653_0_0|CSTM-ALL|CSTM-00|2020|PDM|1179.00|99|0.00|AEG 10 (NO REV)
20|FH_F135653_0_0|CSTM-ALL|CSTM-00|2020|PDM|1686.00|99|0.00|AEG 6 (NO REV)
20|FH_F135653_0_0|SrvcGrp|84442|2022|PDM|14000.00|99|0.00|REVISION KNEE
20|FH_F135653_0_0|SrvcGrp|85198|2022|PDM|7000.00|99|0.00|AETNA KNEE ARTHROSCOPY
20|FH_F135653_0_0|SrvcGrp|96353|2022|PDM|12500.00|99|0.00|RECONSTRUCT ANKLE JOINT
20|FH_F135688_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F135764_0_0|SrvcGrp|73483|2022|PDM|1100.00|99|0.00|AETNA SUBACUTE III
20|FH_F135764_0_0|SrvcGrp|82037|2022|PDM|1350.00|99|0.00|AETNA ICU
20|FH_F135764_0_0|SrvcGrp|93924|2022|PDM|1262.00|99|0.00|AETNA MEDICAL SERVICES
20|FH_F135771_0_0|SrvcGrp|90707|2022|PDM|169.46|99|0.00|AETNA HOSPICE CARE
20|FH_F135771_0_0|SrvcGrp|92502|2022|PDM|654.59|99|0.00|HOSPICE GENERAL IP CARE
20|FH_F135779_0_0|SrvcGrp|73842|2022|PDM|217.00|99|0.00|AETNA INTENSIVE OUTPATIENT
20|FH_F135779_0_0|SrvcGrp|86722|2022|PDM|217.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)
20|FH_F135779_0_0|SrvcGrp|89417|2022|PDM|467.00|99|0.00|PARTIAL HOSPITALIZATION
20|FH_F135840_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F135840_0_0|SrvcGrp|112792|2022|PDM|550.00|99|0.00|BREAST PROCEDURE
20|FH_F135840_0_0|SrvcGrp|112793|2022|PDM|550.00|99|0.00|BREAST PROCEDURE
20|FH_F135840_0_0|SrvcGrp|112794|2022|PDM|550.00|99|0.00|BREAST PROCEDURE
20|FH_F135840_0_0|SrvcGrp|74587|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F135840_0_0|SrvcGrp|75485|2022|PDM|662.00|99|0.00|AEG 4
20|FH_F135840_0_0|SrvcGrp|75493|2022|PDM|1022.00|99|0.00|AEG 8
20|FH_F135840_0_0|SrvcGrp|79588|2022|PDM|550.00|99|0.00|CPT 43235
20|FH_F135840_0_0|SrvcGrp|82307|2022|PDM|550.00|99|0.00|COLORECTAL CANCER SCREENING
20|FH_F135840_0_0|SrvcGrp|84972|2022|PDM|550.00|99|0.00|CPT 43247
20|FH_F135891_0_0|SrvcGrp|30089|2022|PDM|450.00|99|0.00|HEMODIALYSIS SERVICES
20|FH_F135891_0_0|SrvcGrp|73606|2022|PDM|500.00|99|0.00|AETNA SKILLED NURSING CARE
20|FH_F135891_0_0|SrvcGrp|79720|2022|PDM|1000.00|99|0.00|ACUTE REHAB II
20|FH_F135891_0_0|SrvcGrp|90101|2022|PDM|0.10|99|0.00|AETNA MED RECORD COPY
20|FH_F135897_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F135897_0_0|CSTM-ALL|CSTM-00|2020|PDM|1410.00|99|0.00|AEG 8 (NO REV)
20|FH_F135897_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 10 (NO REV)
20|FH_F135897_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F135897_0_0|SrvcGrp|85563|2022|PDM|979.00|99|0.00|INCISION OF EYE
20|FH_F135900_0_0|SrvcGrp|87536|2022|PDM|300.00|99|0.00|MED REHAB DAY PROGRAM (HALF)
20|FH_F135900_0_0|SrvcGrp|87537|2022|PDM|450.00|99|0.00|MED REHAB DAY PROGRAM (FULL)
20|FH_F135930_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F135930_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|RESIDENTIAL TREATMENT PSYCHIATIC OR CD
20|FH_F136002_0_0|SrvcGrp|46605|2022|PDM|81.60|99|0.00|CLINICAL SOCIAL WORKER SERVICES
20|FH_F136002_0_0|SrvcGrp|88621|2022|PDM|86.70|99|0.00|SKILLED NURSING LPN
20|FH_F136037_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F136037_0_0|SrvcGrp|46903|2022|PDM|655.00|99|0.00|RESIDENTIAL TREATMENT
20|FH_F136037_0_0|SrvcGrp|73842|2022|PDM|233.00|99|0.00|AETNA INTENSIVE OUTPATIENT
20|FH_F136037_0_0|SrvcGrp|86723|2022|PDM|416.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)
20|FH_F136092_0_0|SrvcGrp|65720|2022|PDM|105.00|99|0.00|RESPITE CARE
20|FH_F136092_0_0|SrvcGrp|80918|2022|PDM|105.00|99|0.00|RESPITE CARE
20|FH_F136092_0_0|SrvcGrp|83521|2022|PDM|105.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F136092_0_0|SrvcGrp|83522|2022|PDM|105.00|99|0.00|RESPITE CARE
20|FH_F136092_0_0|SrvcGrp|93098|2022|PDM|105.00|99|0.00|HOSPICE CARE
20|FH_F136132_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F136189_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F136195_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F136195_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F136195_0_0|SrvcGrp|82981|2022|PDM|120.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F136207_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F136207_0_0|SrvcGrp|30089|2022|PDM|450.00|99|0.00|HEMODIALYSIS SERVICES
20|FH_F136207_0_0|SrvcGrp|73483|2022|PDM|850.00|99|0.00|AETNA SUBACUTE III
20|FH_F136207_0_0|SrvcGrp|73601|2022|PDM|1850.00|99|0.00|AETNA INTERMEDIATE ICU/CCU
20|FH_F136276_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F136276_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F136318_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F136318_0_0|SrvcGrp|108484|2022|PDM|796.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY
20|FH_F136318_0_0|SrvcGrp|87317|2022|PDM|1103.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)
20|FH_F136327_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F136327_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F136327_0_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F136330_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F136330_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F136330_0_0|SrvcGrp|11442|2022|PDM|780.00|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)
20|FH_F136353_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F136353_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F136355_0_0|SrvcGrp|87077|2022|PDM|155.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F136359_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F136359_0_0|CSTM-ALL|CSTM-00|2020|PDM|1450.00|99|0.00|AEG 1 (NO REV)
20|FH_F136359_0_0|CSTM-ALL|CSTM-00|2020|PDM|1975.00|99|0.00|AEG 10 (NO REV)
20|FH_F136359_0_0|CSTM-ALL|CSTM-00|2020|PDM|2925.00|99|0.00|AEG 8 (NO REV)
20|FH_F136359_0_0|SrvcGrp|100080|2022|PDM|4920.00|99|0.00|UNLISTED PROC FOOT OR TOES
20|FH_F136359_0_0|SrvcGrp|107187|2022|PDM|3120.00|99|0.00|REVISE TWO EYE MUSCLES
20|FH_F136359_0_0|SrvcGrp|112581|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F136359_0_0|SrvcGrp|112854|2022|PDM|8890.00|99|0.00|NECK SPINE DISK SURGERY
20|FH_F136359_0_0|SrvcGrp|112856|2022|PDM|3475.00|99|0.00|ANKLE / HEEL SERVICES
20|FH_F136359_0_0|SrvcGrp|112858|2022|PDM|11680.00|99|0.00|PROCEDURES OF FOOT BONES
20|FH_F136359_0_0|SrvcGrp|112861|2022|PDM|2375.00|99|0.00|INCISION OF SPINAL NERVE
20|FH_F136359_0_0|SrvcGrp|27315|2022|PDM|5980.00|99|0.00|TENDON REPAIR
20|FH_F136359_0_0|SrvcGrp|28549|2022|PDM|4400.00|99|0.00|VITRECTOMY
20|FH_F136359_0_0|SrvcGrp|36865|2022|PDM|6275.00|99|0.00|NUCLEOPLASTY
20|FH_F136359_0_0|SrvcGrp|65403|2022|PDM|2625.00|99|0.00|CPT 42830
20|FH_F136359_0_0|SrvcGrp|71666|2022|PDM|8500.00|99|0.00|CPT 63655
20|FH_F136359_0_0|SrvcGrp|74039|2022|PDM|6315.00|99|0.00|LAMINECTOMY
20|FH_F136376_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F136376_0_0|SrvcGrp|73842|2022|PDM|205.00|99|0.00|AETNA INTENSIVE OUTPATIENT
20|FH_F136382_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F136382_0_0|CSTM-ALL|CSTM-00|2020|PDM|1150.00|99|0.00|AEG 5  (NO REV)
20|FH_F136382_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|AEG 1 (NO REV)
20|FH_F136382_0_0|SrvcGrp|104719|2022|PDM|2214.00|99|0.00|RELIEVE INNER EYE PRESSURE
20|FH_F136382_0_0|SrvcGrp|112581|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F136393_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 2 (NO REV)
20|FH_F136393_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 6 (NO REV)
20|FH_F136393_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|AEG 8 (NO REV)
20|FH_F136393_0_0|SrvcGrp|112878|2022|PDM|3200.00|99|0.00|INSERT 1 ELECTRODE PM DEFIB
20|FH_F136393_0_0|SrvcGrp|112880|2022|PDM|3200.00|99|0.00|REMOVE AND REPLACE PM GEN SINGL
20|FH_F136393_0_0|SrvcGrp|91577|2022|PDM|12000.00|99|0.00|FEM/POPL REVASC STNT & ATHER
20|FH_F136395_0_0|CSTM-ALL|CSTM-00|2020|PDM|2400.00|99|0.00|AEG 5  (NO REV)
20|FH_F136395_0_0|SrvcGrp|112581|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F136395_0_0|SrvcGrp|112862|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F136407_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F136407_0_0|CSTM-ALL|CSTM-00|2020|PDM|3520.00|99|0.00|AEG 6 (NO REV)
20|FH_F136407_0_0|SrvcGrp|59841|2022|PDM|2310.00|99|0.00|SUBMUCOUS RESECTION
20|FH_F136410_0_0|CSTM-ALL|CSTM-00|2020|PDM|1273.00|99|0.00|AEG 1 (NO REV)
20|FH_F136429_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F136429_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|AEG 4 (NO REV)
20|FH_F136429_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|AEG 6 (NO REV)
20|FH_F136429_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|AEG 9 (NO REV)
20|FH_F136429_0_0|CSTM-ALL|CSTM-00|2020|PDM|625.00|99|0.00|AEG 2 (NO REV)
20|FH_F136429_0_0|SrvcGrp|79590|2022|PDM|679.00|99|0.00|CPT 43248
20|FH_F136467_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F136467_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F136467_0_0|CSTM-ALL|CSTM-00|2020|PDM|1425.00|99|0.00|AEG 3 (NO REV) W/O MUSCULOSKELETAL SERVICES
20|FH_F136467_0_0|CSTM-ALL|CSTM-00|2020|PDM|1625.00|99|0.00|AEG 10 (NO REV)
20|FH_F136467_0_0|CSTM-ALL|CSTM-00|2020|PDM|1815.00|99|0.00|AEG 5  (NO REV) W/O MUSCULOSKELETAL SERVICES
20|FH_F136467_0_0|CSTM-ALL|CSTM-00|2020|PDM|2197.00|99|0.00|AEG 8 (NO REV)
20|FH_F136467_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F136467_0_0|SrvcGrp|111966|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F136467_0_0|SrvcGrp|11673|2022|PDM|3246.00|99|0.00|CPT 29888
20|FH_F136467_0_0|SrvcGrp|58671|2022|PDM|866.00|99|0.00|ASC CARVE OUT 64721
20|FH_F136467_0_0|SrvcGrp|76604|2022|PDM|1939.00|99|0.00|CPT 25447
20|FH_F136473_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F136473_0_0|CSTM-ALL|CSTM-00|2020|PDM|1185.00|99|0.00|AEG 5  (NO REV)
20|FH_F136473_0_0|CSTM-ALL|CSTM-00|2020|PDM|1475.00|99|0.00|AEG 7 (NO REV)
20|FH_F136473_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 1 (NO REV)
20|FH_F136473_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 2 (NO REV)
20|FH_F136473_0_0|SrvcGrp|112581|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F136485_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS
20|FH_F136490_0_0|CSTM-ALL|CSTM-00|2020|PDM|1130.00|99|0.00|AEG 6 (NO REV)
20|FH_F136490_0_0|CSTM-ALL|CSTM-00|2020|PDM|1360.00|99|0.00|AEG 7 (NO REV)
20|FH_F136490_0_0|CSTM-ALL|CSTM-00|2020|PDM|860.00|99|0.00|AEG 10 (NO REV)
20|FH_F136490_0_0|SrvcGrp|93759|2022|PCT|0.00|99|0.00|CARDIAC CATH
20|FH_F136493_0_0|SrvcGrp|80918|2022|PDM|190.00|99|0.00|RESPITE CARE
20|FH_F136507_0_0|SrvcGrp|83522|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F136510_0_0|CSTM-ALL|CSTM-00|2020|PDM|1971.00|99|0.00|AEG 6 (NO REV)
20|FH_F136510_0_0|CSTM-ALL|CSTM-00|2020|PDM|2406.00|99|0.00|AEG 7 (NO REV)
20|FH_F136510_0_0|SrvcGrp|104358|2022|PDM|2886.00|99|0.00|CONJUNCTIVOPLASTY
20|FH_F136510_0_0|SrvcGrp|110827|2022|PDM|3882.00|99|0.00|REPAIR OF EYE WOUND
20|FH_F136510_0_0|SrvcGrp|46906|2022|PDM|3882.00|99|0.00|CORNEAL TISSUE
20|FH_F136510_0_0|SrvcGrp|82570|2022|PDM|1733.00|99|0.00|REVISION EYELID/EXCESS SKIN
20|FH_F136510_0_0|SrvcGrp|84123|2022|PDM|5480.00|99|0.00|INSERT ANT SEGMENT DRAIN EXT
20|FH_F136510_0_0|SrvcGrp|84278|2022|PDM|3882.00|99|0.00|CORNEAL TRANSPLANT
20|FH_F136510_0_0|SrvcGrp|88154|2022|PDM|3882.00|99|0.00|LASER TREATMENT OLD RETINA
20|FH_F136510_0_0|SrvcGrp|95819|2022|PDM|3881.00|99|0.00|GONIOTOMY
20|FH_F136541_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.94|99|0.00|OP SVCS
20|FH_F136547_0_0|SrvcGrp|79720|2022|PDM|1014.00|99|0.00|ACUTE REHAB II
20|FH_F136571_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F136591_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|OP SVCS
20|FH_F136591_0_0|SrvcGrp|11258|2022|PCT|0.50|99|0.00|DRUGS
20|FH_F136591_0_0|SrvcGrp|3157|2022|PDM|1076.34|99|0.00|ACUTE REHABILITATION
20|FH_F136592_0_0|CSTM-ALL|CSTM-00|2020|PDM|1248.00|99|0.00|AEG 8 (NO REV)
20|FH_F136592_0_0|SrvcGrp|107878|2022|PDM|1990.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT
20|FH_F136592_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F136606_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F136606_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F136654_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|AEG 4 (NO REV)
20|FH_F136654_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|AEG 6 (NO REV)
20|FH_F136677_0_0|CSTM-ALL|CSTM-00|2020|PDM|1586.00|99|0.00|AEG 9 (NO REV)
20|FH_F136677_0_0|CSTM-ALL|CSTM-00|2020|PDM|387.00|99|0.00|AEG 1 (NO REV)
20|FH_F136677_0_0|CSTM-ALL|CSTM-00|2020|PDM|592.00|99|0.00|AEG 3 (NO REV)
20|FH_F136677_0_0|CSTM-ALL|CSTM-00|2020|PDM|731.00|99|0.00|AEG 10 (NO REV)
20|FH_F136684_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F136684_0_0|CSTM-ALL|CSTM-00|2020|PDM|1077.00|99|0.00|AEG 8 (NO REV)
20|FH_F136684_0_0|CSTM-ALL|CSTM-00|2020|PDM|1086.00|99|0.00|AEG 7 (NO REV)
20|FH_F136684_0_0|SrvcGrp|112364|2022|PDM|69.36|99|0.00|BEVACIZUMAB INJECTION
20|FH_F136684_0_0|SrvcGrp|112918|2022|PCT|1.00|99|0.00|POSTERIOR CHAMBER INTRAOCULA
20|FH_F136728_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F136728_0_0|SrvcGrp|82981|2022|PDM|195.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F136735_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F136735_0_0|CSTM-ALL|CSTM-00|2020|PDM|1379.00|99|0.00|AEG 6 (NO REV)
20|FH_F136735_0_0|CSTM-ALL|CSTM-00|2020|PDM|1457.00|99|0.00|AEG 3 (NO REV)
20|FH_F136735_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|DEVICE INSERTION
20|FH_F136735_0_0|SrvcGrp|77507|2022|PCT|1.00|99|0.00|AETNA CORNEAL TISSUE HANDLING
20|FH_F136735_0_0|SrvcGrp|78046|2022|PCT|1.00|99|0.00|AETNA AQUEOUS SHUNT
20|FH_F136751_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F136751_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|AEG 1 (NO REV)
20|FH_F136751_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|AEG 4 (NO REV)
20|FH_F124505_0_0|SrvcGrp|80543|2022|PDM|968.00|99|0.00|AETNA MEDICARE OUTPATIENT GROUPER 7
20|FH_F124505_0_0|SrvcGrp|80544|2022|PDM|956.00|99|0.00|AETNA MEDICARE OUTPATIENT GROUPER 8
20|FH_F124505_0_0|SrvcGrp|99073|2022|PDM|1.32|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F124542_0_0|SrvcGrp|80538|2022|PDM|434.00|99|0.00|AETNA MEDICARE OUTPATIENT GROUPER 2
20|FH_F124542_0_0|SrvcGrp|80539|2022|PDM|496.00|99|0.00|AETNA MEDICARE OUTPATIENT GROUPER 3
20|FH_F124542_0_0|SrvcGrp|80540|2022|PDM|612.00|99|0.00|AETNA MEDICARE OUTPATIENT GROUPER 4
20|FH_F124542_0_0|SrvcGrp|80543|2022|PDM|968.00|99|0.00|AETNA MEDICARE OUTPATIENT GROUPER 7
20|FH_F124608_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F124608_0_0|CSTM-ALL|CSTM-00|2020|PDM|1523.00|99|0.00|AEG 8 (NO REV)
20|FH_F124608_0_0|CSTM-ALL|CSTM-00|2020|PDM|2216.00|99|0.00|AEG 7 (NO REV)
20|FH_F124608_0_0|CSTM-ALL|CSTM-00|2020|PDM|714.00|99|0.00|AEG 1 (NO REV)
20|FH_F124608_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|AEG 2 (NO REV)
20|FH_F124608_0_0|SrvcGrp|100919|2022|PDM|8160.00|99|0.00|SPINE PROSTH DEVICE
20|FH_F124608_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F124608_0_0|SrvcGrp|109911|2022|PDM|6630.00|99|0.00|WRIST REPLACEMENT
20|FH_F124608_0_0|SrvcGrp|27261|2022|PDM|7344.00|99|0.00|CPT 27446
20|FH_F124608_0_0|SrvcGrp|33967|2022|PDM|3138.00|99|0.00|CPT 47562
20|FH_F124608_0_0|SrvcGrp|34606|2022|PDM|4284.00|99|0.00|CPT 29827
20|FH_F124608_0_0|SrvcGrp|47142|2022|PDM|3138.00|99|0.00|CPT 49650
20|FH_F124608_0_0|SrvcGrp|67065|2022|PDM|5916.00|99|0.00|CERVICAL SURGERY
20|FH_F124608_0_0|SrvcGrp|77021|2022|PDM|5865.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY
20|FH_F124608_0_0|SrvcGrp|82107|2022|PDM|2550.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F124608_0_0|SrvcGrp|89857|2022|PDM|6452.00|99|0.00|REMOVAL OF SPINAL LAMINA
20|FH_F124660_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F124660_0_0|SrvcGrp|72996|2022|PDM|744.00|99|0.00|AEG 4
20|FH_F124660_0_0|SrvcGrp|73006|2022|PDM|1575.00|99|0.00|AEG 9
20|FH_F124711_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 9 (NO REV)
20|FH_F124711_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 4 (NO REV)
20|FH_F124711_0_0|CSTM-ALL|CSTM-00|2020|PDM|645.00|99|0.00|AEG 6 (NO REV)
20|FH_F124711_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 10 (NO REV)
20|FH_F124711_0_0|CSTM-ALL|CSTM-00|2020|PDM|934.00|99|0.00|AEG 8 (NO REV)
20|FH_F124727_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F124727_0_0|SrvcGrp|108041|2022|PDM|425.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME
20|FH_F124738_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F124738_0_0|SrvcGrp|72994|2022|PDM|500.00|99|0.00|AEG 3
20|FH_F124738_0_0|SrvcGrp|73000|2022|PDM|820.00|99|0.00|AEG 6
20|FH_F124738_0_0|SrvcGrp|73004|2022|PDM|960.00|99|0.00|AEG 8
20|FH_F124743_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F124743_0_0|SrvcGrp|82223|2022|PDM|125.00|99|0.00|HOSPICE CARE
20|FH_F124743_0_0|SrvcGrp|84185|2022|PDM|125.00|99|0.00|RESPITE CARE
20|FH_F124785_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F124788_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F124788_0_0|SrvcGrp|72990|2022|PDM|333.00|99|0.00|AEG 1
20|FH_F124788_0_0|SrvcGrp|72998|2022|PDM|717.00|99|0.00|AEG 5
20|FH_F124788_0_0|SrvcGrp|73008|2022|PDM|333.00|99|0.00|AEG 10
20|FH_F124854_0_0|SrvcGrp|80920|2022|PDM|475.00|99|0.00|HOSPICE SERVICES
20|FH_F124903_0_0|SrvcGrp|82981|2022|PDM|90.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F124917_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F124926_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F124926_0_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F124927_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F124927_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 5  (NO REV)
20|FH_F124927_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 6 (NO REV)
20|FH_F124927_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 7 (NO REV)
20|FH_F124927_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 2 (NO REV)
20|FH_F124927_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 10 (NO REV)
20|FH_F124927_0_0|SrvcGrp|108935|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F124927_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F124965_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F124965_0_0|SrvcGrp|72992|2022|PDM|760.00|99|0.00|AEG 2
20|FH_F124965_0_0|SrvcGrp|72998|2022|PDM|1300.00|99|0.00|AEG 5
20|FH_F124965_0_0|SrvcGrp|73002|2022|PDM|1500.00|99|0.00|AEG 7
20|FH_F124976_0_0|SrvcGrp|12659|2022|PDM|651.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT
20|FH_F124976_0_0|SrvcGrp|73841|2022|PDM|531.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP
20|FH_F124976_0_0|SrvcGrp|89149|2022|PDM|247.00|99|0.00|OP INTENSIVE
20|FH_F124976_0_0|SrvcGrp|89337|2022|PDM|998.00|99|0.00|DETOXIFICATION
20|FH_F125020_0_0|CSTM-ALL|CSTM-00|2020|PCT|40.00|99|0.00|OP SVCS
20|FH_F125053_0_0|SrvcGrp|72990|2022|PDM|360.00|99|0.00|AEG 1
20|FH_F125053_0_0|SrvcGrp|73008|2022|PDM|360.00|99|0.00|AEG 10
20|FH_F125053_0_0|SrvcGrp|78286|2022|PDM|8280.00|99|0.00|CPT 49322
20|FH_F125053_0_0|SrvcGrp|79589|2022|PDM|1923.00|99|0.00|UPPER GI
20|FH_F125053_0_0|SrvcGrp|79594|2022|PDM|2259.00|99|0.00|CPT 45380
20|FH_F125053_0_0|SrvcGrp|79595|2022|PDM|2535.00|99|0.00|CPT 45385
20|FH_F125053_0_0|SrvcGrp|85000|2022|PDM|2410.50|99|0.00|CPT 45384
20|FH_F125069_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F125069_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F125069_0_0|SrvcGrp|72992|2022|PDM|912.00|99|0.00|AEG 2
20|FH_F125103_0_0|SrvcGrp|103621|2022|PDM|215.00|99|0.00|AETNA DIALYSIS
20|FH_F125103_0_0|SrvcGrp|28786|2022|PDM|550.00|99|0.00|CPT CODE 90937
20|FH_F125110_0_0|CSTM-ALL|CSTM-00|2020|PDM|1466.00|99|0.00|AEG 8 (NO REV)
20|FH_F125110_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 7 (NO REV)
20|FH_F125110_0_0|CSTM-ALL|CSTM-00|2020|PDM|673.00|99|0.00|AEG 2 (NO REV)
20|FH_F136751_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|AEG 8 (NO REV)
20|FH_F136751_0_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|AEG 7 (NO REV)
20|FH_F136751_0_0|SrvcGrp|11306|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F136751_0_0|SrvcGrp|26278|2022|PDM|4600.00|99|0.00|CPT 29881
20|FH_F136751_0_0|SrvcGrp|33967|2022|PDM|5200.00|99|0.00|CPT 47562
20|FH_F136751_0_0|SrvcGrp|72121|2022|PDM|7500.00|99|0.00|ARTHOSCOPY
20|FH_F136751_0_0|SrvcGrp|78096|2022|PDM|7500.00|99|0.00|AETNA ARTHROSCOPY BICEPS
20|FH_F136751_0_0|SrvcGrp|84939|2022|PDM|16000.00|99|0.00|SHOULDER JOINT
20|FH_F136751_0_0|SrvcGrp|88159|2022|PDM|9500.00|99|0.00|LOW BACK DISK SURGERY
20|FH_F136751_0_0|SrvcGrp|92364|2022|PDM|16000.00|99|0.00|ARTHRODESIS SACROILIAC JOINT
20|FH_F136751_0_0|SrvcGrp|97730|2022|PDM|20500.00|99|0.00|REVERSE HIP JOINT
20|FH_F136751_0_0|SrvcGrp|97895|2022|PDM|20500.00|99|0.00|REVISE KNEE 2
20|FH_F136752_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|AEG 2 (NO REV)
20|FH_F136756_0_0|SrvcGrp|112965|2022|PDM|1980.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F136756_0_0|SrvcGrp|72994|2022|PDM|772.20|99|0.00|AEG 3
20|FH_F136756_0_0|SrvcGrp|72998|2022|PDM|1043.90|99|0.00|AEG 5
20|FH_F136756_0_0|SrvcGrp|73000|2022|PDM|1170.40|99|0.00|AEG 6
20|FH_F136779_0_0|CSTM-ALL|CSTM-00|2020|PDM|1714.00|99|0.00|AEG 8 (NO REV)
20|FH_F136779_0_0|CSTM-ALL|CSTM-00|2020|PDM|1732.00|99|0.00|AEG 7 (NO REV)
20|FH_F136779_0_0|CSTM-ALL|CSTM-00|2020|PDM|1747.00|99|0.00|AEG 9 (NO REV)
20|FH_F136779_0_0|CSTM-ALL|CSTM-00|2020|PDM|580.00|99|0.00|AEG 1 (NO REV)
20|FH_F136779_0_0|CSTM-ALL|CSTM-00|2020|PDM|856.00|99|0.00|AEG 3 (NO REV)
20|FH_F136779_0_0|SrvcGrp|104021|2022|PDM|2652.00|99|0.00|CYSTOSCOPY PROSTATIC IMP 1-3
20|FH_F136779_0_0|SrvcGrp|112920|2022|PDM|2154.00|99|0.00|SHOULDER ARTHOSCOPY PROCEDURES
20|FH_F136779_0_0|SrvcGrp|112921|2022|PDM|2154.00|99|0.00|SHOULDER ANDOSCOPY PROCEDURES
20|FH_F136779_0_0|SrvcGrp|112924|2022|PDM|3546.00|99|0.00|IMPLNT SPINAL CANAL CATH
20|FH_F136779_0_0|SrvcGrp|112925|2022|PDM|5909.00|99|0.00|NECK SPINE DISK SURGERY
20|FH_F136779_0_0|SrvcGrp|112928|2022|PDM|7725.00|99|0.00|ILIAC REVASC W/STENT
20|FH_F136779_0_0|SrvcGrp|112930|2022|PDM|8606.00|99|0.00|NECK AND SPINE FUSION
20|FH_F136779_0_0|SrvcGrp|19921|2022|PDM|2732.00|99|0.00|ARTHROSCOPICALLY LIGAMENT REPAIR
20|FH_F136779_0_0|SrvcGrp|44461|2022|PDM|4593.00|99|0.00|INSERTION / REPLACEMENT OF SPINAL NEUROSTIMULATOR GENERATOR
20|FH_F136779_0_0|SrvcGrp|91522|2022|PDM|1380.00|99|0.00|NASAL/SINUS ENDOSCOPY
20|FH_F136779_0_0|SrvcGrp|99073|2022|PDM|1.35|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F136780_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F136780_0_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F136790_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F136790_0_0|SrvcGrp|12043|2022|PDM|1187.00|99|0.00|CPT 99205
20|FH_F136790_0_0|SrvcGrp|13631|2022|PDM|154.00|99|0.00|CPT 99213
20|FH_F136790_0_0|SrvcGrp|13632|2022|PDM|1187.00|99|0.00|CPT 99215
20|FH_F136793_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F136793_0_0|CSTM-ALL|CSTM-00|2020|PDM|1124.00|99|0.00|AEG 8 (NO REV)
20|FH_F136793_0_0|CSTM-ALL|CSTM-00|2020|PDM|1151.00|99|0.00|AEG 7 (NO REV)
20|FH_F136793_0_0|CSTM-ALL|CSTM-00|2020|PDM|1547.00|99|0.00|AEG 9 (NO REV)
20|FH_F136793_0_0|CSTM-ALL|CSTM-00|2020|PDM|743.00|99|0.00|AEG 4 (NO REV)
20|FH_F136793_0_0|CSTM-ALL|CSTM-00|2020|PDM|955.00|99|0.00|AEG 6 (NO REV)
20|FH_F136793_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F136806_0_0|CSTM-ALL|CSTM-00|2020|PDM|1248.00|99|0.00|AEG 5  (NO REV)
20|FH_F136806_0_0|CSTM-ALL|CSTM-00|2020|PDM|1747.00|99|0.00|AEG 9 (NO REV)
20|FH_F136806_0_0|CSTM-ALL|CSTM-00|2020|PDM|776.00|99|0.00|AEG 2 (NO REV)
20|FH_F136806_0_0|CSTM-ALL|CSTM-00|2020|PDM|856.00|99|0.00|AEG 3 (NO REV)
20|FH_F136806_0_0|CSTM-ALL|CSTM-00|2020|PDM|869.00|99|0.00|AEG 10 (NO REV)
20|FH_F136806_0_0|SrvcGrp|104448|2022|PDM|3713.00|99|0.00|CYSTOSCOPY IMPLANT 4 OR MORE
20|FH_F136806_0_0|SrvcGrp|105490|2022|PDM|2154.00|99|0.00|KNEE ARTHROSCOPY PROCEDURES
20|FH_F136806_0_0|SrvcGrp|112953|2022|PDM|10300.00|99|0.00|INSRT PULSE GEN W/ DUAL LEADS
20|FH_F136806_0_0|SrvcGrp|14614|2022|PDM|3787.00|99|0.00|LITHOTRIPSY
20|FH_F136806_0_0|SrvcGrp|27315|2022|PDM|3463.00|99|0.00|TENDON REPAIR
20|FH_F136806_0_0|SrvcGrp|59841|2022|PDM|1340.00|99|0.00|SUBMUCOUS RESECTION
20|FH_F136812_0_0|SrvcGrp|107749|2022|PDM|175.00|99|0.00|CAPD/CCPD
20|FH_F136818_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F136818_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 5  (NO REV)
20|FH_F136818_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 7 (NO REV)
20|FH_F136818_0_0|CSTM-ALL|CSTM-00|2020|PDM|788.00|99|0.00|AEG 3 (NO REV)
20|FH_F136818_0_0|SrvcGrp|101845|2022|PDM|3200.00|99|0.00|OPEN TREATMENT OF DISTAL RADIAL 3 OR MORE FRAGMENTS
20|FH_F136818_0_0|SrvcGrp|112862|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F136818_0_0|SrvcGrp|112935|2022|PDM|10000.00|99|0.00|KNEES, HIP & JOINT RECONSTRUCTION
20|FH_F136832_0_0|SrvcGrp|110585|2022|PCT|0.00|99|0.00|ACUTE REHABILITATION I
20|FH_F136832_0_0|SrvcGrp|73559|2022|PDM|1818.00|99|0.00|AETNA INTENSIVE CARE
20|FH_F136832_0_0|SrvcGrp|78579|2022|PDM|1616.00|99|0.00|AETNA ACUTE IP MEDICAL SVCS
20|FH_F136887_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F136887_0_0|CSTM-ALL|CSTM-00|2020|PDM|2360.00|99|0.00|AEG 4 (NO REV)
20|FH_F136947_0_0|SrvcGrp|100961|2022|PDM|1000.00|99|0.00|AMB SRVC NEONAT TRNSPRT BS RATE EMERG 1 WAY
20|FH_F136947_0_0|SrvcGrp|106291|2022|PDM|400.00|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT LEVEL 1 (HCFA)
20|FH_F136947_0_0|SrvcGrp|106300|2022|PDM|450.00|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT (HCFA)
20|FH_F136947_0_0|SrvcGrp|107353|2022|PDM|1000.00|99|0.00|AMB SRVC NEONAT TRNSPRT BS RATE EMERG 1 WAY (HCFA)
20|FH_F136947_0_0|SrvcGrp|13683|2022|PDM|700.00|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2
20|FH_F136987_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F136987_0_0|SrvcGrp|78579|2022|PDM|1616.00|99|0.00|AETNA ACUTE IP MEDICAL SVCS
20|FH_F137067_0_0|CSTM-ALL|CSTM-00|2020|PDM|1092.00|99|0.00|AEG 10 (NO REV)
20|FH_F137067_0_0|CSTM-ALL|CSTM-00|2020|PDM|773.00|99|0.00|AEG 2 (NO REV)
20|FH_F137067_0_0|SrvcGrp|100011|2022|PDM|6884.00|99|0.00|ANKLE ARTHROSCOPY
20|FH_F137067_0_0|SrvcGrp|103585|2022|PDM|3150.00|99|0.00|REMOVE SPINE ELTRD PLATE
20|FH_F137067_0_0|SrvcGrp|109966|2022|PDM|5250.00|99|0.00|DECOMPRESS SPINE CORD ADD-ON
20|FH_F137067_0_0|SrvcGrp|11673|2022|PDM|9975.00|99|0.00|CPT 29888
20|FH_F137067_0_0|SrvcGrp|27261|2022|PDM|21000.00|99|0.00|CPT 27446
20|FH_F137067_0_0|SrvcGrp|67065|2022|PDM|16800.00|99|0.00|CERVICAL SURGERY
20|FH_F137067_0_0|SrvcGrp|74039|2022|PDM|6983.00|99|0.00|LAMINECTOMY
20|FH_F137067_0_0|SrvcGrp|88160|2022|PDM|5250.00|99|0.00|LAMINECTOMY W/FACETECTOMY
20|FH_F137067_0_0|SrvcGrp|88161|2022|PDM|5250.00|99|0.00|LAMINECTOMY W/FACE-THORACIC
20|FH_F137067_0_0|SrvcGrp|88163|2022|PDM|21000.00|99|0.00|LUMBAR SPINE FUSION
20|FH_F137067_0_0|SrvcGrp|88600|2022|PDM|2625.00|99|0.00|WRIST ARTHROS DIAG W/WO BIO
20|FH_F137067_0_0|SrvcGrp|92408|2022|PDM|6300.00|99|0.00|PERQ VERTEBRAL AUGMENTATION
20|FH_F137067_0_0|SrvcGrp|93063|2022|PDM|18900.00|99|0.00|LUMBAR ARTIF DISKECTOMY
20|FH_F137067_0_0|SrvcGrp|98267|2022|PDM|21000.00|99|0.00|REVISION OF KNEE JOINT
20|FH_F137067_0_0|SrvcGrp|99167|2022|PDM|5250.00|99|0.00|CPT 63057
20|FH_F137087_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 2 (NO REV)
20|FH_F137087_0_0|CSTM-ALL|CSTM-00|2020|PDM|3750.00|99|0.00|AEG 5  (NO REV)
20|FH_F137087_0_0|SrvcGrp|71666|2022|PDM|10765.00|99|0.00|CPT 63655
20|FH_F137239_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F137239_0_0|SrvcGrp|86722|2022|PDM|235.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)
20|FH_F137239_0_0|SrvcGrp|86723|2022|PDM|451.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)
20|FH_F137239_0_0|SrvcGrp|89149|2022|PDM|235.00|99|0.00|OP INTENSIVE
20|FH_F137243_0_0|SrvcGrp|82981|2022|PDM|100.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F137248_0_0|CSTM-ALL|CSTM-00|2020|PDM|1196.00|99|0.00|AEG 1 (NO REV)
20|FH_F137248_0_0|CSTM-ALL|CSTM-00|2020|PDM|2040.00|99|0.00|AEG 3 (NO REV)
20|FH_F137248_0_0|CSTM-ALL|CSTM-00|2020|PDM|2550.00|99|0.00|AEG 4 (NO REV)
20|FH_F137248_0_0|CSTM-ALL|CSTM-00|2020|PDM|3017.00|99|0.00|AEG 8 (NO REV)
20|FH_F137248_0_0|CSTM-ALL|CSTM-00|2020|PDM|841.50|99|0.00|AEG 10 (NO REV)
20|FH_F137248_0_0|SrvcGrp|104747|2022|PDM|4058.00|99|0.00|INCISION OF HEEL BONE
20|FH_F137248_0_0|SrvcGrp|11043|2022|PDM|1977.00|99|0.00|CARPAL TUNNEL RELEASE
20|FH_F137248_0_0|SrvcGrp|113065|2022|PDM|3978.00|99|0.00|REVISION OF FOOT TENDON
20|FH_F137248_0_0|SrvcGrp|19921|2022|PDM|3978.00|99|0.00|ARTHROSCOPICALLY LIGAMENT REPAIR
20|FH_F137248_0_0|SrvcGrp|64761|2022|PDM|4058.00|99|0.00|DISCECTOMY
20|FH_F137248_0_0|SrvcGrp|96919|2022|PDM|3978.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F137287_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F137287_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F137288_0_0|SrvcGrp|113071|2022|PDM|600.00|99|0.00|FULL DAY OP THERAPY
20|FH_F137288_0_0|SrvcGrp|113072|2022|PDM|300.00|99|0.00|HALF DAY OP THERAPY
20|FH_F137310_0_0|SrvcGrp|98062|2022|PDM|432.00|99|0.00|HOSPICE INPATIENT RESPITE CARE PER DIEM
20|FH_F137353_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F137362_0_0|SrvcGrp|81023|2022|PDM|214.00|99|0.00|AETNA CAPD CCPD IPD DIALYSIS PROC
20|FH_F137363_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F137363_0_0|CSTM-ALL|CSTM-00|2020|PDM|1133.00|99|0.00|AEG 7 (NO REV)
20|FH_F137363_0_0|CSTM-ALL|CSTM-00|2020|PDM|1236.00|99|0.00|AEG 8 (NO REV)
20|FH_F137363_0_0|CSTM-ALL|CSTM-00|2020|PDM|406.85|99|0.00|AEG 1 (NO REV)
20|FH_F137363_0_0|CSTM-ALL|CSTM-00|2020|PDM|612.85|99|0.00|AEG 3 (NO REV)
20|FH_F137363_0_0|SrvcGrp|104639|2022|PDM|4500.00|99|0.00|REMOVE & REPLACE PM GEN SINGL
20|FH_F137363_0_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS
20|FH_F137363_0_0|SrvcGrp|16732|2022|PDM|1854.00|99|0.00|HYSTEROSCOPY ABLATION
20|FH_F137363_0_0|SrvcGrp|84720|2022|PCT|0.00|99|0.00|AETNA LITHOTRIPSY ESWL INCIDENTAL CODES
20|FH_F137447_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F137447_0_0|SrvcGrp|106314|2022|PDM|698.10|99|0.00|ADVANCED LIFE SUPPORT LEVEL 2 (ALS2) (HCFA)
20|FH_F137447_0_0|SrvcGrp|13262|2022|PDM|4.00|99|0.00|GROUND MILEAGE, PER STATUTE MILE
20|FH_F137530_0_0|SrvcGrp|112581|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F137587_0_0|SrvcGrp|108180|2022|PDM|665.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD
20|FH_F137587_0_0|SrvcGrp|111448|2022|PDM|705.00|99|0.00|HOME HEMODIALYSIS TRAINING & TREATMENT
20|FH_F137587_0_0|SrvcGrp|112172|2022|PDM|311.00|99|0.00|CAPD/CCPD TRAINING W/ TREATMENT
20|FH_F137610_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F137610_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F137610_0_0|SrvcGrp|46903|2022|PDM|411.00|99|0.00|RESIDENTIAL TREATMENT
20|FH_F137638_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F137638_0_0|SrvcGrp|108484|2022|PDM|774.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY
20|FH_F137638_0_0|SrvcGrp|90854|2022|PDM|928.00|99|0.00|AETNA IP DETOXIFICATION SERVICES
20|FH_F137639_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.44|99|0.00|OP SVCS
20|FH_F137639_0_0|SrvcGrp|1259|2022|PDM|1700.00|99|0.00|INTERMEDIATE INTENSIVE CARE UNIT
20|FH_F137639_0_0|SrvcGrp|3142|2022|PDM|1900.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F137798_0_0|SrvcGrp|104229|2022|PDM|743.00|99|0.00|HOSPICE IN HOME (HCFA)
20|FH_F137798_0_0|SrvcGrp|104230|2022|PDM|140.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F137798_0_0|SrvcGrp|82222|2022|PDM|128.00|99|0.00|HOSPICE CARE
20|FH_F137798_0_0|SrvcGrp|82223|2022|PDM|743.00|99|0.00|HOSPICE CARE
20|FH_F137798_0_0|SrvcGrp|84185|2022|PDM|140.00|99|0.00|RESPITE CARE
20|FH_F137798_0_0|SrvcGrp|95661|2022|PDM|140.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F137799_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F137847_0_0|SrvcGrp|106048|2022|PDM|725.00|99|0.00|AETNA IP REHAB ALCOHOL DRUG
20|FH_F137847_0_0|SrvcGrp|89337|2022|PDM|830.00|99|0.00|DETOXIFICATION
20|FH_F137906_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F137906_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F137906_0_0|SrvcGrp|29155|2022|PDM|100.00|99|0.00|HOSPICE SVCS
20|FH_F137906_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F137906_0_0|SrvcGrp|84185|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F137906_0_0|SrvcGrp|95661|2022|PDM|100.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F137933_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|AEG 4 (NO REV)
20|FH_F137933_0_0|CSTM-ALL|CSTM-00|2020|PDM|5000.00|99|0.00|AEG 9 (NO REV) W/O KIDNEY LITHOTRIPSY
20|FH_F137933_0_0|CSTM-ALL|CSTM-00|2020|PDM|7000.00|99|0.00|AEG 6 (NO REV)
20|FH_F137933_0_0|SrvcGrp|109629|2022|PDM|13100.00|99|0.00|CENTER FOR UROLOGIC SURGERY LLC
20|FH_F137933_0_0|SrvcGrp|113160|2022|PDM|3500.00|99|0.00|KIDNEY ENDOSCOPY
20|FH_F137933_0_0|SrvcGrp|86942|2022|PDM|13300.00|99|0.00|CPT 53445
20|FH_F137940_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F137940_0_0|SrvcGrp|106291|2022|PDM|219.93|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT LEVEL 1 (HCFA)
20|FH_F137940_0_0|SrvcGrp|106314|2022|PDM|499.11|99|0.00|ADVANCED LIFE SUPPORT LEVEL 2 (ALS2) (HCFA)
20|FH_F137940_0_0|SrvcGrp|13262|2022|PDM|6.55|99|0.00|GROUND MILEAGE, PER STATUTE MILE
20|FH_F137940_0_0|SrvcGrp|13422|2022|PDM|219.93|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC
20|FH_F137940_0_0|SrvcGrp|2067|2022|PDM|595.64|99|0.00|SPECIALTY CARE TRANSPORT
20|FH_F137943_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F137943_0_0|CSTM-ALL|CSTM-00|2020|PDM|1150.00|99|0.00|AEG 8 (NO REV)
20|FH_F137943_0_0|SrvcGrp|113196|2022|PDM|1660.00|99|0.00|ECP CILIARY BODY DESTRUCTION
20|FH_F137943_0_0|SrvcGrp|54162|2022|PDM|1660.00|99|0.00|REVISION OF AQUEOUS SHUNT
20|FH_F137943_0_0|SrvcGrp|79792|2022|PDM|1660.00|99|0.00|EYE/OCULAR ADNEXA SURGERY
20|FH_F137946_0_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)
20|FH_F137946_0_0|SrvcGrp|113227|2022|PDM|142.63|99|0.00|COVID-19 NFCT DS VIR RESP RNA 3 TRGT
20|FH_F137946_0_0|SrvcGrp|113229|2022|PDM|142.63|99|0.00|COVID-19 NFCT DS VIR RESP RNA 4 TRGT (HCFA)
20|FH_F137946_0_0|SrvcGrp|113231|2022|PDM|105.33|99|0.00|COVID-19 NEUTRLZG ANTB SARSCOV2 TITER
20|FH_F137946_0_0|SrvcGrp|113243|2022|PDM|42.28|99|0.00|COVID-19 SVNT SARSCOV2 ELISA PLSM SRM (HCFA)
20|FH_F137946_0_0|SrvcGrp|113245|2022|PDM|42.13|99|0.00|COVID-19 NEUTRLZG ANTB SARSCOV2 SCR (HCFA)
20|FH_F137946_0_0|SrvcGrp|113248|2022|PDM|51.31|99|0.00|COVID-19 SARS-COV-2 AMP PRB (HCFA)
20|FH_F137946_0_0|SrvcGrp|113251|2022|PDM|41.38|99|0.00|COVID-19 SARS-COV-2 W/ OPTIC (HCFA)
20|FH_F137946_0_0|SrvcGrp|87077|2022|PDM|140.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F137950_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F137950_0_0|CSTM-ALL|CSTM-00|2020|PDM|1760.00|99|0.00|AEG 10 (NO REV)
20|FH_F137950_0_0|CSTM-ALL|CSTM-00|2020|PDM|2310.00|99|0.00|AEG 8 (NO REV)
20|FH_F137951_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|AEG 9 (NO REV)
20|FH_F137951_0_0|CSTM-ALL|CSTM-00|2020|PDM|825.00|99|0.00|AEG 3 (NO REV)
20|FH_F137951_0_0|SrvcGrp|113168|2022|PDM|1479.00|99|0.00|REMOVAL OF KNEECAP BURSA
20|FH_F137951_0_0|SrvcGrp|23585|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F137951_0_0|SrvcGrp|26278|2022|PDM|1436.00|99|0.00|CPT 29881
20|FH_F137951_0_0|SrvcGrp|27315|2022|PDM|3223.00|99|0.00|TENDON REPAIR
20|FH_F137951_0_0|SrvcGrp|33984|2022|PDM|1479.00|99|0.00|HAMMERTOE CORRECTION
20|FH_F137951_0_0|SrvcGrp|35668|2022|PDM|1436.00|99|0.00|CPT 29824
20|FH_F137951_0_0|SrvcGrp|71666|2022|PDM|3000.00|99|0.00|CPT 63655
20|FH_F137951_0_0|SrvcGrp|74039|2022|PDM|3000.00|99|0.00|LAMINECTOMY
20|FH_F137951_0_0|SrvcGrp|84939|2022|PDM|12000.00|99|0.00|SHOULDER JOINT
20|FH_F137951_0_0|SrvcGrp|88487|2022|PDM|3000.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION
20|FH_F137951_0_0|SrvcGrp|88491|2022|PDM|3000.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR
20|FH_F137951_0_0|SrvcGrp|89980|2022|PDM|4508.00|99|0.00|OPEN TREATMENT OF DISTAL
20|FH_F137951_0_0|SrvcGrp|90420|2022|PDM|4296.00|99|0.00|REPAIR CLAVICLE FRACTURE
20|FH_F137951_0_0|SrvcGrp|95819|2022|PDM|2050.00|99|0.00|GONIOTOMY
20|FH_F137951_0_0|SrvcGrp|98003|2022|PDM|4203.00|99|0.00|BIMALLEOLAR ANKLE FRACTURE
20|FH_F137972_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AEG 1 (NO REV)
20|FH_F137972_0_0|CSTM-ALL|CSTM-00|2020|PDM|693.00|99|0.00|AEG 2 (NO REV)
20|FH_F137984_0_0|CSTM-ALL|CSTM-00|2020|PCT|36500.00|99|0.00|TIMELY FILING
20|FH_F137984_0_0|CSTM-ALL|CSTM-00|2020|PCT|68.00|99|0.00|OP SVCS
20|FH_F137986_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F137986_0_0|CSTM-ALL|CSTM-00|2020|PDM|1150.00|99|0.00|AEG 5  (NO REV)
20|FH_F137986_0_0|CSTM-ALL|CSTM-00|2020|PDM|825.00|99|0.00|AEG 3 (NO REV)
20|FH_F137986_0_0|SrvcGrp|113168|2022|PDM|1479.00|99|0.00|REMOVAL OF KNEECAP BURSA
20|FH_F137986_0_0|SrvcGrp|113170|2022|PDM|1458.00|99|0.00|UPPER GI OPTIC ENDOMICROSCOPY
20|FH_F137986_0_0|SrvcGrp|26274|2022|PDM|1436.00|99|0.00|CPT 29877
20|FH_F137986_0_0|SrvcGrp|27261|2022|PDM|9393.00|99|0.00|CPT 27446
20|FH_F137986_0_0|SrvcGrp|34606|2022|PDM|3223.00|99|0.00|CPT 29827
20|FH_F137986_0_0|SrvcGrp|71666|2022|PDM|3000.00|99|0.00|CPT 63655
20|FH_F137986_0_0|SrvcGrp|72121|2022|PDM|3131.00|99|0.00|ARTHOSCOPY
20|FH_F137986_0_0|SrvcGrp|74039|2022|PDM|3000.00|99|0.00|LAMINECTOMY
20|FH_F137986_0_0|SrvcGrp|75002|2022|PDM|4509.00|99|0.00|ARTHOSCOPY
20|FH_F137986_0_0|SrvcGrp|82114|2022|PDM|1478.00|99|0.00|MENISCUS REPAIR MED OR LAT
20|FH_F137986_0_0|SrvcGrp|88487|2022|PDM|3000.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION
20|FH_F137986_0_0|SrvcGrp|88491|2022|PDM|3000.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR
20|FH_F137986_0_0|SrvcGrp|95819|2022|PDM|2050.00|99|0.00|GONIOTOMY
20|FH_F138010_0_0|SrvcGrp|63119|2022|PDM|25.00|99|0.00|BASIC HOME HOSPICE CARE
20|FH_F138010_0_0|SrvcGrp|90707|2022|PDM|100.00|99|0.00|AETNA HOSPICE CARE
20|FH_F138010_0_0|SrvcGrp|93098|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F138021_0_0|CSTM-ALL|CSTM-00|2020|PDM|325.00|99|0.00|AEG 1 (NO REV)
20|FH_F138054_0_0|SrvcGrp|42971|2022|PDM|161.00|99|0.00|SKN RN
20|FH_F138054_0_0|SrvcGrp|48394|2022|PDM|66.63|99|0.00|SKILLED NURSING SERVICES
20|FH_F138054_0_0|SrvcGrp|48396|2022|PDM|144.00|99|0.00|OT SERVICES
20|FH_F138054_0_0|SrvcGrp|66265|2022|PDM|144.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F138054_0_0|SrvcGrp|88621|2022|PDM|161.00|99|0.00|SKILLED NURSING LPN
20|FH_F138152_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F138191_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F138196_0_0|CSTM-ALL|CSTM-00|2020|PDM|620.00|99|0.00|AEG 10 (NO REV)
20|FH_F138196_0_0|CSTM-ALL|CSTM-00|2020|PDM|766.00|99|0.00|AEG 4 (NO REV)
20|FH_F138196_0_0|SrvcGrp|13557|2022|PDM|2500.00|99|0.00|CORNEAL TISSUE SVCS
20|FH_F138197_0_0|CSTM-ALL|CSTM-00|2020|PDM|1239.00|99|0.00|AEG 5  (NO REV)
20|FH_F138197_0_0|CSTM-ALL|CSTM-00|2020|PDM|771.75|99|0.00|AEG 2 (NO REV) W/O NERVOUS SYSTEM
20|FH_F138197_0_0|CSTM-ALL|CSTM-00|2020|PDM|882.00|99|0.00|AEG 3 (NO REV)
20|FH_F138197_0_0|SrvcGrp|19991|2022|PDM|2312.00|99|0.00|NERVOUS SYSTEM SERVICES
20|FH_F138197_0_0|SrvcGrp|80139|2022|PDM|4883.00|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F138213_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F138214_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F138219_0_0|SrvcGrp|25688|2022|PDM|424.00|99|0.00|HOME HEMODIALYSIS
20|FH_F138236_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F138236_0_0|SrvcGrp|104226|2022|PDM|105.00|99|0.00|HOSPICE CARE (HCFA)
20|FH_F138236_0_0|SrvcGrp|29155|2022|PDM|105.00|99|0.00|HOSPICE SVCS
20|FH_F138236_0_0|SrvcGrp|82222|2022|PDM|105.00|99|0.00|HOSPICE CARE
20|FH_F138283_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F138283_0_0|SrvcGrp|113272|2022|PDM|112.00|99|0.00|NURSING ASSESSMENT/EVAL
20|FH_F138283_0_0|SrvcGrp|29347|2022|PDM|37.00|99|0.00|HOME HEALTH AIDE
20|FH_F138283_0_0|SrvcGrp|34146|2022|PDM|118.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F138283_0_0|SrvcGrp|34389|2022|PDM|118.00|99|0.00|SPEECH THERAPY
20|FH_F138283_0_0|SrvcGrp|73524|2022|PDM|107.00|99|0.00|PHYSICAL THERAPY
20|FH_F138296_0_0|CSTM-ALL|CSTM-00|2020|PCT|50.00|99|0.00|IMPLANTS
20|FH_F138296_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS
20|FH_F138350_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F138350_0_0|CSTM-ALL|CSTM-00|2020|PDM|1328.00|99|0.00|AEG 9 (NO REV)
20|FH_F138350_0_0|CSTM-ALL|CSTM-00|2020|PDM|684.00|99|0.00|AEG 2 (NO REV)
20|FH_F138350_0_0|CSTM-ALL|CSTM-00|2020|PDM|783.00|99|0.00|AEG 3 (NO REV)
20|FH_F138350_0_0|CSTM-ALL|CSTM-00|2020|PDM|884.00|99|0.00|AEG 10 (NO REV)
20|FH_F138353_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 1 (NO REV)
20|FH_F138353_0_0|CSTM-ALL|CSTM-00|2020|PDM|672.00|99|0.00|AEG 6 (NO REV)
20|FH_F138416_0_0|CSTM-ALL|CSTM-00|2020|PCT|12000.00|99|0.00|TIMELY FILING
20|FH_F138417_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F138417_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD
20|FH_F138417_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|DME
20|FH_F138420_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 2 (NO REV)
20|FH_F138420_0_0|CSTM-ALL|CSTM-00|2020|PDM|2383.00|99|0.00|AEG 8 (NO REV)
20|FH_F138420_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F138422_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F138450_0_0|SrvcGrp|112064|2022|PCT|0.93|99|0.00|CARDIAC CATHETERIZATION
20|FH_F138450_0_0|SrvcGrp|113275|2022|PDM|100.00|99|0.00|COVID-19 AMP PRB HGH THRUPUT
20|FH_F138451_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F138452_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|TELEHEALTH SERVICES
20|FH_F138457_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F138457_0_0|CSTM-ALL|CSTM-00|2020|PDM|771.00|99|0.00|AEG 2 (NO REV)
20|FH_F138457_0_0|CSTM-ALL|CSTM-00|2020|PDM|771.00|99|0.00|AETNA SURGERY DEFAULT WITHOUT GROUPER 1 & 2
20|FH_F138460_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F138460_0_0|CSTM-ALL|CSTM-00|2020|PCT|12000.00|99|0.00|TIMELY FILING
20|FH_F138478_0_0|SrvcGrp|104009|2022|PDM|5394.02|99|0.00|REMOVE AND REPLACE PM GEN SINGL
20|FH_F138478_0_0|SrvcGrp|108087|2022|PDM|516.06|99|0.00|INSERT NON-TUNNL CNTRL CVC
20|FH_F138478_0_0|SrvcGrp|109492|2022|PDM|6572.12|99|0.00|INSERT HEART PM ATRIAL
20|FH_F138478_0_0|SrvcGrp|109493|2022|PDM|6792.89|99|0.00|INSERT HEART PM VENTRICULAR
20|FH_F138478_0_0|SrvcGrp|109495|2022|PDM|6861.39|99|0.00|INSERT PULSE GEN DUAL LEADS
20|FH_F138478_0_0|SrvcGrp|109502|2022|PDM|10435.89|99|0.00|INSERT PULSE GEN MULT LEADS
20|FH_F138478_0_0|SrvcGrp|109504|2022|PDM|6793.71|99|0.00|REMV & REPLC PM GEN DUAL LEAD
20|FH_F138478_0_0|SrvcGrp|109505|2022|PDM|10507.16|99|0.00|REMV & REPLC PM GEN MULT LEADS
20|FH_F138478_0_0|SrvcGrp|109509|2022|PDM|6974.46|99|0.00|REMOVE PACEMAKER SYSTEM
20|FH_F138478_0_0|SrvcGrp|113282|2022|PDM|5570.24|99|0.00|INSJ SUBQ IMPLTBL DFB ELCTR
20|FH_F138478_0_0|SrvcGrp|113285|2022|PDM|2066.18|99|0.00|HEMODIALYSIS
20|FH_F138478_0_0|SrvcGrp|76023|2022|PDM|23759.57|99|0.00|OP AICD 33249
20|FH_F138478_0_0|SrvcGrp|77290|2022|PDM|283.51|99|0.00|AETNA REMV TUNNLD CVC W/O SUBQ PORT
20|FH_F138478_0_0|SrvcGrp|88481|2022|PDM|23793.91|99|0.00|AETNA RMVL & RPLCMT DFB GEN MLT LEAD
20|FH_F138478_0_0|SrvcGrp|88485|2022|PDM|729.67|99|0.00|AETNA REVISE POCKET PACEMAKER
20|FH_F138478_0_0|SrvcGrp|92406|2022|PDM|17355.00|99|0.00|REMOVAL & REPLACE PULSE GEN 1 LEAD
20|FH_F138488_0_0|CSTM-ALL|CSTM-00|2020|PDM|490.45|99|0.00|AEG 3 (NO REV)
20|FH_F138488_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 1 (NO REV)
20|FH_F138488_0_0|CSTM-ALL|CSTM-00|2020|PDM|823.39|99|0.00|AEG 9 (NO REV)
20|FH_F138488_0_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F138491_0_0|SrvcGrp|89781|2022|PDM|85.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F138532_0_0|SrvcGrp|108043|2022|PDM|182.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD
20|FH_F138533_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F138533_0_0|CSTM-ALL|CSTM-00|2020|PDM|590.00|99|0.00|AETNA SURGERY DEFAULT WITHOUT GROUPER 1 & 2
20|FH_F138578_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F138578_0_0|SrvcGrp|82981|2022|PDM|90.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F138589_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F138589_0_0|SrvcGrp|82981|2022|PDM|90.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F138611_0_0|CSTM-ALL|CSTM-00|2020|PDM|3903.00|99|0.00|AEG 5  (NO REV)
20|FH_F125113_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F125113_0_0|CSTM-ALL|CSTM-00|2020|PDM|1518.00|99|0.00|AEG 5  (NO REV)
20|FH_F125113_0_0|CSTM-ALL|CSTM-00|2020|PDM|2835.00|99|0.00|AEG 9 (NO REV)
20|FH_F125113_0_0|CSTM-ALL|CSTM-00|2020|PDM|3149.00|99|0.00|AEG 7 (NO REV)
20|FH_F125113_0_0|CSTM-ALL|CSTM-00|2020|PDM|705.00|99|0.00|AEG 1 (NO REV)
20|FH_F125113_0_0|SrvcGrp|108267|2022|PCT|0.00|99|0.00|AETNA IMAGING
20|FH_F125113_0_0|SrvcGrp|19991|2022|PDM|4000.00|99|0.00|NERVOUS SYSTEM SERVICES
20|FH_F125124_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F125124_0_0|SrvcGrp|72994|2022|PDM|549.00|99|0.00|AEG 3
20|FH_F125124_0_0|SrvcGrp|73004|2022|PDM|950.00|99|0.00|AEG 8
20|FH_F125124_0_0|SrvcGrp|79583|2022|PDM|2028.00|99|0.00|CPT 45381
20|FH_F125134_0_0|SrvcGrp|110069|2022|PDM|320.00|99|0.00|DIALYSIS PATIENT TRAINING
20|FH_F125163_0_0|SrvcGrp|108081|2022|PDM|557.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS
20|FH_F125163_0_0|SrvcGrp|108082|2022|PDM|1325.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER
20|FH_F125173_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F125173_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F125173_0_0|SrvcGrp|108041|2022|PDM|400.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME
20|FH_F125182_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F125182_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F125182_0_0|SrvcGrp|72992|2022|PDM|482.00|99|0.00|AEG 2
20|FH_F125182_0_0|SrvcGrp|72996|2022|PDM|680.00|99|0.00|AEG 4
20|FH_F125182_0_0|SrvcGrp|73000|2022|PDM|905.00|99|0.00|AEG 6
20|FH_F125182_0_0|SrvcGrp|79579|2022|PDM|3315.00|99|0.00|CPT 43251
20|FH_F125182_0_0|SrvcGrp|79590|2022|PDM|1884.00|99|0.00|CPT 43248
20|FH_F125206_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F125206_0_0|CSTM-ALL|CSTM-00|2020|PDM|2739.00|99|0.00|COVENTRY ENHANCED GROUPER 5
20|FH_F125206_0_0|CSTM-ALL|CSTM-00|2020|PDM|2976.00|99|0.00|COVENTRY ENHANCED GROUPER 6
20|FH_F125206_0_0|CSTM-ALL|CSTM-00|2020|PDM|3157.00|99|0.00|COVENTRY ENHANCED GROUPER 9
20|FH_F125206_0_0|SrvcGrp|11663|2022|PCT|0.55|99|0.00|IMPLANTS
20|FH_F125244_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F125244_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 4 (NO REV)
20|FH_F125244_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 10 (NO REV)
20|FH_F125244_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 7 (NO REV)
20|FH_F125244_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|AEG 9 (NO REV)
20|FH_F125244_0_0|SrvcGrp|101526|2022|PDM|5500.00|99|0.00|LAPARO-ASST VAG HYSTERECTOMY
20|FH_F125244_0_0|SrvcGrp|16732|2022|PDM|4000.00|99|0.00|HYSTEROSCOPY ABLATION
20|FH_F125244_0_0|SrvcGrp|26002|2022|PDM|200.00|99|0.00|C-ARM AND LASER
20|FH_F125244_0_0|SrvcGrp|27346|2022|PDM|4000.00|99|0.00|REPAIR BLADDER DEFECT
20|FH_F125244_0_0|SrvcGrp|63471|2022|PDM|17500.00|99|0.00|CPT 64590
20|FH_F125244_0_0|SrvcGrp|68000|2022|PDM|4000.00|99|0.00|CPT 58561
20|FH_F125244_0_0|SrvcGrp|73495|2022|PDM|5000.00|99|0.00|AETNA MYOMECTOMY
20|FH_F125244_0_0|SrvcGrp|83817|2022|PDM|5500.00|99|0.00|LAPAROSCOPY LYSIS ADHESIONS
20|FH_F125249_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F125249_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F125249_0_0|CSTM-ALL|CSTM-00|2020|PDM|1149.00|99|0.00|AEG 10 (NO REV)
20|FH_F125249_0_0|CSTM-ALL|CSTM-00|2020|PDM|1149.00|99|0.00|AEG 3 W/O MUSCULOSKELETAL (NO REV)
20|FH_F125249_0_0|CSTM-ALL|CSTM-00|2020|PDM|1554.00|99|0.00|AEG 6 (NO REV)
20|FH_F125249_0_0|CSTM-ALL|CSTM-00|2020|PDM|1723.00|99|0.00|AEG 7 (NO REV)
20|FH_F125249_0_0|CSTM-ALL|CSTM-00|2020|PDM|1825.00|99|0.00|AEG 8 (NO REV)
20|FH_F125249_0_0|SrvcGrp|100039|2022|PDM|1400.00|99|0.00|REPAIR OF HEEL FRACTURE
20|FH_F125249_0_0|SrvcGrp|100070|2022|PDM|1200.00|99|0.00|REVISION OF UNSTABLE KNEECAP
20|FH_F125249_0_0|SrvcGrp|100921|2022|PDM|3000.00|99|0.00|SPI  PROSTH DEVICE
20|FH_F125249_0_0|SrvcGrp|107361|2022|PDM|4000.00|99|0.00|SECOND LEVEL CER DISKECTOMY
20|FH_F125249_0_0|SrvcGrp|108255|2022|PDM|1400.00|99|0.00|AETNA REPAIR CLAVICLE DISLOCATION
20|FH_F125249_0_0|SrvcGrp|108258|2022|PDM|1200.00|99|0.00|AETNA PARTIAL REMOVAL OF ELBOW
20|FH_F125249_0_0|SrvcGrp|108260|2022|PDM|1000.00|99|0.00|AETNA FIXATION OF KNEE JOINT
20|FH_F125249_0_0|SrvcGrp|33971|2022|PDM|1700.00|99|0.00|CPT 25652
20|FH_F125249_0_0|SrvcGrp|41334|2022|PDM|15500.00|99|0.00|TOTAL KNEE
20|FH_F125249_0_0|SrvcGrp|67066|2022|PDM|4500.00|99|0.00|CERVICAL SURGERY
20|FH_F125249_0_0|SrvcGrp|67072|2022|PDM|2500.00|99|0.00|CPT 22845
20|FH_F125249_0_0|SrvcGrp|75002|2022|PDM|2000.00|99|0.00|ARTHOSCOPY
20|FH_F125249_0_0|SrvcGrp|84939|2022|PDM|14500.00|99|0.00|SHOULDER JOINT
20|FH_F125249_0_0|SrvcGrp|88065|2022|PDM|12000.00|99|0.00|TOTAL DISC ARTHROPLASTY
20|FH_F125249_0_0|SrvcGrp|89946|2022|PDM|1200.00|99|0.00|REPAIR OF KNEE LIGAMENT
20|FH_F125249_0_0|SrvcGrp|89980|2022|PDM|2000.00|99|0.00|OPEN TREATMENT OF DISTAL
20|FH_F125249_0_0|SrvcGrp|90063|2022|PDM|1400.00|99|0.00|REPAIR BICEPS TENDON RUPTURE
20|FH_F125249_0_0|SrvcGrp|90357|2022|PDM|1200.00|99|0.00|REPAIR OF ANKLE FRACTURE
20|FH_F125249_0_0|SrvcGrp|90417|2022|PDM|1200.00|99|0.00|TREATMENT OF JOINT
20|FH_F125249_0_0|SrvcGrp|92006|2022|PDM|1700.00|99|0.00|SCAPULAR FRACTURE
20|FH_F125249_0_0|SrvcGrp|92370|2022|PDM|700.00|99|0.00|FUSION OF KNUCKLE JOINT
20|FH_F125249_0_0|SrvcGrp|95560|2022|PDM|1400.00|99|0.00|REMOVAL OF SHOULDER BONE
20|FH_F125259_0_0|CSTM-ALL|CSTM-00|2020|PDM|1190.00|99|0.00|AEG 5  (NO REV)
20|FH_F125259_0_0|CSTM-ALL|CSTM-00|2020|PDM|1880.00|99|0.00|AEG 9 (NO REV)
20|FH_F125259_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F125259_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F125259_0_0|SrvcGrp|108117|2022|PDM|1750.00|99|0.00|AV FUSION / FOREARM VEIN
20|FH_F125259_0_0|SrvcGrp|108119|2022|PDM|1300.00|99|0.00|ARTERY-VEIN FUSION
20|FH_F125260_0_0|SrvcGrp|46605|2022|PDM|221.86|99|0.00|CLINICAL SOCIAL WORKER SERVICES
20|FH_F125260_0_0|SrvcGrp|48385|2022|PDM|220.60|99|0.00|SPEECH THERAPY
20|FH_F125260_0_0|SrvcGrp|88620|2022|PDM|185.10|99|0.00|SKILLED NURSING RN
20|FH_F138611_0_0|CSTM-ALL|CSTM-00|2020|PDM|4518.00|99|0.00|AEG 6 (NO REV)
20|FH_F138611_0_0|CSTM-ALL|CSTM-00|2020|PDM|7283.00|99|0.00|AEG 9 (NO REV)
20|FH_F138611_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F138611_0_0|SrvcGrp|11306|2022|PCT|0.80|99|0.00|IMPLANTS
20|FH_F138611_0_0|SrvcGrp|88155|2022|PDM|14894.00|99|0.00|REVISE KNEECAP WITH IMPLANT
20|FH_F138611_0_0|SrvcGrp|93431|2022|PDM|14894.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT
20|FH_F138636_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F138649_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE
20|FH_F138651_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE
20|FH_F138651_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS
20|FH_F138682_0_0|CSTM-ALL|CSTM-00|2020|PDM|483.00|99|0.00|AEG 10 (NO REV)
20|FH_F138682_0_0|CSTM-ALL|CSTM-00|2020|PDM|483.00|99|0.00|AEG 5  (NO REV)
20|FH_F138682_0_0|CSTM-ALL|CSTM-00|2020|PDM|483.00|99|0.00|AEG 7 (NO REV)
20|FH_F138682_0_0|CSTM-ALL|CSTM-00|2020|PDM|483.00|99|0.00|AEG 9 (NO REV)
20|FH_F138710_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F138713_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F138713_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F138734_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F138734_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F138734_0_0|SrvcGrp|108484|2022|PDM|554.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY
20|FH_F138751_0_0|SrvcGrp|107748|2022|PDM|424.00|99|0.00|HEMODIALYSIS IN CENTER
20|FH_F138751_0_0|SrvcGrp|108043|2022|PDM|182.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD
20|FH_F138827_0_0|SrvcGrp|87077|2022|PDM|170.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F138873_0_0|CSTM-ALL|CSTM-00|2020|PDM|1132.00|99|0.00|AEG 7 (NO REV)
20|FH_F138873_0_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F138882_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F138882_0_0|CSTM-ALL|CSTM-00|2020|PDM|1562.00|99|0.00|AEG 2 (NO REV)
20|FH_F138882_0_0|SrvcGrp|110820|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES
20|FH_F138882_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F138929_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F138929_0_0|CSTM-ALL|CSTM-00|2020|PDM|1210.00|99|0.00|AEG 4 (NO REV)
20|FH_F138929_0_0|CSTM-ALL|CSTM-00|2020|PDM|1870.00|99|0.00|AEG 8 (NO REV)
20|FH_F138929_0_0|CSTM-ALL|CSTM-00|2020|PDM|2310.00|99|0.00|AEG 9 (NO REV)
20|FH_F138929_0_0|CSTM-ALL|CSTM-00|2020|PDM|935.00|99|0.00|AEG 2 (NO REV)
20|FH_F138929_0_0|SrvcGrp|100014|2022|PDM|5005.00|99|0.00|REPAIR RADIUS OR ULNA
20|FH_F138929_0_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS
20|FH_F138929_0_0|SrvcGrp|26274|2022|PDM|3300.00|99|0.00|CPT 29877
20|FH_F138929_0_0|SrvcGrp|26278|2022|PDM|3300.00|99|0.00|CPT 29881
20|FH_F138929_0_0|SrvcGrp|27261|2022|PDM|15400.00|99|0.00|CPT 27446
20|FH_F138929_0_0|SrvcGrp|35668|2022|PDM|3520.00|99|0.00|CPT 29824
20|FH_F138929_0_0|SrvcGrp|41325|2022|PDM|4620.00|99|0.00|OP SURGERY CPT 24342
20|FH_F138929_0_0|SrvcGrp|41334|2022|PDM|17600.00|99|0.00|TOTAL KNEE
20|FH_F138929_0_0|SrvcGrp|71666|2022|PDM|13520.00|99|0.00|CPT 63655
20|FH_F138929_0_0|SrvcGrp|74039|2022|PDM|6600.00|99|0.00|LAMINECTOMY
20|FH_F138929_0_0|SrvcGrp|82107|2022|PDM|3520.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F138929_0_0|SrvcGrp|85792|2022|PDM|5005.00|99|0.00|OPEN TREATMENT OF DISTAL
20|FH_F138929_0_0|SrvcGrp|88161|2022|PDM|6600.00|99|0.00|LAMINECTOMY W/FACE-THORACIC
20|FH_F138929_0_0|SrvcGrp|90063|2022|PDM|5005.00|99|0.00|REPAIR BICEPS TENDON RUPTURE
20|FH_F138929_0_0|SrvcGrp|97730|2022|PDM|17600.00|99|0.00|REVERSE HIP JOINT
20|FH_F138929_0_0|SrvcGrp|97895|2022|PDM|16500.00|99|0.00|REVISE KNEE 2
20|FH_F138929_0_0|SrvcGrp|99161|2022|PDM|17600.00|99|0.00|CPT 27138
20|FH_F138932_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F138934_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|AEG 5  (NO REV)
20|FH_F138934_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|AEG 7 (NO REV)
20|FH_F138934_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|AEG 8 (NO REV)
20|FH_F138963_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F138963_0_0|SrvcGrp|79720|2022|PDM|1034.00|99|0.00|ACUTE REHAB II
20|FH_F138987_0_0|SrvcGrp|113454|2022|PDM|32.00|99|0.00|HOSPICE CARE
20|FH_F138987_0_0|SrvcGrp|63297|2022|PDM|126.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F138987_0_0|SrvcGrp|97507|2022|PDM|646.00|99|0.00|AETNA HOSPICE
20|FH_F138995_0_0|CSTM-ALL|CSTM-00|2020|PDM|1269.00|99|0.00|AEG 6 (NO REV)
20|FH_F138995_0_0|CSTM-ALL|CSTM-00|2020|PDM|1491.00|99|0.00|AEG 8 (NO REV)
20|FH_F138995_0_0|CSTM-ALL|CSTM-00|2020|PDM|1784.00|99|0.00|AEG 9 (NO REV)
20|FH_F138995_0_0|SrvcGrp|111994|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES
20|FH_F138995_0_0|SrvcGrp|35669|2022|PDM|2520.00|99|0.00|CPT 63650
20|FH_F138995_0_0|SrvcGrp|35670|2022|PDM|3600.00|99|0.00|SPINAL NEUROSTIMULATORS PROCEDURE
20|FH_F138995_0_0|SrvcGrp|65403|2022|PDM|1199.00|99|0.00|CPT 42830
20|FH_F139048_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F139048_0_0|CSTM-ALL|CSTM-00|2020|PDM|1485.00|99|0.00|AEG 7 (NO REV)
20|FH_F139048_0_0|CSTM-ALL|CSTM-00|2020|PDM|680.00|99|0.00|AEG 1 (NO REV)
20|FH_F139048_0_0|CSTM-ALL|CSTM-00|2020|PDM|858.00|99|0.00|AEG 2 (NO REV)
20|FH_F139048_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F139147_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F139147_0_0|CSTM-ALL|CSTM-00|2020|PDM|1943.00|99|0.00|AEG 3 (NO REV)
20|FH_F139147_0_0|CSTM-ALL|CSTM-00|2020|PDM|2373.00|99|0.00|AEG 6 (NO REV)
20|FH_F139147_0_0|CSTM-ALL|CSTM-00|2020|PDM|2946.00|99|0.00|AEG 7 (NO REV)
20|FH_F139147_0_0|SrvcGrp|15473|2022|PDM|5305.00|99|0.00|CPT CODE 42820
20|FH_F139147_0_0|SrvcGrp|65403|2022|PDM|5305.00|99|0.00|CPT 42830
20|FH_F139147_0_0|SrvcGrp|78283|2022|PDM|5150.00|99|0.00|CPT 49505
20|FH_F139147_0_0|SrvcGrp|79594|2022|PDM|1804.00|99|0.00|CPT 45380
20|FH_F139147_0_0|SrvcGrp|79595|2022|PDM|1804.00|99|0.00|CPT 45385
20|FH_F139147_0_0|SrvcGrp|88824|2022|PDM|9270.00|99|0.00|CPT 69631
20|FH_F139147_0_0|SrvcGrp|89404|2022|PDM|14057.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F139147_0_0|SrvcGrp|93432|2022|PDM|14057.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT
20|FH_F139169_0_0|CSTM-ALL|CSTM-00|2020|PDM|1672.56|99|0.00|AEG 10 (NO REV)
20|FH_F139169_0_0|SrvcGrp|11663|2022|PCT|1.05|99|0.00|IMPLANTS
20|FH_F139173_0_0|SrvcGrp|73701|2022|PDM|164.00|99|0.00|AETNA - SKILLED NURSING
20|FH_F139173_0_0|SrvcGrp|94781|2022|PDM|450.00|99|0.00|HOSPICE IN LTCH (HCFA)
20|FH_F139173_0_0|SrvcGrp|97506|2022|PDM|172.09|99|0.00|AETNA HOSPICE ALL OTHER CARE
20|FH_F139177_0_0|CSTM-ALL|CSTM-00|2020|PDM|1535.00|99|0.00|AEG 8 (NO REV)
20|FH_F139177_0_0|CSTM-ALL|CSTM-00|2020|PDM|1888.00|99|0.00|AEG 9 (NO REV)
20|FH_F139177_0_0|CSTM-ALL|CSTM-00|2020|PDM|512.00|99|0.00|AEG 1 (NO REV)
20|FH_F139177_0_0|SrvcGrp|112581|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F139207_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F139236_0_0|CSTM-ALL|CSTM-00|2020|PDM|1131.00|99|0.00|AEG 5  (NO REV)
20|FH_F139236_0_0|CSTM-ALL|CSTM-00|2020|PDM|990.00|99|0.00|AEG 4 (NO REV)
20|FH_F139236_0_0|SrvcGrp|112581|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F139236_0_0|SrvcGrp|113114|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F139238_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F139238_0_0|CSTM-ALL|CSTM-00|2020|PDM|1566.40|99|0.00|AEG 7 (NO REV)
20|FH_F139238_0_0|CSTM-ALL|CSTM-00|2020|PDM|708.40|99|0.00|AEG 2 (NO REV)
20|FH_F139238_0_0|CSTM-ALL|CSTM-00|2020|PDM|808.50|99|0.00|AEG 3 (NO REV)
20|FH_F139238_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F139238_0_0|SrvcGrp|11259|2022|PCT|0.26|99|0.00|DRUGS
20|FH_F139241_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F139241_0_0|CSTM-ALL|CSTM-00|2020|PDM|951.00|99|0.00|AEG 5  (NO REV)
20|FH_F139241_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F139241_0_0|SrvcGrp|11663|2022|PCT|0.55|99|0.00|IMPLANTS
20|FH_F139241_0_0|SrvcGrp|12491|2022|PCT|0.55|99|0.00|PACEMAKER
20|FH_F139241_0_0|SrvcGrp|13187|2022|PCT|0.55|99|0.00|INTRAOCULAR LENSES
20|FH_F139241_0_0|SrvcGrp|27918|2022|PDM|1858.00|99|0.00|CPT 23410, 23412
20|FH_F139241_0_0|SrvcGrp|77582|2022|PDM|1639.00|99|0.00|CPT 31255
20|FH_F139274_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F139274_0_0|CSTM-ALL|CSTM-00|2020|PDM|1410.00|99|0.00|AEG 8 (NO REV)
20|FH_F139274_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|AEG 1 (NO REV)
20|FH_F139274_0_0|CSTM-ALL|CSTM-00|2020|PDM|693.00|99|0.00|AEG 2 (NO REV)
20|FH_F139274_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 10 (NO REV)
20|FH_F139299_0_0|SrvcGrp|46903|2022|PDM|700.00|99|0.00|RESIDENTIAL TREATMENT
20|FH_F139299_0_0|SrvcGrp|73842|2022|PDM|230.00|99|0.00|AETNA INTENSIVE OUTPATIENT
20|FH_F139299_0_0|SrvcGrp|89417|2022|PDM|435.00|99|0.00|PARTIAL HOSPITALIZATION
20|FH_F139309_0_0|SrvcGrp|82981|2022|PDM|125.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F139470_0_0|SrvcGrp|87077|2022|PDM|100.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F139509_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F139509_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|AEG 9 (NO REV)
20|FH_F139509_0_0|CSTM-ALL|CSTM-00|2020|PDM|329.00|99|0.00|AEG 1 (NO REV)
20|FH_F139509_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|AEG 10 (NO REV)
20|FH_F139509_0_0|CSTM-ALL|CSTM-00|2020|PDM|696.00|99|0.00|AEG 5  (NO REV)
20|FH_F139509_0_0|CSTM-ALL|CSTM-00|2020|PDM|807.00|99|0.00|AEG 6 (NO REV)
20|FH_F139509_0_0|CSTM-ALL|CSTM-00|2020|PDM|949.00|99|0.00|AEG 8 (NO REV)
20|FH_F139509_0_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F139515_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F139515_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F139515_0_0|SrvcGrp|100919|2022|PDM|13596.00|99|0.00|SPINE PROSTH DEVICE
20|FH_F139515_0_0|SrvcGrp|102899|2022|PDM|1648.00|99|0.00|PARTIAL REMOVAL OF VULVA
20|FH_F139515_0_0|SrvcGrp|106266|2022|PDM|4352.00|99|0.00|NSL/SINS NDSC TOT W/ SPHENDT
20|FH_F139515_0_0|SrvcGrp|107361|2022|PDM|14420.00|99|0.00|SECOND LEVEL CER DISKECTOMY
20|FH_F139515_0_0|SrvcGrp|113571|2022|PDM|1380.00|99|0.00|REMOVAL OF PILONIDAL LESION
20|FH_F139515_0_0|SrvcGrp|113572|2022|PDM|1473.00|99|0.00|EXCISION OF NECK LESION - (3 CM)
20|FH_F139515_0_0|SrvcGrp|16289|2022|PDM|1626.00|99|0.00|CARPAL TUNNEL RELEASE
20|FH_F139515_0_0|SrvcGrp|33967|2022|PDM|2850.00|99|0.00|CPT 47562
20|FH_F139515_0_0|SrvcGrp|33987|2022|PDM|1625.00|99|0.00|CPT 57522
20|FH_F139515_0_0|SrvcGrp|34606|2022|PDM|3200.00|99|0.00|CPT 29827
20|FH_F139515_0_0|SrvcGrp|36865|2022|PDM|4101.00|99|0.00|NUCLEOPLASTY
20|FH_F139515_0_0|SrvcGrp|59841|2022|PDM|1200.00|99|0.00|SUBMUCOUS RESECTION
20|FH_F139515_0_0|SrvcGrp|67065|2022|PDM|14069.00|99|0.00|CERVICAL SURGERY
20|FH_F139515_0_0|SrvcGrp|67066|2022|PDM|10355.00|99|0.00|CERVICAL SURGERY
20|FH_F139515_0_0|SrvcGrp|67068|2022|PDM|16995.00|99|0.00|LUMBAR SPINE FUSION COMBINED
20|FH_F139515_0_0|SrvcGrp|67069|2022|PDM|16995.00|99|0.00|CPT 22634
20|FH_F139515_0_0|SrvcGrp|77021|2022|PDM|8196.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY
20|FH_F139515_0_0|SrvcGrp|79593|2022|PDM|711.00|99|0.00|CPT 45378
20|FH_F139515_0_0|SrvcGrp|83350|2022|PDM|3348.00|99|0.00|AETNA LAPAR HERNIA REPAIR
20|FH_F139515_0_0|SrvcGrp|88147|2022|PDM|2075.00|99|0.00|LAPAROSCOPY REMOVE ADNEXA
20|FH_F139515_0_0|SrvcGrp|88160|2022|PDM|8549.00|99|0.00|LAMINECTOMY W/FACETECTOMY
20|FH_F139515_0_0|SrvcGrp|88487|2022|PDM|7236.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION
20|FH_F139515_0_0|SrvcGrp|88493|2022|PDM|5665.00|99|0.00|AETNA VERTEBROPLASTY ADDL INJECT
20|FH_F139515_0_0|SrvcGrp|89857|2022|PDM|8549.00|99|0.00|REMOVAL OF SPINAL LAMINA
20|FH_F139515_0_0|SrvcGrp|90778|2022|PDM|2395.00|99|0.00|HEMIOPLASTY
20|FH_F139515_0_0|SrvcGrp|92364|2022|PDM|14420.00|99|0.00|ARTHRODESIS SACROILIAC JOINT
20|FH_F139515_0_0|SrvcGrp|92365|2022|PDM|14420.00|99|0.00|FUSION OF SACROILIAC JOINT
20|FH_F139515_0_0|SrvcGrp|92408|2022|PDM|6775.00|99|0.00|PERQ VERTEBRAL AUGMENTATION
20|FH_F139515_0_0|SrvcGrp|92409|2022|PDM|4917.00|99|0.00|PERQ CERVICOTHORACIC INJECT
20|FH_F139515_0_0|SrvcGrp|92416|2022|PDM|8549.00|99|0.00|CERVICAL LAMINOTOMY
20|FH_F139515_0_0|SrvcGrp|95559|2022|PDM|8442.00|99|0.00|HIP JOINT
20|FH_F139515_0_0|SrvcGrp|98497|2022|PDM|16995.00|99|0.00|ARTHRODESIS POSTERIOR TECH
20|FH_F139530_0_0|SrvcGrp|82981|2022|PDM|125.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F139551_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F139551_0_0|CSTM-ALL|CSTM-00|2020|PDM|1979.00|99|0.00|AEG 6 (NO REV)
20|FH_F139551_0_0|CSTM-ALL|CSTM-00|2020|PDM|952.00|99|0.00|AEG 1 (NO REV)
20|FH_F139551_0_0|SrvcGrp|100919|2022|PDM|4411.00|99|0.00|SPINE PROSTH DEVICE
20|FH_F139551_0_0|SrvcGrp|100921|2022|PDM|4411.00|99|0.00|SPI  PROSTH DEVICE
20|FH_F139551_0_0|SrvcGrp|11673|2022|PDM|5400.00|99|0.00|CPT 29888
20|FH_F139551_0_0|SrvcGrp|26274|2022|PDM|2537.00|99|0.00|CPT 29877
20|FH_F139551_0_0|SrvcGrp|26275|2022|PDM|3042.00|99|0.00|CPT 29826
20|FH_F139551_0_0|SrvcGrp|33967|2022|PDM|3495.00|99|0.00|CPT 47562
20|FH_F139551_0_0|SrvcGrp|35668|2022|PDM|2537.00|99|0.00|CPT 29824
20|FH_F139551_0_0|SrvcGrp|35672|2022|PDM|4531.00|99|0.00|CPT 23412
20|FH_F139551_0_0|SrvcGrp|37317|2022|PDM|4500.00|99|0.00|LITHOTRIPSY
20|FH_F139551_0_0|SrvcGrp|77021|2022|PDM|5769.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY
20|FH_F139551_0_0|SrvcGrp|88065|2022|PDM|13750.00|99|0.00|TOTAL DISC ARTHROPLASTY
20|FH_F139551_0_0|SrvcGrp|88160|2022|PDM|5769.00|99|0.00|LAMINECTOMY W/FACETECTOMY
20|FH_F139551_0_0|SrvcGrp|88164|2022|PDM|12916.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR
20|FH_F139551_0_0|SrvcGrp|89404|2022|PDM|16500.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F139551_0_0|SrvcGrp|89980|2022|PDM|4965.00|99|0.00|OPEN TREATMENT OF DISTAL
20|FH_F139551_0_0|SrvcGrp|93059|2022|PDM|4574.00|99|0.00|SPINAL BONE AUTOGRAFT
20|FH_F139551_0_0|SrvcGrp|93431|2022|PDM|17500.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT
20|FH_F139551_0_0|SrvcGrp|93432|2022|PDM|17500.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT
20|FH_F139551_0_0|SrvcGrp|99073|2022|PDM|2.00|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F139565_0_0|CSTM-ALL|CSTM-00|2020|PDM|1078.00|99|0.00|AEG 2 (NO REV)
20|FH_F139565_0_0|CSTM-ALL|CSTM-00|2020|PDM|1196.00|99|0.00|AEG 3 (NO REV)
20|FH_F139565_0_0|CSTM-ALL|CSTM-00|2020|PDM|1473.00|99|0.00|AEG 10 (NO REV)
20|FH_F139565_0_0|CSTM-ALL|CSTM-00|2020|PDM|1473.00|99|0.00|AEG 4 (NO REV)
20|FH_F139565_0_0|SrvcGrp|109764|2022|PDM|4590.00|99|0.00|REPAIR EYELID DEFECT
20|FH_F139565_0_0|SrvcGrp|42429|2022|PDM|1721.00|99|0.00|OP SURGERY CPT 66761
20|FH_F139565_0_0|SrvcGrp|46886|2022|PDM|4590.00|99|0.00|REMOVAL OF EYELID LESION
20|FH_F139565_0_0|SrvcGrp|62740|2022|PDM|5738.00|99|0.00|SURGERY CARVE OUTS
20|FH_F139565_0_0|SrvcGrp|84279|2022|PDM|9754.00|99|0.00|CORNEAL TRANSPLANT
20|FH_F139566_0_0|SrvcGrp|82981|2022|PDM|130.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F139573_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F139573_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F139573_0_0|SrvcGrp|57965|2022|PDM|373.33|99|0.00|HOSPICE RESPITE SVCS
20|FH_F139573_0_0|SrvcGrp|57966|2022|PDM|842.10|99|0.00|HOSPICE CARE
20|FH_F139576_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F139576_0_0|CSTM-ALL|CSTM-00|2020|PDM|1244.00|99|0.00|AEG 2 (NO REV)
20|FH_F139576_0_0|CSTM-ALL|CSTM-00|2020|PDM|1254.00|99|0.00|AEG 10 (NO REV)
20|FH_F139576_0_0|CSTM-ALL|CSTM-00|2020|PDM|1392.00|99|0.00|AEG 3 (NO REV)
20|FH_F139576_0_0|CSTM-ALL|CSTM-00|2020|PDM|2268.00|99|0.00|AEG 6 (NO REV)
20|FH_F139576_0_0|CSTM-ALL|CSTM-00|2020|PDM|2720.00|99|0.00|AEG 8 (NO REV)
20|FH_F139576_0_0|SrvcGrp|113637|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES
20|FH_F139576_0_0|SrvcGrp|16692|2022|PDM|2868.00|99|0.00|KNEE SCOPE
20|FH_F139576_0_0|SrvcGrp|19923|2022|PDM|2856.00|99|0.00|HYSTEROSCOPY
20|FH_F139576_0_0|SrvcGrp|68054|2022|PDM|2651.00|99|0.00|CPT 52332
20|FH_F139576_0_0|SrvcGrp|73616|2022|PDM|2497.00|99|0.00|AETNA WRIST ENDOSCOPY
20|FH_F139580_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F139580_0_0|SrvcGrp|107748|2022|PDM|424.00|99|0.00|HEMODIALYSIS IN CENTER
20|FH_F139580_0_0|SrvcGrp|107749|2022|PDM|182.00|99|0.00|CAPD/CCPD
20|FH_F139580_0_0|SrvcGrp|107750|2022|PDM|25.00|99|0.00|TRAINING INCL A TREATMENT
20|FH_F139580_0_0|SrvcGrp|108042|2022|PDM|424.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD
20|FH_F139580_0_0|SrvcGrp|113580|2022|PDM|150.00|99|0.00|DIALYSIS PATIENT TRAINING
20|FH_F139587_0_0|SrvcGrp|108899|2022|PDM|1025.00|99|0.00|HOSPICE INPATIENT RESPITE CARE
20|FH_F139587_0_0|SrvcGrp|113492|2022|PDM|195.36|99|0.00|HOSPICE ROUTINE HOME CARE
20|FH_F139587_0_0|SrvcGrp|82224|2022|PDM|58.52|99|0.00|HOSPICE CONT HOME CARE
20|FH_F139587_0_0|SrvcGrp|98062|2022|PDM|452.08|99|0.00|HOSPICE INPATIENT RESPITE CARE PER DIEM
20|FH_F139594_0_0|CSTM-ALL|CSTM-00|2020|PDM|2138.00|99|0.00|AEG 8 (NO REV)
20|FH_F139594_0_0|CSTM-ALL|CSTM-00|2020|PDM|534.00|99|0.00|AEG 1 (NO REV)
20|FH_F139594_0_0|SrvcGrp|113576|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F139607_0_0|CSTM-ALL|CSTM-00|2020|PDM|1008.00|99|0.00|AEG 2 (NO REV)
20|FH_F139607_0_0|CSTM-ALL|CSTM-00|2020|PDM|1410.00|99|0.00|AEG 4 (NO REV)
20|FH_F139607_0_0|CSTM-ALL|CSTM-00|2020|PDM|1512.00|99|0.00|AEG 10 (NO REV)
20|FH_F139607_0_0|CSTM-ALL|CSTM-00|2020|PDM|1755.00|99|0.00|AEG 6  W/O BREAKOUT SURG (NO REV)
20|FH_F139607_0_0|SrvcGrp|113114|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F139607_0_0|SrvcGrp|12491|2022|PCT|0.30|99|0.00|PACEMAKER
20|FH_F139607_0_0|SrvcGrp|74670|2022|PCT|0.30|99|0.00|AETNA OP INTRAOCULAR LENS
20|FH_F139607_0_0|SrvcGrp|76847|2022|PDM|1678.00|99|0.00|AETNA ARTHROSCOPY
20|FH_F139689_0_0|SrvcGrp|107746|2022|PCT|0.90|99|0.00|PARSABIV
20|FH_F139689_0_0|SrvcGrp|107747|2022|PDM|533.00|99|0.00|HOME HEMODIALYSIS
20|FH_F139689_0_0|SrvcGrp|108042|2022|PDM|541.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD
20|FH_F139690_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F139690_0_0|SrvcGrp|107747|2022|PDM|375.00|99|0.00|HOME HEMODIALYSIS
20|FH_F139690_0_0|SrvcGrp|107749|2022|PDM|214.00|99|0.00|CAPD/CCPD
20|FH_F139690_0_0|SrvcGrp|108042|2022|PDM|500.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD
20|FH_F139690_0_0|SrvcGrp|113580|2022|PDM|150.00|99|0.00|DIALYSIS PATIENT TRAINING
20|FH_F139703_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE
20|FH_F139719_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F139719_0_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC
20|FH_F139719_0_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB
20|FH_F139719_0_0|SrvcGrp|82981|2022|PDM|120.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F139750_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F139750_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.40|99|0.00|HSS ASC
20|FH_F139755_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F139755_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F139779_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS
20|FH_F139789_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F139825_0_0|CSTM-ALL|CSTM-00|2020|PDM|1473.00|99|0.00|AEG 4 (NO REV)
20|FH_F139825_0_0|CSTM-ALL|CSTM-00|2020|PDM|2952.00|99|0.00|AEG 9 (NO REV)
20|FH_F139825_0_0|CSTM-ALL|CSTM-00|2020|PDM|781.00|99|0.00|AEG 1 (NO REV)
20|FH_F139825_0_0|SrvcGrp|109758|2022|PDM|11475.00|99|0.00|COLLAGEN CROSSLINKING CORNEA
20|FH_F139825_0_0|SrvcGrp|109759|2022|PDM|5738.00|99|0.00|REMOVAL CORNEAL EPITHELIUM
20|FH_F139825_0_0|SrvcGrp|84278|2022|PDM|9754.00|99|0.00|CORNEAL TRANSPLANT
20|FH_F139825_0_0|SrvcGrp|84279|2022|PDM|9754.00|99|0.00|CORNEAL TRANSPLANT
20|FH_F139873_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F139873_0_0|CSTM-ALL|CSTM-00|2020|PDM|1338.00|99|0.00|AEG 10 (NO REV)
20|FH_F139873_0_0|CSTM-ALL|CSTM-00|2020|PDM|1338.00|99|0.00|AEG 4 (NO REV)
20|FH_F139873_0_0|CSTM-ALL|CSTM-00|2020|PDM|1517.00|99|0.00|AEG 5  (NO REV)
20|FH_F139873_0_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F139873_0_0|SrvcGrp|26273|2022|PDM|2215.00|99|0.00|CPT 29880
20|FH_F139873_0_0|SrvcGrp|33967|2022|PDM|2215.00|99|0.00|CPT 47562
20|FH_F139873_0_0|SrvcGrp|35668|2022|PDM|2215.00|99|0.00|CPT 29824
20|FH_F139887_0_0|CSTM-ALL|CSTM-00|2020|PDM|1040.00|99|0.00|AEG 5  (NO REV)
20|FH_F139887_0_0|CSTM-ALL|CSTM-00|2020|PDM|1410.00|99|0.00|AEG 8 (NO REV)
20|FH_F139887_0_0|CSTM-ALL|CSTM-00|2020|PDM|1442.00|99|0.00|AEG 7 (NO REV)
20|FH_F139887_0_0|SrvcGrp|113589|2022|PDM|1848.00|99|0.00|REMOVAL OF TOE
20|FH_F139887_0_0|SrvcGrp|33982|2022|PDM|1848.00|99|0.00|CPT 28296
20|FH_F139887_0_0|SrvcGrp|92197|2022|PDM|5973.00|99|0.00|CORRECTION OF BUNION
20|FH_F139910_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F139910_0_0|CSTM-ALL|CSTM-00|2020|PDM|404.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F139916_0_0|SrvcGrp|108484|2022|PDM|668.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY
20|FH_F139916_0_0|SrvcGrp|46903|2022|PDM|668.00|99|0.00|RESIDENTIAL TREATMENT
20|FH_F139916_0_0|SrvcGrp|86723|2022|PDM|453.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)
20|FH_F139916_0_0|SrvcGrp|89417|2022|PDM|468.00|99|0.00|PARTIAL HOSPITALIZATION
20|FH_F139927_0_0|SrvcGrp|471|2022|PDM|798.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F139927_0_0|SrvcGrp|76501|2022|PDM|523.00|99|0.00|SUB-ACUTE - LEVEL I
20|FH_F139927_0_0|SrvcGrp|78455|2022|PCT|0.60|99|0.00|HIGH COST DRUGS
20|FH_F139927_0_0|SrvcGrp|84779|2022|PCT|0.60|99|0.00|ENTERAL AND PARENTERAL THERAPY
20|FH_F139952_0_0|CSTM-ALL|CSTM-00|2020|PDM|888.00|99|0.00|AEG 4 (NO REV)
20|FH_F139952_0_0|CSTM-ALL|CSTM-00|2020|PDM|888.00|99|0.00|AEG 6 (NO REV)
20|FH_F139952_0_0|CSTM-ALL|CSTM-00|2020|PDM|888.00|99|0.00|AEG 7 (NO REV)
20|FH_F140007_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F140007_0_0|CSTM-ALL|CSTM-00|2020|PDM|3218.00|99|0.00|AEG 6 (NO REV)
20|FH_F140007_0_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F140007_0_0|SrvcGrp|113576|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F140007_0_0|SrvcGrp|12309|2022|PDM|7887.00|99|0.00|MICRODISKETOMY
20|FH_F140007_0_0|SrvcGrp|16693|2022|PDM|3470.00|99|0.00|KNEE SCOPE, MENISCECTOMY
20|FH_F140007_0_0|SrvcGrp|84442|2022|PDM|10190.00|99|0.00|REVISION KNEE
20|FH_F140007_0_0|SrvcGrp|93741|2022|PDM|8045.00|99|0.00|REVISE SPINE ELECTRODE PERCUTANEOUS ARRAY
20|FH_F140007_0_0|SrvcGrp|96352|2022|PDM|6032.00|99|0.00|ANKLE JOINT
20|FH_F140007_0_0|SrvcGrp|96354|2022|PDM|7887.00|99|0.00|REMOVAL OF ANKLE JOINT
20|FH_F140007_0_0|SrvcGrp|96355|2022|PDM|8045.00|99|0.00|SPINE FIXATION
20|FH_F140007_0_0|SrvcGrp|97019|2022|PDM|4206.00|99|0.00|ARTHROSCOPY BICEPS TENODESIS
20|FH_F140007_0_0|SrvcGrp|97039|2022|PDM|3539.00|99|0.00|KNEE ARTHROSCOPY
20|FH_F140007_0_0|SrvcGrp|97059|2022|PDM|3470.00|99|0.00|MENISCUS REPAIR, MED OR LAT
20|FH_F140007_0_0|SrvcGrp|97119|2022|PDM|8045.00|99|0.00|NECK SPINE DISK SURGERY
20|FH_F140007_0_0|SrvcGrp|97179|2022|PDM|7887.00|99|0.00|DECOMPRESS SPINE CORD ADD-ON
20|FH_F140007_0_0|SrvcGrp|97239|2022|PDM|8045.00|99|0.00|DISKECTOMY CERVICAL SINGLE
20|FH_F140007_0_0|SrvcGrp|97362|2022|PDM|7887.00|99|0.00|INCISE SPINAL COLUMN NERVES
20|FH_F140035_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F140035_0_0|SrvcGrp|26001|2022|PDM|249.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F140102_0_0|SrvcGrp|104224|2022|PDM|105.00|99|0.00|HOSPICE CARE PROVIDED IN INPATIENT HOSPICE FACILITY (HCFA)
20|FH_F140102_0_0|SrvcGrp|104226|2022|PDM|105.00|99|0.00|HOSPICE CARE (HCFA)
20|FH_F140102_0_0|SrvcGrp|104229|2022|PDM|105.00|99|0.00|HOSPICE IN HOME (HCFA)
20|FH_F140105_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F140105_0_0|CSTM-ALL|CSTM-00|2020|PDM|871.00|99|0.00|AEG 10 (NO REV)
20|FH_F140105_0_0|CSTM-ALL|CSTM-00|2020|PDM|871.00|99|0.00|AEG 2 (NO REV)
20|FH_F140175_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F140175_0_0|SrvcGrp|113609|2022|PCT|0.00|99|0.00|HYPERBARIC CHAMBER INCIDENTAL
20|FH_F140207_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F140209_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|AEG 3 (NO REV)
20|FH_F140209_0_0|CSTM-ALL|CSTM-00|2020|PDM|1325.00|99|0.00|AEG 6 (NO REV)
20|FH_F140209_0_0|CSTM-ALL|CSTM-00|2020|PDM|1375.00|99|0.00|AEG 4 (NO REV)
20|FH_F140209_0_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F125328_0_0|SrvcGrp|104555|2022|PDM|9427.50|99|0.00|HYSTEROSCOPY REMOVE FB
20|FH_F125328_0_0|SrvcGrp|110066|2022|PDM|768.00|99|0.00|ANOSCOPY CONTROL BLEEDING
20|FH_F125328_0_0|SrvcGrp|27347|2022|PDM|12535.50|99|0.00|CPT 58558
20|FH_F125328_0_0|SrvcGrp|27348|2022|PDM|8520.00|99|0.00|OP SURGERY (CPT 58662)
20|FH_F125328_0_0|SrvcGrp|67989|2022|PDM|2370.00|99|0.00|CPT 49320
20|FH_F125328_0_0|SrvcGrp|72994|2022|PDM|549.00|99|0.00|AEG 3
20|FH_F125328_0_0|SrvcGrp|73000|2022|PDM|905.00|99|0.00|AEG 6
20|FH_F125328_0_0|SrvcGrp|79579|2022|PDM|3315.00|99|0.00|CPT 43251
20|FH_F125328_0_0|SrvcGrp|79595|2022|PDM|2535.00|99|0.00|CPT 45385
20|FH_F125328_0_0|SrvcGrp|83817|2022|PDM|14356.50|99|0.00|LAPAROSCOPY LYSIS ADHESIONS
20|FH_F125328_0_0|SrvcGrp|88147|2022|PDM|15798.00|99|0.00|LAPAROSCOPY REMOVE ADNEXA
20|FH_F125473_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F125473_0_0|CSTM-ALL|CSTM-00|2020|PDM|1722.00|99|0.00|AEG 1 (NO REV)
20|FH_F125473_0_0|CSTM-ALL|CSTM-00|2020|PDM|3906.00|99|0.00|AEG 5  (NO REV)
20|FH_F125473_0_0|CSTM-ALL|CSTM-00|2020|PDM|7482.00|99|0.00|AEG 7 (NO REV)
20|FH_F125473_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F125657_0_0|SrvcGrp|87077|2022|PDM|130.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F125677_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS
20|FH_F125772_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|AEG 5  (NO REV)
20|FH_F125772_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|AEG 8 (NO REV)
20|FH_F125772_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|AEG 9 (NO REV)
20|FH_F125772_0_0|CSTM-ALL|CSTM-00|2020|PDM|975.00|99|0.00|AEG 1 (NO REV)
20|FH_F125870_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F125870_0_0|SrvcGrp|110211|2022|PDM|1295.00|99|0.00|INCISE INNER EYE ADHESIONS
20|FH_F125870_0_0|SrvcGrp|114518|2022|PDM|3095.00|99|0.00|INSERTION DRAINAGE DEVICE
20|FH_F125870_0_0|SrvcGrp|28549|2022|PDM|2445.00|99|0.00|VITRECTOMY
20|FH_F125870_0_0|SrvcGrp|72992|2022|PDM|992.00|99|0.00|AEG 2
20|FH_F125870_0_0|SrvcGrp|72994|2022|PDM|1195.00|99|0.00|AEG 3
20|FH_F125870_0_0|SrvcGrp|73002|2022|PDM|2247.00|99|0.00|AEG 7
20|FH_F125870_0_0|SrvcGrp|73008|2022|PDM|746.00|99|0.00|AEG 10
20|FH_F125870_0_0|SrvcGrp|88154|2022|PDM|2445.00|99|0.00|LASER TREATMENT OLD RETINA
20|FH_F125910_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F125910_0_0|SrvcGrp|87077|2022|PDM|113.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F125928_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F125928_0_0|SrvcGrp|106291|2022|PDM|217.36|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT LEVEL 1 (HCFA)
20|FH_F125928_0_0|SrvcGrp|106300|2022|PDM|289.81|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT (HCFA)
20|FH_F125928_0_0|SrvcGrp|106314|2022|PDM|498.38|99|0.00|ADVANCED LIFE SUPPORT LEVEL 2 (ALS2) (HCFA)
20|FH_F125928_0_0|SrvcGrp|106317|2022|PDM|588.69|99|0.00|SPECIALTY CARE TRANSPORT (HCFA)
20|FH_F125938_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F125938_0_0|SrvcGrp|73606|2022|PCT|0.75|99|0.00|AETNA SKILLED NURSING CARE
20|FH_F125938_0_0|SrvcGrp|79720|2022|PCT|0.75|99|0.00|ACUTE REHAB II
20|FH_F125946_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F126070_0_0|SrvcGrp|72994|2022|PDM|620.00|99|0.00|AEG 3
20|FH_F126073_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F126104_0_0|SrvcGrp|108041|2022|PDM|450.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME
20|FH_F126104_0_0|SrvcGrp|108042|2022|PDM|400.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD
20|FH_F126104_0_0|SrvcGrp|108043|2022|PDM|171.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD
20|FH_F126104_0_0|SrvcGrp|108082|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER
20|FH_F126116_0_0|CSTM-ALL|CSTM-00|2020|PDM|1392.00|99|0.00|AEG 4 (NO REV)
20|FH_F126116_0_0|CSTM-ALL|CSTM-00|2020|PDM|1825.00|99|0.00|AEG 6 (NO REV)
20|FH_F126116_0_0|CSTM-ALL|CSTM-00|2020|PDM|2198.00|99|0.00|AEG 7 (NO REV)
20|FH_F126116_0_0|CSTM-ALL|CSTM-00|2020|PDM|986.00|99|0.00|AEG 2 (NO REV)
20|FH_F126116_0_0|SrvcGrp|103642|2022|PDM|7395.00|99|0.00|AETNA FEM/POPL REVASE W/ATHER
20|FH_F126116_0_0|SrvcGrp|103643|2022|PDM|7179.00|99|0.00|AETNA FEM/POPL REVASE W/ STENT
20|FH_F126116_0_0|SrvcGrp|103645|2022|PDM|11079.00|99|0.00|AETNA TIB/ PER REVASE W/ STENT
20|FH_F126116_0_0|SrvcGrp|109443|2022|PDM|390.00|99|0.00|HEART ELECTROCONVERSION
20|FH_F126116_0_0|SrvcGrp|109504|2022|PDM|9084.00|99|0.00|REMV & REPLC PM GEN DUAL LEAD
20|FH_F126116_0_0|SrvcGrp|110349|2022|PDM|1125.00|99|0.00|REOPEN FALLOPIAN TUBE
20|FH_F126116_0_0|SrvcGrp|89404|2022|PDM|13500.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F126305_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F126345_0_0|SrvcGrp|101524|2022|PDM|1480.00|99|0.00|MISSED ABORTION SECOND TRIMESTER
20|FH_F126345_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F126345_0_0|SrvcGrp|106718|2022|PDM|1480.00|99|0.00|INDUCED ABORTION BY DILATION AND CURETTAGE
20|FH_F126345_0_0|SrvcGrp|33977|2022|PDM|1480.00|99|0.00|CPT 59820
20|FH_F126345_0_0|SrvcGrp|63472|2022|PDM|2376.00|99|0.00|CPT 64581
20|FH_F126345_0_0|SrvcGrp|72992|2022|PDM|610.00|99|0.00|AEG 2
20|FH_F126345_0_0|SrvcGrp|72998|2022|PDM|979.00|99|0.00|AEG 5
20|FH_F126345_0_0|SrvcGrp|73000|2022|PDM|1136.00|99|0.00|AEG 6
20|FH_F126345_0_0|SrvcGrp|89869|2022|PDM|1480.00|99|0.00|SPONTANEOUS ABORTION
20|FH_F126502_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F126502_0_0|SrvcGrp|82981|2022|PDM|133.95|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F126502_0_0|SrvcGrp|87077|2022|PDM|133.95|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F126523_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F126523_0_0|SrvcGrp|108935|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F126523_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F126523_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F126523_0_0|SrvcGrp|72992|2022|PDM|680.00|99|0.00|AEG 2
20|FH_F126523_0_0|SrvcGrp|72998|2022|PDM|1050.00|99|0.00|AEG 5
20|FH_F126523_0_0|SrvcGrp|73006|2022|PDM|1500.00|99|0.00|AEG 9
20|FH_F126527_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F140209_0_0|SrvcGrp|113576|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F140247_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|HSS ASC INVOICE
20|FH_F140247_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE
20|FH_F140295_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F140295_0_0|CSTM-ALL|CSTM-00|2020|PDM|1894.00|99|0.00|AEG 3 (NO REV)
20|FH_F140295_0_0|CSTM-ALL|CSTM-00|2020|PDM|2801.00|99|0.00|AEG 10 (NO REV)
20|FH_F140295_0_0|CSTM-ALL|CSTM-00|2020|PDM|5354.00|99|0.00|AEG 9 (NO REV)
20|FH_F140295_0_0|SrvcGrp|112035|2022|PDM|3348.00|99|0.00|ANKLE IMPLANT
20|FH_F140295_0_0|SrvcGrp|113628|2022|PDM|5835.00|99|0.00|REVISE KNUCKLE JOINT
20|FH_F140295_0_0|SrvcGrp|11673|2022|PDM|7225.00|99|0.00|CPT 29888
20|FH_F140295_0_0|SrvcGrp|16289|2022|PDM|2758.00|99|0.00|CARPAL TUNNEL RELEASE
20|FH_F140295_0_0|SrvcGrp|26274|2022|PDM|3481.00|99|0.00|CPT 29877
20|FH_F140295_0_0|SrvcGrp|35668|2022|PDM|2827.00|99|0.00|CPT 29824
20|FH_F140295_0_0|SrvcGrp|41334|2022|PDM|20085.00|99|0.00|TOTAL KNEE
20|FH_F140295_0_0|SrvcGrp|54943|2022|PDM|4164.00|99|0.00|REPAIR OF SLAP LESION
20|FH_F140295_0_0|SrvcGrp|75002|2022|PDM|4135.00|99|0.00|ARTHOSCOPY
20|FH_F140295_0_0|SrvcGrp|84939|2022|PDM|18566.00|99|0.00|SHOULDER JOINT
20|FH_F140295_0_0|SrvcGrp|85792|2022|PDM|4892.00|99|0.00|OPEN TREATMENT OF DISTAL
20|FH_F140295_0_0|SrvcGrp|88024|2022|PDM|7936.00|99|0.00|REMOVAL OF POSTERIOR SEGMENTAL INSTRUMENTATION
20|FH_F140295_0_0|SrvcGrp|88491|2022|PDM|7197.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR
20|FH_F140295_0_0|SrvcGrp|88820|2022|PDM|4010.00|99|0.00|CPT 24359
20|FH_F140295_0_0|SrvcGrp|89980|2022|PDM|4837.00|99|0.00|OPEN TREATMENT OF DISTAL
20|FH_F140295_0_0|SrvcGrp|90363|2022|PDM|6896.00|99|0.00|REVISE/IMPLANT FINGER JOINT
20|FH_F140295_0_0|SrvcGrp|91566|2022|PDM|4509.00|99|0.00|REVISE FINGER JOINT
20|FH_F140295_0_0|SrvcGrp|92823|2022|PDM|4774.00|99|0.00|REVISE KNUCKLE WITH IMPLANT
20|FH_F140295_0_0|SrvcGrp|93431|2022|PDM|13261.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT
20|FH_F140295_0_0|SrvcGrp|93432|2022|PDM|12200.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT
20|FH_F140295_0_0|SrvcGrp|93807|2022|PDM|2966.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY
20|FH_F140295_0_0|SrvcGrp|95559|2022|PDM|11845.00|99|0.00|HIP JOINT
20|FH_F140295_0_0|SrvcGrp|99073|2022|PDM|1.56|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F140340_0_0|SrvcGrp|82981|2022|PDM|120.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F140349_0_0|CSTM-ALL|CSTM-00|2020|PDM|428.00|99|0.00|AEG 8 (NO REV)
20|FH_F140349_0_0|CSTM-ALL|CSTM-00|2020|PDM|428.00|99|0.00|AEG 9 (NO REV)
20|FH_F140373_0_0|CSTM-ALL|CSTM-00|2020|PDM|1519.00|99|0.00|AEG 8 (NO REV)
20|FH_F140373_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F140427_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 3 (NO REV) W/O GEN MULT LEADS
20|FH_F140427_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 1 (NO REV)
20|FH_F140427_0_0|SrvcGrp|104316|2022|PDM|5300.00|99|0.00|PERC DRUG-EL COR STENT SING
20|FH_F140427_0_0|SrvcGrp|108518|2022|PDM|900.00|99|0.00|IMPLANT PAT ACTIVE HT RECORD
20|FH_F140427_0_0|SrvcGrp|113637|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES
20|FH_F140427_0_0|SrvcGrp|96380|2022|PDM|2500.00|99|0.00|AETNA INS/REP SUBQ DEFIBRILLATOR
20|FH_F140472_0_0|SrvcGrp|15480|2022|PDM|80.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F140472_0_0|SrvcGrp|15788|2022|PDM|80.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F140575_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F140575_0_0|CSTM-ALL|CSTM-00|2020|PCT|36500.00|99|0.00|TIMELY FILING
20|FH_F140576_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F140576_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F140576_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F140578_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F140579_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|GENERAL ACUTE CARE
20|FH_F140608_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F140608_0_0|SrvcGrp|23683|2022|PDM|122.00|99|0.00|SKILLED NURSING RN
20|FH_F140608_0_0|SrvcGrp|48394|2022|PDM|61.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F140608_0_0|SrvcGrp|88620|2022|PDM|120.00|99|0.00|SKILLED NURSING RN
20|FH_F140629_0_0|CSTM-ALL|CSTM-00|2020|PDM|1148.00|99|0.00|AEG 4 (NO REV)
20|FH_F140629_0_0|CSTM-ALL|CSTM-00|2020|PDM|658.00|99|0.00|AEG 1 (NO REV)
20|FH_F140629_0_0|SrvcGrp|103570|2022|PDM|2497.00|99|0.00|ARTHROSCOPIC FRACTURE
20|FH_F140629_0_0|SrvcGrp|104108|2022|PDM|1016.00|99|0.00|EXCISION OF BREAST LESION ID
20|FH_F140629_0_0|SrvcGrp|107088|2022|PDM|2497.00|99|0.00|JAW ARTHROSCOPY/TMJ SURG
20|FH_F140629_0_0|SrvcGrp|108461|2022|PDM|1302.00|99|0.00|SLIDING REPAIR ING HERNIA
20|FH_F140629_0_0|SrvcGrp|111804|2022|PDM|1016.00|99|0.00|CYSTOSCOPY & REVISE URETHRA
20|FH_F140629_0_0|SrvcGrp|113615|2022|PDM|1098.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F140629_0_0|SrvcGrp|113665|2022|PDM|2497.00|99|0.00|LAPAROSCOPY
20|FH_F140629_0_0|SrvcGrp|113667|2022|PDM|2497.00|99|0.00|ESOPHAGUS LAPAROSCOPY
20|FH_F140629_0_0|SrvcGrp|113671|2022|PDM|2497.00|99|0.00|SPLEEN LAPAROSCOPE
20|FH_F140629_0_0|SrvcGrp|113674|2022|PDM|2497.00|99|0.00|UNLISTED LAPAROSCOPY
20|FH_F140629_0_0|SrvcGrp|113675|2022|PDM|2497.00|99|0.00|LAPARO ABLATE LIVER TUMOR RF
20|FH_F140629_0_0|SrvcGrp|113680|2022|PDM|2497.00|99|0.00|UNLISTED URETER LAPAROSCOPY
20|FH_F140629_0_0|SrvcGrp|113683|2022|PDM|2497.00|99|0.00|LAPARO SLING OPERATION
20|FH_F140629_0_0|SrvcGrp|113687|2022|PDM|2497.00|99|0.00|LAPARO ABLATE RENAL CYST
20|FH_F140629_0_0|SrvcGrp|113689|2022|PDM|2497.00|99|0.00|VAGUS NERVE LAPAROSCOPY
20|FH_F140629_0_0|SrvcGrp|26274|2022|PDM|2497.00|99|0.00|CPT 29877
20|FH_F140629_0_0|SrvcGrp|27316|2022|PDM|2497.00|99|0.00|TONSILS & ADENOIDS (42820)
20|FH_F140629_0_0|SrvcGrp|41546|2022|PDM|2497.00|99|0.00|LAPAROSCOPIC APPENDECTOMY
20|FH_F140629_0_0|SrvcGrp|44068|2022|PDM|1016.00|99|0.00|CPT 52332
20|FH_F140629_0_0|SrvcGrp|82111|2022|PDM|2497.00|99|0.00|KNEE ARTHROSCOPY SURGICAL
20|FH_F140629_0_0|SrvcGrp|82113|2022|PDM|2497.00|99|0.00|KNEE ARTHROSCOPY SURGERY
20|FH_F140629_0_0|SrvcGrp|83646|2022|PDM|1372.00|99|0.00|CPT 31276
20|FH_F140629_0_0|SrvcGrp|88600|2022|PDM|2497.00|99|0.00|WRIST ARTHROS DIAG W/WO BIO
20|FH_F140629_0_0|SrvcGrp|98525|2022|PDM|1016.00|99|0.00|CYSTOURETHROSCOPY
20|FH_F140629_0_0|SrvcGrp|99155|2022|PDM|2497.00|99|0.00|WRST ARTHROS SURG
20|FH_F140651_0_0|CSTM-ALL|CSTM-00|2020|PDM|2398.00|99|0.00|AEG 4 (NO REV)
20|FH_F140651_0_0|CSTM-ALL|CSTM-00|2020|PDM|2552.00|99|0.00|AEG 5  (NO REV)
20|FH_F140651_0_0|CSTM-ALL|CSTM-00|2020|PDM|3234.00|99|0.00|AEG 9 (NO REV)
20|FH_F140651_0_0|CSTM-ALL|CSTM-00|2020|PDM|594.00|99|0.00|AEG 1 (NO REV)
20|FH_F140651_0_0|SrvcGrp|103974|2022|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES
20|FH_F140689_0_0|SrvcGrp|87077|2022|PDM|165.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F140762_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F140762_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F140762_0_0|CSTM-ALL|CSTM-00|2020|PDM|471.00|99|0.00|AEG 1 (NO REV)
20|FH_F140762_0_0|CSTM-ALL|CSTM-00|2020|PDM|633.00|99|0.00|AEG 2 (NO REV)
20|FH_F140762_0_0|SrvcGrp|104719|2022|PDM|1723.00|99|0.00|RELIEVE INNER EYE PRESSURE
20|FH_F140762_0_0|SrvcGrp|108434|2022|PDM|2677.00|99|0.00|INSJ AQUEOUS DRAIN DEV 1ST
20|FH_F140762_0_0|SrvcGrp|113696|2022|PDM|1723.00|99|0.00|AQUEOUS SHUNT EYE W/O GRAFT
20|FH_F140762_0_0|SrvcGrp|11663|2022|PCT|0.52|99|0.00|IMPLANTS
20|FH_F140762_0_0|SrvcGrp|12491|2022|PCT|0.52|99|0.00|PACEMAKER
20|FH_F140762_0_0|SrvcGrp|94902|2022|PDM|2508.00|99|0.00|INSERT ANT SEGMENT DRAIN EXT
20|FH_F140790_0_0|CSTM-ALL|CSTM-00|2020|PDM|1070.00|99|0.00|AEG 7 (NO REV)
20|FH_F140790_0_0|CSTM-ALL|CSTM-00|2020|PDM|1655.00|99|0.00|AEG 9 (NO REV)
20|FH_F140790_0_0|CSTM-ALL|CSTM-00|2020|PDM|779.00|99|0.00|AEG 10 (NO REV)
20|FH_F140790_0_0|SrvcGrp|28549|2022|PDM|2750.00|99|0.00|VITRECTOMY
20|FH_F140790_0_0|SrvcGrp|28551|2022|PDM|2750.00|99|0.00|REPAIR OF COMPLEX RETINAL DETACHMENT
20|FH_F140827_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F140827_0_0|CSTM-ALL|CSTM-00|2020|PDM|659.00|99|0.00|AEG 1 (NO REV)
20|FH_F140827_0_0|CSTM-ALL|CSTM-00|2020|PDM|764.00|99|0.00|AEG 10 (NO REV)
20|FH_F140873_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F140873_0_0|SrvcGrp|104226|2022|PDM|152.00|99|0.00|HOSPICE CARE (HCFA)
20|FH_F140873_0_0|SrvcGrp|104230|2022|PDM|152.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F140873_0_0|SrvcGrp|80920|2022|PDM|735.00|99|0.00|HOSPICE SERVICES
20|FH_F140873_0_0|SrvcGrp|82223|2022|PDM|152.00|99|0.00|HOSPICE CARE
20|FH_F140873_0_0|SrvcGrp|84185|2022|PDM|152.00|99|0.00|RESPITE CARE
20|FH_F140987_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F140987_0_0|CSTM-ALL|CSTM-00|2020|PDM|2900.00|99|0.00|AEG 3 (NO REV)
20|FH_F140990_0_0|SrvcGrp|107747|2022|PDM|592.00|99|0.00|HOME HEMODIALYSIS
20|FH_F140990_0_0|SrvcGrp|108082|2022|PDM|155.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER
20|FH_F140998_0_0|CSTM-ALL|CSTM-00|2020|PCT|63.00|99|0.00|OP SVCS
20|FH_F141007_0_0|CSTM-ALL|CSTM-00|2020|PCT|62.50|99|0.00|OP SVCS
20|FH_F141007_0_0|CSTM-ALL|CSTM-00|2020|PCT|64.00|99|0.00|GENERAL ACUTE CARE
20|FH_F141021_0_0|SrvcGrp|105819|2022|PDM|1270.00|99|0.00|AETNA RESIDENTIAL TREATMNT-EATING DISORDERS
20|FH_F141031_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F141031_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F141034_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F141034_0_0|SrvcGrp|107749|2022|PDM|171.00|99|0.00|CAPD/CCPD
20|FH_F141035_0_0|CSTM-ALL|CSTM-00|2020|PDM|1927.00|99|0.00|AEG 4 (NO REV)
20|FH_F141035_0_0|CSTM-ALL|CSTM-00|2020|PDM|3042.00|99|0.00|AEG 10 (NO REV)
20|FH_F141035_0_0|CSTM-ALL|CSTM-00|2020|PDM|4094.00|99|0.00|AEG 9 (NO REV)
20|FH_F141035_0_0|SrvcGrp|104111|2022|PDM|3932.00|99|0.00|EXCISE WRIST TENDON SHEATH
20|FH_F141035_0_0|SrvcGrp|110994|2022|PDM|6016.00|99|0.00|DEB SKIN BONE AT FX SITE
20|FH_F141035_0_0|SrvcGrp|113576|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F141035_0_0|SrvcGrp|113715|2022|PDM|7008.00|99|0.00|AMPUTATION OF FINGER / THUMB
20|FH_F141035_0_0|SrvcGrp|113718|2022|PDM|4029.00|99|0.00|TENDON EXCISION PALM / FINGER
20|FH_F141035_0_0|SrvcGrp|113719|2022|PDM|7396.00|99|0.00|REPAIR MUSCLES OF HAND
20|FH_F141035_0_0|SrvcGrp|76602|2022|PDM|3932.00|99|0.00|CPT 25000
20|FH_F141035_0_0|SrvcGrp|82720|2022|PDM|3932.00|99|0.00|WRIST ENDOSCOPY/SURGERY
20|FH_F141035_0_0|SrvcGrp|83846|2022|PDM|7008.00|99|0.00|RELEASE PALM CONTRACTURE
20|FH_F141035_0_0|SrvcGrp|98005|2022|PDM|7008.00|99|0.00|DISTAL PHALANGEAL FRACTURE
20|FH_F141129_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F141129_0_0|SrvcGrp|29137|2022|PDM|11.00|99|0.00|HOME HEALTH AIDE
20|FH_F141167_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F141167_0_0|SrvcGrp|107749|2022|PDM|214.00|99|0.00|CAPD/CCPD
20|FH_F141169_0_0|CSTM-ALL|CSTM-00|2020|PDM|1480.00|99|0.00|AEG 9 (NO REV)
20|FH_F141169_0_0|CSTM-ALL|CSTM-00|2020|PDM|563.00|99|0.00|AEG 3 (NO REV)
20|FH_F141169_0_0|CSTM-ALL|CSTM-00|2020|PDM|696.00|99|0.00|AEG 4 (NO REV)
20|FH_F141169_0_0|SrvcGrp|113730|2022|PDM|1389.00|99|0.00|INDUCED ABORTION BY DILATION AND CURETTAGE
20|FH_F141169_0_0|SrvcGrp|113732|2022|PDM|403.00|99|0.00|EXAM OF VAGINA
20|FH_F141170_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F141170_0_0|CSTM-ALL|CSTM-00|2020|PDM|1045.00|99|0.00|AEG 4 (NO REV)
20|FH_F141170_0_0|CSTM-ALL|CSTM-00|2020|PDM|2222.00|99|0.00|AEG 9 (NO REV)
20|FH_F141170_0_0|CSTM-ALL|CSTM-00|2020|PDM|880.00|99|0.00|AEG 3 (NO REV)
20|FH_F141170_0_0|SrvcGrp|103327|2022|PDM|16000.00|99|0.00|INSJ STABLJ DEV W/DCMPRN
20|FH_F141170_0_0|SrvcGrp|103586|2022|PDM|2390.00|99|0.00|REMOVE SPINE INFUSION
20|FH_F141170_0_0|SrvcGrp|103592|2022|PDM|6000.00|99|0.00|VERTEBRAL ART
20|FH_F141170_0_0|SrvcGrp|27330|2022|PDM|3820.00|99|0.00|CPT 27096
20|FH_F141170_0_0|SrvcGrp|67065|2022|PDM|16400.00|99|0.00|CERVICAL SURGERY
20|FH_F141170_0_0|SrvcGrp|71666|2022|PDM|16000.00|99|0.00|CPT 63655
20|FH_F141170_0_0|SrvcGrp|74039|2022|PDM|5010.00|99|0.00|LAMINECTOMY
20|FH_F141170_0_0|SrvcGrp|77021|2022|PDM|5010.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY
20|FH_F141170_0_0|SrvcGrp|88159|2022|PDM|5010.00|99|0.00|LOW BACK DISK SURGERY
20|FH_F141170_0_0|SrvcGrp|99166|2022|PDM|3890.00|99|0.00|CPT 63005
20|FH_F141170_0_0|SrvcGrp|99168|2022|PDM|970.00|99|0.00|CPT 22899
20|FH_F141207_0_0|SrvcGrp|83857|2022|PDM|995.00|99|0.00|IP HOSPICE SVCS
20|FH_F141210_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F141210_0_0|CSTM-ALL|CSTM-00|2020|PDM|1327.00|99|0.00|AEG 1 (NO REV)
20|FH_F141210_0_0|CSTM-ALL|CSTM-00|2020|PDM|1885.00|99|0.00|AEG 3 (NO REV)
20|FH_F141210_0_0|CSTM-ALL|CSTM-00|2020|PDM|2228.00|99|0.00|AEG 8 (NO REV)
20|FH_F141210_0_0|CSTM-ALL|CSTM-00|2020|PDM|2652.00|99|0.00|AEG 7 (NO REV)
20|FH_F141210_0_0|CSTM-ALL|CSTM-00|2020|PDM|2833.00|99|0.00|AEG 9 (NO REV)
20|FH_F141210_0_0|SrvcGrp|88599|2022|PDM|5150.00|99|0.00|ENDOSCOPY MAXILLARY SINUS
20|FH_F141210_0_0|SrvcGrp|89404|2022|PDM|13648.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F141210_0_0|SrvcGrp|89882|2022|PDM|5150.00|99|0.00|AETNA REMOVAL OF TONSILS
20|FH_F141210_0_0|SrvcGrp|93432|2022|PDM|13648.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT
20|FH_F141211_0_0|CSTM-ALL|CSTM-00|2020|PDM|2106.00|99|0.00|AEG 4 (NO REV)
20|FH_F141217_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F141217_0_0|CSTM-ALL|CSTM-00|2020|PDM|1748.00|99|0.00|AEG 6 (NO REV)
20|FH_F141217_0_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F141217_0_0|SrvcGrp|27261|2022|PDM|9500.00|99|0.00|CPT 27446
20|FH_F141217_0_0|SrvcGrp|41334|2022|PDM|9500.00|99|0.00|TOTAL KNEE
20|FH_F141248_0_0|SrvcGrp|3178|2022|PDM|927.00|99|0.00|ACUTE PSYCH
20|FH_F141267_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F141267_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F141267_0_0|SrvcGrp|103911|2022|PDM|939.00|99|0.00|HOSPICE CARE PROVIDED IN INPATIENT HOSPICE FACILITY
20|FH_F141267_0_0|SrvcGrp|113662|2022|PDM|172.00|99|0.00|HOSPICE ROUT HOME CARE-DIEM
20|FH_F141267_0_0|SrvcGrp|80918|2022|PDM|939.00|99|0.00|RESPITE CARE
20|FH_F141267_0_0|SrvcGrp|95661|2022|PDM|939.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F141274_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F141274_0_0|SrvcGrp|113738|2022|PDM|10.00|99|0.00|LABORATORY (MOD 26)
20|FH_F141411_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F141411_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|AEG 9 (NO REV)
20|FH_F141411_0_0|SrvcGrp|113758|2022|PDM|4500.00|99|0.00|DEBRIDEMENT OF SKIN
20|FH_F141411_0_0|SrvcGrp|113760|2022|PDM|5000.00|99|0.00|WOUND OR LESION REPAIR
20|FH_F141411_0_0|SrvcGrp|64517|2022|PDM|20000.00|99|0.00|REDUCE MANMMAPLASTY
20|FH_F141411_0_0|SrvcGrp|83839|2022|PDM|28200.00|99|0.00|BREAST RECONSTRUCTION
20|FH_F141411_0_0|SrvcGrp|84182|2022|PDM|5400.00|99|0.00|AETNA REMOVAL OF BREAST CAPSULE
20|FH_F141447_0_0|CSTM-ALL|CSTM-00|2020|PDM|1716.00|99|0.00|AEG 7 (NO REV)
20|FH_F141447_0_0|CSTM-ALL|CSTM-00|2020|PDM|1782.00|99|0.00|AEG 8 (NO REV)
20|FH_F141447_0_0|CSTM-ALL|CSTM-00|2020|PDM|785.00|99|0.00|AEG 2 (NO REV)
20|FH_F141447_0_0|CSTM-ALL|CSTM-00|2020|PDM|924.00|99|0.00|AEG 4 (NO REV)
20|FH_F141447_0_0|SrvcGrp|113114|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F141471_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 8 (NO REV)
20|FH_F141471_0_0|CSTM-ALL|CSTM-00|2020|PDM|725.00|99|0.00|AEG 2 (NO REV)
20|FH_F141471_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|AEG 3 (NO REV)
20|FH_F141471_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 10 (NO REV)
20|FH_F141471_0_0|SrvcGrp|113284|2022|PDM|1551.00|99|0.00|LIGATION/BANDING A-V
20|FH_F141471_0_0|SrvcGrp|68546|2022|PDM|1613.00|99|0.00|CPT 36558
20|FH_F141471_0_0|SrvcGrp|77278|2022|PDM|1613.00|99|0.00|AETNA REPL TUNNLD CNTRL CVC W/O PORT/PUMP
20|FH_F141507_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F141507_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F141507_0_0|CSTM-ALL|CSTM-00|2020|PDM|1296.00|99|0.00|AEG 5  (NO REV)
20|FH_F141507_0_0|CSTM-ALL|CSTM-00|2020|PDM|810.00|99|0.00|AEG 2 (NO REV)
20|FH_F141507_0_0|CSTM-ALL|CSTM-00|2020|PDM|896.00|99|0.00|AEG 3 (NO REV)
20|FH_F141507_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F141507_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F141507_0_0|SrvcGrp|113775|2022|PDM|2400.00|99|0.00|INSJ AQUEOUS DRAIN DEV 1ST & ADDL
20|FH_F141511_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F141511_0_0|SrvcGrp|73483|2022|PCT|0.00|99|0.00|AETNA SUBACUTE III
20|FH_F141651_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F141651_0_0|CSTM-ALL|CSTM-00|2020|PDM|1210.00|99|0.00|AEG 6 (NO REV)
20|FH_F141651_0_0|CSTM-ALL|CSTM-00|2020|PDM|1430.00|99|0.00|AEG 8 (NO REV)
20|FH_F141651_0_0|CSTM-ALL|CSTM-00|2020|PDM|891.00|99|0.00|AEG 10 (NO REV)
20|FH_F141651_0_0|SrvcGrp|105244|2022|PDM|198.00|99|0.00|INCISION OF EARDRUM
20|FH_F141651_0_0|SrvcGrp|105245|2022|PDM|186.00|99|0.00|CREATE EARDRUM OPENING
20|FH_F141651_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F141651_0_0|SrvcGrp|106267|2022|PDM|2200.00|99|0.00|NSL/SINS NDSC SPHN TISS RMVL
20|FH_F141651_0_0|SrvcGrp|13187|2022|PCT|0.00|99|0.00|INTRAOCULAR LENSES
20|FH_F141651_0_0|SrvcGrp|59840|2022|PDM|1650.00|99|0.00|TYMPANOSTOMY
20|FH_F141651_0_0|SrvcGrp|77582|2022|PDM|2310.00|99|0.00|CPT 31255
20|FH_F141651_0_0|SrvcGrp|78098|2022|PDM|2420.00|99|0.00|AETNA REMOVAL OF TONSILS
20|FH_F141651_0_0|SrvcGrp|84910|2022|PDM|3850.00|99|0.00|ENDOSCOPY
20|FH_F141707_0_0|CSTM-ALL|CSTM-00|2020|PDM|3375.00|99|0.00|AEG 9 (NO REV)
20|FH_F141829_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F141829_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F141829_0_0|SrvcGrp|106291|2022|PDM|281.18|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT LEVEL 1 (HCFA)
20|FH_F141829_0_0|SrvcGrp|106300|2022|PDM|256.53|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT (HCFA)
20|FH_F141829_0_0|SrvcGrp|13262|2022|PDM|5.48|99|0.00|GROUND MILEAGE, PER STATUTE MILE
20|FH_F141837_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F141837_0_0|SrvcGrp|106294|2022|PDM|750.00|99|0.00|AMBULANCE SERVICE EMERGENCY TRANSPORT LEVEL 1 (HFCA)
20|FH_F141837_0_0|SrvcGrp|106300|2022|PDM|600.00|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT (HCFA)
20|FH_F141837_0_0|SrvcGrp|106314|2022|PDM|900.00|99|0.00|ADVANCED LIFE SUPPORT LEVEL 2 (ALS2) (HCFA)
20|FH_F141837_0_0|SrvcGrp|13597|2022|PDM|300.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT
20|FH_F141861_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F141861_0_0|CSTM-ALL|CSTM-00|2020|PDM|592.00|99|0.00|AEG 3 (NO REV)
20|FH_F141861_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F141873_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F141873_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F141873_0_0|SrvcGrp|108484|2022|PDM|702.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY
20|FH_F141874_0_0|SrvcGrp|22596|2022|PDM|175.46|99|0.00|HOSPICE CARE
20|FH_F141877_0_0|CSTM-ALL|CSTM-00|2020|PDM|564.00|99|0.00|AEG 10 (NO REV)
20|FH_F141877_0_0|CSTM-ALL|CSTM-00|2020|PDM|662.00|99|0.00|AEG 5  (NO REV)
20|FH_F141901_0_0|CSTM-ALL|CSTM-00|2020|PDM|1607.57|99|0.00|ASPG IX
20|FH_F141901_0_0|CSTM-ALL|CSTM-00|2020|PDM|399.79|99|0.00|ASPG I
20|FH_F141937_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F141937_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F142070_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F142070_0_0|SrvcGrp|107747|2022|PDM|675.00|99|0.00|HOME HEMODIALYSIS
20|FH_F142070_0_0|SrvcGrp|108043|2022|PDM|300.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD
20|FH_F142073_0_0|CSTM-ALL|CSTM-00|2020|PDM|1590.00|99|0.00|AEG 6 (NO REV)
20|FH_F142073_0_0|CSTM-ALL|CSTM-00|2020|PDM|1790.00|99|0.00|AEG 7 (NO REV)
20|FH_F142073_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|AEG 1 (NO REV)
20|FH_F142073_0_0|SrvcGrp|101117|2022|PDM|1000.00|99|0.00|INCISION EXTENSOR TENDON
20|FH_F142073_0_0|SrvcGrp|109966|2022|PDM|5980.00|99|0.00|DECOMPRESS SPINE CORD ADD-ON
20|FH_F142073_0_0|SrvcGrp|113114|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F142073_0_0|SrvcGrp|113861|2022|PDM|1000.00|99|0.00|REMOVE WRIST TENDON LESION
20|FH_F142073_0_0|SrvcGrp|115169|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F142073_0_0|SrvcGrp|11663|2022|PCT|1.05|99|0.00|IMPLANTS
20|FH_F142073_0_0|SrvcGrp|12309|2022|PDM|5980.00|99|0.00|MICRODISKETOMY
20|FH_F142073_0_0|SrvcGrp|16693|2022|PDM|1500.00|99|0.00|KNEE SCOPE, MENISCECTOMY
20|FH_F142073_0_0|SrvcGrp|41335|2022|PDM|11900.00|99|0.00|TOTAL HIP
20|FH_F142073_0_0|SrvcGrp|58993|2022|PDM|5980.00|99|0.00|DISKECTOMY
20|FH_F142073_0_0|SrvcGrp|70749|2022|PDM|2300.00|99|0.00|CPT 29823
20|FH_F142073_0_0|SrvcGrp|74039|2022|PDM|5980.00|99|0.00|LAMINECTOMY
20|FH_F142073_0_0|SrvcGrp|76604|2022|PDM|1740.00|99|0.00|CPT 25447
20|FH_F142073_0_0|SrvcGrp|77021|2022|PDM|5980.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY
20|FH_F142073_0_0|SrvcGrp|84939|2022|PDM|11900.00|99|0.00|SHOULDER JOINT
20|FH_F142073_0_0|SrvcGrp|88159|2022|PDM|5980.00|99|0.00|LOW BACK DISK SURGERY
20|FH_F142073_0_0|SrvcGrp|88491|2022|PDM|5980.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR
20|FH_F142073_0_0|SrvcGrp|95559|2022|PDM|11900.00|99|0.00|HIP JOINT
20|FH_F142073_0_0|SrvcGrp|96349|2022|PDM|11900.00|99|0.00|NECK SPINE FUSE
20|FH_F142073_0_0|SrvcGrp|96959|2022|PDM|1700.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F142073_0_0|SrvcGrp|97219|2022|PDM|5980.00|99|0.00|DECOMPRESS SPINE CORD ADD-ON
20|FH_F142073_0_0|SrvcGrp|98595|2022|PDM|5980.00|99|0.00|SPINAL CRD DECOMP->2 LUMBAR
20|FH_F142073_0_0|SrvcGrp|98596|2022|PDM|5980.00|99|0.00|LOW BACK DISK SURGERY
20|FH_F142073_0_0|SrvcGrp|98601|2022|PDM|5980.00|99|0.00|TRANSPEDICULAR 1 SEG THORACIC
20|FH_F142073_0_0|SrvcGrp|99161|2022|PDM|11900.00|99|0.00|CPT 27138
20|FH_F142073_0_0|SrvcGrp|99167|2022|PDM|5980.00|99|0.00|CPT 63057
20|FH_F142087_0_0|SrvcGrp|108093|2022|PDM|15500.00|99|0.00|REVISE HIP ARTHROPLASTY
20|FH_F142087_0_0|SrvcGrp|113852|2022|PDM|1250.00|99|0.00|STENT PACEMT ANTE COROTID
20|FH_F142087_0_0|SrvcGrp|113853|2022|PDM|3000.00|99|0.00|CARDIAC CATHERIZATION INCL INJECTIONS
20|FH_F142087_0_0|SrvcGrp|113854|2022|PDM|6600.00|99|0.00|REMOVE/REINSER SPINE FIXATION DEVICE
20|FH_F142087_0_0|SrvcGrp|41334|2022|PDM|15000.00|99|0.00|TOTAL KNEE
20|FH_F142087_0_0|SrvcGrp|67068|2022|PDM|15000.00|99|0.00|LUMBAR SPINE FUSION COMBINED
20|FH_F142087_0_0|SrvcGrp|80617|2022|PDM|15000.00|99|0.00|ARTHOPLASTY
20|FH_F142087_0_0|SrvcGrp|84939|2022|PDM|15000.00|99|0.00|SHOULDER JOINT
20|FH_F142087_0_0|SrvcGrp|86233|2022|PDM|16400.00|99|0.00|AETNA RECONSTRUCT ANKLE JOINT
20|FH_F142087_0_0|SrvcGrp|93431|2022|PDM|15000.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT
20|FH_F142227_0_0|CSTM-ALL|CSTM-00|2020|PCT|54.40|99|0.00|OP SVCS
20|FH_F142227_0_0|CSTM-ALL|CSTM-00|2020|PCT|54.50|99|0.00|GENERAL ACUTE CARE
20|FH_F142228_0_0|CSTM-ALL|CSTM-00|2020|PCT|54.70|99|0.00|OP SVCS
20|FH_F142228_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.10|99|0.00|GENERAL ACUTE CARE
20|FH_F142252_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F142252_0_0|SrvcGrp|82981|2022|PDM|255.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F142327_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F142327_0_0|CSTM-ALL|CSTM-00|2020|PDM|670.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F142327_0_0|CSTM-ALL|CSTM-00|2020|PDM|840.00|99|0.00|AEG 6 (NO REV)
20|FH_F142327_0_0|CSTM-ALL|CSTM-00|2020|PDM|985.00|99|0.00|AEG 8 (NO REV)
20|FH_F142327_0_0|SrvcGrp|109794|2022|PDM|2500.00|99|0.00|COLLAGEN CROSSLINKING CORNEA
20|FH_F142327_0_0|SrvcGrp|71087|2022|PDM|1000.00|99|0.00|CARVE OUTS V2787
20|FH_F142332_0_0|SrvcGrp|29346|2022|PDM|50.00|99|0.00|SKILLED NURSING- LPN
20|FH_F142332_0_0|SrvcGrp|48394|2022|PDM|40.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F142332_0_0|SrvcGrp|73523|2022|PDM|70.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F142370_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F142370_0_0|SrvcGrp|113543|2022|PDM|142.63|99|0.00|COVID-19 SARSCOV2&INF A&B&RSV AMP PRB
20|FH_F142370_0_0|SrvcGrp|113544|2022|PDM|41.38|99|0.00|COVID-19 SARS-COV-2 W/ OPTIC
20|FH_F142370_0_0|SrvcGrp|113547|2022|PDM|142.63|99|0.00|COVID-19 NFCT DS VIR RESP RNA 3 TRGT
20|FH_F142370_0_0|SrvcGrp|113550|2022|PDM|51.31|99|0.00|COVID-19 LAB TESTING
20|FH_F142370_0_0|SrvcGrp|113921|2022|PDM|13.00|99|0.00|COVID-19 SPECIMEN HANDLING PT-LAB (HCFA)
20|FH_F142370_0_0|SrvcGrp|73559|2022|PDM|1595.00|99|0.00|AETNA INTENSIVE CARE
20|FH_F142370_0_0|SrvcGrp|73601|2022|PDM|1430.00|99|0.00|AETNA INTERMEDIATE ICU/CCU
20|FH_F142370_0_0|SrvcGrp|73659|2022|PDM|1265.00|99|0.00|AETNA MED & SURG SVCS
20|FH_F142376_0_0|CSTM-ALL|CSTM-00|2020|PDM|1122.00|99|0.00|AEG 3 (NO REV)
20|FH_F142376_0_0|CSTM-ALL|CSTM-00|2020|PDM|1346.00|99|0.00|AEG 4 (NO REV)
20|FH_F142376_0_0|CSTM-ALL|CSTM-00|2020|PDM|1459.00|99|0.00|AEG 5  (NO REV)
20|FH_F142376_0_0|CSTM-ALL|CSTM-00|2020|PDM|2356.00|99|0.00|AEG 9 (NO REV)
20|FH_F142376_0_0|SrvcGrp|106218|2022|PDM|2805.00|99|0.00|SP BONE ALGRFT
20|FH_F142376_0_0|SrvcGrp|112115|2022|PDM|9873.00|99|0.00|SPINE FUSION EXTRA SEGMENT
20|FH_F142376_0_0|SrvcGrp|113576|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F142376_0_0|SrvcGrp|113970|2022|PDM|1459.00|99|0.00|INSJ STABLJ DEV W/ DCMPRN
20|FH_F142376_0_0|SrvcGrp|113972|2022|PDM|462.00|99|0.00|DRAIN CEREBRO SPINAL FLUID
20|FH_F142376_0_0|SrvcGrp|113973|2022|PDM|462.00|99|0.00|TREAT LUMBAR SPINE LESIO 8
20|FH_F142376_0_0|SrvcGrp|113976|2022|PDM|28.00|99|0.00|ANALYZE SPINE INFUSION PUMP
20|FH_F142376_0_0|SrvcGrp|113978|2022|PDM|462.00|99|0.00|NJX AA&/STRD GNCLR NRV BRNCH
20|FH_F142376_0_0|SrvcGrp|113980|2022|PDM|1432.00|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F142376_0_0|SrvcGrp|113991|2022|PDM|20.00|99|0.00|ANALYZE SPINE INFUS PUMP
20|FH_F142376_0_0|SrvcGrp|58755|2022|PDM|6446.00|99|0.00|INJECTION PROC FOR JOINT
20|FH_F142376_0_0|SrvcGrp|62287|2022|PDM|1159.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F142376_0_0|SrvcGrp|68048|2022|PDM|6977.00|99|0.00|CPT 64581
20|FH_F142376_0_0|SrvcGrp|80137|2022|PDM|20408.00|99|0.00|IMPLANT SPINAL INFUSION
20|FH_F142376_0_0|SrvcGrp|87123|2022|PDM|1159.00|99|0.00|DESTROY LUMB/SAC FACET JNT
20|FH_F142376_0_0|SrvcGrp|97299|2022|PDM|2640.00|99|0.00|REMOVE SPINE ELTRD PLATE
20|FH_F142376_0_0|SrvcGrp|98563|2022|PDM|17545.00|99|0.00|LUMBAR SPINE FUSION
20|FH_F142376_0_0|SrvcGrp|98580|2022|PDM|20878.00|99|0.00|ARTHRODESIS SACROILIAC JOINT
20|FH_F142376_0_0|SrvcGrp|98586|2022|PDM|15987.00|99|0.00|REPLACEMENT OF VAGUS NERVE
20|FH_F142376_0_0|SrvcGrp|98589|2022|PDM|13983.00|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F142376_0_0|SrvcGrp|99073|2022|PDM|246.00|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F142454_0_0|CSTM-ALL|CSTM-00|2020|PDM|1034.00|99|0.00|AEG 6 (NO REV)
20|FH_F142454_0_0|CSTM-ALL|CSTM-00|2020|PDM|692.00|99|0.00|AEG 4 (NO REV)
20|FH_F142454_0_0|SrvcGrp|113988|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F142454_0_0|SrvcGrp|114518|2022|PDM|6000.00|99|0.00|INSERTION DRAINAGE DEVICE
20|FH_F142454_0_0|SrvcGrp|42551|2022|PDM|832.00|99|0.00|OP SURGERY
20|FH_F142454_0_0|SrvcGrp|95110|2022|PDM|1000.00|99|0.00|DIABETIC RETINOPATHY
20|FH_F142587_0_0|SrvcGrp|92502|2022|PDM|935.94|99|0.00|HOSPICE GENERAL IP CARE
20|FH_F142655_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F142673_0_0|CSTM-ALL|CSTM-00|2020|PDM|1017.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F142694_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F142710_0_0|SrvcGrp|29155|2022|PDM|105.00|99|0.00|HOSPICE SVCS
20|FH_F142710_0_0|SrvcGrp|80918|2022|PDM|125.00|99|0.00|RESPITE CARE
20|FH_F142785_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F142826_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS
20|FH_F142894_0_0|SrvcGrp|82222|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F142930_0_0|SrvcGrp|29155|2022|PDM|100.00|99|0.00|HOSPICE SVCS
20|FH_F142930_0_0|SrvcGrp|84185|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F142992_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F143036_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F143050_0_0|SrvcGrp|47348|2022|PDM|250.00|99|0.00|AIR AMBULANCE SVC PER MILE
20|FH_F143067_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F143201_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F143297_0_0|CSTM-ALL|CSTM-00|2020|PDM|1138.00|99|0.00|AEG 10 (NO REV)
20|FH_F143297_0_0|CSTM-ALL|CSTM-00|2020|PDM|489.00|99|0.00|AEG 1 (NO REV)
20|FH_F143297_0_0|CSTM-ALL|CSTM-00|2020|PDM|888.00|99|0.00|AEG 3 (NO REV)
20|FH_F143388_0_0|SrvcGrp|80920|2022|PDM|475.00|99|0.00|HOSPICE SERVICES
20|FH_F143450_0_0|CSTM-ALL|CSTM-00|2020|PDM|1249.00|99|0.00|AEG 7 (NO REV)
20|FH_F143450_0_0|SrvcGrp|114024|2022|PDM|706.00|99|0.00|ENDOSCOPIC US EXAM ESOPH
20|FH_F143450_0_0|SrvcGrp|114025|2022|PDM|727.00|99|0.00|ESOPH ENDOSCOPY W/DRAIN CYST
20|FH_F143450_0_0|SrvcGrp|114026|2022|PDM|706.00|99|0.00|UPPER GI ENDOSCOPY W/US FN BX
20|FH_F143450_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F143457_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|OP SVCS
20|FH_F143467_0_0|CSTM-ALL|CSTM-00|2020|PDM|1540.00|99|0.00|AEG 3 (NO REV)
20|FH_F143467_0_0|CSTM-ALL|CSTM-00|2020|PDM|2310.00|99|0.00|AEG 7 (NO REV)
20|FH_F143467_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F143467_0_0|SrvcGrp|105632|2022|PDM|1424.00|99|0.00|AMPUTATION OF TOE
20|FH_F143467_0_0|SrvcGrp|108095|2022|PDM|1424.00|99|0.00|PARTIAL REMOVAL FOOT FASCIA
20|FH_F143467_0_0|SrvcGrp|114043|2022|PDM|3140.00|99|0.00|LEG TENDON REPAIR
20|FH_F143467_0_0|SrvcGrp|114044|2022|PDM|1424.00|99|0.00|REMOVAL OF ANKLE/HEEL LESION
20|FH_F143467_0_0|SrvcGrp|70746|2022|PDM|1424.00|99|0.00|CPT 28292
20|FH_F143467_0_0|SrvcGrp|89989|2022|PDM|4551.00|99|0.00|FUSION OF BIG TOE JOINT
20|FH_F143467_0_0|SrvcGrp|92197|2022|PDM|4601.00|99|0.00|CORRECTION OF BUNION
20|FH_F143467_0_0|SrvcGrp|92368|2022|PDM|1424.00|99|0.00|REPAIR OF LEG TENDON
20|FH_F143467_0_0|SrvcGrp|98460|2022|PDM|1424.00|99|0.00|AMPUTATION FOOT TRANSMETATARSAL
20|FH_F143467_0_0|SrvcGrp|98469|2022|PDM|1424.00|99|0.00|AMPUTATION METATARSAL
20|FH_F143467_0_0|SrvcGrp|98470|2022|PDM|1424.00|99|0.00|AMPUTATION TOE
20|FH_F143467_0_0|SrvcGrp|98524|2022|PDM|1424.00|99|0.00|EXCISION OF BONE CYST
20|FH_F143487_0_0|CSTM-ALL|CSTM-00|2020|PDM|658.00|99|0.00|AEG 1 (NO REV)
20|FH_F143487_0_0|SrvcGrp|103861|2022|PDM|2060.00|99|0.00|GASTROESOPHOGEAL STUDY
20|FH_F143509_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|HSS ASC
20|FH_F143528_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F143528_0_0|CSTM-ALL|CSTM-00|2020|PDM|1575.00|99|0.00|AEG 2 (NO REV)
20|FH_F143528_0_0|CSTM-ALL|CSTM-00|2020|PDM|2100.00|99|0.00|AEG 6 (NO REV)
20|FH_F143528_0_0|SrvcGrp|100011|2022|PDM|5250.00|99|0.00|ANKLE ARTHROSCOPY
20|FH_F143528_0_0|SrvcGrp|103585|2022|PDM|3045.00|99|0.00|REMOVE SPINE ELTRD PLATE
20|FH_F143528_0_0|SrvcGrp|107099|2022|PDM|1914.15|99|0.00|TREATMENT OF NOSE FRACTURE
20|FH_F143528_0_0|SrvcGrp|109016|2022|PDM|1914.15|99|0.00|REMOVAL OF ADENOIDS
20|FH_F143528_0_0|SrvcGrp|111966|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F143528_0_0|SrvcGrp|114086|2022|PDM|4861.50|99|0.00|CORRECTION HALLUX VALGUS
20|FH_F143528_0_0|SrvcGrp|114087|2022|PDM|5250.00|99|0.00|SPINAL CRD DECOMP
20|FH_F143528_0_0|SrvcGrp|114089|2022|PDM|5250.00|99|0.00|REPAIR OF TENDONS
20|FH_F143528_0_0|SrvcGrp|11663|2022|PCT|0.00|99|0.00|IMPLANTS
20|FH_F143528_0_0|SrvcGrp|11673|2022|PDM|6022.80|99|0.00|CPT 29888
20|FH_F143528_0_0|SrvcGrp|11674|2022|PDM|5250.00|99|0.00|OP SURG
20|FH_F143528_0_0|SrvcGrp|34606|2022|PDM|5250.00|99|0.00|CPT 29827
20|FH_F143528_0_0|SrvcGrp|35669|2022|PDM|3150.00|99|0.00|CPT 63650
20|FH_F143528_0_0|SrvcGrp|41334|2022|PDM|14700.00|99|0.00|TOTAL KNEE
20|FH_F143528_0_0|SrvcGrp|41335|2022|PDM|12600.00|99|0.00|TOTAL HIP
20|FH_F143528_0_0|SrvcGrp|67065|2022|PDM|10474.80|99|0.00|CERVICAL SURGERY
20|FH_F143528_0_0|SrvcGrp|75002|2022|PDM|3925.95|99|0.00|ARTHOSCOPY
20|FH_F143528_0_0|SrvcGrp|77021|2022|PDM|5250.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY
20|FH_F143528_0_0|SrvcGrp|78096|2022|PDM|5250.00|99|0.00|AETNA ARTHROSCOPY BICEPS
20|FH_F143528_0_0|SrvcGrp|88599|2022|PDM|3439.80|99|0.00|ENDOSCOPY MAXILLARY SINUS
20|FH_F143528_0_0|SrvcGrp|88823|2022|PDM|1914.15|99|0.00|REPAIR OF EARDRUM
20|FH_F143528_0_0|SrvcGrp|89848|2022|PDM|10500.00|99|0.00|SPINE FUSION EXTRA SEGMENT
20|FH_F143528_0_0|SrvcGrp|89979|2022|PDM|17575.95|99|0.00|RECONSTRUCT SHOULDER JOINT
20|FH_F143528_0_0|SrvcGrp|90157|2022|PDM|1914.15|99|0.00|AETNA REMOVAL OF TONSILS
20|FH_F143528_0_0|SrvcGrp|92197|2022|PDM|3952.20|99|0.00|CORRECTION OF BUNION
20|FH_F143530_0_0|SrvcGrp|80920|2022|PDM|475.00|99|0.00|HOSPICE SERVICES
20|FH_F143530_0_0|SrvcGrp|84185|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F143539_0_0|CSTM-ALL|CSTM-00|2020|PDM|2188.00|99|0.00|AEG 8 (NO REV)
20|FH_F143539_0_0|CSTM-ALL|CSTM-00|2020|PDM|754.14|99|0.00|AEG 1 (NO REV)
20|FH_F143539_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F143539_0_0|SrvcGrp|109760|2022|PDM|6427.00|99|0.00|TRANSLUM DIL EYE CANAL
20|FH_F143539_0_0|SrvcGrp|42428|2022|PDM|1607.00|99|0.00|OP SURGERY CPT 65855
20|FH_F143539_0_0|SrvcGrp|42551|2022|PDM|1607.00|99|0.00|OP SURGERY
20|FH_F143539_0_0|SrvcGrp|82570|2022|PDM|4285.00|99|0.00|REVISION EYELID/EXCESS SKIN
20|FH_F143539_0_0|SrvcGrp|85966|2022|PDM|7820.00|99|0.00|EXTRACAPSULAR CATARACT
20|FH_F143542_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F143542_0_0|CSTM-ALL|CSTM-00|2020|PDM|1473.00|99|0.00|AEG 10 (NO REV)
20|FH_F143542_0_0|CSTM-ALL|CSTM-00|2020|PDM|1473.00|99|0.00|AEG 4 (NO REV)
20|FH_F143542_0_0|CSTM-ALL|CSTM-00|2020|PDM|1499.00|99|0.00|AEG 5  (NO REV)
20|FH_F143542_0_0|CSTM-ALL|CSTM-00|2020|PDM|2265.00|99|0.00|AEG 8 (NO REV)
20|FH_F143542_0_0|CSTM-ALL|CSTM-00|2020|PDM|2338.00|99|0.00|AEG 7 (NO REV)
20|FH_F143542_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F143542_0_0|SrvcGrp|109767|2022|PDM|2869.00|99|0.00|COVER EYE W/ MEMBRANE INCIDENTAL CODES
20|FH_F143542_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS
20|FH_F143542_0_0|SrvcGrp|42427|2022|PDM|6885.00|99|0.00|OP SURGERY CPT 65420
20|FH_F143542_0_0|SrvcGrp|42428|2022|PDM|1721.00|99|0.00|OP SURGERY CPT 65855
20|FH_F143542_0_0|SrvcGrp|42550|2022|PDM|5738.00|99|0.00|OP SURGERY CPT 66984
20|FH_F143542_0_0|SrvcGrp|46906|2022|PDM|9754.00|99|0.00|CORNEAL TISSUE
20|FH_F143542_0_0|SrvcGrp|95107|2022|PDM|5738.00|99|0.00|INTRAOCULAR LENS PROSTHESIS
20|FH_F143564_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F143564_0_0|CSTM-ALL|CSTM-00|2020|PDM|655.00|99|0.00|AEG 2 (NO REV)
20|FH_F143564_0_0|SrvcGrp|105753|2022|PDM|2002.00|99|0.00|GASTRIC RESTRICTIVE PROCEDURE
20|FH_F143564_0_0|SrvcGrp|115351|2022|PDM|1050.00|99|0.00|GASTRIC RESTRICTIVE PROCEDURE
20|FH_F143564_0_0|SrvcGrp|58779|2022|PDM|3500.00|99|0.00|HERNIA REPAIR W/ MESH
20|FH_F143564_0_0|SrvcGrp|87842|2022|PDM|12000.00|99|0.00|LAPAROSCOPY - GASTRIC
20|FH_F143571_0_0|SrvcGrp|29353|2022|PDM|153.00|99|0.00|HOSPICE SVCS
20|FH_F143571_0_0|SrvcGrp|65720|2022|PDM|153.00|99|0.00|RESPITE CARE
20|FH_F143571_0_0|SrvcGrp|74546|2022|PDM|543.00|99|0.00|HOSPICE SERVICES
20|FH_F143571_0_0|SrvcGrp|80317|2022|PDM|153.00|99|0.00|RESPITE CARE
20|FH_F143571_0_0|SrvcGrp|83519|2022|PDM|153.00|99|0.00|HOSPICE CARE (ALL OTHER)
20|FH_F143571_0_0|SrvcGrp|89822|2022|PDM|153.00|99|0.00|HOSPICE ROUTINE HOME CARE
20|FH_F143577_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F143580_0_0|SrvcGrp|13681|2022|PDM|425.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT
20|FH_F143580_0_0|SrvcGrp|2067|2022|PDM|1200.00|99|0.00|SPECIALTY CARE TRANSPORT
20|FH_F143648_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F143648_0_0|CSTM-ALL|CSTM-00|2020|PDM|1282.00|99|0.00|AEG 8 (NO REV)
20|FH_F143648_0_0|CSTM-ALL|CSTM-00|2020|PDM|1765.00|99|0.00|AEG 9 (NO REV)
20|FH_F143648_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|AEG 2 (NO REV)
20|FH_F143648_0_0|SrvcGrp|108124|2022|PDM|784.00|99|0.00|REMOVE INTRAUTERINE DEVICE
20|FH_F143648_0_0|SrvcGrp|114091|2022|PDM|1960.00|99|0.00|INCISION AND DRAINAGE
20|FH_F143648_0_0|SrvcGrp|12491|2022|PCT|0.00|99|0.00|PACEMAKER
20|FH_F143648_0_0|SrvcGrp|89865|2022|PDM|7000.00|99|0.00|AETNA ENDOMETRIAL CRYOABLATION
20|FH_F143650_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F143650_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F143650_0_0|SrvcGrp|12491|2022|PCT|0.50|99|0.00|PACEMAKER
20|FH_F143650_0_0|SrvcGrp|26276|2022|PDM|1800.00|99|0.00|CPT 29819
20|FH_F143650_0_0|SrvcGrp|33984|2022|PDM|1800.00|99|0.00|HAMMERTOE CORRECTION
20|FH_F143650_0_0|SrvcGrp|41325|2022|PDM|2800.00|99|0.00|OP SURGERY CPT 24342
20|FH_F143650_0_0|SrvcGrp|54943|2022|PDM|2800.00|99|0.00|REPAIR OF SLAP LESION
20|FH_F143650_0_0|SrvcGrp|72992|2022|PDM|1175.00|99|0.00|AEG 2
20|FH_F143650_0_0|SrvcGrp|73008|2022|PDM|1700.00|99|0.00|AEG 10
20|FH_F143650_0_0|SrvcGrp|82114|2022|PDM|1800.00|99|0.00|MENISCUS REPAIR MED OR LAT
20|FH_F143650_0_0|SrvcGrp|82298|2022|PDM|4000.00|99|0.00|AETNA LAP SLEEVE GASTRECTOMY
20|FH_F143650_0_0|SrvcGrp|83839|2022|PDM|4100.00|99|0.00|BREAST RECONSTRUCTION
20|FH_F143668_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F143668_0_0|SrvcGrp|114062|2022|PDM|370.00|99|0.00|SEGMENTAL PNEUMATIC TRUNK (MOD NU)
20|FH_F143668_0_0|SrvcGrp|114070|2022|PDM|110.00|99|0.00|SEGMENTAL PNEUMATIC (MOD NU)
20|FH_F143668_0_0|SrvcGrp|115711|2022|PDM|2475.00|99|0.00|PNEUMATIC COMPRESSOR (MOD UE)
20|FH_F143668_0_0|SrvcGrp|115712|2022|PDM|277.50|99|0.00|SEGMENTAL PNEUMATIC TRUNK (MOD UE)
20|FH_F143668_0_0|SrvcGrp|115713|2022|PDM|262.50|99|0.00|SEGMENTAL PNEUMATIC CHEST (MOD UE)
20|FH_F143684_0_0|CSTM-ALL|CSTM-00|2020|PDM|1019.00|99|0.00|AEG 3 (NO REV)
20|FH_F143684_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 5  (NO REV)
20|FH_F143684_0_0|CSTM-ALL|CSTM-00|2020|PDM|2036.00|99|0.00|AEG 7 (NO REV)
20|FH_F143684_0_0|CSTM-ALL|CSTM-00|2020|PDM|857.00|99|0.00|AEG 2 (NO REV)
20|FH_F143684_0_0|SrvcGrp|103236|2022|PDM|12393.00|99|0.00|AETNA INSJ STABLJ DEV
20|FH_F143684_0_0|SrvcGrp|108835|2022|PDM|3000.00|99|0.00|LEAD NEUROSTIMULATOR
20|FH_F143684_0_0|SrvcGrp|109250|2022|PCT|0.00|99|0.00|IMPLANT NEURORECEIVER 23
20|FH_F143684_0_0|SrvcGrp|111807|2022|PDM|1700.00|99|0.00|INTERSPINOUS IMPLANT
20|FH_F143684_0_0|SrvcGrp|58638|2022|PDM|2563.00|99|0.00|CPT 63688
20|FH_F143684_0_0|SrvcGrp|92364|2022|PDM|18135.00|99|0.00|ARTHRODESIS SACROILIAC JOINT
20|FH_F143771_0_0|SrvcGrp|103911|2022|PDM|641.00|99|0.00|HOSPICE CARE PROVIDED IN INPATIENT HOSPICE FACILITY
20|FH_F143771_0_0|SrvcGrp|80918|2022|PDM|142.00|99|0.00|RESPITE CARE
20|FH_F143771_0_0|SrvcGrp|82222|2022|PDM|136.00|99|0.00|HOSPICE CARE
20|FH_F143783_0_0|SrvcGrp|113454|2022|PDM|105.00|99|0.00|HOSPICE CARE
20|FH_F143783_0_0|SrvcGrp|114101|2022|PDM|105.00|99|0.00|HOSPICE CARE IN HOSPICE FACIILITY (HCFA)
20|FH_F143783_0_0|SrvcGrp|95661|2022|PDM|105.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F143783_0_0|SrvcGrp|97703|2022|PDM|105.00|99|0.00|HOSPICE IN LTCH (HCFA)
20|FH_F143783_0_0|SrvcGrp|97705|2022|PDM|105.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F143793_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F143828_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F143828_0_0|CSTM-ALL|CSTM-00|2020|PDM|1194.00|99|0.00|AEG 2 (NO REV)
20|FH_F143832_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F143832_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F143832_0_0|CSTM-ALL|CSTM-00|2020|PDM|2016.30|99|0.00|AEG 8 (NO REV)
20|FH_F143832_0_0|CSTM-ALL|CSTM-00|2020|PDM|2378.55|99|0.00|AEG 7 (NO REV)
20|FH_F143832_0_0|CSTM-ALL|CSTM-00|2020|PDM|771.64|99|0.00|AEG 10 (NO REV)
20|FH_F143832_0_0|CSTM-ALL|CSTM-00|2020|PDM|852.41|99|0.00|AEG 2 (NO REV)
20|FH_F143832_0_0|SrvcGrp|108166|2022|PDM|1218.06|99|0.00|ESTABLISH ACCESS TO AORTA
20|FH_F143832_0_0|SrvcGrp|108174|2022|PDM|2405.06|99|0.00|TIB/PER REVASC W/TLA
20|FH_F143832_0_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F143832_0_0|SrvcGrp|114107|2022|PDM|2429.11|99|0.00|FEM/POPL REVASC W/ STENT
20|FH_F143848_0_0|SrvcGrp|73483|2022|PDM|1963.00|99|0.00|AETNA SUBACUTE III
20|FH_F143898_0_0|SrvcGrp|104226|2022|PDM|100.00|99|0.00|HOSPICE CARE (HCFA)
20|FH_F143898_0_0|SrvcGrp|104230|2022|PDM|160.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F143988_0_0|CSTM-ALL|CSTM-00|2020|PCT|2.10|99|0.00|HSS ASC
20|FH_F144014_0_0|SrvcGrp|87077|2022|PDM|180.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F144021_0_0|SrvcGrp|108043|2022|PDM|207.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD
20|FH_F144021_0_0|SrvcGrp|111468|2022|PDM|152.00|99|0.00|DIALYSIS PATIENT TRAINING
20|FH_F144029_0_0|SrvcGrp|107748|2022|PDM|500.00|99|0.00|HEMODIALYSIS IN CENTER
20|FH_F144029_0_0|SrvcGrp|107749|2022|PDM|214.00|99|0.00|CAPD/CCPD
20|FH_F144039_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F144039_0_0|CSTM-ALL|CSTM-00|2020|PDM|781.00|99|0.00|AEG 1 (NO REV)
20|FH_F144039_0_0|SrvcGrp|109760|2022|PDM|6885.00|99|0.00|TRANSLUM DIL EYE CANAL
20|FH_F144039_0_0|SrvcGrp|109769|2022|PCT|0.00|99|0.00|COVER EYE W/ MEMBRANE SUTURE INCIDENTAL CODES
20|FH_F144039_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS
20|FH_F144039_0_0|SrvcGrp|46886|2022|PDM|4590.00|99|0.00|REMOVAL OF EYELID LESION
20|FH_F144039_0_0|SrvcGrp|78046|2022|PCT|1.00|99|0.00|AETNA AQUEOUS SHUNT
20|FH_F144039_0_0|SrvcGrp|82570|2022|PDM|4590.00|99|0.00|REVISION EYELID/EXCESS SKIN
20|FH_F144191_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 2 (NO REV)
20|FH_F144191_0_0|SrvcGrp|113939|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F144191_0_0|SrvcGrp|114139|2022|PDM|1400.00|99|0.00|REMOVAL OF TISSUE FOR GRAFT
20|FH_F144191_0_0|SrvcGrp|34606|2022|PDM|2600.00|99|0.00|CPT 29827
20|FH_F144191_0_0|SrvcGrp|41334|2022|PDM|9875.00|99|0.00|TOTAL KNEE
20|FH_F144191_0_0|SrvcGrp|89980|2022|PDM|3700.00|99|0.00|OPEN TREATMENT OF DISTAL
20|FH_F144228_0_0|CSTM-ALL|CSTM-00|2020|PDM|2275.00|99|0.00|AEG 6 (NO REV)
20|FH_F144228_0_0|CSTM-ALL|CSTM-00|2020|PDM|2680.00|99|0.00|AEG 8 (NO REV)
20|FH_F144228_0_0|CSTM-ALL|CSTM-00|2020|PDM|838.00|99|0.00|AEG 1 (NO REV)
20|FH_F144228_0_0|SrvcGrp|114140|2022|PDM|1027.00|99|0.00|REMOVAL OF SKIN LESION
20|FH_F144228_0_0|SrvcGrp|114142|2022|PDM|1078.00|99|0.00|TREAT KNEE DISLOCATION
20|FH_F144228_0_0|SrvcGrp|19922|2022|PDM|5858.00|99|0.00|ARTHROSCOPY OF SHOULDER
20|FH_F144248_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F144248_0_0|CSTM-ALL|CSTM-00|2020|PDM|1078.00|99|0.00|AEG 2 (NO REV)
20|FH_F144248_0_0|CSTM-ALL|CSTM-00|2020|PDM|1196.00|99|0.00|AEG 3 (NO REV)
20|FH_F144248_0_0|CSTM-ALL|CSTM-00|2020|PDM|781.00|99|0.00|AEG 1 (NO REV)
20|FH_F144248_0_0|SrvcGrp|106235|2022|PDM|6885.00|99|0.00|CYPASS
20|FH_F144248_0_0|SrvcGrp|109348|2022|PDM|2869.00|99|0.00|EXCISION OF LESION OF EYELID
20|FH_F144248_0_0|SrvcGrp|109759|2022|PDM|5738.00|99|0.00|REMOVAL CORNEAL EPITHELIUM
20|FH_F144248_0_0|SrvcGrp|109765|2022|PDM|1721.00|99|0.00|CLOSURE OF LACRIMAL PUNCTUM
20|FH_F144248_0_0|SrvcGrp|114442|2022|PDM|12049.00|99|0.00|EXTRACAPSULAR CATARACT REMOVAL, INSERT LENS
20|FH_F144248_0_0|SrvcGrp|45583|2022|PDM|9754.00|99|0.00|CPT 65730
20|FH_F144248_0_0|SrvcGrp|46906|2022|PDM|9754.00|99|0.00|CORNEAL TISSUE
20|FH_F144248_0_0|SrvcGrp|62740|2022|PDM|5738.00|99|0.00|SURGERY CARVE OUTS
20|FH_F144248_0_0|SrvcGrp|78046|2022|PCT|1.04|99|0.00|AETNA AQUEOUS SHUNT
20|FH_F144248_0_0|SrvcGrp|82570|2022|PDM|4590.00|99|0.00|REVISION EYELID/EXCESS SKIN
20|FH_F144248_0_0|SrvcGrp|84278|2022|PDM|9754.00|99|0.00|CORNEAL TRANSPLANT
20|FH_F144248_0_0|SrvcGrp|85966|2022|PDM|7459.00|99|0.00|EXTRACAPSULAR CATARACT
20|FH_F144248_0_0|SrvcGrp|95107|2022|PDM|5738.00|99|0.00|INTRAOCULAR LENS PROSTHESIS
20|FH_F144291_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F144291_0_0|SrvcGrp|108042|2022|PDM|424.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD
20|FH_F144327_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F144548_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F144548_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F144648_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F144648_0_0|SrvcGrp|107748|2022|PDM|424.00|99|0.00|HEMODIALYSIS IN CENTER
20|FH_F144651_0_0|SrvcGrp|101102|2022|PDM|15000.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT
20|FH_F144651_0_0|SrvcGrp|101103|2022|PDM|15000.00|99|0.00|REVIS SHOULDER JOINT
20|FH_F144651_0_0|SrvcGrp|101114|2022|PDM|15000.00|99|0.00|ARTHOPLASTY
20|FH_F144651_0_0|SrvcGrp|114171|2022|PDM|1250.00|99|0.00|STENT PACEMT ANTE COROTID
20|FH_F144651_0_0|SrvcGrp|114172|2022|PDM|3000.00|99|0.00|SPINE FIXATION
20|FH_F144651_0_0|SrvcGrp|114175|2022|PDM|6000.00|99|0.00|SPINE PROCEDURES
20|FH_F144651_0_0|SrvcGrp|40002|2022|PDM|15500.00|99|0.00|TOTAL HIP
20|FH_F144769_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.53|99|0.00|ANGIOPLASTY
20|FH_F144769_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.53|99|0.00|DRG 124-125 CARDIAC CATH
20|FH_F144769_0_0|SrvcGrp|104458|2022|PDM|4928.00|99|0.00|MATERNITY CARE (VAGINAL DELIVERY)
20|FH_F144769_0_0|SrvcGrp|329|2022|PDM|21560.00|99|0.00|DRG 288 GASTROPLASTY PROCEDURE OBESITY
20|FH_F144769_0_0|SrvcGrp|360|2022|PDM|1155.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F144769_0_0|SrvcGrp|44564|2022|PDM|539.00|99|0.00|NEWBORN NURSERY
20|FH_F144769_0_0|SrvcGrp|74586|2022|PCT|0.21|99|0.00|AETNA OP HIGH COST DRUGS
20|FH_F144769_0_0|SrvcGrp|78579|2022|PDM|2503.00|99|0.00|AETNA ACUTE IP MEDICAL SVCS
20|FH_F144769_0_0|SrvcGrp|941|2022|PDM|3390.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F144808_0_0|CSTM-ALL|CSTM-00|2020|PDM|1613.00|99|0.00|AEG 2 (NO REV)
20|FH_F144808_0_0|CSTM-ALL|CSTM-00|2020|PDM|2346.00|99|0.00|AEG 6 (NO REV)
20|FH_F144808_0_0|CSTM-ALL|CSTM-00|2020|PDM|2888.00|99|0.00|AEG 9 (NO REV)
20|FH_F144808_0_0|CSTM-ALL|CSTM-00|2020|PDM|963.00|99|0.00|AEG 10 (NO REV)
20|FH_F144808_0_0|SrvcGrp|11673|2022|PDM|4812.00|99|0.00|CPT 29888
20|FH_F144808_0_0|SrvcGrp|41334|2022|PDM|7215.00|99|0.00|TOTAL KNEE
20|FH_F144808_0_0|SrvcGrp|67068|2022|PDM|7699.00|99|0.00|LUMBAR SPINE FUSION COMBINED
20|FH_F144808_0_0|SrvcGrp|71666|2022|PDM|4812.00|99|0.00|CPT 63655
20|FH_F144808_0_0|SrvcGrp|77021|2022|PDM|7215.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY
20|FH_F144828_0_0|CSTM-ALL|CSTM-00|2020|PDM|1430.00|99|0.00|AEG 6 (NO REV)
20|FH_F144828_0_0|CSTM-ALL|CSTM-00|2020|PDM|1613.00|99|0.00|AEG 8 (NO REV)
20|FH_F144828_0_0|SrvcGrp|104943|2022|PDM|3850.00|99|0.00|DELAYED BREAST PROSTHESIS
20|FH_F144828_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F144828_0_0|SrvcGrp|114193|2022|PDM|3014.00|99|0.00|REMOVAL OF TISSUE FOR GRAFT
20|FH_F144828_0_0|SrvcGrp|83145|2022|PDM|4400.00|99|0.00|AETNA BREAST RECONSTRUCTION
20|FH_F144828_0_0|SrvcGrp|83838|2022|PDM|3351.00|99|0.00|SUSPENSION OF BREAST
20|FH_F144848_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F144848_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F144848_0_0|CSTM-ALL|CSTM-00|2020|PDM|669.00|99|0.00|AEG 4 (NO REV)
20|FH_F144848_0_0|SrvcGrp|104163|2022|PDM|4575.00|99|0.00|KYPHOPLASTY
20|FH_F144848_0_0|SrvcGrp|114179|2022|PDM|3866.00|99|0.00|ABLATE BONE TUMOR(S) PERQ
20|FH_F144848_0_0|SrvcGrp|44461|2022|PDM|30900.00|99|0.00|INSERTION / REPLACEMENT OF SPINAL NEUROSTIMULATOR GENERATOR
20|FH_F144848_0_0|SrvcGrp|96349|2022|PDM|11442.00|99|0.00|NECK SPINE FUSE
20|FH_F145188_0_0|CSTM-ALL|CSTM-00|2020|PDM|495.00|99|0.00|AEG 2 (NO REV)
20|FH_F145188_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS
20|FH_F145348_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F145448_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F145448_0_0|CSTM-ALL|CSTM-00|2020|PDM|446.00|99|0.00|AEG 2 (NO REV)
20|FH_F145448_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|AEG 3 (NO REV)
20|FH_F145448_0_0|CSTM-ALL|CSTM-00|2020|PDM|973.00|99|0.00|AEG 8 (NO REV)
20|FH_F145448_0_0|SrvcGrp|113988|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F145508_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F145508_0_0|SrvcGrp|104228|2022|PDM|181.21|99|0.00|HOSPICE CARE (HCFA)
20|FH_F145508_0_0|SrvcGrp|29155|2022|PDM|181.21|99|0.00|HOSPICE SVCS
20|FH_F145508_0_0|SrvcGrp|80920|2022|PDM|956.15|99|0.00|HOSPICE SERVICES
20|FH_F145508_0_0|SrvcGrp|82223|2022|PDM|181.21|99|0.00|HOSPICE CARE
20|FH_F145543_0_0|CSTM-ALL|CSTM-00|2020|PDM|1339.00|99|0.00|AEG 9 (NO REV)
20|FH_F145543_0_0|CSTM-ALL|CSTM-00|2020|PDM|485.00|99|0.00|AEG 3 (NO REV)
20|FH_F145543_0_0|CSTM-ALL|CSTM-00|2020|PDM|931.00|99|0.00|AEG 7 (NO REV)
20|FH_F145543_0_0|SrvcGrp|113988|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F145543_0_0|SrvcGrp|114206|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F145543_0_0|SrvcGrp|114207|2022|PDM|770.00|99|0.00|REVISION OF LOWER EYELID
20|FH_F145543_0_0|SrvcGrp|114208|2022|PDM|931.00|99|0.00|REPAIR OF BROW PTOSIS
20|FH_F145543_0_0|SrvcGrp|85563|2022|PDM|931.00|99|0.00|INCISION OF EYE
20|FH_F145563_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F145567_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F145567_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F145583_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F145587_0_0|CSTM-ALL|CSTM-00|2020|PDM|1029.00|99|0.00|AEG 10 (NO REV)
20|FH_F145587_0_0|CSTM-ALL|CSTM-00|2020|PDM|1413.45|99|0.00|AEG 7 (NO REV)
20|FH_F145587_0_0|CSTM-ALL|CSTM-00|2020|PDM|1728.30|99|0.00|AEG 9 (NO REV)
20|FH_F145587_0_0|CSTM-ALL|CSTM-00|2020|PDM|466.52|99|0.00|AEG 1 (NO REV)
20|FH_F145587_0_0|CSTM-ALL|CSTM-00|2020|PDM|810.33|99|0.00|AEG 3 (NO REV)
20|FH_F145587_0_0|CSTM-ALL|CSTM-00|2020|PDM|971.25|99|0.00|AEG 5  (NO REV)
20|FH_F145587_0_0|CSTM-ALL|CSTM-00|2020|PDM|983.97|99|0.00|AEG 4 (NO REV)
20|FH_F145587_0_0|SrvcGrp|100661|2022|PDM|1262.70|99|0.00|AETNA OP SURGERY
20|FH_F145587_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F145587_0_0|SrvcGrp|26279|2022|PDM|1262.70|99|0.00|CPT 29884
20|FH_F145587_0_0|SrvcGrp|28547|2022|PDM|1779.93|99|0.00|VITRECTOMY
20|FH_F145587_0_0|SrvcGrp|33724|2022|PDM|1262.70|99|0.00|ARTHROSCOPY
20|FH_F145587_0_0|SrvcGrp|33983|2022|PDM|1262.70|99|0.00|CPT 28080
20|FH_F145587_0_0|SrvcGrp|38909|2022|PDM|1779.93|99|0.00|CPT 67036 - VITRECTOMY, MECHANICAL
20|FH_F145587_0_0|SrvcGrp|82110|2022|PDM|1262.70|99|0.00|KNEE ARTHROSCOPY DIAGNOSTIC
20|FH_F145587_0_0|SrvcGrp|82111|2022|PDM|1262.70|99|0.00|KNEE ARTHROSCOPY SURGICAL
20|FH_F145599_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING
20|FH_F145599_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|CARDIAC CATH LAB SVCS
20|FH_F145689_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F145690_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F145721_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F145721_0_0|SrvcGrp|113454|2022|PDM|135.00|99|0.00|HOSPICE CARE
20|FH_F145721_0_0|SrvcGrp|82222|2022|PDM|135.00|99|0.00|HOSPICE CARE
20|FH_F145721_0_0|SrvcGrp|83857|2022|PDM|925.00|99|0.00|IP HOSPICE SVCS
20|FH_F145722_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F145722_0_0|SrvcGrp|87077|2022|PDM|125.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F145739_0_0|CSTM-ALL|CSTM-00|2020|PDM|1101.00|99|0.00|AEG 8 (NO REV)
20|FH_F145739_0_0|CSTM-ALL|CSTM-00|2020|PDM|1516.00|99|0.00|AEG 9 (NO REV)
20|FH_F145739_0_0|CSTM-ALL|CSTM-00|2020|PDM|812.00|99|0.00|AEG 5  (NO REV)
20|FH_F145739_0_0|SrvcGrp|111630|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F145739_0_0|SrvcGrp|114177|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F145752_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F145762_0_0|CSTM-ALL|CSTM-00|2020|PDM|1054.00|99|0.00|AEG 6 (NO REV)
20|FH_F145762_0_0|CSTM-ALL|CSTM-00|2020|PDM|571.00|99|0.00|AEG 2 (NO REV)
20|FH_F145781_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F145781_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 6 (NO REV)
20|FH_F145781_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 7 (NO REV)
20|FH_F145781_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|AETNA AEG 8 WITHOUT EXTRACAPSULAR (NO REV)
20|FH_F145781_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|AEG 9 (NO REV)
20|FH_F145781_0_0|CSTM-ALL|CSTM-00|2020|PDM|535.00|99|0.00|AEG 2 (NO REV)
20|FH_F145781_0_0|SrvcGrp|114304|2022|PDM|1200.00|99|0.00|REVISE EYE W/ IMPLANT
20|FH_F145784_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F145784_0_0|CSTM-ALL|CSTM-00|2020|PDM|2010.00|99|0.00|AEG 7 (NO REV)
20|FH_F145784_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|AEG 8 (NO REV)
20|FH_F145784_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|AEG 9 (NO REV)
20|FH_F145784_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F145784_0_0|SrvcGrp|39906|2022|PDM|3500.00|99|0.00|MASTECTOMY, SIMPLE, COMPLETE
20|FH_F145870_0_0|CSTM-ALL|CSTM-00|2020|PDM|1255.00|99|0.00|AEG 6 (NO REV)
20|FH_F145870_0_0|CSTM-ALL|CSTM-00|2020|PDM|1705.00|99|0.00|AEG 8 (NO REV)
20|FH_F145877_0_0|SrvcGrp|11606|2022|PDM|1450.00|99|0.00|ACUTE CARE (MEDICAL & SURGICAL)
20|FH_F145920_0_0|CSTM-ALL|CSTM-00|2020|PDM|1122.00|99|0.00|AEG 10 (NO REV)
20|FH_F145920_0_0|CSTM-ALL|CSTM-00|2020|PDM|1678.00|99|0.00|AEG 3 (NO REV)
20|FH_F145920_0_0|CSTM-ALL|CSTM-00|2020|PDM|3017.00|99|0.00|AEG 8 (NO REV)
20|FH_F145920_0_0|SrvcGrp|105286|2022|PDM|3366.00|99|0.00|LAP VENT/ABD HERN PROC COMP
20|FH_F145920_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F145920_0_0|SrvcGrp|47142|2022|PDM|3366.00|99|0.00|CPT 49650
20|FH_F145920_0_0|SrvcGrp|74670|2022|PCT|1.00|99|0.00|AETNA OP INTRAOCULAR LENS
20|FH_F145946_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F145959_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F145959_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.20|99|0.00|OP SVCS
20|FH_F145959_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F146012_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F146112_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|OP SVCS
20|FH_F146117_0_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|AEG 1 (NO REV)
20|FH_F146117_0_0|CSTM-ALL|CSTM-00|2020|PDM|2150.00|99|0.00|AEG 3 (NO REV)
20|FH_F146117_0_0|CSTM-ALL|CSTM-00|2020|PDM|2448.00|99|0.00|AEG 4 (NO REV)
20|FH_F146117_0_0|CSTM-ALL|CSTM-00|2020|PDM|2700.00|99|0.00|AEG 10 (NO REV)
20|FH_F146117_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|AEG 8 (NO REV)
20|FH_F146117_0_0|CSTM-ALL|CSTM-00|2020|PDM|4854.00|99|0.00|AEG 9 (NO REV)
20|FH_F146117_0_0|SrvcGrp|84939|2022|PDM|3118.00|99|0.00|SHOULDER JOINT
20|FH_F146117_0_0|SrvcGrp|93433|2022|PDM|3118.00|99|0.00|PARTIAL HIP REPLACEMENT
20|FH_F146117_0_0|SrvcGrp|99163|2022|PDM|2804.00|99|0.00|CPT 27703
20|FH_F146122_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|GENERAL ACUTE CARE
20|FH_F146125_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F146125_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F146125_0_0|CSTM-ALL|CSTM-00|2020|PDM|1457.00|99|0.00|AEG 6 (NO REV)
20|FH_F146125_0_0|CSTM-ALL|CSTM-00|2020|PDM|1465.00|99|0.00|AEG 8 (NO REV)
20|FH_F146125_0_0|CSTM-ALL|CSTM-00|2020|PDM|1550.00|99|0.00|AEG 5  (NO REV)
20|FH_F146125_0_0|CSTM-ALL|CSTM-00|2020|PDM|572.00|99|0.00|AEG 1 (NO REV)
20|FH_F146125_0_0|SrvcGrp|105701|2022|PDM|2334.00|99|0.00|REPAIR OF VAGINA
20|FH_F146125_0_0|SrvcGrp|114014|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES
20|FH_F146125_0_0|SrvcGrp|26273|2022|PDM|3197.00|99|0.00|CPT 29880
20|FH_F146125_0_0|SrvcGrp|26275|2022|PDM|3100.00|99|0.00|CPT 29826
20|FH_F146125_0_0|SrvcGrp|26278|2022|PDM|3197.00|99|0.00|CPT 29881
20|FH_F146125_0_0|SrvcGrp|34606|2022|PDM|3100.00|99|0.00|CPT 29827
20|FH_F146125_0_0|SrvcGrp|65625|2022|PDM|2100.00|99|0.00|CPT 30520
20|FH_F146125_0_0|SrvcGrp|75181|2022|PCT|1.00|99|0.00|AETNA IMPLANTS
20|FH_F146125_0_0|SrvcGrp|78283|2022|PDM|3100.00|99|0.00|CPT 49505
20|FH_F146125_0_0|SrvcGrp|99073|2022|PDM|1.38|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F146204_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F146204_0_0|CSTM-ALL|CSTM-00|2020|PDM|1442.00|99|0.00|AEG 7 (NO REV)
20|FH_F146204_0_0|CSTM-ALL|CSTM-00|2020|PDM|1942.00|99|0.00|AEG 9 (NO REV)
20|FH_F146204_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 10 (NO REV)
20|FH_F146204_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 4 (NO REV)
20|FH_F146204_0_0|SrvcGrp|104753|2022|PDM|1500.00|99|0.00|PELVIC EXAMINATION
20|FH_F146204_0_0|SrvcGrp|110349|2022|PDM|1922.00|99|0.00|REOPEN FALLOPIAN TUBE
20|FH_F146204_0_0|SrvcGrp|114177|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F146204_0_0|SrvcGrp|42472|2022|PDM|2376.00|99|0.00|CPT 58670
20|FH_F146204_0_0|SrvcGrp|75282|2022|PDM|1500.00|99|0.00|DIAGNOSTIC HYSTEROSCOPY
20|FH_F146217_0_0|SrvcGrp|29155|2022|PDM|141.22|99|0.00|HOSPICE SVCS
20|FH_F146217_0_0|SrvcGrp|82222|2022|PDM|178.66|99|0.00|HOSPICE CARE
20|FH_F146217_0_0|SrvcGrp|95660|2022|PDM|913.07|99|0.00|HOSPICE SERVICES (HCFA)
20|FH_F146239_0_0|SrvcGrp|87077|2022|PDM|250.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F146266_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F146266_0_0|CSTM-ALL|CSTM-00|2020|PDM|1090.00|99|0.00|AEG 1 (NO REV)
20|FH_F146266_0_0|CSTM-ALL|CSTM-00|2020|PDM|1825.00|99|0.00|AEG 3 (NO REV)
20|FH_F146266_0_0|SrvcGrp|100000|2022|PDM|6582.00|99|0.00|RECONSTRUCT WRIST DIST ULNA
20|FH_F146266_0_0|SrvcGrp|100041|2022|PDM|8573.00|99|0.00|REPAIR HUMERUS FRACTURE I
20|FH_F146266_0_0|SrvcGrp|100042|2022|PDM|9173.00|99|0.00|REPAIR HUMERUS FRACTURE II
20|FH_F146266_0_0|SrvcGrp|105636|2022|PDM|10213.00|99|0.00|REALIGNMENT OF KNEE
20|FH_F146266_0_0|SrvcGrp|108351|2022|PDM|14441.00|99|0.00|REPAIR RADIUS FRACTURE
20|FH_F146266_0_0|SrvcGrp|109833|2022|PDM|18552.00|99|0.00|REPLACE ELBOW JOINT
20|FH_F146266_0_0|SrvcGrp|110757|2022|PDM|7231.00|99|0.00|CERVICAL VERTEBRAL CORPECTOMY
20|FH_F146266_0_0|SrvcGrp|16289|2022|PDM|2587.00|99|0.00|CARPAL TUNNEL RELEASE
20|FH_F146266_0_0|SrvcGrp|26273|2022|PDM|2770.00|99|0.00|CPT 29880
20|FH_F146266_0_0|SrvcGrp|26275|2022|PDM|3450.00|99|0.00|CPT 29826
20|FH_F146266_0_0|SrvcGrp|27330|2022|PDM|3772.00|99|0.00|CPT 27096
20|FH_F146266_0_0|SrvcGrp|35672|2022|PDM|3455.00|99|0.00|CPT 23412
20|FH_F146266_0_0|SrvcGrp|41325|2022|PDM|3690.00|99|0.00|OP SURGERY CPT 24342
20|FH_F146266_0_0|SrvcGrp|54943|2022|PDM|3950.00|99|0.00|REPAIR OF SLAP LESION
20|FH_F146266_0_0|SrvcGrp|67068|2022|PDM|20512.00|99|0.00|LUMBAR SPINE FUSION COMBINED
20|FH_F146266_0_0|SrvcGrp|70749|2022|PDM|3300.00|99|0.00|CPT 29823
20|FH_F146266_0_0|SrvcGrp|71666|2022|PDM|7349.00|99|0.00|CPT 63655
20|FH_F146266_0_0|SrvcGrp|72121|2022|PDM|4100.00|99|0.00|ARTHOSCOPY
20|FH_F146266_0_0|SrvcGrp|74039|2022|PDM|8444.00|99|0.00|LAMINECTOMY
20|FH_F146266_0_0|SrvcGrp|78096|2022|PDM|7168.00|99|0.00|AETNA ARTHROSCOPY BICEPS
20|FH_F146266_0_0|SrvcGrp|84307|2022|PDM|1725.00|99|0.00|TENDON REPAIR
20|FH_F146266_0_0|SrvcGrp|87677|2022|PDM|1928.00|99|0.00|CERVICAL OR THORACIC SURGERY
20|FH_F146266_0_0|SrvcGrp|88161|2022|PDM|7892.00|99|0.00|LAMINECTOMY W/FACE-THORACIC
20|FH_F146266_0_0|SrvcGrp|88491|2022|PDM|5475.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR
20|FH_F146266_0_0|SrvcGrp|88492|2022|PDM|5914.00|99|0.00|AETNA SPINAL BONE AUTOGRAFT
20|FH_F146266_0_0|SrvcGrp|88740|2022|PDM|5719.00|99|0.00|SP BONE ALGRFT
20|FH_F146266_0_0|SrvcGrp|88820|2022|PDM|1840.00|99|0.00|CPT 24359
20|FH_F146266_0_0|SrvcGrp|89840|2022|PDM|14196.00|99|0.00|THORAX SPINE FUSION
20|FH_F146266_0_0|SrvcGrp|89848|2022|PDM|14196.00|99|0.00|SPINE FUSION EXTRA SEGMENT
20|FH_F146266_0_0|SrvcGrp|90420|2022|PDM|5500.00|99|0.00|REPAIR CLAVICLE FRACTURE
20|FH_F146266_0_0|SrvcGrp|92014|2022|PDM|2485.00|99|0.00|PHALANGEAL SHAFT FRACTURE
20|FH_F146266_0_0|SrvcGrp|92367|2022|PDM|1325.00|99|0.00|TRANSPLANT HAND TENDON
20|FH_F146266_0_0|SrvcGrp|92415|2022|PDM|7168.00|99|0.00|NECK SPINE DISK SURGERY
20|FH_F146266_0_0|SrvcGrp|93057|2022|PDM|5914.00|99|0.00|SPINAL BONE AUTOGRAFT
20|FH_F146266_0_0|SrvcGrp|93433|2022|PDM|15771.00|99|0.00|PARTIAL HIP REPLACEMENT
20|FH_F146266_0_0|SrvcGrp|97895|2022|PDM|7945.00|99|0.00|REVISE KNEE 2
20|FH_F146266_0_0|SrvcGrp|99166|2022|PDM|7892.00|99|0.00|CPT 63005
20|FH_F146283_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.52|99|0.00|OP SVCS
20|FH_F146284_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.53|99|0.00|OP SVCS
20|FH_F146286_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.56|99|0.00|OP SVCS
20|FH_F146289_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.53|99|0.00|OP SVCS
20|FH_F146290_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS
20|FH_F146292_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.59|99|0.00|OP SVCS
20|FH_F146369_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F146369_0_0|SrvcGrp|74668|2022|PDM|300.00|99|0.00|AETNA INTENSIVE OUTPATIENT
20|FH_F146399_0_0|SrvcGrp|107749|2022|PDM|182.00|99|0.00|CAPD/CCPD
20|FH_F146399_0_0|SrvcGrp|108082|2022|PDM|25.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER
20|FH_F146399_0_0|SrvcGrp|111468|2022|PDM|150.00|99|0.00|DIALYSIS PATIENT TRAINING
20|FH_F146568_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC
20|FH_F146569_0_0|SrvcGrp|93098|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F146595_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F146595_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.60|99|0.00|HSS ASC
20|FH_F146644_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.07|99|0.00|HSS ASC
20|FH_F146647_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F146661_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.43|99|0.00|HSS ASC
20|FH_F146760_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F146765_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F146785_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.70|99|0.00|GENERAL ACUTE CARE
20|FH_F146789_0_0|CSTM-ALL|CSTM-00|2020|PCT|63.70|99|0.00|OP SVCS
20|FH_F146790_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F146790_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|AEG 3 (NO REV)
20|FH_F126527_0_0|SrvcGrp|82223|2022|PDM|110.00|99|0.00|HOSPICE CARE
20|FH_F126554_0_0|CSTM-ALL|CSTM-00|2020|PDM|1785.00|99|0.00|AEG 8 (NO REV)
20|FH_F126554_0_0|CSTM-ALL|CSTM-00|2020|PDM|811.00|99|0.00|AEG 3 (NO REV)
20|FH_F126554_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F126554_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F126554_0_0|SrvcGrp|92364|2022|PDM|11000.00|99|0.00|ARTHRODESIS SACROILIAC JOINT
20|FH_F126567_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F126600_0_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F126732_0_0|SrvcGrp|87077|2022|PDM|135.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F126759_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F126904_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F126904_0_0|SrvcGrp|82223|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F126930_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F126964_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F126990_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|MID-LEVEL
20|FH_F126990_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANESTHESIOLOGIST/CRNA (HAN2)(HSUR) SAME DOS
20|FH_F126990_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|NON-ANESTHESIOLOGIST/CRNA (HAN3)
20|FH_F126990_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|NON-ANESTHESIOLOGY (HANE) (HSMI) (SAMD) SAME DOS
20|FH_F126990_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REVENUE CODE W/O CPT SAME DOS
20|FH_F127011_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F127011_0_0|SrvcGrp|87077|2022|PDM|137.70|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F127068_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F127073_0_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F127105_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F127105_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC
20|FH_F127132_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F127132_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F127132_0_0|SrvcGrp|108041|2022|PDM|400.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME
20|FH_F127132_0_0|SrvcGrp|108081|2022|PDM|171.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS
20|FH_F127188_0_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F127199_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F127199_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F127199_0_0|SrvcGrp|65720|2022|PDM|114.00|99|0.00|RESPITE CARE
20|FH_F127199_0_0|SrvcGrp|83857|2022|PDM|475.00|99|0.00|IP HOSPICE SVCS
20|FH_F127199_0_0|SrvcGrp|90707|2022|PDM|114.00|99|0.00|AETNA HOSPICE CARE
20|FH_F127207_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F127207_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F127207_0_0|SrvcGrp|104228|2022|PDM|90.00|99|0.00|HOSPICE CARE (HCFA)
20|FH_F127207_0_0|SrvcGrp|104229|2022|PDM|90.00|99|0.00|HOSPICE IN HOME (HCFA)
20|FH_F127207_0_0|SrvcGrp|82223|2022|PDM|90.00|99|0.00|HOSPICE CARE
20|FH_F127207_0_0|SrvcGrp|84185|2022|PDM|90.00|99|0.00|RESPITE CARE
20|FH_F127214_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F127214_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F127324_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F127324_0_0|CSTM-ALL|CSTM-00|2020|PDM|2750.00|99|0.00|AEG 10 (NO REV)
20|FH_F127324_0_0|SrvcGrp|110674|2022|PDM|11480.00|99|0.00|MUSCULOSKELETAL SYSTEM
20|FH_F127324_0_0|SrvcGrp|110675|2022|PDM|11480.00|99|0.00|NERVOUS SYSTEM
20|FH_F127324_0_0|SrvcGrp|82694|2022|PDM|1725.00|99|0.00|PODIATRY
20|FH_F127324_0_0|SrvcGrp|87059|2022|PDM|3105.00|99|0.00|REPAIR OF TENDON
20|FH_F127324_0_0|SrvcGrp|87060|2022|PDM|3105.00|99|0.00|SHOULDER ARTHROSCOPY/SURGERY
20|FH_F127325_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F127325_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F127325_0_0|SrvcGrp|34342|2022|PCT|0.00|99|0.00|IMPLANTS
20|FH_F127325_0_0|SrvcGrp|72996|2022|PDM|602.00|99|0.00|AEG 4
20|FH_F127326_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS
20|FH_F127343_0_0|CSTM-ALL|CSTM-00|2020|PDM|1744.00|99|0.00|AEG 7 (NO REV)
20|FH_F127343_0_0|SrvcGrp|110673|2022|PDM|14830.00|99|0.00|MUSCULOSKELETAL SYSTEM
20|FH_F127343_0_0|SrvcGrp|110675|2022|PDM|11480.00|99|0.00|NERVOUS SYSTEM
20|FH_F127399_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F127399_0_0|SrvcGrp|101520|2022|PDM|7699.00|99|0.00|T1H W/T/O (<250G)
20|FH_F127399_0_0|SrvcGrp|104112|2022|PDM|2497.00|99|0.00|REPAIR OF ANKLE FRACTURE
20|FH_F127399_0_0|SrvcGrp|105701|2022|PDM|4682.00|99|0.00|REPAIR OF VAGINA
20|FH_F127399_0_0|SrvcGrp|107868|2022|PDM|4682.00|99|0.00|AETNA LAPAROSCOPY SURGICAL
20|FH_F127399_0_0|SrvcGrp|108255|2022|PDM|3641.00|99|0.00|AETNA REPAIR CLAVICLE DISLOCATION
20|FH_F127399_0_0|SrvcGrp|108260|2022|PDM|1248.00|99|0.00|AETNA FIXATION OF KNEE JOINT
20|FH_F127399_0_0|SrvcGrp|110677|2022|PDM|2289.00|99|0.00|CLOSURE OF VAGINA
20|FH_F127399_0_0|SrvcGrp|110678|2022|PDM|14045.00|99|0.00|DRAINAGE OF HIP JOINT
20|FH_F127399_0_0|SrvcGrp|72990|2022|PDM|936.00|99|0.00|AEG 1
20|FH_F127399_0_0|SrvcGrp|72994|2022|PDM|2081.00|99|0.00|AEG 3
20|FH_F127399_0_0|SrvcGrp|73002|2022|PDM|3329.00|99|0.00|AEG 7
20|FH_F127399_0_0|SrvcGrp|73004|2022|PDM|1769.00|99|0.00|AEG 8
20|FH_F127399_0_0|SrvcGrp|73008|2022|PDM|1873.00|99|0.00|AEG 10
20|FH_F127399_0_0|SrvcGrp|77021|2022|PDM|3849.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY
20|FH_F127399_0_0|SrvcGrp|83835|2022|PDM|2913.00|99|0.00|REPLACE TISSUE EXPANDER
20|FH_F127399_0_0|SrvcGrp|84939|2022|PDM|14045.00|99|0.00|SHOULDER JOINT
20|FH_F127399_0_0|SrvcGrp|85778|2022|PDM|2913.00|99|0.00|REPAIR OF ANKLE FRACTURE
20|FH_F127399_0_0|SrvcGrp|85792|2022|PDM|4162.00|99|0.00|OPEN TREATMENT OF DISTAL
20|FH_F127399_0_0|SrvcGrp|91567|2022|PDM|2913.00|99|0.00|REPAIR OF KNEECAP TENDON
20|FH_F127399_0_0|SrvcGrp|92819|2022|PDM|6763.00|99|0.00|HIP ARTHOSCOPY
20|FH_F127399_0_0|SrvcGrp|98003|2022|PDM|2913.00|99|0.00|BIMALLEOLAR ANKLE FRACTURE
20|FH_F127418_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F127418_0_0|SrvcGrp|110758|2022|PDM|30935.95|99|0.00|CERVCAL OPEN TX OF VERTEBRAL FX
20|FH_F127418_0_0|SrvcGrp|110760|2022|PDM|15165.94|99|0.00|POSTERIOR OPEN TX OF VERTEBRAL FX
20|FH_F127418_0_0|SrvcGrp|110763|2022|PDM|3661.67|99|0.00|LUMBAR VERTEBRAL CORPECTOMY
20|FH_F127418_0_0|SrvcGrp|110767|2022|PDM|5009.38|99|0.00|2ND LEVEL INJ PARAVERT F JNT L/S
20|FH_F127418_0_0|SrvcGrp|110768|2022|PDM|5009.38|99|0.00|3RD LEVEL INJ PARAVERT F JNT L/S
20|FH_F127418_0_0|SrvcGrp|11306|2022|PCT|1.10|99|0.00|IMPLANTS
20|FH_F127418_0_0|SrvcGrp|46857|2022|PDM|4446.75|99|0.00|CPT CODE 62284
20|FH_F127418_0_0|SrvcGrp|67068|2022|PDM|38245.92|99|0.00|LUMBAR SPINE FUSION COMBINED
20|FH_F127418_0_0|SrvcGrp|88492|2022|PDM|2327.65|99|0.00|AETNA SPINAL BONE AUTOGRAFT
20|FH_F127418_0_0|SrvcGrp|88494|2022|PDM|8125.25|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION
20|FH_F127418_0_0|SrvcGrp|89842|2022|PDM|31737.62|99|0.00|LUMBAR
20|FH_F127418_0_0|SrvcGrp|89844|2022|PDM|26798.82|99|0.00|REINSERT SPINAL FIXATION
20|FH_F127418_0_0|SrvcGrp|89847|2022|PDM|14873.91|99|0.00|REMOVE SPINE FIXATION DEVICE
20|FH_F127418_0_0|SrvcGrp|89848|2022|PDM|8123.26|99|0.00|SPINE FUSION EXTRA SEGMENT
20|FH_F127418_0_0|SrvcGrp|89852|2022|PDM|29585.59|99|0.00|OPEN TREATMENT VERTEBRAL FRA
20|FH_F127418_0_0|SrvcGrp|89860|2022|PDM|10658.38|99|0.00|SPINAL DISK SURGERY ADD-ON
20|FH_F127418_0_0|SrvcGrp|93057|2022|PDM|3466.97|99|0.00|SPINAL BONE AUTOGRAFT
20|FH_F127418_0_0|SrvcGrp|93059|2022|PDM|3823.90|99|0.00|SPINAL BONE AUTOGRAFT
20|FH_F127418_0_0|SrvcGrp|93069|2022|PDM|15787.41|99|0.00|POSTERIOR NON-SEGMENTAL INST
20|FH_F127418_0_0|SrvcGrp|96799|2022|PDM|6691.56|99|0.00|DESTROY C/TH FACET JNT ADDL
20|FH_F127418_0_0|SrvcGrp|98497|2022|PDM|26571.83|99|0.00|ARTHRODESIS POSTERIOR TECH
20|FH_F127418_0_0|SrvcGrp|99164|2022|PDM|16174.66|99|0.00|CPT 22846
20|FH_F127422_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F127422_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|DEVICE INSERTION
20|FH_F127422_0_0|SrvcGrp|72996|2022|PDM|630.00|99|0.00|AEG 4
20|FH_F127422_0_0|SrvcGrp|73008|2022|PDM|333.00|99|0.00|AEG 10
20|FH_F127448_0_0|SrvcGrp|107794|2022|PDM|3900.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE
20|FH_F127448_0_0|SrvcGrp|36991|2022|PCT|0.00|99|0.00|IMPLANTS
20|FH_F127448_0_0|SrvcGrp|72990|2022|PDM|600.00|99|0.00|AEG 1
20|FH_F127448_0_0|SrvcGrp|72994|2022|PDM|920.00|99|0.00|AEG 3
20|FH_F127448_0_0|SrvcGrp|72998|2022|PDM|1100.00|99|0.00|AEG 5
20|FH_F127448_0_0|SrvcGrp|73002|2022|PDM|1500.00|99|0.00|AEG 7
20|FH_F127558_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE
20|FH_F127560_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F127560_0_0|SrvcGrp|46482|2022|PDM|150.00|99|0.00|S9083 PER VISIT
20|FH_F127604_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F127604_0_0|SrvcGrp|82981|2022|PDM|180.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F127711_0_0|CSTM-ALL|CSTM-00|2020|PDM|1171.00|99|0.00|AEG 2 (NO REV)
20|FH_F127711_0_0|CSTM-ALL|CSTM-00|2020|PDM|1655.00|99|0.00|AEG 4 (NO REV)
20|FH_F127711_0_0|CSTM-ALL|CSTM-00|2020|PDM|2633.00|99|0.00|AEG 8 (NO REV)
20|FH_F127711_0_0|CSTM-ALL|CSTM-00|2020|PDM|3526.00|99|0.00|AEG 9 (NO REV)
20|FH_F127998_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F128027_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F128027_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F128027_0_0|CSTM-ALL|CSTM-00|2020|PCT|2.25|99|0.00|HSS ASC
20|FH_F128027_0_0|SrvcGrp|64719|2022|PDM|1120.00|99|0.00|CPT 45382
20|FH_F128027_0_0|SrvcGrp|64720|2022|PDM|1260.00|99|0.00|CPT 45385
20|FH_F128027_0_0|SrvcGrp|64732|2022|PDM|1050.00|99|0.00|CPT 43239
20|FH_F128031_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F128031_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F128031_0_0|SrvcGrp|109143|2022|PDM|3080.00|99|0.00|SPINAL INSTRUMENTATION
20|FH_F128031_0_0|SrvcGrp|110950|2022|PDM|2065.00|99|0.00|ARTHROSCOPIC PROCEDURES
20|FH_F128031_0_0|SrvcGrp|110952|2022|PDM|9680.00|99|0.00|SPINAL FUSION
20|FH_F128031_0_0|SrvcGrp|40002|2022|PDM|17600.00|99|0.00|TOTAL HIP
20|FH_F128031_0_0|SrvcGrp|96353|2022|PDM|18700.00|99|0.00|RECONSTRUCT ANKLE JOINT
20|FH_F128073_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F128073_0_0|SrvcGrp|82981|2022|PDM|100.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F128185_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F128185_0_0|CSTM-ALL|CSTM-00|2020|PDM|1556.00|99|0.00|AEG 4 (NO REV)
20|FH_F128185_0_0|CSTM-ALL|CSTM-00|2020|PDM|1841.00|99|0.00|AEG 5  (NO REV)
20|FH_F128185_0_0|CSTM-ALL|CSTM-00|2020|PDM|1875.00|99|0.00|AEG 9 (NO REV)
20|FH_F128185_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F128188_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F128237_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F128237_0_0|SrvcGrp|29155|2022|PDM|100.00|99|0.00|HOSPICE SVCS
20|FH_F128246_0_0|SrvcGrp|111034|2022|PDM|726.00|99|0.00|REPAIR EYELID DEFECT
20|FH_F128246_0_0|SrvcGrp|111037|2022|PDM|588.00|99|0.00|REPAIR OF ECTROPION
20|FH_F128246_0_0|SrvcGrp|111039|2022|PDM|726.00|99|0.00|REPAIR OF ENTROPION
20|FH_F128246_0_0|SrvcGrp|111041|2022|PDM|841.00|99|0.00|DRAINAGE OF ABCESS
20|FH_F128246_0_0|SrvcGrp|111044|2022|PDM|378.00|99|0.00|REMOVAL OF EYE LESION
20|FH_F128246_0_0|SrvcGrp|111045|2022|PDM|726.00|99|0.00|LASER SURGERY EYE STRANDS
20|FH_F128246_0_0|SrvcGrp|111047|2022|PDM|673.00|99|0.00|REVISION OF EYELID
20|FH_F128246_0_0|SrvcGrp|79792|2022|PDM|1176.00|99|0.00|EYE/OCULAR ADNEXA SURGERY
20|FH_F128270_0_0|SrvcGrp|42782|2022|PDM|80.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F128334_0_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F128360_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F128360_0_0|CSTM-ALL|CSTM-00|2020|PDM|1282.00|99|0.00|AEG 8 (NO REV)
20|FH_F146790_0_0|CSTM-ALL|CSTM-00|2020|PDM|1900.00|99|0.00|AEG 4 (NO REV)
20|FH_F146790_0_0|CSTM-ALL|CSTM-00|2020|PDM|2750.00|99|0.00|AEG 7 (NO REV)
20|FH_F146790_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|AEG 8 (NO REV)
20|FH_F146792_0_0|CSTM-ALL|CSTM-00|2020|PDM|3192.00|99|0.00|AEG 6 (NO REV)
20|FH_F146792_0_0|CSTM-ALL|CSTM-00|2020|PDM|5177.00|99|0.00|AEG 9 (NO REV)
20|FH_F146792_0_0|SrvcGrp|11306|2022|PCT|0.80|99|0.00|IMPLANTS
20|FH_F146803_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F146803_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F146803_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 1 (NO REV)
20|FH_F146807_28655_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS
20|FH_F146859_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F146859_0_0|CSTM-ALL|CSTM-00|2020|PDM|1591.00|99|0.00|AEG 6 (NO REV)
20|FH_F146859_0_0|SrvcGrp|101108|2022|PDM|1443.00|99|0.00|REINSERTION OF RUPTURED BICEPS OR TRICEPS TENDON
20|FH_F146859_0_0|SrvcGrp|101117|2022|PDM|2118.00|99|0.00|INCISION EXTENSOR TENDON
20|FH_F146859_0_0|SrvcGrp|104096|2022|PDM|3462.00|99|0.00|ANKLE ARTHROSCOPY/SURGERY
20|FH_F146859_0_0|SrvcGrp|108306|2022|PDM|1465.00|99|0.00|AETNA REPAIR ULNA FRACTURE
20|FH_F146859_0_0|SrvcGrp|108311|2022|PDM|1422.00|99|0.00|AETNA REPAIR ACHILLES TENDON
20|FH_F146859_0_0|SrvcGrp|109670|2022|PDM|4328.00|99|0.00|CERV ARTIFIC DISKECTOMY
20|FH_F146859_0_0|SrvcGrp|113861|2022|PDM|2150.00|99|0.00|REMOVE WRIST TENDON LESION
20|FH_F146859_0_0|SrvcGrp|113988|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F146859_0_0|SrvcGrp|114840|2022|PDM|2077.00|99|0.00|FOOT TENDON REPAIR
20|FH_F146859_0_0|SrvcGrp|114846|2022|PDM|1394.00|99|0.00|NONUNION CARPAL BONE REPAIR
20|FH_F146859_0_0|SrvcGrp|114847|2022|PDM|2539.00|99|0.00|ELBOW REPAIR
20|FH_F146859_0_0|SrvcGrp|114860|2022|PDM|2929.00|99|0.00|POSTERIOR NON-SEGMENTAL INST
20|FH_F146859_0_0|SrvcGrp|114900|2022|PDM|5004.00|99|0.00|AMPUTATION FOLLOW-UP SURGERY
20|FH_F146859_0_0|SrvcGrp|16670|2022|PDM|1749.00|99|0.00|ULNAR NERVE AT ELBOW
20|FH_F146859_0_0|SrvcGrp|44461|2022|PDM|6092.00|99|0.00|INSERTION / REPLACEMENT OF SPINAL NEUROSTIMULATOR GENERATOR
20|FH_F146859_0_0|SrvcGrp|82689|2022|PDM|2108.00|99|0.00|SCOPE PLANTAR FASCIOTOMY
20|FH_F146859_0_0|SrvcGrp|83624|2022|PDM|3767.00|99|0.00|REPAIR BICEPS TENDON RUPTURE
20|FH_F146859_0_0|SrvcGrp|85198|2022|PDM|3404.00|99|0.00|AETNA KNEE ARTHROSCOPY
20|FH_F146885_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F146904_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F146909_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F146909_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F146933_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.90|99|0.00|HSS ASC
20|FH_F147009_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F147009_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|AEG 3 (NO REV)
20|FH_F147009_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|AEG 5  (NO REV)
20|FH_F147009_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|AEG 6 (NO REV)
20|FH_F147161_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|GENERAL ACUTE CARE
20|FH_F147162_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|GENERAL ACUTE CARE
20|FH_F147163_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE
20|FH_F147164_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.90|99|0.00|GENERAL ACUTE CARE
20|FH_F147211_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS
20|FH_F147211_0_0|SrvcGrp|11852|2022|PCT|0.60|99|0.00|IMPLANTS
20|FH_F147211_0_0|SrvcGrp|12846|2022|PCT|0.60|99|0.00|PHARMACY SVCS
20|FH_F147211_0_0|SrvcGrp|35058|2022|PDM|750.00|99|0.00|MRI - IP
20|FH_F147211_0_0|SrvcGrp|42623|2022|PDM|718.00|99|0.00|SUBACUTE - LEVEL III
20|FH_F147212_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F147212_0_0|SrvcGrp|3327|2022|PDM|255.00|99|0.00|HOSPICE SERVICE - IP RESPITE
20|FH_F147340_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F147340_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F147340_0_0|SrvcGrp|106655|2022|PCT|0.50|99|0.00|PARSABIV
20|FH_F147363_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F147363_0_0|SrvcGrp|16|2022|PDM|1000.00|99|0.00|ACUTE REHABILITATION
20|FH_F147372_0_0|SrvcGrp|108484|2022|PDM|825.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY
20|FH_F147403_0_0|SrvcGrp|82981|2022|PDM|250.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F147418_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F147418_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F147418_0_0|CSTM-ALL|CSTM-00|2020|PDM|2600.00|99|0.00|AEG 5  (NO REV)
20|FH_F147418_0_0|CSTM-ALL|CSTM-00|2020|PDM|2840.00|99|0.00|AEG 6 (NO REV)
20|FH_F147418_0_0|CSTM-ALL|CSTM-00|2020|PDM|5000.00|99|0.00|AEG 9 (NO REV)
20|FH_F147418_0_0|SrvcGrp|104642|2022|PDM|13000.00|99|0.00|RECONSTRUCT SHOULDER JOINT
20|FH_F147418_0_0|SrvcGrp|113940|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F147418_0_0|SrvcGrp|113988|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F147418_0_0|SrvcGrp|115021|2022|PDM|7000.00|99|0.00|SPINE
20|FH_F147418_0_0|SrvcGrp|85740|2022|PDM|13000.00|99|0.00|TOTAL KNEE REPLACEMENT
20|FH_F147418_0_0|SrvcGrp|99073|2022|PDM|1.28|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F147502_0_0|SrvcGrp|104226|2022|PDM|150.00|99|0.00|HOSPICE CARE (HCFA)
20|FH_F147502_0_0|SrvcGrp|104228|2022|PDM|150.00|99|0.00|HOSPICE CARE (HCFA)
20|FH_F147502_0_0|SrvcGrp|104230|2022|PDM|100.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F147502_0_0|SrvcGrp|23683|2022|PDM|85.00|99|0.00|SKILLED NURSING RN
20|FH_F147532_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F147532_0_0|SrvcGrp|113451|2022|PDM|87.23|99|0.00|HOSPICE CARE
20|FH_F147532_0_0|SrvcGrp|63297|2022|PDM|717.20|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F147532_0_0|SrvcGrp|74546|2022|PDM|384.52|99|0.00|HOSPICE SERVICES
20|FH_F147532_0_0|SrvcGrp|89822|2022|PDM|144.84|99|0.00|HOSPICE ROUTINE HOME CARE
20|FH_F147532_0_0|SrvcGrp|90477|2022|PDM|144.84|99|0.00|HOSPICE
20|FH_F147661_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F147800_0_0|CSTM-ALL|CSTM-00|2020|PDM|367.00|99|0.00|AEG 1 (NO REV) W/O SURGICAL CARVE OUTS
20|FH_F147800_0_0|CSTM-ALL|CSTM-00|2020|PDM|563.00|99|0.00|AEG 3 (NO REV)
20|FH_F147800_0_0|SrvcGrp|100864|2022|PDM|55.00|99|0.00|DRAIN/INJ JOINT/BURSA W/O U
20|FH_F147800_0_0|SrvcGrp|110768|2022|PDM|458.00|99|0.00|3RD LEVEL INJ PARAVERT F JNT L/S
20|FH_F147800_0_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS
20|FH_F147800_0_0|SrvcGrp|115143|2022|PDM|880.00|99|0.00|INJ ANES AGT; SUP HYPOGASTR
20|FH_F147800_0_0|SrvcGrp|115144|2022|PDM|660.00|99|0.00|NJX AA&/STRD NTRCOST NRV 1
20|FH_F147800_0_0|SrvcGrp|115145|2022|PDM|660.00|99|0.00|NJX AA&/STRD PUDENDAL NERVE
20|FH_F147800_0_0|SrvcGrp|115151|2022|PDM|55.00|99|0.00|NJX AA&/STRD GR OCPL NRV
20|FH_F147800_0_0|SrvcGrp|115841|2022|PDM|11000.00|99|0.00|PERQ NJX ALGC CT LMBR 1ST
20|FH_F147800_0_0|SrvcGrp|35669|2022|PDM|7700.00|99|0.00|CPT 63650
20|FH_F147800_0_0|SrvcGrp|90976|2022|PDM|1210.00|99|0.00|INJECTION PARAVERTEBRAL FACET JOINT
20|FH_F147800_0_0|SrvcGrp|92364|2022|PDM|16453.00|99|0.00|ARTHRODESIS SACROILIAC JOINT
20|FH_F147800_0_0|SrvcGrp|98103|2022|PDM|83.00|99|0.00|INJECTION TRIGGER POINTS >3
20|FH_F147800_0_0|SrvcGrp|99073|2022|PDM|1.38|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F147899_0_0|CSTM-ALL|CSTM-00|2020|PDM|443.00|99|0.00|AEG 1 (NO REV)
20|FH_F147919_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F147980_0_0|SrvcGrp|104226|2022|PDM|20.00|99|0.00|HOSPICE CARE (HCFA)
20|FH_F147980_0_0|SrvcGrp|80918|2022|PDM|95.00|99|0.00|RESPITE CARE
20|FH_F147980_0_0|SrvcGrp|82223|2022|PDM|95.00|99|0.00|HOSPICE CARE
20|FH_F147980_0_0|SrvcGrp|84185|2022|PDM|95.00|99|0.00|RESPITE CARE
20|FH_F148008_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F148020_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F148020_0_0|SrvcGrp|472|2022|PDM|528.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F148103_0_0|CSTM-ALL|CSTM-00|2020|PCT|36500.00|99|0.00|TIMELY FILING
20|FH_F148166_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F148166_0_0|SrvcGrp|80098|2022|PDM|56.00|99|0.00|AETNA HOSPICE CONTINUOUS HOME CARE
20|FH_F148166_0_0|SrvcGrp|92502|2022|PDM|980.00|99|0.00|HOSPICE GENERAL IP CARE
20|FH_F148181_0_0|SrvcGrp|63297|2022|PDM|155.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F148181_0_0|SrvcGrp|80918|2022|PDM|837.00|99|0.00|RESPITE CARE
20|FH_F148186_0_0|SrvcGrp|100961|2022|PDM|345.00|99|0.00|AMB SRVC NEONAT TRNSPRT BS RATE EMERG 1 WAY
20|FH_F148186_0_0|SrvcGrp|106300|2022|PDM|247.00|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT (HCFA)
20|FH_F148186_0_0|SrvcGrp|13422|2022|PDM|285.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC
20|FH_F148243_0_0|SrvcGrp|33982|2022|PDM|1450.00|99|0.00|CPT 28296
20|FH_F148243_0_0|SrvcGrp|36591|2022|PDM|26000.00|99|0.00|CPT 63685
20|FH_F148243_0_0|SrvcGrp|58638|2022|PDM|1500.00|99|0.00|CPT 63688
20|FH_F148243_0_0|SrvcGrp|79579|2022|PDM|879.00|99|0.00|CPT 43251
20|FH_F148243_0_0|SrvcGrp|79591|2022|PDM|400.00|99|0.00|CPT 43450
20|FH_F148243_0_0|SrvcGrp|79594|2022|PDM|770.00|99|0.00|CPT 45380
20|FH_F148243_0_0|SrvcGrp|82301|2022|PDM|260.00|99|0.00|HEMORRHOIDECTOMY
20|FH_F148243_0_0|SrvcGrp|88487|2022|PDM|3000.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION
20|FH_F148243_0_0|SrvcGrp|90606|2022|PDM|1250.00|99|0.00|INSERT LENS PROSTHESIS
20|FH_F148243_0_0|SrvcGrp|93724|2022|PDM|900.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY
20|FH_F148243_0_0|SrvcGrp|96819|2022|PDM|957.00|99|0.00|DESTROY L/S FACET JNT ADDL
20|FH_F148243_0_0|SrvcGrp|98326|2022|PDM|7500.00|99|0.00|PERQ LAMOT/LAM LUMBAR
20|FH_F148260_0_0|CSTM-ALL|CSTM-00|2020|PDM|10850.00|99|0.00|AEG 7 (NO REV)
20|FH_F148260_0_0|CSTM-ALL|CSTM-00|2020|PDM|10850.00|99|0.00|AEG 8 (NO REV)
20|FH_F148260_0_0|CSTM-ALL|CSTM-00|2020|PDM|15017.00|99|0.00|AEG 6 (NO REV) W/O UTERUS LAP/HYSTERO
20|FH_F148260_0_0|CSTM-ALL|CSTM-00|2020|PDM|2556.00|99|0.00|AEG 2 (NO REV)
20|FH_F148260_0_0|SrvcGrp|101519|2022|PDM|14871.00|99|0.00|T1H UTERUS (<250G)
20|FH_F148260_0_0|SrvcGrp|27347|2022|PDM|4824.00|99|0.00|CPT 58558
20|FH_F148260_0_0|SrvcGrp|67989|2022|PDM|4796.00|99|0.00|CPT 49320
20|FH_F148260_0_0|SrvcGrp|67994|2022|PDM|3964.00|99|0.00|CPT 58120
20|FH_F148260_0_0|SrvcGrp|87026|2022|PDM|1549.00|99|0.00|CYSTOSCOPY AND TREATMENT
20|FH_F148267_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F148267_0_0|SrvcGrp|96699|2022|PDM|155.60|99|0.00|HOSPICE ROUTINE HOME CARE
20|FH_F148326_0_0|CSTM-ALL|CSTM-00|2020|PDM|2193.00|99|0.00|AEG 10 (NO REV)
20|FH_F148326_0_0|SrvcGrp|90376|2022|PDM|8489.00|99|0.00|REVISION OF KNEE JOINTLANT
20|FH_F148344_0_0|SrvcGrp|89337|2022|PDM|918.00|99|0.00|DETOXIFICATION
20|FH_F148345_0_0|CSTM-ALL|CSTM-00|2020|PDM|1069.00|99|0.00|AEG 4 (NO REV)
20|FH_F148345_0_0|CSTM-ALL|CSTM-00|2020|PDM|1818.00|99|0.00|AEG 8 (NO REV)
20|FH_F148345_0_0|CSTM-ALL|CSTM-00|2020|PDM|1860.00|99|0.00|AEG 7 (NO REV)
20|FH_F148345_0_0|CSTM-ALL|CSTM-00|2020|PDM|2384.00|99|0.00|AEG 9 (NO REV)
20|FH_F148345_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F148346_0_0|SrvcGrp|108484|2022|PDM|1191.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY
20|FH_F148347_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F148347_0_0|CSTM-ALL|CSTM-00|2020|PDM|1197.00|99|0.00|AEG 6 (NO REV)
20|FH_F148347_0_0|CSTM-ALL|CSTM-00|2020|PDM|1942.00|99|0.00|AEG 9 (NO REV)
20|FH_F148347_0_0|CSTM-ALL|CSTM-00|2020|PDM|693.00|99|0.00|AEG 2 (NO REV)
20|FH_F148347_0_0|SrvcGrp|107757|2022|PDM|5063.00|99|0.00|LAP PARAESOPH HER RPR W/ MESH
20|FH_F148347_0_0|SrvcGrp|35921|2022|PDM|11616.00|99|0.00|BARIATRIC SURGERY
20|FH_F148347_0_0|SrvcGrp|78283|2022|PDM|4831.20|99|0.00|CPT 49505
20|FH_F148347_0_0|SrvcGrp|82115|2022|PDM|3993.00|99|0.00|REPAIR UMBIL HERNIA
20|FH_F148347_0_0|SrvcGrp|87844|2022|PDM|12778.00|99|0.00|LAPARASCOPY - GASTRIC
20|FH_F148429_0_0|SrvcGrp|16|2022|PDM|1372.00|99|0.00|ACUTE REHABILITATION
20|FH_F148439_0_0|SrvcGrp|73606|2022|PCT|0.00|99|0.00|AETNA SKILLED NURSING CARE
20|FH_F148488_0_0|SrvcGrp|46903|2022|PDM|440.00|99|0.00|RESIDENTIAL TREATMENT
20|FH_F148488_0_0|SrvcGrp|75419|2022|PDM|300.00|99|0.00|OP PARTIAL HOSPITALIZATION
20|FH_F148489_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F148494_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F148494_0_0|SrvcGrp|101103|2022|PDM|15000.00|99|0.00|REVIS SHOULDER JOINT
20|FH_F148494_0_0|SrvcGrp|113840|2022|PDM|15500.00|99|0.00|REVISE HIP ARTHROPLASTY
20|FH_F148494_0_0|SrvcGrp|114172|2022|PDM|3000.00|99|0.00|SPINE FIXATION
20|FH_F148494_0_0|SrvcGrp|114173|2022|PDM|3000.00|99|0.00|CARDIAC CATHERIZATION INCL INJECTIONS
20|FH_F148494_0_0|SrvcGrp|96350|2022|PDM|15000.00|99|0.00|SHOULDER JOINT
20|FH_F148499_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|HSS ASC
20|FH_F148521_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F148521_0_0|CSTM-ALL|CSTM-00|2020|PDM|352.00|99|0.00|AETNA SURGERY DEFAULT WITHOUT GROUPER 1
20|FH_F148521_0_0|SrvcGrp|23585|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F148541_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F148541_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F148555_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F148555_0_0|CSTM-ALL|CSTM-00|2020|PDM|1099.00|99|0.00|AEG 8 (NO REV)
20|FH_F148555_0_0|CSTM-ALL|CSTM-00|2020|PDM|505.00|99|0.00|AEG 2 (NO REV)
20|FH_F148555_0_0|SrvcGrp|110820|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES
20|FH_F148555_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F148555_0_0|SrvcGrp|115435|2022|PDM|4326.00|99|0.00|INSERT HEART PM ATRIAL
20|FH_F148555_0_0|SrvcGrp|115436|2022|PDM|3090.00|99|0.00|INSERT HEART PM VENTRICULAR
20|FH_F148555_0_0|SrvcGrp|115445|2022|PDM|3090.00|99|0.00|INSERT PACING LEAD & CONNECT
20|FH_F148555_0_0|SrvcGrp|115449|2022|PDM|3090.00|99|0.00|REMOVE & REPLACE PM GEN DUAL LEAD
20|FH_F148555_0_0|SrvcGrp|115501|2022|PDM|3090.00|99|0.00|STIMULATION, PACING HEART
20|FH_F148639_0_0|CSTM-ALL|CSTM-00|2020|PDM|1056.00|99|0.00|AEG 5  (NO REV)
20|FH_F148639_0_0|CSTM-ALL|CSTM-00|2020|PDM|1180.00|99|0.00|AEG 6 (NO REV)
20|FH_F148639_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|AEG 10 (NO REV)
20|FH_F148639_0_0|CSTM-ALL|CSTM-00|2020|PDM|614.00|99|0.00|AEG 1 (NO REV)
20|FH_F148639_0_0|CSTM-ALL|CSTM-00|2020|PDM|659.00|99|0.00|AEG 2 (NO REV)
20|FH_F148639_0_0|CSTM-ALL|CSTM-00|2020|PDM|767.00|99|0.00|AEG 3 (NO REV)
20|FH_F148639_0_0|SrvcGrp|109967|2022|PDM|5294.00|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F148639_0_0|SrvcGrp|115486|2022|PDM|4260.00|99|0.00|LOW BACK DISK SURGERY
20|FH_F148639_0_0|SrvcGrp|11673|2022|PDM|3084.00|99|0.00|CPT 29888
20|FH_F148639_0_0|SrvcGrp|54943|2022|PDM|3000.00|99|0.00|REPAIR OF SLAP LESION
20|FH_F148639_0_0|SrvcGrp|58636|2022|PDM|5140.00|99|0.00|CPT 62362
20|FH_F148639_0_0|SrvcGrp|63462|2022|PDM|2642.00|99|0.00|CPT 64595
20|FH_F148639_0_0|SrvcGrp|63467|2022|PDM|2159.00|99|0.00|CPT 64585
20|FH_F148639_0_0|SrvcGrp|70749|2022|PDM|1800.00|99|0.00|CPT 29823
20|FH_F148639_0_0|SrvcGrp|82109|2022|PDM|1131.00|99|0.00|REVISE ULNAR NERVE ELBOW
20|FH_F148639_0_0|SrvcGrp|88596|2022|PDM|1054.00|99|0.00|EXC OF TRIANG FIBROCARTILAGE
20|FH_F148639_0_0|SrvcGrp|92010|2022|PDM|1131.00|99|0.00|LESION OF TENDON SHEATH OR JOINT CAPSULE
20|FH_F148639_0_0|SrvcGrp|92364|2022|PDM|6779.00|99|0.00|ARTHRODESIS SACROILIAC JOINT
20|FH_F148639_0_0|SrvcGrp|99159|2022|PDM|2400.00|99|0.00|KNEE ARTHROSCOPY/SURGICAL
20|FH_F148645_0_0|CSTM-ALL|CSTM-00|2020|PDM|2087.19|99|0.00|AEG 3 (NO REV)
20|FH_F148645_0_0|CSTM-ALL|CSTM-00|2020|PDM|3160.00|99|0.00|AEG 5  (NO REV)
20|FH_F148645_0_0|CSTM-ALL|CSTM-00|2020|PDM|3448.39|99|0.00|AEG 6 (NO REV)
20|FH_F148645_0_0|CSTM-ALL|CSTM-00|2020|PDM|5315.88|99|0.00|AEG 9 (NO REV)
20|FH_F148645_0_0|CSTM-ALL|CSTM-00|2020|PDM|983.43|99|0.00|AEG 1 (NO REV)
20|FH_F148645_0_0|SrvcGrp|114924|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F148667_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F148667_0_0|CSTM-ALL|CSTM-00|2020|PDM|1233.00|99|0.00|AEG 4 (NO REV)
20|FH_F148667_0_0|CSTM-ALL|CSTM-00|2020|PDM|1467.00|99|0.00|AEG 10 (NO REV)
20|FH_F148667_0_0|CSTM-ALL|CSTM-00|2020|PDM|1687.00|99|0.00|AEG 7 (NO REV)
20|FH_F148667_0_0|CSTM-ALL|CSTM-00|2020|PDM|976.00|99|0.00|AEG 3 (NO REV)
20|FH_F148667_0_0|SrvcGrp|100059|2022|PDM|2856.00|99|0.00|REPAIR ULNA FRACTURE
20|FH_F148667_0_0|SrvcGrp|105658|2022|PDM|2856.00|99|0.00|REPAIR FRACTURE OF RADIUS
20|FH_F148667_0_0|SrvcGrp|108348|2022|PDM|2856.00|99|0.00|TREAT FRACTURE RADIUS/ULNA
20|FH_F148667_0_0|SrvcGrp|115493|2022|PDM|2052.00|99|0.00|FINGER JOINT FUSION
20|FH_F148667_0_0|SrvcGrp|16289|2022|PDM|1704.00|99|0.00|CARPAL TUNNEL RELEASE
20|FH_F148667_0_0|SrvcGrp|26274|2022|PDM|2856.00|99|0.00|CPT 29877
20|FH_F148667_0_0|SrvcGrp|26432|2022|PDM|2856.00|99|0.00|OP SURGICAL SERVICES
20|FH_F148667_0_0|SrvcGrp|41335|2022|PDM|11000.00|99|0.00|TOTAL HIP
20|FH_F148667_0_0|SrvcGrp|92010|2022|PDM|1118.00|99|0.00|LESION OF TENDON SHEATH OR JOINT CAPSULE
20|FH_F148667_0_0|SrvcGrp|99073|2022|PDM|1.66|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F148719_0_0|CSTM-ALL|CSTM-00|2020|PCT|50.00|99|0.00|OP SVCS
20|FH_F148720_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F148720_0_0|SrvcGrp|104055|2022|PDM|30.00|99|0.00|INFLUENZA VACCINE
20|FH_F148720_0_0|SrvcGrp|79618|2022|PDM|325.00|99|0.00|CPT CODE 90945 (HCFA)
20|FH_F148839_0_0|CSTM-ALL|CSTM-00|2020|PDM|335.00|99|0.00|AEG 1 (NO REV)
20|FH_F148839_0_0|CSTM-ALL|CSTM-00|2020|PDM|513.00|99|0.00|AEG 3 (NO REV)
20|FH_F148839_0_0|CSTM-ALL|CSTM-00|2020|PDM|634.00|99|0.00|AEG 10 (NO REV)
20|FH_F148839_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F148839_0_0|SrvcGrp|114443|2022|PDM|3246.00|99|0.00|EXTRACAPSULAR CATARACT REMOVAL, INSERT LENS
20|FH_F148839_0_0|SrvcGrp|95819|2022|PDM|1919.00|99|0.00|GONIOTOMY
20|FH_F148859_0_0|SrvcGrp|103992|2022|PDM|1353.00|99|0.00|CYSTOSCOPY AND TREATMENT
20|FH_F148859_0_0|SrvcGrp|108395|2022|PDM|263.00|99|0.00|SET RADIATION THERAPY FIELD
20|FH_F148859_0_0|SrvcGrp|115525|2022|PDM|1248.00|99|0.00|CYSTOSCOPY
20|FH_F148859_0_0|SrvcGrp|115527|2022|PDM|73.87|99|0.00|INJECTION
20|FH_F148859_0_0|SrvcGrp|115528|2022|PDM|69.71|99|0.00|BLADDER IRRIGATION
20|FH_F148859_0_0|SrvcGrp|115536|2022|PDM|6462.00|99|0.00|BLADDER PROCEDURES
20|FH_F148859_0_0|SrvcGrp|22780|2022|PDM|1974.00|99|0.00|CPT 55875
20|FH_F148859_0_0|SrvcGrp|3932|2022|PDM|4280.00|99|0.00|LITHOTRIPSY
20|FH_F148859_0_0|SrvcGrp|47544|2022|PDM|3919.00|99|0.00|PERCUTANEOUS IMPLANT OF NEUROSTIMULATOR ELECTRODES
20|FH_F148859_0_0|SrvcGrp|68054|2022|PDM|1248.00|99|0.00|CPT 52332
20|FH_F148859_0_0|SrvcGrp|68056|2022|PDM|791.00|99|0.00|CPT 55700
20|FH_F148860_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F148865_0_0|SrvcGrp|65720|2022|PDM|145.00|99|0.00|RESPITE CARE
20|FH_F148883_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F148884_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F148884_0_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F148887_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F148887_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F148892_0_0|CSTM-ALL|CSTM-00|2020|PDM|732.16|99|0.00|AEG 3 (NO REV)
20|FH_F148892_0_0|SrvcGrp|103236|2022|PDM|19580.00|99|0.00|AETNA INSJ STABLJ DEV
20|FH_F148892_0_0|SrvcGrp|110570|2022|PDM|668.00|99|0.00|NERVE BLOCK INJECTION 7
20|FH_F148892_0_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS
20|FH_F148892_0_0|SrvcGrp|113271|2022|PDM|1293.00|99|0.00|GENICULAR NERVE BLOCK
20|FH_F148892_0_0|SrvcGrp|45063|2022|PDM|668.00|99|0.00|CPT 64493  INJECTION CARVE OUT
20|FH_F148892_0_0|SrvcGrp|58634|2022|PDM|7680.00|99|0.00|NEUROELECTRODES IMPLANT
20|FH_F148892_0_0|SrvcGrp|58638|2022|PDM|2940.00|99|0.00|CPT 63688
20|FH_F148892_0_0|SrvcGrp|90974|2022|PDM|668.00|99|0.00|CERVICAL OR THORACIC INJECTION W/ IMAGING GUIDANCE
20|FH_F148900_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F148900_0_0|CSTM-ALL|CSTM-00|2020|PDM|477.62|99|0.00|AEG 1 (NO REV)
20|FH_F148900_0_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS
20|FH_F148900_0_0|SrvcGrp|113271|2022|PDM|1293.00|99|0.00|GENICULAR NERVE BLOCK
20|FH_F148900_0_0|SrvcGrp|115145|2022|PDM|668.00|99|0.00|NJX AA&/STRD PUDENDAL NERVE
20|FH_F148900_0_0|SrvcGrp|35669|2022|PDM|7183.00|99|0.00|CPT 63650
20|FH_F148900_0_0|SrvcGrp|53065|2022|PDM|668.00|99|0.00|INJECTION(S), LUMBAR OR SACRAL, SINGLE LEVEL
20|FH_F148900_0_0|SrvcGrp|58634|2022|PDM|7680.00|99|0.00|NEUROELECTRODES IMPLANT
20|FH_F148900_0_0|SrvcGrp|90974|2022|PDM|668.00|99|0.00|CERVICAL OR THORACIC INJECTION W/ IMAGING GUIDANCE
20|FH_F148927_0_0|CSTM-ALL|CSTM-00|2020|PDM|1236.00|99|0.00|AEG 2 (NO REV)
20|FH_F148927_0_0|CSTM-ALL|CSTM-00|2020|PDM|1900.00|99|0.00|AEG 4 (NO REV)
20|FH_F148927_0_0|CSTM-ALL|CSTM-00|2020|PDM|2100.00|99|0.00|AEG 5  (NO REV)
20|FH_F148927_0_0|SrvcGrp|115557|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F148927_0_0|SrvcGrp|16684|2022|PCT|0.33|99|0.00|DRUGS
20|FH_F148927_0_0|SrvcGrp|24714|2022|PCT|0.47|99|0.00|INTRAOCULAR LENS
20|FH_F148981_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F148981_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|AEG 10 (NO REV)
20|FH_F148981_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|AEG 2 (NO REV)
20|FH_F148981_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|AEG 5  (NO REV)
20|FH_F148981_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|AEG 6 (NO REV)
20|FH_F148981_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|AEG 7 (NO REV)
20|FH_F148981_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|AEG 9 (NO REV)
20|FH_F149024_0_0|CSTM-ALL|CSTM-00|2020|PDM|1095.60|99|0.00|AEG 4 (NO REV)
20|FH_F149024_0_0|CSTM-ALL|CSTM-00|2020|PDM|1423.40|99|0.00|AEG 6 (NO REV)
20|FH_F149024_0_0|CSTM-ALL|CSTM-00|2020|PDM|1678.60|99|0.00|AEG 8 (NO REV)
20|FH_F149024_0_0|CSTM-ALL|CSTM-00|2020|PDM|1730.30|99|0.00|AEG 10 (NO REV)
20|FH_F149024_0_0|CSTM-ALL|CSTM-00|2020|PDM|1730.30|99|0.00|AEG 7 (NO REV)
20|FH_F149024_0_0|CSTM-ALL|CSTM-00|2020|PDM|775.50|99|0.00|AEG 2 (NO REV)
20|FH_F149047_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F149047_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F149047_0_0|SrvcGrp|87077|2022|PDM|135.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F149083_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING
20|FH_F149083_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|DRUGS
20|FH_F149083_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F149085_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F149085_0_0|SrvcGrp|22528|2022|PCT|0.00|99|0.00|DAY HOSPITAL FULL DAY
20|FH_F149085_0_0|SrvcGrp|73485|2022|PDM|1350.00|99|0.00|AETNA REHAB
20|FH_F149085_0_0|SrvcGrp|80258|2022|PCT|0.00|99|0.00|AETNA SKILLED CARE
20|FH_F149179_0_0|CSTM-ALL|CSTM-00|2020|PDM|2400.00|99|0.00|AEG 4 (NO REV)
20|FH_F149179_0_0|SrvcGrp|114924|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F149179_0_0|SrvcGrp|115169|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F149179_0_0|SrvcGrp|115605|2022|PDM|4900.00|99|0.00|NECK SPINE FUSE
20|FH_F149179_0_0|SrvcGrp|115611|2022|PDM|7283.00|99|0.00|CATH DIALYSIS CIRCUIT
20|FH_F149179_0_0|SrvcGrp|115613|2022|PDM|4578.00|99|0.00|ARTHROS, SYNOVECT, SURG
20|FH_F149179_0_0|SrvcGrp|99073|2022|PDM|1.36|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F149240_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F149240_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F149240_0_0|SrvcGrp|80918|2022|PDM|144.84|99|0.00|RESPITE CARE
20|FH_F149240_0_0|SrvcGrp|84185|2022|PDM|144.84|99|0.00|RESPITE CARE
20|FH_F149242_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F149242_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS
20|FH_F149242_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|HSS ASC
20|FH_F149248_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F149248_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F149248_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 1 (NO REV)
20|FH_F149248_0_0|CSTM-ALL|CSTM-00|2020|PDM|620.00|99|0.00|AEG 2 (NO REV)
20|FH_F149263_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F149263_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 1 (NO REV)
20|FH_F149263_0_0|CSTM-ALL|CSTM-00|2020|PDM|1836.00|99|0.00|AEG 2 (NO REV)
20|FH_F149263_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|AEG 3 (NO REV)
20|FH_F149263_0_0|CSTM-ALL|CSTM-00|2020|PDM|2400.00|99|0.00|AEG 4 (NO REV)
20|FH_F149263_0_0|SrvcGrp|107793|2022|PDM|9180.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE
20|FH_F149263_0_0|SrvcGrp|115608|2022|PDM|5100.00|99|0.00|REPAIR BICEPS TENDON RUPTURE
20|FH_F128360_0_0|CSTM-ALL|CSTM-00|2020|PDM|831.00|99|0.00|AEG 10 (NO REV)
20|FH_F128379_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F128379_0_0|CSTM-ALL|CSTM-00|2020|PDM|1144.00|99|0.00|AEG 3 (NO REV)
20|FH_F128379_0_0|CSTM-ALL|CSTM-00|2020|PDM|1488.00|99|0.00|AEG 10 (NO REV)
20|FH_F128379_0_0|CSTM-ALL|CSTM-00|2020|PDM|2060.00|99|0.00|AEG 7 (NO REV)
20|FH_F128379_0_0|SrvcGrp|67064|2022|PDM|2861.00|99|0.00|MUSCULOSKELETAL SYSTEM
20|FH_F128379_0_0|SrvcGrp|67066|2022|PDM|7553.00|99|0.00|CERVICAL SURGERY
20|FH_F128379_0_0|SrvcGrp|88492|2022|PDM|2861.00|99|0.00|AETNA SPINAL BONE AUTOGRAFT
20|FH_F128379_0_0|SrvcGrp|92410|2022|PDM|7553.00|99|0.00|SPINE FUSION EXTRA SEGMENT
20|FH_F128446_0_0|SrvcGrp|82981|2022|PDM|161.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F128580_0_0|CSTM-ALL|CSTM-00|2020|PDM|456.00|99|0.00|AEG 2 (NO REV)
20|FH_F128580_0_0|CSTM-ALL|CSTM-00|2020|PDM|525.00|99|0.00|AEG 3 (NO REV)
20|FH_F128580_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F128580_0_0|SrvcGrp|107792|2022|PDM|6002.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE
20|FH_F128580_0_0|SrvcGrp|107877|2022|PDM|522.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT
20|FH_F128580_0_0|SrvcGrp|109135|2022|PDM|2248.00|99|0.00|AV FISTULA EXCISION
20|FH_F128580_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F128580_0_0|SrvcGrp|111139|2022|PDM|2248.00|99|0.00|ARTERY-VEIN GRAFT
20|FH_F128698_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F128698_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F128699_0_0|SrvcGrp|82222|2022|PDM|90.00|99|0.00|HOSPICE CARE
20|FH_F128699_0_0|SrvcGrp|84185|2022|PDM|90.00|99|0.00|RESPITE CARE
20|FH_F128804_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F128804_0_0|CSTM-ALL|CSTM-00|2020|PDM|1320.00|99|0.00|AEG 2 (NO REV)
20|FH_F128804_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F128804_0_0|SrvcGrp|106264|2022|PDM|5170.00|99|0.00|NSL/SINS NDSC W/ SINS DILATION
20|FH_F128804_0_0|SrvcGrp|106266|2022|PDM|4263.00|99|0.00|NSL/SINS NDSC TOT W/ SPHENDT
20|FH_F128804_0_0|SrvcGrp|106267|2022|PDM|4263.00|99|0.00|NSL/SINS NDSC SPHN TISS RMVL
20|FH_F128804_0_0|SrvcGrp|13990|2022|PCT|1.05|99|0.00|PACEMAKER
20|FH_F128804_0_0|SrvcGrp|83646|2022|PDM|3520.00|99|0.00|CPT 31276
20|FH_F128821_0_0|SrvcGrp|107746|2022|PCT|0.90|99|0.00|PARSABIV
20|FH_F128821_0_0|SrvcGrp|108042|2022|PDM|424.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD
20|FH_F128833_0_0|SrvcGrp|108041|2022|PDM|400.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME
20|FH_F128839_0_0|SrvcGrp|73842|2022|PDM|200.00|99|0.00|AETNA INTENSIVE OUTPATIENT
20|FH_F128880_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F128893_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F128893_0_0|SrvcGrp|63297|2022|PDM|150.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F128893_0_0|SrvcGrp|89781|2022|PDM|160.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F128893_0_0|SrvcGrp|95660|2022|PDM|600.00|99|0.00|HOSPICE SERVICES (HCFA)
20|FH_F128924_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F128924_0_0|SrvcGrp|111215|2022|PDM|182.00|99|0.00|CAPD/CCPD
20|FH_F128977_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F128977_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F128988_0_0|SrvcGrp|82223|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F129053_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F129053_0_0|CSTM-ALL|CSTM-00|2020|PDM|1847.00|99|0.00|AEG 4 (NO REV)
20|FH_F129053_0_0|CSTM-ALL|CSTM-00|2020|PDM|2861.00|99|0.00|AEG 8 (NO REV)
20|FH_F129053_0_0|SrvcGrp|11673|2022|PDM|2705.00|99|0.00|CPT 29888
20|FH_F129053_0_0|SrvcGrp|85792|2022|PDM|2081.00|99|0.00|OPEN TREATMENT OF DISTAL
20|FH_F129175_0_0|CSTM-ALL|CSTM-00|2020|PDM|1109.00|99|0.00|AEG 8 (NO REV)
20|FH_F129175_0_0|CSTM-ALL|CSTM-00|2020|PDM|489.00|99|0.00|AEG 2 (NO REV)
20|FH_F129175_0_0|CSTM-ALL|CSTM-00|2020|PDM|784.00|99|0.00|AEG 5  (NO REV)
20|FH_F129175_0_0|SrvcGrp|110768|2022|PDM|97.04|99|0.00|3RD LEVEL INJ PARAVERT F JNT L/S
20|FH_F129189_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F129189_0_0|SrvcGrp|82981|2022|PDM|100.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F129189_0_0|SrvcGrp|87077|2022|PDM|100.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F129225_0_0|CSTM-ALL|CSTM-00|2020|PDM|1688.96|99|0.00|2005 ASPG GROUPER IX
20|FH_F129225_0_0|CSTM-ALL|CSTM-00|2020|PDM|562.57|99|0.00|2005 ASPG GROUPER II
20|FH_F129225_0_0|CSTM-ALL|CSTM-00|2020|PDM|904.39|99|0.00|2005 ASPG GROUPER V
20|FH_F129225_0_0|SrvcGrp|90318|2022|PCT|1.10|99|0.00|IMPLANTS/PROSTHETICS
20|FH_F129248_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F129248_0_0|CSTM-ALL|CSTM-00|2020|PDM|1345.68|99|0.00|2005 ASPG GROUPER VIII
20|FH_F129248_0_0|CSTM-ALL|CSTM-00|2020|PDM|616.83|99|0.00|2005 ASPG GROUPER II
20|FH_F129248_0_0|CSTM-ALL|CSTM-00|2020|PDM|991.63|99|0.00|2005 ASPG GROUPER X
20|FH_F129254_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F129254_0_0|CSTM-ALL|CSTM-00|2020|PDM|794.66|99|0.00|ASPG IV
20|FH_F129260_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F129260_0_0|CSTM-ALL|CSTM-00|2020|PDM|1081.30|99|0.00|AEG 8 (NO REV)
20|FH_F129260_0_0|CSTM-ALL|CSTM-00|2020|PDM|640.00|99|0.00|AEG 1 (NO REV)
20|FH_F129310_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F129310_0_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F129364_0_0|SrvcGrp|107748|2022|PDM|424.00|99|0.00|HEMODIALYSIS IN CENTER
20|FH_F129364_0_0|SrvcGrp|111218|2022|PDM|182.00|99|0.00|CAPD/CCPD
20|FH_F129472_0_0|CSTM-ALL|CSTM-00|2020|PDM|740.00|99|0.00|AEG 3 (NO REV)
20|FH_F129487_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F129487_0_0|SrvcGrp|41327|2022|PDM|2369.00|99|0.00|OP SURGERY CPT 28308
20|FH_F129487_0_0|SrvcGrp|72990|2022|PDM|900.00|99|0.00|AEG 1
20|FH_F129487_0_0|SrvcGrp|72994|2022|PDM|1718.00|99|0.00|AEG 3
20|FH_F129487_0_0|SrvcGrp|74585|2022|PCT|1.05|99|0.00|AETNA OP IMPLANTS
20|FH_F129500_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F149263_0_0|SrvcGrp|115609|2022|PDM|3450.00|99|0.00|ANKLE FRACTURE REPAIR
20|FH_F149263_0_0|SrvcGrp|115613|2022|PDM|4400.00|99|0.00|ARTHROS, SYNOVECT, SURG
20|FH_F149263_0_0|SrvcGrp|65350|2022|PDM|4998.00|99|0.00|KNEE ARTHRO/ANTER
20|FH_F149263_0_0|SrvcGrp|89404|2022|PDM|6936.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F149263_0_0|SrvcGrp|99073|2022|PDM|1.39|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F149267_0_0|CSTM-ALL|CSTM-00|2020|PDM|2711.00|99|0.00|AEG 7 (NO REV)
20|FH_F149267_0_0|CSTM-ALL|CSTM-00|2020|PDM|764.00|99|0.00|AEG 2 (NO REV)
20|FH_F149271_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F149273_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F149273_0_0|CSTM-ALL|CSTM-00|2020|PDM|3060.00|99|0.00|AEG 9 (NO REV)
20|FH_F149273_0_0|CSTM-ALL|CSTM-00|2020|PDM|3264.00|99|0.00|AEG 7 (NO REV)
20|FH_F149273_0_0|SrvcGrp|107793|2022|PDM|9000.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE
20|FH_F149273_0_0|SrvcGrp|10986|2022|PDM|4900.00|99|0.00|ARTHROSCOPIC KNEE REPAIR
20|FH_F149273_0_0|SrvcGrp|115169|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F149273_0_0|SrvcGrp|115608|2022|PDM|5000.00|99|0.00|REPAIR BICEPS TENDON RUPTURE
20|FH_F149273_0_0|SrvcGrp|115609|2022|PDM|3589.00|99|0.00|ANKLE FRACTURE REPAIR
20|FH_F149273_0_0|SrvcGrp|115612|2022|PDM|5722.00|99|0.00|HIP ARTHRO W/ FEMOROPLASTY
20|FH_F149273_0_0|SrvcGrp|115613|2022|PDM|4488.00|99|0.00|ARTHROS, SYNOVECT, SURG
20|FH_F149273_0_0|SrvcGrp|115614|2022|PDM|4058.00|99|0.00|LAMINOTOMY/LAMINECTOMY
20|FH_F149273_0_0|SrvcGrp|36591|2022|PDM|4058.00|99|0.00|CPT 63685
20|FH_F149273_0_0|SrvcGrp|99073|2022|PDM|1.36|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F149401_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F149401_0_0|SrvcGrp|109036|2022|PDM|572.00|99|0.00|PARTIAL HOSPITALIZATION
20|FH_F149401_0_0|SrvcGrp|98701|2022|PDM|329.00|99|0.00|AETNA OP EATING DISORDERS
20|FH_F149439_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F149439_0_0|SrvcGrp|3327|2022|PDM|515.00|99|0.00|HOSPICE SERVICE - IP RESPITE
20|FH_F149442_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F149442_0_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING
20|FH_F149442_0_0|SrvcGrp|112223|2022|PDM|95.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)
20|FH_F149479_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F149479_0_0|SrvcGrp|105820|2022|PDM|1500.00|99|0.00|IP PSYCH EATING DISORDERS
20|FH_F149517_0_0|SrvcGrp|63297|2022|PDM|190.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F149517_0_0|SrvcGrp|87799|2022|PDM|194.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)
20|FH_F149523_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.11|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE
20|FH_F149523_0_0|SrvcGrp|101280|2022|PDM|15500.00|99|0.00|TOTAL HIP ARTHROPLASTY
20|FH_F149523_0_0|SrvcGrp|113840|2022|PDM|15500.00|99|0.00|REVISE HIP ARTHROPLASTY
20|FH_F149523_0_0|SrvcGrp|114170|2022|PDM|10000.00|99|0.00|LUMB ARTIF DISKECTOMY ADDL
20|FH_F149528_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F149528_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F149543_0_0|SrvcGrp|107749|2022|PDM|182.00|99|0.00|CAPD/CCPD
20|FH_F149543_0_0|SrvcGrp|108082|2022|PDM|25.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER
20|FH_F149581_0_0|SrvcGrp|73485|2022|PDM|1008.00|99|0.00|AETNA REHAB
20|FH_F149603_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F149605_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F149605_0_0|SrvcGrp|29353|2022|PDM|153.00|99|0.00|HOSPICE SVCS
20|FH_F149605_0_0|SrvcGrp|63297|2022|PDM|153.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F149605_0_0|SrvcGrp|73656|2022|PDM|661.00|99|0.00|AETNA HOSPICE SVCS
20|FH_F149605_0_0|SrvcGrp|80317|2022|PDM|153.00|99|0.00|RESPITE CARE
20|FH_F149605_0_0|SrvcGrp|90477|2022|PDM|153.00|99|0.00|HOSPICE
20|FH_F149660_0_0|SrvcGrp|13262|2022|PDM|3.70|99|0.00|GROUND MILEAGE, PER STATUTE MILE
20|FH_F149660_0_0|SrvcGrp|13422|2022|PDM|189.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC
20|FH_F149660_0_0|SrvcGrp|13595|2022|PDM|199.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC
20|FH_F149660_0_0|SrvcGrp|14557|2022|PDM|44.00|99|0.00|AMBULANCE SVCS - WHEELCHAIR VAN
20|FH_F149660_0_0|SrvcGrp|84284|2022|PDM|249.00|99|0.00|AMBULANCE SVC NEONATAL EMERG TRANSPORT
20|FH_F149679_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F149679_0_0|SrvcGrp|106291|2022|PDM|188.89|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT LEVEL 1 (HCFA)
20|FH_F149679_0_0|SrvcGrp|106314|2022|PDM|594.21|99|0.00|ADVANCED LIFE SUPPORT LEVEL 2 (ALS2) (HCFA)
20|FH_F149679_0_0|SrvcGrp|13595|2022|PDM|198.55|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC
20|FH_F149700_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F149700_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F149701_0_0|SrvcGrp|31931|2022|PDM|351.00|99|0.00|SKILLED NURSING CARE
20|FH_F149701_0_0|SrvcGrp|87536|2022|PCT|0.00|99|0.00|MED REHAB DAY PROGRAM (HALF)
20|FH_F149719_0_0|SrvcGrp|107747|2022|PDM|550.00|99|0.00|HOME HEMODIALYSIS
20|FH_F149719_0_0|SrvcGrp|107750|2022|PDM|25.00|99|0.00|TRAINING INCL A TREATMENT
20|FH_F149779_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F149779_0_0|CSTM-ALL|CSTM-00|2020|PDM|1896.00|99|0.00|AEG 2 (NO REV)
20|FH_F149779_0_0|CSTM-ALL|CSTM-00|2020|PDM|3178.00|99|0.00|AEG 9 (NO REV)
20|FH_F149779_0_0|CSTM-ALL|CSTM-00|2020|PDM|3204.00|99|0.00|AEG 6 (NO REV)
20|FH_F149868_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F149868_0_0|SrvcGrp|90477|2022|PDM|190.00|99|0.00|HOSPICE
20|FH_F149868_0_0|SrvcGrp|93100|2022|PDM|678.00|99|0.00|RESPITE CARE
20|FH_F149882_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F149959_0_0|SrvcGrp|108484|2022|PDM|750.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY
20|FH_F149959_0_0|SrvcGrp|75419|2022|PDM|525.00|99|0.00|OP PARTIAL HOSPITALIZATION
20|FH_F149980_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F149980_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F149980_0_0|CSTM-ALL|CSTM-00|2020|PDM|1131.00|99|0.00|AEG 4 (NO REV)
20|FH_F149980_0_0|CSTM-ALL|CSTM-00|2020|PDM|1513.00|99|0.00|AEG 7 (NO REV)
20|FH_F149980_0_0|CSTM-ALL|CSTM-00|2020|PDM|330.00|99|0.00|AEG 1 (NO REV)
20|FH_F149980_0_0|CSTM-ALL|CSTM-00|2020|PDM|330.00|99|0.00|AEG 10 (NO REV)
20|FH_F149980_0_0|SrvcGrp|113697|2022|PDM|1921.00|99|0.00|TRANSLUM DIL EYE CANAL
20|FH_F149980_0_0|SrvcGrp|115762|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F149980_0_0|SrvcGrp|115793|2022|PDM|1280.00|99|0.00|REVISE EYE MUSCLE
20|FH_F149980_0_0|SrvcGrp|115795|2022|PDM|696.00|99|0.00|UPPR GI ENDOSCOPY DIAGNOSIS
20|FH_F149980_0_0|SrvcGrp|94899|2022|PDM|2954.00|99|0.00|VITRECTOMY
20|FH_F150025_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F150025_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F150060_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F150060_0_0|SrvcGrp|108484|2022|PDM|800.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY
20|FH_F150060_0_0|SrvcGrp|89337|2022|PDM|1000.00|99|0.00|DETOXIFICATION
20|FH_F150079_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F150102_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F150102_0_0|CSTM-ALL|CSTM-00|2020|PDM|2277.00|99|0.00|AEG 2 (NO REV)
20|FH_F150102_0_0|CSTM-ALL|CSTM-00|2020|PDM|2527.00|99|0.00|AEG 7 (NO REV)
20|FH_F150164_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F150200_0_0|CSTM-ALL|CSTM-00|2020|PDM|1080.00|99|0.00|AEG 2 (NO REV)
20|FH_F150200_0_0|CSTM-ALL|CSTM-00|2020|PDM|795.00|99|0.00|AEG 10 (NO REV)
20|FH_F150200_0_0|SrvcGrp|115169|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F150200_0_0|SrvcGrp|27400|2022|PDM|2865.00|99|0.00|ARTHROSCOPY OF SHOULDER
20|FH_F150200_0_0|SrvcGrp|67065|2022|PDM|10612.00|99|0.00|CERVICAL SURGERY
20|FH_F150200_0_0|SrvcGrp|74039|2022|PDM|4682.00|99|0.00|LAMINECTOMY
20|FH_F150200_0_0|SrvcGrp|77461|2022|PDM|2865.00|99|0.00|CPT 52356
20|FH_F150200_0_0|SrvcGrp|88160|2022|PDM|4776.00|99|0.00|LAMINECTOMY W/FACETECTOMY
20|FH_F150200_0_0|SrvcGrp|92364|2022|PDM|8670.00|99|0.00|ARTHRODESIS SACROILIAC JOINT
20|FH_F150220_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F150220_0_0|CSTM-ALL|CSTM-00|2020|PDM|1368.00|99|0.00|AEG 2 (NO REV)
20|FH_F150220_0_0|CSTM-ALL|CSTM-00|2020|PDM|1535.00|99|0.00|AEG 3 (NO REV)
20|FH_F150220_0_0|CSTM-ALL|CSTM-00|2020|PDM|2239.00|99|0.00|AEG 10 (NO REV)
20|FH_F150220_0_0|SrvcGrp|113988|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F150224_0_0|SrvcGrp|92501|2022|PDM|350.00|99|0.00|HOSPICE IP RESPITE CARE
20|FH_F150226_0_0|SrvcGrp|13262|2022|PDM|3.68|99|0.00|GROUND MILEAGE, PER STATUTE MILE
20|FH_F150314_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F150314_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F150314_0_0|SrvcGrp|46903|2022|PDM|600.00|99|0.00|RESIDENTIAL TREATMENT
20|FH_F150324_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F150324_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F150520_0_0|CSTM-ALL|CSTM-00|2020|PDM|736.00|99|0.00|AEG 2 (NO REV)
20|FH_F150521_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F150521_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F150535_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F150536_0_0|SrvcGrp|87077|2022|PDM|100.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F150542_0_0|SrvcGrp|82981|2022|PDM|130.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F150599_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F150599_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F150599_0_0|CSTM-ALL|CSTM-00|2020|PDM|509.00|99|0.00|AETNA SURGERY DEFAULT WITHOUT GROUPER 1 & 2
20|FH_F150619_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F150619_0_0|SrvcGrp|13990|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F150663_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F150663_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F150663_0_0|SrvcGrp|46903|2022|PDM|700.00|99|0.00|RESIDENTIAL TREATMENT
20|FH_F150699_0_0|SrvcGrp|104635|2022|PDM|9727.00|99|0.00|INSERT PULSE GEN SNGL LEAD
20|FH_F150699_0_0|SrvcGrp|104638|2022|PDM|12296.00|99|0.00|INSERT HEART PM ATRIAL
20|FH_F150699_0_0|SrvcGrp|109502|2022|PDM|22004.00|99|0.00|INSERT PULSE GEN MULT LEADS
20|FH_F150699_0_0|SrvcGrp|109503|2022|PDM|3383.00|99|0.00|REPOSITION L VENTRIC LEAD
20|FH_F150699_0_0|SrvcGrp|113940|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F150699_0_0|SrvcGrp|88481|2022|PDM|38826.00|99|0.00|AETNA RMVL & RPLCMT DFB GEN MLT LEAD
20|FH_F150699_0_0|SrvcGrp|91959|2022|PDM|29461.00|99|0.00|INSERT PULSE GENERATOR
20|FH_F150699_0_0|SrvcGrp|92406|2022|PDM|28053.00|99|0.00|REMOVAL & REPLACE PULSE GEN 1 LEAD
20|FH_F150759_0_0|CSTM-ALL|CSTM-00|2020|PDM|1339.00|99|0.00|AEG 9 (NO REV)
20|FH_F150759_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|AEG 5  (NO REV)
20|FH_F150759_0_0|SrvcGrp|98448|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F150763_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F150763_0_0|CSTM-ALL|CSTM-00|2020|PDM|2374.00|99|0.00|AEG 4 (NO REV)
20|FH_F150763_0_0|CSTM-ALL|CSTM-00|2020|PDM|2705.00|99|0.00|AEG 5  (NO REV)
20|FH_F150763_0_0|CSTM-ALL|CSTM-00|2020|PDM|3144.00|99|0.00|AEG 6 (NO REV)
20|FH_F150763_0_0|CSTM-ALL|CSTM-00|2020|PDM|3144.00|99|0.00|AEG 9 (NO REV)
20|FH_F150781_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F150906_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F150906_0_0|SrvcGrp|115902|2022|PDM|457.00|99|0.00|HOSPICE IN LT/NON-SKILLED NF
20|FH_F150910_0_0|SrvcGrp|113854|2022|PDM|4740.00|99|0.00|REMOVE/REINSER SPINE FIXATION DEVICE
20|FH_F150910_0_0|SrvcGrp|113855|2022|PDM|3000.00|99|0.00|SPINE FIXATION
20|FH_F150910_0_0|SrvcGrp|80617|2022|PDM|10500.00|99|0.00|ARTHOPLASTY
20|FH_F150910_0_0|SrvcGrp|89842|2022|PDM|10500.00|99|0.00|LUMBAR
20|FH_F150910_0_0|SrvcGrp|93432|2022|PDM|10500.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT
20|FH_F150910_0_0|SrvcGrp|98497|2022|PDM|10800.00|99|0.00|ARTHRODESIS POSTERIOR TECH
20|FH_F150936_0_0|SrvcGrp|82981|2022|PDM|90.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F150939_0_0|SrvcGrp|100240|2022|PCT|0.00|99|0.00|CHEMISTRY
20|FH_F150939_0_0|SrvcGrp|100244|2022|PCT|0.00|99|0.00|CHYLMD TRACH
20|FH_F150939_0_0|SrvcGrp|100245|2022|PCT|0.00|99|0.00|INFLUENZA ASSAY W/ OPTIC
20|FH_F150939_0_0|SrvcGrp|100246|2022|PCT|0.00|99|0.00|STREP A ASSAY W/ OPTIC
20|FH_F150939_0_0|SrvcGrp|100248|2022|PDM|48.00|99|0.00|REMOVAL OF SKIN TAGS
20|FH_F150939_0_0|SrvcGrp|100250|2022|PDM|32.00|99|0.00|REPAIR SUPERFICIAL WOUND(S) (2.5 CM OR LESS)
20|FH_F150939_0_0|SrvcGrp|100251|2022|PDM|43.00|99|0.00|REPAIR SUPERFICIAL WOUND(S) (2.6 - 7.5 CM)
20|FH_F150939_0_0|SrvcGrp|100254|2022|PDM|85.00|99|0.00|REPAIR SUPERFICIAL WOUND(S) (20.1 - 30.0 CM)
20|FH_F150939_0_0|SrvcGrp|100266|2022|PDM|4.30|99|0.00|TB INTRADERMAL TEST
20|FH_F150939_0_0|SrvcGrp|100269|2022|PDM|68.25|99|0.00|HEPA VACCINE ADULT IM
20|FH_F150939_0_0|SrvcGrp|100274|2022|PDM|40.50|99|0.00|TETANUS DIPHTHERIA TOXOI
20|FH_F150939_0_0|SrvcGrp|100275|2022|PDM|127.25|99|0.00|MENINGOCOCCL POLYSACCHRID VA
20|FH_F150939_0_0|SrvcGrp|100277|2022|PDM|59.71|99|0.00|HEPB VACCINE ADULT
20|FH_F150939_0_0|SrvcGrp|100278|2022|PDM|0.29|99|0.00|INJ DEXAMETHASONE ACETATE
20|FH_F150939_0_0|SrvcGrp|100280|2022|PDM|2.69|99|0.00|NEBULIZER ADMINISTRATION SET
20|FH_F150939_0_0|SrvcGrp|101741|2022|PDM|3.00|99|0.00|IMMUN ADMIN ORAL/NASAL
20|FH_F150939_0_0|SrvcGrp|111060|2022|PDM|20.53|99|0.00|TOXOIDS VACCINES
20|FH_F150939_0_0|SrvcGrp|115899|2022|PDM|9.97|99|0.00|IIV4 VACCINE SPLT 0.25 ML IM
20|FH_F150939_0_0|SrvcGrp|22379|2022|PDM|24.00|99|0.00|CPT CODE 94010
20|FH_F150939_0_0|SrvcGrp|45307|2022|PDM|10.00|99|0.00|ADMIN OF INFLUENZA VIRUS VACCINE
20|FH_F150939_0_0|SrvcGrp|53786|2022|PDM|12.00|99|0.00|BREATHING DEVICE
20|FH_F150939_0_0|SrvcGrp|68240|2022|PDM|37.00|99|0.00|DESTRUCTION WARTS - 1ST LESION
20|FH_F150939_0_0|SrvcGrp|82744|2022|PDM|6.60|99|0.00|URINE CULTURE COLONY COUNT
20|FH_F150939_0_0|SrvcGrp|94882|2022|PDM|12.70|99|0.00|FLU VIRUS VACC-SPLIT 3 YRS & ABOVE
20|FH_F150939_0_0|SrvcGrp|96499|2022|PDM|10.00|99|0.00|ADMIN OF PNEUMOCOCCAL VACCINE
20|FH_F150948_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F150948_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F150948_0_0|SrvcGrp|108093|2022|PDM|10950.00|99|0.00|REVISE HIP ARTHROPLASTY
20|FH_F150948_0_0|SrvcGrp|113851|2022|PDM|10500.00|99|0.00|ARTHRDSIS LAT MINI DISKECT
20|FH_F150948_0_0|SrvcGrp|113853|2022|PDM|3000.00|99|0.00|CARDIAC CATHERIZATION INCL INJECTIONS
20|FH_F150948_0_0|SrvcGrp|84939|2022|PDM|10500.00|99|0.00|SHOULDER JOINT
20|FH_F150948_0_0|SrvcGrp|88157|2022|PDM|10950.00|99|0.00|TOTAL HIP ARTHROPLASTY
20|FH_F150948_0_0|SrvcGrp|89404|2022|PDM|10950.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F150948_0_0|SrvcGrp|89842|2022|PDM|10500.00|99|0.00|LUMBAR
20|FH_F150948_0_0|SrvcGrp|93432|2022|PDM|10500.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT
20|FH_F150949_0_0|SrvcGrp|113851|2022|PDM|10500.00|99|0.00|ARTHRDSIS LAT MINI DISKECT
20|FH_F150949_0_0|SrvcGrp|113853|2022|PDM|3000.00|99|0.00|CARDIAC CATHERIZATION INCL INJECTIONS
20|FH_F150949_0_0|SrvcGrp|113856|2022|PDM|10000.00|99|0.00|SPINE PROCEDURES
20|FH_F150949_0_0|SrvcGrp|113857|2022|PDM|6000.00|99|0.00|SPINE PROCEDURES
20|FH_F150949_0_0|SrvcGrp|93431|2022|PDM|10500.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT
20|FH_F150951_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F150951_0_0|SrvcGrp|82222|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F150951_0_0|SrvcGrp|83857|2022|PDM|475.00|99|0.00|IP HOSPICE SVCS
20|FH_F150959_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F150959_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|AEG 5  (NO REV)
20|FH_F150959_0_0|CSTM-ALL|CSTM-00|2020|PDM|2439.80|99|0.00|AEG 9 (NO REV)
20|FH_F150959_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F150959_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F150982_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F150982_0_0|CSTM-ALL|CSTM-00|2020|PDM|1074.00|99|0.00|AEG 3 (NO REV)
20|FH_F150982_0_0|CSTM-ALL|CSTM-00|2020|PDM|2753.00|99|0.00|AEG 10 (NO REV)
20|FH_F150982_0_0|SrvcGrp|100920|2022|PDM|3303.00|99|0.00|SPINE PRO DEVICE
20|FH_F150982_0_0|SrvcGrp|100923|2022|PDM|1040.00|99|0.00|DRUGS
20|FH_F150982_0_0|SrvcGrp|101520|2022|PDM|2527.00|99|0.00|T1H W/T/O (<250G)
20|FH_F150982_0_0|SrvcGrp|101525|2022|PDM|2527.00|99|0.00|MYOMECTOMY
20|FH_F150982_0_0|SrvcGrp|103542|2022|PDM|6056.00|99|0.00|ANKLE ARTHROSCOPY/SURGERY
20|FH_F150982_0_0|SrvcGrp|103967|2022|PDM|1981.00|99|0.00|TRANSURETHRAL INCISION OF PR
20|FH_F150982_0_0|SrvcGrp|104008|2022|PDM|4992.00|99|0.00|CORRECTION HALUX RIDGUS W IMPLANTS
20|FH_F150982_0_0|SrvcGrp|104449|2022|PDM|3853.00|99|0.00|CYSTOURETHRO W/ IMPLANT
20|FH_F150982_0_0|SrvcGrp|105637|2022|PDM|2202.00|99|0.00|KNEE ARTHROSCOPY
20|FH_F150982_0_0|SrvcGrp|105639|2022|PDM|1976.00|99|0.00|INCISION OF ACHILLES TENDON
20|FH_F150982_0_0|SrvcGrp|105640|2022|PDM|1040.00|99|0.00|NJX INTERLAMINAR CRV/THRC
20|FH_F150982_0_0|SrvcGrp|105658|2022|PDM|5284.00|99|0.00|REPAIR FRACTURE OF RADIUS
20|FH_F150982_0_0|SrvcGrp|106266|2022|PDM|2753.00|99|0.00|NSL/SINS NDSC TOT W/ SPHENDT
20|FH_F150982_0_0|SrvcGrp|111589|2022|PDM|1382.00|99|0.00|REVISE ULNAR NERVE AT WRIST
20|FH_F150982_0_0|SrvcGrp|111803|2022|PDM|1927.00|99|0.00|EXCISION OF URETHRA LESION
20|FH_F150982_0_0|SrvcGrp|111805|2022|PDM|4404.00|99|0.00|REMOVAL OF FACE WRINKLES
20|FH_F150982_0_0|SrvcGrp|114443|2022|PDM|2808.00|99|0.00|EXTRACAPSULAR CATARACT REMOVAL, INSERT LENS
20|FH_F150982_0_0|SrvcGrp|115929|2022|PDM|3971.00|99|0.00|LAPAROSCOPY
20|FH_F150982_0_0|SrvcGrp|26278|2022|PDM|2202.00|99|0.00|CPT 29881
20|FH_F150982_0_0|SrvcGrp|27402|2022|PDM|3083.00|99|0.00|LASER PROCEDURES
20|FH_F150982_0_0|SrvcGrp|33966|2022|PDM|2202.00|99|0.00|CPT 29866
20|FH_F150982_0_0|SrvcGrp|33977|2022|PDM|1981.00|99|0.00|CPT 59820
20|FH_F150982_0_0|SrvcGrp|33987|2022|PDM|2147.00|99|0.00|CPT 57522
20|FH_F150982_0_0|SrvcGrp|35668|2022|PDM|3303.00|99|0.00|CPT 29824
20|FH_F150982_0_0|SrvcGrp|44068|2022|PDM|3303.00|99|0.00|CPT 52332
20|FH_F150982_0_0|SrvcGrp|49205|2022|PDM|2392.00|99|0.00|REPAIR DETACHED RETINA
20|FH_F150982_0_0|SrvcGrp|58634|2022|PDM|8320.00|99|0.00|NEUROELECTRODES IMPLANT
20|FH_F150982_0_0|SrvcGrp|63459|2022|PDM|3303.00|99|0.00|CPT 52601
20|FH_F150982_0_0|SrvcGrp|65625|2022|PDM|2147.00|99|0.00|CPT 30520
20|FH_F150982_0_0|SrvcGrp|67072|2022|PDM|3854.00|99|0.00|CPT 22845
20|FH_F150982_0_0|SrvcGrp|67989|2022|PDM|4955.00|99|0.00|CPT 49320
20|FH_F150982_0_0|SrvcGrp|77447|2022|PDM|1802.00|99|0.00|ENDOSCOPIC INJECTION
20|FH_F150982_0_0|SrvcGrp|77448|2022|PDM|2532.00|99|0.00|CYSTOSCOPY AND TREATMENT
20|FH_F150982_0_0|SrvcGrp|77450|2022|PDM|1322.00|99|0.00|CPT 54161
20|FH_F150982_0_0|SrvcGrp|77582|2022|PDM|2753.00|99|0.00|CPT 31255
20|FH_F150982_0_0|SrvcGrp|78093|2022|PDM|2753.00|99|0.00|AETNA NASAL ENDOSCOPY SURG
20|FH_F150982_0_0|SrvcGrp|79101|2022|PDM|2478.00|99|0.00|AETNA NASAL ENDOSCOPY
20|FH_F150982_0_0|SrvcGrp|79595|2022|PDM|1382.00|99|0.00|CPT 45385
20|FH_F150982_0_0|SrvcGrp|82111|2022|PDM|2202.00|99|0.00|KNEE ARTHROSCOPY SURGICAL
20|FH_F150982_0_0|SrvcGrp|82114|2022|PDM|2202.00|99|0.00|MENISCUS REPAIR MED OR LAT
20|FH_F150982_0_0|SrvcGrp|83642|2022|PDM|2202.00|99|0.00|CPT 29883
20|FH_F150982_0_0|SrvcGrp|83643|2022|PDM|2202.00|99|0.00|CPT 29885
20|FH_F150982_0_0|SrvcGrp|84279|2022|PDM|2392.00|99|0.00|CORNEAL TRANSPLANT
20|FH_F150982_0_0|SrvcGrp|85966|2022|PDM|1382.00|99|0.00|EXTRACAPSULAR CATARACT
20|FH_F150982_0_0|SrvcGrp|86460|2022|PDM|6606.00|99|0.00|REVISE BREAST RECONSTRUCTION
20|FH_F150982_0_0|SrvcGrp|88162|2022|PDM|8809.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON
20|FH_F150982_0_0|SrvcGrp|89988|2022|PDM|1976.00|99|0.00|REPAIR HALLUX RIGIDUS
20|FH_F150982_0_0|SrvcGrp|90822|2022|PDM|2753.00|99|0.00|NASAL/SINUS ENDOSCOPY SURGERY
20|FH_F150982_0_0|SrvcGrp|92369|2022|PDM|4160.00|99|0.00|REPAIR OF ANKLE LIGAMENTS
20|FH_F150982_0_0|SrvcGrp|92547|2022|PDM|2202.00|99|0.00|SKIN FULL GRAFT PROCEDURE
20|FH_F150982_0_0|SrvcGrp|98003|2022|PDM|5200.00|99|0.00|BIMALLEOLAR ANKLE FRACTURE
20|FH_F150982_0_0|SrvcGrp|99174|2022|PDM|1927.00|99|0.00|CPT 30140
20|FH_F151002_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F151002_0_0|SrvcGrp|114926|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES
20|FH_F151002_0_0|SrvcGrp|23585|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F151084_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F151139_0_0|SrvcGrp|100959|2022|PDM|7500.00|99|0.00|AMB SRVC CONVNTION AIR TRANSPORT 1 WAY
20|FH_F151143_0_0|SrvcGrp|115962|2022|PDM|4250.00|99|0.00|NON-EMERGENT AIR TRANSPORT 1 WAY (MOD NE)
20|FH_F151156_0_0|CSTM-ALL|CSTM-00|2020|PDM|36.00|99|0.00|AEG 7 (NO REV)
20|FH_F151157_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F151157_0_0|CSTM-ALL|CSTM-00|2020|PDM|35.00|99|0.00|AEG 10 (NO REV)
20|FH_F151202_0_0|SrvcGrp|108484|2022|PDM|450.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY
20|FH_F151225_0_0|SrvcGrp|32189|2022|PDM|204.00|99|0.00|RESPITE CARE
20|FH_F151225_0_0|SrvcGrp|33722|2022|PDM|46.00|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F151225_0_0|SrvcGrp|76528|2022|PDM|208.00|99|0.00|HOSPICE LTCH
20|FH_F151399_0_0|SrvcGrp|100959|2022|PDM|11724.00|99|0.00|AMB SRVC CONVNTION AIR TRANSPORT 1 WAY
20|FH_F151399_0_0|SrvcGrp|106317|2022|PDM|3945.00|99|0.00|SPECIALTY CARE TRANSPORT (HCFA)
20|FH_F151400_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F151400_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F151400_0_0|CSTM-ALL|CSTM-00|2020|PDM|2275.00|99|0.00|AEG 6 (NO REV)
20|FH_F151400_0_0|CSTM-ALL|CSTM-00|2020|PDM|2435.00|99|0.00|AEG 3 (NO REV)
20|FH_F151400_0_0|CSTM-ALL|CSTM-00|2020|PDM|3802.00|99|0.00|AEG 5  (NO REV)
20|FH_F151400_0_0|CSTM-ALL|CSTM-00|2020|PDM|838.00|99|0.00|AEG 1 (NO REV)
20|FH_F151400_0_0|SrvcGrp|80139|2022|PDM|6900.00|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F151400_0_0|SrvcGrp|97319|2022|PDM|6700.00|99|0.00|REVISE SPINE ELTRD PLATE
20|FH_F151400_0_0|SrvcGrp|99073|2022|PCT|0.00|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F151423_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|GENERAL ACUTE CARE
20|FH_F151424_0_0|CSTM-ALL|CSTM-00|2020|PCT|30.00|99|0.00|OP SVCS
20|FH_F151517_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F151517_0_0|SrvcGrp|74668|2022|PDM|214.00|99|0.00|AETNA INTENSIVE OUTPATIENT
20|FH_F151751_0_0|CSTM-ALL|CSTM-00|2020|PDM|1224.00|99|0.00|AEG 10 (NO REV)
20|FH_F151751_0_0|CSTM-ALL|CSTM-00|2020|PDM|1281.00|99|0.00|AEG 6 (NO REV)
20|FH_F151751_0_0|CSTM-ALL|CSTM-00|2020|PDM|1734.00|99|0.00|AEG 8 (NO REV)
20|FH_F151780_0_0|SrvcGrp|82981|2022|PDM|140.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F31029_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F31032_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F31056_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|LAP CHOLECYSTECTOMY
20|FH_F31056_0_0|CSTM-ALL|CSTM-00|2020|PDM|2063.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31056_0_0|CSTM-ALL|CSTM-00|2020|PDM|867.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F31064_0_0|CSTM-ALL|CSTM-00|2020|PCT|57.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31064_0_0|CSTM-ALL|CSTM-00|2020|PCT|57.00|99|0.00|OP SVCS
20|FH_F31087_0_0|SrvcGrp|10517|2022|PDM|55.00|99|0.00|HOME HEALTH AIDE VISIT
20|FH_F31087_0_0|SrvcGrp|10518|2022|PDM|98.00|99|0.00|ENTEROSTOMAL VISIT F/U VISIT
20|FH_F31087_0_0|SrvcGrp|10931|2022|PCT|0.97|99|0.00|DME/ORTHOTICS/PROSTHETICS
20|FH_F31087_0_0|SrvcGrp|3140|2022|PCT|0.97|99|0.00|PHARMACY SERVICES
20|FH_F31087_0_0|SrvcGrp|471|2022|PDM|495.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F31087_0_0|SrvcGrp|9263|2022|PDM|132.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F31101_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31101_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F31111_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|GENERAL ACUTE CARE
20|FH_F31111_0_0|SrvcGrp|111932|2022|PDM|87.00|99|0.00|COVID-19 NON-CDC TESTING LAB
20|FH_F31111_0_0|SrvcGrp|111934|2022|PDM|87.00|99|0.00|COVID-19 NUCLEIC ACID
20|FH_F31150_0_0|SrvcGrp|9863|2022|PDM|1400.00|99|0.00|INTENSIVE CARE/CORONARY CARE UNIT
20|FH_F31184_0_0|CSTM-ALL|CSTM-00|2020|PDM|16100.00|99|0.00|MS DRG 248 249 PERCUTANEOUS CARDIO PROCEDURE
20|FH_F31184_0_0|CSTM-ALL|CSTM-00|2020|PDM|29500.00|99|0.00|MS DRG 227
20|FH_F31184_0_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|OP SVCS
20|FH_F31184_0_0|CSTM-ALL|CSTM-00|2020|PDM|39500.00|99|0.00|MS DRG 231
20|FH_F31184_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|MS DRG 765-766 C-SECTION
20|FH_F31184_0_0|SrvcGrp|72|2022|PDM|400.00|99|0.00|NEWBORN NURSERY
20|FH_F31204_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F31204_0_0|SrvcGrp|110|2022|PDM|635.00|99|0.00|CD - REHABILITATION
20|FH_F31204_0_0|SrvcGrp|3328|2022|PDM|210.00|99|0.00|OP PSYCH HOSPITALIZATION - ADOLESCENT
20|FH_F31218_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SURGERY
20|FH_F31248_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F31340_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F31340_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|SKILLED NURSING CARE
20|FH_F31370_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31370_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS
20|FH_F31375_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31381_0_0|SrvcGrp|72|2022|PDM|200.00|99|0.00|NEWBORN NURSERY
20|FH_F31398_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31433_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|HEMOPHILIA FACTOR
20|FH_F31433_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|TAKE HOME DRUGS
20|FH_F31464_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|GENERAL ACUTE CARE
20|FH_F31466_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|PSYCHIATRIC OP SVCS
20|FH_F31466_0_0|CSTM-ALL|CSTM-00|2020|PDM|694.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31466_0_0|SrvcGrp|23587|2022|PDM|694.00|99|0.00|RESIDENTIAL TREATMENT - PSYCH
20|FH_F31481_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE
20|FH_F31508_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F31525_0_0|SrvcGrp|16|2022|PDM|1015.00|99|0.00|ACUTE REHABILITATION
20|FH_F31530_0_0|SrvcGrp|472|2022|PDM|650.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F31530_0_0|SrvcGrp|9539|2022|PDM|375.00|99|0.00|SUBACUTE CARE
20|FH_F31540_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31542_0_0|CSTM-ALL|CSTM-00|2020|PDM|2658.00|99|0.00|ASPG VIII
20|FH_F31542_0_0|CSTM-ALL|CSTM-00|2020|PDM|3153.00|99|0.00|ASPG IX
20|FH_F31542_0_0|CSTM-ALL|CSTM-00|2020|PDM|3200.00|99|0.00|MS DRG 765-766 C-SECTION
20|FH_F31542_0_0|CSTM-ALL|CSTM-00|2020|PDM|785.00|99|0.00|ASPG I
20|FH_F31542_0_0|SrvcGrp|10924|2022|PDM|3800.00|99|0.00|PTCA W/O STENT
20|FH_F31542_0_0|SrvcGrp|12394|2022|PCT|1.00|99|0.00|PROSTHETICS/IMPLANTS/DEVICES
20|FH_F31542_0_0|SrvcGrp|9774|2022|PDM|1400.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F31594_0_0|SrvcGrp|16|2022|PDM|450.00|99|0.00|ACUTE REHABILITATION
20|FH_F31595_0_0|CSTM-ALL|CSTM-00|2020|PDM|1750.00|99|0.00|C-SECTION
20|FH_F31595_0_0|CSTM-ALL|CSTM-00|2020|PDM|1750.00|99|0.00|NORMAL DELIVERY
20|FH_F31595_0_0|SrvcGrp|10410|2022|PDM|85.00|99|0.00|SKILLED NURSING CARE
20|FH_F31595_0_0|SrvcGrp|10432|2022|PCT|0.93|99|0.00|TREATMENT ROOM
20|FH_F31600_0_0|CSTM-ALL|CSTM-00|2020|PCT|91.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31612_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.10|99|0.00|OP SVCS
20|FH_F31783_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|MS DRG 247
20|FH_F31783_0_0|CSTM-ALL|CSTM-00|2020|PDM|14910.00|99|0.00|MS DRG 248
20|FH_F31783_0_0|CSTM-ALL|CSTM-00|2020|PDM|24360.00|99|0.00|MSDRG 226-227 CV SURG CARDIAC DEFIBRILLATOR
20|FH_F31783_0_0|CSTM-ALL|CSTM-00|2020|PDM|25250.00|99|0.00|MSDRG 228-230
20|FH_F31783_0_0|CSTM-ALL|CSTM-00|2020|PDM|7400.00|99|0.00|MS DRG 287
20|FH_F31783_0_0|SrvcGrp|13215|2022|PCT|0.60|99|0.00|PHARMACY SVCS
20|FH_F31783_0_0|SrvcGrp|19661|2022|PDM|35700.00|99|0.00|MS DRG 216-218 ONLY CARDIAC VALVE PROCEDURE W/CARDIAC CATH
20|FH_F31783_0_0|SrvcGrp|43|2022|PCT|0.40|99|0.00|IMPLANTS
20|FH_F31796_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31798_0_0|SrvcGrp|14177|2022|PDM|19495.00|99|0.00|BARIATRIC SVCS
20|FH_F31824_0_0|CSTM-ALL|CSTM-00|2020|PDM|1600.00|99|0.00|OP SURG
20|FH_F31825_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|OP SVCS
20|FH_F31827_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS
20|FH_F31863_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F31882_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31908_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31921_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31928_0_0|CSTM-ALL|CSTM-00|2020|PDM|790.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31928_0_0|SrvcGrp|12918|2022|PDM|790.00|99|0.00|GYNECOLOGICAL MED/SURG
20|FH_F31928_0_0|SrvcGrp|3719|2022|PDM|300.00|99|0.00|NEWBORN NURSERY
20|FH_F31936_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS
20|FH_F31940_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31959_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F31960_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F31968_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31985_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|OP SVCS
20|FH_F31990_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F31998_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31998_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F32000_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F32001_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F32014_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32060_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F32066_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.77|99|0.00|GENERAL ACUTE CARE
20|FH_F32066_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.77|99|0.00|OP SVCS
20|FH_F32088_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32093_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F32097_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS
20|FH_F32114_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32123_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32125_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32125_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS
20|FH_F32127_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32135_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32141_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F32151_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|OP SVCS
20|FH_F32156_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32156_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F32177_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32192_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32198_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS
20|FH_F32200_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32200_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F32201_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS
20|FH_F32211_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F32220_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS
20|FH_F32228_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32236_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32284_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32286_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32286_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F32289_0_0|CSTM-ALL|CSTM-00|2020|PCT|99.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32301_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32301_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F32316_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32325_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS
20|FH_F32362_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32370_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F32375_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32376_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32382_0_0|CSTM-ALL|CSTM-00|2020|PCT|86.00|99|0.00|OP SVCS
20|FH_F32401_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32411_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32420_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32420_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F32424_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32427_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS
20|FH_F32429_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32429_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F32453_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS
20|FH_F32466_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32484_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32484_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F32486_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F32494_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F32502_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F32509_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE
20|FH_F32509_0_0|SrvcGrp|14063|2022|PDM|14359.00|99|0.00|PACEMAKER
20|FH_F32509_0_0|SrvcGrp|9911|2022|PCT|0.80|99|0.00|EMERGENCY ROOM SVCS
20|FH_F32522_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F32525_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32529_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32532_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32565_0_0|CSTM-ALL|CSTM-00|2020|PCT|86.00|99|0.00|OP SVCS
20|FH_F32614_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32623_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32623_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F32640_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE
20|FH_F32653_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32686_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32686_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F32703_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS
20|FH_F32727_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F32731_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32736_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS
20|FH_F32751_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F32769_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32772_0_0|SrvcGrp|3378|2022|PCT|0.95|99|0.00|OBSERVATION SVCS
20|FH_F32778_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32784_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F32792_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32792_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F32799_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F32803_0_0|CSTM-ALL|CSTM-00|2020|PDM|1461.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32803_0_0|SrvcGrp|10716|2022|PCT|0.65|99|0.00|CARDIAC CATHETERIZATION
20|FH_F32803_0_0|SrvcGrp|13199|2022|PDM|3000.00|99|0.00|TRAUMA CARE
20|FH_F32803_0_0|SrvcGrp|80|2022|PDM|875.00|99|0.00|ACUTE PSYCH
20|FH_F32825_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|MS DRG 742
20|FH_F32825_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|MS DRG 743
20|FH_F32825_0_0|CSTM-ALL|CSTM-00|2020|PDM|10058.00|99|0.00|MSDRG 250-251 PERCUTANEOUS CARDIO PROC
20|FH_F32825_0_0|CSTM-ALL|CSTM-00|2020|PDM|3491.00|99|0.00|MSDRG 286-287 CARDIAC CATH
20|FH_F32825_0_0|SrvcGrp|10107|2022|PCT|0.60|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F32825_0_0|SrvcGrp|11258|2022|PCT|0.60|99|0.00|DRUGS
20|FH_F32825_0_0|SrvcGrp|701|2022|PDM|1748.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F32833_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS
20|FH_F32834_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32834_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F32838_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32848_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32850_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32869_0_0|CSTM-ALL|CSTM-00|2020|PDM|1050.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F32869_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|MS DRG 765-766 C-SECTION
20|FH_F32869_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|MS DRG 767-768, 774-775 NORMAL DELIVERY
20|FH_F32869_0_0|CSTM-ALL|CSTM-00|2020|PDM|16500.00|99|0.00|MS DRG 491, 515-517, 917-918 KYPHOPLASTY
20|FH_F32869_0_0|CSTM-ALL|CSTM-00|2020|PDM|22000.00|99|0.00|MSDRG 228-230
20|FH_F32869_0_0|CSTM-ALL|CSTM-00|2020|PDM|29000.00|99|0.00|MSDRG 226-227 CV SURG CARDIAC DEFIBRILLATOR
20|FH_F32869_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|MS DRG 287
20|FH_F32869_0_0|SrvcGrp|12032|2022|PDM|3000.00|99|0.00|TRANSURETHRAL MICROWAVE THERAPY
20|FH_F32869_0_0|SrvcGrp|14285|2022|PDM|12000.00|99|0.00|BARIATRIC SURGERY
20|FH_F32869_0_0|SrvcGrp|16|2022|PDM|700.00|99|0.00|ACUTE REHABILITATION
20|FH_F32870_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32877_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F32885_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32902_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32913_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F32914_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32916_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32917_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F32926_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F32927_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS
20|FH_F32929_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32935_0_0|SrvcGrp|16|2022|PDM|968.00|99|0.00|ACUTE REHABILITATION
20|FH_F32938_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|OP SVCS
20|FH_F32938_0_0|SrvcGrp|6|2022|PDM|5800.00|99|0.00|OP SURGERY
20|FH_F32938_0_0|SrvcGrp|9978|2022|PDM|1485.00|99|0.00|ACUTE INPATIENT MEDICAL SVCS
20|FH_F32958_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS
20|FH_F32978_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS
20|FH_F32984_0_0|CSTM-ALL|CSTM-00|2020|PCT|86.40|99|0.00|GENERAL ACUTE CARE
20|FH_F32986_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|OP SVCS
20|FH_F32994_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32995_0_0|CSTM-ALL|CSTM-00|2020|PDM|1050.00|99|0.00|ASPG II
20|FH_F32995_0_0|CSTM-ALL|CSTM-00|2020|PDM|1483.00|99|0.00|ASPG IV
20|FH_F32995_0_0|CSTM-ALL|CSTM-00|2020|PDM|3156.00|99|0.00|ASPG IX
20|FH_F32995_0_0|SrvcGrp|10923|2022|PDM|7532.00|99|0.00|PTCA W/DRUG ELUTING STENT
20|FH_F32995_0_0|SrvcGrp|12212|2022|PDM|750.00|99|0.00|MAGNETIC RESONANCE IMAGING (MRI)
20|FH_F32995_0_0|SrvcGrp|13231|2022|PDM|1275.00|99|0.00|INTERMEDIATE MED/SURG SVCS
20|FH_F32995_0_0|SrvcGrp|3420|2022|PDM|4500.00|99|0.00|OP LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F32995_0_0|SrvcGrp|411|2022|PDM|4000.00|99|0.00|OP CARDIAC CATH
20|FH_F32995_0_0|SrvcGrp|88|2022|PDM|5000.00|99|0.00|OP LITHOTRIPSY
20|FH_F32995_0_0|SrvcGrp|9936|2022|PDM|90.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F32995_0_0|SrvcGrp|9937|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F32996_0_0|CSTM-ALL|CSTM-00|2020|PDM|1944.00|99|0.00|MS DRG 765-766 C-SECTION
20|FH_F32996_0_0|SrvcGrp|11606|2022|PDM|918.00|99|0.00|ACUTE CARE (MEDICAL & SURGICAL)
20|FH_F32996_0_0|SrvcGrp|8950|2022|PDM|2700.00|99|0.00|INTERMEDIATE ICU/CCU
20|FH_F33003_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F33015_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE
20|FH_F33015_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F33063_0_0|SrvcGrp|3577|2022|PDM|300.00|99|0.00|PARTIAL HOSPITALIZATION
20|FH_F33099_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F33163_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33175_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33181_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|ANGIOPLASTY
20|FH_F33181_0_0|CSTM-ALL|CSTM-00|2020|PDM|17000.00|99|0.00|CORONARY BYPASS SURGERY
20|FH_F33182_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS
20|FH_F33199_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33225_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33233_0_0|SrvcGrp|14593|2022|PDM|3402.00|99|0.00|NEURO - PSYCH EXAM
20|FH_F33233_0_0|SrvcGrp|14826|2022|PDM|543.38|99|0.00|DAY TREATMENT
20|FH_F33233_0_0|SrvcGrp|3259|2022|PDM|822.15|99|0.00|ACUTE REHABILITATION
20|FH_F33241_0_0|CSTM-ALL|CSTM-00|2020|PDM|1050.00|99|0.00|ASPG II
20|FH_F33241_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|ASPG III
20|FH_F33241_0_0|CSTM-ALL|CSTM-00|2020|PDM|1687.00|99|0.00|ASPG V
20|FH_F33241_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|MS DRG 767-768, 774-775 NORMAL DELIVERY
20|FH_F33241_0_0|SrvcGrp|13123|2022|PDM|550.00|99|0.00|COMPUTED TOMOGRAPHY (CT)
20|FH_F33241_0_0|SrvcGrp|88|2022|PDM|4500.00|99|0.00|OP LITHOTRIPSY
20|FH_F33269_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33282_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33285_0_0|CSTM-ALL|CSTM-00|2020|PCT|99.00|99|0.00|OP SVCS
20|FH_F33295_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33295_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F33311_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33319_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F33322_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE
20|FH_F33322_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F33322_0_0|SrvcGrp|3178|2022|PDM|926.00|99|0.00|ACUTE PSYCH
20|FH_F33322_0_0|SrvcGrp|8|2022|PCT|0.90|99|0.00|BURN INTENSIVE CARE
20|FH_F33331_0_0|CSTM-ALL|CSTM-00|2020|PCT|91.50|99|0.00|GENERAL ACUTE CARE
20|FH_F33334_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F33381_0_0|CSTM-ALL|CSTM-00|2020|PDM|13650.00|99|0.00|MSDRG 250-251 PERCUTANEOUS CARDIO PROC
20|FH_F33381_0_0|CSTM-ALL|CSTM-00|2020|PDM|21076.00|99|0.00|MS DRG 246
20|FH_F33381_0_0|CSTM-ALL|CSTM-00|2020|PDM|2151.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33381_0_0|CSTM-ALL|CSTM-00|2020|PDM|5678.00|99|0.00|MS DRG 765-766 C-SECTION
20|FH_F33381_0_0|SrvcGrp|941|2022|PDM|2871.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F33385_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33390_0_0|SrvcGrp|11199|2022|PCT|0.75|99|0.00|HYPERBARIC CHAMBER
20|FH_F33390_0_0|SrvcGrp|12299|2022|PCT|0.75|99|0.00|PROSTHETICS/IMPLANTS/DEVICES
20|FH_F33390_0_0|SrvcGrp|14886|2022|PCT|0.75|99|0.00|TRANSPORTATION
20|FH_F33390_0_0|SrvcGrp|9774|2022|PDM|1798.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F33415_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33435_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33451_0_0|CSTM-ALL|CSTM-00|2020|PDM|2237.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33479_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS
20|FH_F33483_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33486_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33486_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS
20|FH_F33496_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33497_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33515_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|OP SVCS
20|FH_F33521_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F33527_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F33530_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|TRAUMA CARE
20|FH_F33535_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33556_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F33556_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33566_0_0|SrvcGrp|10013|2022|PDM|689.00|99|0.00|NEWBORN NURSERY
20|FH_F33566_0_0|SrvcGrp|16|2022|PDM|1035.00|99|0.00|ACUTE REHABILITATION
20|FH_F33566_0_0|SrvcGrp|31038|2022|PDM|26530.00|99|0.00|MS DRG 233-234 ONLY
20|FH_F33566_0_0|SrvcGrp|39522|2022|PDM|63672.00|99|0.00|MS DRG 216-218 ONLY
20|FH_F33566_0_0|SrvcGrp|59856|2022|PDM|9550.00|99|0.00|MS DRG 244 OR 249 ONLY
20|FH_F33581_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F33581_0_0|CSTM-ALL|CSTM-00|2020|PDM|1944.00|99|0.00|MS DRG 767-768, 774-775 NORMAL DELIVERY
20|FH_F33581_0_0|CSTM-ALL|CSTM-00|2020|PDM|3240.00|99|0.00|CORONARY CARE UNIT
20|FH_F33581_0_0|SrvcGrp|8950|2022|PDM|2700.00|99|0.00|INTERMEDIATE ICU/CCU
20|FH_F33592_0_0|CSTM-ALL|CSTM-00|2020|PDM|109.00|99|0.00|OP SVCS
20|FH_F33592_0_0|CSTM-ALL|CSTM-00|2020|PDM|480.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33612_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33642_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 020-022
20|FH_F33642_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 028-030 SPINE SURGERY
20|FH_F33642_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 417-419
20|FH_F33642_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 471-473 CERVICAL FUSION
20|FH_F33642_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 691-692 URINARY STONES
20|FH_F33642_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MSDRG 286-287 CARDIAC CATH
20|FH_F33642_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|TRAUMA ACTIVATION
20|FH_F33642_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|ASPG I
20|FH_F33642_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33642_0_0|CSTM-ALL|CSTM-00|2020|PDM|1900.00|99|0.00|ASPG IV
20|FH_F33642_0_0|CSTM-ALL|CSTM-00|2020|PDM|3975.00|99|0.00|MS DRG 765-766 C-SECTION
20|FH_F33642_0_0|SrvcGrp|13360|2022|PDM|750.00|99|0.00|EMERGENCY ROOM SVCS LEVEL II
20|FH_F33642_0_0|SrvcGrp|13361|2022|PCT|0.75|99|0.00|EMERGENCY ROOM SVCS LEVEL III
20|FH_F33642_0_0|SrvcGrp|13715|2022|PCT|0.60|99|0.00|DME/ORTHOTICS/PROSTHETICS/IMPLANTS
20|FH_F33642_0_0|SrvcGrp|18200|2022|PCT|0.75|99|0.00|MS DRG 026
20|FH_F33642_0_0|SrvcGrp|18791|2022|PCT|0.75|99|0.00|MS DRG 215
20|FH_F33645_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33649_0_0|CSTM-ALL|CSTM-00|2020|PDM|675.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33649_0_0|SrvcGrp|109|2022|PDM|625.00|99|0.00|CD - DETOX
20|FH_F33650_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33659_0_0|SrvcGrp|15389|2022|PDM|95.00|99|0.00|SOCIAL WORKER (MEDICAL)
20|FH_F33659_0_0|SrvcGrp|15390|2022|PDM|45.00|99|0.00|HOME HEALTH AIDE VISIT
20|FH_F33685_0_0|SrvcGrp|115|2022|PDM|522.00|99|0.00|SKILLED NURSING CARE
20|FH_F33685_0_0|SrvcGrp|63|2022|PDM|650.00|99|0.00|SUBACUTE CARE
20|FH_F33712_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 028-030 SPINE SURGERY
20|FH_F33712_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 459-460
20|FH_F33712_0_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|ASPG II
20|FH_F33712_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|ACUTE PSYCH
20|FH_F33712_0_0|SrvcGrp|10903|2022|PDM|750.00|99|0.00|EMERGENCY ROOM LEVEL I
20|FH_F33712_0_0|SrvcGrp|10906|2022|PCT|0.75|99|0.00|EMERGENCY ROOM LEVEL IV
20|FH_F33712_0_0|SrvcGrp|10964|2022|PDM|1500.00|99|0.00|ACUTE IP MED/SURG SVCS
20|FH_F33712_0_0|SrvcGrp|12406|2022|PCT|0.60|99|0.00|DRUGS
20|FH_F33712_0_0|SrvcGrp|15350|2022|PCT|0.75|99|0.00|TRAUMA ACTIVATION
20|FH_F33712_0_0|SrvcGrp|15369|2022|PCT|0.60|99|0.00|LABORATORY
20|FH_F33712_0_0|SrvcGrp|18200|2022|PCT|0.75|99|0.00|MS DRG 026
20|FH_F33712_0_0|SrvcGrp|73420|2022|PDM|3500.00|99|0.00|UNGROUPABLE ASPG + REV CODES
20|FH_F33719_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F33719_0_0|CSTM-ALL|CSTM-00|2020|PDM|1830.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33719_0_0|SrvcGrp|15361|2022|PDM|3351.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F33719_0_0|SrvcGrp|6|2022|PCT|0.70|99|0.00|OP SURGERY
20|FH_F33725_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.97|99|0.00|OP SVCS
20|FH_F33725_0_0|SrvcGrp|13385|2022|PDM|75.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F33744_0_0|CSTM-ALL|CSTM-00|2020|PDM|7950.00|99|0.00|MS DRG 242
20|FH_F33744_0_0|CSTM-ALL|CSTM-00|2020|PDM|7950.00|99|0.00|MS DRGS 258-262 PACEMAKER REVISION OR REPLACEMENT
20|FH_F33744_0_0|SrvcGrp|24|2022|PDM|5300.00|99|0.00|CARDIAC CATH
20|FH_F33744_0_0|SrvcGrp|38|2022|PDM|3498.00|99|0.00|NORMAL DELIVERY
20|FH_F33782_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.97|99|0.00|OP SVCS
20|FH_F33782_0_0|SrvcGrp|11442|2022|PDM|480.00|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)
20|FH_F33785_0_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|ONCOLOGY
20|FH_F33785_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|DIALYSIS SVCS
20|FH_F33785_0_0|SrvcGrp|12543|2022|PDM|5000.00|99|0.00|LAPAROSCOPIC HYSTERECTOMY
20|FH_F33785_0_0|SrvcGrp|16|2022|PDM|750.00|99|0.00|ACUTE REHABILITATION
20|FH_F33785_0_0|SrvcGrp|290|2022|PDM|5000.00|99|0.00|IP LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F33785_0_0|SrvcGrp|360|2022|PDM|900.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F33785_0_0|SrvcGrp|439|2022|PDM|1500.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F33785_0_0|SrvcGrp|588|2022|PDM|1800.00|99|0.00|CORONARY CARE UNIT
20|FH_F33791_0_0|SrvcGrp|10393|2022|PDM|1750.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F33791_0_0|SrvcGrp|111924|2022|PDM|2200.00|99|0.00|C-SECTION DELIVERY INCLUDES NEWBORN
20|FH_F33791_0_0|SrvcGrp|16|2022|PDM|750.00|99|0.00|ACUTE REHABILITATION
20|FH_F33825_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33832_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS
20|FH_F33845_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33850_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33851_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS
20|FH_F33855_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33856_0_0|SrvcGrp|117|2022|PCT|0.85|99|0.00|OP LAPAROSCOPIC SVCS
20|FH_F33856_0_0|SrvcGrp|12117|2022|PCT|0.85|99|0.00|MAGNETIC RESONANCE IMAGING
20|FH_F33856_0_0|SrvcGrp|12886|2022|PCT|0.85|99|0.00|HOSPICE SVCS (HOME CARE)
20|FH_F33856_0_0|SrvcGrp|38|2022|PDM|2000.00|99|0.00|NORMAL DELIVERY
20|FH_F33865_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.63|99|0.00|OP SVCS
20|FH_F33866_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F33900_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F33916_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F33972_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS
20|FH_F34022_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34024_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34040_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34048_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34048_0_0|SrvcGrp|21778|2022|PCT|0.70|99|0.00|BONE MARROW TRANSPLANT
20|FH_F34050_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS
20|FH_F34100_0_0|CSTM-ALL|CSTM-00|2020|PDM|90.00|99|0.00|OP SVCS
20|FH_F34100_0_0|SrvcGrp|3259|2022|PDM|700.00|99|0.00|ACUTE REHABILITATION
20|FH_F34109_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34109_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|OP SVCS
20|FH_F34112_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|OP SVCS
20|FH_F34112_0_0|SrvcGrp|16099|2022|PDM|5550.00|99|0.00|LAPAROSCOPIC PROSTATECTOMY
20|FH_F34112_0_0|SrvcGrp|16199|2022|PDM|5600.00|99|0.00|ANGIOPLASTY
20|FH_F34112_0_0|SrvcGrp|38|2022|PDM|1275.00|99|0.00|NORMAL DELIVERY
20|FH_F34112_0_0|SrvcGrp|6|2022|PCT|0.82|99|0.00|OP SURGERY
20|FH_F34130_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34138_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34138_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F34145_0_0|SrvcGrp|6|2022|PCT|0.80|99|0.00|OP SURGERY
20|FH_F34148_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F34154_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F34155_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE
20|FH_F34182_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|OP SVCS
20|FH_F34182_0_0|CSTM-ALL|CSTM-00|2020|PDM|10805.00|99|0.00|MS DRG 242 PERMANENT CARDIAC PACEMAKER
20|FH_F34182_0_0|CSTM-ALL|CSTM-00|2020|PDM|10805.00|99|0.00|MS DRG 260-262 CARDIAC PACEMAKER REVISION
20|FH_F34182_0_0|CSTM-ALL|CSTM-00|2020|PDM|16823.00|99|0.00|MS DRG 469-470
20|FH_F34182_0_0|CSTM-ALL|CSTM-00|2020|PDM|20737.00|99|0.00|MS DRGS 666-667 PROSTATECTOMY W/O CC
20|FH_F34182_0_0|CSTM-ALL|CSTM-00|2020|PDM|2729.00|99|0.00|MS DRG 233
20|FH_F34182_0_0|CSTM-ALL|CSTM-00|2020|PDM|2729.00|99|0.00|MS DRG 234
20|FH_F34182_0_0|CSTM-ALL|CSTM-00|2020|PDM|2729.00|99|0.00|MS DRG 235
20|FH_F34182_0_0|CSTM-ALL|CSTM-00|2020|PDM|2729.00|99|0.00|MS DRG 248
20|FH_F34182_0_0|CSTM-ALL|CSTM-00|2020|PDM|2729.00|99|0.00|MSDRG 219-221 CARDIAC VLV PX+OTR MJR CARDIOTHORACIC PX W/CC
20|FH_F34182_0_0|CSTM-ALL|CSTM-00|2020|PDM|2729.00|99|0.00|MSDRG 224-225 CARDIAC DEFIB W/O AMI/HF SHOCK
20|FH_F34182_0_0|CSTM-ALL|CSTM-00|2020|PDM|6611.00|99|0.00|MS DRG 691
20|FH_F34182_0_0|SrvcGrp|13649|2022|PDM|2729.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F34182_0_0|SrvcGrp|20096|2022|PDM|2729.00|99|0.00|MS DRG 222-223 ONLY
20|FH_F34182_0_0|SrvcGrp|63|2022|PDM|927.00|99|0.00|SUBACUTE CARE
20|FH_F34182_0_0|SrvcGrp|675|2022|PDM|2953.00|99|0.00|PEDIATRIC INPATIENT SVCS
20|FH_F34182_0_0|SrvcGrp|8950|2022|PDM|2953.00|99|0.00|INTERMEDIATE ICU/CCU
20|FH_F34188_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F34197_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34197_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F34221_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34229_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34240_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34241_0_0|SrvcGrp|3044|2022|PDM|1250.00|99|0.00|TRANSITIONAL CARE UNIT
20|FH_F34262_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34263_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34266_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34269_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|OP SVCS
20|FH_F34272_0_0|CSTM-ALL|CSTM-00|2020|PCT|91.50|99|0.00|GENERAL ACUTE CARE
20|FH_F34283_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F34286_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F34315_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS
20|FH_F34316_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F34321_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34328_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS
20|FH_F34349_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OP SVCS
20|FH_F34351_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F34361_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34363_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F34363_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34371_0_0|SrvcGrp|10540|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE
20|FH_F34371_0_0|SrvcGrp|10541|2022|PDM|90.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F34371_0_0|SrvcGrp|10542|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY SVCS
20|FH_F34371_0_0|SrvcGrp|10543|2022|PDM|100.00|99|0.00|SPEECH THERAPY SVCS
20|FH_F34371_0_0|SrvcGrp|10544|2022|PDM|90.00|99|0.00|ENTEROSTOMAL THERAPY SERVICES
20|FH_F34398_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F34400_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34422_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F34454_0_0|SrvcGrp|10410|2022|PDM|42.25|99|0.00|SKILLED NURSING CARE
20|FH_F34454_0_0|SrvcGrp|8962|2022|PDM|82.50|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F34454_0_0|SrvcGrp|9828|2022|PDM|36.00|99|0.00|HOME HEALTH AIDE
20|FH_F34454_0_0|SrvcGrp|9832|2022|PDM|84.50|99|0.00|ST SVCS
20|FH_F34472_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F34498_0_0|SrvcGrp|12693|2022|PDM|1364.00|99|0.00|CAPD/CCPD TRAINING
20|FH_F34523_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F34532_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|TELEMETRY
20|FH_F34546_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|IMPLANTS
20|FH_F34546_0_0|SrvcGrp|177|2022|PDM|1100.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F34546_0_0|SrvcGrp|701|2022|PDM|1250.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F34546_0_0|SrvcGrp|97|2022|PDM|2100.00|99|0.00|C-SECTION
20|FH_F34550_0_0|SrvcGrp|11199|2022|PCT|0.70|99|0.00|HYPERBARIC CHAMBER
20|FH_F34550_0_0|SrvcGrp|115|2022|PDM|596.00|99|0.00|SKILLED NURSING CARE
20|FH_F34550_0_0|SrvcGrp|16|2022|PDM|738.00|99|0.00|ACUTE REHABILITATION
20|FH_F34550_0_0|SrvcGrp|3409|2022|PDM|386.00|99|0.00|NEWBORN NURSERY
20|FH_F34604_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F34626_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|OP SVCS
20|FH_F34626_0_0|SrvcGrp|42975|2022|PDM|95.00|99|0.00|PHYSICAL THERAPIST
20|FH_F34626_0_0|SrvcGrp|59726|2022|PDM|95.00|99|0.00|RN VISIT HOME HEALTH
20|FH_F34636_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE
20|FH_F34636_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.83|99|0.00|OP SVCS
20|FH_F34641_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|ADOLESCENT PSYCH PARTIAL HOSP
20|FH_F34652_0_0|SrvcGrp|10671|2022|PDM|5694.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F34652_0_0|SrvcGrp|3066|2022|PCT|0.60|99|0.00|HIGH-COST DRUGS
20|FH_F34660_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34662_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34662_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F34672_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34686_0_0|CSTM-ALL|CSTM-00|2020|PCT|50.00|99|0.00|IMPLANTS
20|FH_F34686_0_0|CSTM-ALL|CSTM-00|2020|PCT|68.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34688_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34691_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|OP SVCS
20|FH_F34691_0_0|SrvcGrp|11199|2022|PCT|0.75|99|0.00|HYPERBARIC CHAMBER
20|FH_F34691_0_0|SrvcGrp|16|2022|PDM|1245.00|99|0.00|ACUTE REHABILITATION
20|FH_F34705_0_0|CSTM-ALL|CSTM-00|2020|PCT|99.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34705_0_0|CSTM-ALL|CSTM-00|2020|PCT|99.00|99|0.00|OP SVCS
20|FH_F34709_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34709_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F34710_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F34739_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F34747_0_0|CSTM-ALL|CSTM-00|2020|PDM|1098.52|99|0.00|ASPG VI
20|FH_F34747_0_0|CSTM-ALL|CSTM-00|2020|PDM|1292.20|99|0.00|ASPG VIII
20|FH_F34747_0_0|CSTM-ALL|CSTM-00|2020|PDM|586.60|99|0.00|ASPG II
20|FH_F34747_0_0|CSTM-ALL|CSTM-00|2020|PDM|670.60|99|0.00|ASPG III
20|FH_F34764_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.40|99|0.00|OP SVCS
20|FH_F34777_0_0|CSTM-ALL|CSTM-00|2020|PDM|1660.00|99|0.00|ACUTE IP MED SVCS
20|FH_F34777_0_0|CSTM-ALL|CSTM-00|2020|PDM|355.00|99|0.00|CD PARTIAL HOSPITALIZATION
20|FH_F34777_0_0|CSTM-ALL|CSTM-00|2020|PDM|755.00|99|0.00|ACUTE PSYCH
20|FH_F34777_0_0|CSTM-ALL|CSTM-00|2020|PDM|9400.00|99|0.00|ORTHOPEDIC SURGERY
20|FH_F34777_0_0|SrvcGrp|1306|2022|PDM|355.00|99|0.00|OP PSYCH PARTIAL HOSP
20|FH_F34777_0_0|SrvcGrp|17353|2022|PDM|4515.00|99|0.00|LAPAROSCOPIC SURGERY
20|FH_F34777_0_0|SrvcGrp|60357|2022|PDM|6995.00|99|0.00|PTC ANGIOPLASTY
20|FH_F34786_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F34797_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34806_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F34816_0_0|CSTM-ALL|CSTM-00|2020|PCT|69.00|99|0.00|OP SVCS
20|FH_F34817_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34838_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34852_0_0|SrvcGrp|12596|2022|PCT|0.70|99|0.00|OP RADIOLOGY
20|FH_F34852_0_0|SrvcGrp|59078|2022|PCT|0.70|99|0.00|RADIOLOGY
20|FH_F34854_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F34888_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34899_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F34904_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F34918_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|MED/SURG OTHER SUPPLIES/DEVICES
20|FH_F34918_0_0|CSTM-ALL|CSTM-00|2020|PDM|1547.00|99|0.00|ACUTE PSYCH
20|FH_F34918_0_0|SrvcGrp|26036|2022|PCT|0.70|99|0.00|DRUGS
20|FH_F34918_0_0|SrvcGrp|439|2022|PDM|3094.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F34938_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE
20|FH_F34963_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34963_0_0|SrvcGrp|3327|2022|PDM|525.00|99|0.00|HOSPICE SERVICE - IP RESPITE
20|FH_F34963_0_0|SrvcGrp|3810|2022|PDM|140.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F34983_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.84|99|0.00|OP SVCS
20|FH_F34983_0_0|CSTM-ALL|CSTM-00|2020|PDM|1234.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F34983_0_0|SrvcGrp|439|2022|PDM|2040.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F34983_0_0|SrvcGrp|97|2022|PDM|1530.00|99|0.00|C-SECTION
20|FH_F34984_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34984_0_0|CSTM-ALL|CSTM-00|2020|PDM|55.00|99|0.00|5781263-GA-PT/OT/ST-CPT
20|FH_F35009_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35009_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F35010_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F35013_0_0|CSTM-ALL|CSTM-00|2020|PCT|50.00|99|0.00|OP SVCS
20|FH_F35019_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35042_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|PROFESSIONAL FEES ON CMS1500
20|FH_F35042_0_0|SrvcGrp|72|2022|PDM|656.00|99|0.00|NEWBORN NURSERY
20|FH_F35051_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35051_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|OP SVCS
20|FH_F35056_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.84|99|0.00|MENTAL HEALTH / DETOX
20|FH_F35056_0_0|CSTM-ALL|CSTM-00|2020|PDM|2067.00|99|0.00|ASPG III
20|FH_F35056_0_0|SrvcGrp|11108|2022|PDM|450.00|99|0.00|NEWBORN NURSERY
20|FH_F35056_0_0|SrvcGrp|15156|2022|PCT|1.10|99|0.00|IMPLANTS
20|FH_F35056_0_0|SrvcGrp|63|2022|PDM|320.00|99|0.00|SUBACUTE CARE
20|FH_F35086_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.00|99|0.00|OP SVCS
20|FH_F35088_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|MSDRG 242-244, 258-262 PACEMAKER INSERTION/REVISION
20|FH_F35088_0_0|SrvcGrp|23342|2022|PCT|0.90|99|0.00|TRAUMA CARE
20|FH_F35088_0_0|SrvcGrp|537|2022|PCT|0.44|99|0.00|OBSERVATION SERVICES
20|FH_F35088_0_0|SrvcGrp|56465|2022|PDM|5302.00|99|0.00|OP PTCA ANGIOPLASTY
20|FH_F35093_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35103_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F35123_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F35133_0_0|CSTM-ALL|CSTM-00|2020|PDM|13500.00|99|0.00|MS DRG 237
20|FH_F35133_0_0|CSTM-ALL|CSTM-00|2020|PDM|28200.00|99|0.00|MSDRG 216-218 CARDIAC VALVE PROCEDURE W/ CARDIAC CATH
20|FH_F35133_0_0|CSTM-ALL|CSTM-00|2020|PDM|28200.00|99|0.00|MSDRG 231-232 CORONARY BYPASS
20|FH_F35133_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|ACUTE PSYCH
20|FH_F35164_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F35166_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|IMPLANTS
20|FH_F35166_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|OP SVCS
20|FH_F35167_0_0|CSTM-ALL|CSTM-00|2020|PDM|3406.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35173_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.71|99|0.00|OP SVCS
20|FH_F35173_0_0|SrvcGrp|15663|2022|PCT|0.90|99|0.00|TRAUMA CARE
20|FH_F35173_0_0|SrvcGrp|24|2022|PDM|3663.00|99|0.00|CARDIAC CATH
20|FH_F35173_0_0|SrvcGrp|6|2022|PCT|0.71|99|0.00|OP SURGERY
20|FH_F35173_0_0|SrvcGrp|997|2022|PCT|0.70|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F35174_0_0|CSTM-ALL|CSTM-00|2020|PDM|1005.00|99|0.00|NEWBORN NURSERY - LEVEL I
20|FH_F35174_0_0|CSTM-ALL|CSTM-00|2020|PDM|1209.00|99|0.00|ACUTE PSYCH
20|FH_F35174_0_0|CSTM-ALL|CSTM-00|2020|PDM|5426.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F35174_0_0|SrvcGrp|13217|2022|PCT|0.75|99|0.00|ORTHOTICS/PROSTHETICS/IMPLANTS
20|FH_F35174_0_0|SrvcGrp|19846|2022|PCT|0.75|99|0.00|MS DRG 249 ONLY
20|FH_F35174_0_0|SrvcGrp|20898|2022|PCT|0.75|99|0.00|MS DRG 246 ONLY
20|FH_F35174_0_0|SrvcGrp|3360|2022|PCT|0.75|99|0.00|HIGH COST DRUGS
20|FH_F35174_0_0|SrvcGrp|38|2022|PDM|4864.00|99|0.00|NORMAL DELIVERY
20|FH_F35176_0_0|SrvcGrp|10410|2022|PDM|42.25|99|0.00|SKILLED NURSING CARE
20|FH_F35176_0_0|SrvcGrp|12403|2022|PDM|26.25|99|0.00|CONTINUOUS HOMECARE
20|FH_F35176_0_0|SrvcGrp|12856|2022|PDM|42.25|99|0.00|NURSING CARE
20|FH_F35176_0_0|SrvcGrp|13703|2022|PDM|26.75|99|0.00|LICENSED PRACTICAL NURSE- HOURLY
20|FH_F35176_0_0|SrvcGrp|9828|2022|PDM|36.00|99|0.00|HOME HEALTH AIDE
20|FH_F35176_0_0|SrvcGrp|9829|2022|PDM|85.50|99|0.00|PT SVCS
20|FH_F35202_0_0|SrvcGrp|12264|2022|PDM|59.85|99|0.00|DIETICIAN OR LPN SERVICES
20|FH_F35202_0_0|SrvcGrp|12401|2022|PDM|84.00|99|0.00|RN VISIT
20|FH_F35202_0_0|SrvcGrp|13703|2022|PDM|26.25|99|0.00|LICENSED PRACTICAL NURSE- HOURLY
20|FH_F35202_0_0|SrvcGrp|8962|2022|PDM|84.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F35202_0_0|SrvcGrp|9829|2022|PDM|84.00|99|0.00|PT SVCS
20|FH_F35210_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|99|0.00|OP SVCS
20|FH_F35210_0_0|CSTM-ALL|CSTM-00|2020|PDM|1380.00|99|0.00|ACUTE GERIATRIC PSYCHIATRIC
20|FH_F35210_0_0|SrvcGrp|60098|2022|PCT|0.65|99|0.00|PACEMAKER IMPLANTATION - MS DRG ONLY
20|FH_F35210_0_0|SrvcGrp|65|2022|PDM|3199.00|99|0.00|OBSTETRICAL CARE
20|FH_F35212_0_0|SrvcGrp|10410|2022|PDM|42.25|99|0.00|SKILLED NURSING CARE
20|FH_F35212_0_0|SrvcGrp|12264|2022|PDM|60.75|99|0.00|DIETICIAN OR LPN SERVICES
20|FH_F35212_0_0|SrvcGrp|12401|2022|PDM|85.50|99|0.00|RN VISIT
20|FH_F35212_0_0|SrvcGrp|26001|2022|PDM|94.50|99|0.00|HOSPICE RESPITE SVCS
20|FH_F35216_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F35216_0_0|CSTM-ALL|CSTM-00|2020|PDM|1075.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35216_0_0|CSTM-ALL|CSTM-00|2020|PDM|2250.00|99|0.00|MS DRG 767-768, 774-775 NORMAL DELIVERY
20|FH_F35216_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|ASPG V
20|FH_F35216_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|ASPG VII
20|FH_F35216_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|ASPG X
20|FH_F35216_0_0|CSTM-ALL|CSTM-00|2020|PDM|6500.00|99|0.00|MS DRGS 258-262 PACEMAKER REVISION OR REPLACEMENT
20|FH_F35216_0_0|SrvcGrp|11000|2022|PCT|0.60|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F35216_0_0|SrvcGrp|12137|2022|PCT|0.75|99|0.00|EMERGENCY ROOM SVCS W/TRAUMA
20|FH_F35216_0_0|SrvcGrp|12904|2022|PDM|850.00|99|0.00|MRI
20|FH_F35216_0_0|SrvcGrp|17849|2022|PDM|1375.00|99|0.00|ICU / CCU
20|FH_F35221_0_0|SrvcGrp|72|2022|PDM|350.00|99|0.00|NEWBORN NURSERY
20|FH_F35245_0_0|SrvcGrp|9937|2022|PDM|70.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F35259_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.66|99|0.00|OP SVCS
20|FH_F35259_0_0|SrvcGrp|30619|2022|PCT|0.66|99|0.00|GAMMA KNIFE
20|FH_F35259_0_0|SrvcGrp|30620|2022|PCT|0.66|99|0.00|CARDIAC ABLATIONS
20|FH_F35259_0_0|SrvcGrp|65820|2022|PCT|0.37|99|0.00|OP PHARMACEUTICALS
20|FH_F35259_0_0|SrvcGrp|69840|2022|PCT|0.68|99|0.00|DIRECTIONAL CORONARY ATHERECTOMY
20|FH_F35262_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F35263_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35271_0_0|SrvcGrp|16|2022|PDM|800.00|99|0.00|ACUTE REHABILITATION
20|FH_F35271_0_0|SrvcGrp|19973|2022|PDM|550.00|99|0.00|CAT SCAN
20|FH_F35271_0_0|SrvcGrp|3099|2022|PDM|3500.00|99|0.00|OP SURGERY
20|FH_F35271_0_0|SrvcGrp|9911|2022|PCT|0.70|99|0.00|EMERGENCY ROOM SVCS
20|FH_F35271_0_0|SrvcGrp|9978|2022|PDM|1100.00|99|0.00|ACUTE INPATIENT MEDICAL SVCS
20|FH_F35278_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F35278_0_0|CSTM-ALL|CSTM-00|2020|PDM|80.00|99|0.00|PHYSICAL THERAPY
20|FH_F35287_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS
20|FH_F35344_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F35344_0_0|CSTM-ALL|CSTM-00|2020|PDM|1412.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F35344_0_0|SrvcGrp|1259|2022|PDM|1785.00|99|0.00|INTERMEDIATE INTENSIVE CARE UNIT
20|FH_F35344_0_0|SrvcGrp|184|2022|PDM|2076.00|99|0.00|MEDICAL INTENSIVE CARE
20|FH_F35344_0_0|SrvcGrp|528|2022|PDM|1785.00|99|0.00|TELEMETRY UNIT
20|FH_F35344_0_0|SrvcGrp|9488|2022|PDM|6644.00|99|0.00|OP LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F35345_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F35346_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35347_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F35357_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.77|99|0.00|GENERAL ACUTE CARE
20|FH_F35357_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.77|99|0.00|OP SVCS
20|FH_F35366_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F35366_0_0|CSTM-ALL|CSTM-00|2020|PDM|45.00|99|0.00|PT/OT/ST
20|FH_F35368_0_0|SrvcGrp|12220|2022|PDM|1433.00|99|0.00|PACEMAKER REPLACEMENT PROCEDURE- IP
20|FH_F35368_0_0|SrvcGrp|12234|2022|PDM|1433.00|99|0.00|PACEMAKER REPLACEMENT PX
20|FH_F35368_0_0|SrvcGrp|12859|2022|PDM|5544.00|99|0.00|ELECTROPHYSIOLOGY
20|FH_F35368_0_0|SrvcGrp|38|2022|PDM|1400.00|99|0.00|NORMAL DELIVERY
20|FH_F35368_0_0|SrvcGrp|72|2022|PDM|443.00|99|0.00|NEWBORN NURSERY
20|FH_F35369_0_0|CSTM-ALL|CSTM-00|2020|PDM|1850.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F35369_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|SHORT STAY SURGICAL
20|FH_F35369_0_0|SrvcGrp|12714|2022|PDM|13000.00|99|0.00|BRACHIOTHERAPY
20|FH_F35369_0_0|SrvcGrp|9438|2022|PCT|0.80|99|0.00|TRAUMA CARE
20|FH_F35381_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F35381_0_0|CSTM-ALL|CSTM-00|2020|PDM|707.00|99|0.00|ADULT PSYCHIATRIC
20|FH_F35381_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|ADOLESCENT PSYCHIATRIC
20|FH_F35381_0_0|SrvcGrp|189|2022|PCT|0.70|99|0.00|DURABLE MEDICAL EQUIPMENT
20|FH_F35381_0_0|SrvcGrp|190|2022|PCT|0.75|99|0.00|BLOOD AND BLOOD PRODUCTS
20|FH_F35381_0_0|SrvcGrp|361|2022|PDM|1820.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F35381_0_0|SrvcGrp|903|2022|PDM|2349.00|99|0.00|PTC ANGIOPLASTY
20|FH_F35384_0_0|CSTM-ALL|CSTM-00|2020|PDM|3351.00|99|0.00|MS DRG 222-227, 246-249 ANGIOPLASTY
20|FH_F35384_0_0|SrvcGrp|115|2022|PDM|522.00|99|0.00|SKILLED NURSING CARE
20|FH_F35387_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F35387_0_0|CSTM-ALL|CSTM-00|2020|PDM|3351.00|99|0.00|MS DRG 222-227, 246-249 ANGIOPLASTY
20|FH_F35387_0_0|SrvcGrp|11083|2022|PDM|1117.00|99|0.00|NORMAL DELIVERY (MOTHER ONLY)
20|FH_F35387_0_0|SrvcGrp|11086|2022|PDM|1178.00|99|0.00|CSECT (MOTHER ONLY)
20|FH_F35388_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS/DME/DIALYSIS
20|FH_F35388_0_0|CSTM-ALL|CSTM-00|2020|PDM|2800.00|99|0.00|MS DRG 767-768, 774-775 NORMAL DELIVERY
20|FH_F35388_0_0|SrvcGrp|11258|2022|PCT|0.50|99|0.00|DRUGS
20|FH_F35388_0_0|SrvcGrp|11259|2022|PCT|0.50|99|0.00|DRUGS
20|FH_F35388_0_0|SrvcGrp|9911|2022|PCT|0.65|99|0.00|EMERGENCY ROOM SVCS
20|FH_F35404_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|CV SURGERY
20|FH_F35404_0_0|CSTM-ALL|CSTM-00|2020|PDM|4200.00|99|0.00|MS DRG 765-766 C-SECTION
20|FH_F35404_0_0|SrvcGrp|12047|2022|PCT|0.55|99|0.00|CPT CODES 80000-89999, 36415 (LAB)
20|FH_F35404_0_0|SrvcGrp|12195|2022|PDM|150.00|99|0.00|OBSERVATION SVCS
20|FH_F35404_0_0|SrvcGrp|9911|2022|PCT|0.55|99|0.00|EMERGENCY ROOM SVCS
20|FH_F35404_0_0|SrvcGrp|9936|2022|PDM|120.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F35408_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35408_0_0|SrvcGrp|16898|2022|PDM|252.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC
20|FH_F35408_0_0|SrvcGrp|19607|2022|PDM|550.00|99|0.00|SPECIALTY CARE TRANSPORT
20|FH_F35411_0_0|CSTM-ALL|CSTM-00|2020|PDM|1794.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35411_0_0|CSTM-ALL|CSTM-00|2020|PDM|204.00|99|0.00|PSYCH/CD INTENSIVE CARE SVCS
20|FH_F35411_0_0|CSTM-ALL|CSTM-00|2020|PDM|3326.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F35411_0_0|CSTM-ALL|CSTM-00|2020|PDM|576.00|99|0.00|MULTIPLE BIRTH
20|FH_F35411_0_0|SrvcGrp|3029|2022|PDM|576.00|99|0.00|NEWBORN NURSERY
20|FH_F35411_0_0|SrvcGrp|3226|2022|PDM|8050.00|99|0.00|CARDIAC BRACHYTHERAPY
20|FH_F35411_0_0|SrvcGrp|9510|2022|PDM|875.00|99|0.00|SKILLED NURSING CARE
20|FH_F35416_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|AZT (ZIDOVUDINE)
20|FH_F35416_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|TPA
20|FH_F35416_0_0|SrvcGrp|10927|2022|PDM|1140.00|99|0.00|COMPUTED TOMOGRAPHY (CT)
20|FH_F35416_0_0|SrvcGrp|11301|2022|PDM|1200.00|99|0.00|MAGNETIC RESONANCE IMAGING
20|FH_F35416_0_0|SrvcGrp|13476|2022|PCT|0.80|99|0.00|TRAUMA CARE
20|FH_F35416_0_0|SrvcGrp|15132|2022|PDM|2850.00|99|0.00|ACUTE IP MEDICAL SVCS
20|FH_F35416_0_0|SrvcGrp|15967|2022|PDM|3420.00|99|0.00|ICU
20|FH_F35416_0_0|SrvcGrp|15971|2022|PDM|6900.00|99|0.00|ELECTROPHYSIOLOGY
20|FH_F35416_0_0|SrvcGrp|23348|2022|PDM|20700.00|99|0.00|CV SURGERY MS DRG'S ONLY 216-221, 231-236
20|FH_F35416_0_0|SrvcGrp|30623|2022|PDM|6300.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788
20|FH_F35416_0_0|SrvcGrp|38285|2022|PCT|1.00|99|0.00|PROTON ACCELERATOR
20|FH_F35416_0_0|SrvcGrp|411|2022|PCT|0.80|99|0.00|OP CARDIAC CATH
20|FH_F35416_0_0|SrvcGrp|6|2022|PCT|0.70|99|0.00|OP SURGERY
20|FH_F35416_0_0|SrvcGrp|70644|2022|PDM|50400.00|99|0.00|PEDIATRIC CARDIOVASCULAR SURGERY
20|FH_F35416_0_0|SrvcGrp|941|2022|PDM|3960.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F35446_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|DRUGS
20|FH_F35446_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|TRAUMA CARE
20|FH_F35446_0_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|ACUTE IP MED SVCS
20|FH_F35446_0_0|CSTM-ALL|CSTM-00|2020|PDM|233.00|99|0.00|PARTIAL HOSPITALIZATION
20|FH_F35446_0_0|CSTM-ALL|CSTM-00|2020|PDM|42436.00|99|0.00|MS DRG 216-227, 231-236 CV SURGERY
20|FH_F35446_0_0|SrvcGrp|43|2022|PCT|0.70|99|0.00|IMPLANTS
20|FH_F35446_0_0|SrvcGrp|997|2022|PCT|0.70|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F35448_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|AMBULANCE SERVICES
20|FH_F35448_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS
20|FH_F35453_0_0|CSTM-ALL|CSTM-00|2020|PDM|1265.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35458_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F35458_0_0|CSTM-ALL|CSTM-00|2020|PDM|1750.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F35458_0_0|CSTM-ALL|CSTM-00|2020|PDM|3245.00|99|0.00|MS DRG 774-775 NORMAL DELIVERY
20|FH_F35458_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|ASPG IV
20|FH_F35458_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|ASPG V
20|FH_F35458_0_0|CSTM-ALL|CSTM-00|2020|PDM|425.00|99|0.00|NEWBORN NURSERY - LEVEL I
20|FH_F35476_0_0|CSTM-ALL|CSTM-00|2020|PDM|11000.00|99|0.00|MS DRG 287
20|FH_F35476_0_0|SrvcGrp|11442|2022|PDM|855.00|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)
20|FH_F35476_0_0|SrvcGrp|19671|2022|PDM|11000.00|99|0.00|MS DRG 286 ONLY CIRCULATORY DISORDERS W/CARD CATH COMPLEX DX
20|FH_F35476_0_0|SrvcGrp|20293|2022|PDM|30000.00|99|0.00|MS DRG 235-236 ONLY CV SURGERY
20|FH_F35476_0_0|SrvcGrp|3077|2022|PCT|0.83|99|0.00|IMPLANTS
20|FH_F35499_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35506_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35513_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.97|99|0.00|GENERAL ACUTE CARE
20|FH_F35527_0_0|SrvcGrp|16494|2022|PDM|425.00|99|0.00|MULTIPLE SLEEP LATENCY
20|FH_F35527_0_0|SrvcGrp|16495|2022|PDM|850.00|99|0.00|POLYSOMNOGRAPHY
20|FH_F35571_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35593_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35599_0_0|CSTM-ALL|CSTM-00|2020|PDM|925.00|99|0.00|ABORTION 16-24.5 WEEKS
20|FH_F35631_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35631_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F35660_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35660_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F35678_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|CIRCULATORY DSRDR W/ACUTE MYCRDL INFRCTN MS DRG 281-282 OTLR
20|FH_F35678_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F35678_0_0|CSTM-ALL|CSTM-00|2020|PDM|14126.00|99|0.00|MSDRG 242-244, 258-262 PACEMAKER INSERTION/REVISION
20|FH_F35678_0_0|CSTM-ALL|CSTM-00|2020|PDM|16952.00|99|0.00|MS DRG 033
20|FH_F35678_0_0|CSTM-ALL|CSTM-00|2020|PDM|3107.00|99|0.00|ORTHOPEDIC SURGERY
20|FH_F35678_0_0|CSTM-ALL|CSTM-00|2020|PDM|35315.00|99|0.00|MS DRGS 233-236 CV SURGERY
20|FH_F35678_0_0|CSTM-ALL|CSTM-00|2020|PDM|8476.00|99|0.00|MS DRG 037
20|FH_F35678_0_0|CSTM-ALL|CSTM-00|2020|PDM|8476.00|99|0.00|MS DRG 038
20|FH_F35678_0_0|SrvcGrp|8950|2022|PDM|1696.00|99|0.00|INTERMEDIATE ICU/CCU
20|FH_F35716_0_0|SrvcGrp|22954|2022|PDM|94.50|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F35730_0_0|CSTM-ALL|CSTM-00|2020|PDM|50.00|99|0.00|HOME HEALTH AIDE VISIT
20|FH_F35730_0_0|CSTM-ALL|CSTM-00|2020|PDM|90.00|99|0.00|PHYSICAL THERAPY
20|FH_F35748_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35748_0_0|SrvcGrp|16746|2022|PDM|70.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F35783_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F35796_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.50|99|0.00|OP SVCS
20|FH_F35798_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS
20|FH_F35802_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS
20|FH_F35823_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F35857_0_0|SrvcGrp|30401|2022|PCT|1.00|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F35875_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F35884_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F35924_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35925_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35925_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|OP SVCS
20|FH_F35929_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS
20|FH_F35966_0_0|CSTM-ALL|CSTM-00|2020|PDM|275.00|99|0.00|ADVANCED LIFE SUPPORT (ALS) PARAMEDIC INTERCEPT
20|FH_F35966_0_0|SrvcGrp|16896|2022|PDM|550.00|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2
20|FH_F35966_0_0|SrvcGrp|16897|2022|PDM|415.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC
20|FH_F35966_0_0|SrvcGrp|16898|2022|PDM|495.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC
20|FH_F35966_0_0|SrvcGrp|19609|2022|PDM|38.50|99|0.00|NONEMERGENCY TRANSPORTATION, WHEELCHAIR VAN
20|FH_F35967_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F35982_0_0|CSTM-ALL|CSTM-00|2020|PDM|1080.00|99|0.00|ASPG VI
20|FH_F35982_0_0|CSTM-ALL|CSTM-00|2020|PDM|387.00|99|0.00|ASPG I
20|FH_F35982_0_0|SrvcGrp|3932|2022|PDM|4500.00|99|0.00|LITHOTRIPSY
20|FH_F35987_0_0|SrvcGrp|3015|2022|PCT|0.60|99|0.00|SUPPLIES
20|FH_F35987_0_0|SrvcGrp|701|2022|PDM|3008.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F35990_0_0|CSTM-ALL|CSTM-00|2020|PDM|1029.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F35990_0_0|SrvcGrp|108|2022|PCT|0.75|99|0.00|EXTRA CORPOREAL MEMBRANE OXYGEN
20|FH_F35990_0_0|SrvcGrp|16679|2022|PDM|4743.00|99|0.00|LAPAROSCOPIC PROCEDURES
20|FH_F35990_0_0|SrvcGrp|177|2022|PDM|2111.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F35990_0_0|SrvcGrp|33793|2022|PDM|6087.00|99|0.00|MSDRG 246-251 ONLY ANGIOPLASTY
20|FH_F36002_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36006_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36034_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36036_0_0|SrvcGrp|10617|2022|PDM|70.00|99|0.00|RN VISIT
20|FH_F36036_0_0|SrvcGrp|16544|2022|PDM|200.00|99|0.00|TOCOLYTIC THERAPY
20|FH_F36036_0_0|SrvcGrp|22089|2022|PDM|60.00|99|0.00|HCPCS S9001
20|FH_F36036_0_0|SrvcGrp|22090|2022|PDM|60.00|99|0.00|HCPCS S9211
20|FH_F36045_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F36049_0_0|CSTM-ALL|CSTM-00|2020|PDM|303.00|99|0.00|CT SCAN
20|FH_F36052_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36101_0_0|SrvcGrp|3810|2022|PDM|105.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F36118_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F36118_0_0|SrvcGrp|12263|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE- HOURLY
20|FH_F36118_0_0|SrvcGrp|14412|2022|PDM|600.00|99|0.00|HOSPICE CARE
20|FH_F36118_0_0|SrvcGrp|3327|2022|PDM|90.00|99|0.00|HOSPICE SERVICE - IP RESPITE
20|FH_F36127_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36137_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36146_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|GENERAL ACUTE CARE
20|FH_F36146_0_0|SrvcGrp|14221|2022|PCT|0.40|99|0.00|IMPLANTS/PROSTHETICS/DEVICES
20|FH_F36150_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|ACUTE PSYCH
20|FH_F36150_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36154_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F36154_0_0|SrvcGrp|701|2022|PDM|2027.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F36154_0_0|SrvcGrp|72|2022|PDM|400.00|99|0.00|NEWBORN NURSERY
20|FH_F36170_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F36170_0_0|SrvcGrp|4109|2022|PDM|618.00|99|0.00|ACUTE PSYCH
20|FH_F36202_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|MSDRG 215-227, 231-232, 237-238, 250-251, 286-287 CV SURGERY
20|FH_F36202_0_0|SrvcGrp|147|2022|PCT|0.80|99|0.00|HOME HEALTH CARE
20|FH_F36202_0_0|SrvcGrp|2738|2022|PCT|0.75|99|0.00|IMPLANTS
20|FH_F36202_0_0|SrvcGrp|72|2022|PDM|1177.00|99|0.00|NEWBORN NURSERY
20|FH_F36207_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36207_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F36207_0_0|CSTM-ALL|CSTM-00|2020|PDM|275.00|99|0.00|ADVANCED LIFE SUPPORT (ALS) PARAMEDIC INTERCEPT
20|FH_F36211_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F36222_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F36222_0_0|SrvcGrp|72|2022|PDM|232.00|99|0.00|NEWBORN NURSERY
20|FH_F36225_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36238_0_0|CSTM-ALL|CSTM-00|2020|PCT|99.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36238_0_0|CSTM-ALL|CSTM-00|2020|PCT|99.00|99|0.00|OP SVCS
20|FH_F36263_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|GENERAL ACUTE CARE
20|FH_F36274_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F36274_0_0|SrvcGrp|9828|2022|PDM|50.00|99|0.00|HOME HEALTH AIDE
20|FH_F36277_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F36277_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F36280_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36286_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F36299_0_0|SrvcGrp|115|2022|PDM|465.00|99|0.00|SKILLED NURSING CARE
20|FH_F36299_0_0|SrvcGrp|13088|2022|PCT|0.75|99|0.00|ER SVCS
20|FH_F36299_0_0|SrvcGrp|3378|2022|PCT|0.75|99|0.00|OBSERVATION SVCS
20|FH_F36323_0_0|SrvcGrp|19984|2022|PDM|45.00|99|0.00|THERAPY
20|FH_F36323_0_0|SrvcGrp|472|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F36323_0_0|SrvcGrp|473|2022|PDM|395.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F36341_0_0|CSTM-ALL|CSTM-00|2020|PDM|1518.00|99|0.00|ASPG V
20|FH_F36341_0_0|SrvcGrp|12280|2022|PCT|0.50|99|0.00|IMPLANTS
20|FH_F36341_0_0|SrvcGrp|3095|2022|PDM|578.00|99|0.00|ROOM AND BOARD PRIVATE
20|FH_F36348_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE
20|FH_F36350_0_0|SrvcGrp|975|2022|PDM|4084.00|99|0.00|TUBILIZATION
20|FH_F36366_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36366_0_0|CSTM-ALL|CSTM-00|2020|PDM|152.00|99|0.00|CPT 95806
20|FH_F36366_0_0|CSTM-ALL|CSTM-00|2020|PDM|684.00|99|0.00|CPT 95805 (W/MOD TC)
20|FH_F36366_0_0|CSTM-ALL|CSTM-00|2020|PDM|868.00|99|0.00|CPT 95811 (W/MOD TC)
20|FH_F36366_0_0|SrvcGrp|13620|2022|PDM|1094.00|99|0.00|SLEEP STUDIES
20|FH_F36366_0_0|SrvcGrp|13621|2022|PDM|783.00|99|0.00|SLEEP STUDIES
20|FH_F36381_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36381_0_0|SrvcGrp|12995|2022|PCT|0.55|99|0.00|DIALYSIS
20|FH_F36381_0_0|SrvcGrp|3259|2022|PDM|800.00|99|0.00|ACUTE REHABILITATION
20|FH_F36382_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36383_0_0|CSTM-ALL|CSTM-00|2020|PDM|1450.00|99|0.00|ACUTE IP MED SVCS
20|FH_F36384_0_0|CSTM-ALL|CSTM-00|2020|PCT|61.30|99|0.00|OP SVCS
20|FH_F36385_0_0|SrvcGrp|11000|2022|PCT|1.10|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F36386_0_0|SrvcGrp|14412|2022|PDM|460.00|99|0.00|HOSPICE CARE
20|FH_F36386_0_0|SrvcGrp|3810|2022|PDM|120.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F36401_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.90|99|0.00|GENERAL ACUTE CARE
20|FH_F36403_0_0|SrvcGrp|12496|2022|PDM|475.00|99|0.00|ACUTE REHABILITATION
20|FH_F36409_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE
20|FH_F36409_0_0|SrvcGrp|15873|2022|PDM|26.25|99|0.00|HOSPICE SERVICE - CONTINUOUS HOME CARE
20|FH_F36409_0_0|SrvcGrp|3809|2022|PDM|483.00|99|0.00|HOSPICE CARE
20|FH_F36420_0_0|SrvcGrp|186|2022|PDM|1900.00|99|0.00|INTENSIVE & INTERMEDIATE UNIT CARE
20|FH_F36420_0_0|SrvcGrp|97|2022|PDM|4500.00|99|0.00|C-SECTION
20|FH_F36429_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F36431_0_0|CSTM-ALL|CSTM-00|2020|PDM|1263.78|99|0.00|ASPG VI
20|FH_F36431_0_0|CSTM-ALL|CSTM-00|2020|PDM|1275.00|99|0.00|OP ARTHROSCOPY
20|FH_F36431_0_0|CSTM-ALL|CSTM-00|2020|PDM|1488.69|99|0.00|ASPG VIII
20|FH_F36431_0_0|CSTM-ALL|CSTM-00|2020|PDM|1521.84|99|0.00|ASPG VII
20|FH_F36431_0_0|CSTM-ALL|CSTM-00|2020|PDM|709.92|99|0.00|ASPG II
20|FH_F36433_0_0|CSTM-ALL|CSTM-00|2020|PDM|2812.00|99|0.00|MSDRG 243, 249 CV SURGERY
20|FH_F36433_0_0|SrvcGrp|360|2022|PDM|1190.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F36433_0_0|SrvcGrp|65|2022|PDM|3785.00|99|0.00|OBSTETRICAL CARE
20|FH_F36439_0_0|SrvcGrp|23005|2022|PDM|650.00|99|0.00|V5256
20|FH_F36439_0_0|SrvcGrp|23009|2022|PDM|1300.00|99|0.00|V5252
20|FH_F36439_0_0|SrvcGrp|23010|2022|PDM|1300.00|99|0.00|V5251
20|FH_F36439_0_0|SrvcGrp|23014|2022|PDM|650.00|99|0.00|V5245
20|FH_F36439_0_0|SrvcGrp|24404|2022|PDM|450.00|99|0.00|HEARING AIDE
20|FH_F109343_0_0|SrvcGrp|103264|2022|PDM|1650.00|99|0.00|TRANSFER TO HOSPITAL
20|FH_F109343_0_0|SrvcGrp|103606|2022|PCT|0.00|99|0.00|NURSERY
20|FH_F109343_0_0|SrvcGrp|359|2022|PDM|550.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL I
20|FH_F109346_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F109346_0_0|SrvcGrp|103264|2022|PDM|1650.00|99|0.00|TRANSFER TO HOSPITAL
20|FH_F109346_0_0|SrvcGrp|103604|2022|PCT|0.00|99|0.00|TRANSFER TO HOSPITAL
20|FH_F109346_0_0|SrvcGrp|103606|2022|PCT|0.00|99|0.00|NURSERY
20|FH_F109346_0_0|SrvcGrp|359|2022|PDM|550.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL I
20|FH_F109394_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F109484_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F109484_0_0|SrvcGrp|73002|2022|PDM|995.00|99|0.00|AEG 7
20|FH_F109484_0_0|SrvcGrp|73004|2022|PDM|973.00|99|0.00|AEG 8
20|FH_F109484_0_0|SrvcGrp|93759|2022|PCT|0.00|99|0.00|CARDIAC CATH
20|FH_F109503_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F109503_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|AEG 9 (NO REV)
20|FH_F109503_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|AEG 2 (NO REV)
20|FH_F109503_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 10 (NO REV)
20|FH_F109503_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 3 (NO REV)
20|FH_F109503_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 4 (NO REV)
20|FH_F109503_0_0|CSTM-ALL|CSTM-00|2020|PDM|940.00|99|0.00|AEG 7 (NO REV)
20|FH_F109513_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F109513_0_0|SrvcGrp|73000|2022|PDM|1161.00|99|0.00|AEG 6
20|FH_F109513_0_0|SrvcGrp|76604|2022|PDM|1800.00|99|0.00|CPT 25447
20|FH_F109513_0_0|SrvcGrp|83838|2022|PDM|1850.00|99|0.00|SUSPENSION OF BREAST
20|FH_F109513_0_0|SrvcGrp|84180|2022|PDM|2800.00|99|0.00|AETNA DELAYED BREAST PROSTHESIS
20|FH_F109513_0_0|SrvcGrp|84181|2022|PDM|2700.00|99|0.00|AETNA IMMEDIATE BREAST PROSTHESIS
20|FH_F109513_0_0|SrvcGrp|86460|2022|PDM|2700.00|99|0.00|REVISE BREAST RECONSTRUCTION
20|FH_F109513_0_0|SrvcGrp|90418|2022|PDM|2800.00|99|0.00|ENLARGE BREAST WITH IMPLANT
20|FH_F109513_0_0|SrvcGrp|90429|2022|PDM|2700.00|99|0.00|REPAIR WRIST BONE FRACTURE
20|FH_F109513_0_0|SrvcGrp|90433|2022|PDM|1500.00|99|0.00|HAND PROCEDURES
20|FH_F109513_0_0|SrvcGrp|90435|2022|PDM|5300.00|99|0.00|NECK SPINE DISK SURGERY
20|FH_F109513_0_0|SrvcGrp|93121|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F109513_0_0|SrvcGrp|99067|2022|PDM|4500.00|99|0.00|SPINE PROSTH DEVICE
20|FH_F109513_0_0|SrvcGrp|99161|2022|PDM|10000.00|99|0.00|CPT 27138
20|FH_F109538_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F109577_0_0|SrvcGrp|103610|2022|PDM|123.00|99|0.00|DIABETIC MGMT PROGRAM - GROUP
20|FH_F109577_0_0|SrvcGrp|103614|2022|PDM|123.00|99|0.00|MED NUTRITION - GROUP
20|FH_F109577_0_0|SrvcGrp|103615|2022|PDM|123.00|99|0.00|DIABETIC MANAGEMENT TRN PER INDIVIDUAL
20|FH_F109577_0_0|SrvcGrp|103616|2022|PDM|123.00|99|0.00|DIABETIC MANAGEMENT TRN INDIV/GROUP
20|FH_F109577_0_0|SrvcGrp|22384|2022|PDM|135.00|99|0.00|HOME VISIT PRENATAL
20|FH_F109577_0_0|SrvcGrp|26160|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE VISIT
20|FH_F109577_0_0|SrvcGrp|27540|2022|PDM|123.00|99|0.00|NUTRITIONAL ASSESSMENT (FOLLOW UP)
20|FH_F109577_0_0|SrvcGrp|53144|2022|PDM|133.00|99|0.00|SPEECH THERAPY
20|FH_F109577_0_0|SrvcGrp|73701|2022|PDM|59.00|99|0.00|AETNA - SKILLED NURSING
20|FH_F109577_0_0|SrvcGrp|80918|2022|PDM|195.00|99|0.00|RESPITE CARE
20|FH_F109577_0_0|SrvcGrp|80920|2022|PDM|855.00|99|0.00|HOSPICE SERVICES
20|FH_F109577_0_0|SrvcGrp|87394|2022|PDM|133.00|99|0.00|HCPCS G0152 (HCFA)
20|FH_F109577_0_0|SrvcGrp|91214|2022|PDM|123.00|99|0.00|MED NUTRITION
20|FH_F109577_0_0|SrvcGrp|93339|2022|PDM|123.00|99|0.00|AETNA MED NUTRITION GROUP
20|FH_F109577_0_0|SrvcGrp|95660|2022|PDM|855.00|99|0.00|HOSPICE SERVICES (HCFA)
20|FH_F109581_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F109581_0_0|SrvcGrp|75483|2022|PDM|975.00|99|0.00|AEG 3
20|FH_F109581_0_0|SrvcGrp|75493|2022|PDM|1087.00|99|0.00|AEG 8
20|FH_F109601_0_0|SrvcGrp|75483|2022|PDM|620.00|99|0.00|AEG 3
20|FH_F109601_0_0|SrvcGrp|75489|2022|PDM|916.00|99|0.00|AEG 6
20|FH_F109601_0_0|SrvcGrp|85022|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F109606_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F109606_0_0|CSTM-ALL|CSTM-00|2020|PDM|587.00|99|0.00|AEG 1 (NO REV)
20|FH_F109607_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F109630_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 10 (NO REV)
20|FH_F109630_0_0|CSTM-ALL|CSTM-00|2020|PDM|1255.80|99|0.00|AEG 4 (NO REV)
20|FH_F109630_0_0|CSTM-ALL|CSTM-00|2020|PDM|798.20|99|0.00|AEG 2 (NO REV)
20|FH_F109630_0_0|SrvcGrp|85022|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F109630_0_0|SrvcGrp|93121|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F109645_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F109645_0_0|SrvcGrp|103685|2022|PDM|88.00|99|0.00|PHYSICAL THERAPY (HCFA)
20|FH_F109645_0_0|SrvcGrp|34146|2022|PDM|88.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F109645_0_0|SrvcGrp|34356|2022|PDM|85.00|99|0.00|T1001
20|FH_F109645_0_0|SrvcGrp|34357|2022|PDM|70.00|99|0.00|PHYSICAL THERAPY SVCS MOD GP
20|FH_F109648_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|AEG 3 (NO REV)
20|FH_F109648_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|AEG 6 (NO REV)
20|FH_F109762_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F109762_0_0|SrvcGrp|72990|2022|PDM|375.00|99|0.00|AEG 1
20|FH_F109762_0_0|SrvcGrp|77507|2022|PCT|1.00|99|0.00|AETNA CORNEAL TISSUE HANDLING
20|FH_F109762_0_0|SrvcGrp|93121|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F109803_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F109803_0_0|CSTM-ALL|CSTM-00|2020|PDM|406.00|99|0.00|AEG 1 (NO REV)
20|FH_F109803_0_0|CSTM-ALL|CSTM-00|2020|PDM|625.00|99|0.00|AEG 3 (NO REV)
20|FH_F109803_0_0|CSTM-ALL|CSTM-00|2020|PDM|825.00|99|0.00|AEG 10 (NO REV)
20|FH_F109803_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F109821_0_0|CSTM-ALL|CSTM-00|2020|PDM|663.00|99|0.00|AEG 3 (NO REV)
20|FH_F109821_0_0|SrvcGrp|102260|2022|PDM|10000.00|99|0.00|AETNA TOTAL JOINT REPLACEMENT
20|FH_F109821_0_0|SrvcGrp|78701|2022|PDM|1530.00|99|0.00|AETNA REPAIRING HERN PREMIE REDUC
20|FH_F109821_0_0|SrvcGrp|78713|2022|PDM|2550.00|99|0.00|AETNA SPINAL STIMULATOR
20|FH_F109843_0_0|CSTM-ALL|CSTM-00|2020|PDM|1980.00|99|0.00|AEG 10 (NO REV)
20|FH_F109843_0_0|CSTM-ALL|CSTM-00|2020|PDM|3410.00|99|0.00|AEG 6 (NO REV)
20|FH_F109843_0_0|CSTM-ALL|CSTM-00|2020|PDM|4345.00|99|0.00|AETNA AEG 7 (NO REV) W/O TENODESIS
20|FH_F109843_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F109843_0_0|SrvcGrp|103771|2022|PDM|2640.00|99|0.00|SHOULDER ARTHROSCOPY/SURGERY
20|FH_F109843_0_0|SrvcGrp|28443|2022|PDM|2640.00|99|0.00|ARTHROSCOPY KNEE
20|FH_F109848_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F109907_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F109926_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F109926_0_0|CSTM-ALL|CSTM-00|2020|PDM|1158.00|99|0.00|AEG 9 (NO REV)
20|FH_F109926_0_0|CSTM-ALL|CSTM-00|2020|PDM|387.00|99|0.00|AEG 1 (NO REV)
20|FH_F109926_0_0|CSTM-ALL|CSTM-00|2020|PDM|520.00|99|0.00|AEG 2 (NO REV)
20|FH_F109926_0_0|CSTM-ALL|CSTM-00|2020|PDM|776.00|99|0.00|AEG 10 (NO REV)
20|FH_F109926_0_0|SrvcGrp|78047|2022|PCT|1.00|99|0.00|AETNA VISION SERVICES
20|FH_F109926_0_0|SrvcGrp|84121|2022|PCT|1.00|99|0.00|OCULAR IMPLANTS
20|FH_F109941_0_0|SrvcGrp|82981|2022|PDM|100.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F109951_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F109951_0_0|CSTM-ALL|CSTM-00|2020|PDM|1133.00|99|0.00|COVENTRY ENHANCED GROUPER 1
20|FH_F109951_0_0|CSTM-ALL|CSTM-00|2020|PDM|2687.00|99|0.00|COVENTRY ENHANCED GROUPER 5
20|FH_F109951_0_0|SrvcGrp|12491|2022|PCT|0.45|99|0.00|PACEMAKER
20|FH_F109963_0_0|SrvcGrp|72992|2022|PDM|497.00|99|0.00|AEG 2
20|FH_F109963_0_0|SrvcGrp|73000|2022|PDM|857.00|99|0.00|AEG 6
20|FH_F109980_0_0|SrvcGrp|73601|2022|PDM|1450.00|99|0.00|AETNA INTERMEDIATE ICU/CCU
20|FH_F110061_0_0|SrvcGrp|103865|2022|PDM|3300.00|99|0.00|PT PRGRM FOR IMPLT NEUROSTIM
20|FH_F110061_0_0|SrvcGrp|44461|2022|PDM|20000.00|99|0.00|INSERTION / REPLACEMENT OF SPINAL NEUROSTIMULATOR GENERATOR
20|FH_F110061_0_0|SrvcGrp|75483|2022|PDM|540.00|99|0.00|AEG 3
20|FH_F110061_0_0|SrvcGrp|75491|2022|PDM|1054.00|99|0.00|AEG 7
20|FH_F110067_0_0|CSTM-ALL|CSTM-00|2020|PCT|69.00|99|0.00|GENERAL ACUTE CARE
20|FH_F110102_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F110102_0_0|SrvcGrp|103846|2022|PDM|650.00|99|0.00|HOSPICE CARE
20|FH_F110102_0_0|SrvcGrp|104133|2022|PDM|650.00|99|0.00|IP HOSPICE
20|FH_F110102_0_0|SrvcGrp|104334|2022|PDM|150.00|99|0.00|IP HOSPICE HOME CARE
20|FH_F110102_0_0|SrvcGrp|63297|2022|PDM|150.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F110102_0_0|SrvcGrp|65720|2022|PDM|150.00|99|0.00|RESPITE CARE
20|FH_F110102_0_0|SrvcGrp|95779|2022|PDM|150.00|99|0.00|HOSPICE CARE
20|FH_F110103_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F110103_0_0|SrvcGrp|79720|2022|PDM|850.00|99|0.00|ACUTE REHAB II
20|FH_F110121_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F110121_0_0|SrvcGrp|74587|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F110140_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F110160_0_0|SrvcGrp|103300|2022|PDM|1350.00|99|0.00|OPHTHALMOLOGY
20|FH_F110160_0_0|SrvcGrp|104172|2022|PDM|1793.00|99|0.00|AEG 9 W/O CPT 29862
20|FH_F110160_0_0|SrvcGrp|72992|2022|PDM|696.00|99|0.00|AEG 2
20|FH_F110160_0_0|SrvcGrp|73000|2022|PDM|1115.00|99|0.00|AEG 6
20|FH_F110180_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|99|0.00|OP SVCS
20|FH_F110184_0_0|SrvcGrp|15860|2022|PDM|800.00|99|0.00|SUB-ACUTE REHAB
20|FH_F110184_0_0|SrvcGrp|16|2022|PDM|800.00|99|0.00|ACUTE REHABILITATION
20|FH_F110220_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F110233_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F110233_0_0|SrvcGrp|75506|2022|PCT|0.94|99|0.00|VASCULAR DIAGNOSTIC STUDIES
20|FH_F110236_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F110240_0_0|CSTM-ALL|CSTM-00|2020|PDM|716.00|99|0.00|AEG 10 (NO REV)
20|FH_F110240_0_0|SrvcGrp|79589|2022|PDM|743.00|99|0.00|UPPER GI
20|FH_F110240_0_0|SrvcGrp|79594|2022|PDM|743.00|99|0.00|CPT 45380
20|FH_F110263_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F110263_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F110263_0_0|CSTM-ALL|CSTM-00|2020|PDM|1649.00|99|0.00|AEG 4 (NO REV)
20|FH_F110263_0_0|CSTM-ALL|CSTM-00|2020|PDM|2487.00|99|0.00|AEG 7 (NO REV)
20|FH_F110263_0_0|CSTM-ALL|CSTM-00|2020|PDM|2732.00|99|0.00|AEG 8 (NO REV)
20|FH_F110263_0_0|CSTM-ALL|CSTM-00|2020|PDM|805.00|99|0.00|AEG 1 (NO REV)
20|FH_F110263_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F110263_0_0|SrvcGrp|115581|2022|PDM|7354.00|99|0.00|CYSTOURETHROSCOPY/URETEROSCO (HCFA)
20|FH_F110263_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F110263_0_0|SrvcGrp|63471|2022|PDM|20785.00|99|0.00|CPT 64590
20|FH_F110263_0_0|SrvcGrp|63472|2022|PDM|8919.00|99|0.00|CPT 64581
20|FH_F110263_0_0|SrvcGrp|77461|2022|PDM|7575.00|99|0.00|CPT 52356
20|FH_F110263_0_0|SrvcGrp|86233|2022|PDM|13084.00|99|0.00|AETNA RECONSTRUCT ANKLE JOINT
20|FH_F110263_0_0|SrvcGrp|88354|2022|PDM|27715.00|99|0.00|CPT 63685 (HCFA)
20|FH_F110263_0_0|SrvcGrp|93595|2022|PDM|13477.00|99|0.00|ARTHROPLASTY(HCFA)
20|FH_F110263_0_0|SrvcGrp|93596|2022|PDM|13084.00|99|0.00|SHOULDER JOINT(HCFA)
20|FH_F110263_0_0|SrvcGrp|93600|2022|PDM|12703.00|99|0.00|TOTAL HIP ARTHOPLASTY(HCFA)
20|FH_F110263_0_0|SrvcGrp|93601|2022|PDM|8577.00|99|0.00|REVISON OF KNEE JOINT(HCFA)
20|FH_F110263_0_0|SrvcGrp|93602|2022|PDM|13477.00|99|0.00|TOTAL KNEE(HCFA)
20|FH_F110308_0_0|SrvcGrp|72994|2022|PDM|500.00|99|0.00|AEG 3
20|FH_F110308_0_0|SrvcGrp|73008|2022|PDM|150.00|99|0.00|AEG 10
20|FH_F110342_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F110342_0_0|SrvcGrp|41334|2022|PDM|8323.20|99|0.00|TOTAL KNEE
20|FH_F110342_0_0|SrvcGrp|72996|2022|PDM|1500.00|99|0.00|AEG 4
20|FH_F110342_0_0|SrvcGrp|73004|2022|PDM|2200.00|99|0.00|AEG 8
20|FH_F110360_0_0|CSTM-ALL|CSTM-00|2020|PDM|1155.00|99|0.00|AEG 8 (NO REV)
20|FH_F110360_0_0|CSTM-ALL|CSTM-00|2020|PDM|1260.00|99|0.00|AEG 9 (NO REV)
20|FH_F110360_0_0|CSTM-ALL|CSTM-00|2020|PDM|393.25|99|0.00|AEG 1 (NO REV)
20|FH_F110360_0_0|CSTM-ALL|CSTM-00|2020|PDM|682.50|99|0.00|AEG 3 (NO REV)
20|FH_F110363_0_0|SrvcGrp|103949|2022|PDM|662.00|99|0.00|HOSPICE IN SNF
20|FH_F110381_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F110381_0_0|SrvcGrp|100006|2022|PDM|2014.00|99|0.00|RECONSTRUCT ELBOW MED LIGMNT
20|FH_F110381_0_0|SrvcGrp|11673|2022|PDM|2332.00|99|0.00|CPT 29888
20|FH_F110381_0_0|SrvcGrp|72996|2022|PDM|1272.00|99|0.00|AEG 4
20|FH_F110381_0_0|SrvcGrp|73000|2022|PDM|1484.00|99|0.00|AEG 6
20|FH_F110381_0_0|SrvcGrp|73002|2022|PDM|2438.00|99|0.00|AEG 7
20|FH_F110381_0_0|SrvcGrp|73004|2022|PDM|2650.00|99|0.00|AEG 8
20|FH_F110400_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F110400_0_0|SrvcGrp|87077|2022|PDM|140.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F110453_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F110453_0_0|SrvcGrp|72990|2022|PDM|358.00|99|0.00|AEG 1
20|FH_F110453_0_0|SrvcGrp|72994|2022|PDM|548.00|99|0.00|AEG 3
20|FH_F110453_0_0|SrvcGrp|72998|2022|PDM|771.00|99|0.00|AEG 5
20|FH_F110453_0_0|SrvcGrp|73002|2022|PDM|1070.00|99|0.00|AEG 7
20|FH_F110453_0_0|SrvcGrp|73004|2022|PDM|1050.00|99|0.00|AEG 8
20|FH_F110564_0_0|SrvcGrp|72998|2022|PDM|717.00|99|0.00|AEG 5
20|FH_F110564_0_0|SrvcGrp|73000|2022|PDM|826.00|99|0.00|AEG 6
20|FH_F110564_0_0|SrvcGrp|73004|2022|PDM|973.00|99|0.00|AEG 8
20|FH_F110564_0_0|SrvcGrp|73006|2022|PDM|1339.00|99|0.00|AEG 9
20|FH_F110604_0_0|SrvcGrp|103236|2022|PDM|18150.00|99|0.00|AETNA INSJ STABLJ DEV
20|FH_F110604_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F110604_0_0|SrvcGrp|103586|2022|PDM|6050.00|99|0.00|REMOVE SPINE INFUSION
20|FH_F110604_0_0|SrvcGrp|36591|2022|PDM|48400.00|99|0.00|CPT 63685
20|FH_F110604_0_0|SrvcGrp|58634|2022|PDM|6050.00|99|0.00|NEUROELECTRODES IMPLANT
20|FH_F110604_0_0|SrvcGrp|58638|2022|PDM|2310.00|99|0.00|CPT 63688
20|FH_F110604_0_0|SrvcGrp|84912|2022|PDM|2640.00|99|0.00|PERQ VERTEBRAL AUGMENTATION
20|FH_F110604_0_0|SrvcGrp|87679|2022|PDM|1100.00|99|0.00|LUMBAR OR SACRAL SURGERY
20|FH_F110604_0_0|SrvcGrp|88317|2022|PDM|1100.00|99|0.00|TESTING EBN 1.6 R4 2015
20|FH_F110604_0_0|SrvcGrp|88739|2022|PDM|6050.00|99|0.00|IMPLANT SPINAL CANAL
20|FH_F110606_0_0|SrvcGrp|82981|2022|PDM|165.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F110621_0_0|CSTM-ALL|CSTM-00|2020|PDM|531.00|99|0.00|AEG 3 (NO REV)
20|FH_F110621_0_0|CSTM-ALL|CSTM-00|2020|PDM|868.00|99|0.00|AEG 6 (NO REV)
20|FH_F110621_0_0|SrvcGrp|103867|2022|PCT|1.10|99|0.00|AETNA IMPLANTS
20|FH_F110666_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F110666_0_0|SrvcGrp|82981|2022|PDM|90.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F110666_0_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F110720_0_0|SrvcGrp|104098|2022|PDM|4669.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT
20|FH_F110720_0_0|SrvcGrp|12309|2022|PDM|4882.00|99|0.00|MICRODISKETOMY
20|FH_F110720_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F110720_0_0|SrvcGrp|72996|2022|PDM|2584.00|99|0.00|AEG 4
20|FH_F110720_0_0|SrvcGrp|72998|2022|PDM|2961.00|99|0.00|AEG 5
20|FH_F110720_0_0|SrvcGrp|73000|2022|PDM|3041.00|99|0.00|AEG 6
20|FH_F110720_0_0|SrvcGrp|73002|2022|PDM|3083.00|99|0.00|AEG 7
20|FH_F110720_0_0|SrvcGrp|73006|2022|PDM|3409.00|99|0.00|AEG 9
20|FH_F110720_0_0|SrvcGrp|73008|2022|PDM|1273.00|99|0.00|AEG 10
20|FH_F110803_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F110902_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F110902_0_0|SrvcGrp|87077|2022|PDM|110.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F110927_0_0|CSTM-ALL|CSTM-00|2020|PCT|64.00|99|0.00|GENERAL ACUTE CARE
20|FH_F110940_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 5  (NO REV)
20|FH_F110940_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|AEG 2 (NO REV)
20|FH_F110940_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 3 (NO REV)
20|FH_F110940_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|AEG 6 (NO REV)
20|FH_F110940_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F110940_0_0|SrvcGrp|81859|2022|PDM|2200.00|99|0.00|AETNA CARDIAC CATH
20|FH_F110967_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|ASPG X
20|FH_F110967_0_0|CSTM-ALL|CSTM-00|2020|PDM|1512.54|99|0.00|ASPG IV
20|FH_F110967_0_0|CSTM-ALL|CSTM-00|2020|PDM|1721.40|99|0.00|ASPG V
20|FH_F110967_0_0|CSTM-ALL|CSTM-00|2020|PDM|2123.43|99|0.00|ASPG VII
20|FH_F110980_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F111001_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F111001_0_0|CSTM-ALL|CSTM-00|2020|PDM|11.00|99|0.00|RESPITE CARE (MOD TE)
20|FH_F111001_0_0|CSTM-ALL|CSTM-00|2020|PDM|18.00|99|0.00|RN HIGH TECH HOURLY
20|FH_F111001_0_0|SrvcGrp|104237|2022|PDM|3.00|99|0.00|UNSKILLED RESPITE CARE
20|FH_F111001_0_0|SrvcGrp|48396|2022|PDM|100.00|99|0.00|OT SERVICES
20|FH_F111044_0_0|CSTM-ALL|CSTM-00|2020|PDM|1030.00|99|0.00|AEG 10 (NO REV)
20|FH_F111044_0_0|CSTM-ALL|CSTM-00|2020|PDM|1682.00|99|0.00|AEG 7 (NO REV)
20|FH_F111044_0_0|CSTM-ALL|CSTM-00|2020|PDM|759.00|99|0.00|AEG 1 (NO REV)
20|FH_F111044_0_0|SrvcGrp|102459|2022|PDM|1648.00|99|0.00|CPT 29894
20|FH_F111044_0_0|SrvcGrp|104171|2022|PDM|1648.00|99|0.00|AETNA ARTHROSCOPY SURGERY SYNOVECT
20|FH_F111044_0_0|SrvcGrp|82720|2022|PDM|1648.00|99|0.00|WRIST ENDOSCOPY/SURGERY
20|FH_F111046_0_0|SrvcGrp|13262|2022|PDM|11.33|99|0.00|GROUND MILEAGE, PER STATUTE MILE
20|FH_F111046_0_0|SrvcGrp|13683|2022|PDM|765.00|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2
20|FH_F111064_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F111064_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F111163_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F111163_0_0|CSTM-ALL|CSTM-00|2020|PDM|564.00|99|0.00|AEG 2 (NO REV)
20|FH_F111163_0_0|CSTM-ALL|CSTM-00|2020|PDM|848.00|99|0.00|AEG 4 (NO REV)
20|FH_F111180_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F111189_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F111207_0_0|SrvcGrp|25696|2022|PDM|950.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F111207_0_0|SrvcGrp|25697|2022|PDM|750.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F111260_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F111263_0_0|SrvcGrp|82981|2022|PDM|130.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F111263_0_0|SrvcGrp|87077|2022|PDM|130.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F111265_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F111288_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F111288_0_0|SrvcGrp|113480|2022|PDM|32640.00|99|0.00|GASTRIC RESTRICTIVE
20|FH_F111288_0_0|SrvcGrp|41334|2022|PDM|25908.00|99|0.00|TOTAL KNEE
20|FH_F111288_0_0|SrvcGrp|41335|2022|PDM|25602.00|99|0.00|TOTAL HIP
20|FH_F111288_0_0|SrvcGrp|42550|2022|PDM|2552.00|99|0.00|OP SURGERY CPT 66984
20|FH_F111288_0_0|SrvcGrp|58993|2022|PDM|7831.00|99|0.00|DISKECTOMY
20|FH_F111288_0_0|SrvcGrp|67065|2022|PDM|19003.00|99|0.00|CERVICAL SURGERY
20|FH_F111288_0_0|SrvcGrp|67072|2022|PDM|4364.00|99|0.00|CPT 22845
20|FH_F111288_0_0|SrvcGrp|67119|2022|PDM|2067.00|99|0.00|ARTHODESIS
20|FH_F111288_0_0|SrvcGrp|77021|2022|PDM|5832.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY
20|FH_F111288_0_0|SrvcGrp|81904|2022|PDM|22542.00|99|0.00|LAP PARASOPHAG HERNIA REPAIR
20|FH_F111288_0_0|SrvcGrp|87842|2022|PDM|25500.00|99|0.00|LAPAROSCOPY - GASTRIC
20|FH_F111288_0_0|SrvcGrp|87844|2022|PDM|22542.00|99|0.00|LAPARASCOPY - GASTRIC
20|FH_F111288_0_0|SrvcGrp|88737|2022|PDM|8670.00|99|0.00|LAPARO PROC
20|FH_F111288_0_0|SrvcGrp|90420|2022|PDM|7677.00|99|0.00|REPAIR CLAVICLE FRACTURE
20|FH_F111288_0_0|SrvcGrp|99174|2022|PDM|2564.00|99|0.00|CPT 30140
20|FH_F111320_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F111320_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|AEG 10 (NO REV)
20|FH_F111320_0_0|SrvcGrp|104357|2022|PDM|1750.00|99|0.00|DACRYOCYSTORHINOSTOMY
20|FH_F111320_0_0|SrvcGrp|104358|2022|PDM|1750.00|99|0.00|CONJUNCTIVOPLASTY
20|FH_F111500_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F111500_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.80|99|0.00|HSS ASC
20|FH_F111582_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F111582_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F111593_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F111593_0_0|SrvcGrp|104448|2022|PDM|7500.00|99|0.00|CYSTOSCOPY IMPLANT 4 OR MORE
20|FH_F111593_0_0|SrvcGrp|14614|2022|PDM|8250.00|99|0.00|LITHOTRIPSY
20|FH_F111593_0_0|SrvcGrp|27402|2022|PDM|3495.50|99|0.00|LASER PROCEDURES
20|FH_F111593_0_0|SrvcGrp|72994|2022|PDM|2200.00|99|0.00|AEG 3
20|FH_F111593_0_0|SrvcGrp|98526|2022|PDM|2640.00|99|0.00|CYSTOURETHROSCOPY
20|FH_F111594_0_0|CSTM-ALL|CSTM-00|2020|PDM|1613.00|99|0.00|AEG 2 (NO REV)
20|FH_F111594_0_0|CSTM-ALL|CSTM-00|2020|PDM|2336.00|99|0.00|AEG 5  (NO REV)
20|FH_F111594_0_0|CSTM-ALL|CSTM-00|2020|PDM|2788.00|99|0.00|AEG 8 (NO REV)
20|FH_F111594_0_0|CSTM-ALL|CSTM-00|2020|PDM|962.00|99|0.00|AEG 10 (NO REV)
20|FH_F111594_0_0|SrvcGrp|34606|2022|PDM|2887.00|99|0.00|CPT 29827
20|FH_F111594_0_0|SrvcGrp|41334|2022|PDM|7215.00|99|0.00|TOTAL KNEE
20|FH_F111594_0_0|SrvcGrp|67065|2022|PDM|7699.00|99|0.00|CERVICAL SURGERY
20|FH_F111594_0_0|SrvcGrp|78096|2022|PDM|2887.00|99|0.00|AETNA ARTHROSCOPY BICEPS
20|FH_F111594_0_0|SrvcGrp|88163|2022|PDM|5296.00|99|0.00|LUMBAR SPINE FUSION
20|FH_F111594_0_0|SrvcGrp|89840|2022|PDM|7699.00|99|0.00|THORAX SPINE FUSION
20|FH_F111594_0_0|SrvcGrp|89842|2022|PDM|7699.00|99|0.00|LUMBAR
20|FH_F111594_0_0|SrvcGrp|98499|2022|PDM|7215.00|99|0.00|INCISE SPINAL COLUMN NERVES
20|FH_F111625_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F111826_0_0|SrvcGrp|101320|2022|PDM|1200.00|99|0.00|PARAVERTEBRAL FACET JOINT NERVE
20|FH_F111826_0_0|SrvcGrp|72992|2022|PDM|907.50|99|0.00|AEG 2
20|FH_F111826_0_0|SrvcGrp|73008|2022|PDM|1045.00|99|0.00|AEG 10
20|FH_F111835_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.49|99|0.00|ASPG IV
20|FH_F111840_0_0|SrvcGrp|75495|2022|PDM|1288.00|99|0.00|AEG 9
20|FH_F111852_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F111862_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F111925_0_0|CSTM-ALL|CSTM-00|2020|PDM|1418.00|99|0.00|AEG 8 (NO REV)
20|FH_F111925_0_0|CSTM-ALL|CSTM-00|2020|PDM|835.00|99|0.00|AEG 3 (NO REV)
20|FH_F111925_0_0|CSTM-ALL|CSTM-00|2020|PDM|977.00|99|0.00|AEG 4 (NO REV)
20|FH_F111925_0_0|SrvcGrp|28547|2022|PDM|1602.00|99|0.00|VITRECTOMY
20|FH_F111925_0_0|SrvcGrp|28548|2022|PDM|1602.00|99|0.00|VITRECTOMY
20|FH_F111925_0_0|SrvcGrp|28549|2022|PDM|1602.00|99|0.00|VITRECTOMY
20|FH_F111925_0_0|SrvcGrp|28550|2022|PDM|1602.00|99|0.00|VITRECTOMY
20|FH_F111925_0_0|SrvcGrp|46887|2022|PDM|1602.00|99|0.00|REPAIR DETACHED RETINA
20|FH_F111925_0_0|SrvcGrp|92659|2022|PDM|1602.00|99|0.00|REPAIR OF RETINAL DETACHMENT
20|FH_F111925_0_0|SrvcGrp|95108|2022|PDM|1602.00|99|0.00|RETINAL DETACHMENT
20|FH_F111986_0_0|SrvcGrp|104108|2022|PDM|1545.00|99|0.00|EXCISION OF BREAST LESION ID
20|FH_F111986_0_0|SrvcGrp|104111|2022|PDM|1854.00|99|0.00|EXCISE WRIST TENDON SHEATH
20|FH_F111986_0_0|SrvcGrp|104113|2022|PDM|1236.00|99|0.00|REMOVE ANAL FIST COMPLEX
20|FH_F111986_0_0|SrvcGrp|104114|2022|PDM|1236.00|99|0.00|INCISION OF FOOT FASCIA
20|FH_F111986_0_0|SrvcGrp|104117|2022|PDM|1236.00|99|0.00|REMOVE IN/EX HEM GROUPS = 2
20|FH_F111986_0_0|SrvcGrp|104122|2022|PDM|1442.00|99|0.00|BIOPSY/REMOVAL, LYMPH NODE(S)
20|FH_F111986_0_0|SrvcGrp|27345|2022|PDM|2060.00|99|0.00|OP SURGERY (CPT 49650)
20|FH_F111986_0_0|SrvcGrp|33985|2022|PDM|1545.00|99|0.00|CPT 19120
20|FH_F111986_0_0|SrvcGrp|33986|2022|PDM|927.00|99|0.00|CPT 26055
20|FH_F111986_0_0|SrvcGrp|33987|2022|PDM|1236.00|99|0.00|CPT 57522
20|FH_F111986_0_0|SrvcGrp|39906|2022|PDM|2163.00|99|0.00|MASTECTOMY, SIMPLE, COMPLETE
20|FH_F111986_0_0|SrvcGrp|41325|2022|PDM|2472.00|99|0.00|OP SURGERY CPT 24342
20|FH_F111986_0_0|SrvcGrp|58636|2022|PDM|2575.00|99|0.00|CPT 62362
20|FH_F111986_0_0|SrvcGrp|63469|2022|PDM|721.00|99|0.00|CPT 55700
20|FH_F111986_0_0|SrvcGrp|64517|2022|PDM|2472.00|99|0.00|REDUCE MANMMAPLASTY
20|FH_F111986_0_0|SrvcGrp|75885|2022|PDM|2060.00|99|0.00|AETNA CPT 49560
20|FH_F111986_0_0|SrvcGrp|87421|2022|PDM|1133.00|99|0.00|CYSTOURETHROSCOPY
20|FH_F111986_0_0|SrvcGrp|89981|2022|PDM|3605.00|99|0.00|SHOULDER ARTHROSCOPY / SURGERY
20|FH_F111986_0_0|SrvcGrp|92366|2022|PDM|2472.00|99|0.00|REPAIR ACHILLES TENDON
20|FH_F112024_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F112064_0_0|SrvcGrp|103901|2022|PDM|641.00|99|0.00|RESPITE CARE
20|FH_F112064_0_0|SrvcGrp|103903|2022|PDM|161.07|99|0.00|HOSPICE IN SNF
20|FH_F112064_0_0|SrvcGrp|29155|2022|PCT|0.00|99|0.00|HOSPICE SVCS
20|FH_F112080_0_0|SrvcGrp|35669|2022|PDM|6000.00|99|0.00|CPT 63650
20|FH_F112080_0_0|SrvcGrp|72990|2022|PDM|660.00|99|0.00|AEG 1
20|FH_F112080_0_0|SrvcGrp|72996|2022|PDM|914.00|99|0.00|AEG 4
20|FH_F112080_0_0|SrvcGrp|73008|2022|PDM|914.00|99|0.00|AEG 10
20|FH_F112080_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F112089_0_0|CSTM-ALL|CSTM-00|2020|PDM|1441.00|99|0.00|AEG 3 (NO REV)
20|FH_F112089_0_0|CSTM-ALL|CSTM-00|2020|PDM|1666.00|99|0.00|AEG 5  (NO REV)
20|FH_F112133_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F112133_0_0|CSTM-ALL|CSTM-00|2020|PDM|1339.00|99|0.00|AEG 9 (NO REV)
20|FH_F112133_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 1 (NO REV)
20|FH_F112133_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|AEG 6 (NO REV)
20|FH_F112133_0_0|CSTM-ALL|CSTM-00|2020|PDM|973.00|99|0.00|AEG 8 (NO REV)
20|FH_F112133_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|AEG 7 (NO REV)
20|FH_F112153_0_0|CSTM-ALL|CSTM-00|2020|PDM|1125.00|99|0.00|AEG 9 (NO REV)
20|FH_F112153_0_0|CSTM-ALL|CSTM-00|2020|PDM|725.00|99|0.00|AEG 4 (NO REV)
20|FH_F112163_0_0|SrvcGrp|75399|2022|PDM|0.15|99|0.00|MED RECORD COPY
20|FH_F112165_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F112165_0_0|SrvcGrp|72990|2022|PDM|995.00|99|0.00|AEG 1
20|FH_F112165_0_0|SrvcGrp|73002|2022|PDM|2550.00|99|0.00|AEG 7
20|FH_F112263_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F112263_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 10 (NO REV)
20|FH_F112263_0_0|SrvcGrp|35669|2022|PDM|5720.00|99|0.00|CPT 63650
20|FH_F112263_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F112272_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F112272_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F112272_0_0|SrvcGrp|30089|2022|PDM|442.00|99|0.00|HEMODIALYSIS SERVICES
20|FH_F112272_0_0|SrvcGrp|73601|2022|PDM|1456.00|99|0.00|AETNA INTERMEDIATE ICU/CCU
20|FH_F112272_0_0|SrvcGrp|82037|2022|PDM|1560.00|99|0.00|AETNA ICU
20|FH_F112325_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F112325_0_0|SrvcGrp|83519|2022|PDM|100.00|99|0.00|HOSPICE CARE (ALL OTHER)
20|FH_F112374_0_0|SrvcGrp|10391|2022|PDM|1456.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F112377_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F112408_0_0|SrvcGrp|471|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F112446_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F112452_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F112453_0_0|SrvcGrp|63119|2022|PDM|24.15|99|0.00|BASIC HOME HOSPICE CARE
20|FH_F112453_0_0|SrvcGrp|93098|2022|PDM|105.00|99|0.00|HOSPICE CARE
20|FH_F112468_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F112468_0_0|SrvcGrp|72994|2022|PDM|658.00|99|0.00|AEG 3
20|FH_F112468_0_0|SrvcGrp|72996|2022|PDM|727.00|99|0.00|AEG 4
20|FH_F112468_0_0|SrvcGrp|72998|2022|PDM|817.00|99|0.00|AEG 5
20|FH_F112468_0_0|SrvcGrp|73000|2022|PDM|928.00|99|0.00|AEG 6
20|FH_F112468_0_0|SrvcGrp|73002|2022|PDM|1114.00|99|0.00|AEG 7
20|FH_F112508_0_0|SrvcGrp|30089|2022|PDM|442.00|99|0.00|HEMODIALYSIS SERVICES
20|FH_F112508_0_0|SrvcGrp|73485|2022|PDM|832.00|99|0.00|AETNA REHAB
20|FH_F112526_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F112526_0_0|SrvcGrp|30609|2022|PDM|24.15|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F112526_0_0|SrvcGrp|65720|2022|PDM|105.00|99|0.00|RESPITE CARE
20|FH_F112526_0_0|SrvcGrp|74546|2022|PDM|499.00|99|0.00|HOSPICE SERVICES
20|FH_F112526_0_0|SrvcGrp|89822|2022|PDM|105.00|99|0.00|HOSPICE ROUTINE HOME CARE
20|FH_F112526_0_0|SrvcGrp|93098|2022|PDM|105.00|99|0.00|HOSPICE CARE
20|FH_F112545_0_0|CSTM-ALL|CSTM-00|2020|PCT|68.00|99|0.00|OP SVCS
20|FH_F112568_0_0|SrvcGrp|104837|2022|PDM|240.60|99|0.00|HOSPICE CARE
20|FH_F112568_0_0|SrvcGrp|104838|2022|PDM|240.60|99|0.00|HOSPICE CARE (HCFA)
20|FH_F112568_0_0|SrvcGrp|104839|2022|PDM|240.60|99|0.00|HOSPICE CARE
20|FH_F112568_0_0|SrvcGrp|104844|2022|PDM|312.65|99|0.00|CLINICAL SOCIAL WORKER IN HOME
20|FH_F112568_0_0|SrvcGrp|104845|2022|PDM|180.71|99|0.00|HOME HEALTH AIDE IN HOME
20|FH_F112631_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F112631_0_0|SrvcGrp|72992|2022|PDM|637.00|99|0.00|AEG 2
20|FH_F112631_0_0|SrvcGrp|74587|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F112665_0_0|CSTM-ALL|CSTM-00|2020|PDM|1155.00|99|0.00|AEG 1 (NO REV)
20|FH_F112665_0_0|CSTM-ALL|CSTM-00|2020|PDM|2336.00|99|0.00|AEG 5  (NO REV)
20|FH_F112665_0_0|SrvcGrp|103965|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F112665_0_0|SrvcGrp|13187|2022|PCT|1.00|99|0.00|INTRAOCULAR LENSES
20|FH_F112665_0_0|SrvcGrp|27261|2022|PDM|8661.00|99|0.00|CPT 27446
20|FH_F112665_0_0|SrvcGrp|54943|2022|PDM|2887.00|99|0.00|REPAIR OF SLAP LESION
20|FH_F112665_0_0|SrvcGrp|67065|2022|PDM|7699.00|99|0.00|CERVICAL SURGERY
20|FH_F112665_0_0|SrvcGrp|74039|2022|PDM|7215.00|99|0.00|LAMINECTOMY
20|FH_F112665_0_0|SrvcGrp|77021|2022|PDM|7215.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY
20|FH_F112665_0_0|SrvcGrp|88158|2022|PDM|7215.00|99|0.00|NECK SPINE DISK SURGERY
20|FH_F112665_0_0|SrvcGrp|88160|2022|PDM|7215.00|99|0.00|LAMINECTOMY W/FACETECTOMY
20|FH_F112665_0_0|SrvcGrp|98495|2022|PDM|7699.00|99|0.00|ARTHRODESIS POSTERIOR TECH
20|FH_F112665_0_0|SrvcGrp|98497|2022|PDM|7699.00|99|0.00|ARTHRODESIS POSTERIOR TECH
20|FH_F112665_0_0|SrvcGrp|98499|2022|PDM|7215.00|99|0.00|INCISE SPINAL COLUMN NERVES
20|FH_F112668_0_0|SrvcGrp|82138|2022|PDM|535.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F112704_0_0|CSTM-ALL|CSTM-00|2020|PDM|1304.60|99|0.00|AEG 6 (NO REV)
20|FH_F112704_0_0|CSTM-ALL|CSTM-00|2020|PDM|705.10|99|0.00|AEG 2 (NO REV)
20|FH_F112704_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F112704_0_0|SrvcGrp|35669|2022|PDM|5500.00|99|0.00|CPT 63650
20|FH_F112708_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F112708_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F112708_0_0|CSTM-ALL|CSTM-00|2020|PDM|1838.00|99|0.00|AEG 9 (NO REV)
20|FH_F112708_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|AEG 10 (NO REV)
20|FH_F112708_0_0|SrvcGrp|85022|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F112708_0_0|SrvcGrp|99981|2022|PDM|2223.00|99|0.00|LAPAROSCOPY SERVICES
20|FH_F112726_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|GENERAL ACUTE CARE
20|FH_F112791_0_0|SrvcGrp|72994|2022|PDM|535.00|99|0.00|AEG 3
20|FH_F112791_0_0|SrvcGrp|72996|2022|PDM|661.00|99|0.00|AEG 4
20|FH_F112791_0_0|SrvcGrp|72998|2022|PDM|752.00|99|0.00|AEG 5
20|FH_F112791_0_0|SrvcGrp|73004|2022|PDM|1102.00|99|0.00|AEG 8
20|FH_F112791_0_0|SrvcGrp|73008|2022|PDM|535.00|99|0.00|AEG 10
20|FH_F112823_0_0|CSTM-ALL|CSTM-00|2020|PDM|1038.00|99|0.00|AEG 6 (NO REV)
20|FH_F112823_0_0|CSTM-ALL|CSTM-00|2020|PDM|1259.00|99|0.00|AEG 7 (NO REV)
20|FH_F112823_0_0|CSTM-ALL|CSTM-00|2020|PDM|792.00|99|0.00|AEG 4 (NO REV)
20|FH_F112823_0_0|CSTM-ALL|CSTM-00|2020|PDM|908.00|99|0.00|AEG 5  (NO REV)
20|FH_F112844_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F112844_0_0|SrvcGrp|63297|2022|PDM|115.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F112844_0_0|SrvcGrp|89822|2022|PDM|115.00|99|0.00|HOSPICE ROUTINE HOME CARE
20|FH_F112863_0_0|CSTM-ALL|CSTM-00|2020|PDM|1742.00|99|0.00|AEG 9 (NO REV)
20|FH_F112863_0_0|CSTM-ALL|CSTM-00|2020|PDM|433.00|99|0.00|AEG 1 (NO REV)
20|FH_F112863_0_0|CSTM-ALL|CSTM-00|2020|PDM|820.00|99|0.00|AEG 4 (NO REV)
20|FH_F112863_0_0|SrvcGrp|104250|2022|PDM|2002.00|99|0.00|FOREHEAD FLAP WITH PRESERV
20|FH_F112863_0_0|SrvcGrp|104251|2022|PDM|1141.00|99|0.00|SKIN TISSUE REARRANGEMENT
20|FH_F112863_0_0|SrvcGrp|104256|2022|PDM|1141.00|99|0.00|SKIN TISSUE REARRANGEMENT
20|FH_F112863_0_0|SrvcGrp|104258|2022|PDM|1141.00|99|0.00|SKIN TISSUE REARRANGEMENT
20|FH_F112908_0_0|SrvcGrp|23683|2022|PDM|34.00|99|0.00|SKILLED NURSING RN
20|FH_F112908_0_0|SrvcGrp|27969|2022|PDM|13.00|99|0.00|HOME HEALTH AIDE
20|FH_F112908_0_0|SrvcGrp|88621|2022|PDM|87.00|99|0.00|SKILLED NURSING LPN
20|FH_F112943_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F112943_0_0|CSTM-ALL|CSTM-00|2020|PDM|1391.50|99|0.00|AEG 8 (NO REV)
20|FH_F112946_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F112946_0_0|CSTM-ALL|CSTM-00|2020|PDM|1025.00|99|0.00|COVENTRY ENHANCED GROUPER 8
20|FH_F112946_0_0|CSTM-ALL|CSTM-00|2020|PDM|1060.00|99|0.00|COVENTRY ENHANCED GROUPER 7
20|FH_F112956_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F112956_0_0|SrvcGrp|73486|2022|PCT|0.00|99|0.00|AETNA CONTRAST AGENT
20|FH_F112956_0_0|SrvcGrp|75481|2022|PDM|536.00|99|0.00|AEG 2
20|FH_F112956_0_0|SrvcGrp|75487|2022|PDM|783.00|99|0.00|AEG 5
20|FH_F112956_0_0|SrvcGrp|75489|2022|PDM|902.00|99|0.00|AEG 6
20|FH_F112956_0_0|SrvcGrp|75493|2022|PDM|1072.00|99|0.00|AEG 8
20|FH_F112962_0_0|CSTM-ALL|CSTM-00|2020|PDM|1128.00|99|0.00|AEG 7 (NO REV)
20|FH_F112962_0_0|CSTM-ALL|CSTM-00|2020|PDM|1517.00|99|0.00|AEG 9 (NO REV)
20|FH_F112962_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F112967_0_0|SrvcGrp|47411|2022|PDM|115.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F112967_0_0|SrvcGrp|80317|2022|PDM|115.00|99|0.00|RESPITE CARE
20|FH_F112967_0_0|SrvcGrp|89781|2022|PDM|115.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F112967_0_0|SrvcGrp|90478|2022|PDM|115.00|99|0.00|HOSPICE
20|FH_F112967_0_0|SrvcGrp|93098|2022|PDM|115.00|99|0.00|HOSPICE CARE
20|FH_F112995_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F112995_0_0|CSTM-ALL|CSTM-00|2020|PDM|1172.78|99|0.00|AEG 8 (NO REV)
20|FH_F112995_0_0|CSTM-ALL|CSTM-00|2020|PDM|1199.30|99|0.00|AEG 7 (NO REV)
20|FH_F112995_0_0|CSTM-ALL|CSTM-00|2020|PDM|401.37|99|0.00|AEG 1 (NO REV)
20|FH_F113025_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F113025_0_0|SrvcGrp|103965|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F113025_0_0|SrvcGrp|104721|2022|PDM|653.00|99|0.00|REVISE EYELID W/ EXCESS SKIN
20|FH_F113025_0_0|SrvcGrp|104724|2022|PDM|765.00|99|0.00|EXTRACAPSULAR CATARACT
20|FH_F113025_0_0|SrvcGrp|75489|2022|PDM|865.00|99|0.00|AEG 6
20|FH_F113025_0_0|SrvcGrp|75491|2022|PDM|1043.00|99|0.00|AEG 7
20|FH_F113025_0_0|SrvcGrp|85906|2022|PDM|475.00|99|0.00|CPT 66710
20|FH_F113041_0_0|CSTM-ALL|CSTM-00|2020|PCT|66.00|99|0.00|GENERAL ACUTE CARE
20|FH_F113041_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)
20|FH_F113074_0_0|CSTM-ALL|CSTM-00|2020|PDM|1151.00|99|0.00|AEG 7 (NO REV)
20|FH_F113074_0_0|CSTM-ALL|CSTM-00|2020|PDM|363.00|99|0.00|AEG 1 (NO REV)
20|FH_F113074_0_0|CSTM-ALL|CSTM-00|2020|PDM|556.00|99|0.00|AEG 3 (NO REV)
20|FH_F113074_0_0|CSTM-ALL|CSTM-00|2020|PDM|963.00|99|0.00|AEG 6 (NO REV)
20|FH_F113074_0_0|SrvcGrp|105013|2022|PDM|1950.00|99|0.00|AETNA RETNAL CODES
20|FH_F113074_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F113130_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 1 (NO REV)
20|FH_F113130_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|AEG 2 (NO REV)
20|FH_F113139_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F113139_0_0|CSTM-ALL|CSTM-00|2020|PDM|1050.00|99|0.00|AEG 5  (NO REV)
20|FH_F113139_0_0|SrvcGrp|103671|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F113143_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F113255_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F113255_0_0|SrvcGrp|72990|2022|PDM|509.00|99|0.00|AEG 1
20|FH_F113305_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F113305_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F36450_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F36450_0_0|CSTM-ALL|CSTM-00|2020|PDM|4150.00|99|0.00|LITHOTRIPSY
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|100.59|99|0.00|SALLY BALIN,999182,ASC 226
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|106.24|99|0.00|SALLY BALIN,999182,ASC 122
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|1127.78|99|0.00|SALLY BALIN,999182,ASC 801
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|1158.55|99|0.00|SALLY BALIN,999182,ASC 701
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|120.65|99|0.00|SALLY BALIN,999182,ASC 121
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|1559.10|99|0.00|SALLY BALIN,999182,ASC 901
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|175.49|99|0.00|SALLY BALIN,999182,ASC 114
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|175.49|99|0.00|SALLY BALIN,999182,ASC 220
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|207.32|99|0.00|SALLY BALIN,999182,ASC 113
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|259.40|99|0.00|SALLY BALIN,999182,ASC 110
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|286.34|99|0.00|SALLY BALIN,999182,ASC 107
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|292.86|99|0.00|SALLY BALIN,999182,ASC 214
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|390.54|99|0.00|SALLY BALIN,999182,ASC 210
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|455.21|99|0.00|SALLY BALIN,999182,ASC 207
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|464.86|99|0.00|SALLY BALIN,999182,ASC 404
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|487.28|99|0.00|SALLY BALIN,999182,ASC 403
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|956.62|99|0.00|SALLY BALIN,999182,ASC 601
20|FH_F36464_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36472_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|ACUTE PSYCH
20|FH_F36472_0_0|SrvcGrp|12116|2022|PCT|0.65|99|0.00|DRUGS
20|FH_F36472_0_0|SrvcGrp|6|2022|PCT|0.80|99|0.00|OP SURGERY
20|FH_F36472_0_0|SrvcGrp|944|2022|PCT|0.65|99|0.00|BARIATRIC SVCS
20|FH_F36476_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F36479_0_0|CSTM-ALL|CSTM-00|2020|PDM|1257.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36492_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36492_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F36492_0_0|SrvcGrp|103974|2022|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES
20|FH_F36492_0_0|SrvcGrp|73004|2022|PDM|1681.00|99|0.00|AEG 8
20|FH_F36492_0_0|SrvcGrp|73006|2022|PDM|1428.00|99|0.00|AEG 9
20|FH_F36500_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F36521_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F36521_0_0|CSTM-ALL|CSTM-00|2020|PDM|875.00|99|0.00|ACUTE IP MED SVCS
20|FH_F36521_0_0|SrvcGrp|177|2022|PDM|950.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F36521_0_0|SrvcGrp|38|2022|PDM|1600.00|99|0.00|NORMAL DELIVERY
20|FH_F36521_0_0|SrvcGrp|97|2022|PDM|2600.00|99|0.00|C-SECTION
20|FH_F36532_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36533_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS
20|FH_F36541_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F36541_0_0|SrvcGrp|9774|2022|PDM|2645.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F36542_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|OP SVCS
20|FH_F36552_0_0|CSTM-ALL|CSTM-00|2020|PDM|21510.00|99|0.00|MS DRG 237
20|FH_F36552_0_0|CSTM-ALL|CSTM-00|2020|PDM|29295.00|99|0.00|MS DRG 219
20|FH_F36552_0_0|CSTM-ALL|CSTM-00|2020|PDM|29295.00|99|0.00|MS DRG 220
20|FH_F36552_0_0|CSTM-ALL|CSTM-00|2020|PDM|29840.00|99|0.00|MS DRG 230
20|FH_F36552_0_0|CSTM-ALL|CSTM-00|2020|PDM|5720.00|99|0.00|MS DRG 281
20|FH_F36552_0_0|CSTM-ALL|CSTM-00|2020|PDM|5720.00|99|0.00|MS DRG 282
20|FH_F36552_0_0|CSTM-ALL|CSTM-00|2020|PDM|6685.00|99|0.00|MS DRG 260
20|FH_F36552_0_0|CSTM-ALL|CSTM-00|2020|PDM|8425.00|99|0.00|MS DRG 280
20|FH_F36552_0_0|SrvcGrp|16|2022|PDM|750.00|99|0.00|ACUTE REHABILITATION
20|FH_F36552_0_0|SrvcGrp|2738|2022|PCT|0.60|99|0.00|IMPLANTS
20|FH_F36552_0_0|SrvcGrp|701|2022|PDM|1300.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F36555_0_0|SrvcGrp|473|2022|PDM|429.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F36555_0_0|SrvcGrp|474|2022|PDM|390.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F36576_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|IMPLANTS
20|FH_F36576_0_0|CSTM-ALL|CSTM-00|2020|PDM|1232.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36576_0_0|SrvcGrp|1171|2022|PCT|0.85|99|0.00|IMPLANTS
20|FH_F36576_0_0|SrvcGrp|333|2022|PCT|0.90|99|0.00|HOSPICE SVCS
20|FH_F36590_0_0|CSTM-ALL|CSTM-00|2020|PDM|1199.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36590_0_0|CSTM-ALL|CSTM-00|2020|PDM|428.00|99|0.00|CD PARTIAL HOSPITALIZATION
20|FH_F36590_0_0|CSTM-ALL|CSTM-00|2020|PDM|616.00|99|0.00|ACUTE PSYCH
20|FH_F36590_0_0|SrvcGrp|129|2022|PCT|0.70|99|0.00|COCHLEAR IMPLANTS
20|FH_F36594_0_0|SrvcGrp|12856|2022|PDM|53.00|99|0.00|NURSING CARE
20|FH_F36594_0_0|SrvcGrp|9828|2022|PDM|42.00|99|0.00|HOME HEALTH AIDE
20|FH_F36594_0_0|SrvcGrp|9829|2022|PDM|102.00|99|0.00|PT SVCS
20|FH_F36595_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36595_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F36620_0_0|SrvcGrp|472|2022|PDM|552.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F36634_0_0|CSTM-ALL|CSTM-00|2020|PDM|2811.00|99|0.00|ANGIOPLASTY
20|FH_F36634_0_0|SrvcGrp|12394|2022|PCT|0.70|99|0.00|PROSTHETICS/IMPLANTS/DEVICES
20|FH_F36634_0_0|SrvcGrp|361|2022|PDM|1352.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F36669_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36669_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F36679_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36679_0_0|CSTM-ALL|CSTM-00|2020|PDM|65.00|99|0.00|5781263-GA-PT/OT/ST-CPT
20|FH_F36681_0_0|CSTM-ALL|CSTM-00|2020|PDM|1313.00|99|0.00|ASPG VIII
20|FH_F36681_0_0|CSTM-ALL|CSTM-00|2020|PDM|1343.00|99|0.00|ASPG VII
20|FH_F36681_0_0|CSTM-ALL|CSTM-00|2020|PDM|602.00|99|0.00|ASPG II
20|FH_F36681_0_0|CSTM-ALL|CSTM-00|2020|PDM|688.00|99|0.00|ASPG III
20|FH_F36683_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|OP SVCS
20|FH_F36683_0_0|CSTM-ALL|CSTM-00|2020|PDM|1311.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36683_0_0|CSTM-ALL|CSTM-00|2020|PDM|23413.00|99|0.00|MS DRG 234
20|FH_F36683_0_0|CSTM-ALL|CSTM-00|2020|PDM|27873.00|99|0.00|MS DRG 220
20|FH_F36683_0_0|CSTM-ALL|CSTM-00|2020|PDM|31218.00|99|0.00|MS DRG 217
20|FH_F36683_0_0|CSTM-ALL|CSTM-00|2020|PDM|31218.00|99|0.00|MS DRG 218
20|FH_F36683_0_0|SrvcGrp|65|2022|PDM|1202.00|99|0.00|OBSTETRICAL CARE
20|FH_F36683_0_0|SrvcGrp|656|2022|PCT|0.65|99|0.00|DEFINITIVE OBSERVATION UNIT
20|FH_F36683_0_0|SrvcGrp|72|2022|PDM|328.00|99|0.00|NEWBORN NURSERY
20|FH_F36683_0_0|SrvcGrp|8968|2022|PDM|2077.00|99|0.00|NICU LEVEL III & IV
20|FH_F36701_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS
20|FH_F36704_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|MSDRG 216-218 CARDIAC VALVE PROCEDURE W/CARDIAC CATH OTLR
20|FH_F36704_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|ACUTE IP MEDICAL SVCS
20|FH_F36704_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36704_0_0|SrvcGrp|13123|2022|PDM|350.00|99|0.00|COMPUTED TOMOGRAPHY (CT)
20|FH_F36704_0_0|SrvcGrp|13749|2022|PDM|550.00|99|0.00|OP MRI
20|FH_F36704_0_0|SrvcGrp|3275|2022|PDM|1775.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F36704_0_0|SrvcGrp|9503|2022|PDM|1350.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F36715_0_0|CSTM-ALL|CSTM-00|2020|PDM|1489.00|99|0.00|ACUTE IP MED SVCS
20|FH_F36715_0_0|CSTM-ALL|CSTM-00|2020|PDM|758.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F36715_0_0|SrvcGrp|16|2022|PDM|899.00|99|0.00|ACUTE REHABILITATION
20|FH_F36715_0_0|SrvcGrp|72|2022|PDM|320.00|99|0.00|NEWBORN NURSERY
20|FH_F36734_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36737_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|OP SVCS
20|FH_F36743_0_0|CSTM-ALL|CSTM-00|2020|PDM|1770.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F36743_0_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|ACUTE IP SVCS ONE DAY STAY
20|FH_F36743_0_0|CSTM-ALL|CSTM-00|2020|PDM|3900.00|99|0.00|MS DRG 242-244 PACEMAKER IMPLANT W/ACUTE INFARCTION
20|FH_F36743_0_0|CSTM-ALL|CSTM-00|2020|PDM|5500.00|99|0.00|MSDRG 286-287 CARDIAC CATH
20|FH_F36743_0_0|SrvcGrp|115|2022|PDM|755.00|99|0.00|SKILLED NURSING CARE
20|FH_F36743_0_0|SrvcGrp|23929|2022|PCT|0.65|99|0.00|HIGH COST DRUGS
20|FH_F36743_0_0|SrvcGrp|2741|2022|PCT|0.65|99|0.00|DRUGS
20|FH_F36743_0_0|SrvcGrp|360|2022|PDM|2200.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F36743_0_0|SrvcGrp|361|2022|PDM|2300.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F36743_0_0|SrvcGrp|38|2022|PDM|2100.00|99|0.00|NORMAL DELIVERY
20|FH_F36743_0_0|SrvcGrp|453|2022|PDM|520.00|99|0.00|PSYCH PARTIAL HOSP
20|FH_F36743_0_0|SrvcGrp|49|2022|PDM|12500.00|99|0.00|HIP REPLACEMENT
20|FH_F36743_0_0|SrvcGrp|6|2022|PCT|0.79|99|0.00|OP SURGERY
20|FH_F36743_0_0|SrvcGrp|701|2022|PDM|2400.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F36761_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS
20|FH_F36766_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|OP SVCS
20|FH_F36767_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS
20|FH_F36803_0_0|SrvcGrp|38|2022|PDM|2500.00|99|0.00|NORMAL DELIVERY
20|FH_F36803_0_0|SrvcGrp|72|2022|PDM|400.00|99|0.00|NEWBORN NURSERY
20|FH_F36822_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F36822_0_0|SrvcGrp|3069|2022|PCT|0.60|99|0.00|IMPLANTS
20|FH_F36822_0_0|SrvcGrp|3271|2022|PDM|2106.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F36822_0_0|SrvcGrp|58543|2022|PDM|8500.00|99|0.00|MS DRG 619-621
20|FH_F36822_0_0|SrvcGrp|9826|2022|PCT|0.50|99|0.00|OP SURGERY
20|FH_F36835_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F36854_0_0|SrvcGrp|38|2022|PDM|5180.00|99|0.00|NORMAL DELIVERY
20|FH_F36854_0_0|SrvcGrp|453|2022|PDM|500.00|99|0.00|PSYCH PARTIAL HOSP
20|FH_F36854_0_0|SrvcGrp|701|2022|PDM|3160.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F36854_0_0|SrvcGrp|97|2022|PDM|6955.00|99|0.00|C-SECTION
20|FH_F36864_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36864_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|OP SVCS
20|FH_F36883_0_0|SrvcGrp|16429|2022|PCT|0.52|99|0.00|OBSERVATION SVCS
20|FH_F36883_0_0|SrvcGrp|70399|2022|PDM|260.00|99|0.00|PSYCHIATIC/PSYCHOLOGIC SERVICE
20|FH_F36883_0_0|SrvcGrp|73652|2022|PDM|312.50|99|0.00|AETNA OP PSYCH PARTIAL HOSP
20|FH_F36883_0_0|SrvcGrp|90076|2022|PCT|0.52|99|0.00|CARDIC CATH PROCEDURES
20|FH_F36892_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36892_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F36895_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|OP SVCS
20|FH_F36915_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F36917_0_0|SrvcGrp|10951|2022|PDM|105.00|99|0.00|PARTIAL HOSPITALIZATION PSYCH/CD
20|FH_F36926_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F36955_0_0|SrvcGrp|3087|2022|PDM|770.00|99|0.00|CD - DETOX
20|FH_F36998_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS
20|FH_F37058_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F37058_0_0|SrvcGrp|23387|2022|PDM|80.00|99|0.00|PT/OT/ST
20|FH_F37067_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F37078_0_0|SrvcGrp|472|2022|PDM|338.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F37078_0_0|SrvcGrp|473|2022|PDM|286.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F37081_0_0|CSTM-ALL|CSTM-00|2020|PDM|17440.00|99|0.00|MS DRG 480
20|FH_F37081_0_0|CSTM-ALL|CSTM-00|2020|PDM|1897.00|99|0.00|ACUTE IP MED SVCS
20|FH_F37081_0_0|CSTM-ALL|CSTM-00|2020|PDM|24400.00|99|0.00|MS DRG 246-247 CV SURGERY
20|FH_F37081_0_0|CSTM-ALL|CSTM-00|2020|PDM|30500.00|99|0.00|MS DRG 237
20|FH_F37081_0_0|CSTM-ALL|CSTM-00|2020|PDM|38486.00|99|0.00|MSDRG 233-234 CORONARY BYPASS
20|FH_F37081_0_0|CSTM-ALL|CSTM-00|2020|PDM|51493.00|99|0.00|MSDRG 231-232 CORONARY BYPASS
20|FH_F37081_0_0|CSTM-ALL|CSTM-00|2020|PDM|52864.00|99|0.00|MS DRG 216-218
20|FH_F37081_0_0|SrvcGrp|16|2022|PDM|1086.00|99|0.00|ACUTE REHABILITATION
20|FH_F37081_0_0|SrvcGrp|177|2022|PDM|2345.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F37081_0_0|SrvcGrp|3029|2022|PDM|712.00|99|0.00|NEWBORN NURSERY
20|FH_F37081_0_0|SrvcGrp|409|2022|PCT|0.80|99|0.00|ER SVCS
20|FH_F37081_0_0|SrvcGrp|537|2022|PDM|1500.00|99|0.00|OBSERVATION SERVICES
20|FH_F37104_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|SUPPLIES
20|FH_F129509_0_0|SrvcGrp|111327|2022|PDM|1128.00|99|0.00|REVISION OF SCIATIC NERVE
20|FH_F129509_0_0|SrvcGrp|111328|2022|PDM|5332.00|99|0.00|PERQ VERTEBRAL AUGMENTATION
20|FH_F129509_0_0|SrvcGrp|35669|2022|PDM|3280.00|99|0.00|CPT 63650
20|FH_F129509_0_0|SrvcGrp|67068|2022|PDM|5125.00|99|0.00|LUMBAR SPINE FUSION COMBINED
20|FH_F129509_0_0|SrvcGrp|67072|2022|PDM|7175.00|99|0.00|CPT 22845
20|FH_F129509_0_0|SrvcGrp|67119|2022|PDM|5125.00|99|0.00|ARTHODESIS
20|FH_F129509_0_0|SrvcGrp|72992|2022|PDM|675.00|99|0.00|AEG 2
20|FH_F129509_0_0|SrvcGrp|72998|2022|PDM|1053.00|99|0.00|AEG 5
20|FH_F129509_0_0|SrvcGrp|74039|2022|PDM|3767.00|99|0.00|LAMINECTOMY
20|FH_F129509_0_0|SrvcGrp|77021|2022|PDM|3767.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY
20|FH_F129509_0_0|SrvcGrp|82109|2022|PDM|1128.00|99|0.00|REVISE ULNAR NERVE ELBOW
20|FH_F129509_0_0|SrvcGrp|88164|2022|PDM|5125.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR
20|FH_F129509_0_0|SrvcGrp|92409|2022|PDM|5139.00|99|0.00|PERQ CERVICOTHORACIC INJECT
20|FH_F129509_0_0|SrvcGrp|92415|2022|PDM|3767.00|99|0.00|NECK SPINE DISK SURGERY
20|FH_F129526_0_0|CSTM-ALL|CSTM-00|2020|PDM|1073.80|99|0.00|2005 ASPG GROUPER VI
20|FH_F129526_0_0|CSTM-ALL|CSTM-00|2020|PDM|819.00|99|0.00|2005 ASPG GROUPER X
20|FH_F129526_0_0|CSTM-ALL|CSTM-00|2020|PDM|819.00|99|0.00|OP SVCS
20|FH_F129535_0_0|SrvcGrp|71219|2022|PDM|550.00|99|0.00|COLONOSCOPY CPT 45382
20|FH_F129535_0_0|SrvcGrp|75483|2022|PDM|485.00|99|0.00|AEG 3
20|FH_F129535_0_0|SrvcGrp|75485|2022|PDM|600.00|99|0.00|AEG 4
20|FH_F129535_0_0|SrvcGrp|75487|2022|PDM|685.00|99|0.00|AEG 5
20|FH_F129535_0_0|SrvcGrp|75497|2022|PDM|700.00|99|0.00|AEG 10
20|FH_F129535_0_0|SrvcGrp|79593|2022|PDM|550.00|99|0.00|CPT 45378
20|FH_F129535_0_0|SrvcGrp|79595|2022|PDM|550.00|99|0.00|CPT 45385
20|FH_F129535_0_0|SrvcGrp|91569|2022|PDM|725.00|99|0.00|REMOVE HEMMORRHOIDS AND FISSURE
20|FH_F129536_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F129536_0_0|CSTM-ALL|CSTM-00|2020|PDM|1059.00|99|0.00|AEG 8 (NO REV)
20|FH_F129536_0_0|CSTM-ALL|CSTM-00|2020|PDM|2526.00|99|0.00|IMPLANTS
20|FH_F129536_0_0|CSTM-ALL|CSTM-00|2020|PDM|501.00|99|0.00|AEG 3 (NO REV)
20|FH_F129536_0_0|SrvcGrp|108385|2022|PCT|1.00|99|0.00|AQUEOUS SHUNT
20|FH_F129536_0_0|SrvcGrp|92084|2022|PDM|1793.00|99|0.00|CORNEAL TRANSPLANT
20|FH_F129597_0_0|SrvcGrp|83857|2022|PDM|475.00|99|0.00|IP HOSPICE SVCS
20|FH_F129597_0_0|SrvcGrp|84185|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F129638_0_0|SrvcGrp|104363|2022|PCT|0.00|99|0.00|HOSPITAL OP DIALYSIS
20|FH_F129638_0_0|SrvcGrp|109057|2022|PCT|0.00|99|0.00|CARDIAC STUDIES
20|FH_F129638_0_0|SrvcGrp|75506|2022|PCT|0.00|99|0.00|VASCULAR DIAGNOSTIC STUDIES
20|FH_F129644_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F129644_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F129644_0_0|SrvcGrp|111216|2022|PDM|400.00|99|0.00|ACUTE KIDNEY INJURY HEMODIALYSIS NO ESRD
20|FH_F129644_0_0|SrvcGrp|111388|2022|PDM|171.00|99|0.00|ACUTE KIDNEY INJURY - IPD/CAPD/CCPD - NO ESRD
20|FH_F129653_0_0|SrvcGrp|107361|2022|PDM|4000.00|99|0.00|SECOND LEVEL CER DISKECTOMY
20|FH_F129653_0_0|SrvcGrp|36591|2022|PDM|4000.00|99|0.00|CPT 63685
20|FH_F129653_0_0|SrvcGrp|67066|2022|PDM|4000.00|99|0.00|CERVICAL SURGERY
20|FH_F129653_0_0|SrvcGrp|67072|2022|PDM|4000.00|99|0.00|CPT 22845
20|FH_F129653_0_0|SrvcGrp|73000|2022|PDM|2015.00|99|0.00|AEG 6
20|FH_F129653_0_0|SrvcGrp|73004|2022|PDM|2405.00|99|0.00|AEG 8
20|FH_F129653_0_0|SrvcGrp|73006|2022|PDM|3250.00|99|0.00|AEG 9
20|FH_F129653_0_0|SrvcGrp|88163|2022|PDM|4000.00|99|0.00|LUMBAR SPINE FUSION
20|FH_F129653_0_0|SrvcGrp|90974|2022|PDM|2000.00|99|0.00|CERVICAL OR THORACIC INJECTION W/ IMAGING GUIDANCE
20|FH_F129653_0_0|SrvcGrp|99073|2022|PDM|1.32|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F129673_0_0|SrvcGrp|110638|2022|PDM|974.11|99|0.00|HOSPICE GENERAL INPATIENT CARE
20|FH_F129673_0_0|SrvcGrp|111405|2022|PDM|185.00|99|0.00|MED SOC SERVICE
20|FH_F129673_0_0|SrvcGrp|14494|2022|PDM|55.30|99|0.00|CONTINUOUS HOMECARE
20|FH_F129673_0_0|SrvcGrp|92501|2022|PDM|434.41|99|0.00|HOSPICE IP RESPITE CARE
20|FH_F129713_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F129713_0_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F129754_0_0|CSTM-ALL|CSTM-00|2020|PDM|415.30|99|0.00|2005 ASPG GROUPER I
20|FH_F129754_0_0|CSTM-ALL|CSTM-00|2020|PDM|556.23|99|0.00|2005 ASPG GROUPER II
20|FH_F129754_0_0|CSTM-ALL|CSTM-00|2020|PDM|636.05|99|0.00|2005 ASPG GROUPER III
20|FH_F129754_0_0|CSTM-ALL|CSTM-00|2020|PDM|785.71|99|0.00|2005 ASPG GROUPER IV
20|FH_F129785_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F129793_0_0|CSTM-ALL|CSTM-00|2020|PDM|1199.72|99|0.00|2006 MEDICARE ASPG VI
20|FH_F129810_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F129828_0_0|SrvcGrp|87077|2022|PDM|140.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F129888_0_0|CSTM-ALL|CSTM-00|2020|PDM|2092.80|99|0.00|2005 ASPG GROUPER IX
20|FH_F129888_0_0|CSTM-ALL|CSTM-00|2020|PDM|797.11|99|0.00|2005 ASPG GROUPER III
20|FH_F129888_0_0|CSTM-ALL|CSTM-00|2020|PDM|984.66|99|0.00|2005 ASPG GROUPER IV
20|FH_F129888_0_0|CSTM-ALL|CSTM-00|2020|PDM|984.66|99|0.00|2005 ASPG GROUPER X
20|FH_F129892_0_0|CSTM-ALL|CSTM-00|2020|PDM|682.00|99|0.00|AEG 10 (NO REV)
20|FH_F129892_0_0|SrvcGrp|35668|2022|PDM|1715.00|99|0.00|CPT 29824
20|FH_F129892_0_0|SrvcGrp|84939|2022|PDM|2550.00|99|0.00|SHOULDER JOINT
20|FH_F129912_0_0|CSTM-ALL|CSTM-00|2020|PDM|530.00|99|0.00|AMBULATORY SURGERY W/O AEG 1 & 2
20|FH_F129912_0_0|CSTM-ALL|CSTM-00|2020|PDM|775.00|99|0.00|AEG 2 (NO REV)
20|FH_F129913_0_0|CSTM-ALL|CSTM-00|2020|PDM|1101.88|99|0.00|2005 ASPG GROUPER IV
20|FH_F129913_0_0|CSTM-ALL|CSTM-00|2020|PDM|2341.94|99|0.00|2005 ASPG GROUPER IX
20|FH_F129913_0_0|SrvcGrp|90318|2022|PCT|1.10|99|0.00|IMPLANTS/PROSTHETICS
20|FH_F129941_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|OP SVCS
20|FH_F130025_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F130025_0_0|SrvcGrp|82037|2022|PDM|1623.00|99|0.00|AETNA ICU
20|FH_F130035_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F130035_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F130035_0_0|SrvcGrp|108041|2022|PDM|473.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME
20|FH_F130035_0_0|SrvcGrp|108546|2022|PDM|203.00|99|0.00|PERITONEAL TREATMENTS W/ PATIENT TRAINING
20|FH_F130108_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 028-030 SPINE SURGERY
20|FH_F130108_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 216-221, 231-232 CV SURGERY
20|FH_F130108_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 459-460
20|FH_F130108_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 471-473 CERVICAL FUSION
20|FH_F130108_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MSDRG 242-244, 258-262 PACEMAKER INSERTION/REVISION
20|FH_F130108_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MSDRG 286-287 CARDIAC CATH
20|FH_F130108_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|GENERAL ACUTE CARE
20|FH_F130108_0_0|CSTM-ALL|CSTM-00|2020|PDM|1900.00|99|0.00|ASPG IV
20|FH_F130108_0_0|CSTM-ALL|CSTM-00|2020|PDM|2900.00|99|0.00|ASPG VI
20|FH_F130108_0_0|CSTM-ALL|CSTM-00|2020|PDM|2900.00|99|0.00|ASPG VII
20|FH_F130108_0_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|OP SVCS
20|FH_F130108_0_0|SrvcGrp|10903|2022|PDM|750.00|99|0.00|EMERGENCY ROOM LEVEL I
20|FH_F130108_0_0|SrvcGrp|12406|2022|PCT|0.60|99|0.00|DRUGS
20|FH_F130108_0_0|SrvcGrp|13715|2022|PCT|0.60|99|0.00|DME/ORTHOTICS/PROSTHETICS/IMPLANTS
20|FH_F130108_0_0|SrvcGrp|14614|2022|PDM|5250.00|99|0.00|LITHOTRIPSY
20|FH_F130108_0_0|SrvcGrp|15369|2022|PCT|0.60|99|0.00|LABORATORY
20|FH_F130108_0_0|SrvcGrp|16|2022|PDM|800.00|99|0.00|ACUTE REHABILITATION
20|FH_F130108_0_0|SrvcGrp|18197|2022|PCT|0.75|99|0.00|MS DRG 025
20|FH_F130108_0_0|SrvcGrp|30623|2022|PDM|3975.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788
20|FH_F130108_0_0|SrvcGrp|361|2022|PDM|900.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F130108_0_0|SrvcGrp|48950|2022|PCT|0.60|99|0.00|RADIOLOGY (WITHOUT MRI AND CT SCANS)
20|FH_F130108_0_0|SrvcGrp|941|2022|PDM|1300.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F130112_0_0|CSTM-ALL|CSTM-00|2020|PDM|1485.00|99|0.00|AEG 3 (NO REV)
20|FH_F130112_0_0|CSTM-ALL|CSTM-00|2020|PDM|849.00|99|0.00|AEG 2 (NO REV)
20|FH_F130146_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F130182_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F130182_0_0|CSTM-ALL|CSTM-00|2020|PDM|1569.00|99|0.00|AEG 9 (NO REV)
20|FH_F130182_0_0|CSTM-ALL|CSTM-00|2020|PDM|674.00|99|0.00|AEG 2 (NO REV)
20|FH_F130182_0_0|SrvcGrp|104921|2022|PDM|104.00|99|0.00|HEART FLOW RESERVE MEASURE-CONCUR
20|FH_F130182_0_0|SrvcGrp|109447|2022|PDM|1457.00|99|0.00|CORONARY ARTERY ANGIO S&I
20|FH_F130182_0_0|SrvcGrp|109450|2022|PDM|1457.00|99|0.00|R HRT ART/GRFT ANGIO
20|FH_F130182_0_0|SrvcGrp|111516|2022|PDM|79.00|99|0.00|INJECT SUPRVLV AORTOGRAPHY
20|FH_F130182_0_0|SrvcGrp|111519|2022|PDM|364.00|99|0.00|STAB PHLEBECT VV 1 EXT; >20
20|FH_F130182_0_0|SrvcGrp|27261|2022|PDM|8323.00|99|0.00|CPT 27446
20|FH_F130182_0_0|SrvcGrp|88156|2022|PDM|8323.00|99|0.00|REVISION OF KNEE JOINT
20|FH_F130302_0_0|SrvcGrp|72990|2022|PDM|1008.00|99|0.00|AEG 1
20|FH_F130302_0_0|SrvcGrp|72994|2022|PDM|1423.00|99|0.00|AEG 3
20|FH_F130302_0_0|SrvcGrp|72996|2022|PDM|1624.00|99|0.00|AEG 4
20|FH_F130302_0_0|SrvcGrp|72998|2022|PDM|1892.00|99|0.00|AEG 5
20|FH_F130302_0_0|SrvcGrp|73000|2022|PDM|2251.00|99|0.00|AEG 6
20|FH_F130302_0_0|SrvcGrp|73006|2022|PDM|1008.00|99|0.00|AEG 9
20|FH_F130302_0_0|SrvcGrp|83379|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH INCIDENTAL CODES
20|FH_F130317_0_0|SrvcGrp|69441|2022|PDM|308.42|99|0.00|CLINIC VISIT
20|FH_F130328_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F130328_0_0|SrvcGrp|80918|2022|PDM|198.00|99|0.00|RESPITE CARE
20|FH_F130328_0_0|SrvcGrp|94780|2022|PDM|176.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)
20|FH_F130330_0_0|SrvcGrp|87077|2022|PDM|114.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F130331_0_0|SrvcGrp|57966|2022|PDM|550.00|99|0.00|HOSPICE CARE
20|FH_F130331_0_0|SrvcGrp|57967|2022|PDM|140.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F130350_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F130350_0_0|CSTM-ALL|CSTM-00|2020|PDM|1056.00|99|0.00|AEG 5  (NO REV)
20|FH_F130350_0_0|CSTM-ALL|CSTM-00|2020|PDM|640.00|99|0.00|AEG 2 (NO REV)
20|FH_F130350_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F130371_0_0|SrvcGrp|74584|2022|PCT|0.92|99|0.00|AETNA OBSERVATION SERVICES
20|FH_F130371_0_0|SrvcGrp|75506|2022|PCT|0.92|99|0.00|VASCULAR DIAGNOSTIC STUDIES
20|FH_F130371_0_0|SrvcGrp|90882|2022|PCT|0.92|99|0.00|AETNA CARDIAC CATHETERIZATION
20|FH_F130468_0_0|CSTM-ALL|CSTM-00|2020|PDM|2141.40|99|0.00|AEG 5  (NO REV)
20|FH_F130468_0_0|CSTM-ALL|CSTM-00|2020|PDM|2395.70|99|0.00|AEG 10 (NO REV)
20|FH_F130468_0_0|SrvcGrp|11663|2022|PCT|1.15|99|0.00|IMPLANTS
20|FH_F130468_0_0|SrvcGrp|65350|2022|PDM|2847.40|99|0.00|KNEE ARTHRO/ANTER
20|FH_F130468_0_0|SrvcGrp|78403|2022|PDM|0.25|99|0.00|AETNA MED RECORD
20|FH_F130468_0_0|SrvcGrp|88218|2022|PDM|6500.10|99|0.00|LOW BACK DISK SURGERY
20|FH_F130468_0_0|SrvcGrp|92360|2022|PDM|10503.00|99|0.00|REMOVAL OF HIP PROSTHESIS
20|FH_F130468_0_0|SrvcGrp|97732|2022|PDM|9919.40|99|0.00|TREAT THIGH FRACTURE 1
20|FH_F130501_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F130654_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|HOSPITAL OP DIALYSIS
20|FH_F130654_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OBSERVATION SERVICES
20|FH_F130676_0_0|SrvcGrp|79720|2022|PDM|1575.00|99|0.00|ACUTE REHAB II
20|FH_F130676_0_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE
20|FH_F130676_0_0|SrvcGrp|87537|2022|PCT|0.00|99|0.00|MED REHAB DAY PROGRAM (FULL)
20|FH_F130682_0_0|CSTM-ALL|CSTM-00|2020|PDM|1044.00|99|0.00|AEG 4 (NO REV)
20|FH_F130682_0_0|CSTM-ALL|CSTM-00|2020|PDM|1188.00|99|0.00|AEG 10 (NO REV)
20|FH_F130682_0_0|CSTM-ALL|CSTM-00|2020|PDM|1370.00|99|0.00|AEG 6 (NO REV)
20|FH_F130682_0_0|SrvcGrp|106265|2022|PDM|9207.00|99|0.00|NSL/SINS NDSC TOTAL
20|FH_F130682_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F130682_0_0|SrvcGrp|59840|2022|PDM|2900.00|99|0.00|TYMPANOSTOMY
20|FH_F130682_0_0|SrvcGrp|65625|2022|PDM|4980.00|99|0.00|CPT 30520
20|FH_F130682_0_0|SrvcGrp|99174|2022|PDM|4980.00|99|0.00|CPT 30140
20|FH_F130707_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37104_0_0|CSTM-ALL|CSTM-00|2020|PDM|1137.00|99|0.00|ASPG VIII
20|FH_F37104_0_0|CSTM-ALL|CSTM-00|2020|PDM|50.00|99|0.00|INTRAOCULAR LENS
20|FH_F37117_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|MRI
20|FH_F37146_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F37152_0_0|SrvcGrp|80|2022|PDM|1500.00|99|0.00|ACUTE PSYCH
20|FH_F37155_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37155_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F37173_0_0|SrvcGrp|23387|2022|PDM|70.00|99|0.00|PT/OT/ST
20|FH_F37174_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS
20|FH_F37181_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.87|99|0.00|OP SVCS
20|FH_F37185_0_0|CSTM-ALL|CSTM-00|2020|PDM|48.00|99|0.00|OP SVCS
20|FH_F37194_0_0|CSTM-ALL|CSTM-00|2020|PDM|125.00|99|0.00|OP SVCS
20|FH_F37198_0_0|SrvcGrp|3029|2022|PCT|0.75|99|0.00|NEWBORN NURSERY
20|FH_F37198_0_0|SrvcGrp|31793|2022|PCT|0.75|99|0.00|PACEMAKER IMPLANT
20|FH_F37215_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F37227_0_0|CSTM-ALL|CSTM-00|2020|PDM|385.00|99|0.00|ASPG I
20|FH_F37230_0_0|SrvcGrp|15391|2022|PDM|117.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F37230_0_0|SrvcGrp|15392|2022|PDM|117.00|99|0.00|PHYSICAL THERAPY
20|FH_F37257_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|BURN SVCS
20|FH_F37267_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE
20|FH_F37267_0_0|SrvcGrp|10410|2022|PDM|42.25|99|0.00|SKILLED NURSING CARE
20|FH_F37267_0_0|SrvcGrp|12263|2022|PDM|17.50|99|0.00|HOME HEALTH AIDE- HOURLY
20|FH_F37267_0_0|SrvcGrp|12401|2022|PDM|85.50|99|0.00|RN VISIT
20|FH_F37267_0_0|SrvcGrp|12856|2022|PDM|42.25|99|0.00|NURSING CARE
20|FH_F37267_0_0|SrvcGrp|9828|2022|PDM|36.00|99|0.00|HOME HEALTH AIDE
20|FH_F37285_0_0|CSTM-ALL|CSTM-00|2020|PDM|1490.00|99|0.00|AEG 8 (NO REV)
20|FH_F37292_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F37292_0_0|SrvcGrp|3259|2022|PDM|1629.00|99|0.00|ACUTE REHABILITATION
20|FH_F37294_0_0|CSTM-ALL|CSTM-00|2020|PDM|1391.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F37294_0_0|SrvcGrp|108|2022|PCT|0.80|99|0.00|EXTRA CORPOREAL MEMBRANE OXYGEN
20|FH_F37294_0_0|SrvcGrp|23|2022|PCT|0.80|99|0.00|BONE MARROW TRANSPLANT
20|FH_F37294_0_0|SrvcGrp|72|2022|PDM|562.00|99|0.00|NEWBORN NURSERY
20|FH_F37361_0_0|SrvcGrp|9828|2022|PDM|40.70|99|0.00|HOME HEALTH AIDE
20|FH_F37361_0_0|SrvcGrp|9829|2022|PDM|88.00|99|0.00|PT SVCS
20|FH_F37361_0_0|SrvcGrp|9830|2022|PDM|88.00|99|0.00|OT SVCS
20|FH_F37364_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|MULTIPLE BIRTH
20|FH_F37364_0_0|SrvcGrp|26177|2022|PCT|0.85|99|0.00|BONE MARROW TRANSPLANT
20|FH_F37366_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F37385_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.97|99|0.00|OP SVCS
20|FH_F37385_0_0|SrvcGrp|15391|2022|PDM|125.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F37394_0_0|SrvcGrp|472|2022|PDM|800.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F37404_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F37422_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37422_0_0|SrvcGrp|472|2022|PDM|320.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F37422_0_0|SrvcGrp|474|2022|PDM|190.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F37433_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37433_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F37440_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F37440_0_0|CSTM-ALL|CSTM-00|2020|PDM|875.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37440_0_0|SrvcGrp|115|2022|PDM|315.00|99|0.00|SKILLED NURSING CARE
20|FH_F37443_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F37443_0_0|CSTM-ALL|CSTM-00|2020|PDM|1559.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37443_0_0|CSTM-ALL|CSTM-00|2020|PDM|4500.00|99|0.00|NORMAL DELIVERY
20|FH_F37443_0_0|SrvcGrp|109|2022|PDM|910.00|99|0.00|CD - DETOX
20|FH_F37443_0_0|SrvcGrp|360|2022|PDM|2100.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F37444_0_0|SrvcGrp|15145|2022|PCT|0.70|99|0.00|DIALYSIS
20|FH_F37444_0_0|SrvcGrp|16616|2022|PCT|0.72|99|0.00|HOME HEALTH AIDE
20|FH_F37444_0_0|SrvcGrp|9861|2022|PCT|0.70|99|0.00|ACUTE REHABILITATION
20|FH_F37468_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37468_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F37478_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F37487_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F37487_0_0|SrvcGrp|16616|2022|PDM|27.00|99|0.00|HOME HEALTH AIDE
20|FH_F37487_0_0|SrvcGrp|16620|2022|PDM|80.00|99|0.00|PT SVCS
20|FH_F37487_0_0|SrvcGrp|9934|2022|PDM|1100.00|99|0.00|GENERAL ACUTE CARE W/VENTILATOR SVCS
20|FH_F37490_0_0|CSTM-ALL|CSTM-00|2020|PDM|741.17|99|0.00|ASPG X
20|FH_F37490_0_0|CSTM-ALL|CSTM-00|2020|PDM|75.00|99|0.00|RADIOLOGY - SPINE
20|FH_F37490_0_0|SrvcGrp|26431|2022|PDM|4750.00|99|0.00|OP SURGICAL SERVICES
20|FH_F37491_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F37491_0_0|SrvcGrp|3577|2022|PDM|340.00|99|0.00|PARTIAL HOSPITALIZATION
20|FH_F37493_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F37493_0_0|CSTM-ALL|CSTM-00|2020|PDM|2099.00|99|0.00|ACUTE IP MED SVCS
20|FH_F37493_0_0|SrvcGrp|8950|2022|PDM|3602.00|99|0.00|INTERMEDIATE ICU/CCU
20|FH_F37493_0_0|SrvcGrp|8968|2022|PDM|2536.00|99|0.00|NICU LEVEL III & IV
20|FH_F37494_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F37494_0_0|CSTM-ALL|CSTM-00|2020|PDM|1368.48|99|0.00|ASPG X
20|FH_F37494_0_0|CSTM-ALL|CSTM-00|2020|PDM|2555.50|99|0.00|ASPG IX
20|FH_F37545_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37554_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|MRI W/CONTRAST
20|FH_F37569_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37569_0_0|CSTM-ALL|CSTM-00|2020|PDM|35.00|99|0.00|BAYRHOD/WINRHOSDF/RHO D IMMUNE GLOB
20|FH_F37573_0_0|SrvcGrp|3066|2022|PCT|0.83|99|0.00|HIGH-COST DRUGS
20|FH_F37573_0_0|SrvcGrp|9858|2022|PDM|407.00|99|0.00|SKILLED NURSING CARE
20|FH_F37590_0_0|SrvcGrp|12401|2022|PDM|84.00|99|0.00|RN VISIT
20|FH_F37590_0_0|SrvcGrp|8962|2022|PDM|84.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F37611_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F37611_0_0|SrvcGrp|472|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F37639_0_0|CSTM-ALL|CSTM-00|2020|PDM|1030.14|99|0.00|ASPG VI
20|FH_F37639_0_0|CSTM-ALL|CSTM-00|2020|PDM|1240.28|99|0.00|ASPG VII
20|FH_F37639_0_0|CSTM-ALL|CSTM-00|2020|PDM|415.09|99|0.00|ASPG I
20|FH_F37639_0_0|CSTM-ALL|CSTM-00|2020|PDM|893.75|99|0.00|ASPG V
20|FH_F37659_0_0|CSTM-ALL|CSTM-00|2020|PDM|1547.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37659_0_0|SrvcGrp|14088|2022|PDM|600.00|99|0.00|ELECTRO CONVULSIVE THERAPY
20|FH_F37659_0_0|SrvcGrp|26987|2022|PDM|54901.00|99|0.00|BMT AUTOLOGOUS TRANSPLANT
20|FH_F37659_0_0|SrvcGrp|65|2022|PDM|1756.00|99|0.00|OBSTETRICAL CARE
20|FH_F37659_0_0|SrvcGrp|89|2022|PDM|131763.00|99|0.00|LIVER TRANSPLANT
20|FH_F37659_0_0|SrvcGrp|8950|2022|PDM|2305.00|99|0.00|INTERMEDIATE ICU/CCU
20|FH_F37667_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37679_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F37679_0_0|SrvcGrp|10579|2022|PDM|35.00|99|0.00|HYDRATION THERAPY - 2 LITERS
20|FH_F37679_0_0|SrvcGrp|14948|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY
20|FH_F37679_0_0|SrvcGrp|17001|2022|PDM|110.00|99|0.00|TOTAL PARENTERAL NUTRITION; ONE LITER PER DAY
20|FH_F37679_0_0|SrvcGrp|17004|2022|PDM|61.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 24HRS
20|FH_F37679_0_0|SrvcGrp|17008|2022|PDM|61.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 4HRS
20|FH_F37679_0_0|SrvcGrp|17013|2022|PDM|61.00|99|0.00|HOME INFUSION THERAPY
20|FH_F37679_0_0|SrvcGrp|17302|2022|PDM|39.00|99|0.00|HYDRATION THERAPY - 3+ LITERS
20|FH_F37679_0_0|SrvcGrp|20480|2022|PDM|61.00|99|0.00|HOME INFUSION THERAPY
20|FH_F37679_0_0|SrvcGrp|21920|2022|PDM|61.00|99|0.00|UNCLASSIFIED INFUSION THERAPY
20|FH_F37679_0_0|SrvcGrp|24748|2022|PDM|61.00|99|0.00|CORTICOSTEROID THERAPY
20|FH_F37679_0_0|SrvcGrp|24754|2022|PDM|15.00|99|0.00|INTERFERON INJECTION THERAPY
20|FH_F37679_0_0|SrvcGrp|26844|2022|PDM|15.25|99|0.00|CONTINUOUS ANTICOAGULANT THERAPY (MOD SJ)
20|FH_F37679_0_0|SrvcGrp|26855|2022|PDM|30.50|99|0.00|HOME INFUSION THERAPY (MOD SH)
20|FH_F37679_0_0|SrvcGrp|26856|2022|PDM|15.25|99|0.00|HOME INFUSION THERAPY (MOD SJ)
20|FH_F37679_0_0|SrvcGrp|26858|2022|PDM|15.25|99|0.00|HOME INFUSION THERAPY (MOD SJ)
20|FH_F37679_0_0|SrvcGrp|26859|2022|PDM|30.50|99|0.00|DIURETIC IV THERAPY (MOD SH)
20|FH_F37679_0_0|SrvcGrp|26863|2022|PDM|30.50|99|0.00|MISC INFUSION THERAPY (MOD SH)
20|FH_F37679_0_0|SrvcGrp|27036|2022|PDM|55.00|99|0.00|TOTAL PARENTERAL NUTRITION; LESS THAN 2 LITERS(MOD SH)
20|FH_F37679_0_0|SrvcGrp|27040|2022|PDM|55.00|99|0.00|TOTAL PARENTERAL NUTRITION;MORE THAN 3 LITERS (MOD SH)
20|FH_F37679_0_0|SrvcGrp|27045|2022|PDM|15.25|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 12HRS (MOD SJ)
20|FH_F37679_0_0|SrvcGrp|27050|2022|PDM|30.50|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 4HRS(MOD SH)
20|FH_F37679_0_0|SrvcGrp|27051|2022|PDM|15.25|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 4HRS (MOD SJ)
20|FH_F37679_0_0|SrvcGrp|27054|2022|PDM|16.75|99|0.00|HYDRATION THERAPY - 1 LITER (MOD SH)
20|FH_F37679_0_0|SrvcGrp|27056|2022|PDM|17.50|99|0.00|HYDRATION THERAPY - 2 LITERS (MOD SH)
20|FH_F37679_0_0|SrvcGrp|27058|2022|PDM|18.75|99|0.00|HYDRATION THERAPY - 3 LITERS (MOD SH)
20|FH_F37679_0_0|SrvcGrp|27059|2022|PDM|9.38|99|0.00|HYDRATION THERAPY - 3 LITERS (MOD SJ)
20|FH_F37679_0_0|SrvcGrp|27060|2022|PDM|19.50|99|0.00|HYDRATION THERAPY - 3+ LITERS (MOD SH)
20|FH_F37679_0_0|SrvcGrp|27063|2022|PDM|15.25|99|0.00|HOME INFUSION THERAPY
20|FH_F37679_0_0|SrvcGrp|27065|2022|PDM|15.25|99|0.00|CHEMOTHERAPY (MOD SJ)
20|FH_F37679_0_0|SrvcGrp|27069|2022|PDM|15.25|99|0.00|PAIN MANAGAMENT - INTERMITTENT (MOD SJ)
20|FH_F37679_0_0|SrvcGrp|27077|2022|PDM|20.00|99|0.00|HOME INFUSION (MOD SJ)
20|FH_F37679_0_0|SrvcGrp|27078|2022|PDM|50.00|99|0.00|PICC LINE INSERT
20|FH_F37679_0_0|SrvcGrp|27079|2022|PDM|25.00|99|0.00|PICC LINE INSERT
20|FH_F37679_0_0|SrvcGrp|27126|2022|PDM|7.50|99|0.00|ANTI-EMETICS INJECTION THERAPY (MOD SH)
20|FH_F37679_0_0|SrvcGrp|27127|2022|PDM|3.75|99|0.00|ANTI-EMETICS INJECTION THERAPY (MOD SJ)
20|FH_F37679_0_0|SrvcGrp|27131|2022|PDM|3.75|99|0.00|HORMONE INJECTION THERAPY (MOD SJ)
20|FH_F37679_0_0|SrvcGrp|27133|2022|PDM|3.75|99|0.00|GROWTH HORMONE (MOD SJ)
20|FH_F37679_0_0|SrvcGrp|27141|2022|PDM|3.75|99|0.00|HORMONAL INJECTION THERAPY (MOD SJ)
20|FH_F37679_0_0|SrvcGrp|27142|2022|PDM|7.50|99|0.00|HOME INFUSION THERAPY (MOD SH)
20|FH_F37679_0_0|SrvcGrp|27144|2022|PDM|7.50|99|0.00|HOME INJECTABLE THERAPY (MOD SH)
20|FH_F37679_0_0|SrvcGrp|27145|2022|PDM|3.75|99|0.00|HOME INJECTABLE THERAPY (MOD SJ)
20|FH_F37680_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|OP SVCS
20|FH_F37698_0_0|SrvcGrp|9527|2022|PDM|1200.00|99|0.00|NORMAL DELIVERY
20|FH_F37703_0_0|SrvcGrp|3327|2022|PDM|143.00|99|0.00|HOSPICE SERVICE - IP RESPITE
20|FH_F37703_0_0|SrvcGrp|3810|2022|PDM|135.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F37708_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F37724_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.50|99|0.00|GENERAL ACUTE CARE
20|FH_F37733_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37733_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F37733_0_0|SrvcGrp|27218|2022|PDM|550.00|99|0.00|SKILLED NURSING - LEVEL V
20|FH_F37734_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS
20|FH_F37753_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37753_0_0|CSTM-ALL|CSTM-00|2020|PDM|52.00|99|0.00|THERAPY VISITS
20|FH_F37777_0_0|CSTM-ALL|CSTM-00|2020|PDM|300.00|99|0.00|JOINT REPLACEMENT/ ORTHO / GENERAL DAY TREATMENT
20|FH_F37777_0_0|SrvcGrp|36229|2022|PDM|1050.00|99|0.00|TRAUMA - SPINAL CORD, BRAIN, BURNS, AMPUTEE
20|FH_F37778_0_0|CSTM-ALL|CSTM-00|2020|PDM|1468.00|99|0.00|ASPG VI
20|FH_F37778_0_0|CSTM-ALL|CSTM-00|2020|PDM|1749.00|99|0.00|SHOULDER REPAIR
20|FH_F37778_0_0|CSTM-ALL|CSTM-00|2020|PDM|1884.00|99|0.00|ENDOSCOPY/ARTHOSCOPY
20|FH_F37778_0_0|CSTM-ALL|CSTM-00|2020|PDM|895.00|99|0.00|BUNION CORRECTION
20|FH_F37778_0_0|SrvcGrp|27315|2022|PDM|1749.00|99|0.00|TENDON REPAIR
20|FH_F37804_0_0|SrvcGrp|25155|2022|PDM|50.00|99|0.00|PT/OT/ST
20|FH_F37809_0_0|CSTM-ALL|CSTM-00|2020|PDM|2544.00|99|0.00|ASPG III
20|FH_F37809_0_0|CSTM-ALL|CSTM-00|2020|PDM|3498.00|99|0.00|ASPG VII
20|FH_F37809_0_0|SrvcGrp|68079|2022|PDM|2703.00|99|0.00|UNGROUPED SURGERY
20|FH_F37812_0_0|CSTM-ALL|CSTM-00|2020|PCT|10400.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F37812_0_0|CSTM-ALL|CSTM-00|2020|PCT|22500.00|99|0.00|HI TECH SKILLED NURSING SERVICES
20|FH_F37812_0_0|CSTM-ALL|CSTM-00|2020|PCT|22500.00|99|0.00|SPEECH THERAPY
20|FH_F37847_0_0|SrvcGrp|12401|2022|PDM|93.50|99|0.00|RN VISIT
20|FH_F37847_0_0|SrvcGrp|9829|2022|PDM|93.50|99|0.00|PT SVCS
20|FH_F37850_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|BLOOD PRODUCTS
20|FH_F37850_0_0|CSTM-ALL|CSTM-00|2020|PDM|757.00|99|0.00|ACUTE PSYCH
20|FH_F37850_0_0|SrvcGrp|701|2022|PDM|2163.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F37878_0_0|SrvcGrp|100948|2022|PDM|52.00|99|0.00|HOME HEALTH LPN SERVICE
20|FH_F37878_0_0|SrvcGrp|104433|2022|PDM|100.00|99|0.00|HIGH TECH SPECIALITY NURSE (MOD TG)
20|FH_F37878_0_0|SrvcGrp|10540|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE
20|FH_F37878_0_0|SrvcGrp|10542|2022|PDM|80.00|99|0.00|OCCUPATIONAL THERAPY SVCS
20|FH_F37878_0_0|SrvcGrp|10543|2022|PDM|80.00|99|0.00|SPEECH THERAPY SVCS
20|FH_F37882_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.00|99|0.00|OP SVCS
20|FH_F37897_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37901_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F37904_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS
20|FH_F37909_0_0|SrvcGrp|16748|2022|PDM|70.00|99|0.00|OCCUPATIONAL THERAPY RE-EVAL
20|FH_F37910_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|ACUTE IP MEDICAL SERVICES
20|FH_F37910_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F37934_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37934_0_0|SrvcGrp|3932|2022|PDM|3350.00|99|0.00|LITHOTRIPSY
20|FH_F37937_0_0|CSTM-ALL|CSTM-00|2020|PDM|100.00|99|0.00|SKILLED LPN VISIT
20|FH_F37937_0_0|SrvcGrp|11072|2022|PDM|100.00|99|0.00|SPEECH THERAPY SVCS
20|FH_F37937_0_0|SrvcGrp|11085|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE
20|FH_F37960_0_0|CSTM-ALL|CSTM-00|2020|PDM|1010.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37960_0_0|CSTM-ALL|CSTM-00|2020|PDM|1010.00|99|0.00|MS DRG 765-766 C-SECTION
20|FH_F37963_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37987_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|ASPG X
20|FH_F37987_0_0|CSTM-ALL|CSTM-00|2020|PDM|693.00|99|0.00|ASPG IV
20|FH_F37996_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F38007_0_0|SrvcGrp|27889|2022|PCT|0.95|99|0.00|TRAUMA
20|FH_F38007_0_0|SrvcGrp|361|2022|PDM|3195.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F38007_0_0|SrvcGrp|9114|2022|PDM|3715.00|99|0.00|OTHER INTENSIVE CARE
20|FH_F38016_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F38016_0_0|CSTM-ALL|CSTM-00|2020|PDM|1179.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38016_0_0|SrvcGrp|23348|2022|PDM|3461.00|99|0.00|CV SURGERY MS DRG'S ONLY 216-221, 231-236
20|FH_F38016_0_0|SrvcGrp|361|2022|PDM|784.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F38016_0_0|SrvcGrp|72|2022|PDM|324.00|99|0.00|NEWBORN NURSERY
20|FH_F38034_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP ELECTROPHYSIOLOGY + ANGIO
20|FH_F38034_0_0|CSTM-ALL|CSTM-00|2020|PDM|4171.00|99|0.00|MS DRG 216-221, 231-234 CV SURGERY
20|FH_F38034_0_0|SrvcGrp|24|2022|PDM|4171.00|99|0.00|CARDIAC CATH
20|FH_F38034_0_0|SrvcGrp|28271|2022|PCT|0.60|99|0.00|IMPLANTS
20|FH_F38034_0_0|SrvcGrp|3418|2022|PDM|3634.00|99|0.00|NEONATAL INTENSIVE CARE UNIT
20|FH_F38034_0_0|SrvcGrp|409|2022|PCT|0.85|99|0.00|ER SVCS
20|FH_F38034_0_0|SrvcGrp|705|2022|PCT|0.60|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F38037_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38039_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F38047_0_0|SrvcGrp|115|2022|PDM|313.00|99|0.00|SKILLED NURSING CARE
20|FH_F38047_0_0|SrvcGrp|72|2022|PDM|277.00|99|0.00|NEWBORN NURSERY
20|FH_F38051_0_0|CSTM-ALL|CSTM-00|2020|PDM|125.00|99|0.00|CD DAY TREATMENT
20|FH_F38061_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38061_0_0|CSTM-ALL|CSTM-00|2020|PDM|1632.00|99|0.00|ASPG IX
20|FH_F38061_0_0|CSTM-ALL|CSTM-00|2020|PDM|543.40|99|0.00|ASPG II
20|FH_F38061_0_0|CSTM-ALL|CSTM-00|2020|PDM|594.00|99|0.00|ASPG III
20|FH_F38069_0_0|SrvcGrp|27726|2022|PCT|0.87|99|0.00|OP SURGERY
20|FH_F38076_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38076_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F38080_0_0|CSTM-ALL|CSTM-00|2020|PDM|1150.00|99|0.00|AEG 4 (NO REV)
20|FH_F38080_0_0|CSTM-ALL|CSTM-00|2020|PDM|1340.00|99|0.00|AEG 5  (NO REV)
20|FH_F38080_0_0|CSTM-ALL|CSTM-00|2020|PDM|1525.00|99|0.00|AEG 6 (NO REV)
20|FH_F38080_0_0|CSTM-ALL|CSTM-00|2020|PDM|2330.00|99|0.00|AEG 9 (NO REV)
20|FH_F38080_0_0|CSTM-ALL|CSTM-00|2020|PDM|770.00|99|0.00|AEG 1 (NO REV)
20|FH_F38080_0_0|CSTM-ALL|CSTM-00|2020|PDM|890.00|99|0.00|AEG 3 (NO REV)
20|FH_F38081_0_0|SrvcGrp|13133|2022|PDM|46.00|99|0.00|PT/OT/ST
20|FH_F38081_0_0|SrvcGrp|472|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F38081_0_0|SrvcGrp|473|2022|PDM|375.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F38089_0_0|CSTM-ALL|CSTM-00|2020|PDM|709.00|99|0.00|ADOLESCENT PSYCHIATRIC
20|FH_F38089_0_0|CSTM-ALL|CSTM-00|2020|PDM|7797.00|99|0.00|HYSTERECTOMY SERVICES
20|FH_F38089_0_0|CSTM-ALL|CSTM-00|2020|PDM|9639.00|99|0.00|MSDRG 246-251 ANGIOPLASTY
20|FH_F38089_0_0|SrvcGrp|97|2022|PDM|4962.00|99|0.00|C-SECTION
20|FH_F38090_0_0|CSTM-ALL|CSTM-00|2020|PDM|624.00|99|0.00|ACUTE PSYCH
20|FH_F38090_0_0|SrvcGrp|38|2022|PDM|3477.00|99|0.00|NORMAL DELIVERY
20|FH_F38090_0_0|SrvcGrp|63|2022|PDM|624.00|99|0.00|SUBACUTE CARE
20|FH_F38090_0_0|SrvcGrp|701|2022|PDM|2105.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F38135_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|CV SURGERY MS DRG 216-218, 231-234
20|FH_F38135_0_0|CSTM-ALL|CSTM-00|2020|PDM|1323.00|99|0.00|ACUTE ADULT MEDICAL SVCS
20|FH_F38151_0_0|CSTM-ALL|CSTM-00|2020|PDM|1315.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38151_0_0|SrvcGrp|28277|2022|PCT|0.85|99|0.00|AZT / TPA / PENTAMIDINE
20|FH_F38151_0_0|SrvcGrp|290|2022|PCT|0.85|99|0.00|IP LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F38151_0_0|SrvcGrp|38|2022|PDM|2704.00|99|0.00|NORMAL DELIVERY
20|FH_F38159_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38159_0_0|CSTM-ALL|CSTM-00|2020|PDM|1057.22|99|0.00|YORK END CTR HAPA EAST ASPG VIII
20|FH_F38159_0_0|CSTM-ALL|CSTM-00|2020|PDM|1070.00|99|0.00|YORK END CTR HAPA EAST ASPG VII
20|FH_F38159_0_0|CSTM-ALL|CSTM-00|2020|PDM|479.18|99|0.00|YORK END CTR HAPA EAST ASPG II
20|FH_F38159_0_0|CSTM-ALL|CSTM-00|2020|PDM|71.50|99|0.00|NOMINAL FEE CODES/OFC BASED PROC
20|FH_F38159_0_0|CSTM-ALL|CSTM-00|2020|PDM|770.09|99|0.00|YORK END CTR HAPA EAST ASPG V
20|FH_F38172_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38218_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38221_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.83|99|0.00|GENERAL ACUTE CARE
20|FH_F38227_0_0|SrvcGrp|44819|2022|PDM|70.00|99|0.00|SPEECH THERAPY
20|FH_F38249_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F38249_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|TAMPA GENERAL HOSP MSDRG @ 70%
20|FH_F38249_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F38249_0_0|SrvcGrp|34168|2022|PCT|0.95|99|0.00|BURN SERVICES MS DRG
20|FH_F38249_0_0|SrvcGrp|4109|2022|PDM|500.00|99|0.00|ACUTE PSYCH
20|FH_F38250_0_0|CSTM-ALL|CSTM-00|2020|PDM|592.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38288_0_0|CSTM-ALL|CSTM-00|2020|PDM|366.00|99|0.00|ASPG I
20|FH_F38288_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|ASPG III
20|FH_F38288_0_0|CSTM-ALL|CSTM-00|2020|PDM|693.00|99|0.00|ASPG IV
20|FH_F38289_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38289_0_0|SrvcGrp|58755|2022|PDM|5270.78|99|0.00|INJECTION PROC FOR JOINT
20|FH_F38332_0_0|CSTM-ALL|CSTM-00|2020|PDM|12064.00|99|0.00|MS DRG 248
20|FH_F38332_0_0|CSTM-ALL|CSTM-00|2020|PDM|12064.00|99|0.00|MS DRG 249
20|FH_F38332_0_0|CSTM-ALL|CSTM-00|2020|PDM|12064.00|99|0.00|MS DRG 255
20|FH_F38332_0_0|CSTM-ALL|CSTM-00|2020|PDM|12064.00|99|0.00|MS DRG 256
20|FH_F38332_0_0|CSTM-ALL|CSTM-00|2020|PDM|12064.00|99|0.00|MS DRG 257
20|FH_F38332_0_0|CSTM-ALL|CSTM-00|2020|PDM|42216.00|99|0.00|MS DRG 216
20|FH_F38332_0_0|CSTM-ALL|CSTM-00|2020|PDM|42216.00|99|0.00|MS DRG 217
20|FH_F38332_0_0|CSTM-ALL|CSTM-00|2020|PDM|42216.00|99|0.00|MS DRG 218
20|FH_F38332_0_0|CSTM-ALL|CSTM-00|2020|PDM|42216.00|99|0.00|MS DRG 219
20|FH_F38332_0_0|CSTM-ALL|CSTM-00|2020|PDM|42216.00|99|0.00|MS DRG 220
20|FH_F38332_0_0|CSTM-ALL|CSTM-00|2020|PDM|42216.00|99|0.00|MS DRG 230
20|FH_F38332_0_0|SrvcGrp|88|2022|PDM|6032.00|99|0.00|OP LITHOTRIPSY
20|FH_F38349_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.65|99|0.00|GENERAL ACUTE CARE
20|FH_F38363_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38364_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F38371_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38376_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F38376_0_0|SrvcGrp|1168|2022|PDM|25.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F38387_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38389_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38410_0_0|CSTM-ALL|CSTM-00|2020|PDM|102.00|99|0.00|SKILLED NURSING
20|FH_F38410_0_0|SrvcGrp|10407|2022|PDM|55.00|99|0.00|HOME INFUSION
20|FH_F38410_0_0|SrvcGrp|10545|2022|PDM|115.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F38410_0_0|SrvcGrp|11798|2022|PDM|112.00|99|0.00|HOME INFUSION NURSING SVCS
20|FH_F38410_0_0|SrvcGrp|27968|2022|PDM|41.00|99|0.00|SKILLED NURSING LPN
20|FH_F38411_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 918
20|FH_F38411_0_0|CSTM-ALL|CSTM-00|2020|PDM|1799.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38411_0_0|SrvcGrp|20071|2022|PDM|950.00|99|0.00|MS DRG 945-946
20|FH_F38411_0_0|SrvcGrp|20908|2022|PCT|0.80|99|0.00|MS DRG 247 ONLY
20|FH_F38411_0_0|SrvcGrp|360|2022|PDM|900.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F38411_0_0|SrvcGrp|941|2022|PDM|3450.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F38417_0_0|CSTM-ALL|CSTM-00|2020|PDM|366.00|99|0.00|ASPG I
20|FH_F38420_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS
20|FH_F38425_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F38425_0_0|SrvcGrp|10407|2022|PDM|55.00|99|0.00|HOME INFUSION
20|FH_F38425_0_0|SrvcGrp|10540|2022|PDM|22.00|99|0.00|HOME HEALTH AIDE
20|FH_F38438_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS
20|FH_F38450_0_0|SrvcGrp|473|2022|PDM|375.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F38450_0_0|SrvcGrp|474|2022|PDM|325.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F38473_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38473_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F38473_0_0|SrvcGrp|10540|2022|PDM|22.00|99|0.00|HOME HEALTH AIDE
20|FH_F38473_0_0|SrvcGrp|22387|2022|PDM|50.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F38473_0_0|SrvcGrp|27968|2022|PDM|41.00|99|0.00|SKILLED NURSING LPN
20|FH_F38475_0_0|CSTM-ALL|CSTM-00|2020|PDM|102.00|99|0.00|SKILLED NURSING
20|FH_F38475_0_0|CSTM-ALL|CSTM-00|2020|PDM|45.00|99|0.00|LPN HI TECH - HOURLY
20|FH_F38475_0_0|SrvcGrp|10545|2022|PDM|115.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F38475_0_0|SrvcGrp|10615|2022|PDM|120.00|99|0.00|HOME HEALTH AIDE
20|FH_F38475_0_0|SrvcGrp|10624|2022|PDM|68.00|99|0.00|CPT CODE 99347
20|FH_F38475_0_0|SrvcGrp|11798|2022|PDM|112.00|99|0.00|HOME INFUSION NURSING SVCS
20|FH_F38475_0_0|SrvcGrp|22387|2022|PDM|50.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F38476_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38476_0_0|CSTM-ALL|CSTM-00|2020|PDM|102.00|99|0.00|SKILLED NURSING
20|FH_F38476_0_0|SrvcGrp|10542|2022|PDM|110.00|99|0.00|OCCUPATIONAL THERAPY SVCS
20|FH_F38476_0_0|SrvcGrp|10615|2022|PDM|120.00|99|0.00|HOME HEALTH AIDE
20|FH_F38488_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F38526_0_0|CSTM-ALL|CSTM-00|2020|PDM|1770.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F38526_0_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|ACUTE IP SVCS ONE DAY STAY
20|FH_F38526_0_0|SrvcGrp|115|2022|PDM|755.00|99|0.00|SKILLED NURSING CARE
20|FH_F38526_0_0|SrvcGrp|12969|2022|PDM|619.00|99|0.00|NEWBORN NURSERY
20|FH_F38526_0_0|SrvcGrp|13482|2022|PDM|2040.00|99|0.00|INTERMEDIATE CARDIAC CARE UNIT
20|FH_F38526_0_0|SrvcGrp|23958|2022|PCT|0.65|99|0.00|PHARMACY
20|FH_F38526_0_0|SrvcGrp|38|2022|PDM|2100.00|99|0.00|NORMAL DELIVERY
20|FH_F38526_0_0|SrvcGrp|59813|2022|PDM|3500.00|99|0.00|PEDIATRIC ONE DAY STAY
20|FH_F38526_0_0|SrvcGrp|701|2022|PDM|2400.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F38526_0_0|SrvcGrp|97|2022|PDM|2100.00|99|0.00|C-SECTION
20|FH_F38560_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|PACEMKR/PROSTHETIC/ORTHOTIC/IMPLANT/DME
20|FH_F38560_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 927-929, 933-935 BURN SERVICES
20|FH_F38560_0_0|SrvcGrp|13551|2022|PDM|350.00|99|0.00|NEWBORN NURSERY
20|FH_F38560_0_0|SrvcGrp|24|2022|PDM|1800.00|99|0.00|CARDIAC CATH
20|FH_F38560_0_0|SrvcGrp|29498|2022|PDM|2500.00|99|0.00|ICU
20|FH_F38560_0_0|SrvcGrp|29524|2022|PDM|4500.00|99|0.00|ADULT PACEMAKER
20|FH_F38584_0_0|SrvcGrp|17065|2022|PDM|535.00|99|0.00|ASPG I
20|FH_F38584_0_0|SrvcGrp|17069|2022|PDM|822.00|99|0.00|ASPG III
20|FH_F38584_0_0|SrvcGrp|17083|2022|PDM|822.00|99|0.00|ASPG X
20|FH_F38591_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AMBULATORY SERVICES
20|FH_F38591_0_0|SrvcGrp|12104|2022|PCT|0.70|99|0.00|DRUGS
20|FH_F38591_0_0|SrvcGrp|12837|2022|PCT|0.70|99|0.00|INTRAOCULAR LENSES
20|FH_F38591_0_0|SrvcGrp|13187|2022|PCT|0.70|99|0.00|INTRAOCULAR LENSES
20|FH_F38601_0_0|SrvcGrp|13631|2022|PDM|100.00|99|0.00|CPT 99213
20|FH_F38601_0_0|SrvcGrp|13640|2022|PDM|100.00|99|0.00|CPT 99202
20|FH_F38673_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38676_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F38677_0_0|CSTM-ALL|CSTM-00|2020|PDM|300.00|99|0.00|ULTRAFILTRATION
20|FH_F38677_0_0|SrvcGrp|17378|2022|PDM|135.00|99|0.00|CAPD TRAINING
20|FH_F38677_0_0|SrvcGrp|25688|2022|PDM|300.00|99|0.00|HOME HEMODIALYSIS
20|FH_F38686_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38696_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38696_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 216
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 217
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 218
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 235
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 236
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 237
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 238
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 242
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 243
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 461
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 470
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 471
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 472
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 483
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 484
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|SPINAL FUSION
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.83|99|0.00|OP SVCS
20|FH_F38700_0_0|SrvcGrp|11000|2022|PCT|0.83|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F38700_0_0|SrvcGrp|19108|2022|PCT|0.80|99|0.00|MS DRG 619
20|FH_F38700_0_0|SrvcGrp|65|2022|PDM|2641.00|99|0.00|OBSTETRICAL CARE
20|FH_F38709_0_0|SrvcGrp|24703|2022|PDM|335.00|99|0.00|NEWBORN NURSERY
20|FH_F38709_0_0|SrvcGrp|3987|2022|PCT|0.80|99|0.00|TRAUMA CARE
20|FH_F38718_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38730_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|HOSPICE SERVICES
20|FH_F38780_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38780_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F38790_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.77|99|0.00|MSDRG 246-251 ANGIOPLASTY
20|FH_F38790_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.77|99|0.00|MSDRG 286-287 CARDIAC CATH
20|FH_F38790_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F38790_0_0|CSTM-ALL|CSTM-00|2020|PDM|1177.00|99|0.00|TRANSITIONAL CARE UNIT
20|FH_F38790_0_0|SrvcGrp|3029|2022|PDM|562.00|99|0.00|NEWBORN NURSERY
20|FH_F38790_0_0|SrvcGrp|6|2022|PCT|0.75|99|0.00|OP SURGERY
20|FH_F38804_0_0|CSTM-ALL|CSTM-00|2020|PCT|59.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38804_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|ORTHOTICS/PROSTHETICS/IMPLANTS
20|FH_F38805_0_0|CSTM-ALL|CSTM-00|2020|PDM|300.00|99|0.00|NEWBORN NURSERY
20|FH_F38807_0_0|SrvcGrp|17073|2022|PDM|717.00|99|0.00|ASPG V
20|FH_F38807_0_0|SrvcGrp|17081|2022|PDM|1339.00|99|0.00|ASPG IX
20|FH_F38808_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38808_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|IMPLANTS
20|FH_F38808_0_0|SrvcGrp|17081|2022|PDM|1473.00|99|0.00|ASPG IX
20|FH_F38826_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|ANGIOPLASTY
20|FH_F38826_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|BURN SVCS
20|FH_F38826_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|CHEMICAL DEPENDENCY
20|FH_F38826_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F38826_0_0|SrvcGrp|361|2022|PCT|0.73|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F38826_0_0|SrvcGrp|941|2022|PCT|0.73|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F38838_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38843_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|ACUTE REHABILITATION
20|FH_F38843_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38847_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F38847_0_0|CSTM-ALL|CSTM-00|2020|PDM|1150.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38847_0_0|SrvcGrp|13162|2022|PCT|1.10|99|0.00|HIGH COST DRUGS
20|FH_F38847_0_0|SrvcGrp|13292|2022|PCT|1.10|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F38848_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|ACUTE PSYCH
20|FH_F38848_0_0|SrvcGrp|97|2022|PDM|4500.00|99|0.00|C-SECTION
20|FH_F38860_0_0|SrvcGrp|16777|2022|PCT|1.00|99|0.00|ORGAN ACQUISITION
20|FH_F38865_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|AZT (ZIDOVUDINE)
20|FH_F38865_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|IMPLANTS
20|FH_F38865_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F38865_0_0|SrvcGrp|24|2022|PDM|2800.00|99|0.00|CARDIAC CATH
20|FH_F38865_0_0|SrvcGrp|63|2022|PCT|0.65|99|0.00|SUBACUTE CARE
20|FH_F38865_0_0|SrvcGrp|941|2022|PDM|1860.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F38865_0_0|SrvcGrp|97|2022|PDM|4050.00|99|0.00|C-SECTION
20|FH_F38867_0_0|CSTM-ALL|CSTM-00|2020|PDM|365.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F38867_0_0|SrvcGrp|453|2022|PDM|250.00|99|0.00|PSYCH PARTIAL HOSP
20|FH_F38883_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38889_0_0|SrvcGrp|72|2022|PDM|368.00|99|0.00|NEWBORN NURSERY
20|FH_F38900_0_0|SrvcGrp|997|2022|PCT|0.70|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F38914_0_0|CSTM-ALL|CSTM-00|2020|PDM|1025.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38933_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38945_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38948_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 248-251 PTCA
20|FH_F38948_0_0|CSTM-ALL|CSTM-00|2020|PDM|1398.00|99|0.00|ACUTE IP MED SVCS
20|FH_F38948_0_0|CSTM-ALL|CSTM-00|2020|PDM|1899.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F38948_0_0|CSTM-ALL|CSTM-00|2020|PDM|739.00|99|0.00|ACUTE PSYCH
20|FH_F38948_0_0|CSTM-ALL|CSTM-00|2020|PDM|739.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F38949_0_0|CSTM-ALL|CSTM-00|2020|PDM|1355.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38949_0_0|SrvcGrp|10111|2022|PCT|0.60|99|0.00|IMPLANTS
20|FH_F38949_0_0|SrvcGrp|24|2022|PDM|3614.00|99|0.00|CARDIAC CATH
20|FH_F38949_0_0|SrvcGrp|28227|2022|PDM|8504.00|99|0.00|ANGIOPLASTY
20|FH_F38949_0_0|SrvcGrp|38|2022|PDM|1913.00|99|0.00|NORMAL DELIVERY
20|FH_F38949_0_0|SrvcGrp|97|2022|PDM|3933.00|99|0.00|C-SECTION
20|FH_F38953_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38953_0_0|SrvcGrp|25697|2022|PDM|1200.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F38953_0_0|SrvcGrp|35054|2022|PDM|1300.00|99|0.00|SKILLED NURSING - LEVEL 2
20|FH_F38955_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F38955_0_0|SrvcGrp|177|2022|PDM|3423.44|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F38955_0_0|SrvcGrp|38|2022|PDM|2397.33|99|0.00|NORMAL DELIVERY
20|FH_F38955_0_0|SrvcGrp|72|2022|PDM|628.44|99|0.00|NEWBORN NURSERY
20|FH_F38961_0_0|SrvcGrp|27830|2022|PDM|42.00|99|0.00|THERAPY
20|FH_F38967_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38967_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F38977_0_0|SrvcGrp|3029|2022|PDM|298.00|99|0.00|NEWBORN NURSERY
20|FH_F38982_0_0|CSTM-ALL|CSTM-00|2020|PDM|692.00|99|0.00|ACUTE PSYCH
20|FH_F38982_0_0|SrvcGrp|361|2022|PDM|2391.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F38982_0_0|SrvcGrp|65|2022|PDM|1762.00|99|0.00|OBSTETRICAL CARE
20|FH_F38982_0_0|SrvcGrp|72|2022|PDM|377.00|99|0.00|NEWBORN NURSERY
20|FH_F38982_0_0|SrvcGrp|941|2022|PDM|2391.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F38983_0_0|CSTM-ALL|CSTM-00|2020|PDM|2100.00|99|0.00|PSYCHIATRIC FULL DAY TREATMENT
20|FH_F38983_0_0|CSTM-ALL|CSTM-00|2020|PDM|625.00|99|0.00|ACUTE PSYCH
20|FH_F38984_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38986_0_0|CSTM-ALL|CSTM-00|2020|PDM|1185.00|99|0.00|ACUTE IP MED SVCS
20|FH_F38986_0_0|SrvcGrp|115|2022|PDM|370.00|99|0.00|SKILLED NURSING CARE
20|FH_F38986_0_0|SrvcGrp|12846|2022|PCT|0.60|99|0.00|PHARMACY SVCS
20|FH_F38986_0_0|SrvcGrp|3029|2022|PDM|370.00|99|0.00|NEWBORN NURSERY
20|FH_F38999_0_0|SrvcGrp|361|2022|PDM|2484.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F38999_0_0|SrvcGrp|675|2022|PDM|1573.00|99|0.00|PEDIATRIC INPATIENT SVCS
20|FH_F38999_0_0|SrvcGrp|9533|2022|PDM|1811.00|99|0.00|ONCOLOGY
20|FH_F39018_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|ACUTE PSYCH
20|FH_F39022_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|PSYCHIATRIC EATING DISORDERS
20|FH_F39022_0_0|SrvcGrp|10425|2022|PDM|710.00|99|0.00|NEWBORN NURSERY
20|FH_F39039_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39041_0_0|SrvcGrp|13236|2022|PDM|2736.00|99|0.00|ICU/CCU
20|FH_F39041_0_0|SrvcGrp|30175|2022|PCT|0.75|99|0.00|CV SURGERY (MS DRG)
20|FH_F39041_0_0|SrvcGrp|3029|2022|PDM|806.00|99|0.00|NEWBORN NURSERY
20|FH_F39041_0_0|SrvcGrp|413|2022|PCT|0.75|99|0.00|TRANSPLANT SVCS
20|FH_F39041_0_0|SrvcGrp|453|2022|PDM|461.00|99|0.00|PSYCH PARTIAL HOSP
20|FH_F39053_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39066_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39066_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|ACUTE PSYCH
20|FH_F39066_0_0|SrvcGrp|3132|2022|PCT|0.80|99|0.00|IMPLANTS
20|FH_F39066_0_0|SrvcGrp|360|2022|PDM|1200.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F39066_0_0|SrvcGrp|997|2022|PCT|0.80|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F39080_0_0|SrvcGrp|30061|2022|PDM|6480.00|99|0.00|MULTI-BIRTH C-SECTION
20|FH_F39080_0_0|SrvcGrp|97|2022|PDM|5400.00|99|0.00|C-SECTION
20|FH_F39082_0_0|CSTM-ALL|CSTM-00|2020|PDM|13141.00|99|0.00|MS DRG 460
20|FH_F39082_0_0|CSTM-ALL|CSTM-00|2020|PDM|2147.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39082_0_0|CSTM-ALL|CSTM-00|2020|PDM|28472.00|99|0.00|MS DRG 237
20|FH_F39082_0_0|CSTM-ALL|CSTM-00|2020|PDM|37963.00|99|0.00|MS DRG 216-218
20|FH_F39082_0_0|CSTM-ALL|CSTM-00|2020|PDM|666.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F39082_0_0|SrvcGrp|15|2022|PDM|2147.00|99|0.00|PEDIATRIC INTENSIVE CARE UNIT
20|FH_F39082_0_0|SrvcGrp|359|2022|PDM|460.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL I
20|FH_F39082_0_0|SrvcGrp|360|2022|PDM|2215.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F39085_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F39085_0_0|SrvcGrp|7|2022|PCT|0.85|99|0.00|NEONATAL INTENSIVE
20|FH_F39090_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F39098_0_0|CSTM-ALL|CSTM-00|2020|PDM|578.00|99|0.00|ACUTE PSYCH
20|FH_F39098_0_0|SrvcGrp|22661|2022|PCT|0.75|99|0.00|ANGIOPLASTY
20|FH_F39098_0_0|SrvcGrp|24|2022|PCT|0.75|99|0.00|CARDIAC CATH
20|FH_F39098_0_0|SrvcGrp|701|2022|PDM|1576.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F39101_0_0|SrvcGrp|19661|2022|PDM|49800.00|99|0.00|MS DRG 216-218 ONLY CARDIAC VALVE PROCEDURE W/CARDIAC CATH
20|FH_F39121_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE
20|FH_F39121_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F39138_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|MSDRG 216-218 CARDIAC VALVE PROCEDURE W/CARDIAC CATH OTLR
20|FH_F130723_0_0|CSTM-ALL|CSTM-00|2020|PDM|1298.00|99|0.00|AEG 9 (NO REV)
20|FH_F130723_0_0|CSTM-ALL|CSTM-00|2020|PDM|323.00|99|0.00|AEG 1 (NO REV)
20|FH_F130723_0_0|CSTM-ALL|CSTM-00|2020|PDM|805.00|99|0.00|AEG 6 (NO REV)
20|FH_F130723_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F130723_0_0|SrvcGrp|86505|2022|PDM|1500.00|99|0.00|DENTAL SURGERY
20|FH_F130747_0_0|CSTM-ALL|CSTM-00|2020|PDM|2601.00|99|0.00|AEG 3 (NO REV)
20|FH_F130747_0_0|CSTM-ALL|CSTM-00|2020|PDM|3069.00|99|0.00|AEG 4 (NO REV)
20|FH_F130747_0_0|CSTM-ALL|CSTM-00|2020|PDM|4110.00|99|0.00|AEG 5  (NO REV)
20|FH_F130747_0_0|CSTM-ALL|CSTM-00|2020|PDM|4994.00|99|0.00|AEG 7 (NO REV)
20|FH_F130747_0_0|SrvcGrp|100046|2022|PDM|2601.00|99|0.00|TREAT METATARSAL FRACTURE
20|FH_F130747_0_0|SrvcGrp|103236|2022|PDM|6242.00|99|0.00|AETNA INSJ STABLJ DEV
20|FH_F130747_0_0|SrvcGrp|103328|2022|PDM|6242.00|99|0.00|INSJ STABLJ DEV W/ DCMPRN
20|FH_F130747_0_0|SrvcGrp|103564|2022|PDM|5202.00|99|0.00|REPAIR FINGER TENDON
20|FH_F130747_0_0|SrvcGrp|107361|2022|PDM|26010.00|99|0.00|SECOND LEVEL CER DISKECTOMY
20|FH_F130747_0_0|SrvcGrp|111586|2022|PDM|6763.00|99|0.00|BONE MARROW ASPIR BONE GRFG
20|FH_F130747_0_0|SrvcGrp|111589|2022|PDM|2809.00|99|0.00|REVISE ULNAR NERVE AT WRIST
20|FH_F130747_0_0|SrvcGrp|26273|2022|PDM|5202.00|99|0.00|CPT 29880
20|FH_F130747_0_0|SrvcGrp|26278|2022|PDM|5202.00|99|0.00|CPT 29881
20|FH_F130747_0_0|SrvcGrp|26432|2022|PDM|5202.00|99|0.00|OP SURGICAL SERVICES
20|FH_F130747_0_0|SrvcGrp|35668|2022|PDM|5202.00|99|0.00|CPT 29824
20|FH_F130747_0_0|SrvcGrp|35669|2022|PDM|3849.00|99|0.00|CPT 63650
20|FH_F130747_0_0|SrvcGrp|35670|2022|PDM|36414.00|99|0.00|SPINAL NEUROSTIMULATORS PROCEDURE
20|FH_F130747_0_0|SrvcGrp|54962|2022|PDM|6503.00|99|0.00|RECONSTRUCTION OF SHOULDER CUFF (ROTATOR)
20|FH_F130747_0_0|SrvcGrp|58638|2022|PDM|6763.00|99|0.00|CPT 63688
20|FH_F130747_0_0|SrvcGrp|67068|2022|PDM|36414.00|99|0.00|LUMBAR SPINE FUSION COMBINED
20|FH_F130747_0_0|SrvcGrp|69981|2022|PDM|4682.00|99|0.00|CPT 24358
20|FH_F130747_0_0|SrvcGrp|71666|2022|PDM|17167.00|99|0.00|CPT 63655
20|FH_F130747_0_0|SrvcGrp|76604|2022|PDM|6763.00|99|0.00|CPT 25447
20|FH_F130747_0_0|SrvcGrp|78096|2022|PDM|5202.00|99|0.00|AETNA ARTHROSCOPY BICEPS
20|FH_F130747_0_0|SrvcGrp|80617|2022|PDM|26010.00|99|0.00|ARTHOPLASTY
20|FH_F130747_0_0|SrvcGrp|88820|2022|PDM|4682.00|99|0.00|CPT 24359
20|FH_F130747_0_0|SrvcGrp|89860|2022|PDM|8843.00|99|0.00|SPINAL DISK SURGERY ADD-ON
20|FH_F130747_0_0|SrvcGrp|89861|2022|PDM|8843.00|99|0.00|LUMBAR LAMINOTOMY
20|FH_F130747_0_0|SrvcGrp|90357|2022|PDM|4682.00|99|0.00|REPAIR OF ANKLE FRACTURE
20|FH_F130747_0_0|SrvcGrp|92366|2022|PDM|4682.00|99|0.00|REPAIR ACHILLES TENDON
20|FH_F130747_0_0|SrvcGrp|92819|2022|PDM|5202.00|99|0.00|HIP ARTHOSCOPY
20|FH_F130747_0_0|SrvcGrp|99073|2022|PDM|1.45|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F130751_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F130757_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|GENERAL ACUTE CARE
20|FH_F130763_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F130763_0_0|CSTM-ALL|CSTM-00|2020|PDM|2612.00|99|0.00|AEG 8 (NO REV)
20|FH_F130763_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F130763_0_0|SrvcGrp|106264|2022|PDM|6043.00|99|0.00|NSL/SINS NDSC W/ SINS DILATION
20|FH_F130763_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F130763_0_0|SrvcGrp|11673|2022|PDM|6012.00|99|0.00|CPT 29888
20|FH_F130763_0_0|SrvcGrp|26274|2022|PDM|3450.00|99|0.00|CPT 29877
20|FH_F130763_0_0|SrvcGrp|26275|2022|PDM|3346.00|99|0.00|CPT 29826
20|FH_F130763_0_0|SrvcGrp|26432|2022|PDM|3450.00|99|0.00|OP SURGICAL SERVICES
20|FH_F130763_0_0|SrvcGrp|27261|2022|PDM|15683.00|99|0.00|CPT 27446
20|FH_F130763_0_0|SrvcGrp|27344|2022|PDM|3258.00|99|0.00|OP SURGERY (CPT 42821)
20|FH_F130763_0_0|SrvcGrp|33982|2022|PDM|2927.00|99|0.00|CPT 28296
20|FH_F130763_0_0|SrvcGrp|35668|2022|PDM|4391.00|99|0.00|CPT 29824
20|FH_F130763_0_0|SrvcGrp|35672|2022|PDM|3163.00|99|0.00|CPT 23412
20|FH_F130763_0_0|SrvcGrp|41327|2022|PDM|3346.00|99|0.00|OP SURGERY CPT 28308
20|FH_F130763_0_0|SrvcGrp|47142|2022|PDM|4077.00|99|0.00|CPT 49650
20|FH_F130763_0_0|SrvcGrp|67064|2022|PDM|5823.00|99|0.00|MUSCULOSKELETAL SYSTEM
20|FH_F130763_0_0|SrvcGrp|67065|2022|PDM|15683.00|99|0.00|CERVICAL SURGERY
20|FH_F130763_0_0|SrvcGrp|69964|2022|PDM|2954.00|99|0.00|CPT 23120
20|FH_F130763_0_0|SrvcGrp|70746|2022|PDM|3450.00|99|0.00|CPT 28292
20|FH_F130763_0_0|SrvcGrp|72121|2022|PDM|4705.00|99|0.00|ARTHOSCOPY
20|FH_F130763_0_0|SrvcGrp|78282|2022|PDM|3346.00|99|0.00|CPT 47563
20|FH_F130763_0_0|SrvcGrp|82107|2022|PDM|4391.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F130763_0_0|SrvcGrp|82108|2022|PDM|4391.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F130763_0_0|SrvcGrp|88160|2022|PDM|7319.00|99|0.00|LAMINECTOMY W/FACETECTOMY
20|FH_F130763_0_0|SrvcGrp|89404|2022|PDM|15683.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F130763_0_0|SrvcGrp|89853|2022|PDM|4367.00|99|0.00|NASAL/SINUS ENDOSCOPY-SURG
20|FH_F130763_0_0|SrvcGrp|89861|2022|PDM|7319.00|99|0.00|LUMBAR LAMINOTOMY
20|FH_F130763_0_0|SrvcGrp|89988|2022|PDM|3450.00|99|0.00|REPAIR HALLUX RIGIDUS
20|FH_F130763_0_0|SrvcGrp|90157|2022|PDM|3258.00|99|0.00|AETNA REMOVAL OF TONSILS
20|FH_F130763_0_0|SrvcGrp|91880|2022|PDM|9514.00|99|0.00|OSSEOINTEGRATED IMPLANT
20|FH_F130763_0_0|SrvcGrp|94989|2022|PDM|4367.00|99|0.00|SINUS ENDO W/ BALLOON DILATION
20|FH_F130763_0_0|SrvcGrp|99167|2022|PDM|7319.00|99|0.00|CPT 63057
20|FH_F130770_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F130796_0_0|SrvcGrp|82981|2022|PDM|110.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F130796_0_0|SrvcGrp|87077|2022|PDM|110.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F130826_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F130826_0_0|CSTM-ALL|CSTM-00|2020|PDM|1516.00|99|0.00|AEG 9 (NO REV)
20|FH_F130844_0_0|CSTM-ALL|CSTM-00|2020|PDM|2419.00|99|0.00|GENERAL ACUTE CARE
20|FH_F130861_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F130923_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F130941_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.47|99|0.00|OP SVCS
20|FH_F130977_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.41|99|0.00|OP SVCS
20|FH_F130977_0_0|SrvcGrp|11606|2022|PDM|1450.00|99|0.00|ACUTE CARE (MEDICAL & SURGICAL)
20|FH_F130977_0_0|SrvcGrp|13188|2022|PCT|0.47|99|0.00|DRUGS
20|FH_F130977_0_0|SrvcGrp|3142|2022|PDM|1695.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F130977_0_0|SrvcGrp|33659|2022|PDM|400.00|99|0.00|DIALYSIS SERVICES
20|FH_F130978_0_0|SrvcGrp|108041|2022|PDM|400.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME
20|FH_F130978_0_0|SrvcGrp|108043|2022|PDM|171.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD
20|FH_F130997_0_0|SrvcGrp|87077|2022|PDM|110.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F131000_0_0|CSTM-ALL|CSTM-00|2020|PDM|2081.00|99|0.00|AEG 8 (NO REV)
20|FH_F131000_0_0|CSTM-ALL|CSTM-00|2020|PDM|807.00|99|0.00|AEG 1 (NO REV)
20|FH_F131000_0_0|SrvcGrp|100045|2022|PDM|2971.00|99|0.00|REVISION OF FOOT TENDON
20|FH_F131000_0_0|SrvcGrp|100919|2022|PDM|4776.00|99|0.00|SPINE PROSTH DEVICE
20|FH_F131000_0_0|SrvcGrp|100920|2022|PDM|4776.00|99|0.00|SPINE PRO DEVICE
20|FH_F131000_0_0|SrvcGrp|102480|2022|PDM|2494.00|99|0.00|CPT 29897
20|FH_F131000_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F131000_0_0|SrvcGrp|106265|2022|PDM|5114.00|99|0.00|NSL/SINS NDSC TOTAL
20|FH_F131000_0_0|SrvcGrp|111602|2022|PDM|2335.00|99|0.00|LARYNGOSCOPY
20|FH_F131000_0_0|SrvcGrp|26273|2022|PDM|3343.00|99|0.00|CPT 29880
20|FH_F131000_0_0|SrvcGrp|44068|2022|PDM|3608.00|99|0.00|CPT 52332
20|FH_F131000_0_0|SrvcGrp|59705|2022|PDM|2441.00|99|0.00|SEPTOPLASTY
20|FH_F131000_0_0|SrvcGrp|63466|2022|PDM|3608.00|99|0.00|CPT 52005
20|FH_F131000_0_0|SrvcGrp|70749|2022|PDM|3343.00|99|0.00|CPT 29823
20|FH_F131000_0_0|SrvcGrp|72121|2022|PDM|29806.00|99|0.00|ARTHOSCOPY
20|FH_F131000_0_0|SrvcGrp|74039|2022|PDM|6450.00|99|0.00|LAMINECTOMY
20|FH_F131000_0_0|SrvcGrp|78097|2022|PDM|3343.00|99|0.00|AETNA NASAL ENDOSCOPY
20|FH_F131000_0_0|SrvcGrp|85792|2022|PDM|3954.00|99|0.00|OPEN TREATMENT OF DISTAL
20|FH_F131000_0_0|SrvcGrp|88492|2022|PDM|4457.00|99|0.00|AETNA SPINAL BONE AUTOGRAFT
20|FH_F131000_0_0|SrvcGrp|89980|2022|PDM|3954.00|99|0.00|OPEN TREATMENT OF DISTAL
20|FH_F131000_0_0|SrvcGrp|90795|2022|PDM|2787.00|99|0.00|EXCISION INFERIOR TURBINATE
20|FH_F131000_0_0|SrvcGrp|91880|2022|PDM|7283.00|99|0.00|OSSEOINTEGRATED IMPLANT
20|FH_F131000_0_0|SrvcGrp|94989|2022|PDM|3343.00|99|0.00|SINUS ENDO W/ BALLOON DILATION
20|FH_F131100_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F131100_0_0|CSTM-ALL|CSTM-00|2020|PDM|1330.00|99|0.00|AEG 6 (NO REV)
20|FH_F131100_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F131100_0_0|SrvcGrp|111738|2022|PDM|1500.00|99|0.00|REMOVE FEMUR LESION/BURSA
20|FH_F131100_0_0|SrvcGrp|111740|2022|PDM|2300.00|99|0.00|ARTHROSCOPY
20|FH_F131113_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F131127_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F131127_0_0|CSTM-ALL|CSTM-00|2020|PDM|1272.00|99|0.00|AEG 1 (NO REV)
20|FH_F131127_0_0|CSTM-ALL|CSTM-00|2020|PDM|2543.00|99|0.00|AEG 10 (NO REV)
20|FH_F131127_0_0|CSTM-ALL|CSTM-00|2020|PDM|3826.00|99|0.00|AEG 7 (NO REV)
20|FH_F131127_0_0|CSTM-ALL|CSTM-00|2020|PDM|4610.00|99|0.00|AEG 9 (NO REV)
20|FH_F131127_0_0|SrvcGrp|111746|2022|PDM|6556.00|99|0.00|REVISE BREAST RECONSTRUCTION
20|FH_F131128_0_0|CSTM-ALL|CSTM-00|2020|PDM|1765.00|99|0.00|AEG 7 (NO REV)
20|FH_F131128_0_0|SrvcGrp|76604|2022|PDM|1546.00|99|0.00|CPT 25447
20|FH_F131128_0_0|SrvcGrp|85792|2022|PDM|4774.00|99|0.00|OPEN TREATMENT OF DISTAL
20|FH_F131128_0_0|SrvcGrp|90426|2022|PDM|2334.00|99|0.00|SHOULDER ARTHROSCOPY SURGERY
20|FH_F131128_0_0|SrvcGrp|98006|2022|PDM|2122.00|99|0.00|PHALANGEAL SHAFT FRACTURE
20|FH_F131148_0_0|SrvcGrp|83235|2022|PCT|0.60|99|0.00|AMBULATORY SURGERY
20|FH_F131169_0_0|SrvcGrp|108041|2022|PDM|400.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME
20|FH_F131169_0_0|SrvcGrp|108043|2022|PDM|171.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD
20|FH_F131169_0_0|SrvcGrp|108082|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER
20|FH_F131187_0_0|SrvcGrp|108041|2022|PDM|400.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME
20|FH_F131208_0_0|SrvcGrp|106300|2022|PDM|502.70|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT (HCFA)
20|FH_F131208_0_0|SrvcGrp|13597|2022|PDM|315.70|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT
20|FH_F131282_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 4 (NO REV)
20|FH_F131282_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|AEG 3 (NO REV)
20|FH_F131282_0_0|SrvcGrp|104721|2022|PDM|810.00|99|0.00|REVISE EYELID W/ EXCESS SKIN
20|FH_F131282_0_0|SrvcGrp|104723|2022|PDM|817.00|99|0.00|REPAIR EYELID DEFECT
20|FH_F131282_0_0|SrvcGrp|78046|2022|PCT|1.00|99|0.00|AETNA AQUEOUS SHUNT
20|FH_F131282_0_0|SrvcGrp|91759|2022|PCT|1.00|99|0.00|OCULAR IMPLANT
20|FH_F131324_0_0|CSTM-ALL|CSTM-00|2020|PDM|542.00|99|0.00|AEG 1 (NO REV)
20|FH_F131327_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F131327_0_0|CSTM-ALL|CSTM-00|2020|PDM|1426.00|99|0.00|AEG 3 (NO REV)
20|FH_F131327_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F131327_0_0|SrvcGrp|111630|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F131331_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F131331_0_0|SrvcGrp|104228|2022|PDM|55.66|99|0.00|HOSPICE CARE (HCFA)
20|FH_F131331_0_0|SrvcGrp|29155|2022|PDM|165.42|99|0.00|HOSPICE SVCS
20|FH_F131331_0_0|SrvcGrp|82223|2022|PDM|55.66|99|0.00|HOSPICE CARE
20|FH_F131371_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F131371_0_0|CSTM-ALL|CSTM-00|2020|PDM|3100.00|99|0.00|AEG 4 (NO REV)
20|FH_F131371_0_0|CSTM-ALL|CSTM-00|2020|PDM|3150.00|99|0.00|AEG 3 (NO REV)
20|FH_F131371_0_0|SrvcGrp|101102|2022|PDM|17000.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT
20|FH_F131371_0_0|SrvcGrp|101280|2022|PDM|17000.00|99|0.00|TOTAL HIP ARTHROPLASTY
20|FH_F131371_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F131371_0_0|SrvcGrp|44461|2022|PDM|45162.00|99|0.00|INSERTION / REPLACEMENT OF SPINAL NEUROSTIMULATOR GENERATOR
20|FH_F131379_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F131379_0_0|SrvcGrp|108042|2022|PDM|400.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD
20|FH_F131412_0_0|SrvcGrp|82223|2022|PDM|34.91|99|0.00|HOSPICE CARE
20|FH_F131433_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F131433_0_0|SrvcGrp|82981|2022|PDM|149.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F131472_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F131494_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F131494_0_0|CSTM-ALL|CSTM-00|2020|PDM|338.00|99|0.00|AEG 2 W/O FEMALE GENITAL SERVICE (NO REV)
20|FH_F131494_0_0|CSTM-ALL|CSTM-00|2020|PDM|420.00|99|0.00|AEG 8 (NO REV)
20|FH_F131494_0_0|CSTM-ALL|CSTM-00|2020|PDM|420.00|99|0.00|AEG 9 (NO REV)
20|FH_F131494_0_0|SrvcGrp|101527|2022|PDM|481.00|99|0.00|HYSTEROSCOPY LYSIS
20|FH_F131494_0_0|SrvcGrp|27347|2022|PDM|473.00|99|0.00|CPT 58558
20|FH_F131494_0_0|SrvcGrp|75282|2022|PDM|265.00|99|0.00|DIAGNOSTIC HYSTEROSCOPY
20|FH_F131494_0_0|SrvcGrp|89869|2022|PDM|410.00|99|0.00|SPONTANEOUS ABORTION
20|FH_F131498_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F131498_0_0|SrvcGrp|24739|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F131498_0_0|SrvcGrp|63119|2022|PDM|23.00|99|0.00|BASIC HOME HOSPICE CARE
20|FH_F131498_0_0|SrvcGrp|80317|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F131498_0_0|SrvcGrp|95441|2022|PDM|100.00|99|0.00|HOSPICE OR HOME CARE
20|FH_F131505_0_0|CSTM-ALL|CSTM-00|2020|PDM|526.00|99|0.00|AEG 4 (NO REV)
20|FH_F131505_0_0|SrvcGrp|111630|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F131505_0_0|SrvcGrp|27347|2022|PDM|473.00|99|0.00|CPT 58558
20|FH_F131605_0_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F131605_0_0|SrvcGrp|472|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F131608_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F131608_0_0|SrvcGrp|65720|2022|PDM|165.42|99|0.00|RESPITE CARE
20|FH_F131608_0_0|SrvcGrp|90707|2022|PDM|34.91|99|0.00|AETNA HOSPICE CARE
20|FH_F131609_0_0|SrvcGrp|82981|2022|PDM|100.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F131630_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F131630_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F131630_0_0|CSTM-ALL|CSTM-00|2020|PDM|1498.00|99|0.00|AEG 3 (NO REV)
20|FH_F131630_0_0|CSTM-ALL|CSTM-00|2020|PDM|2107.00|99|0.00|AEG 5 (NO REV) W/O MUSCULOSKELETAL SYSTEM
20|FH_F131630_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F131630_0_0|SrvcGrp|34342|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F131630_0_0|SrvcGrp|85792|2022|PDM|2081.00|99|0.00|OPEN TREATMENT OF DISTAL
20|FH_F131630_0_0|SrvcGrp|88596|2022|PDM|2549.00|99|0.00|EXC OF TRIANG FIBROCARTILAGE
20|FH_F131954_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE
20|FH_F131965_0_0|SrvcGrp|63297|2022|PDM|100.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F131965_0_0|SrvcGrp|83521|2022|PDM|100.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F131965_0_0|SrvcGrp|83857|2022|PDM|475.00|99|0.00|IP HOSPICE SVCS
20|FH_F131965_0_0|SrvcGrp|93098|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F131974_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F131982_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F131982_0_0|SrvcGrp|57965|2022|PDM|131.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F131982_0_0|SrvcGrp|57967|2022|PDM|143.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F131982_0_0|SrvcGrp|57968|2022|PDM|30.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F131996_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F131996_0_0|CSTM-ALL|CSTM-00|2020|PDM|433.00|99|0.00|AEG 1 (NO REV)
20|FH_F132016_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE
20|FH_F132016_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.50|99|0.00|HSS ASC
20|FH_F132032_0_0|SrvcGrp|29155|2022|PDM|100.00|99|0.00|HOSPICE SVCS
20|FH_F132032_0_0|SrvcGrp|33722|2022|PDM|23.00|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F132032_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F132032_0_0|SrvcGrp|83857|2022|PDM|475.00|99|0.00|IP HOSPICE SVCS
20|FH_F132073_0_0|SrvcGrp|57967|2022|PDM|143.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F132080_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F132080_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F132080_0_0|SrvcGrp|89781|2022|PDM|169.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F132092_0_0|SrvcGrp|87799|2022|PDM|169.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)
20|FH_F132092_0_0|SrvcGrp|93098|2022|PDM|169.00|99|0.00|HOSPICE CARE
20|FH_F132092_0_0|SrvcGrp|94780|2022|PDM|169.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)
20|FH_F132092_0_0|SrvcGrp|97506|2022|PDM|169.00|99|0.00|AETNA HOSPICE ALL OTHER CARE
20|FH_F132092_0_0|SrvcGrp|97702|2022|PDM|169.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)
20|FH_F132125_0_0|SrvcGrp|76501|2022|PDM|750.00|99|0.00|SUB-ACUTE - LEVEL I
20|FH_F132130_0_0|CSTM-ALL|CSTM-00|2020|PDM|432.00|99|0.00|AEG 2 (NO REV)
20|FH_F132130_0_0|CSTM-ALL|CSTM-00|2020|PDM|948.00|99|0.00|AEG 8 (NO REV)
20|FH_F132133_0_0|CSTM-ALL|CSTM-00|2020|PDM|1101.00|99|0.00|AEG 8 (NO REV)
20|FH_F132133_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|AEG 1 (NO REV)
20|FH_F132133_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|AEG 10 (NO REV)
20|FH_F132133_0_0|CSTM-ALL|CSTM-00|2020|PDM|533.00|99|0.00|AEG 2 (NO REV)
20|FH_F132133_0_0|CSTM-ALL|CSTM-00|2020|PDM|812.00|99|0.00|AEG 5  (NO REV)
20|FH_F132133_0_0|SrvcGrp|111966|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F132160_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F132160_0_0|SrvcGrp|109761|2022|PDM|4590.00|99|0.00|REMOVE EYELID LESIONS
20|FH_F132160_0_0|SrvcGrp|109767|2022|PCT|0.00|99|0.00|COVER EYE W/ MEMBRANE INCIDENTAL CODES
20|FH_F132160_0_0|SrvcGrp|109795|2022|PCT|0.00|99|0.00|COLLAGEN CROSSLINKING CORNEA INCIDENTAL CODES
20|FH_F132160_0_0|SrvcGrp|42428|2022|PDM|1721.00|99|0.00|OP SURGERY CPT 65855
20|FH_F132160_0_0|SrvcGrp|62740|2022|PDM|5738.00|99|0.00|SURGERY CARVE OUTS
20|FH_F132160_0_0|SrvcGrp|78046|2022|PCT|1.00|99|0.00|AETNA AQUEOUS SHUNT
20|FH_F132190_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132190_0_0|CSTM-ALL|CSTM-00|2020|PDM|1083.00|99|0.00|AEG 6 (NO REV)
20|FH_F132190_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|AEG 3 (NO REV)
20|FH_F132190_0_0|SrvcGrp|101110|2022|PDM|2500.00|99|0.00|ARTHROSCOPY
20|FH_F132190_0_0|SrvcGrp|103572|2022|PDM|2500.00|99|0.00|KNEE ARTHOROSCOPY
20|FH_F132190_0_0|SrvcGrp|109618|2022|PDM|2600.00|99|0.00|IMPLANT NEUROELECTRODES 29
20|FH_F132190_0_0|SrvcGrp|109621|2022|PDM|1900.00|99|0.00|PERQ CERVICOTHORACIC INJECTION
20|FH_F132190_0_0|SrvcGrp|19920|2022|PDM|2500.00|99|0.00|ARTHROSCOPY OF SHOULDER
20|FH_F132190_0_0|SrvcGrp|97039|2022|PDM|2500.00|99|0.00|KNEE ARTHROSCOPY
20|FH_F132193_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132193_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|AEG 10 (NO REV)
20|FH_F132193_0_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|AEG 2 (NO REV)
20|FH_F132193_0_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|AEG 4 (NO REV)
20|FH_F132193_0_0|SrvcGrp|21978|2022|PDM|150.00|99|0.00|CPT 77003
20|FH_F132199_0_0|CSTM-ALL|CSTM-00|2020|PDM|1392.85|99|0.00|GENERAL ACUTE CARE
20|FH_F132212_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F132212_0_0|SrvcGrp|14494|2022|PDM|18.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F132212_0_0|SrvcGrp|65720|2022|PDM|90.00|99|0.00|RESPITE CARE
20|FH_F132212_0_0|SrvcGrp|89781|2022|PDM|90.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F132212_0_0|SrvcGrp|92501|2022|PDM|90.00|99|0.00|HOSPICE IP RESPITE CARE
20|FH_F132212_0_0|SrvcGrp|93098|2022|PDM|90.00|99|0.00|HOSPICE CARE
20|FH_F132235_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F132247_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132328_0_0|CSTM-ALL|CSTM-00|2020|PDM|1909.00|99|0.00|AEG 5  (NO REV)
20|FH_F132328_0_0|CSTM-ALL|CSTM-00|2020|PDM|2663.00|99|0.00|AEG 8 (NO REV)
20|FH_F132328_0_0|CSTM-ALL|CSTM-00|2020|PDM|895.00|99|0.00|AEG 1 (NO REV)
20|FH_F132328_0_0|SrvcGrp|103835|2022|PDM|2123.00|99|0.00|AETNA REMOVE BLADDER STONE
20|FH_F132328_0_0|SrvcGrp|105637|2022|PDM|2049.00|99|0.00|KNEE ARTHROSCOPY
20|FH_F132328_0_0|SrvcGrp|107099|2022|PDM|1446.00|99|0.00|TREATMENT OF NOSE FRACTURE
20|FH_F132328_0_0|SrvcGrp|109973|2022|PDM|2383.00|99|0.00|ARTHROSCOPY / SURGERY
20|FH_F132328_0_0|SrvcGrp|111952|2022|PDM|2425.00|99|0.00|CYSTOURETHROSCOPY/URETEROSCO
20|FH_F132328_0_0|SrvcGrp|111953|2022|PDM|2425.00|99|0.00|REVISION OF BLADDER NECK
20|FH_F132328_0_0|SrvcGrp|111955|2022|PDM|3371.00|99|0.00|MALE GENITAL PROCEDURES
20|FH_F132328_0_0|SrvcGrp|26273|2022|PDM|2239.00|99|0.00|CPT 29880
20|FH_F132328_0_0|SrvcGrp|26275|2022|PDM|2289.00|99|0.00|CPT 29826
20|FH_F132328_0_0|SrvcGrp|27402|2022|PDM|3371.00|99|0.00|LASER PROCEDURES
20|FH_F132328_0_0|SrvcGrp|28549|2022|PDM|3490.00|99|0.00|VITRECTOMY
20|FH_F132328_0_0|SrvcGrp|33724|2022|PDM|1745.00|99|0.00|ARTHROSCOPY
20|FH_F132328_0_0|SrvcGrp|33982|2022|PDM|2289.00|99|0.00|CPT 28296
20|FH_F132328_0_0|SrvcGrp|63459|2022|PDM|3371.00|99|0.00|CPT 52601
20|FH_F132328_0_0|SrvcGrp|65625|2022|PDM|2563.00|99|0.00|CPT 30520
20|FH_F132328_0_0|SrvcGrp|66305|2022|PDM|1259.00|99|0.00|CPT 53450
20|FH_F132328_0_0|SrvcGrp|67064|2022|PDM|5202.00|99|0.00|MUSCULOSKELETAL SYSTEM
20|FH_F132328_0_0|SrvcGrp|67072|2022|PDM|5826.00|99|0.00|CPT 22845
20|FH_F132328_0_0|SrvcGrp|72121|2022|PDM|3381.00|99|0.00|ARTHOSCOPY
20|FH_F132328_0_0|SrvcGrp|77021|2022|PDM|6097.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY
20|FH_F132328_0_0|SrvcGrp|78283|2022|PDM|2819.00|99|0.00|CPT 49505
20|FH_F132328_0_0|SrvcGrp|82113|2022|PDM|2195.00|99|0.00|KNEE ARTHROSCOPY SURGERY
20|FH_F132328_0_0|SrvcGrp|82114|2022|PDM|2049.00|99|0.00|MENISCUS REPAIR MED OR LAT
20|FH_F132328_0_0|SrvcGrp|83640|2022|PDM|2049.00|99|0.00|CPT 29887
20|FH_F132328_0_0|SrvcGrp|83641|2022|PDM|4276.00|99|0.00|CPT 29889
20|FH_F132328_0_0|SrvcGrp|83643|2022|PDM|2091.00|99|0.00|CPT 29885
20|FH_F132328_0_0|SrvcGrp|87053|2022|PDM|2123.00|99|0.00|CYSTOSCOPY AND TREATMENT
20|FH_F132328_0_0|SrvcGrp|87679|2022|PDM|2212.00|99|0.00|LUMBAR OR SACRAL SURGERY
20|FH_F132328_0_0|SrvcGrp|88162|2022|PDM|8875.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON
20|FH_F132328_0_0|SrvcGrp|88596|2022|PDM|1746.00|99|0.00|EXC OF TRIANG FIBROCARTILAGE
20|FH_F132328_0_0|SrvcGrp|88600|2022|PDM|2383.00|99|0.00|WRIST ARTHROS DIAG W/WO BIO
20|FH_F132328_0_0|SrvcGrp|89842|2022|PDM|14566.00|99|0.00|LUMBAR
20|FH_F132328_0_0|SrvcGrp|89860|2022|PDM|8875.00|99|0.00|SPINAL DISK SURGERY ADD-ON
20|FH_F132328_0_0|SrvcGrp|89882|2022|PDM|2563.00|99|0.00|AETNA REMOVAL OF TONSILS
20|FH_F132328_0_0|SrvcGrp|89885|2022|PDM|2819.00|99|0.00|AETNA REPAIR HERNIA
20|FH_F132328_0_0|SrvcGrp|92364|2022|PDM|10595.00|99|0.00|ARTHRODESIS SACROILIAC JOINT
20|FH_F132328_0_0|SrvcGrp|92410|2022|PDM|14566.00|99|0.00|SPINE FUSION EXTRA SEGMENT
20|FH_F132328_0_0|SrvcGrp|99073|2022|PDM|1.45|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F132374_0_0|CSTM-ALL|CSTM-00|2020|PDM|1540.18|99|0.00|AEG 10 (NO REV)
20|FH_F132374_0_0|SrvcGrp|11673|2022|PDM|2704.34|99|0.00|CPT 29888
20|FH_F132439_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F132439_0_0|SrvcGrp|92501|2022|PDM|163.24|99|0.00|HOSPICE IP RESPITE CARE
20|FH_F132439_0_0|SrvcGrp|94780|2022|PDM|178.17|99|0.00|HOSPICE OR HH IN HOME (HCFA)
20|FH_F132442_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F132442_0_0|SrvcGrp|82981|2022|PDM|130.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F132487_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132487_0_0|SrvcGrp|83857|2022|PDM|475.00|99|0.00|IP HOSPICE SVCS
20|FH_F132501_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 8 (NO REV)
20|FH_F132501_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 3 (NO REV)
20|FH_F132501_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|AEG 4 (NO REV)
20|FH_F132501_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 6 (NO REV)
20|FH_F132512_0_0|SrvcGrp|100499|2022|PDM|995.00|99|0.00|PARTIAL HOSPITALIZATION EATING DISORDERS
20|FH_F132544_0_0|CSTM-ALL|CSTM-00|2020|PDM|4377.00|99|0.00|AEG 9 (NO REV)
20|FH_F132544_0_0|SrvcGrp|12309|2022|PDM|8007.00|99|0.00|MICRODISKETOMY
20|FH_F132544_0_0|SrvcGrp|16693|2022|PDM|3454.00|99|0.00|KNEE SCOPE, MENISCECTOMY
20|FH_F132544_0_0|SrvcGrp|16694|2022|PDM|3454.00|99|0.00|KNEE SCOPE, CHONDROPLASTY
20|FH_F132544_0_0|SrvcGrp|38015|2022|PDM|8007.00|99|0.00|ARTHRODESIS
20|FH_F132544_0_0|SrvcGrp|3932|2022|PDM|4396.00|99|0.00|LITHOTRIPSY
20|FH_F132544_0_0|SrvcGrp|40002|2022|PDM|8007.00|99|0.00|TOTAL HIP
20|FH_F132544_0_0|SrvcGrp|80139|2022|PDM|7850.00|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F132544_0_0|SrvcGrp|85198|2022|PDM|4803.00|99|0.00|AETNA KNEE ARTHROSCOPY
20|FH_F132544_0_0|SrvcGrp|93740|2022|PDM|7850.00|99|0.00|REVISE/REMOVE NEURO RECEIVER
20|FH_F132544_0_0|SrvcGrp|96352|2022|PDM|6124.00|99|0.00|ANKLE JOINT
20|FH_F132544_0_0|SrvcGrp|96355|2022|PDM|8007.00|99|0.00|SPINE FIXATION
20|FH_F132544_0_0|SrvcGrp|99073|2022|PDM|1.41|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F132545_0_0|CSTM-ALL|CSTM-00|2020|PCT|36500.00|99|0.00|TIMELY FILING
20|FH_F132559_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132559_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F132559_0_0|CSTM-ALL|CSTM-00|2020|PDM|1751.00|99|0.00|AEG 10 (NO REV)
20|FH_F132559_0_0|CSTM-ALL|CSTM-00|2020|PDM|2163.00|99|0.00|AEG 7 (NO REV)
20|FH_F132559_0_0|CSTM-ALL|CSTM-00|2020|PDM|721.00|99|0.00|AEG 1 (NO REV)
20|FH_F132559_0_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS
20|FH_F132559_0_0|SrvcGrp|59841|2022|PDM|1635.00|99|0.00|SUBMUCOUS RESECTION
20|FH_F132559_0_0|SrvcGrp|77582|2022|PDM|2800.00|99|0.00|CPT 31255
20|FH_F132559_0_0|SrvcGrp|90157|2022|PDM|1635.00|99|0.00|AETNA REMOVAL OF TONSILS
20|FH_F132579_0_0|SrvcGrp|22596|2022|PDM|150.00|99|0.00|HOSPICE CARE
20|FH_F132579_0_0|SrvcGrp|92502|2022|PDM|900.00|99|0.00|HOSPICE GENERAL IP CARE
20|FH_F132585_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|OP SVCS
20|FH_F132595_0_0|CSTM-ALL|CSTM-00|2020|PDM|1158.00|99|0.00|ACUTE PSYCH
20|FH_F132595_0_0|CSTM-ALL|CSTM-00|2020|PDM|1931.00|99|0.00|ACUTE IP MED SVCS
20|FH_F132595_0_0|SrvcGrp|112077|2022|PDM|44461.00|99|0.00|CV SURGERY
20|FH_F132595_0_0|SrvcGrp|16|2022|PDM|1423.00|99|0.00|ACUTE REHABILITATION
20|FH_F132595_0_0|SrvcGrp|22148|2022|PDM|293.00|99|0.00|PSYCH PARTIAL HOSP (FULL DAY)
20|FH_F132595_0_0|SrvcGrp|701|2022|PDM|3383.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F132595_0_0|SrvcGrp|941|2022|PDM|3092.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F132606_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F132606_0_0|CSTM-ALL|CSTM-00|2020|PDM|1716.66|99|0.00|AEG 9 (NO REV)
20|FH_F132606_0_0|CSTM-ALL|CSTM-00|2020|PDM|624.24|99|0.00|AEG 2 (NO REV)
20|FH_F132606_0_0|CSTM-ALL|CSTM-00|2020|PDM|873.93|99|0.00|AEG 4 (NO REV)
20|FH_F132606_0_0|CSTM-ALL|CSTM-00|2020|PDM|873.94|99|0.00|AEG 10 (NO REV)
20|FH_F132606_0_0|SrvcGrp|111995|2022|PDM|499.39|99|0.00|CARDIAC CATHETERIZATION
20|FH_F132606_0_0|SrvcGrp|26273|2022|PDM|1305.00|99|0.00|CPT 29880
20|FH_F132606_0_0|SrvcGrp|26274|2022|PDM|1305.00|99|0.00|CPT 29877
20|FH_F132606_0_0|SrvcGrp|34606|2022|PDM|1305.00|99|0.00|CPT 29827
20|FH_F132609_0_0|SrvcGrp|11663|2022|PCT|0.67|99|0.00|IMPLANTS
20|FH_F132609_0_0|SrvcGrp|3409|2022|PDM|508.00|99|0.00|NEWBORN NURSERY
20|FH_F132609_0_0|SrvcGrp|58|2022|PCT|0.67|99|0.00|IP LITHOTRIPSY SVCS
20|FH_F132609_0_0|SrvcGrp|81036|2022|PCT|0.77|99|0.00|ANGIOPLASTY
20|FH_F132612_0_0|SrvcGrp|3409|2022|PDM|508.00|99|0.00|NEWBORN NURSERY
20|FH_F132612_0_0|SrvcGrp|361|2022|PDM|1860.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F132612_0_0|SrvcGrp|413|2022|PCT|0.70|99|0.00|TRANSPLANT SVCS
20|FH_F132612_0_0|SrvcGrp|701|2022|PDM|2872.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F132612_0_0|SrvcGrp|81036|2022|PCT|0.75|99|0.00|ANGIOPLASTY
20|FH_F132612_0_0|SrvcGrp|941|2022|PDM|2872.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F132627_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132627_0_0|SrvcGrp|111527|2022|PDM|291.00|99|0.00|HOME INFUSION (HCFA)
20|FH_F132627_0_0|SrvcGrp|111528|2022|PDM|153.00|99|0.00|PICC LINE INSERTION (HCFA)
20|FH_F132627_0_0|SrvcGrp|111529|2022|PDM|153.00|99|0.00|MID-LINE INSERTION (HCFA)
20|FH_F132627_0_0|SrvcGrp|14494|2022|PDM|291.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F132627_0_0|SrvcGrp|17004|2022|PDM|80.58|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 24HRS
20|FH_F132627_0_0|SrvcGrp|17009|2022|PDM|84.66|99|0.00|HOME INFUSION THERAPY
20|FH_F132627_0_0|SrvcGrp|17013|2022|PDM|80.58|99|0.00|HOME INFUSION THERAPY
20|FH_F132627_0_0|SrvcGrp|21920|2022|PDM|18.36|99|0.00|UNCLASSIFIED INFUSION THERAPY
20|FH_F132627_0_0|SrvcGrp|22589|2022|PDM|80.58|99|0.00|CHEMOTHERAPY NOC
20|FH_F132627_0_0|SrvcGrp|24750|2022|PDM|43.86|99|0.00|ANTI-EMETICS INJECTION THERAPY
20|FH_F132627_0_0|SrvcGrp|24761|2022|PDM|18.36|99|0.00|HOME INFUSION THERAPY
20|FH_F132627_0_0|SrvcGrp|26617|2022|PDM|8.16|99|0.00|HOME INFUSION THERAPY
20|FH_F132627_0_0|SrvcGrp|27969|2022|PDM|52.02|99|0.00|HOME HEALTH AIDE
20|FH_F132627_0_0|SrvcGrp|29075|2022|PDM|64.26|99|0.00|HYDRATION THERAPY
20|FH_F132627_0_0|SrvcGrp|29077|2022|PDM|43.86|99|0.00|HOME TRANSFUSION
20|FH_F132627_0_0|SrvcGrp|29898|2022|PDM|139.00|99|0.00|RN VISIT
20|FH_F132627_0_0|SrvcGrp|46617|2022|PDM|177.00|99|0.00|SKILLED NURSING HOME VISIT OR PROCEDURE
20|FH_F132627_0_0|SrvcGrp|53143|2022|PDM|52.02|99|0.00|RN
20|FH_F132627_0_0|SrvcGrp|53987|2022|PDM|143.00|99|0.00|PHOTOTHERAPY
20|FH_F132627_0_0|SrvcGrp|65621|2022|PDM|66.30|99|0.00|RN NURSING
20|FH_F132627_0_0|SrvcGrp|89621|2022|PDM|347.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F132672_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 1 (NO REV)
20|FH_F132693_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 1 (NO REV)
20|FH_F132693_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|AEG 4 (NO REV)
20|FH_F132693_0_0|SrvcGrp|111966|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F132694_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132711_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F132711_0_0|SrvcGrp|104330|2022|PDM|1000.00|99|0.00|AETNA ACUTE REHAB II
20|FH_F132720_0_0|SrvcGrp|107734|2022|PDM|4476.00|99|0.00|VAGINAL DELIVERY
20|FH_F132720_0_0|SrvcGrp|33793|2022|PDM|13426.00|99|0.00|MSDRG 246-251 ONLY ANGIOPLASTY
20|FH_F132720_0_0|SrvcGrp|3409|2022|PDM|600.00|99|0.00|NEWBORN NURSERY
20|FH_F132720_0_0|SrvcGrp|360|2022|PDM|2059.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F132721_0_0|SrvcGrp|107734|2022|PDM|4476.00|99|0.00|VAGINAL DELIVERY
20|FH_F132721_0_0|SrvcGrp|16|2022|PDM|1611.00|99|0.00|ACUTE REHABILITATION
20|FH_F132721_0_0|SrvcGrp|360|2022|PDM|2059.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F132728_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.63|99|0.00|OP SVCS
20|FH_F132728_0_0|SrvcGrp|16|2022|PDM|1611.00|99|0.00|ACUTE REHABILITATION
20|FH_F132728_0_0|SrvcGrp|47427|2022|PCT|0.65|99|0.00|IMPLANTS
20|FH_F132728_0_0|SrvcGrp|51672|2022|PDM|7161.00|99|0.00|MS DRG 286-287 ONLY
20|FH_F132729_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.72|99|0.00|OP SVCS
20|FH_F132729_0_0|SrvcGrp|107733|2022|PDM|6266.00|99|0.00|CESAREAN SECTION
20|FH_F132729_0_0|SrvcGrp|107734|2022|PDM|4476.00|99|0.00|VAGINAL DELIVERY
20|FH_F132729_0_0|SrvcGrp|16|2022|PDM|1611.00|99|0.00|ACUTE REHABILITATION
20|FH_F132729_0_0|SrvcGrp|360|2022|PDM|2059.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F132729_0_0|SrvcGrp|40820|2022|PDM|3088.00|99|0.00|ICU/CCU
20|FH_F132729_0_0|SrvcGrp|47427|2022|PCT|0.65|99|0.00|IMPLANTS
20|FH_F132732_0_0|SrvcGrp|107733|2022|PDM|6648.00|99|0.00|CESAREAN SECTION
20|FH_F132732_0_0|SrvcGrp|361|2022|PDM|2696.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F132732_0_0|SrvcGrp|39|2022|PCT|0.69|99|0.00|TISSUE PLASMINOGEN ACTIVATOR
20|FH_F132732_0_0|SrvcGrp|47427|2022|PCT|0.69|99|0.00|IMPLANTS
20|FH_F132733_0_0|SrvcGrp|112077|2022|PDM|49616.00|99|0.00|CV SURGERY
20|FH_F132736_0_0|SrvcGrp|107733|2022|PDM|6266.00|99|0.00|CESAREAN SECTION
20|FH_F132736_0_0|SrvcGrp|33793|2022|PDM|13426.00|99|0.00|MSDRG 246-251 ONLY ANGIOPLASTY
20|FH_F132736_0_0|SrvcGrp|3409|2022|PDM|600.00|99|0.00|NEWBORN NURSERY
20|FH_F132736_0_0|SrvcGrp|47427|2022|PCT|0.65|99|0.00|IMPLANTS
20|FH_F132737_0_0|SrvcGrp|107733|2022|PDM|5953.00|99|0.00|CESAREAN SECTION
20|FH_F132737_0_0|SrvcGrp|3078|2022|PCT|0.65|99|0.00|DRUGS
20|FH_F132737_0_0|SrvcGrp|40820|2022|PDM|2933.00|99|0.00|ICU/CCU
20|FH_F132737_0_0|SrvcGrp|47427|2022|PCT|0.65|99|0.00|IMPLANTS
20|FH_F132738_0_0|CSTM-ALL|CSTM-00|2020|PDM|326.00|99|0.00|CD PARTIAL HOSPITALIZATION
20|FH_F132738_0_0|CSTM-ALL|CSTM-00|2020|PDM|566.00|99|0.00|CD RESIDENTIAL TREATMENT
20|FH_F132739_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132739_0_0|SrvcGrp|112034|2022|PCT|0.62|99|0.00|IMPLANTS/PROSTHETIC
20|FH_F132768_0_0|SrvcGrp|472|2022|PDM|1150.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F132768_0_0|SrvcGrp|75545|2022|PDM|1150.00|99|0.00|SUB-ACUTE - LEVEL I AND II
20|FH_F132772_0_0|SrvcGrp|108082|2022|PDM|362.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER
20|FH_F132779_0_0|CSTM-ALL|CSTM-00|2020|PDM|2415.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132779_0_0|SrvcGrp|112234|2022|PDM|45988.00|99|0.00|CARDIAC SERVICES
20|FH_F132779_0_0|SrvcGrp|15|2022|PDM|2415.00|99|0.00|PEDIATRIC INTENSIVE CARE UNIT
20|FH_F132779_0_0|SrvcGrp|3493|2022|PCT|0.59|99|0.00|PHARMACY SVCS
20|FH_F132779_0_0|SrvcGrp|3499|2022|PCT|0.59|99|0.00|IMPLANTS
20|FH_F132779_0_0|SrvcGrp|57384|2022|PDM|16096.00|99|0.00|MS DRG 469-470 ONLY
20|FH_F132779_0_0|SrvcGrp|87309|2022|PDM|18067.00|99|0.00|MSDRG 272 ONLY
20|FH_F132779_0_0|SrvcGrp|89813|2022|PDM|14783.00|99|0.00|MS DRG 498 ONLY
20|FH_F132801_0_0|SrvcGrp|112034|2022|PCT|0.57|99|0.00|IMPLANTS/PROSTHETIC
20|FH_F132809_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132849_0_0|SrvcGrp|104879|2022|PDM|1275.00|99|0.00|REHABILIITATION W/O SC/MCC
20|FH_F132849_0_0|SrvcGrp|32538|2022|PDM|39864.00|99|0.00|MS DRG 216-221 ONLY
20|FH_F132849_0_0|SrvcGrp|97|2022|PDM|5581.00|99|0.00|C-SECTION
20|FH_F132860_0_0|CSTM-ALL|CSTM-00|2020|PDM|5541.00|99|0.00|MSDRG 286-287 CARDIAC CATH
20|FH_F132860_0_0|SrvcGrp|72|2022|PDM|466.00|99|0.00|NEWBORN NURSERY
20|FH_F132878_0_0|CSTM-ALL|CSTM-00|2020|PCT|12000.00|99|0.00|TIMELY FILING
20|FH_F132886_0_0|SrvcGrp|106294|2022|PDM|412.00|99|0.00|AMBULANCE SERVICE EMERGENCY TRANSPORT LEVEL 1 (HFCA)
20|FH_F132886_0_0|SrvcGrp|106317|2022|PDM|594.00|99|0.00|SPECIALTY CARE TRANSPORT (HCFA)
20|FH_F132915_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132915_0_0|CSTM-ALL|CSTM-00|2020|PDM|446.00|99|0.00|AEG 2 (NO REV)
20|FH_F132915_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|AEG 3 (NO REV)
20|FH_F132915_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|AEG 5  (NO REV)
20|FH_F132915_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|AEG 7 (NO REV)
20|FH_F132960_0_0|SrvcGrp|93736|2022|PDM|90.00|99|0.00|URGENT CARE
20|FH_F132968_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F132988_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F132988_0_0|CSTM-ALL|CSTM-00|2020|PDM|2750.00|99|0.00|AEG 8 (NO REV)
20|FH_F132988_0_0|SrvcGrp|100001|2022|PDM|20208.13|99|0.00|WRIST REPLACEMNT TOT WRIST
20|FH_F132988_0_0|SrvcGrp|100007|2022|PDM|12526.11|99|0.00|FUSION OF ANKLE JOINT
20|FH_F132988_0_0|SrvcGrp|100014|2022|PDM|6217.57|99|0.00|REPAIR RADIUS OR ULNA
20|FH_F132988_0_0|SrvcGrp|100044|2022|PDM|5846.69|99|0.00|INCISION OF HEEL BONE
20|FH_F132988_0_0|SrvcGrp|100060|2022|PDM|6047.98|99|0.00|REPAIR MIDFOOT FRACTURE EACH
20|FH_F132988_0_0|SrvcGrp|100062|2022|PDM|5914.35|99|0.00|REPAIR FIBULA NONUNION
20|FH_F132988_0_0|SrvcGrp|100065|2022|PDM|4493.01|99|0.00|DEEP ANT OR POSTER TIBIAL
20|FH_F132988_0_0|SrvcGrp|100072|2022|PDM|6034.45|99|0.00|SHORTEN RADIUS/ULNA
20|FH_F132988_0_0|SrvcGrp|104612|2022|PDM|1766.05|99|0.00|EXC FOOT/TOE TUM SC > 1.5 CM
20|FH_F132988_0_0|SrvcGrp|105632|2022|PDM|2057.62|99|0.00|AMPUTATION OF TOE
20|FH_F132988_0_0|SrvcGrp|107835|2022|PDM|4279.06|99|0.00|NERVE REPAIR
20|FH_F132988_0_0|SrvcGrp|107845|2022|PDM|1279.81|99|0.00|REVISE FINGER/TOE NERVE
20|FH_F132988_0_0|SrvcGrp|109189|2022|PDM|6632.83|99|0.00|TARSAL BONE DISLOCATION TREATMENT
20|FH_F132988_0_0|SrvcGrp|110994|2022|PDM|1766.05|99|0.00|DEB SKIN BONE AT FX SITE
20|FH_F132988_0_0|SrvcGrp|111966|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F132988_0_0|SrvcGrp|112143|2022|PDM|4493.01|99|0.00|FUSION OF KNUCKLE
20|FH_F132988_0_0|SrvcGrp|112145|2022|PDM|4493.01|99|0.00|REPAIR/GRAFT OF THIGH MUSCLE
20|FH_F132988_0_0|SrvcGrp|112146|2022|PDM|4493.01|99|0.00|REPAIR LOWER LEG TENDONS
20|FH_F132988_0_0|SrvcGrp|112148|2022|PDM|3144.78|99|0.00|REPAIR OF DIGIT NERVE
20|FH_F132988_0_0|SrvcGrp|112149|2022|PDM|1154.34|99|0.00|TREAT SHOULDER DISLOCATION
20|FH_F132988_0_0|SrvcGrp|112159|2022|PDM|2057.62|99|0.00|TREAT LOWER LEG BONE LESION
20|FH_F132988_0_0|SrvcGrp|112160|2022|PDM|1766.05|99|0.00|DRAIN SHOULDER LESION
20|FH_F132988_0_0|SrvcGrp|112162|2022|PDM|14776.53|99|0.00|RECONSTRUCT WRIST-LUNATE
20|FH_F132988_0_0|SrvcGrp|112163|2022|PDM|12588.77|99|0.00|REVISE RECONST ELBOW JOINT
20|FH_F132988_0_0|SrvcGrp|112167|2022|PDM|6196.43|99|0.00|REPAIR ELBOW FRACTURE
20|FH_F132988_0_0|SrvcGrp|11673|2022|PDM|6052.21|99|0.00|CPT 29888
20|FH_F132988_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F132988_0_0|SrvcGrp|27315|2022|PDM|4493.01|99|0.00|TENDON REPAIR
20|FH_F132988_0_0|SrvcGrp|34603|2022|PDM|4493.01|99|0.00|CPT 24341
20|FH_F132988_0_0|SrvcGrp|38352|2022|PDM|6093.66|99|0.00|FOOT MUSCLOSKELETAL PROCEDURE
20|FH_F132988_0_0|SrvcGrp|38364|2022|PDM|7510.24|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F132988_0_0|SrvcGrp|41325|2022|PDM|4493.01|99|0.00|OP SURGERY CPT 24342
20|FH_F132988_0_0|SrvcGrp|41334|2022|PDM|17000.00|99|0.00|TOTAL KNEE
20|FH_F132988_0_0|SrvcGrp|67074|2022|PDM|4493.01|99|0.00|AC SURGERY
20|FH_F132988_0_0|SrvcGrp|67279|2022|PDM|12555.41|99|0.00|CERVICAL SURGERY
20|FH_F132988_0_0|SrvcGrp|84313|2022|PDM|2057.62|99|0.00|TENDON REPAIR
20|FH_F132988_0_0|SrvcGrp|84314|2022|PDM|2057.62|99|0.00|MINOR SURGERY
20|FH_F132988_0_0|SrvcGrp|85792|2022|PDM|6359.65|99|0.00|OPEN TREATMENT OF DISTAL
20|FH_F132988_0_0|SrvcGrp|90360|2022|PDM|4493.01|99|0.00|REPAIR FRACTURE OF ULNA
20|FH_F132988_0_0|SrvcGrp|90363|2022|PDM|6024.30|99|0.00|REVISE/IMPLANT FINGER JOINT
20|FH_F132988_0_0|SrvcGrp|90420|2022|PDM|6057.71|99|0.00|REPAIR CLAVICLE FRACTURE
20|FH_F132988_0_0|SrvcGrp|92006|2022|PDM|4493.01|99|0.00|SCAPULAR FRACTURE
20|FH_F132988_0_0|SrvcGrp|92011|2022|PDM|895.82|99|0.00|REMOVAL OF IMPLANT
20|FH_F132988_0_0|SrvcGrp|92364|2022|PDM|20434.62|99|0.00|ARTHRODESIS SACROILIAC JOINT
20|FH_F132988_0_0|SrvcGrp|92370|2022|PDM|2057.62|99|0.00|FUSION OF KNUCKLE JOINT
20|FH_F132988_0_0|SrvcGrp|92819|2022|PDM|4493.01|99|0.00|HIP ARTHOSCOPY
20|FH_F132988_0_0|SrvcGrp|95462|2022|PDM|4493.01|99|0.00|REPAIR OF ANKLE LIGAMENT
20|FH_F132988_0_0|SrvcGrp|96839|2022|PDM|24603.00|99|0.00|REVISE SPINE ELTRD PLATE
20|FH_F132988_0_0|SrvcGrp|98266|2022|PDM|4493.01|99|0.00|REVISE KNEECAP
20|FH_F133002_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F133002_0_0|SrvcGrp|104003|2022|PDM|2287.00|99|0.00|INSERT AQUEOUS DRAIN DEVICES
20|FH_F133002_0_0|SrvcGrp|28547|2022|PDM|1716.00|99|0.00|VITRECTOMY
20|FH_F133002_0_0|SrvcGrp|28551|2022|PDM|1716.00|99|0.00|REPAIR OF COMPLEX RETINAL DETACHMENT
20|FH_F133002_0_0|SrvcGrp|49205|2022|PDM|1716.00|99|0.00|REPAIR DETACHED RETINA
20|FH_F133002_0_0|SrvcGrp|72994|2022|PDM|647.00|99|0.00|AEG 3
20|FH_F133002_0_0|SrvcGrp|73000|2022|PDM|1041.00|99|0.00|AEG 6
20|FH_F133002_0_0|SrvcGrp|73008|2022|PDM|562.00|99|0.00|AEG 10
20|FH_F133002_0_0|SrvcGrp|84279|2022|PDM|1716.00|99|0.00|CORNEAL TRANSPLANT
20|FH_F133002_0_0|SrvcGrp|92659|2022|PDM|1716.00|99|0.00|REPAIR OF RETINAL DETACHMENT
20|FH_F133011_0_0|CSTM-ALL|CSTM-00|2020|PDM|1312.00|99|0.00|AEG 5  (NO REV)
20|FH_F133011_0_0|CSTM-ALL|CSTM-00|2020|PDM|1564.00|99|0.00|AEG 6 (NO REV)
20|FH_F133025_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F133025_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F133025_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F133025_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F133100_0_0|CSTM-ALL|CSTM-00|2020|PDM|1900.00|99|0.00|AEG 9 (NO REV)
20|FH_F133100_0_0|CSTM-ALL|CSTM-00|2020|PDM|475.00|99|0.00|AEG 1 (NO REV)
20|FH_F133132_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F133140_0_0|CSTM-ALL|CSTM-00|2020|PDM|610.00|99|0.00|AEG 5  (NO REV)
20|FH_F133140_0_0|SrvcGrp|14614|2022|PDM|2300.00|99|0.00|LITHOTRIPSY
20|FH_F133155_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F133155_0_0|SrvcGrp|65720|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F133155_0_0|SrvcGrp|90707|2022|PDM|100.00|99|0.00|AETNA HOSPICE CARE
20|FH_F133155_0_0|SrvcGrp|97507|2022|PDM|100.00|99|0.00|AETNA HOSPICE
20|FH_F133178_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F133178_0_0|CSTM-ALL|CSTM-00|2020|PDM|1262.00|99|0.00|AEG 8 (NO REV)
20|FH_F133178_0_0|CSTM-ALL|CSTM-00|2020|PDM|1289.00|99|0.00|AEG 7 (NO REV)
20|FH_F133178_0_0|CSTM-ALL|CSTM-00|2020|PDM|1726.00|99|0.00|AEG 9 (NO REV)
20|FH_F133178_0_0|SrvcGrp|103513|2022|PDM|74.00|99|0.00|VAGINA EXAMINATION & BIOPSY
20|FH_F133178_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F133178_0_0|SrvcGrp|106719|2022|PDM|1255.00|99|0.00|INDUCED ABORTION BY DILATION AND EVACUATION
20|FH_F133178_0_0|SrvcGrp|111966|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F133178_0_0|SrvcGrp|112204|2022|PDM|728.00|99|0.00|DESTRUCTION PENIS LESION
20|FH_F133178_0_0|SrvcGrp|112206|2022|PDM|106.00|99|0.00|DESTROY VULVA LESIONS
20|FH_F133178_0_0|SrvcGrp|112208|2022|PDM|94.00|99|0.00|DESTROY VAGINAL LESIONS SIMPLE
20|FH_F133178_0_0|SrvcGrp|112209|2022|PDM|1255.00|99|0.00|DESTROY VAGINAL LESIONS COMPLEX
20|FH_F133178_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F133178_0_0|SrvcGrp|33977|2022|PDM|1255.00|99|0.00|CPT 59820
20|FH_F133207_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F133207_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F133207_0_0|SrvcGrp|100067|2022|PDM|3360.00|99|0.00|ANKLE ARTHROSCOPY SURGERY
20|FH_F133207_0_0|SrvcGrp|100919|2022|PDM|5040.00|99|0.00|SPINE PROSTH DEVICE
20|FH_F133207_0_0|SrvcGrp|102480|2022|PDM|2632.00|99|0.00|CPT 29897
20|FH_F133207_0_0|SrvcGrp|106264|2022|PDM|5293.00|99|0.00|NSL/SINS NDSC W/ SINS DILATION
20|FH_F133207_0_0|SrvcGrp|107362|2022|PDM|5032.00|99|0.00|ALLOGRAFT FOR SPINE SURGERY
20|FH_F133207_0_0|SrvcGrp|111994|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES
20|FH_F133207_0_0|SrvcGrp|112220|2022|PDM|6684.00|99|0.00|TREATMENT OF FRACTURE
20|FH_F133207_0_0|SrvcGrp|26273|2022|PDM|3529.00|99|0.00|CPT 29880
20|FH_F133207_0_0|SrvcGrp|26274|2022|PDM|3529.00|99|0.00|CPT 29877
20|FH_F133207_0_0|SrvcGrp|27261|2022|PDM|14001.00|99|0.00|CPT 27446
20|FH_F133207_0_0|SrvcGrp|33985|2022|PDM|2632.00|99|0.00|CPT 19120
20|FH_F102302_0_0|SrvcGrp|16670|2022|PDM|1817.00|99|0.00|ULNAR NERVE AT ELBOW
20|FH_F102302_0_0|SrvcGrp|58755|2022|PDM|8900.00|99|0.00|INJECTION PROC FOR JOINT
20|FH_F102302_0_0|SrvcGrp|72990|2022|PDM|615.00|99|0.00|AEG 1
20|FH_F102302_0_0|SrvcGrp|72994|2022|PDM|1034.00|99|0.00|AEG 3
20|FH_F102302_0_0|SrvcGrp|80877|2022|PDM|14300.00|99|0.00|CRANIAL DEVICE INSERTION/REPLACEMENT
20|FH_F102302_0_0|SrvcGrp|93740|2022|PDM|14300.00|99|0.00|REVISE/REMOVE NEURO RECEIVER
20|FH_F102302_0_0|SrvcGrp|93741|2022|PDM|14300.00|99|0.00|REVISE SPINE ELECTRODE PERCUTANEOUS ARRAY
20|FH_F102302_0_0|SrvcGrp|96349|2022|PDM|29900.00|99|0.00|NECK SPINE FUSE
20|FH_F102302_0_0|SrvcGrp|96351|2022|PDM|29900.00|99|0.00|SPINE PROSTHESIS DEVICE
20|FH_F102302_0_0|SrvcGrp|97099|2022|PDM|10850.00|99|0.00|SPINAL DISK SURGERY ADD-ON
20|FH_F102302_0_0|SrvcGrp|97239|2022|PDM|29900.00|99|0.00|DISKECTOMY CERVICAL SINGLE
20|FH_F102302_0_0|SrvcGrp|98563|2022|PDM|39100.00|99|0.00|LUMBAR SPINE FUSION
20|FH_F102302_0_0|SrvcGrp|98570|2022|PDM|29900.00|99|0.00|INSERT SPINE FIXATION DEVICE
20|FH_F102302_0_0|SrvcGrp|98573|2022|PDM|29900.00|99|0.00|DISKECTOMY THORACIC SINGLE
20|FH_F102302_0_0|SrvcGrp|98574|2022|PDM|29900.00|99|0.00|SPINE DISK SURGERY THORAX
20|FH_F102302_0_0|SrvcGrp|98581|2022|PDM|29900.00|99|0.00|FUSION OF SACROILIAC JOINT
20|FH_F102302_0_0|SrvcGrp|98587|2022|PDM|14750.00|99|0.00|IMPLNT SPINAL CANAL CATHETER
20|FH_F102302_0_0|SrvcGrp|98591|2022|PDM|10850.00|99|0.00|LAMINECTOMY OF SPINAL CORD
20|FH_F102302_0_0|SrvcGrp|98594|2022|PDM|10850.00|99|0.00|SPINAL CRD DECOMP->2 CERVIC
20|FH_F102302_0_0|SrvcGrp|98601|2022|PDM|10850.00|99|0.00|TRANSPEDICULAR 1 SEG THORACIC
20|FH_F102302_0_0|SrvcGrp|98606|2022|PDM|1817.00|99|0.00|REVISE HAND/FOOT NERVE
20|FH_F102302_0_0|SrvcGrp|98609|2022|PDM|29900.00|99|0.00|POSTERIOR SEGMENTAL INSTRU
20|FH_F102341_0_0|SrvcGrp|73483|2022|PDM|831.00|99|0.00|AETNA SUBACUTE III
20|FH_F102500_0_0|SrvcGrp|72990|2022|PDM|519.00|99|0.00|AEG 1
20|FH_F102500_0_0|SrvcGrp|72994|2022|PDM|794.00|99|0.00|AEG 3
20|FH_F102500_0_0|SrvcGrp|73002|2022|PDM|1551.00|99|0.00|AEG 7
20|FH_F102500_0_0|SrvcGrp|73006|2022|PDM|2087.00|99|0.00|AEG 9
20|FH_F102500_0_0|SrvcGrp|93121|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F102542_0_0|SrvcGrp|10393|2022|PDM|1550.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F102542_0_0|SrvcGrp|11199|2022|PDM|500.00|99|0.00|HYPERBARIC CHAMBER
20|FH_F102620_0_0|SrvcGrp|33813|2022|PDM|646.88|99|0.00|CD - DETOX
20|FH_F102623_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F102623_0_0|SrvcGrp|26472|2022|PDM|420.00|99|0.00|HEMODIALYSIS
20|FH_F102623_0_0|SrvcGrp|94499|2022|PDM|420.00|99|0.00|PERITONEAL/CAPD/CCPD
20|FH_F102623_0_0|SrvcGrp|94500|2022|PDM|180.00|99|0.00|PERITONEAL/CAPD/CCPD
20|FH_F102641_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F102641_0_0|SrvcGrp|11306|2022|PCT|0.53|99|0.00|IMPLANTS
20|FH_F102641_0_0|SrvcGrp|72992|2022|PDM|753.00|99|0.00|AEG 2
20|FH_F102641_0_0|SrvcGrp|91528|2022|PDM|1295.00|99|0.00|SPINAL CORD IMPLANT
20|FH_F102726_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F102760_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F102844_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 10 (NO REV)
20|FH_F102881_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F102881_0_0|CSTM-ALL|CSTM-00|2020|PDM|2826.00|99|0.00|AEG 8 (NO REV)
20|FH_F102881_0_0|SrvcGrp|98720|2022|PCT|0.90|99|0.00|AETNA IMPLANTS
20|FH_F102920_0_0|SrvcGrp|11306|2022|PCT|0.53|99|0.00|IMPLANTS
20|FH_F102920_0_0|SrvcGrp|72992|2022|PDM|753.00|99|0.00|AEG 2
20|FH_F102920_0_0|SrvcGrp|98779|2022|PDM|3096.00|99|0.00|INCISION OF TENDON SHEATH
20|FH_F102943_0_0|CSTM-ALL|CSTM-00|2020|PDM|1001.00|99|0.00|AEG 8 (NO REV)
20|FH_F102943_0_0|CSTM-ALL|CSTM-00|2020|PDM|1017.00|99|0.00|AEG 7 (NO REV)
20|FH_F102943_0_0|CSTM-ALL|CSTM-00|2020|PDM|521.00|99|0.00|AEG 10 (NO REV)
20|FH_F102943_0_0|CSTM-ALL|CSTM-00|2020|PDM|616.38|99|0.00|AEG 2 (NO REV)
20|FH_F102943_0_0|SrvcGrp|95115|2022|PDM|743.05|99|0.00|BIOPSY OF LIVER
20|FH_F103000_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F103060_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F103060_0_0|SrvcGrp|11000|2022|PCT|1.00|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F103060_0_0|SrvcGrp|54943|2022|PDM|3121.00|99|0.00|REPAIR OF SLAP LESION
20|FH_F103060_0_0|SrvcGrp|58993|2022|PDM|7803.00|99|0.00|DISKECTOMY
20|FH_F103060_0_0|SrvcGrp|72992|2022|PDM|1691.00|99|0.00|AEG 2
20|FH_F103060_0_0|SrvcGrp|72996|2022|PDM|2315.00|99|0.00|AEG 4
20|FH_F103060_0_0|SrvcGrp|72998|2022|PDM|2523.00|99|0.00|AEG 5
20|FH_F103060_0_0|SrvcGrp|73002|2022|PDM|2601.00|99|0.00|AEG 7
20|FH_F103060_0_0|SrvcGrp|89842|2022|PDM|8323.00|99|0.00|LUMBAR
20|FH_F103060_0_0|SrvcGrp|95559|2022|PDM|7803.00|99|0.00|HIP JOINT
20|FH_F103060_0_0|SrvcGrp|98493|2022|PDM|8323.00|99|0.00|THORACIC
20|FH_F103122_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|AEG 5  (NO REV)
20|FH_F103140_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|AETNA NON TRAUMA INJURY
20|FH_F103140_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|DAY HOSPITAL FULL DAY
20|FH_F103140_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F103220_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F103220_0_0|CSTM-ALL|CSTM-00|2020|PDM|1760.00|99|0.00|AEG 2 (NO REV)
20|FH_F103220_0_0|CSTM-ALL|CSTM-00|2020|PDM|1760.00|99|0.00|AEG 4 (NO REV)
20|FH_F103220_0_0|SrvcGrp|107757|2022|PDM|13750.00|99|0.00|LAP PARAESOPH HER RPR W/ MESH
20|FH_F103220_0_0|SrvcGrp|81904|2022|PDM|13750.00|99|0.00|LAP PARASOPHAG HERNIA REPAIR
20|FH_F103220_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F103320_0_0|SrvcGrp|72994|2022|PDM|825.00|99|0.00|AEG 3
20|FH_F103320_0_0|SrvcGrp|72996|2022|PDM|923.00|99|0.00|AEG 4
20|FH_F103320_0_0|SrvcGrp|73000|2022|PDM|1213.00|99|0.00|AEG 6
20|FH_F103320_0_0|SrvcGrp|73004|2022|PDM|1572.00|99|0.00|AEG 8
20|FH_F103781_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F103781_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F103781_0_0|SrvcGrp|48396|2022|PDM|80.00|99|0.00|OT SERVICES
20|FH_F103781_0_0|SrvcGrp|88621|2022|PDM|70.00|99|0.00|SKILLED NURSING LPN
20|FH_F103821_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F103821_0_0|SrvcGrp|472|2022|PDM|703.31|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F104180_0_0|SrvcGrp|472|2022|PDM|594.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F104340_0_0|SrvcGrp|82981|2022|PDM|120.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F104520_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F104520_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F104520_0_0|SrvcGrp|24739|2022|PDM|90.00|99|0.00|RESPITE CARE
20|FH_F104520_0_0|SrvcGrp|80317|2022|PDM|90.00|99|0.00|RESPITE CARE
20|FH_F104700_0_0|SrvcGrp|72996|2022|PDM|1245.00|99|0.00|AEG 4
20|FH_F104700_0_0|SrvcGrp|73002|2022|PDM|1245.00|99|0.00|AEG 7
20|FH_F104700_0_0|SrvcGrp|73004|2022|PDM|1500.00|99|0.00|AEG 8
20|FH_F104740_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F104800_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 9 (NO REV)
20|FH_F104800_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 3 (NO REV)
20|FH_F104800_0_0|CSTM-ALL|CSTM-00|2020|PDM|998.00|99|0.00|AEG 8 (NO REV)
20|FH_F104802_0_0|SrvcGrp|14165|2022|PDM|350.00|99|0.00|PARTIAL HOSP PSYCH/CD
20|FH_F104941_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F105142_0_0|CSTM-ALL|CSTM-00|2020|PDM|512.28|99|0.00|AEG 3 (NO REV)
20|FH_F105142_0_0|CSTM-ALL|CSTM-00|2020|PDM|739.20|99|0.00|AEG 2 (NO REV)
20|FH_F105142_0_0|CSTM-ALL|CSTM-00|2020|PDM|999.46|99|0.00|AEG 7 (NO REV)
20|FH_F105320_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F105320_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|HOSPICE CARE
20|FH_F105320_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F105421_0_0|SrvcGrp|67684|2022|PDM|215.00|99|0.00|PSYCH VISIT
20|FH_F105421_0_0|SrvcGrp|9811|2022|PDM|650.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F105593_0_0|SrvcGrp|46605|2022|PDM|80.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES
20|FH_F105600_0_0|CSTM-ALL|CSTM-00|2020|PDM|1213.00|99|0.00|AEG 6 (NO REV)
20|FH_F105600_0_0|CSTM-ALL|CSTM-00|2020|PDM|912.00|99|0.00|AEG 4 (NO REV)
20|FH_F105680_0_0|SrvcGrp|75485|2022|PDM|1440.00|99|0.00|AEG 4
20|FH_F105680_0_0|SrvcGrp|75489|2022|PDM|1800.00|99|0.00|AEG 6
20|FH_F105680_0_0|SrvcGrp|75493|2022|PDM|1800.00|99|0.00|AEG 8
20|FH_F105680_0_0|SrvcGrp|75495|2022|PDM|1920.00|99|0.00|AEG 9
20|FH_F106020_0_0|CSTM-ALL|CSTM-00|2020|PDM|1108.00|99|0.00|AEG 8 (NO REV)
20|FH_F106020_0_0|SrvcGrp|16732|2022|PDM|2521.00|99|0.00|HYSTEROSCOPY ABLATION
20|FH_F106020_0_0|SrvcGrp|42472|2022|PDM|1681.00|99|0.00|CPT 58670
20|FH_F106500_0_0|CSTM-ALL|CSTM-00|2020|PDM|336.00|99|0.00|CPT 95805 (W/MOD TC)
20|FH_F106500_0_0|CSTM-ALL|CSTM-00|2020|PDM|508.00|99|0.00|CPT 95810 (W/MOD TC)
20|FH_F106500_0_0|CSTM-ALL|CSTM-00|2020|PDM|544.00|99|0.00|CPT 95811 (W/MOD TC)
20|FH_F106500_0_0|CSTM-ALL|CSTM-00|2020|PDM|549.00|99|0.00|AETNA POLYSOMNOGRAPHY
20|FH_F106500_0_0|SrvcGrp|30089|2022|PDM|428.00|99|0.00|HEMODIALYSIS SERVICES
20|FH_F106822_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F106822_0_0|SrvcGrp|100252|2022|PDM|57.00|99|0.00|REPAIR SUPERFICIAL WOUND(S) (7.6 - 12.5 CM)
20|FH_F106822_0_0|SrvcGrp|100253|2022|PDM|57.00|99|0.00|REPAIR SUPERFICIAL WOUND(S) (12.6 - 20.0 CM)
20|FH_F106822_0_0|SrvcGrp|100254|2022|PDM|57.00|99|0.00|REPAIR SUPERFICIAL WOUND(S) (20.1 - 30.0 CM)
20|FH_F106822_0_0|SrvcGrp|100256|2022|PDM|57.00|99|0.00|REPAIR SUPERFICIAL WOUND(S) (2.6 - 5.0 CM)
20|FH_F106822_0_0|SrvcGrp|100260|2022|PDM|57.00|99|0.00|REPAIR SUPERFICIAL WOUND(S) (OVER 30.0 CM)
20|FH_F106822_0_0|SrvcGrp|100264|2022|PDM|30.00|99|0.00|REMOVE IMPACTED EAR WAX
20|FH_F106822_0_0|SrvcGrp|100267|2022|PDM|9.61|99|0.00|URINE BACTERIA CULTURE
20|FH_F106822_0_0|SrvcGrp|100275|2022|PDM|125.60|99|0.00|MENINGOCOCCL POLYSACCHRID VA
20|FH_F106822_0_0|SrvcGrp|100276|2022|PDM|121.00|99|0.00|MCV4 MENACWY VACCINE IM
20|FH_F106822_0_0|SrvcGrp|100278|2022|PDM|0.29|99|0.00|INJ DEXAMETHASONE ACETATE
20|FH_F106822_0_0|SrvcGrp|100281|2022|PDM|7.95|99|0.00|IM ADMIN 1ST/ONLY COMPONENT (HCFA)
20|FH_F106822_0_0|SrvcGrp|100282|2022|PDM|5.00|99|0.00|IM ADMIN EACH ADDL COMPONENT (HCFA)
20|FH_F106822_0_0|SrvcGrp|100283|2022|PDM|7.95|99|0.00|SINGLE IMMUNIZATION ADMIN (HCFA)
20|FH_F106822_0_0|SrvcGrp|101744|2022|PDM|5.00|99|0.00|IM ADMIN EACH ADDL COMPONENT
20|FH_F106822_0_0|SrvcGrp|45307|2022|PDM|7.95|99|0.00|ADMIN OF INFLUENZA VIRUS VACCINE
20|FH_F106822_0_0|SrvcGrp|82746|2022|PDM|12.26|99|0.00|CULT BACT BLD AEROIC ISOLA
20|FH_F106822_0_0|SrvcGrp|91631|2022|PDM|45.00|99|0.00|OFFICE VISIT
20|FH_F106822_0_0|SrvcGrp|94423|2022|PDM|7.95|99|0.00|IMMUNIZATIONS
20|FH_F106822_0_0|SrvcGrp|94882|2022|PDM|12.70|99|0.00|FLU VIRUS VACC-SPLIT 3 YRS & ABOVE
20|FH_F106822_0_0|SrvcGrp|97972|2022|PDM|10.27|99|0.00|TYMPANOMETRY IMPEDANCE TEST
20|FH_F106841_0_0|CSTM-ALL|CSTM-00|2020|PDM|1156.65|99|0.00|AEG 8 (NO REV)
20|FH_F106841_0_0|CSTM-ALL|CSTM-00|2020|PDM|388.57|99|0.00|AEG 1 (NO REV)
20|FH_F106841_0_0|CSTM-ALL|CSTM-00|2020|PDM|837.35|99|0.00|AEG 5  (NO REV)
20|FH_F106841_0_0|CSTM-ALL|CSTM-00|2020|PDM|984.28|99|0.00|AEG 6 (NO REV)
20|FH_F106940_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|GENERAL ACUTE CARE
20|FH_F106942_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F106960_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE
20|FH_F106961_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F106964_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F106964_0_0|CSTM-ALL|CSTM-00|2020|PDM|1145.00|99|0.00|AEG 4 (NO REV)
20|FH_F106964_0_0|CSTM-ALL|CSTM-00|2020|PDM|2436.00|99|0.00|AEG 9 (NO REV)
20|FH_F106964_0_0|CSTM-ALL|CSTM-00|2020|PDM|320.00|99|0.00|AEG 1 (NO REV)
20|FH_F106964_0_0|CSTM-ALL|CSTM-00|2020|PDM|812.00|99|0.00|AEG 2 (NO REV)
20|FH_F106964_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F106980_0_0|SrvcGrp|12491|2022|PCT|1.05|99|0.00|PACEMAKER
20|FH_F106980_0_0|SrvcGrp|705|2022|PCT|1.05|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F106980_0_0|SrvcGrp|73004|2022|PDM|1225.00|99|0.00|AEG 8
20|FH_F107200_0_0|CSTM-ALL|CSTM-00|2020|PDM|1301.00|99|0.00|AEG 10 (NO REV)
20|FH_F133207_0_0|SrvcGrp|34605|2022|PDM|4774.00|99|0.00|CPT 28299
20|FH_F133207_0_0|SrvcGrp|34606|2022|PDM|3883.00|99|0.00|CPT 29827
20|FH_F133207_0_0|SrvcGrp|72121|2022|PDM|3809.00|99|0.00|ARTHOSCOPY
20|FH_F133207_0_0|SrvcGrp|78096|2022|PDM|3809.00|99|0.00|AETNA ARTHROSCOPY BICEPS
20|FH_F133207_0_0|SrvcGrp|82107|2022|PDM|3527.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F133207_0_0|SrvcGrp|83646|2022|PDM|3529.00|99|0.00|CPT 31276
20|FH_F133207_0_0|SrvcGrp|84182|2022|PDM|3192.00|99|0.00|AETNA REMOVAL OF BREAST CAPSULE
20|FH_F133207_0_0|SrvcGrp|88599|2022|PDM|3529.00|99|0.00|ENDOSCOPY MAXILLARY SINUS
20|FH_F133207_0_0|SrvcGrp|90822|2022|PDM|3529.00|99|0.00|NASAL/SINUS ENDOSCOPY SURGERY
20|FH_F133207_0_0|SrvcGrp|91941|2022|PDM|3529.00|99|0.00|NASAL/SINUS ENDOSCOPY WITH DILATION
20|FH_F133207_0_0|SrvcGrp|94989|2022|PDM|3529.00|99|0.00|SINUS ENDO W/ BALLOON DILATION
20|FH_F133207_0_0|SrvcGrp|96539|2022|PDM|4256.00|99|0.00|REVISION OF ANKLE LIGAMENT
20|FH_F133209_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.24|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE
20|FH_F133209_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F133211_0_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB
20|FH_F133211_0_0|SrvcGrp|112224|2022|PDM|95.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)
20|FH_F133215_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F133215_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F133215_0_0|SrvcGrp|63297|2022|PDM|100.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F133215_0_0|SrvcGrp|65720|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F133223_0_0|SrvcGrp|112225|2022|PDM|23.00|99|0.00|COVID-19 SPECIMEN COLLECTION
20|FH_F133224_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS
20|FH_F133232_0_0|SrvcGrp|87077|2022|PDM|120.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F133247_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F133247_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F133247_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)
20|FH_F133327_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F133327_0_0|SrvcGrp|87077|2022|PDM|150.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F133474_0_0|SrvcGrp|100860|2022|PDM|170.00|99|0.00|OFFICE/OUTPATIENT VISIT NEW
20|FH_F133474_0_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)
20|FH_F133474_0_0|SrvcGrp|112727|2022|PDM|45.23|99|0.00|COVID-19 IA NFCT AB SARS COV 2
20|FH_F133485_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE
20|FH_F133492_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F133492_0_0|SrvcGrp|86425|2022|PDM|1327.00|99|0.00|EGD LESION ABLATION
20|FH_F133519_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F133519_0_0|CSTM-ALL|CSTM-00|2020|PDM|1289.00|99|0.00|AEG 7 (NO REV)
20|FH_F133519_0_0|CSTM-ALL|CSTM-00|2020|PDM|670.00|99|0.00|AEG 3 (NO REV)
20|FH_F133519_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F133519_0_0|SrvcGrp|111966|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F133519_0_0|SrvcGrp|112204|2022|PDM|728.00|99|0.00|DESTRUCTION PENIS LESION
20|FH_F133519_0_0|SrvcGrp|112205|2022|PDM|586.00|99|0.00|BIOPSY OF PENIS
20|FH_F133519_0_0|SrvcGrp|112208|2022|PDM|94.00|99|0.00|DESTROY VAGINAL LESIONS SIMPLE
20|FH_F133519_0_0|SrvcGrp|112209|2022|PDM|1255.00|99|0.00|DESTROY VAGINAL LESIONS COMPLEX
20|FH_F133519_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F133536_0_0|CSTM-ALL|CSTM-00|2020|PDM|1012.00|99|0.00|AEG 2 (NO REV)
20|FH_F133536_0_0|CSTM-ALL|CSTM-00|2020|PDM|1760.00|99|0.00|AEG 5  (NO REV)
20|FH_F133536_0_0|CSTM-ALL|CSTM-00|2020|PDM|1870.00|99|0.00|AEG 6 (NO REV)
20|FH_F133536_0_0|CSTM-ALL|CSTM-00|2020|PDM|2640.00|99|0.00|AEG 9 (NO REV)
20|FH_F133536_0_0|SrvcGrp|100002|2022|PDM|3145.00|99|0.00|REPAIR SHOULDER CAPSULE
20|FH_F133536_0_0|SrvcGrp|100065|2022|PDM|1682.00|99|0.00|DEEP ANT OR POSTER TIBIAL
20|FH_F133536_0_0|SrvcGrp|100660|2022|PDM|1100.00|99|0.00|AETNA SURGERY
20|FH_F133536_0_0|SrvcGrp|102481|2022|PDM|3215.00|99|0.00|CPT 29898
20|FH_F133536_0_0|SrvcGrp|109366|2022|PDM|9500.00|99|0.00|RELIEVE SPINAL CORD PRESSURE
20|FH_F133536_0_0|SrvcGrp|11663|2022|PCT|1.10|99|0.00|IMPLANTS
20|FH_F133536_0_0|SrvcGrp|26277|2022|PDM|3215.00|99|0.00|CPT 29874
20|FH_F133536_0_0|SrvcGrp|33724|2022|PDM|3215.00|99|0.00|ARTHROSCOPY
20|FH_F133536_0_0|SrvcGrp|36591|2022|PDM|8250.00|99|0.00|CPT 63685
20|FH_F133536_0_0|SrvcGrp|37166|2022|PDM|1000.00|99|0.00|PNEUMATIC COMPRESSION DEVICE, HIGH PRESSURE
20|FH_F133536_0_0|SrvcGrp|41325|2022|PDM|1682.00|99|0.00|OP SURGERY CPT 24342
20|FH_F133536_0_0|SrvcGrp|55071|2022|PDM|2750.00|99|0.00|ARTHROSCOPY SHOULDER
20|FH_F133536_0_0|SrvcGrp|67065|2022|PDM|17600.00|99|0.00|CERVICAL SURGERY
20|FH_F133536_0_0|SrvcGrp|69964|2022|PDM|2200.00|99|0.00|CPT 23120
20|FH_F133536_0_0|SrvcGrp|69967|2022|PDM|767.00|99|0.00|REMOVAL IMPLANTS
20|FH_F133536_0_0|SrvcGrp|69969|2022|PDM|2100.00|99|0.00|CPT 28285, 28292, 28296
20|FH_F133536_0_0|SrvcGrp|69978|2022|PDM|2415.00|99|0.00|ARTHROPLASTY
20|FH_F133536_0_0|SrvcGrp|82113|2022|PDM|3215.00|99|0.00|KNEE ARTHROSCOPY SURGERY
20|FH_F133536_0_0|SrvcGrp|82720|2022|PDM|2200.00|99|0.00|WRIST ENDOSCOPY/SURGERY
20|FH_F133536_0_0|SrvcGrp|92366|2022|PDM|1682.00|99|0.00|REPAIR ACHILLES TENDON
20|FH_F133536_0_0|SrvcGrp|99073|2022|PDM|1.38|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F133536_0_0|SrvcGrp|99155|2022|PDM|3215.00|99|0.00|WRST ARTHROS SURG
20|FH_F133579_0_0|CSTM-ALL|CSTM-00|2020|PDM|1749.00|99|0.00|DEVICE INSERTION
20|FH_F133579_0_0|CSTM-ALL|CSTM-00|2020|PDM|1906.00|99|0.00|AEG 6 (NO REV)
20|FH_F133579_0_0|CSTM-ALL|CSTM-00|2020|PDM|2291.00|99|0.00|AEG 8 (NO REV)
20|FH_F133579_0_0|CSTM-ALL|CSTM-00|2020|PDM|957.00|99|0.00|AEG 1 (NO REV)
20|FH_F133579_0_0|SrvcGrp|14614|2022|PDM|4060.00|99|0.00|LITHOTRIPSY
20|FH_F133579_0_0|SrvcGrp|28550|2022|PDM|2175.00|99|0.00|VITRECTOMY
20|FH_F133579_0_0|SrvcGrp|35669|2022|PDM|3248.00|99|0.00|CPT 63650
20|FH_F133579_0_0|SrvcGrp|84279|2022|PDM|2551.00|99|0.00|CORNEAL TRANSPLANT
20|FH_F133579_0_0|SrvcGrp|84280|2022|PDM|2551.00|99|0.00|CORNEAL TRANSPLANT
20|FH_F107200_0_0|CSTM-ALL|CSTM-00|2020|PDM|1561.00|99|0.00|AEG 9 (NO REV)
20|FH_F107200_0_0|SrvcGrp|101522|2022|PDM|6242.00|99|0.00|T1H W/T/O UTERUS (>250G)
20|FH_F107200_0_0|SrvcGrp|101523|2022|PDM|1665.00|99|0.00|CERCLAGE OF CERVIX
20|FH_F107200_0_0|SrvcGrp|101526|2022|PDM|5202.00|99|0.00|LAPARO-ASST VAG HYSTERECTOMY
20|FH_F107200_0_0|SrvcGrp|27348|2022|PDM|4422.00|99|0.00|OP SURGERY (CPT 58662)
20|FH_F107200_0_0|SrvcGrp|42472|2022|PDM|2705.00|99|0.00|CPT 58670
20|FH_F107200_0_0|SrvcGrp|78878|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F107200_0_0|SrvcGrp|79937|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F107200_0_0|SrvcGrp|83348|2022|PDM|5202.00|99|0.00|AETNA LAPAR-ASST HYSTERECTOMY
20|FH_F107200_0_0|SrvcGrp|93637|2022|PDM|5722.00|99|0.00|LAPAROSCOPY SURGICAL
20|FH_F107360_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F107400_0_0|SrvcGrp|27969|2022|PDM|23.00|99|0.00|HOME HEALTH AIDE
20|FH_F107400_0_0|SrvcGrp|46605|2022|PDM|125.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES
20|FH_F107400_0_0|SrvcGrp|48385|2022|PDM|125.00|99|0.00|SPEECH THERAPY
20|FH_F107400_0_0|SrvcGrp|48396|2022|PDM|140.00|99|0.00|OT SERVICES
20|FH_F107400_0_0|SrvcGrp|48398|2022|PDM|139.00|99|0.00|PT SERVICES
20|FH_F107400_0_0|SrvcGrp|88621|2022|PDM|120.00|99|0.00|SKILLED NURSING LPN
20|FH_F107480_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F107480_0_0|SrvcGrp|75479|2022|PDM|500.00|99|0.00|AEG 1
20|FH_F107480_0_0|SrvcGrp|75481|2022|PDM|600.00|99|0.00|AEG 2
20|FH_F107600_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F107600_0_0|CSTM-ALL|CSTM-00|2020|PDM|685.00|99|0.00|AEG 4 (NO REV)
20|FH_F107782_0_0|CSTM-ALL|CSTM-00|2020|PDM|1150.00|99|0.00|AEG 1 (NO REV)
20|FH_F107782_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 10 (NO REV)
20|FH_F107782_0_0|CSTM-ALL|CSTM-00|2020|PDM|2400.00|99|0.00|AEG 2 (NO REV)
20|FH_F107782_0_0|CSTM-ALL|CSTM-00|2020|PDM|2450.00|99|0.00|AEG 7 (NO REV)
20|FH_F107922_0_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS
20|FH_F107926_0_0|CSTM-ALL|CSTM-00|2020|PDM|1290.00|99|0.00|AEG 8 (NO REV)
20|FH_F107926_0_0|CSTM-ALL|CSTM-00|2020|PDM|751.00|99|0.00|AEG 4 (NO REV)
20|FH_F107926_0_0|SrvcGrp|112581|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F107926_0_0|SrvcGrp|54086|2022|PDM|1875.00|99|0.00|VITRECTOMY, MECHANICAL, PARS PLANA APPROACH
20|FH_F107926_0_0|SrvcGrp|86034|2022|PDM|1875.00|99|0.00|REPAIR DETACHED RETINA
20|FH_F108420_0_0|CSTM-ALL|CSTM-00|2020|PDM|1850.00|99|0.00|AEG 8 (NO REV)
20|FH_F108420_0_0|CSTM-ALL|CSTM-00|2020|PDM|580.00|99|0.00|AEG 1 (NO REV)
20|FH_F108420_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F108680_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F108680_0_0|CSTM-ALL|CSTM-00|2020|PDM|647.00|99|0.00|AEG 2 (NO REV)
20|FH_F108680_0_0|SrvcGrp|100919|2022|PDM|9900.00|99|0.00|SPINE PROSTH DEVICE
20|FH_F108680_0_0|SrvcGrp|102722|2022|PDM|5720.00|99|0.00|LAMINECTOMY W/ FACETECTOMY
20|FH_F108680_0_0|SrvcGrp|12664|2022|PCT|0.00|99|0.00|IMPLANTS
20|FH_F108680_0_0|SrvcGrp|36591|2022|PDM|28600.00|99|0.00|CPT 63685
20|FH_F108680_0_0|SrvcGrp|58671|2022|PDM|1650.00|99|0.00|ASC CARVE OUT 64721
20|FH_F108680_0_0|SrvcGrp|82109|2022|PDM|1650.00|99|0.00|REVISE ULNAR NERVE ELBOW
20|FH_F108680_0_0|SrvcGrp|88494|2022|PDM|3850.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION
20|FH_F108680_0_0|SrvcGrp|89848|2022|PDM|3276.90|99|0.00|SPINE FUSION EXTRA SEGMENT
20|FH_F108762_0_0|SrvcGrp|42784|2022|PDM|45.00|99|0.00|OCCUPATIONAL THERAPY  SRVCS
20|FH_F108762_0_0|SrvcGrp|473|2022|PDM|315.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F108800_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F108800_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F108800_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|AEG 4 (NO REV)
20|FH_F108800_0_0|CSTM-ALL|CSTM-00|2020|PDM|2450.00|99|0.00|AEG 5  (NO REV)
20|FH_F108800_0_0|SrvcGrp|101182|2022|PDM|3000.00|99|0.00|AETNA SHOULDER
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|DIURETIC THERAPY
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|HOME VISIT - POSTNATAL
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|INTERFERON
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|MIDLINE INSERTION KIT
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|MIDLINE INSERTION NURSING
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|PHENYLKEOTONURIA
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|PHOTOTHERAPY - BILIRUBIN
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|SKILLED NURSING NON IV RELATED
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|SPEECH THERAPY SERVICES
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|TOCOLYTIC THERAPY
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|UNCLASSIFIED INFUSION THERAPY
20|FH_F109000_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F109000_0_0|CSTM-ALL|CSTM-00|2020|PDM|1995.00|99|0.00|AEG 10 (NO REV)
20|FH_F109000_0_0|CSTM-ALL|CSTM-00|2020|PDM|2104.00|99|0.00|AEG 3 (NO REV)
20|FH_F109000_0_0|CSTM-ALL|CSTM-00|2020|PDM|3520.00|99|0.00|AEG 7 (NO REV)
20|FH_F109000_0_0|CSTM-ALL|CSTM-00|2020|PDM|770.00|99|0.00|AEG 1 (NO REV)
20|FH_F109000_0_0|SrvcGrp|102960|2022|PDM|6600.00|99|0.00|SP BONE
20|FH_F109000_0_0|SrvcGrp|40003|2022|PDM|10285.00|99|0.00|TOTAL KNEE
20|FH_F109040_0_0|SrvcGrp|82498|2022|PDM|180.00|99|0.00|DIALYSIS PROCEDURE OTHER THAN HEMODIALYSIS
20|FH_F109248_0_0|CSTM-ALL|CSTM-00|2020|PDM|1545.00|99|0.00|AEG 9 (NO REV)
20|FH_F109248_0_0|CSTM-ALL|CSTM-00|2020|PDM|541.00|99|0.00|AEG 1 (NO REV)
20|FH_F109248_0_0|CSTM-ALL|CSTM-00|2020|PDM|979.00|99|0.00|AEG 5  (NO REV)
20|FH_F109248_0_0|SrvcGrp|103236|2022|PDM|3350.00|99|0.00|AETNA INSJ STABLJ DEV
20|FH_F109252_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F109260_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F109260_0_0|CSTM-ALL|CSTM-00|2020|PDM|1192.99|99|0.00|AEG 2 (NO REV)
20|FH_F109260_0_0|SrvcGrp|41334|2022|PDM|22660.00|99|0.00|TOTAL KNEE
20|FH_F133579_0_0|SrvcGrp|88154|2022|PDM|2205.00|99|0.00|LASER TREATMENT OLD RETINA
20|FH_F133579_0_0|SrvcGrp|90601|2022|PDM|2205.00|99|0.00|REMOVAL OF LENS MATERIAL
20|FH_F133579_0_0|SrvcGrp|92659|2022|PDM|2205.00|99|0.00|REPAIR OF RETINAL DETACHMENT
20|FH_F133585_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F133585_0_0|CSTM-ALL|CSTM-00|2020|PDM|441.00|99|0.00|AEG 1 (NO REV)
20|FH_F133585_0_0|CSTM-ALL|CSTM-00|2020|PDM|836.00|99|0.00|AEG 4 (NO REV)
20|FH_F133585_0_0|SrvcGrp|107878|2022|PDM|2852.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT
20|FH_F133585_0_0|SrvcGrp|107881|2022|PDM|298.00|99|0.00|STENT PLMT CTR DIALYSIS SEG
20|FH_F133585_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F133585_0_0|SrvcGrp|109136|2022|PDM|3092.00|99|0.00|AV FISTULA REVISION
20|FH_F133585_0_0|SrvcGrp|109428|2022|PDM|131.00|99|0.00|INTRVASC US NONCORONARY
20|FH_F133585_0_0|SrvcGrp|109485|2022|PDM|307.00|99|0.00|ILIAC REVASC W/STENT ADD-ON
20|FH_F133585_0_0|SrvcGrp|111518|2022|PDM|330.00|99|0.00|STAB PHLEBECT VV 1 EXT
20|FH_F133585_0_0|SrvcGrp|112382|2022|PDM|183.00|99|0.00|INJECTION THERAPY OF VEINS
20|FH_F133585_0_0|SrvcGrp|112384|2022|PDM|1786.00|99|0.00|REMOVE TUNNELED IP CATH
20|FH_F133585_0_0|SrvcGrp|112387|2022|PDM|230.00|99|0.00|ARTERY X-RAYS ARM/LEG (HCFA)
20|FH_F133585_0_0|SrvcGrp|112389|2022|PDM|151.00|99|0.00|CPT 75774 (HCFA)
20|FH_F133585_0_0|SrvcGrp|17622|2022|PDM|151.00|99|0.00|CPT 75774
20|FH_F133585_0_0|SrvcGrp|77280|2022|PDM|1786.00|99|0.00|AETNA REPL TUNNLD CNTRL CVAD W/SUB
20|FH_F133585_0_0|SrvcGrp|77294|2022|PDM|42.00|99|0.00|AETNA DECLOT VASCULAR DEVICE
20|FH_F133585_0_0|SrvcGrp|89688|2022|PDM|195.00|99|0.00|CONTRAST X-RAY EXAM OF AORTA
20|FH_F133585_0_0|SrvcGrp|89701|2022|PDM|230.00|99|0.00|ARTERY X-RAYS ARM/LEG
20|FH_F133632_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 6 (NO REV)
20|FH_F133632_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 7 (NO REV)
20|FH_F133632_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 2 (NO REV)
20|FH_F133632_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 3 (NO REV)
20|FH_F133632_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|AEG 10 (NO REV)
20|FH_F133701_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F133907_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F133969_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F133969_0_0|CSTM-ALL|CSTM-00|2020|PDM|1117.13|99|0.00|AEG 7 (NO REV)
20|FH_F133990_0_0|CSTM-ALL|CSTM-00|2020|PCT|41.00|99|0.00|AEG 10 (NO REV)
20|FH_F133990_0_0|CSTM-ALL|CSTM-00|2020|PCT|41.00|99|0.00|AEG 2 (NO REV)
20|FH_F133990_0_0|CSTM-ALL|CSTM-00|2020|PCT|41.00|99|0.00|AEG 4 (NO REV)
20|FH_F133990_0_0|CSTM-ALL|CSTM-00|2020|PCT|41.00|99|0.00|AEG 5  (NO REV)
20|FH_F133990_0_0|CSTM-ALL|CSTM-00|2020|PCT|41.00|99|0.00|AEG 6 (NO REV)
20|FH_F133990_0_0|CSTM-ALL|CSTM-00|2020|PCT|41.00|99|0.00|AEG 7 (NO REV)
20|FH_F133990_0_0|CSTM-ALL|CSTM-00|2020|PCT|41.00|99|0.00|AEG 8 (NO REV)
20|FH_F133990_0_0|CSTM-ALL|CSTM-00|2020|PCT|41.00|99|0.00|OP SVCS
20|FH_F133994_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F133994_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F133994_0_0|SrvcGrp|82981|2022|PDM|145.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F134002_0_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F134027_0_0|CSTM-ALL|CSTM-00|2020|PDM|1333.00|99|0.00|AEG 6 (NO REV)
20|FH_F134027_0_0|CSTM-ALL|CSTM-00|2020|PDM|1596.00|99|0.00|AEG 8 (NO REV)
20|FH_F134027_0_0|CSTM-ALL|CSTM-00|2020|PDM|695.00|99|0.00|AEG 2 (NO REV)
20|FH_F134027_0_0|CSTM-ALL|CSTM-00|2020|PDM|882.00|99|0.00|AEG 3 (NO REV)
20|FH_F134027_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|AEG 10 (NO REV)
20|FH_F134027_0_0|SrvcGrp|103671|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F134087_0_0|CSTM-ALL|CSTM-00|2020|PDM|1322.00|99|0.00|AEG 3 (NO REV)
20|FH_F134087_0_0|CSTM-ALL|CSTM-00|2020|PDM|1636.00|99|0.00|AEG 4 (NO REV)
20|FH_F134087_0_0|CSTM-ALL|CSTM-00|2020|PDM|2885.00|99|0.00|AEG 8 (NO REV)
20|FH_F134087_0_0|CSTM-ALL|CSTM-00|2020|PDM|3126.00|99|0.00|AEG 7 (NO REV)
20|FH_F134087_0_0|CSTM-ALL|CSTM-00|2020|PDM|3607.00|99|0.00|AEG 9 (NO REV)
20|FH_F134087_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F134087_0_0|SrvcGrp|109143|2022|PDM|3312.00|99|0.00|SPINAL INSTRUMENTATION
20|FH_F134087_0_0|SrvcGrp|112555|2022|PDM|3607.00|99|0.00|INTERCALARY ALGRFT COMPL
20|FH_F134087_0_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS
20|FH_F134087_0_0|SrvcGrp|75002|2022|PDM|5410.00|99|0.00|ARTHOSCOPY
20|FH_F134087_0_0|SrvcGrp|77021|2022|PDM|5332.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY
20|FH_F134087_0_0|SrvcGrp|84939|2022|PDM|5273.00|99|0.00|SHOULDER JOINT
20|FH_F134087_0_0|SrvcGrp|85792|2022|PDM|4668.00|99|0.00|OPEN TREATMENT OF DISTAL
20|FH_F134087_0_0|SrvcGrp|88160|2022|PDM|5410.00|99|0.00|LAMINECTOMY W/FACETECTOMY
20|FH_F134087_0_0|SrvcGrp|88162|2022|PDM|5410.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON
20|FH_F134087_0_0|SrvcGrp|88164|2022|PDM|9017.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR
20|FH_F134087_0_0|SrvcGrp|88340|2022|PDM|5410.00|99|0.00|SPINAL FUSION
20|FH_F134087_0_0|SrvcGrp|89848|2022|PDM|9017.00|99|0.00|SPINE FUSION EXTRA SEGMENT
20|FH_F134087_0_0|SrvcGrp|89860|2022|PDM|5410.00|99|0.00|SPINAL DISK SURGERY ADD-ON
20|FH_F134087_0_0|SrvcGrp|92410|2022|PDM|5771.00|99|0.00|SPINE FUSION EXTRA SEGMENT
20|FH_F134087_0_0|SrvcGrp|99161|2022|PDM|10455.00|99|0.00|CPT 27138
20|FH_F134087_0_0|SrvcGrp|99162|2022|PDM|10455.00|99|0.00|CPT 24366
20|FH_F134192_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|AEG 3 (NO REV)
20|FH_F134192_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F134202_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F134202_0_0|CSTM-ALL|CSTM-00|2020|PDM|1008.00|99|0.00|AEG 6 (NO REV)
20|FH_F134202_0_0|CSTM-ALL|CSTM-00|2020|PDM|1218.00|99|0.00|AEG 8 (NO REV)
20|FH_F134202_0_0|CSTM-ALL|CSTM-00|2020|PDM|644.70|99|0.00|AEG 10 (NO REV)
20|FH_F134202_0_0|CSTM-ALL|CSTM-00|2020|PDM|735.00|99|0.00|AEG 3 (NO REV)
20|FH_F134202_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F134202_0_0|SrvcGrp|107441|2022|PDM|2896.08|99|0.00|AETNA CYSTOSCOPY PROSTATIC IMPLANTS
20|FH_F109277_0_0|SrvcGrp|11577|2022|PDM|652.00|99|0.00|DIALYSIS
20|FH_F109277_0_0|SrvcGrp|22528|2022|PDM|773.00|99|0.00|DAY HOSPITAL FULL DAY
20|FH_F109277_0_0|SrvcGrp|22529|2022|PDM|663.00|99|0.00|DAY HOSPITAL HALF DAY
20|FH_F109277_0_0|SrvcGrp|3259|2022|PDM|1597.00|99|0.00|ACUTE REHABILITATION
20|FH_F109277_0_0|SrvcGrp|9494|2022|PDM|865.00|99|0.00|SUBACUTE CARE
20|FH_F109279_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F109281_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F109281_0_0|CSTM-ALL|CSTM-00|2020|PDM|2660.00|99|0.00|AEG 9 (NO REV)
20|FH_F109281_0_0|CSTM-ALL|CSTM-00|2020|PDM|584.00|99|0.00|AEG 1 (NO REV)
20|FH_F109281_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|AEG 2 (NO REV)
20|FH_F109282_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F109343_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F109343_0_0|SrvcGrp|103605|2022|PCT|0.00|99|0.00|BIRTHING CENTER
20|FH_F109343_0_0|SrvcGrp|2047|2022|PDM|2860.00|99|0.00|BIRTHING CENTER
20|FH_F109343_0_0|SrvcGrp|84198|2022|PDM|520.00|99|0.00|AETNA MATERNITY TRANSFER
20|FH_F109346_0_0|SrvcGrp|2047|2022|PDM|2860.00|99|0.00|BIRTHING CENTER
20|FH_F109484_0_0|SrvcGrp|72992|2022|PDM|446.00|99|0.00|AEG 2
20|FH_F109484_0_0|SrvcGrp|72994|2022|PDM|510.00|99|0.00|AEG 3
20|FH_F109484_0_0|SrvcGrp|72998|2022|PDM|717.00|99|0.00|AEG 5
20|FH_F109484_0_0|SrvcGrp|73006|2022|PDM|1339.00|99|0.00|AEG 9
20|FH_F109501_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.79|99|0.00|GENERAL ACUTE CARE
20|FH_F109503_0_0|CSTM-ALL|CSTM-00|2020|PDM|315.00|99|0.00|AEG 1 (NO REV)
20|FH_F109503_0_0|CSTM-ALL|CSTM-00|2020|PDM|925.00|99|0.00|AEG 8 (NO REV)
20|FH_F109513_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F109513_0_0|SrvcGrp|27343|2022|PDM|4000.00|99|0.00|OP SURGERY (CPT 25607 - 25609)
20|FH_F109513_0_0|SrvcGrp|67072|2022|PDM|4500.00|99|0.00|CPT 22845
20|FH_F109513_0_0|SrvcGrp|72990|2022|PDM|472.50|99|0.00|AEG 1
20|FH_F109513_0_0|SrvcGrp|72992|2022|PDM|643.50|99|0.00|AEG 2
20|FH_F109513_0_0|SrvcGrp|73002|2022|PDM|1413.00|99|0.00|AEG 7
20|FH_F109513_0_0|SrvcGrp|73008|2022|PDM|913.50|99|0.00|AEG 10
20|FH_F109513_0_0|SrvcGrp|87059|2022|PDM|2700.00|99|0.00|REPAIR OF TENDON
20|FH_F109513_0_0|SrvcGrp|90384|2022|PDM|10000.00|99|0.00|TOTAL HIP ARTHROPLASTY
20|FH_F109513_0_0|SrvcGrp|90421|2022|PDM|4000.00|99|0.00|REPAIR OF ANKLE FRACTURE
20|FH_F109513_0_0|SrvcGrp|90426|2022|PDM|2500.00|99|0.00|SHOULDER ARTHROSCOPY SURGERY
20|FH_F109513_0_0|SrvcGrp|90432|2022|PDM|2000.00|99|0.00|REMOVAL OF BREAST IMPLANT
20|FH_F109513_0_0|SrvcGrp|90437|2022|PDM|2700.00|99|0.00|ANKLE SURGICAL PROCEDURES
20|FH_F109513_0_0|SrvcGrp|95559|2022|PDM|10000.00|99|0.00|HIP JOINT
20|FH_F109526_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F109538_0_0|SrvcGrp|82981|2022|PDM|125.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F109577_0_0|SrvcGrp|103613|2022|PDM|123.00|99|0.00|MED NUTRITION IND SUBSEQUENT
20|FH_F109577_0_0|SrvcGrp|49743|2022|PDM|123.00|99|0.00|DIABETIC MANAGEMENT
20|FH_F109577_0_0|SrvcGrp|63297|2022|PDM|195.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F109577_0_0|SrvcGrp|73523|2022|PDM|133.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F109577_0_0|SrvcGrp|87393|2022|PDM|135.00|99|0.00|HCPCS G0151 (HCFA)
20|FH_F109577_0_0|SrvcGrp|87397|2022|PDM|135.00|99|0.00|CPT 99500 (HCFA)
20|FH_F109577_0_0|SrvcGrp|90341|2022|PDM|135.00|99|0.00|SKILLED NURSING LPN (HCFA)
20|FH_F109577_0_0|SrvcGrp|93146|2022|PDM|123.00|99|0.00|DIABETIC MANAGEMENT PROGRAM
20|FH_F109577_0_0|SrvcGrp|95661|2022|PDM|195.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F109581_0_0|SrvcGrp|75479|2022|PDM|663.00|99|0.00|AEG 1
20|FH_F109581_0_0|SrvcGrp|75481|2022|PDM|886.00|99|0.00|AEG 2
20|FH_F109581_0_0|SrvcGrp|75495|2022|PDM|1512.00|99|0.00|AEG 9
20|FH_F109581_0_0|SrvcGrp|98448|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F109601_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F109601_0_0|SrvcGrp|75493|2022|PDM|1077.00|99|0.00|AEG 8
20|FH_F109601_0_0|SrvcGrp|75495|2022|PDM|1467.00|99|0.00|AEG 9
20|FH_F109601_0_0|SrvcGrp|98448|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F109630_0_0|CSTM-ALL|CSTM-00|2020|PDM|1802.20|99|0.00|AEG 9 (NO REV)
20|FH_F109632_0_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE
20|FH_F109632_0_0|SrvcGrp|83683|2022|PCT|0.00|99|0.00|ACUTE REHAB II
20|FH_F109645_0_0|SrvcGrp|103782|2022|PDM|70.00|99|0.00|PHYSICAL THERAPY SVCS (MOD GP) (HCFA)
20|FH_F109645_0_0|SrvcGrp|103783|2022|PDM|70.00|99|0.00|OCCUPATIONAL THERAPY (MOD GO) (HCFA)
20|FH_F109645_0_0|SrvcGrp|23681|2022|PDM|95.00|99|0.00|HOME VISIT - POSTNATAL
20|FH_F109645_0_0|SrvcGrp|27968|2022|PDM|25.00|99|0.00|SKILLED NURSING LPN
20|FH_F109645_0_0|SrvcGrp|27969|2022|PDM|40.00|99|0.00|HOME HEALTH AIDE
20|FH_F109645_0_0|SrvcGrp|34173|2022|PDM|118.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F109645_0_0|SrvcGrp|34389|2022|PDM|88.00|99|0.00|SPEECH THERAPY
20|FH_F109645_0_0|SrvcGrp|42404|2022|PDM|42.00|99|0.00|VENIPUNCTURE
20|FH_F109645_0_0|SrvcGrp|46118|2022|PDM|65.00|99|0.00|NUTRITNAL CNSLNG/DIABETES EDU
20|FH_F109645_0_0|SrvcGrp|87397|2022|PDM|90.00|99|0.00|CPT 99500 (HCFA)
20|FH_F109645_0_0|SrvcGrp|91678|2022|PDM|88.00|99|0.00|AETNA SKILLED NURSE IN HOME HEALTH SETTING (HCFA)
20|FH_F109648_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F109648_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 1 (NO REV)
20|FH_F109648_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 10 (NO REV)
20|FH_F109648_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|AEG 5  (NO REV)
20|FH_F109648_0_0|SrvcGrp|93121|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F109762_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F109803_0_0|CSTM-ALL|CSTM-00|2020|PDM|1155.00|99|0.00|AEG 9 (NO REV)
20|FH_F109803_0_0|CSTM-ALL|CSTM-00|2020|PDM|1174.00|99|0.00|AEG 7 (NO REV)
20|FH_F109803_0_0|CSTM-ALL|CSTM-00|2020|PDM|551.00|99|0.00|AEG 2 (NO REV)
20|FH_F109803_0_0|CSTM-ALL|CSTM-00|2020|PDM|846.00|99|0.00|AEG 5  (NO REV)
20|FH_F109803_0_0|CSTM-ALL|CSTM-00|2020|PDM|983.00|99|0.00|AEG 6 (NO REV)
20|FH_F109810_0_0|CSTM-ALL|CSTM-00|2020|PCT|67.00|99|0.00|OP SVCS
20|FH_F134202_0_0|SrvcGrp|15473|2022|PDM|1890.00|99|0.00|CPT CODE 42820
20|FH_F134202_0_0|SrvcGrp|74585|2022|PCT|0.00|99|0.00|AETNA OP IMPLANTS
20|FH_F134265_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F134270_0_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|AEG 2 (NO REV)
20|FH_F134270_0_0|CSTM-ALL|CSTM-00|2020|PDM|1975.00|99|0.00|AEG 3 (NO REV)
20|FH_F134270_0_0|CSTM-ALL|CSTM-00|2020|PDM|2075.00|99|0.00|AEG 10 (NO REV)
20|FH_F134270_0_0|SrvcGrp|11673|2022|PDM|10000.00|99|0.00|CPT 29888
20|FH_F134270_0_0|SrvcGrp|84939|2022|PDM|23000.00|99|0.00|SHOULDER JOINT
20|FH_F134287_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.45|99|0.00|HSS ASC
20|FH_F134287_0_0|SrvcGrp|104642|2022|PDM|15000.00|99|0.00|RECONSTRUCT SHOULDER JOINT
20|FH_F134317_0_0|SrvcGrp|79720|2022|PDM|1000.00|99|0.00|ACUTE REHAB II
20|FH_F134368_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F134368_0_0|SrvcGrp|82981|2022|PDM|110.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F134398_0_0|CSTM-ALL|CSTM-00|2020|PDM|709.00|99|0.00|AEG 5  (NO REV)
20|FH_F134398_0_0|CSTM-ALL|CSTM-00|2020|PDM|970.00|99|0.00|AEG 8 (NO REV)
20|FH_F134507_0_0|SrvcGrp|27210|2022|PDM|1144.00|99|0.00|SKILLED NURSING LEVEL I
20|FH_F134603_0_0|CSTM-ALL|CSTM-00|2020|PDM|1550.70|99|0.00|AEG 1 (NO REV)
20|FH_F134603_0_0|CSTM-ALL|CSTM-00|2020|PDM|1957.00|99|0.00|AEG 2 (NO REV)
20|FH_F134603_0_0|CSTM-ALL|CSTM-00|2020|PDM|3692.00|99|0.00|AEG 7 (NO REV)
20|FH_F134603_0_0|CSTM-ALL|CSTM-00|2020|PDM|4284.00|99|0.00|AEG 8 (NO REV)
20|FH_F134612_0_0|CSTM-ALL|CSTM-00|2020|PDM|1101.00|99|0.00|AEG 8 (NO REV)
20|FH_F134612_0_0|CSTM-ALL|CSTM-00|2020|PDM|1332.00|99|0.00|AEG 7 (NO REV)
20|FH_F134612_0_0|CSTM-ALL|CSTM-00|2020|PDM|1696.00|99|0.00|AEG 9 (NO REV)
20|FH_F134612_0_0|CSTM-ALL|CSTM-00|2020|PDM|412.00|99|0.00|AEG 1 (NO REV)
20|FH_F134612_0_0|SrvcGrp|106799|2022|PDM|10000.00|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT
20|FH_F134612_0_0|SrvcGrp|108166|2022|PDM|1500.00|99|0.00|ESTABLISH ACCESS TO AORTA
20|FH_F134654_0_0|SrvcGrp|110062|2022|PDM|75.00|99|0.00|FAMILY ADAPTIVE BH TREATMENT 15 MINS
20|FH_F134676_0_0|SrvcGrp|108042|2022|PDM|424.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD
20|FH_F134707_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F134707_0_0|SrvcGrp|11663|2022|PCT|0.44|99|0.00|IMPLANTS
20|FH_F134707_0_0|SrvcGrp|12491|2022|PCT|0.44|99|0.00|PACEMAKER
20|FH_F134707_0_0|SrvcGrp|78403|2022|PDM|0.15|99|0.00|AETNA MED RECORD
20|FH_F134707_0_0|SrvcGrp|79561|2022|PDM|4430.50|99|0.00|AETNA CARDIAC CATH
20|FH_F134732_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F134732_0_0|CSTM-ALL|CSTM-00|2020|PDM|342.00|99|0.00|AEG 1 (NO REV)
20|FH_F134732_0_0|CSTM-ALL|CSTM-00|2020|PDM|737.00|99|0.00|AEG 5  (NO REV)
20|FH_F134732_0_0|SrvcGrp|107792|2022|PDM|6002.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE
20|FH_F134732_0_0|SrvcGrp|108078|2022|PDM|1306.00|99|0.00|ARTERY-VEIN FUSION
20|FH_F134732_0_0|SrvcGrp|109135|2022|PDM|2248.00|99|0.00|AV FISTULA EXCISION
20|FH_F134732_0_0|SrvcGrp|74670|2022|PCT|0.00|99|0.00|AETNA OP INTRAOCULAR LENS
20|FH_F134732_0_0|SrvcGrp|77278|2022|PDM|1735.00|99|0.00|AETNA REPL TUNNLD CNTRL CVC W/O PORT/PUMP
20|FH_F134738_0_0|CSTM-ALL|CSTM-00|2020|PDM|1150.00|99|0.00|AEG 2 (NO REV)
20|FH_F134738_0_0|CSTM-ALL|CSTM-00|2020|PDM|1900.00|99|0.00|AEG 10 (NO REV)
20|FH_F134738_0_0|CSTM-ALL|CSTM-00|2020|PDM|3125.00|99|0.00|AEG 7 (NO REV)
20|FH_F134738_0_0|CSTM-ALL|CSTM-00|2020|PDM|3750.00|99|0.00|AEG 9 (NO REV)
20|FH_F134738_0_0|SrvcGrp|78403|2022|PDM|0.25|99|0.00|AETNA MED RECORD
20|FH_F134797_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F134797_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F134797_0_0|SrvcGrp|112581|2022|PDM|10000.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F134797_0_0|SrvcGrp|73002|2022|PDM|1332.00|99|0.00|AEG 7
20|FH_F134797_0_0|SrvcGrp|73004|2022|PDM|1101.00|99|0.00|AEG 8
20|FH_F134797_0_0|SrvcGrp|73008|2022|PDM|1051.00|99|0.00|AEG 10
20|FH_F134809_0_0|SrvcGrp|79720|2022|PDM|892.00|99|0.00|ACUTE REHAB II
20|FH_F134809_0_0|SrvcGrp|80258|2022|PCT|0.00|99|0.00|AETNA SKILLED CARE
20|FH_F134819_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F134819_0_0|CSTM-ALL|CSTM-00|2020|PDM|1045.00|99|0.00|AEG 10 (NO REV)
20|FH_F134819_0_0|CSTM-ALL|CSTM-00|2020|PDM|1649.00|99|0.00|AEG 7 (NO REV)
20|FH_F134819_0_0|SrvcGrp|19922|2022|PDM|3102.00|99|0.00|ARTHROSCOPY OF SHOULDER
20|FH_F134819_0_0|SrvcGrp|74585|2022|PCT|0.00|99|0.00|AETNA OP IMPLANTS
20|FH_F134830_0_0|SrvcGrp|57967|2022|PDM|175.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F134830_0_0|SrvcGrp|92502|2022|PDM|975.00|99|0.00|HOSPICE GENERAL IP CARE
20|FH_F134847_0_0|CSTM-ALL|CSTM-00|2020|PDM|1061.00|99|0.00|AEG 1 (NO REV)
20|FH_F134847_0_0|CSTM-ALL|CSTM-00|2020|PDM|1367.00|99|0.00|AEG 2 (NO REV)
20|FH_F134847_0_0|CSTM-ALL|CSTM-00|2020|PDM|1613.00|99|0.00|AEG 3 (NO REV)
20|FH_F134847_0_0|CSTM-ALL|CSTM-00|2020|PDM|2923.00|99|0.00|AEG 8 (NO REV)
20|FH_F134847_0_0|SrvcGrp|101820|2022|PDM|3054.00|99|0.00|HYSTEROSCOPY RESECT SEPTUM
20|FH_F134847_0_0|SrvcGrp|107187|2022|PDM|2647.00|99|0.00|REVISE TWO EYE MUSCLES
20|FH_F134847_0_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS
20|FH_F134847_0_0|SrvcGrp|14614|2022|PDM|4722.00|99|0.00|LITHOTRIPSY
20|FH_F134847_0_0|SrvcGrp|27261|2022|PDM|10026.00|99|0.00|CPT 27446
20|FH_F134847_0_0|SrvcGrp|28548|2022|PDM|3496.00|99|0.00|VITRECTOMY
20|FH_F134847_0_0|SrvcGrp|34606|2022|PDM|5161.00|99|0.00|CPT 29827
20|FH_F134847_0_0|SrvcGrp|46887|2022|PDM|3486.00|99|0.00|REPAIR DETACHED RETINA
20|FH_F134847_0_0|SrvcGrp|63471|2022|PDM|8824.00|99|0.00|CPT 64590
20|FH_F134847_0_0|SrvcGrp|63472|2022|PDM|5091.00|99|0.00|CPT 64581
20|FH_F134847_0_0|SrvcGrp|67066|2022|PDM|22398.00|99|0.00|CERVICAL SURGERY
20|FH_F134847_0_0|SrvcGrp|88162|2022|PDM|8415.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON
20|FH_F134847_0_0|SrvcGrp|88487|2022|PDM|5836.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION
20|FH_F134876_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F134876_0_0|SrvcGrp|57967|2022|PDM|331.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F134876_0_0|SrvcGrp|83099|2022|PDM|54.00|99|0.00|HOSPICE SVCS
20|FH_F109821_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F109821_0_0|CSTM-ALL|CSTM-00|2020|PDM|1020.00|99|0.00|AEG 6 (NO REV)
20|FH_F109821_0_0|CSTM-ALL|CSTM-00|2020|PDM|1275.00|99|0.00|AEG 8 (NO REV)
20|FH_F109821_0_0|CSTM-ALL|CSTM-00|2020|PDM|428.00|99|0.00|AEG 1 (NO REV)
20|FH_F109821_0_0|CSTM-ALL|CSTM-00|2020|PDM|867.00|99|0.00|AEG 4 (NO REV)
20|FH_F109821_0_0|SrvcGrp|103059|2022|PDM|1530.00|99|0.00|NASAL ENDOSCOPY
20|FH_F109821_0_0|SrvcGrp|103079|2022|PDM|1224.00|99|0.00|PODIATRIC SURGERY
20|FH_F109821_0_0|SrvcGrp|103081|2022|PDM|1020.00|99|0.00|AUDITORY SURGERY
20|FH_F109821_0_0|SrvcGrp|91879|2022|PDM|3264.00|99|0.00|PROSTATE LASER ENUCLEATION
20|FH_F109821_0_0|SrvcGrp|93121|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F109843_0_0|CSTM-ALL|CSTM-00|2020|PDM|1980.00|99|0.00|AEG 4 (NO REV)
20|FH_F109843_0_0|CSTM-ALL|CSTM-00|2020|PDM|605.00|99|0.00|AEG 1 (NO REV)
20|FH_F109907_0_0|SrvcGrp|46605|2022|PDM|92.60|99|0.00|CLINICAL SOCIAL WORKER SERVICES
20|FH_F109907_0_0|SrvcGrp|48385|2022|PDM|92.60|99|0.00|SPEECH THERAPY
20|FH_F109907_0_0|SrvcGrp|48398|2022|PDM|92.60|99|0.00|PT SERVICES
20|FH_F109907_0_0|SrvcGrp|88621|2022|PDM|92.60|99|0.00|SKILLED NURSING LPN
20|FH_F109926_0_0|CSTM-ALL|CSTM-00|2020|PDM|733.00|99|0.00|AEG 4 (NO REV)
20|FH_F109926_0_0|CSTM-ALL|CSTM-00|2020|PDM|834.00|99|0.00|AEG 5  (NO REV)
20|FH_F109941_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F109949_0_0|CSTM-ALL|CSTM-00|2020|PDM|525.00|99|0.00|AEG 1 (NO REV)
20|FH_F109951_0_0|CSTM-ALL|CSTM-00|2020|PDM|1761.00|99|0.00|COVENTRY ENHANCED GROUPER 3
20|FH_F109951_0_0|CSTM-ALL|CSTM-00|2020|PDM|2106.00|99|0.00|COVENTRY ENHANCED GROUPER 4
20|FH_F109951_0_0|CSTM-ALL|CSTM-00|2020|PDM|2957.00|99|0.00|COVENTRY ENHANCED GROUPER 8
20|FH_F109951_0_0|CSTM-ALL|CSTM-00|2020|PDM|3025.00|99|0.00|COVENTRY ENHANCED GROUPER 7
20|FH_F109951_0_0|SrvcGrp|705|2022|PCT|0.45|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F109963_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F109963_0_0|SrvcGrp|72996|2022|PDM|715.00|99|0.00|AEG 4
20|FH_F109980_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F110061_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F110061_0_0|SrvcGrp|75487|2022|PDM|759.00|99|0.00|AEG 5
20|FH_F110061_0_0|SrvcGrp|75493|2022|PDM|1034.00|99|0.00|AEG 8
20|FH_F110102_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F110102_0_0|SrvcGrp|104195|2022|PDM|150.00|99|0.00|HOSPICE SNF
20|FH_F110103_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F110103_0_0|SrvcGrp|73485|2022|PDM|850.00|99|0.00|AETNA REHAB
20|FH_F110121_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F110121_0_0|SrvcGrp|72990|2022|PDM|788.00|99|0.00|AEG 1
20|FH_F110121_0_0|SrvcGrp|72996|2022|PDM|2415.00|99|0.00|AEG 4
20|FH_F110121_0_0|SrvcGrp|73000|2022|PDM|3570.00|99|0.00|AEG 6
20|FH_F110121_0_0|SrvcGrp|73006|2022|PDM|3675.00|99|0.00|AEG 9
20|FH_F110121_0_0|SrvcGrp|73008|2022|PDM|1050.00|99|0.00|AEG 10
20|FH_F110140_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.72|99|0.00|HSS ASC
20|FH_F110160_0_0|SrvcGrp|103302|2022|PDM|1000.00|99|0.00|ARTHROSCOPY
20|FH_F110160_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS
20|FH_F110160_0_0|SrvcGrp|72996|2022|PDM|928.00|99|0.00|AEG 4
20|FH_F110160_0_0|SrvcGrp|72998|2022|PDM|960.00|99|0.00|AEG 5
20|FH_F110180_0_0|SrvcGrp|12118|2022|PDM|350.00|99|0.00|COMPUTED TOMOGRAPHY (CT)
20|FH_F110184_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F110184_0_0|SrvcGrp|10393|2022|PDM|1600.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F110184_0_0|SrvcGrp|8950|2022|PDM|1400.00|99|0.00|INTERMEDIATE ICU/CCU
20|FH_F110220_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F110220_0_0|SrvcGrp|103927|2022|PDM|169.04|99|0.00|SLEEP STUDY UNATTENDED(HCFA)
20|FH_F110220_0_0|SrvcGrp|92188|2022|PDM|435.68|99|0.00|CPT 95805  (HCFA)
20|FH_F110220_0_0|SrvcGrp|93688|2022|PDM|739.82|99|0.00|POLYSOMNOGRAPHY (HCFA)
20|FH_F110226_0_0|CSTM-ALL|CSTM-00|2020|PCT|62.00|99|0.00|GENERAL ACUTE CARE
20|FH_F110226_0_0|CSTM-ALL|CSTM-00|2020|PCT|62.00|99|0.00|OP SVCS
20|FH_F110233_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.94|99|0.00|GENERAL ACUTE CARE
20|FH_F110233_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.94|99|0.00|OP SVCS
20|FH_F110240_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F110240_0_0|SrvcGrp|79595|2022|PDM|743.00|99|0.00|CPT 45385
20|FH_F110240_0_0|SrvcGrp|91480|2022|PDM|743.00|99|0.00|COLONOSCOPY W/ LESION REMOVAL  (HCFA)
20|FH_F110262_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F110262_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F110263_0_0|CSTM-ALL|CSTM-00|2020|PDM|1132.00|99|0.00|AEG 2 (NO REV)
20|FH_F110263_0_0|CSTM-ALL|CSTM-00|2020|PDM|3316.00|99|0.00|AEG 9 (NO REV)
20|FH_F110263_0_0|SrvcGrp|113576|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F110263_0_0|SrvcGrp|115220|2022|PDM|8659.00|99|0.00|IMPLANT NEUROELECTRODES (HCFA)
20|FH_F110263_0_0|SrvcGrp|115580|2022|PDM|7575.00|99|0.00|LITHOTRIPSY ESWL (HCFA)
20|FH_F110263_0_0|SrvcGrp|115583|2022|PDM|9007.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY (HCFA)
20|FH_F110263_0_0|SrvcGrp|35669|2022|PDM|9277.00|99|0.00|CPT 63650
20|FH_F110263_0_0|SrvcGrp|41334|2022|PDM|12703.00|99|0.00|TOTAL KNEE
20|FH_F110263_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F110263_0_0|SrvcGrp|89404|2022|PDM|12703.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F110308_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F110308_0_0|SrvcGrp|72998|2022|PDM|700.00|99|0.00|AEG 5
20|FH_F110308_0_0|SrvcGrp|73006|2022|PDM|900.00|99|0.00|AEG 9
20|FH_F110308_0_0|SrvcGrp|98448|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F110342_0_0|SrvcGrp|27261|2022|PDM|3121.20|99|0.00|CPT 27446
20|FH_F110360_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F110360_0_0|CSTM-ALL|CSTM-00|2020|PDM|1709.00|99|0.00|AEG 7 (NO REV)
20|FH_F110360_0_0|CSTM-ALL|CSTM-00|2020|PDM|892.50|99|0.00|AEG 5  (NO REV)
20|FH_F110363_0_0|SrvcGrp|103947|2022|PDM|782.00|99|0.00|HOSPICE OR HOME HLTH IN HOME
20|FH_F110381_0_0|SrvcGrp|103970|2022|PDM|2332.00|99|0.00|AETNA SHOULDER ARTHROSCOPY SURGERY
20|FH_F134876_0_0|SrvcGrp|92501|2022|PDM|804.00|99|0.00|HOSPICE IP RESPITE CARE
20|FH_F134894_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F134895_0_0|CSTM-ALL|CSTM-00|2020|PDM|1048.00|99|0.00|AEG 6 (NO REV)
20|FH_F134895_0_0|CSTM-ALL|CSTM-00|2020|PDM|1369.00|99|0.00|AEG 9 (NO REV)
20|FH_F134895_0_0|CSTM-ALL|CSTM-00|2020|PDM|522.00|99|0.00|AEG 3 (NO REV)
20|FH_F134895_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|AEG 10 (NO REV)
20|FH_F134895_0_0|CSTM-ALL|CSTM-00|2020|PDM|733.00|99|0.00|AEG 5  (NO REV)
20|FH_F134904_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F134904_0_0|CSTM-ALL|CSTM-00|2020|PDM|1785.00|99|0.00|AEG 9 (NO REV)
20|FH_F134904_0_0|CSTM-ALL|CSTM-00|2020|PDM|446.00|99|0.00|AEG 10 (NO REV)
20|FH_F134904_0_0|CSTM-ALL|CSTM-00|2020|PDM|682.00|99|0.00|AEG 3 (NO REV)
20|FH_F134904_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F134917_0_0|CSTM-ALL|CSTM-00|2020|PDM|1041.52|99|0.00|AEG 7 (NO REV)
20|FH_F134917_0_0|CSTM-ALL|CSTM-00|2020|PDM|2117.50|99|0.00|AEG 4 (NO REV)
20|FH_F134917_0_0|CSTM-ALL|CSTM-00|2020|PDM|2194.50|99|0.00|AEG 3 (NO REV)
20|FH_F134917_0_0|CSTM-ALL|CSTM-00|2020|PDM|872.67|99|0.00|AEG 6 (NO REV)
20|FH_F134928_0_0|SrvcGrp|93924|2022|PDM|2100.00|99|0.00|AETNA MEDICAL SERVICES
20|FH_F134930_0_0|SrvcGrp|13927|2022|PCT|0.00|99|0.00|DAY HOSPITAL FULL DAY
20|FH_F134930_0_0|SrvcGrp|30089|2022|PDM|550.00|99|0.00|HEMODIALYSIS SERVICES
20|FH_F134930_0_0|SrvcGrp|31931|2022|PCT|0.00|99|0.00|SKILLED NURSING CARE
20|FH_F134939_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.20|99|0.00|OP SVCS
20|FH_F134968_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F135027_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F135069_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F135069_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 9 (NO REV)
20|FH_F135069_0_0|CSTM-ALL|CSTM-00|2020|PDM|934.00|99|0.00|AEG 8 (NO REV)
20|FH_F135069_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F135179_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F135179_0_0|SrvcGrp|107748|2022|PDM|424.00|99|0.00|HEMODIALYSIS IN CENTER
20|FH_F135239_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F135263_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F135263_0_0|CSTM-ALL|CSTM-00|2020|PDM|1375.00|99|0.00|AEG 9 (NO REV)
20|FH_F135263_0_0|CSTM-ALL|CSTM-00|2020|PDM|425.00|99|0.00|AEG 1 (NO REV)
20|FH_F135263_0_0|CSTM-ALL|CSTM-00|2020|PDM|540.00|99|0.00|AEG 2 (NO REV)
20|FH_F135263_0_0|CSTM-ALL|CSTM-00|2020|PDM|615.00|99|0.00|AEG 3 (NO REV)
20|FH_F135263_0_0|SrvcGrp|112740|2022|PDM|900.00|99|0.00|RECONSTRUCT SHOULDER JOINT
20|FH_F135315_0_0|SrvcGrp|46482|2022|PDM|185.00|99|0.00|S9083 PER VISIT
20|FH_F135316_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F135327_0_0|CSTM-ALL|CSTM-00|2020|PDM|404.00|99|0.00|AEG 1 (NO REV)
20|FH_F135327_0_0|CSTM-ALL|CSTM-00|2020|PDM|953.00|99|0.00|AEG 4 (NO REV)
20|FH_F135327_0_0|SrvcGrp|112581|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F135327_0_0|SrvcGrp|112735|2022|PDM|5300.00|99|0.00|CORNEAL IMPLANTS
20|FH_F135327_0_0|SrvcGrp|84285|2022|PDM|2600.00|99|0.00|REVISE CORNEA WITH IMPLANT
20|FH_F135351_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F135351_0_0|CSTM-ALL|CSTM-00|2020|PDM|1442.00|99|0.00|AEG 7 (NO REV)
20|FH_F135351_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F135351_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F135351_0_0|SrvcGrp|112739|2022|PDM|809.00|99|0.00|NJX INTERLAMINAR CRV/THRC
20|FH_F135351_0_0|SrvcGrp|26278|2022|PDM|7700.00|99|0.00|CPT 29881
20|FH_F135351_0_0|SrvcGrp|34606|2022|PDM|7150.00|99|0.00|CPT 29827
20|FH_F135351_0_0|SrvcGrp|41334|2022|PDM|13750.00|99|0.00|TOTAL KNEE
20|FH_F135351_0_0|SrvcGrp|71666|2022|PDM|38500.00|99|0.00|CPT 63655
20|FH_F135351_0_0|SrvcGrp|87679|2022|PDM|1199.00|99|0.00|LUMBAR OR SACRAL SURGERY
20|FH_F135351_0_0|SrvcGrp|93807|2022|PDM|7221.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY
20|FH_F135450_0_0|SrvcGrp|82981|2022|PDM|120.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F135456_0_0|CSTM-ALL|CSTM-00|2020|PDM|511.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F135456_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|AEG 2 (NO REV)
20|FH_F135466_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 1 (NO REV)
20|FH_F135491_0_0|CSTM-ALL|CSTM-00|2020|PDM|832.00|99|0.00|AEG 5  (NO REV)
20|FH_F135491_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F135491_0_0|SrvcGrp|111136|2022|PCT|1.21|99|0.00|PHENYLEPHRINE KETOROLAC INJECTION
20|FH_F135491_0_0|SrvcGrp|112757|2022|PCT|1.21|99|0.00|DEXAMETHASONE 9% INJECTION
20|FH_F135491_0_0|SrvcGrp|42550|2022|PDM|1143.00|99|0.00|OP SURGERY CPT 66984
20|FH_F135491_0_0|SrvcGrp|78046|2022|PCT|1.21|99|0.00|AETNA AQUEOUS SHUNT
20|FH_F135491_0_0|SrvcGrp|84279|2022|PDM|1980.00|99|0.00|CORNEAL TRANSPLANT
20|FH_F135580_0_0|CSTM-ALL|CSTM-00|2020|PDM|317.00|99|0.00|AEG 1 (NO REV)
20|FH_F135580_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 4 (NO REV)
20|FH_F135580_0_0|CSTM-ALL|CSTM-00|2020|PDM|683.00|99|0.00|AEG 5  (NO REV)
20|FH_F135613_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE
20|FH_F135650_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F135653_0_0|SrvcGrp|107112|2022|PDM|782.00|99|0.00|DENTAL SERVICES UNDER ANESTHESIA
20|FH_F135653_0_0|SrvcGrp|13925|2022|PDM|1665.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F135764_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F135764_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F135764_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F135764_0_0|SrvcGrp|3212|2022|PDM|400.00|99|0.00|HEMODIALYSIS SERVICES
20|FH_F135771_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F135771_0_0|SrvcGrp|14494|2022|PDM|37.74|99|0.00|CONTINUOUS HOMECARE
20|FH_F135779_0_0|SrvcGrp|86723|2022|PDM|467.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)
20|FH_F135779_0_0|SrvcGrp|89149|2022|PDM|217.00|99|0.00|OP INTENSIVE
20|FH_F110381_0_0|SrvcGrp|103973|2022|PDM|8734.00|99|0.00|AETNA DISK SURGERY
20|FH_F110381_0_0|SrvcGrp|11663|2022|PCT|0.50|99|0.00|IMPLANTS
20|FH_F110381_0_0|SrvcGrp|72994|2022|PDM|1034.00|99|0.00|AEG 3
20|FH_F110381_0_0|SrvcGrp|72998|2022|PDM|1537.00|99|0.00|AEG 5
20|FH_F110381_0_0|SrvcGrp|73008|2022|PDM|1272.00|99|0.00|AEG 10
20|FH_F110381_0_0|SrvcGrp|84939|2022|PDM|15500.00|99|0.00|SHOULDER JOINT
20|FH_F110381_0_0|SrvcGrp|85538|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F110381_0_0|SrvcGrp|89404|2022|PDM|16250.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F110453_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F110453_0_0|SrvcGrp|73000|2022|PDM|892.00|99|0.00|AEG 6
20|FH_F110564_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F110564_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F110564_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|DEVICE INSERTION
20|FH_F110564_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F110564_0_0|SrvcGrp|72992|2022|PDM|446.00|99|0.00|AEG 2
20|FH_F110564_0_0|SrvcGrp|72994|2022|PDM|510.00|99|0.00|AEG 3
20|FH_F110564_0_0|SrvcGrp|72996|2022|PDM|630.00|99|0.00|AEG 4
20|FH_F110564_0_0|SrvcGrp|73008|2022|PDM|750.00|99|0.00|AEG 10
20|FH_F110604_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F110604_0_0|CSTM-ALL|CSTM-00|2020|PDM|1375.00|99|0.00|AEG 10 (NO REV)
20|FH_F110604_0_0|CSTM-ALL|CSTM-00|2020|PDM|1540.00|99|0.00|AEG 5  (NO REV)
20|FH_F110604_0_0|CSTM-ALL|CSTM-00|2020|PDM|1815.00|99|0.00|AEG 6 (NO REV)
20|FH_F110604_0_0|CSTM-ALL|CSTM-00|2020|PDM|2640.00|99|0.00|AEG 8 (NO REV)
20|FH_F110604_0_0|CSTM-ALL|CSTM-00|2020|PDM|2860.00|99|0.00|AEG 9 (NO REV)
20|FH_F110604_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AEG 1 (NO REV)
20|FH_F110604_0_0|SrvcGrp|100661|2022|PDM|1485.00|99|0.00|AETNA OP SURGERY
20|FH_F110604_0_0|SrvcGrp|103329|2022|PDM|8250.00|99|0.00|INSJ STABLJ DEV W/ DCMPRN
20|FH_F110604_0_0|SrvcGrp|109967|2022|PDM|48400.00|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F110604_0_0|SrvcGrp|35669|2022|PDM|9176.20|99|0.00|CPT 63650
20|FH_F110604_0_0|SrvcGrp|38364|2022|PDM|6050.00|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F110604_0_0|SrvcGrp|58636|2022|PDM|20900.00|99|0.00|CPT 62362
20|FH_F110604_0_0|SrvcGrp|63472|2022|PDM|9176.00|99|0.00|CPT 64581
20|FH_F110604_0_0|SrvcGrp|71666|2022|PDM|23100.00|99|0.00|CPT 63655
20|FH_F110604_0_0|SrvcGrp|90977|2022|PDM|1100.00|99|0.00|INJECTION PARAVERTEBRAL FACET JOINT
20|FH_F110604_0_0|SrvcGrp|92364|2022|PDM|18150.00|99|0.00|ARTHRODESIS SACROILIAC JOINT
20|FH_F110604_0_0|SrvcGrp|93807|2022|PDM|6715.50|99|0.00|REVISE SPINE ELTRD PERQ ARAY
20|FH_F110606_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F110606_0_0|SrvcGrp|87077|2022|PDM|165.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F110609_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F110621_0_0|CSTM-ALL|CSTM-00|2020|PDM|1035.00|99|0.00|AEG 7 (NO REV)
20|FH_F110621_0_0|CSTM-ALL|CSTM-00|2020|PDM|465.00|99|0.00|AEG 2 (NO REV)
20|FH_F110621_0_0|CSTM-ALL|CSTM-00|2020|PDM|746.00|99|0.00|AEG 5  (NO REV)
20|FH_F110661_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F110702_0_0|SrvcGrp|36093|2022|PDM|812.00|99|0.00|ACUTE REHABILITATION
20|FH_F110702_0_0|SrvcGrp|83683|2022|PDM|812.00|99|0.00|ACUTE REHAB II
20|FH_F110720_0_0|SrvcGrp|104097|2022|PDM|2759.00|99|0.00|INCISION OF TENDON & MUSCLE
20|FH_F110720_0_0|SrvcGrp|104099|2022|PDM|2998.00|99|0.00|REPAIR OF THIGH MUSCLE
20|FH_F110720_0_0|SrvcGrp|19922|2022|PDM|4882.00|99|0.00|ARTHROSCOPY OF SHOULDER
20|FH_F110720_0_0|SrvcGrp|72990|2022|PDM|1008.00|99|0.00|AEG 1
20|FH_F110720_0_0|SrvcGrp|94560|2022|PDM|4245.00|99|0.00|REPAIR CLAVICLE FRACTURE
20|FH_F110720_0_0|SrvcGrp|96939|2022|PDM|4882.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F110720_0_0|SrvcGrp|97239|2022|PDM|4882.00|99|0.00|DISKECTOMY CERVICAL SINGLE
20|FH_F110741_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F110741_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|OP SVCS
20|FH_F110803_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F110902_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F110940_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F110940_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 10 (NO REV)
20|FH_F110940_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|AEG 7 (NO REV)
20|FH_F110967_0_0|CSTM-ALL|CSTM-00|2020|PDM|1269.07|99|0.00|ASPG II
20|FH_F110967_0_0|CSTM-ALL|CSTM-00|2020|PDM|1451.18|99|0.00|ASPG III
20|FH_F110967_0_0|CSTM-ALL|CSTM-00|2020|PDM|2060.45|99|0.00|ASPG VIII
20|FH_F110967_0_0|CSTM-ALL|CSTM-00|2020|PDM|2857.55|99|0.00|ASPG IX
20|FH_F110971_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F110980_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F111001_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F111001_0_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE
20|FH_F111001_0_0|SrvcGrp|48385|2022|PDM|100.00|99|0.00|SPEECH THERAPY
20|FH_F111001_0_0|SrvcGrp|48398|2022|PDM|100.00|99|0.00|PT SERVICES
20|FH_F111044_0_0|CSTM-ALL|CSTM-00|2020|PDM|1645.00|99|0.00|AEG 8 (NO REV)
20|FH_F111044_0_0|CSTM-ALL|CSTM-00|2020|PDM|2101.00|99|0.00|AEG 9 (NO REV) W/O 29848, 29893
20|FH_F111044_0_0|CSTM-ALL|CSTM-00|2020|PDM|924.00|99|0.00|AEG 2 (NO REV)
20|FH_F111044_0_0|SrvcGrp|103542|2022|PDM|1648.00|99|0.00|ANKLE ARTHROSCOPY/SURGERY
20|FH_F111044_0_0|SrvcGrp|26277|2022|PDM|2266.00|99|0.00|CPT 29874
20|FH_F111044_0_0|SrvcGrp|33724|2022|PDM|2266.00|99|0.00|ARTHROSCOPY
20|FH_F111044_0_0|SrvcGrp|35672|2022|PDM|2987.00|99|0.00|CPT 23412
20|FH_F111044_0_0|SrvcGrp|82112|2022|PDM|2266.00|99|0.00|KNEE ARTHROSCOPY SURGERY
20|FH_F111044_0_0|SrvcGrp|88596|2022|PDM|1648.00|99|0.00|EXC OF TRIANG FIBROCARTILAGE
20|FH_F111046_0_0|SrvcGrp|13597|2022|PDM|283.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT
20|FH_F111046_0_0|SrvcGrp|13681|2022|PDM|567.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT
20|FH_F111046_0_0|SrvcGrp|78403|2022|PDM|0.25|99|0.00|AETNA MED RECORD
20|FH_F111141_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F111163_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F135840_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F135840_0_0|SrvcGrp|75481|2022|PDM|468.00|99|0.00|AEG 2
20|FH_F135840_0_0|SrvcGrp|79578|2022|PDM|550.00|99|0.00|CPT 43246
20|FH_F135840_0_0|SrvcGrp|79579|2022|PDM|550.00|99|0.00|CPT 43251
20|FH_F135840_0_0|SrvcGrp|79583|2022|PDM|550.00|99|0.00|CPT 45381
20|FH_F135840_0_0|SrvcGrp|79590|2022|PDM|550.00|99|0.00|CPT 43248
20|FH_F135891_0_0|SrvcGrp|73485|2022|PDM|900.00|99|0.00|AETNA REHAB
20|FH_F135891_0_0|SrvcGrp|87537|2022|PDM|450.00|99|0.00|MED REHAB DAY PROGRAM (FULL)
20|FH_F135897_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F135897_0_0|CSTM-ALL|CSTM-00|2020|PDM|1039.00|99|0.00|AEG 5  (NO REV)
20|FH_F135897_0_0|SrvcGrp|105033|2022|PDM|2750.00|99|0.00|INSERTION OF ANTERIOR SEGMENT AQUEOUS DRAINAGE DEVICE
20|FH_F135900_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F135900_0_0|SrvcGrp|30089|2022|PDM|450.00|99|0.00|HEMODIALYSIS SERVICES
20|FH_F135900_0_0|SrvcGrp|73483|2022|PDM|500.00|99|0.00|AETNA SUBACUTE III
20|FH_F135900_0_0|SrvcGrp|73485|2022|PDM|900.00|99|0.00|AETNA REHAB
20|FH_F135900_0_0|SrvcGrp|79720|2022|PDM|1000.00|99|0.00|ACUTE REHAB II
20|FH_F135929_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F135930_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.30|99|0.00|OP SVCS
20|FH_F135982_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F136037_0_0|SrvcGrp|73841|2022|PDM|416.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP
20|FH_F136037_0_0|SrvcGrp|86722|2022|PDM|233.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)
20|FH_F136037_0_0|SrvcGrp|90854|2022|PDM|921.00|99|0.00|AETNA IP DETOXIFICATION SERVICES
20|FH_F136092_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F136132_0_0|SrvcGrp|111934|2022|PDM|51.31|99|0.00|COVID-19 NUCLEIC ACID
20|FH_F136132_0_0|SrvcGrp|112813|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER
20|FH_F136189_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE
20|FH_F136207_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F136276_0_0|SrvcGrp|87077|2022|PDM|154.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F136318_0_0|SrvcGrp|89337|2022|PDM|1103.00|99|0.00|DETOXIFICATION
20|FH_F136327_0_0|SrvcGrp|82981|2022|PDM|90.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F136330_0_0|SrvcGrp|13722|2022|PDM|176.00|99|0.00|HOSPICE SERVICE - ROUTINE HOME CARE
20|FH_F136353_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F136355_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F136359_0_0|CSTM-ALL|CSTM-00|2020|PDM|2400.00|99|0.00|AEG 6 (NO REV)
20|FH_F136359_0_0|SrvcGrp|103329|2022|PDM|8100.00|99|0.00|INSJ STABLJ DEV W/ DCMPRN
20|FH_F136359_0_0|SrvcGrp|107515|2022|PDM|6450.00|99|0.00|ENT1 PROCEDURES
20|FH_F136359_0_0|SrvcGrp|112852|2022|PDM|5350.00|99|0.00|ORTHOPEDIC SERVICES
20|FH_F136359_0_0|SrvcGrp|112859|2022|PDM|15250.00|99|0.00|TOTAL SHOULDER HIP AND KNEES
20|FH_F136359_0_0|SrvcGrp|112860|2022|PDM|1450.00|99|0.00|TREAT LOWER LEG DISLOCATION
20|FH_F136359_0_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS
20|FH_F136359_0_0|SrvcGrp|28548|2022|PDM|6500.00|99|0.00|VITRECTOMY
20|FH_F136359_0_0|SrvcGrp|36591|2022|PDM|9500.00|99|0.00|CPT 63685
20|FH_F136359_0_0|SrvcGrp|38364|2022|PDM|5100.00|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F136359_0_0|SrvcGrp|38909|2022|PDM|4750.00|99|0.00|CPT 67036 - VITRECTOMY, MECHANICAL
20|FH_F136359_0_0|SrvcGrp|46887|2022|PDM|4775.00|99|0.00|REPAIR DETACHED RETINA
20|FH_F136359_0_0|SrvcGrp|46890|2022|PDM|5225.00|99|0.00|IMPLANT EYE SHUNT
20|FH_F136359_0_0|SrvcGrp|49205|2022|PDM|4000.00|99|0.00|REPAIR DETACHED RETINA
20|FH_F136359_0_0|SrvcGrp|63471|2022|PDM|8410.00|99|0.00|CPT 64590
20|FH_F136359_0_0|SrvcGrp|67066|2022|PDM|19570.00|99|0.00|CERVICAL SURGERY
20|FH_F136359_0_0|SrvcGrp|70749|2022|PDM|4475.00|99|0.00|CPT 29823
20|FH_F136359_0_0|SrvcGrp|99172|2022|PDM|6500.00|99|0.00|CPT 28740
20|FH_F136376_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F136376_0_0|SrvcGrp|73841|2022|PDM|447.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP
20|FH_F136376_0_0|SrvcGrp|86723|2022|PDM|447.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)
20|FH_F136382_0_0|CSTM-ALL|CSTM-00|2020|PDM|1600.00|99|0.00|AEG 7 (NO REV)
20|FH_F136382_0_0|CSTM-ALL|CSTM-00|2020|PDM|725.00|99|0.00|AEG 2 (NO REV)
20|FH_F136382_0_0|CSTM-ALL|CSTM-00|2020|PDM|825.00|99|0.00|AEG 10 (NO REV)
20|FH_F136382_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F136393_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F136393_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|AEG 9 (NO REV)
20|FH_F136393_0_0|CSTM-ALL|CSTM-00|2020|PDM|5500.00|99|0.00|AEG 7 (NO REV)
20|FH_F136393_0_0|SrvcGrp|103646|2022|PDM|6400.00|99|0.00|AETNA TIB/ PER REVASE STENT & ATHER
20|FH_F136393_0_0|SrvcGrp|109497|2022|PDM|2000.00|99|0.00|REPOSITION PACING-DEFIB LEA
20|FH_F136393_0_0|SrvcGrp|109500|2022|PDM|2000.00|99|0.00|REPAIR LEAD PACE-DEFIB ONE
20|FH_F136393_0_0|SrvcGrp|109508|2022|PDM|4800.00|99|0.00|REMOVAL OF PM GENERATOR
20|FH_F136393_0_0|SrvcGrp|112883|2022|PDM|8000.00|99|0.00|FEM/POPL REVAS W/ATHER
20|FH_F136393_0_0|SrvcGrp|76024|2022|PDM|6000.00|99|0.00|PACEMAKER
20|FH_F136393_0_0|SrvcGrp|88482|2022|PDM|2000.00|99|0.00|AETNA REMOVE PULSE GENERATOR
20|FH_F136395_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F136395_0_0|CSTM-ALL|CSTM-00|2020|PDM|2100.00|99|0.00|AEG 4 (NO REV)
20|FH_F136395_0_0|CSTM-ALL|CSTM-00|2020|PDM|2650.00|99|0.00|AEG 8 (NO REV)
20|FH_F136395_0_0|CSTM-ALL|CSTM-00|2020|PDM|3200.00|99|0.00|AEG 9 (NO REV)
20|FH_F136401_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F136401_0_0|SrvcGrp|87077|2022|PDM|154.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F136407_0_0|CSTM-ALL|CSTM-00|2020|PDM|2464.00|99|0.00|AEG 9 (NO REV) W/O MIDDLE EAR PROCEDURE
20|FH_F136407_0_0|CSTM-ALL|CSTM-00|2020|PDM|2695.00|99|0.00|AEG 3 (NO REV) W/O ENDOSCOPY
20|FH_F136407_0_0|SrvcGrp|13187|2022|PCT|0.00|99|0.00|INTRAOCULAR LENSES
20|FH_F136407_0_0|SrvcGrp|36864|2022|PDM|16500.00|99|0.00|COCHLEAR IMPLANTS
20|FH_F136410_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F136417_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F136429_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F136429_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|AEG 5  (NO REV)
20|FH_F136429_0_0|SrvcGrp|38364|2022|PDM|1400.00|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F136429_0_0|SrvcGrp|79588|2022|PDM|525.00|99|0.00|CPT 43235
20|FH_F136429_0_0|SrvcGrp|79595|2022|PDM|714.00|99|0.00|CPT 45385
20|FH_F136429_0_0|SrvcGrp|82307|2022|PDM|700.00|99|0.00|COLORECTAL CANCER SCREENING
20|FH_F136429_0_0|SrvcGrp|82310|2022|PDM|700.00|99|0.00|COLORECTAL CANCER SCREENING
20|FH_F136467_0_0|CSTM-ALL|CSTM-00|2020|PDM|1540.00|99|0.00|AEG 4 (NO REV)
20|FH_F136467_0_0|CSTM-ALL|CSTM-00|2020|PDM|1750.00|99|0.00|AEG 6 (NO REV)
20|FH_F136467_0_0|CSTM-ALL|CSTM-00|2020|PDM|715.00|99|0.00|AEG 1 (NO REV)
20|FH_F136467_0_0|SrvcGrp|108854|2022|PDM|263.00|99|0.00|OSSICULA IMPLANT
20|FH_F136467_0_0|SrvcGrp|27261|2022|PDM|7575.00|99|0.00|CPT 27446
20|FH_F136467_0_0|SrvcGrp|36864|2022|PDM|3152.00|99|0.00|COCHLEAR IMPLANTS
20|FH_F136467_0_0|SrvcGrp|89980|2022|PDM|1624.00|99|0.00|OPEN TREATMENT OF DISTAL
20|FH_F136473_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F136473_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 10 (NO REV)
20|FH_F136473_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 6 (NO REV)
20|FH_F136473_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 8 (NO REV)
20|FH_F136473_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F136485_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE
20|FH_F136490_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F136490_0_0|CSTM-ALL|CSTM-00|2020|PDM|697.00|99|0.00|AEG 3 (NO REV)
20|FH_F136490_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F136493_0_0|SrvcGrp|93098|2022|PDM|56.00|99|0.00|HOSPICE CARE
20|FH_F136493_0_0|SrvcGrp|97507|2022|PDM|56.00|99|0.00|AETNA HOSPICE
20|FH_F136507_0_0|SrvcGrp|97506|2022|PDM|120.00|99|0.00|AETNA HOSPICE ALL OTHER CARE
20|FH_F136510_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F136510_0_0|CSTM-ALL|CSTM-00|2020|PDM|3145.00|99|0.00|AEG 9 (NO REV)
20|FH_F136510_0_0|CSTM-ALL|CSTM-00|2020|PDM|803.00|99|0.00|AEG 1 (NO REV)
20|FH_F136510_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F136510_0_0|SrvcGrp|112181|2022|PDM|2142.00|99|0.00|DRAINAGE OF EYE
20|FH_F136510_0_0|SrvcGrp|114518|2022|PDM|5746.00|99|0.00|INSERTION DRAINAGE DEVICE
20|FH_F136510_0_0|SrvcGrp|28548|2022|PDM|3882.00|99|0.00|VITRECTOMY
20|FH_F136510_0_0|SrvcGrp|28551|2022|PDM|3882.00|99|0.00|REPAIR OF COMPLEX RETINAL DETACHMENT
20|FH_F136510_0_0|SrvcGrp|45583|2022|PDM|3882.00|99|0.00|CPT 65730
20|FH_F136510_0_0|SrvcGrp|53703|2022|PDM|2142.00|99|0.00|REVISE AQUEOUS SHUNT TO EXTRAOCULAR RESIVOIR
20|FH_F136510_0_0|SrvcGrp|87386|2022|PDM|2866.00|99|0.00|AMNIOTIC MEMBRANE TRANSPLANTATION
20|FH_F136510_0_0|SrvcGrp|90603|2022|PDM|3882.00|99|0.00|EXTRACTION OF LENS
20|FH_F136541_0_0|SrvcGrp|111932|2022|PDM|51.31|99|0.00|COVID-19 NON-CDC TESTING LAB
20|FH_F136547_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F136547_0_0|SrvcGrp|73485|2022|PDM|892.50|99|0.00|AETNA REHAB
20|FH_F136592_0_0|CSTM-ALL|CSTM-00|2020|PDM|663.00|99|0.00|AEG 3 (NO REV)
20|FH_F136592_0_0|SrvcGrp|107792|2022|PDM|5870.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE
20|FH_F136592_0_0|SrvcGrp|107793|2022|PDM|9450.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE
20|FH_F136592_0_0|SrvcGrp|77278|2022|PDM|1240.00|99|0.00|AETNA REPL TUNNLD CNTRL CVC W/O PORT/PUMP
20|FH_F136606_0_0|SrvcGrp|87077|2022|PDM|130.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F136608_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F136608_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F136608_0_0|SrvcGrp|107748|2022|PDM|424.00|99|0.00|HEMODIALYSIS IN CENTER
20|FH_F136608_0_0|SrvcGrp|107749|2022|PDM|164.00|99|0.00|CAPD/CCPD
20|FH_F136608_0_0|SrvcGrp|108042|2022|PDM|424.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD
20|FH_F136629_0_0|CSTM-ALL|CSTM-00|2020|PCT|81.50|99|0.00|GENERAL ACUTE CARE
20|FH_F136654_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F136654_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F136654_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING
20|FH_F136668_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|AEG 8 (NO REV)
20|FH_F136677_0_0|CSTM-ALL|CSTM-00|2020|PDM|731.00|99|0.00|AEG 4 (NO REV)
20|FH_F136677_0_0|CSTM-ALL|CSTM-00|2020|PDM|965.00|99|0.00|AEG 6 (NO REV)
20|FH_F136684_0_0|CSTM-ALL|CSTM-00|2020|PDM|545.00|99|0.00|AEG 3 (NO REV)
20|FH_F136684_0_0|SrvcGrp|112862|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F136728_0_0|SrvcGrp|87077|2022|PDM|195.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F136735_0_0|CSTM-ALL|CSTM-00|2020|PDM|1753.00|99|0.00|AEG 8 (NO REV)
20|FH_F136735_0_0|CSTM-ALL|CSTM-00|2020|PDM|1769.00|99|0.00|AEG 4 (NO REV)
20|FH_F136735_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F136735_0_0|SrvcGrp|112933|2022|PDM|150.00|99|0.00|EPILATION SURGERY
20|FH_F136735_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F136735_0_0|SrvcGrp|73008|2022|PDM|1248.00|99|0.00|AEG 10
20|FH_F136751_0_0|CSTM-ALL|CSTM-00|2020|PDM|2399.00|99|0.00|AEG 10 (NO REV)
20|FH_F136751_0_0|CSTM-ALL|CSTM-00|2020|PDM|2700.00|99|0.00|AEG 3 (NO REV)
20|FH_F136751_0_0|CSTM-ALL|CSTM-00|2020|PDM|3300.00|99|0.00|AEG 5  (NO REV)
20|FH_F136751_0_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|AEG 6 (NO REV)
20|FH_F136751_0_0|SrvcGrp|34606|2022|PDM|7500.00|99|0.00|CPT 29827
20|FH_F136751_0_0|SrvcGrp|36591|2022|PDM|36000.00|99|0.00|CPT 63685
20|FH_F136751_0_0|SrvcGrp|67068|2022|PDM|16000.00|99|0.00|LUMBAR SPINE FUSION COMBINED
20|FH_F136751_0_0|SrvcGrp|77021|2022|PDM|9500.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY
20|FH_F136752_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F136752_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F136752_0_0|CSTM-ALL|CSTM-00|2020|PDM|653.00|99|0.00|AETNA SURGERY DEFAULT WITHOUT GROUPER 1 & 2
20|FH_F136756_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F136756_0_0|SrvcGrp|72992|2022|PDM|558.80|99|0.00|AEG 2
20|FH_F136756_0_0|SrvcGrp|73002|2022|PDM|1290.30|99|0.00|AEG 7
20|FH_F136756_0_0|SrvcGrp|73004|2022|PDM|1377.20|99|0.00|AEG 8
20|FH_F136779_0_0|CSTM-ALL|CSTM-00|2020|PDM|1458.00|99|0.00|AEG 6 (NO REV)
20|FH_F136779_0_0|CSTM-ALL|CSTM-00|2020|PDM|776.00|99|0.00|AEG 2 (NO REV)
20|FH_F136779_0_0|SrvcGrp|104022|2022|PDM|3713.00|99|0.00|CYSTOSCOPY IMPLANT 4 OR MORE
20|FH_F136779_0_0|SrvcGrp|112581|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F136779_0_0|SrvcGrp|112862|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F136779_0_0|SrvcGrp|112927|2022|PDM|11473.00|99|0.00|RECONSTRUCT SHOULDER JOINT
20|FH_F136779_0_0|SrvcGrp|57864|2022|PDM|1340.00|99|0.00|SUBMUCOUS RESECTION
20|FH_F136780_0_0|SrvcGrp|472|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F136780_0_0|SrvcGrp|75545|2022|PDM|395.00|99|0.00|SUB-ACUTE - LEVEL I AND II
20|FH_F136787_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F136790_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F136790_0_0|SrvcGrp|13630|2022|PDM|647.00|99|0.00|CPT 99204
20|FH_F136793_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F136793_0_0|CSTM-ALL|CSTM-00|2020|PDM|590.00|99|0.00|AEG 3 (NO REV)
20|FH_F136793_0_0|SrvcGrp|112581|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F136806_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F136806_0_0|CSTM-ALL|CSTM-00|2020|PDM|1664.00|99|0.00|AEG 8 (NO REV)
20|FH_F136806_0_0|CSTM-ALL|CSTM-00|2020|PDM|1732.00|99|0.00|AEG 7 (NO REV)
20|FH_F136806_0_0|CSTM-ALL|CSTM-00|2020|PDM|580.00|99|0.00|AEG 1 (NO REV)
20|FH_F136806_0_0|SrvcGrp|112581|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F136806_0_0|SrvcGrp|112946|2022|PDM|7597.00|99|0.00|ILIAC REVASC W/ STENT
20|FH_F136806_0_0|SrvcGrp|112947|2022|PDM|11473.00|99|0.00|RECONSTRUCT SHOULDER JOINT
20|FH_F136806_0_0|SrvcGrp|112948|2022|PDM|9076.00|99|0.00|NECK AND SPINE FUSION
20|FH_F136806_0_0|SrvcGrp|112952|2022|PDM|5737.00|99|0.00|NECK SPINE DISK SURGERY
20|FH_F136806_0_0|SrvcGrp|34606|2022|PDM|3362.00|99|0.00|CPT 29827
20|FH_F136806_0_0|SrvcGrp|35670|2022|PDM|4459.00|99|0.00|SPINAL NEUROSTIMULATORS PROCEDURE
20|FH_F136806_0_0|SrvcGrp|55071|2022|PDM|2218.00|99|0.00|ARTHROSCOPY SHOULDER
20|FH_F136806_0_0|SrvcGrp|94883|2022|PDM|1340.00|99|0.00|NASAL/SINUS ENDOSCOPY
20|FH_F136812_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F136818_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F136818_0_0|CSTM-ALL|CSTM-00|2020|PDM|1365.00|99|0.00|AEG 8 (NO REV)
20|FH_F136818_0_0|SrvcGrp|112581|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F136818_0_0|SrvcGrp|112934|2022|PDM|1015.00|99|0.00|MUSCULOSKELETAL SURGERY
20|FH_F136818_0_0|SrvcGrp|58755|2022|PDM|3600.00|99|0.00|INJECTION PROC FOR JOINT
20|FH_F136832_0_0|SrvcGrp|110579|2022|PCT|0.00|99|0.00|INTERMEDIATE ICU/CCU
20|FH_F136832_0_0|SrvcGrp|30089|2022|PDM|404.00|99|0.00|HEMODIALYSIS SERVICES
20|FH_F136843_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F136843_0_0|SrvcGrp|107749|2022|PDM|164.00|99|0.00|CAPD/CCPD
20|FH_F136843_0_0|SrvcGrp|108042|2022|PDM|424.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD
20|FH_F136887_0_0|CSTM-ALL|CSTM-00|2020|PDM|2946.00|99|0.00|AEG 7 (NO REV)
20|FH_F136887_0_0|SrvcGrp|112862|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F136887_0_0|SrvcGrp|112978|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES
20|FH_F136887_0_0|SrvcGrp|96350|2022|PDM|14057.00|99|0.00|SHOULDER JOINT
20|FH_F136887_0_0|SrvcGrp|97019|2022|PDM|9018.00|99|0.00|ARTHROSCOPY BICEPS TENODESIS
20|FH_F136947_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F136947_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F136947_0_0|SrvcGrp|106294|2022|PDM|525.00|99|0.00|AMBULANCE SERVICE EMERGENCY TRANSPORT LEVEL 1 (HFCA)
20|FH_F136947_0_0|SrvcGrp|106314|2022|PDM|700.00|99|0.00|ADVANCED LIFE SUPPORT LEVEL 2 (ALS2) (HCFA)
20|FH_F136947_0_0|SrvcGrp|106317|2022|PDM|800.00|99|0.00|SPECIALTY CARE TRANSPORT (HCFA)
20|FH_F136947_0_0|SrvcGrp|13597|2022|PDM|350.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT
20|FH_F136987_0_0|SrvcGrp|110579|2022|PCT|0.00|99|0.00|INTERMEDIATE ICU/CCU
20|FH_F136987_0_0|SrvcGrp|36093|2022|PCT|0.00|99|0.00|ACUTE REHABILITATION
20|FH_F137057_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F137057_0_0|SrvcGrp|104745|2022|PDM|165.00|99|0.00|HOSPICE
20|FH_F137057_0_0|SrvcGrp|108899|2022|PDM|980.00|99|0.00|HOSPICE INPATIENT RESPITE CARE
20|FH_F137057_0_0|SrvcGrp|14494|2022|PDM|56.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F137057_0_0|SrvcGrp|98062|2022|PDM|432.00|99|0.00|HOSPICE INPATIENT RESPITE CARE PER DIEM
20|FH_F137067_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F137067_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F137067_0_0|CSTM-ALL|CSTM-00|2020|PDM|1092.00|99|0.00|AEG 4 (NO REV)
20|FH_F137067_0_0|CSTM-ALL|CSTM-00|2020|PDM|1242.00|99|0.00|AEG 5  (NO REV)
20|FH_F137067_0_0|CSTM-ALL|CSTM-00|2020|PDM|1431.00|99|0.00|AEG 6 (NO REV)
20|FH_F137067_0_0|CSTM-ALL|CSTM-00|2020|PDM|1685.00|99|0.00|AEG 8 (NO REV)
20|FH_F137067_0_0|SrvcGrp|100067|2022|PDM|2625.00|99|0.00|ANKLE ARTHROSCOPY SURGERY
20|FH_F137067_0_0|SrvcGrp|103329|2022|PDM|18900.00|99|0.00|INSJ STABLJ DEV W/ DCMPRN
20|FH_F137067_0_0|SrvcGrp|107361|2022|PDM|18900.00|99|0.00|SECOND LEVEL CER DISKECTOMY
20|FH_F137067_0_0|SrvcGrp|109965|2022|PDM|5250.00|99|0.00|THORAX SPINE DISK SURGERY
20|FH_F137067_0_0|SrvcGrp|112862|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F137067_0_0|SrvcGrp|34606|2022|PDM|6825.00|99|0.00|CPT 29827
20|FH_F137067_0_0|SrvcGrp|35672|2022|PDM|6825.00|99|0.00|CPT 23412
20|FH_F137067_0_0|SrvcGrp|36591|2022|PDM|46200.00|99|0.00|CPT 63685
20|FH_F137067_0_0|SrvcGrp|41334|2022|PDM|18900.00|99|0.00|TOTAL KNEE
20|FH_F137067_0_0|SrvcGrp|67066|2022|PDM|16800.00|99|0.00|CERVICAL SURGERY
20|FH_F137067_0_0|SrvcGrp|67068|2022|PDM|21000.00|99|0.00|LUMBAR SPINE FUSION COMBINED
20|FH_F137067_0_0|SrvcGrp|67279|2022|PDM|16800.00|99|0.00|CERVICAL SURGERY
20|FH_F137067_0_0|SrvcGrp|72121|2022|PDM|7350.00|99|0.00|ARTHOSCOPY
20|FH_F137067_0_0|SrvcGrp|77021|2022|PDM|7350.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY
20|FH_F137067_0_0|SrvcGrp|84939|2022|PDM|25200.00|99|0.00|SHOULDER JOINT
20|FH_F137067_0_0|SrvcGrp|88156|2022|PDM|21000.00|99|0.00|REVISION OF KNEE JOINT
20|FH_F137067_0_0|SrvcGrp|88494|2022|PDM|6300.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION
20|FH_F137067_0_0|SrvcGrp|88596|2022|PDM|2625.00|99|0.00|EXC OF TRIANG FIBROCARTILAGE
20|FH_F137067_0_0|SrvcGrp|89842|2022|PDM|21000.00|99|0.00|LUMBAR
20|FH_F137067_0_0|SrvcGrp|89848|2022|PDM|21000.00|99|0.00|SPINE FUSION EXTRA SEGMENT
20|FH_F137067_0_0|SrvcGrp|89857|2022|PDM|6019.00|99|0.00|REMOVAL OF SPINAL LAMINA
20|FH_F137067_0_0|SrvcGrp|89860|2022|PDM|7350.00|99|0.00|SPINAL DISK SURGERY ADD-ON
20|FH_F137067_0_0|SrvcGrp|92411|2022|PDM|5250.00|99|0.00|RELIEVE SPINAL CORD PRESSURE
20|FH_F137067_0_0|SrvcGrp|92416|2022|PDM|2520.00|99|0.00|CERVICAL LAMINOTOMY
20|FH_F137067_0_0|SrvcGrp|93724|2022|PDM|2625.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY
20|FH_F137087_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F137087_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|AEG 1 (NO REV)
20|FH_F137087_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F137087_0_0|SrvcGrp|113021|2022|PDM|20000.00|99|0.00|KNEE SERVICES
20|FH_F137087_0_0|SrvcGrp|11673|2022|PDM|6150.00|99|0.00|CPT 29888
20|FH_F137087_0_0|SrvcGrp|35670|2022|PDM|28000.00|99|0.00|SPINAL NEUROSTIMULATORS PROCEDURE
20|FH_F137087_0_0|SrvcGrp|41334|2022|PDM|23000.00|99|0.00|TOTAL KNEE
20|FH_F137087_0_0|SrvcGrp|54962|2022|PDM|9250.00|99|0.00|RECONSTRUCTION OF SHOULDER CUFF (ROTATOR)
20|FH_F137239_0_0|SrvcGrp|90854|2022|PDM|885.00|99|0.00|AETNA IP DETOXIFICATION SERVICES
20|FH_F137248_0_0|CSTM-ALL|CSTM-00|2020|PDM|1428.00|99|0.00|AEG 2 (NO REV)
20|FH_F137248_0_0|CSTM-ALL|CSTM-00|2020|PDM|2731.00|99|0.00|AEG 5  (NO REV)
20|FH_F137248_0_0|CSTM-ALL|CSTM-00|2020|PDM|2882.00|99|0.00|AEG 7 (NO REV)
20|FH_F137248_0_0|SrvcGrp|113066|2022|PDM|2393.00|99|0.00|SKIN TISSUE REARRANGEMENT
20|FH_F137248_0_0|SrvcGrp|113068|2022|PDM|3978.00|99|0.00|TREATMENT OF FRACTURE
20|FH_F137248_0_0|SrvcGrp|44461|2022|PDM|5722.00|99|0.00|INSERTION / REPLACEMENT OF SPINAL NEUROSTIMULATOR GENERATOR
20|FH_F137248_0_0|SrvcGrp|97019|2022|PDM|3978.00|99|0.00|ARTHROSCOPY BICEPS TENODESIS
20|FH_F137288_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F137310_0_0|SrvcGrp|14494|2022|PDM|56.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F137350_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F137362_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F137362_0_0|SrvcGrp|113091|2022|PDM|214.00|99|0.00|ACUTE KIDNEY INJURY
20|FH_F137363_0_0|CSTM-ALL|CSTM-00|2020|PDM|772.50|99|0.00|AEG 4 (NO REV)
20|FH_F137363_0_0|SrvcGrp|104638|2022|PDM|3100.00|99|0.00|INSERT HEART PM ATRIAL
20|FH_F137363_0_0|SrvcGrp|108518|2022|PDM|3100.00|99|0.00|IMPLANT PAT ACTIVE HT RECORD
20|FH_F137363_0_0|SrvcGrp|110618|2022|PDM|1854.00|99|0.00|LAPAROSCOPY SERVICES
20|FH_F137363_0_0|SrvcGrp|96385|2022|PDM|4500.00|99|0.00|AETNA IMPLANT DEFIBRILLATOR
20|FH_F137447_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F137447_0_0|SrvcGrp|106317|2022|PDM|500.00|99|0.00|SPECIALTY CARE TRANSPORT (HCFA)
20|FH_F137447_0_0|SrvcGrp|107353|2022|PDM|339.03|99|0.00|AMB SRVC NEONAT TRNSPRT BS RATE EMERG 1 WAY (HCFA)
20|FH_F137459_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F137459_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F137459_0_0|SrvcGrp|3178|2022|PDM|800.00|99|0.00|ACUTE PSYCH
20|FH_F137530_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F137530_0_0|SrvcGrp|107794|2022|PDM|9466.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE
20|FH_F137530_0_0|SrvcGrp|107877|2022|PDM|1298.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT
20|FH_F137530_0_0|SrvcGrp|107879|2022|PDM|6507.00|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT
20|FH_F137567_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F137587_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F137587_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F137587_0_0|SrvcGrp|108043|2022|PDM|297.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD
20|FH_F137587_0_0|SrvcGrp|108546|2022|PDM|297.00|99|0.00|PERITONEAL TREATMENTS W/ PATIENT TRAINING
20|FH_F137610_0_0|SrvcGrp|73605|2022|PDM|958.00|99|0.00|AETNA ACUTE PSYCH
20|FH_F137610_0_0|SrvcGrp|73841|2022|PDM|381.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP
20|FH_F137610_0_0|SrvcGrp|73842|2022|PDM|151.00|99|0.00|AETNA INTENSIVE OUTPATIENT
20|FH_F137610_0_0|SrvcGrp|86722|2022|PDM|151.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)
20|FH_F137610_0_0|SrvcGrp|89417|2022|PDM|381.00|99|0.00|PARTIAL HOSPITALIZATION
20|FH_F137638_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F137638_0_0|CSTM-ALL|CSTM-00|2020|PDM|1538.00|99|0.00|RESIDENT TRTMNT-EATING DISORDERS
20|FH_F137638_0_0|SrvcGrp|46903|2022|PDM|774.00|99|0.00|RESIDENTIAL TREATMENT
20|FH_F137638_0_0|SrvcGrp|73841|2022|PDM|484.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP
20|FH_F137798_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F137798_0_0|SrvcGrp|80920|2022|PDM|567.00|99|0.00|HOSPICE SERVICES
20|FH_F137798_0_0|SrvcGrp|95660|2022|PDM|567.00|99|0.00|HOSPICE SERVICES (HCFA)
20|FH_F137799_0_0|SrvcGrp|63297|2022|PDM|100.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F137799_0_0|SrvcGrp|65720|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F137799_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F137799_0_0|SrvcGrp|93098|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F137847_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F137847_0_0|SrvcGrp|46903|2022|PDM|605.00|99|0.00|RESIDENTIAL TREATMENT
20|FH_F137902_0_0|SrvcGrp|3178|2022|PDM|1000.00|99|0.00|ACUTE PSYCH
20|FH_F137902_0_0|SrvcGrp|86722|2022|PDM|161.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)
20|FH_F137902_0_0|SrvcGrp|89417|2022|PDM|269.00|99|0.00|PARTIAL HOSPITALIZATION
20|FH_F137906_0_0|SrvcGrp|104230|2022|PDM|100.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F137906_0_0|SrvcGrp|82222|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F137933_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 10 (NO REV)
20|FH_F137933_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|AEG 3 (NO REV)
20|FH_F137933_0_0|SrvcGrp|107575|2022|PDM|3500.00|99|0.00|REMOVAL OF KIDNEY STONE
20|FH_F137933_0_0|SrvcGrp|113158|2022|PDM|3500.00|99|0.00|KIDNEY ENDOSCOPY & BIOPSY
20|FH_F137933_0_0|SrvcGrp|113162|2022|PDM|12200.00|99|0.00|INSERT TANDEM CUFF
20|FH_F137933_0_0|SrvcGrp|77451|2022|PDM|5800.00|99|0.00|CPT 53440
20|FH_F137933_0_0|SrvcGrp|87056|2022|PDM|13100.00|99|0.00|REMOVE/REPLACE PENIS PROSTHETIC
20|FH_F137940_0_0|SrvcGrp|106317|2022|PDM|595.64|99|0.00|SPECIALTY CARE TRANSPORT (HCFA)
20|FH_F137940_0_0|SrvcGrp|107353|2022|PDM|345.36|99|0.00|AMB SRVC NEONAT TRNSPRT BS RATE EMERG 1 WAY (HCFA)
20|FH_F137940_0_0|SrvcGrp|13683|2022|PDM|499.11|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2
20|FH_F137943_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F137943_0_0|CSTM-ALL|CSTM-00|2020|PDM|1150.00|99|0.00|AEG 10 (NO REV)
20|FH_F137943_0_0|CSTM-ALL|CSTM-00|2020|PDM|2900.00|99|0.00|DEVICE INSERTION
20|FH_F137943_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|AEG 6 (NO REV)
20|FH_F137943_0_0|SrvcGrp|104719|2022|PDM|3040.00|99|0.00|RELIEVE INNER EYE PRESSURE
20|FH_F137943_0_0|SrvcGrp|106216|2022|PDM|2859.00|99|0.00|CORNEAL TRANSPLANT ENDOTHELIAL
20|FH_F137943_0_0|SrvcGrp|109738|2022|PDM|2300.00|99|0.00|OCULR RECNSTR; LIMBL CONJNCT
20|FH_F137943_0_0|SrvcGrp|113195|2022|PDM|1660.00|99|0.00|REINFORCE/GRAFT EYE WALL
20|FH_F137943_0_0|SrvcGrp|113197|2022|PDM|1660.00|99|0.00|FISTULIZATION OF SCLERA
20|FH_F137943_0_0|SrvcGrp|113198|2022|PDM|1400.00|99|0.00|BIOPSY OF CORNEA
20|FH_F137943_0_0|SrvcGrp|54084|2022|PDM|4029.00|99|0.00|IMPLANT EYE SHUNT
20|FH_F137943_0_0|SrvcGrp|79794|2022|PDM|1660.00|99|0.00|EYE/OCULAR ADNEXA SURGERY
20|FH_F137943_0_0|SrvcGrp|92548|2022|PDM|703.00|99|0.00|REMOVAL OF EYE LESION
20|FH_F137946_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F137946_0_0|SrvcGrp|113221|2022|PDM|416.78|99|0.00|COVID-19 NFCT DS 22 TRGT SARS-COV-2 (HCFA)
20|FH_F137946_0_0|SrvcGrp|113222|2022|PDM|416.78|99|0.00|COVID-19 NFCT DS 22 TRGT SARS-COV-2
20|FH_F137946_0_0|SrvcGrp|113225|2022|PDM|416.78|99|0.00|COVID-19 NFCT DS DNA&RNA 21 SARSCOV2 (HCFA)
20|FH_F137946_0_0|SrvcGrp|113228|2022|PDM|142.63|99|0.00|COVID-19 NFCT DS VIR RESP RNA 4 TRGT
20|FH_F137946_0_0|SrvcGrp|113232|2022|PDM|42.13|99|0.00|COVID-19 SARS-COV-2 ANTB QUANTITATIVE
20|FH_F137946_0_0|SrvcGrp|113233|2022|PDM|42.13|99|0.00|COVID-19 SARS-COV-2 ANTB QUANTITATIVE (HFCA)
20|FH_F137946_0_0|SrvcGrp|113234|2022|PDM|142.63|99|0.00|COVID-19 SARSCOV2 & INF A&B AMP PRB
20|FH_F137946_0_0|SrvcGrp|113235|2022|PDM|142.63|99|0.00|COVID-19 SARSCOV2&INF A&B&RSV AMP PRB
20|FH_F137946_0_0|SrvcGrp|113237|2022|PDM|35.92|99|0.00|COVID-19 NCOV DIAGNOSTIC P (HCFA)
20|FH_F137946_0_0|SrvcGrp|113238|2022|PDM|51.31|99|0.00|COVID-19 LAB TEST NON-CDC (HCFA)
20|FH_F137946_0_0|SrvcGrp|113239|2022|PDM|100.00|99|0.00|COVID-19 AMP PRB HGH THRUPUT (HCFA)
20|FH_F137946_0_0|SrvcGrp|113240|2022|PDM|100.00|99|0.00|COVID-19 TEST NON-CDC HGH THRU (HCFA)
20|FH_F137946_0_0|SrvcGrp|113244|2022|PDM|142.63|99|0.00|COVID-19 NFCT DS VIR RESP RNA 3 TRGT (HCFA)
20|FH_F137946_0_0|SrvcGrp|113249|2022|PDM|142.63|99|0.00|COVID-19 SARSCOV2 & INF A&B AMP PRB (HCFA)
20|FH_F137950_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F137950_0_0|CSTM-ALL|CSTM-00|2020|PDM|770.00|99|0.00|AEG 1 (NO REV)
20|FH_F137951_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|AEG 8 (NO REV)
20|FH_F137951_0_0|CSTM-ALL|CSTM-00|2020|PDM|825.00|99|0.00|AEG 10 (NO REV)
20|FH_F137951_0_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F137951_0_0|SrvcGrp|113167|2022|PDM|1436.00|99|0.00|PERCUTANEOUS SKELETAL FIX
20|FH_F137951_0_0|SrvcGrp|16289|2022|PDM|890.00|99|0.00|CARPAL TUNNEL RELEASE
20|FH_F137951_0_0|SrvcGrp|26273|2022|PDM|1436.00|99|0.00|CPT 29880
20|FH_F137951_0_0|SrvcGrp|27261|2022|PDM|9393.00|99|0.00|CPT 27446
20|FH_F137951_0_0|SrvcGrp|34606|2022|PDM|3223.00|99|0.00|CPT 29827
20|FH_F137951_0_0|SrvcGrp|36591|2022|PDM|3000.00|99|0.00|CPT 63685
20|FH_F137951_0_0|SrvcGrp|41334|2022|PDM|9393.00|99|0.00|TOTAL KNEE
20|FH_F137951_0_0|SrvcGrp|41335|2022|PDM|10500.00|99|0.00|TOTAL HIP
20|FH_F137951_0_0|SrvcGrp|54943|2022|PDM|3131.00|99|0.00|REPAIR OF SLAP LESION
20|FH_F137951_0_0|SrvcGrp|58634|2022|PDM|3000.00|99|0.00|NEUROELECTRODES IMPLANT
20|FH_F137951_0_0|SrvcGrp|85778|2022|PDM|4138.00|99|0.00|REPAIR OF ANKLE FRACTURE
20|FH_F137951_0_0|SrvcGrp|88065|2022|PDM|3000.00|99|0.00|TOTAL DISC ARTHROPLASTY
20|FH_F137951_0_0|SrvcGrp|97484|2022|PDM|1458.00|99|0.00|ENDO CHOLANGIOPANCREATOGRAPH
20|FH_F137972_0_0|CSTM-ALL|CSTM-00|2020|PDM|1442.00|99|0.00|AEG 7 (NO REV)
20|FH_F137972_0_0|CSTM-ALL|CSTM-00|2020|PDM|743.00|99|0.00|AEG 3 (NO REV)
20|FH_F137972_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 10 (NO REV)
20|FH_F137972_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F137972_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F137986_0_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|AEG 6 (NO REV)
20|FH_F137986_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|AEG 1 (NO REV)
20|FH_F137986_0_0|CSTM-ALL|CSTM-00|2020|PDM|825.00|99|0.00|AEG 10 (NO REV)
20|FH_F137986_0_0|SrvcGrp|113114|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F137986_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F137986_0_0|SrvcGrp|11673|2022|PDM|4326.00|99|0.00|CPT 29888
20|FH_F137986_0_0|SrvcGrp|27315|2022|PDM|3223.00|99|0.00|TENDON REPAIR
20|FH_F137986_0_0|SrvcGrp|35669|2022|PDM|3000.00|99|0.00|CPT 63650
20|FH_F137986_0_0|SrvcGrp|41334|2022|PDM|9393.00|99|0.00|TOTAL KNEE
20|FH_F137986_0_0|SrvcGrp|63471|2022|PDM|3000.00|99|0.00|CPT 64590
20|FH_F137986_0_0|SrvcGrp|67065|2022|PDM|3000.00|99|0.00|CERVICAL SURGERY
20|FH_F137986_0_0|SrvcGrp|77021|2022|PDM|3000.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY
20|FH_F137986_0_0|SrvcGrp|80063|2022|PDM|1228.00|99|0.00|HEMORRHOIDECTOMY
20|FH_F137986_0_0|SrvcGrp|85778|2022|PDM|4138.00|99|0.00|REPAIR OF ANKLE FRACTURE
20|FH_F137986_0_0|SrvcGrp|89980|2022|PDM|4508.00|99|0.00|OPEN TREATMENT OF DISTAL
20|FH_F137986_0_0|SrvcGrp|98003|2022|PDM|4203.00|99|0.00|BIMALLEOLAR ANKLE FRACTURE
20|FH_F138010_0_0|SrvcGrp|80920|2022|PDM|475.00|99|0.00|HOSPICE SERVICES
20|FH_F138021_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F138021_0_0|CSTM-ALL|CSTM-00|2020|PDM|625.00|99|0.00|AEG 4 (NO REV)
20|FH_F138021_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|AEG 5  (NO REV)
20|FH_F138021_0_0|CSTM-ALL|CSTM-00|2020|PDM|980.00|99|0.00|AEG 8 (NO REV)
20|FH_F138021_0_0|CSTM-ALL|CSTM-00|2020|PDM|990.00|99|0.00|AEG 7 (NO REV)
20|FH_F138054_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F138054_0_0|SrvcGrp|48398|2022|PDM|146.00|99|0.00|PT SERVICES
20|FH_F138152_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F138191_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F138196_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 9 (NO REV)
20|FH_F138196_0_0|CSTM-ALL|CSTM-00|2020|PDM|620.00|99|0.00|AEG 3 (NO REV)
20|FH_F138196_0_0|SrvcGrp|48380|2022|PDM|530.00|99|0.00|CARVE OUT V2788
20|FH_F138197_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F138197_0_0|CSTM-ALL|CSTM-00|2020|PDM|1430.10|99|0.00|AEG 6 (NO REV) W/O SPINAL PROCEDURES
20|FH_F138197_0_0|CSTM-ALL|CSTM-00|2020|PDM|2315.25|99|0.00|AEG 9 (NO REV)
20|FH_F138197_0_0|SrvcGrp|103236|2022|PDM|2495.00|99|0.00|AETNA INSJ STABLJ DEV
20|FH_F138197_0_0|SrvcGrp|113271|2022|PDM|830.00|99|0.00|GENICULAR NERVE BLOCK
20|FH_F138197_0_0|SrvcGrp|87679|2022|PDM|830.00|99|0.00|LUMBAR OR SACRAL SURGERY
20|FH_F138216_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F138217_0_0|CSTM-ALL|CSTM-00|2020|PCT|12000.00|99|0.00|TIMELY FILING
20|FH_F138217_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|DIAGNOSTIC RADIOLOGY SERVICES
20|FH_F138218_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F138219_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F138236_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F138236_0_0|SrvcGrp|104229|2022|PDM|105.00|99|0.00|HOSPICE IN HOME (HCFA)
20|FH_F138236_0_0|SrvcGrp|104230|2022|PDM|105.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F138236_0_0|SrvcGrp|82223|2022|PDM|105.00|99|0.00|HOSPICE CARE
20|FH_F138283_0_0|SrvcGrp|23683|2022|PDM|30.00|99|0.00|SKILLED NURSING RN
20|FH_F138283_0_0|SrvcGrp|34173|2022|PDM|115.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F138283_0_0|SrvcGrp|46104|2022|PDM|112.00|99|0.00|HOME VISIT - PRENATAL
20|FH_F138283_0_0|SrvcGrp|46118|2022|PDM|112.00|99|0.00|NUTRITNAL CNSLNG/DIABETES EDU
20|FH_F138283_0_0|SrvcGrp|53144|2022|PDM|107.00|99|0.00|SPEECH THERAPY
20|FH_F138283_0_0|SrvcGrp|63297|2022|PDM|113.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F138283_0_0|SrvcGrp|90340|2022|PDM|90.00|99|0.00|SKILLED NURSING LPN
20|FH_F138296_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F138350_0_0|CSTM-ALL|CSTM-00|2020|PDM|1399.00|99|0.00|AEG 7 (NO REV)
20|FH_F138350_0_0|SrvcGrp|113114|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F138350_0_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F138350_0_0|SrvcGrp|12664|2022|PCT|0.78|99|0.00|IMPLANTS
20|FH_F138353_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F138416_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|HOSPICE SERVICES
20|FH_F138416_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|HOSPICE SVCS
20|FH_F138417_0_0|CSTM-ALL|CSTM-00|2020|PCT|12000.00|99|0.00|TIMELY FILING
20|FH_F138417_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|AETNA ENTERAL & PARENTERAL
20|FH_F138417_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|DME PROSTHETICS AND ORTHOTICS
20|FH_F138417_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F138420_0_0|CSTM-ALL|CSTM-00|2020|PDM|1769.00|99|0.00|AEG 5  (NO REV)
20|FH_F138420_0_0|CSTM-ALL|CSTM-00|2020|PDM|2023.00|99|0.00|AEG 6 (NO REV)
20|FH_F138420_0_0|CSTM-ALL|CSTM-00|2020|PDM|2456.00|99|0.00|AEG 10 (NO REV)
20|FH_F138420_0_0|CSTM-ALL|CSTM-00|2020|PDM|840.00|99|0.00|AEG 1 (NO REV)
20|FH_F138422_0_0|CSTM-ALL|CSTM-00|2020|PDM|407.00|99|0.00|AEG 1 (NO REV)
20|FH_F138422_0_0|CSTM-ALL|CSTM-00|2020|PDM|562.00|99|0.00|AEG 10 (NO REV)
20|FH_F138422_0_0|CSTM-ALL|CSTM-00|2020|PDM|562.00|99|0.00|AEG 2 (NO REV)
20|FH_F138422_0_0|CSTM-ALL|CSTM-00|2020|PDM|562.00|99|0.00|AEG 6 (NO REV)
20|FH_F138422_0_0|CSTM-ALL|CSTM-00|2020|PDM|562.00|99|0.00|AEG 7 (NO REV)
20|FH_F138450_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F138450_0_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING
20|FH_F138450_0_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB
20|FH_F138450_0_0|SrvcGrp|112676|2022|PDM|42.13|99|0.00|COVID-19 SARS-COV-2 ANTIBODY
20|FH_F138450_0_0|SrvcGrp|74403|2022|PCT|0.93|99|0.00|AETNA OBSERVATION SERVICES
20|FH_F138451_0_0|SrvcGrp|83960|2022|PCT|0.90|99|0.00|CARDIAC CATHETERIZATION
20|FH_F138452_0_0|CSTM-ALL|CSTM-00|2020|PCT|12000.00|99|0.00|TIMELY FILING
20|FH_F138452_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F138452_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|UNCLASSIFIED DRUGS
20|FH_F138460_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|AETNA BEHAVIOR OBSERVATION
20|FH_F138460_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|AETNA IP DETOXIFICATION SERVICES
20|FH_F138460_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|AMBULATORY DETOX - ALCOHOL AND DRUG REHAB
20|FH_F138460_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|RESIDENTIAL TREATMENT PSYCHIATIC OR CD OUTLIER
20|FH_F138478_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F138478_0_0|SrvcGrp|104635|2022|PDM|5518.23|99|0.00|INSERT PULSE GEN SNGL LEAD
20|FH_F138478_0_0|SrvcGrp|107793|2022|PDM|9060.49|99|0.00|DIALYSIS CIRCUIT PROCEDURE
20|FH_F138478_0_0|SrvcGrp|107794|2022|PDM|3722.40|99|0.00|DIALYSIS CIRCUIT PROCEDURE
20|FH_F138478_0_0|SrvcGrp|109500|2022|PDM|1341.77|99|0.00|REPAIR LEAD PACE-DEFIB ONE
20|FH_F138478_0_0|SrvcGrp|109503|2022|PDM|1193.56|99|0.00|REPOSITION L VENTRIC LEAD
20|FH_F138478_0_0|SrvcGrp|110703|2022|PDM|3383.82|99|0.00|INSERTION OF HEART ELECTRODE
20|FH_F138478_0_0|SrvcGrp|113281|2022|PDM|5220.46|99|0.00|INSERT/REPLACE OF CARD ELECT
20|FH_F138478_0_0|SrvcGrp|113283|2022|PDM|1341.77|99|0.00|REPOS PREV IMPLTBL SUBQ DFB
20|FH_F138478_0_0|SrvcGrp|113284|2022|PDM|1193.56|99|0.00|LIGATION/BANDING A-V
20|FH_F138478_0_0|SrvcGrp|113287|2022|PCT|0.63|99|0.00|TOTAL JOINTS
20|FH_F138478_0_0|SrvcGrp|12491|2022|PCT|0.63|99|0.00|PACEMAKER
20|FH_F138478_0_0|SrvcGrp|91959|2022|PDM|17567.26|99|0.00|INSERT PULSE GENERATOR
20|FH_F138478_0_0|SrvcGrp|96380|2022|PDM|23546.99|99|0.00|AETNA INS/REP SUBQ DEFIBRILLATOR
20|FH_F138488_0_0|CSTM-ALL|CSTM-00|2020|PDM|558.04|99|0.00|AEG 6 (NO REV)
20|FH_F138488_0_0|CSTM-ALL|CSTM-00|2020|PDM|628.94|99|0.00|AEG 8 (NO REV)
20|FH_F138488_0_0|CSTM-ALL|CSTM-00|2020|PDM|823.99|99|0.00|AEG 5  (NO REV)
20|FH_F138491_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F138491_0_0|SrvcGrp|104226|2022|PDM|85.00|99|0.00|HOSPICE CARE (HCFA)
20|FH_F138491_0_0|SrvcGrp|104228|2022|PDM|85.00|99|0.00|HOSPICE CARE (HCFA)
20|FH_F138491_0_0|SrvcGrp|87799|2022|PDM|85.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)
20|FH_F138532_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F138532_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F138532_0_0|SrvcGrp|107748|2022|PDM|424.00|99|0.00|HEMODIALYSIS IN CENTER
20|FH_F138532_0_0|SrvcGrp|108042|2022|PDM|424.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD
20|FH_F138533_0_0|CSTM-ALL|CSTM-00|2020|PDM|575.00|99|0.00|AEG 2 (NO REV)
20|FH_F138540_0_0|CSTM-ALL|CSTM-00|2020|PCT|61.00|99|0.00|AEG 2 (NO REV)
20|FH_F138611_0_0|CSTM-ALL|CSTM-00|2020|PDM|2429.00|99|0.00|AEG 2 (NO REV)
20|FH_F138611_0_0|CSTM-ALL|CSTM-00|2020|PDM|3425.00|99|0.00|AEG 4 (NO REV)
20|FH_F138611_0_0|CSTM-ALL|CSTM-00|2020|PDM|5417.00|99|0.00|AEG 7 (NO REV)
20|FH_F138611_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F138611_0_0|SrvcGrp|112225|2022|PDM|23.46|99|0.00|COVID-19 SPECIMEN COLLECTION
20|FH_F138611_0_0|SrvcGrp|27261|2022|PDM|14894.00|99|0.00|CPT 27446
20|FH_F138611_0_0|SrvcGrp|41334|2022|PDM|14894.00|99|0.00|TOTAL KNEE
20|FH_F138611_0_0|SrvcGrp|84939|2022|PDM|14894.00|99|0.00|SHOULDER JOINT
20|FH_F138611_0_0|SrvcGrp|89404|2022|PDM|14894.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F138611_0_0|SrvcGrp|93432|2022|PDM|14894.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT
20|FH_F138611_0_0|SrvcGrp|97730|2022|PDM|14894.00|99|0.00|REVERSE HIP JOINT
20|FH_F138636_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F138647_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F138654_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F138682_0_0|CSTM-ALL|CSTM-00|2020|PDM|483.00|99|0.00|AEG 6 (NO REV)
20|FH_F138710_0_0|SrvcGrp|87077|2022|PDM|125.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F138713_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F138734_0_0|SrvcGrp|46903|2022|PDM|543.00|99|0.00|RESIDENTIAL TREATMENT
20|FH_F138734_0_0|SrvcGrp|90854|2022|PDM|859.00|99|0.00|AETNA IP DETOXIFICATION SERVICES
20|FH_F138751_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F138751_0_0|SrvcGrp|113367|2022|PDM|182.00|99|0.00|CAPD/CCPD
20|FH_F138827_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F138827_0_0|SrvcGrp|113445|2022|PDM|100.00|99|0.00|TELEMEDICINE SERVICES (MOD GT) (HCFA)
20|FH_F138873_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F138873_0_0|CSTM-ALL|CSTM-00|2020|PDM|1523.00|99|0.00|AEG 9 (NO REV)
20|FH_F138873_0_0|CSTM-ALL|CSTM-00|2020|PDM|380.00|99|0.00|AEG 1 (NO REV)
20|FH_F138873_0_0|CSTM-ALL|CSTM-00|2020|PDM|556.00|99|0.00|AEG 2 (NO REV)
20|FH_F138873_0_0|CSTM-ALL|CSTM-00|2020|PDM|581.00|99|0.00|AEG 3 (NO REV)
20|FH_F138873_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|AEG 4 (NO REV)
20|FH_F138873_0_0|SrvcGrp|113114|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F138882_0_0|CSTM-ALL|CSTM-00|2020|PDM|2340.00|99|0.00|AEG 3 (NO REV)
20|FH_F138882_0_0|CSTM-ALL|CSTM-00|2020|PDM|2725.00|99|0.00|AEG 4 (NO REV)
20|FH_F138882_0_0|CSTM-ALL|CSTM-00|2020|PDM|2946.00|99|0.00|AEG 6 (NO REV)
20|FH_F138882_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F138929_0_0|SrvcGrp|104112|2022|PDM|4400.00|99|0.00|REPAIR OF ANKLE FRACTURE
20|FH_F138929_0_0|SrvcGrp|109834|2022|PDM|4620.00|99|0.00|REPAIR HUMERUS FRACTURE
20|FH_F138929_0_0|SrvcGrp|113271|2022|PDM|1320.00|99|0.00|GENICULAR NERVE BLOCK
20|FH_F138929_0_0|SrvcGrp|16289|2022|PDM|1457.50|99|0.00|CARPAL TUNNEL RELEASE
20|FH_F138929_0_0|SrvcGrp|33724|2022|PDM|3300.00|99|0.00|ARTHROSCOPY
20|FH_F138929_0_0|SrvcGrp|35666|2022|PDM|1375.00|99|0.00|CPT 23700
20|FH_F138929_0_0|SrvcGrp|35672|2022|PDM|4620.00|99|0.00|CPT 23412
20|FH_F138929_0_0|SrvcGrp|58638|2022|PDM|3850.00|99|0.00|CPT 63688
20|FH_F138929_0_0|SrvcGrp|72121|2022|PDM|3520.00|99|0.00|ARTHOSCOPY
20|FH_F138929_0_0|SrvcGrp|75002|2022|PDM|5005.00|99|0.00|ARTHOSCOPY
20|FH_F138929_0_0|SrvcGrp|77021|2022|PDM|6600.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY
20|FH_F138929_0_0|SrvcGrp|82114|2022|PDM|3300.00|99|0.00|MENISCUS REPAIR MED OR LAT
20|FH_F138929_0_0|SrvcGrp|84939|2022|PDM|17600.00|99|0.00|SHOULDER JOINT
20|FH_F138929_0_0|SrvcGrp|87679|2022|PDM|1457.50|99|0.00|LUMBAR OR SACRAL SURGERY
20|FH_F138929_0_0|SrvcGrp|88155|2022|PDM|13520.00|99|0.00|REVISE KNEECAP WITH IMPLANT
20|FH_F138929_0_0|SrvcGrp|88820|2022|PDM|2310.00|99|0.00|CPT 24359
20|FH_F138929_0_0|SrvcGrp|89980|2022|PDM|5005.00|99|0.00|OPEN TREATMENT OF DISTAL
20|FH_F138929_0_0|SrvcGrp|92009|2022|PDM|4620.00|99|0.00|CARPAL SCAPHOID FRACTURE
20|FH_F138929_0_0|SrvcGrp|92364|2022|PDM|15400.00|99|0.00|ARTHRODESIS SACROILIAC JOINT
20|FH_F138934_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F138934_0_0|CSTM-ALL|CSTM-00|2020|PDM|482.00|99|0.00|AEG 1 (NO REV)
20|FH_F138934_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|AEG 10 (NO REV)
20|FH_F138934_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|AEG 4 (NO REV)
20|FH_F138934_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|AEG 6 (NO REV)
20|FH_F138934_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|AEG 9 (NO REV)
20|FH_F138934_0_0|SrvcGrp|71221|2022|PDM|675.00|99|0.00|EGD W/BALLOON DIALATION CPT 43249
20|FH_F138987_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F138987_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F138987_0_0|SrvcGrp|83522|2022|PDM|134.00|99|0.00|RESPITE CARE
20|FH_F138987_0_0|SrvcGrp|95660|2022|PDM|627.00|99|0.00|HOSPICE SERVICES (HCFA)
20|FH_F138987_0_0|SrvcGrp|97506|2022|PDM|125.00|99|0.00|AETNA HOSPICE ALL OTHER CARE
20|FH_F138995_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F138995_0_0|SrvcGrp|27344|2022|PDM|1500.00|99|0.00|OP SURGERY (CPT 42821)
20|FH_F138995_0_0|SrvcGrp|59705|2022|PDM|1050.00|99|0.00|SEPTOPLASTY
20|FH_F138995_0_0|SrvcGrp|59840|2022|PDM|930.00|99|0.00|TYMPANOSTOMY
20|FH_F138995_0_0|SrvcGrp|77582|2022|PDM|1175.00|99|0.00|CPT 31255
20|FH_F138995_0_0|SrvcGrp|83835|2022|PDM|4200.00|99|0.00|REPLACE TISSUE EXPANDER
20|FH_F138995_0_0|SrvcGrp|87679|2022|PDM|800.00|99|0.00|LUMBAR OR SACRAL SURGERY
20|FH_F138995_0_0|SrvcGrp|89882|2022|PDM|2300.00|99|0.00|AETNA REMOVAL OF TONSILS
20|FH_F138995_0_0|SrvcGrp|90157|2022|PDM|1100.00|99|0.00|AETNA REMOVAL OF TONSILS
20|FH_F139048_0_0|CSTM-ALL|CSTM-00|2020|PDM|1070.00|99|0.00|AEG 5  (NO REV)
20|FH_F139048_0_0|CSTM-ALL|CSTM-00|2020|PDM|880.00|99|0.00|AEG 3 (NO REV)
20|FH_F139048_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F139048_0_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS
20|FH_F139147_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F139147_0_0|CSTM-ALL|CSTM-00|2020|PDM|1704.00|99|0.00|AEG 2 (NO REV)
20|FH_F139147_0_0|CSTM-ALL|CSTM-00|2020|PDM|2939.00|99|0.00|AEG 8 (NO REV)
20|FH_F139147_0_0|SrvcGrp|112978|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES
20|FH_F139147_0_0|SrvcGrp|41334|2022|PDM|13648.00|99|0.00|TOTAL KNEE
20|FH_F139147_0_0|SrvcGrp|59840|2022|PDM|3713.00|99|0.00|TYMPANOSTOMY
20|FH_F139147_0_0|SrvcGrp|90157|2022|PDM|5305.00|99|0.00|AETNA REMOVAL OF TONSILS
20|FH_F139169_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F139169_0_0|CSTM-ALL|CSTM-00|2020|PDM|1229.14|99|0.00|AEG 5  (NO REV)
20|FH_F139169_0_0|CSTM-ALL|CSTM-00|2020|PDM|1635.78|99|0.00|AEG 8 (NO REV)
20|FH_F139169_0_0|CSTM-ALL|CSTM-00|2020|PDM|2249.33|99|0.00|AEG 9 (NO REV)
20|FH_F139169_0_0|CSTM-ALL|CSTM-00|2020|PDM|765.13|99|0.00|AEG 2 (NO REV)
20|FH_F139169_0_0|SrvcGrp|113478|2022|PCT|1.05|99|0.00|IMPLANTS
20|FH_F139169_0_0|SrvcGrp|113479|2022|PDM|1000.00|99|0.00|ESOPH ENDOSCOPY
20|FH_F139173_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F139173_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F139173_0_0|SrvcGrp|29347|2022|PDM|95.00|99|0.00|HOME HEALTH AIDE
20|FH_F139173_0_0|SrvcGrp|46605|2022|PDM|192.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES
20|FH_F139173_0_0|SrvcGrp|48394|2022|PDM|95.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F139173_0_0|SrvcGrp|48398|2022|PDM|192.00|99|0.00|PT SERVICES
20|FH_F139173_0_0|SrvcGrp|88621|2022|PDM|164.00|99|0.00|SKILLED NURSING LPN
20|FH_F139173_0_0|SrvcGrp|89783|2022|PDM|172.09|99|0.00|RESPITE CARE (HCFA)
20|FH_F139173_0_0|SrvcGrp|95660|2022|PDM|911.62|99|0.00|HOSPICE SERVICES (HCFA)
20|FH_F139177_0_0|CSTM-ALL|CSTM-00|2020|PDM|1112.00|99|0.00|AEG 5  (NO REV)
20|FH_F139177_0_0|CSTM-ALL|CSTM-00|2020|PDM|788.00|99|0.00|AEG 3 (NO REV)
20|FH_F139207_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.28|99|0.00|HSS ASC
20|FH_F139236_0_0|CSTM-ALL|CSTM-00|2020|PDM|1563.00|99|0.00|AEG 8 (NO REV)
20|FH_F139238_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F139238_0_0|CSTM-ALL|CSTM-00|2020|PDM|1139.60|99|0.00|AEG 10 (NO REV)
20|FH_F139238_0_0|CSTM-ALL|CSTM-00|2020|PDM|1139.60|99|0.00|AEG 5  (NO REV)
20|FH_F139238_0_0|CSTM-ALL|CSTM-00|2020|PDM|524.70|99|0.00|AEG 1 (NO REV)
20|FH_F139238_0_0|SrvcGrp|11663|2022|PCT|0.32|99|0.00|IMPLANTS
20|FH_F139238_0_0|SrvcGrp|12491|2022|PCT|0.41|99|0.00|PACEMAKER
20|FH_F139241_0_0|CSTM-ALL|CSTM-00|2020|PDM|1257.00|99|0.00|AEG 8 (NO REV)
20|FH_F139241_0_0|CSTM-ALL|CSTM-00|2020|PDM|1319.00|99|0.00|AEG 7 (NO REV)
20|FH_F139241_0_0|CSTM-ALL|CSTM-00|2020|PDM|1777.00|99|0.00|AEG 9 (NO REV)
20|FH_F139241_0_0|CSTM-ALL|CSTM-00|2020|PDM|592.00|99|0.00|AEG 2 (NO REV)
20|FH_F139241_0_0|CSTM-ALL|CSTM-00|2020|PDM|677.00|99|0.00|AEG 3 (NO REV)
20|FH_F139241_0_0|SrvcGrp|28080|2022|PDM|765.00|99|0.00|DIALYSIS
20|FH_F139241_0_0|SrvcGrp|77583|2022|PDM|1202.00|99|0.00|REMOVE TONSILS AND ADENOIDS
20|FH_F139274_0_0|CSTM-ALL|CSTM-00|2020|PDM|1197.00|99|0.00|AEG 6 (NO REV)
20|FH_F139274_0_0|CSTM-ALL|CSTM-00|2020|PDM|1442.00|99|0.00|AEG 7 (NO REV)
20|FH_F139274_0_0|CSTM-ALL|CSTM-00|2020|PDM|742.00|99|0.00|AEG 3 (NO REV)
20|FH_F139289_0_0|SrvcGrp|108899|2022|PDM|1025.00|99|0.00|HOSPICE INPATIENT RESPITE CARE
20|FH_F139289_0_0|SrvcGrp|98062|2022|PDM|452.08|99|0.00|HOSPICE INPATIENT RESPITE CARE PER DIEM
20|FH_F139293_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|GENERAL ACUTE CARE
20|FH_F139299_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F139299_0_0|SrvcGrp|108484|2022|PDM|700.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY
20|FH_F139299_0_0|SrvcGrp|86723|2022|PDM|435.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)
20|FH_F139450_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F139509_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F139509_0_0|CSTM-ALL|CSTM-00|2020|PDM|433.00|99|0.00|AEG 2 (NO REV)
20|FH_F139509_0_0|CSTM-ALL|CSTM-00|2020|PDM|612.00|99|0.00|AEG 4 (NO REV)
20|FH_F139515_0_0|CSTM-ALL|CSTM-00|2020|PDM|1257.00|99|0.00|AEG 6 (NO REV)
20|FH_F139515_0_0|CSTM-ALL|CSTM-00|2020|PDM|1648.00|99|0.00|AEG 7 (NO REV)
20|FH_F139515_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|AEG 10 (NO REV)
20|FH_F139515_0_0|SrvcGrp|105284|2022|PDM|1380.00|99|0.00|REMOVAL OF PILONIDAL LESION
20|FH_F139515_0_0|SrvcGrp|108461|2022|PDM|2318.00|99|0.00|SLIDING REPAIR ING HERNIA
20|FH_F139515_0_0|SrvcGrp|108462|2022|PDM|3348.00|99|0.00|REPAIR LUMBAR HERNIA
20|FH_F139515_0_0|SrvcGrp|109956|2022|PDM|10197.00|99|0.00|INSERT SPINE FIXATION DEVICE
20|FH_F139515_0_0|SrvcGrp|109960|2022|PDM|5252.00|99|0.00|IMPLNT SPINAL CANAL CATHETER
20|FH_F139515_0_0|SrvcGrp|112212|2022|PDM|2781.00|99|0.00|VAGINAL PROLAPSE REPAIR
20|FH_F139515_0_0|SrvcGrp|113570|2022|PDM|1380.00|99|0.00|REMOVAL OF PILONIDAL LESION
20|FH_F139515_0_0|SrvcGrp|27346|2022|PDM|1850.00|99|0.00|REPAIR BLADDER DEFECT
20|FH_F139515_0_0|SrvcGrp|27347|2022|PDM|1957.00|99|0.00|CPT 58558
20|FH_F139515_0_0|SrvcGrp|27348|2022|PDM|2150.00|99|0.00|OP SURGERY (CPT 58662)
20|FH_F139515_0_0|SrvcGrp|3378|2022|PDM|2200.00|99|0.00|OBSERVATION SVCS
20|FH_F139515_0_0|SrvcGrp|33982|2022|PDM|1803.00|99|0.00|CPT 28296
20|FH_F139515_0_0|SrvcGrp|33984|2022|PDM|1391.00|99|0.00|HAMMERTOE CORRECTION
20|FH_F139515_0_0|SrvcGrp|35667|2022|PDM|2122.00|99|0.00|CPT 20680
20|FH_F139515_0_0|SrvcGrp|36591|2022|PDM|22394.00|99|0.00|CPT 63685
20|FH_F139515_0_0|SrvcGrp|42472|2022|PDM|3296.00|99|0.00|CPT 58670
20|FH_F139515_0_0|SrvcGrp|47142|2022|PDM|2850.00|99|0.00|CPT 49650
20|FH_F139515_0_0|SrvcGrp|58776|2022|PDM|8549.00|99|0.00|DISKECTOMY
20|FH_F139515_0_0|SrvcGrp|63471|2022|PDM|8549.00|99|0.00|CPT 64590
20|FH_F139515_0_0|SrvcGrp|63472|2022|PDM|8549.00|99|0.00|CPT 64581
20|FH_F139515_0_0|SrvcGrp|67279|2022|PDM|13261.00|99|0.00|CERVICAL SURGERY
20|FH_F139515_0_0|SrvcGrp|71666|2022|PDM|15299.00|99|0.00|CPT 63655
20|FH_F139515_0_0|SrvcGrp|80617|2022|PDM|13792.00|99|0.00|ARTHOPLASTY
20|FH_F139515_0_0|SrvcGrp|81571|2022|PDM|2926.00|99|0.00|NASAL ENDOSCOPY W/ SINUS OSTIA DILATION
20|FH_F139515_0_0|SrvcGrp|82298|2022|PDM|9270.00|99|0.00|AETNA LAP SLEEVE GASTRECTOMY
20|FH_F139515_0_0|SrvcGrp|88159|2022|PDM|8549.00|99|0.00|LOW BACK DISK SURGERY
20|FH_F139515_0_0|SrvcGrp|88162|2022|PDM|8196.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON
20|FH_F139515_0_0|SrvcGrp|88164|2022|PDM|16995.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR
20|FH_F139515_0_0|SrvcGrp|89860|2022|PDM|8549.00|99|0.00|SPINAL DISK SURGERY ADD-ON
20|FH_F139515_0_0|SrvcGrp|89861|2022|PDM|8549.00|99|0.00|LUMBAR LAMINOTOMY
20|FH_F139515_0_0|SrvcGrp|90798|2022|PDM|14420.00|99|0.00|IMPLANT SPINE INFUSION PUMP19
20|FH_F139515_0_0|SrvcGrp|92405|2022|PDM|5665.00|99|0.00|PERQ LUMBOSACRAL INJECTION
20|FH_F139515_0_0|SrvcGrp|92410|2022|PDM|16995.00|99|0.00|SPINE FUSION EXTRA SEGMENT
20|FH_F139515_0_0|SrvcGrp|92411|2022|PDM|8549.00|99|0.00|RELIEVE SPINAL CORD PRESSURE
20|FH_F139515_0_0|SrvcGrp|92414|2022|PDM|8549.00|99|0.00|SPINAL CRD DECOMP->2 LUMBAR
20|FH_F139515_0_0|SrvcGrp|92415|2022|PDM|8549.00|99|0.00|NECK SPINE DISK SURGERY
20|FH_F139515_0_0|SrvcGrp|99073|2022|PDM|1.61|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F139551_0_0|CSTM-ALL|CSTM-00|2020|PDM|2945.00|99|0.00|AEG 7 (NO REV)
20|FH_F139551_0_0|SrvcGrp|104450|2022|PDM|1750.00|99|0.00|CYSTOURETHRO W/ ADDL IMPLANT
20|FH_F139551_0_0|SrvcGrp|113114|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F139551_0_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F139551_0_0|SrvcGrp|26273|2022|PDM|2800.00|99|0.00|CPT 29880
20|FH_F139551_0_0|SrvcGrp|27261|2022|PDM|16000.00|99|0.00|CPT 27446
20|FH_F139551_0_0|SrvcGrp|27402|2022|PDM|3927.00|99|0.00|LASER PROCEDURES
20|FH_F139551_0_0|SrvcGrp|36591|2022|PDM|6000.00|99|0.00|CPT 63685
20|FH_F139551_0_0|SrvcGrp|41325|2022|PDM|3620.00|99|0.00|OP SURGERY CPT 24342
20|FH_F139551_0_0|SrvcGrp|41327|2022|PDM|1615.00|99|0.00|OP SURGERY CPT 28308
20|FH_F139551_0_0|SrvcGrp|63466|2022|PDM|1654.00|99|0.00|CPT 52005
20|FH_F139551_0_0|SrvcGrp|67064|2022|PDM|4574.00|99|0.00|MUSCULOSKELETAL SYSTEM
20|FH_F139551_0_0|SrvcGrp|70749|2022|PDM|2788.00|99|0.00|CPT 29823
20|FH_F139551_0_0|SrvcGrp|82107|2022|PDM|2982.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F139551_0_0|SrvcGrp|82113|2022|PDM|2537.00|99|0.00|KNEE ARTHROSCOPY SURGERY
20|FH_F139551_0_0|SrvcGrp|85792|2022|PDM|5000.00|99|0.00|OPEN TREATMENT OF DISTAL
20|FH_F139551_0_0|SrvcGrp|88157|2022|PDM|16500.00|99|0.00|TOTAL HIP ARTHROPLASTY
20|FH_F139551_0_0|SrvcGrp|88158|2022|PDM|5769.00|99|0.00|NECK SPINE DISK SURGERY
20|FH_F139551_0_0|SrvcGrp|88159|2022|PDM|5769.00|99|0.00|LOW BACK DISK SURGERY
20|FH_F139551_0_0|SrvcGrp|88491|2022|PDM|5769.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR
20|FH_F139551_0_0|SrvcGrp|88492|2022|PDM|4574.00|99|0.00|AETNA SPINAL BONE AUTOGRAFT
20|FH_F139551_0_0|SrvcGrp|88740|2022|PDM|4574.00|99|0.00|SP BONE ALGRFT
20|FH_F139551_0_0|SrvcGrp|90063|2022|PDM|4500.00|99|0.00|REPAIR BICEPS TENDON RUPTURE
20|FH_F139551_0_0|SrvcGrp|93057|2022|PDM|4574.00|99|0.00|SPINAL BONE AUTOGRAFT
20|FH_F139551_0_0|SrvcGrp|96539|2022|PDM|7400.00|99|0.00|REVISION OF ANKLE LIGAMENT
20|FH_F139565_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F139565_0_0|CSTM-ALL|CSTM-00|2020|PDM|1499.00|99|0.00|AEG 5  (NO REV)
20|FH_F139565_0_0|CSTM-ALL|CSTM-00|2020|PDM|2338.00|99|0.00|AEG 7 (NO REV)
20|FH_F139565_0_0|CSTM-ALL|CSTM-00|2020|PDM|2952.00|99|0.00|AEG 9 (NO REV)
20|FH_F139565_0_0|CSTM-ALL|CSTM-00|2020|PDM|781.00|99|0.00|AEG 1 (NO REV)
20|FH_F139565_0_0|SrvcGrp|106235|2022|PDM|6885.00|99|0.00|CYPASS
20|FH_F139565_0_0|SrvcGrp|109346|2022|PDM|4590.00|99|0.00|EXCISION OF CHALAZION DIFFERENT LIDS
20|FH_F139565_0_0|SrvcGrp|109758|2022|PDM|11475.00|99|0.00|COLLAGEN CROSSLINKING CORNEA
20|FH_F139565_0_0|SrvcGrp|109763|2022|PDM|2869.00|99|0.00|TREAT EYELID LESION
20|FH_F139565_0_0|SrvcGrp|109769|2022|PDM|2433.00|99|0.00|COVER EYE W/ MEMBRANE SUTURE INCIDENTAL CODES
20|FH_F139565_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F139565_0_0|SrvcGrp|114442|2022|PDM|12049.00|99|0.00|EXTRACAPSULAR CATARACT REMOVAL, INSERT LENS
20|FH_F139565_0_0|SrvcGrp|114443|2022|PDM|10328.00|99|0.00|EXTRACAPSULAR CATARACT REMOVAL, INSERT LENS
20|FH_F139565_0_0|SrvcGrp|42551|2022|PDM|1721.00|99|0.00|OP SURGERY
20|FH_F139565_0_0|SrvcGrp|45583|2022|PDM|9754.00|99|0.00|CPT 65730
20|FH_F139565_0_0|SrvcGrp|82570|2022|PDM|4590.00|99|0.00|REVISION EYELID/EXCESS SKIN
20|FH_F139565_0_0|SrvcGrp|84280|2022|PDM|9754.00|99|0.00|CORNEAL TRANSPLANT
20|FH_F139573_0_0|SrvcGrp|57968|2022|PDM|1150.63|99|0.00|CONTINUOUS HOMECARE
20|FH_F139576_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F139576_0_0|CSTM-ALL|CSTM-00|2020|PDM|1750.00|99|0.00|AEG 4 (NO REV)
20|FH_F139576_0_0|SrvcGrp|16468|2022|PDM|2174.00|99|0.00|LASER PROCEDURES
20|FH_F139576_0_0|SrvcGrp|19921|2022|PDM|3060.00|99|0.00|ARTHROSCOPICALLY LIGAMENT REPAIR
20|FH_F139576_0_0|SrvcGrp|23585|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F139576_0_0|SrvcGrp|81418|2022|PDM|5441.00|99|0.00|AETNA LAPARO CHOLECYSTECOMY
20|FH_F139576_0_0|SrvcGrp|97019|2022|PDM|2497.00|99|0.00|ARTHROSCOPY BICEPS TENODESIS
20|FH_F139580_0_0|SrvcGrp|108043|2022|PDM|182.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD
20|FH_F139594_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F139594_0_0|CSTM-ALL|CSTM-00|2020|PDM|1622.00|99|0.00|AEG 6 (NO REV)
20|FH_F139594_0_0|CSTM-ALL|CSTM-00|2020|PDM|1688.00|99|0.00|AEG 9 (NO REV)
20|FH_F139594_0_0|CSTM-ALL|CSTM-00|2020|PDM|1955.00|99|0.00|AEG 7 (NO REV)
20|FH_F139594_0_0|SrvcGrp|104448|2022|PDM|6600.00|99|0.00|CYSTOSCOPY IMPLANT 4 OR MORE
20|FH_F139594_0_0|SrvcGrp|108893|2022|PDM|700.00|99|0.00|IMPLANTABLE TISSUE MARKER
20|FH_F139594_0_0|SrvcGrp|113637|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES
20|FH_F139594_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F139594_0_0|SrvcGrp|63469|2022|PDM|1000.00|99|0.00|CPT 55700
20|FH_F139594_0_0|SrvcGrp|84704|2022|PDM|938.00|99|0.00|CYSTOURETHROSCOPY W/ REMOVAL OF FOREIGN BODY
20|FH_F139607_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F139607_0_0|SrvcGrp|46890|2022|PDM|1910.00|99|0.00|IMPLANT EYE SHUNT
20|FH_F139690_0_0|SrvcGrp|107748|2022|PDM|500.00|99|0.00|HEMODIALYSIS IN CENTER
20|FH_F139690_0_0|SrvcGrp|112094|2022|PDM|500.00|99|0.00|DIALYSIS ULTRAFILTRATION
20|FH_F139715_0_0|SrvcGrp|99073|2022|PDM|1.38|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F139719_0_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA
20|FH_F139719_0_0|SrvcGrp|87077|2022|PDM|120.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F139755_0_0|SrvcGrp|82981|2022|PDM|90.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F139758_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F139779_0_0|CSTM-ALL|CSTM-00|2020|PCT|12000.00|99|0.00|TIMELY FILING
20|FH_F139825_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F139825_0_0|CSTM-ALL|CSTM-00|2020|PDM|1078.00|99|0.00|AEG 2 (NO REV)
20|FH_F139825_0_0|CSTM-ALL|CSTM-00|2020|PDM|1196.00|99|0.00|AEG 3 (NO REV)
20|FH_F139825_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F139825_0_0|SrvcGrp|109346|2022|PDM|4590.00|99|0.00|EXCISION OF CHALAZION DIFFERENT LIDS
20|FH_F139825_0_0|SrvcGrp|109763|2022|PDM|2869.00|99|0.00|TREAT EYELID LESION
20|FH_F139825_0_0|SrvcGrp|109764|2022|PDM|4590.00|99|0.00|REPAIR EYELID DEFECT
20|FH_F139825_0_0|SrvcGrp|109765|2022|PDM|1721.00|99|0.00|CLOSURE OF LACRIMAL PUNCTUM
20|FH_F139825_0_0|SrvcGrp|109769|2022|PDM|2433.00|99|0.00|COVER EYE W/ MEMBRANE SUTURE INCIDENTAL CODES
20|FH_F139825_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F139825_0_0|SrvcGrp|62740|2022|PDM|5738.00|99|0.00|SURGERY CARVE OUTS
20|FH_F139825_0_0|SrvcGrp|84280|2022|PDM|9754.00|99|0.00|CORNEAL TRANSPLANT
20|FH_F139825_0_0|SrvcGrp|85966|2022|PDM|7459.00|99|0.00|EXTRACAPSULAR CATARACT
20|FH_F139873_0_0|CSTM-ALL|CSTM-00|2020|PDM|1080.00|99|0.00|AEG 3 (NO REV)
20|FH_F139873_0_0|CSTM-ALL|CSTM-00|2020|PDM|2105.00|99|0.00|AEG 7 (NO REV)
20|FH_F139873_0_0|CSTM-ALL|CSTM-00|2020|PDM|705.00|99|0.00|AEG 1 (NO REV)
20|FH_F139873_0_0|SrvcGrp|113576|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F139873_0_0|SrvcGrp|23585|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F139873_0_0|SrvcGrp|45583|2022|PDM|2992.00|99|0.00|CPT 65730
20|FH_F139873_0_0|SrvcGrp|84278|2022|PDM|2992.00|99|0.00|CORNEAL TRANSPLANT
20|FH_F139873_0_0|SrvcGrp|99073|2022|PDM|1.56|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F139887_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F139887_0_0|CSTM-ALL|CSTM-00|2020|PDM|1942.00|99|0.00|AEG 9 (NO REV)
20|FH_F139887_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AEG 1 (NO REV)
20|FH_F139887_0_0|CSTM-ALL|CSTM-00|2020|PDM|693.00|99|0.00|AEG 2 (NO REV)
20|FH_F139887_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 10 (NO REV)
20|FH_F139887_0_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS
20|FH_F139887_0_0|SrvcGrp|113588|2022|PDM|826.00|99|0.00|REMOVAL OF FOOT FOREIGN BODY
20|FH_F139887_0_0|SrvcGrp|13187|2022|PCT|0.00|99|0.00|INTRAOCULAR LENSES
20|FH_F139887_0_0|SrvcGrp|34605|2022|PDM|4076.00|99|0.00|CPT 28299
20|FH_F139887_0_0|SrvcGrp|98523|2022|PDM|1848.00|99|0.00|CAPSULOTOMY
20|FH_F139910_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F139910_0_0|CSTM-ALL|CSTM-00|2020|PDM|412.00|99|0.00|AEG 1 (NO REV)
20|FH_F139910_0_0|CSTM-ALL|CSTM-00|2020|PDM|530.00|99|0.00|AEG 2 (NO REV)
20|FH_F139916_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F139927_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.74|99|0.00|GENERAL ACUTE CARE
20|FH_F139952_0_0|CSTM-ALL|CSTM-00|2020|PDM|1138.00|99|0.00|AEG 3 (NO REV)
20|FH_F139952_0_0|CSTM-ALL|CSTM-00|2020|PDM|888.00|99|0.00|AEG 10 (NO REV)
20|FH_F139952_0_0|CSTM-ALL|CSTM-00|2020|PDM|888.00|99|0.00|AEG 5  (NO REV)
20|FH_F139952_0_0|CSTM-ALL|CSTM-00|2020|PDM|888.00|99|0.00|AEG 9 (NO REV)
20|FH_F140007_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F140007_0_0|CSTM-ALL|CSTM-00|2020|PDM|2683.00|99|0.00|AEG 5  (NO REV)
20|FH_F140007_0_0|SrvcGrp|112025|2022|PDM|7887.00|99|0.00|TOTAL HIP ARTHROPLASTY
20|FH_F140007_0_0|SrvcGrp|113594|2022|PDM|8045.00|99|0.00|SPINE PROSTH DEVICE
20|FH_F140007_0_0|SrvcGrp|19922|2022|PDM|4290.00|99|0.00|ARTHROSCOPY OF SHOULDER
20|FH_F140007_0_0|SrvcGrp|93740|2022|PDM|8045.00|99|0.00|REVISE/REMOVE NEURO RECEIVER
20|FH_F140007_0_0|SrvcGrp|96919|2022|PDM|4206.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F140007_0_0|SrvcGrp|96979|2022|PDM|3539.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F140007_0_0|SrvcGrp|97079|2022|PDM|3539.00|99|0.00|MENISCUS REPAIR, MED OR LAT
20|FH_F140007_0_0|SrvcGrp|97159|2022|PDM|8045.00|99|0.00|TRANSPEDICULAR, 1 SEG, LUMBAR
20|FH_F140007_0_0|SrvcGrp|97219|2022|PDM|7887.00|99|0.00|DECOMPRESS SPINE CORD ADD-ON
20|FH_F140007_0_0|SrvcGrp|99073|2022|PDM|1.42|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F140035_0_0|SrvcGrp|42972|2022|PDM|96.00|99|0.00|HOME HEALTH AIDE
20|FH_F140035_0_0|SrvcGrp|48396|2022|PDM|187.00|99|0.00|OT SERVICES
20|FH_F140102_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F140102_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F140102_0_0|SrvcGrp|103911|2022|PDM|105.00|99|0.00|HOSPICE CARE PROVIDED IN INPATIENT HOSPICE FACILITY
20|FH_F140102_0_0|SrvcGrp|104230|2022|PDM|105.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F140102_0_0|SrvcGrp|113619|2022|PDM|105.00|99|0.00|HOSPICE CARE (HCFA)
20|FH_F140102_0_0|SrvcGrp|84185|2022|PDM|105.00|99|0.00|RESPITE CARE
20|FH_F140105_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F140105_0_0|CSTM-ALL|CSTM-00|2020|PDM|871.00|99|0.00|AEG 5  (NO REV)
20|FH_F140175_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F140175_0_0|SrvcGrp|89344|2022|PDM|250.00|99|0.00|HYPERBARIC OXYGEN
20|FH_F140207_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F140209_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F140209_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 10 (NO REV)
20|FH_F140209_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 8 (NO REV)
20|FH_F140209_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 9 (NO REV)
20|FH_F140209_0_0|CSTM-ALL|CSTM-00|2020|PDM|1450.00|99|0.00|AEG 5  (NO REV)
20|FH_F140247_0_0|CSTM-ALL|CSTM-00|2020|PCT|12000.00|99|0.00|TIMELY FILING
20|FH_F140295_0_0|CSTM-ALL|CSTM-00|2020|PDM|3346.00|99|0.00|AEG 6 (NO REV)
20|FH_F140295_0_0|CSTM-ALL|CSTM-00|2020|PDM|3809.00|99|0.00|AEG 7 (NO REV)
20|FH_F140295_0_0|CSTM-ALL|CSTM-00|2020|PDM|3891.00|99|0.00|AEG 8 (NO REV)
20|FH_F140295_0_0|SrvcGrp|26275|2022|PDM|3206.00|99|0.00|CPT 29826
20|FH_F140295_0_0|SrvcGrp|35669|2022|PDM|6474.00|99|0.00|CPT 63650
20|FH_F140295_0_0|SrvcGrp|67065|2022|PDM|10079.00|99|0.00|CERVICAL SURGERY
20|FH_F140295_0_0|SrvcGrp|72121|2022|PDM|4164.00|99|0.00|ARTHOSCOPY
20|FH_F140295_0_0|SrvcGrp|74039|2022|PDM|7416.00|99|0.00|LAMINECTOMY
20|FH_F140295_0_0|SrvcGrp|77021|2022|PDM|7045.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY
20|FH_F140295_0_0|SrvcGrp|80617|2022|PDM|14935.00|99|0.00|ARTHOPLASTY
20|FH_F140295_0_0|SrvcGrp|82114|2022|PDM|4233.00|99|0.00|MENISCUS REPAIR MED OR LAT
20|FH_F140295_0_0|SrvcGrp|84318|2022|PDM|4948.00|99|0.00|SPINE INFUSION
20|FH_F140295_0_0|SrvcGrp|86233|2022|PDM|18540.00|99|0.00|AETNA RECONSTRUCT ANKLE JOINT
20|FH_F140295_0_0|SrvcGrp|88159|2022|PDM|8169.00|99|0.00|LOW BACK DISK SURGERY
20|FH_F140295_0_0|SrvcGrp|88163|2022|PDM|12643.00|99|0.00|LUMBAR SPINE FUSION
20|FH_F140295_0_0|SrvcGrp|88492|2022|PDM|3598.00|99|0.00|AETNA SPINAL BONE AUTOGRAFT
20|FH_F140295_0_0|SrvcGrp|88740|2022|PDM|3443.00|99|0.00|SP BONE ALGRFT
20|FH_F140295_0_0|SrvcGrp|93433|2022|PDM|12360.00|99|0.00|PARTIAL HIP REPLACEMENT
20|FH_F140295_0_0|SrvcGrp|97730|2022|PDM|12200.00|99|0.00|REVERSE HIP JOINT
20|FH_F140295_0_0|SrvcGrp|97741|2022|PDM|10075.00|99|0.00|REVISE KNEE
20|FH_F140295_0_0|SrvcGrp|99067|2022|PDM|7936.00|99|0.00|SPINE PROSTH DEVICE
20|FH_F140295_0_0|SrvcGrp|99163|2022|PDM|12875.00|99|0.00|CPT 27703
20|FH_F140340_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F140349_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F140349_0_0|CSTM-ALL|CSTM-00|2020|PDM|428.00|99|0.00|AEG 10 (NO REV)
20|FH_F140349_0_0|CSTM-ALL|CSTM-00|2020|PDM|428.00|99|0.00|AEG 3 (NO REV)
20|FH_F140349_0_0|CSTM-ALL|CSTM-00|2020|PDM|428.00|99|0.00|AEG 4 (NO REV)
20|FH_F140349_0_0|CSTM-ALL|CSTM-00|2020|PDM|428.00|99|0.00|AEG 6 (NO REV)
20|FH_F140373_0_0|CSTM-ALL|CSTM-00|2020|PDM|1113.00|99|0.00|AEG 5  (NO REV)
20|FH_F140373_0_0|CSTM-ALL|CSTM-00|2020|PDM|547.00|99|0.00|AEG 1 (NO REV)
20|FH_F140373_0_0|CSTM-ALL|CSTM-00|2020|PDM|865.00|99|0.00|AEG 3 (NO REV)
20|FH_F140373_0_0|SrvcGrp|108914|2022|PDM|2789.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F140373_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F140427_0_0|CSTM-ALL|CSTM-00|2020|PDM|1150.00|99|0.00|AEG 5  (NO REV)
20|FH_F140427_0_0|CSTM-ALL|CSTM-00|2020|PDM|2300.00|99|0.00|AEG 7 (NO REV)
20|FH_F140427_0_0|CSTM-ALL|CSTM-00|2020|PDM|875.00|99|0.00|AEG 10 W/O CPT 92978 (NO REV)
20|FH_F140427_0_0|SrvcGrp|104922|2022|PDM|400.00|99|0.00|ENDOLUMINL IVUS OCT C 1ST-CONCUR
20|FH_F140427_0_0|SrvcGrp|106240|2022|PDM|1400.00|99|0.00|STENT REPLACEMENT
20|FH_F140427_0_0|SrvcGrp|109505|2022|PDM|900.00|99|0.00|REMV & REPLC PM GEN MULT LEADS
20|FH_F140427_0_0|SrvcGrp|109507|2022|PDM|2500.00|99|0.00|INSRT PULSE GEN W/ MULT LEADS
20|FH_F140427_0_0|SrvcGrp|113635|2022|PDM|900.00|99|0.00|ENDO CHOLANGIOPANCREATOGRAPH
20|FH_F140427_0_0|SrvcGrp|92406|2022|PDM|2500.00|99|0.00|REMOVAL & REPLACE PULSE GEN 1 LEAD
20|FH_F140427_0_0|SrvcGrp|92407|2022|PDM|2500.00|99|0.00|REMOVAL & REPLACE PULSE GEN 2 LEAD
20|FH_F140472_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F140472_0_0|SrvcGrp|10391|2022|PDM|800.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F140472_0_0|SrvcGrp|10393|2022|PDM|1335.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F140574_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F140575_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F140576_0_0|CSTM-ALL|CSTM-00|2020|PCT|36500.00|99|0.00|TIMELY FILING
20|FH_F140583_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|OP SVCS
20|FH_F140608_0_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE
20|FH_F140608_0_0|SrvcGrp|48385|2022|PDM|134.00|99|0.00|SPEECH THERAPY
20|FH_F140608_0_0|SrvcGrp|48396|2022|PDM|134.00|99|0.00|OT SERVICES
20|FH_F140629_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F140629_0_0|CSTM-ALL|CSTM-00|2020|PDM|2221.00|99|0.00|AEG 9 (NO REV)
20|FH_F140629_0_0|SrvcGrp|103834|2022|PDM|1016.00|99|0.00|AETNA REMOVE BLADDER STONE
20|FH_F140629_0_0|SrvcGrp|104170|2022|PDM|2497.00|99|0.00|AETNA ARTHROSCOPY SURGERY
20|FH_F140629_0_0|SrvcGrp|113576|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F140629_0_0|SrvcGrp|113664|2022|PDM|2497.00|99|0.00|LAPAROSCOPY GASTROSTOMY
20|FH_F140629_0_0|SrvcGrp|113669|2022|PDM|2497.00|99|0.00|LYMPHADENECTOMY LAPAROSCOPY
20|FH_F140629_0_0|SrvcGrp|113681|2022|PDM|2497.00|99|0.00|URETEROLITHOTOMY LAPAROSCOPY
20|FH_F140629_0_0|SrvcGrp|113685|2022|PDM|1016.00|99|0.00|CYSTOURETHROSCOPY W/ URETER
20|FH_F140629_0_0|SrvcGrp|113686|2022|PDM|2497.00|99|0.00|ARTHROSCOPY TEMPORMANDIULAR JOINT
20|FH_F140629_0_0|SrvcGrp|113688|2022|PDM|2497.00|99|0.00|URETERONEOCYSTO LAPAROSCOPIC
20|FH_F140629_0_0|SrvcGrp|113692|2022|PDM|2497.00|99|0.00|ANKLE ARTHROSCOPY
20|FH_F140629_0_0|SrvcGrp|26277|2022|PDM|2497.00|99|0.00|CPT 29874
20|FH_F140629_0_0|SrvcGrp|33724|2022|PDM|2497.00|99|0.00|ARTHROSCOPY
20|FH_F140629_0_0|SrvcGrp|33988|2022|PDM|1016.00|99|0.00|CPT 19101
20|FH_F140629_0_0|SrvcGrp|37317|2022|PDM|3512.00|99|0.00|LITHOTRIPSY
20|FH_F140629_0_0|SrvcGrp|44064|2022|PDM|1016.00|99|0.00|CPT 52351
20|FH_F140629_0_0|SrvcGrp|44067|2022|PDM|1016.00|99|0.00|CPT 52240
20|FH_F140629_0_0|SrvcGrp|63465|2022|PDM|1016.00|99|0.00|CPT 52214
20|FH_F140629_0_0|SrvcGrp|75885|2022|PDM|1302.00|99|0.00|AETNA CPT 49560
20|FH_F140629_0_0|SrvcGrp|78093|2022|PDM|2497.00|99|0.00|AETNA NASAL ENDOSCOPY SURG
20|FH_F140629_0_0|SrvcGrp|79101|2022|PDM|1372.00|99|0.00|AETNA NASAL ENDOSCOPY
20|FH_F140629_0_0|SrvcGrp|82720|2022|PDM|2497.00|99|0.00|WRIST ENDOSCOPY/SURGERY
20|FH_F140629_0_0|SrvcGrp|83350|2022|PDM|2497.00|99|0.00|AETNA LAPAR HERNIA REPAIR
20|FH_F140629_0_0|SrvcGrp|88030|2022|PDM|8400.00|99|0.00|REVISION OF KNEE JOINT
20|FH_F140629_0_0|SrvcGrp|88748|2022|PDM|2497.00|99|0.00|HIP ARTHROSCOPY
20|FH_F140629_0_0|SrvcGrp|89853|2022|PDM|1372.00|99|0.00|NASAL/SINUS ENDOSCOPY-SURG
20|FH_F140629_0_0|SrvcGrp|90383|2022|PDM|8400.00|99|0.00|RECONSTRUCT SHOULDER JOINT
20|FH_F140629_0_0|SrvcGrp|90436|2022|PDM|8400.00|99|0.00|TOTAL HIP ARTHROPLASTY
20|FH_F140629_0_0|SrvcGrp|98404|2022|PDM|2497.00|99|0.00|ARTHROSCOPIC FRACTURE TX
20|FH_F140651_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F140651_0_0|CSTM-ALL|CSTM-00|2020|PDM|2684.00|99|0.00|AEG 6 (NO REV)
20|FH_F140651_0_0|CSTM-ALL|CSTM-00|2020|PDM|2838.00|99|0.00|AEG 7 (NO REV)
20|FH_F140651_0_0|CSTM-ALL|CSTM-00|2020|PDM|2992.00|99|0.00|AEG 8 (NO REV)
20|FH_F140651_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|AEG 10 (NO REV)
20|FH_F140651_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F140690_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F140762_0_0|CSTM-ALL|CSTM-00|2020|PDM|1414.00|99|0.00|AEG 7 (NO REV)
20|FH_F140762_0_0|CSTM-ALL|CSTM-00|2020|PDM|2600.60|99|0.00|DEVICE INSERTION
20|FH_F140762_0_0|SrvcGrp|112817|2022|PCT|1.00|99|0.00|INJ BIMATOPROST INTRACAMERAL IMPLANT
20|FH_F140762_0_0|SrvcGrp|113697|2022|PDM|1723.00|99|0.00|TRANSLUM DIL EYE CANAL
20|FH_F140790_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F140790_0_0|CSTM-ALL|CSTM-00|2020|PDM|551.00|99|0.00|AEG 2 (NO REV)
20|FH_F140790_0_0|SrvcGrp|113615|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F140790_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F140790_0_0|SrvcGrp|38909|2022|PDM|1434.00|99|0.00|CPT 67036 - VITRECTOMY, MECHANICAL
20|FH_F140808_0_0|CSTM-ALL|CSTM-00|2020|PDM|711.00|99|0.00|AEG 2 (NO REV)
20|FH_F140827_0_0|CSTM-ALL|CSTM-00|2020|PDM|1260.00|99|0.00|AEG 5  (NO REV)
20|FH_F140827_0_0|CSTM-ALL|CSTM-00|2020|PDM|1815.00|99|0.00|AEG 8 (NO REV)
20|FH_F140873_0_0|SrvcGrp|104228|2022|PDM|152.00|99|0.00|HOSPICE CARE (HCFA)
20|FH_F140873_0_0|SrvcGrp|104229|2022|PDM|152.00|99|0.00|HOSPICE IN HOME (HCFA)
20|FH_F140873_0_0|SrvcGrp|82222|2022|PDM|152.00|99|0.00|HOSPICE CARE
20|FH_F140873_0_0|SrvcGrp|95660|2022|PDM|735.00|99|0.00|HOSPICE SERVICES (HCFA)
20|FH_F140987_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|AEG 2 (NO REV)
20|FH_F140987_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|AEG 6 (NO REV)
20|FH_F140987_0_0|SrvcGrp|93431|2022|PDM|3750.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT
20|FH_F140990_0_0|SrvcGrp|107748|2022|PDM|592.00|99|0.00|HEMODIALYSIS IN CENTER
20|FH_F140998_0_0|CSTM-ALL|CSTM-00|2020|PCT|63.00|99|0.00|GENERAL ACUTE CARE
20|FH_F141004_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F141034_0_0|SrvcGrp|109080|2022|PDM|25.00|99|0.00|DIALYSIS TRAINING
20|FH_F141035_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F141035_0_0|CSTM-ALL|CSTM-00|2020|PDM|1019.00|99|0.00|AEG 1 (NO REV)
20|FH_F141035_0_0|SrvcGrp|101800|2022|PDM|7008.00|99|0.00|SKELETAL FIXATION
20|FH_F141035_0_0|SrvcGrp|104255|2022|PDM|4450.00|99|0.00|SKIN TISSUE REARRANGEMENT
20|FH_F141035_0_0|SrvcGrp|107826|2022|PDM|7008.00|99|0.00|REMOVAL OF WRIST BONE
20|FH_F141035_0_0|SrvcGrp|107845|2022|PDM|4417.00|99|0.00|REVISE FINGER/TOE NERVE
20|FH_F141035_0_0|SrvcGrp|112150|2022|PDM|3052.00|99|0.00|DRAINAGE OF FINGER ABSCESS
20|FH_F141035_0_0|SrvcGrp|113714|2022|PDM|7129.00|99|0.00|RELEASE PALM CONTRACTURE
20|FH_F141035_0_0|SrvcGrp|113717|2022|PDM|4029.00|99|0.00|RELEASE FINGER CONTRACTURE
20|FH_F141035_0_0|SrvcGrp|33986|2022|PDM|3932.00|99|0.00|CPT 26055
20|FH_F141035_0_0|SrvcGrp|76603|2022|PDM|3932.00|99|0.00|CPT 25111
20|FH_F141035_0_0|SrvcGrp|76604|2022|PDM|7008.00|99|0.00|CPT 25447
20|FH_F141035_0_0|SrvcGrp|85792|2022|PDM|21661.00|99|0.00|OPEN TREATMENT OF DISTAL
20|FH_F141035_0_0|SrvcGrp|90365|2022|PDM|7008.00|99|0.00|REPAIR METACARPAL FRACTURE
20|FH_F141035_0_0|SrvcGrp|91566|2022|PDM|7008.00|99|0.00|REVISE FINGER JOINT
20|FH_F141035_0_0|SrvcGrp|92010|2022|PDM|3932.00|99|0.00|LESION OF TENDON SHEATH OR JOINT CAPSULE
20|FH_F141035_0_0|SrvcGrp|92013|2022|PDM|7008.00|99|0.00|REPAIR OF COLLATERAL LIGAMENT
20|FH_F141035_0_0|SrvcGrp|92014|2022|PDM|7008.00|99|0.00|PHALANGEAL SHAFT FRACTURE
20|FH_F141129_0_0|SrvcGrp|113720|2022|PDM|25.00|99|0.00|VISIT/HOME SERVICE
20|FH_F141129_0_0|SrvcGrp|42824|2022|PDM|43.00|99|0.00|SKILLED NURSING VISIT
20|FH_F141129_0_0|SrvcGrp|45783|2022|PDM|40.00|99|0.00|SKILLED NURSING VISIT
20|FH_F141167_0_0|SrvcGrp|107750|2022|PDM|25.00|99|0.00|TRAINING INCL A TREATMENT
20|FH_F141167_0_0|SrvcGrp|108042|2022|PDM|500.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD
20|FH_F141167_0_0|SrvcGrp|113580|2022|PDM|150.00|99|0.00|DIALYSIS PATIENT TRAINING
20|FH_F141169_0_0|CSTM-ALL|CSTM-00|2020|PDM|829.00|99|0.00|AEG 6 (NO REV)
20|FH_F141169_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F141169_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F141169_0_0|SrvcGrp|113727|2022|PDM|72.00|99|0.00|ULTRASOUND
20|FH_F141169_0_0|SrvcGrp|113728|2022|PDM|72.00|99|0.00|ULTRASOUND (HCFA)
20|FH_F141169_0_0|SrvcGrp|113731|2022|PDM|1389.00|99|0.00|INDUCED ABORTION BY DILATION AND EVACUATION
20|FH_F141169_0_0|SrvcGrp|19923|2022|PDM|1994.00|99|0.00|HYSTEROSCOPY
20|FH_F141169_0_0|SrvcGrp|63457|2022|PDM|156.00|99|0.00|ULTRASOUND
20|FH_F141169_0_0|SrvcGrp|91438|2022|PDM|156.00|99|0.00|ULTRASOUND (HCFA)
20|FH_F141170_0_0|CSTM-ALL|CSTM-00|2020|PDM|1045.00|99|0.00|AEG 10 (NO REV)
20|FH_F141170_0_0|CSTM-ALL|CSTM-00|2020|PDM|797.50|99|0.00|AEG 2 (NO REV)
20|FH_F141170_0_0|SrvcGrp|103585|2022|PDM|2998.00|99|0.00|REMOVE SPINE ELTRD PLATE
20|FH_F39138_0_0|CSTM-ALL|CSTM-00|2020|PDM|21696.00|99|0.00|MSDRG 235-236 CORONARY BYPASS
20|FH_F39138_0_0|CSTM-ALL|CSTM-00|2020|PDM|28711.00|99|0.00|MS DRG 233
20|FH_F39138_0_0|CSTM-ALL|CSTM-00|2020|PDM|30495.00|99|0.00|MSDRG 219-221 CARDIAC VLV PX+OTR MJR CARDIOTHORACIC PX W/CC
20|FH_F39138_0_0|CSTM-ALL|CSTM-00|2020|PDM|44937.00|99|0.00|MS DRG 222-223 CARDIAC DEFIB W/ AMI/HF SHOCK
20|FH_F39138_0_0|CSTM-ALL|CSTM-00|2020|PDM|7674.00|99|0.00|MS DRG 286
20|FH_F39138_0_0|CSTM-ALL|CSTM-00|2020|PDM|9344.00|99|0.00|MSDRG 250-251 PERCUTANEOUS CARDIO PROC
20|FH_F39138_0_0|SrvcGrp|1259|2022|PDM|1639.00|99|0.00|INTERMEDIATE INTENSIVE CARE UNIT
20|FH_F39138_0_0|SrvcGrp|26179|2022|PDM|98.00|99|0.00|OT
20|FH_F39138_0_0|SrvcGrp|411|2022|PDM|4259.00|99|0.00|OP CARDIAC CATH
20|FH_F39138_0_0|SrvcGrp|701|2022|PDM|1944.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F39140_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39140_0_0|SrvcGrp|13640|2022|PDM|110.00|99|0.00|CPT 99202
20|FH_F39151_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|OP SVCS
20|FH_F39162_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F39178_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F39178_0_0|SrvcGrp|72|2022|PDM|540.00|99|0.00|NEWBORN NURSERY
20|FH_F39180_0_0|CSTM-ALL|CSTM-00|2020|PDM|1112.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39180_0_0|SrvcGrp|15357|2022|PCT|0.70|99|0.00|ORTHOTICS/PROSTHETICS/IMPLANTS
20|FH_F39180_0_0|SrvcGrp|30625|2022|PCT|0.70|99|0.00|ORTHOTICS/PROSTHETICS/IMPLANTS
20|FH_F39180_0_0|SrvcGrp|38|2022|PDM|1794.00|99|0.00|NORMAL DELIVERY
20|FH_F39202_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS
20|FH_F39209_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|GENERAL ACUTE CARE
20|FH_F39238_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F39255_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39255_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F39268_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39269_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39270_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F39274_0_0|SrvcGrp|26001|2022|PDM|300.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F39278_0_0|SrvcGrp|12401|2022|PDM|159.00|99|0.00|RN VISIT
20|FH_F39278_0_0|SrvcGrp|72783|2022|PDM|166.00|99|0.00|ST SVCS - VISIT LEVEL
20|FH_F39279_0_0|SrvcGrp|17307|2022|PCT|0.55|99|0.00|DRUGS
20|FH_F39279_0_0|SrvcGrp|30274|2022|PCT|0.55|99|0.00|BLOOD SERVICES
20|FH_F39286_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.83|99|0.00|GENERAL ACUTE CARE
20|FH_F39303_0_0|SrvcGrp|43|2022|PCT|0.80|99|0.00|IMPLANTS
20|FH_F39303_0_0|SrvcGrp|997|2022|PCT|0.80|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F39339_0_0|CSTM-ALL|CSTM-00|2020|PDM|3260.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F39339_0_0|SrvcGrp|1259|2022|PDM|2700.00|99|0.00|INTERMEDIATE INTENSIVE CARE UNIT
20|FH_F39339_0_0|SrvcGrp|3259|2022|PDM|1010.00|99|0.00|ACUTE REHABILITATION
20|FH_F39339_0_0|SrvcGrp|8|2022|PDM|3260.00|99|0.00|BURN INTENSIVE CARE
20|FH_F39343_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F39346_0_0|CSTM-ALL|CSTM-00|2020|PDM|12698.00|99|0.00|MS DRG 238 ONLY
20|FH_F39346_0_0|CSTM-ALL|CSTM-00|2020|PDM|9044.00|99|0.00|CV SURGERY MS DRG 283-285 ONLY
20|FH_F39346_0_0|SrvcGrp|16|2022|PDM|867.00|99|0.00|ACUTE REHABILITATION
20|FH_F39346_0_0|SrvcGrp|19661|2022|PDM|39210.00|99|0.00|MS DRG 216-218 ONLY CARDIAC VALVE PROCEDURE W/CARDIAC CATH
20|FH_F39346_0_0|SrvcGrp|20252|2022|PDM|45190.00|99|0.00|MS DRG 224-225 ONLY
20|FH_F39346_0_0|SrvcGrp|20293|2022|PDM|25602.00|99|0.00|MS DRG 235-236 ONLY CV SURGERY
20|FH_F39346_0_0|SrvcGrp|20910|2022|PDM|30441.00|99|0.00|MS DRG 234 ONLY
20|FH_F39346_0_0|SrvcGrp|21354|2022|PDM|11841.00|99|0.00|MS DRG 250-251 ONLY
20|FH_F39346_0_0|SrvcGrp|2738|2022|PCT|0.70|99|0.00|IMPLANTS
20|FH_F39346_0_0|SrvcGrp|27817|2022|PDM|6950.00|99|0.00|MSDRG 282 ONLY CIRCULATORY DISORDERS W/O CC
20|FH_F39346_0_0|SrvcGrp|29710|2022|PDM|13203.00|99|0.00|OTHER CARDIAC PACEMKR MS DRG 243-244 ONLY
20|FH_F39346_0_0|SrvcGrp|97|2022|PDM|1350.00|99|0.00|C-SECTION
20|FH_F39349_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F39349_0_0|CSTM-ALL|CSTM-00|2020|PDM|632.00|99|0.00|ADULT PSYCHIATRIC
20|FH_F39349_0_0|SrvcGrp|701|2022|PDM|2085.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F39351_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39352_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|HOME HEALTH CARE / HOSPICE
20|FH_F39352_0_0|SrvcGrp|115|2022|PDM|400.00|99|0.00|SKILLED NURSING CARE
20|FH_F39352_0_0|SrvcGrp|997|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F39355_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F39355_0_0|SrvcGrp|109|2022|PDM|475.00|99|0.00|CD - DETOX
20|FH_F39355_0_0|SrvcGrp|115|2022|PDM|490.00|99|0.00|SKILLED NURSING CARE
20|FH_F39355_0_0|SrvcGrp|13880|2022|PCT|1.05|99|0.00|IMPLANTS
20|FH_F39355_0_0|SrvcGrp|16718|2022|PCT|1.05|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F39366_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39391_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39393_0_0|SrvcGrp|17067|2022|PDM|600.00|99|0.00|ASPG II
20|FH_F39398_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39410_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39433_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|OP SVCS
20|FH_F39450_0_0|CSTM-ALL|CSTM-00|2020|PDM|1921.00|99|0.00|MS DRG 216-221, 228-236
20|FH_F39450_0_0|SrvcGrp|361|2022|PDM|1741.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F39450_0_0|SrvcGrp|701|2022|PDM|1770.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F39466_0_0|SrvcGrp|12290|2022|PDM|735.00|99|0.00|DETOXIFICATION
20|FH_F39466_0_0|SrvcGrp|1306|2022|PDM|315.00|99|0.00|OP PSYCH PARTIAL HOSP
20|FH_F39476_0_0|SrvcGrp|16|2022|PDM|961.00|99|0.00|ACUTE REHABILITATION
20|FH_F39476_0_0|SrvcGrp|41406|2022|PDM|1728.00|99|0.00|CARDIAC CATH W/ICD 9
20|FH_F39476_0_0|SrvcGrp|8950|2022|PDM|1496.00|99|0.00|INTERMEDIATE ICU/CCU
20|FH_F39493_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F39515_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39516_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39517_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE
20|FH_F39517_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|OP SVCS
20|FH_F39517_0_0|SrvcGrp|24703|2022|PDM|740.00|99|0.00|NEWBORN NURSERY
20|FH_F39517_0_0|SrvcGrp|361|2022|PCT|0.80|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F39521_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39521_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F39531_0_0|SrvcGrp|177|2022|PDM|2200.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F39531_0_0|SrvcGrp|6|2022|PCT|0.85|99|0.00|OP SURGERY
20|FH_F39531_0_0|SrvcGrp|997|2022|PCT|0.60|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F39532_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.01|99|0.00|GENERAL ACUTE CARE
20|FH_F39532_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.01|99|0.00|OP SVCS
20|FH_F39532_0_0|CSTM-ALL|CSTM-00|2020|PDM|210.00|99|0.00|CD PARTIAL HOSPITALIZATION
20|FH_F39538_0_0|SrvcGrp|13551|2022|PDM|607.00|99|0.00|NEWBORN NURSERY
20|FH_F39540_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.81|99|0.00|GENERAL ACUTE CARE
20|FH_F39541_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F39543_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F39545_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F39546_0_0|CSTM-ALL|CSTM-00|2020|PDM|1435.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39548_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F39549_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F39558_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F39558_0_0|SrvcGrp|17067|2022|PDM|546.00|99|0.00|ASPG II
20|FH_F39558_0_0|SrvcGrp|17081|2022|PDM|1563.00|99|0.00|ASPG IX
20|FH_F39561_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE
20|FH_F39561_0_0|SrvcGrp|3810|2022|PDM|122.47|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F39567_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|TRAUMA CARE
20|FH_F39567_0_0|CSTM-ALL|CSTM-00|2020|PDM|475.00|99|0.00|TRANSITIONAL CARE UNIT
20|FH_F39567_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|ACUTE PSYCH
20|FH_F39567_0_0|SrvcGrp|13551|2022|PDM|300.00|99|0.00|NEWBORN NURSERY
20|FH_F39581_0_0|CSTM-ALL|CSTM-00|2020|PDM|15620.00|99|0.00|OP SVCS
20|FH_F39586_0_0|SrvcGrp|11442|2022|PDM|603.33|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)
20|FH_F39586_0_0|SrvcGrp|1168|2022|PDM|32.91|99|0.00|CONTINUOUS HOMECARE
20|FH_F39604_0_0|SrvcGrp|16321|2022|PDM|28.00|99|0.00|DIALYSIS TRAINING
20|FH_F39617_0_0|SrvcGrp|13551|2022|PDM|318.00|99|0.00|NEWBORN NURSERY
20|FH_F39619_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F39622_0_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|ACUTE IP SVCS ONE DAY STAY
20|FH_F39622_0_0|SrvcGrp|13551|2022|PDM|619.00|99|0.00|NEWBORN NURSERY
20|FH_F39622_0_0|SrvcGrp|23928|2022|PDM|5900.00|99|0.00|ABDOMINAL LAPAROSCOPIC PROCEDURES
20|FH_F39622_0_0|SrvcGrp|23929|2022|PCT|0.65|99|0.00|HIGH COST DRUGS
20|FH_F39622_0_0|SrvcGrp|3037|2022|PDM|6115.00|99|0.00|LITHOTRIPSY
20|FH_F39622_0_0|SrvcGrp|439|2022|PDM|2400.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F39622_0_0|SrvcGrp|49|2022|PDM|12500.00|99|0.00|HIP REPLACEMENT
20|FH_F39622_0_0|SrvcGrp|51|2022|PDM|12500.00|99|0.00|KNEE REPLACEMENT
20|FH_F39623_0_0|SrvcGrp|32555|2022|PDM|450.00|99|0.00|IV HYDRATION FOR HYPEREMESIS
20|FH_F39627_0_0|CSTM-ALL|CSTM-00|2020|PDM|1600.00|99|0.00|ACUTE IP MED SVCS
20|FH_F39627_0_0|SrvcGrp|10421|2022|PDM|21000.00|99|0.00|GAMMA KNIFE
20|FH_F39627_0_0|SrvcGrp|12674|2022|PCT|0.85|99|0.00|IMPLANTS
20|FH_F39627_0_0|SrvcGrp|9927|2022|PDM|3100.00|99|0.00|ROOM & BOARD STERILE ENVIRONMENT
20|FH_F39633_0_0|CSTM-ALL|CSTM-00|2020|PDM|1169.00|99|0.00|DREYER AMB SURGERY - ASPG IV
20|FH_F39633_0_0|SrvcGrp|17075|2022|PDM|1524.00|99|0.00|ASPG VI
20|FH_F39633_0_0|SrvcGrp|17077|2022|PDM|1846.00|99|0.00|ASPG VII
20|FH_F39633_0_0|SrvcGrp|17079|2022|PDM|1797.00|99|0.00|ASPG VIII
20|FH_F39633_0_0|SrvcGrp|17083|2022|PDM|1169.00|99|0.00|ASPG X
20|FH_F39659_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39664_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39673_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39689_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS
20|FH_F39701_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F39701_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|CORNEAL TISSUE IMPLANTS
20|FH_F39701_0_0|CSTM-ALL|CSTM-00|2020|PDM|383.00|99|0.00|AEG 1 (NO REV)
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|IMPLANTS/ PROSTHETICS
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|138.80|99|0.00|ASPG 121
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|138.80|99|0.00|ASPG 223
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|138.80|99|0.00|ASPG 310
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|170.66|99|0.00|ASPG 222
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|176.15|99|0.00|ASPG 118
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|176.63|99|0.00|ASPG 117
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|1793.65|99|0.00|ASPG 9
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|220.25|99|0.00|ASPG 219
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|238.10|99|0.00|ASPG 113
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|246.25|99|0.00|ASPG 112
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|246.25|99|0.00|ASPG 308
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|298.42|99|0.00|ASPG 110
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|418.03|99|0.00|ASPG 213
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|433.05|99|0.00|ASPG 102
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|463.23|99|0.00|ASPG 1
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|523.70|99|0.00|ASPG 207
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|534.00|99|0.00|ASPG 205
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|63.90|99|0.00|ASPG 126
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|709.44|99|0.00|ASPG 3
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|97.09|99|0.00|ASPG 124
20|FH_F39721_0_0|SrvcGrp|16703|2022|PDM|355.00|99|0.00|HEMO/HOME DIALYSIS SVCS
20|FH_F39721_0_0|SrvcGrp|25688|2022|PDM|355.00|99|0.00|HOME HEMODIALYSIS
20|FH_F39740_0_0|CSTM-ALL|CSTM-00|2020|PDM|2185.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39740_0_0|SrvcGrp|21122|2022|PDM|17853.00|99|0.00|MS DRG 459 ONLY
20|FH_F39740_0_0|SrvcGrp|28956|2022|PDM|31890.00|99|0.00|MS DRG 222-225 ONLY CV SURGERY
20|FH_F141170_0_0|SrvcGrp|103589|2022|PDM|6000.00|99|0.00|CAROTID/INOM ART
20|FH_F141170_0_0|SrvcGrp|103590|2022|PDM|6000.00|99|0.00|CAROTID ART
20|FH_F141170_0_0|SrvcGrp|103593|2022|PDM|6000.00|99|0.00|XTRNL CAROTID
20|FH_F141170_0_0|SrvcGrp|35669|2022|PDM|5450.00|99|0.00|CPT 63650
20|FH_F141170_0_0|SrvcGrp|36591|2022|PDM|21999.00|99|0.00|CPT 63685
20|FH_F141170_0_0|SrvcGrp|67066|2022|PDM|7500.00|99|0.00|CERVICAL SURGERY
20|FH_F141170_0_0|SrvcGrp|67068|2022|PDM|18000.00|99|0.00|LUMBAR SPINE FUSION COMBINED
20|FH_F141170_0_0|SrvcGrp|88487|2022|PDM|4880.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION
20|FH_F141207_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F141207_0_0|SrvcGrp|80920|2022|PDM|995.00|99|0.00|HOSPICE SERVICES
20|FH_F141207_0_0|SrvcGrp|89783|2022|PDM|185.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F141207_0_0|SrvcGrp|94781|2022|PDM|205.00|99|0.00|HOSPICE IN LTCH (HCFA)
20|FH_F141210_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|AEG 10 (NO REV)
20|FH_F141210_0_0|SrvcGrp|113576|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F141210_0_0|SrvcGrp|59840|2022|PDM|3713.00|99|0.00|TYMPANOSTOMY
20|FH_F141210_0_0|SrvcGrp|71340|2022|PDM|1804.00|99|0.00|GI SURGERY CARVEOUTS
20|FH_F141210_0_0|SrvcGrp|73610|2022|PCT|1.00|99|0.00|AETNA IMPLANTS
20|FH_F141210_0_0|SrvcGrp|88824|2022|PDM|9548.00|99|0.00|CPT 69631
20|FH_F141211_0_0|CSTM-ALL|CSTM-00|2020|PDM|1761.00|99|0.00|AEG 3 (NO REV)
20|FH_F141211_0_0|CSTM-ALL|CSTM-00|2020|PDM|2106.00|99|0.00|AEG 10 (NO REV)
20|FH_F141211_0_0|CSTM-ALL|CSTM-00|2020|PDM|3098.00|99|0.00|AEG 9 (NO REV)
20|FH_F141212_0_0|SrvcGrp|82981|2022|PDM|125.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F141217_0_0|CSTM-ALL|CSTM-00|2020|PDM|1910.00|99|0.00|AEG 7 (NO REV)
20|FH_F141217_0_0|CSTM-ALL|CSTM-00|2020|PDM|806.00|99|0.00|AEG 2 (NO REV)
20|FH_F141217_0_0|SrvcGrp|113576|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F141217_0_0|SrvcGrp|80617|2022|PDM|9500.00|99|0.00|ARTHOPLASTY
20|FH_F141217_0_0|SrvcGrp|84939|2022|PDM|9500.00|99|0.00|SHOULDER JOINT
20|FH_F141217_0_0|SrvcGrp|86233|2022|PDM|9500.00|99|0.00|AETNA RECONSTRUCT ANKLE JOINT
20|FH_F141267_0_0|SrvcGrp|103899|2022|PDM|172.00|99|0.00|HOSPICE OR HOME HLTH IN HOME
20|FH_F141267_0_0|SrvcGrp|104224|2022|PDM|939.00|99|0.00|HOSPICE CARE PROVIDED IN INPATIENT HOSPICE FACILITY (HCFA)
20|FH_F141267_0_0|SrvcGrp|113620|2022|PDM|550.00|99|0.00|HOSPICE CARE
20|FH_F141267_0_0|SrvcGrp|113663|2022|PDM|172.00|99|0.00|HOSPICE ROUT HOME CARE-DIEM (HCFA)
20|FH_F141267_0_0|SrvcGrp|84185|2022|PDM|90.00|99|0.00|RESPITE CARE
20|FH_F141411_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F141411_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|AEG 6 (NO REV)
20|FH_F141411_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 2 (NO REV)
20|FH_F141411_0_0|SrvcGrp|33985|2022|PDM|10000.00|99|0.00|CPT 19120
20|FH_F141411_0_0|SrvcGrp|74585|2022|PCT|0.00|99|0.00|AETNA OP IMPLANTS
20|FH_F141411_0_0|SrvcGrp|83835|2022|PDM|15000.00|99|0.00|REPLACE TISSUE EXPANDER
20|FH_F141447_0_0|CSTM-ALL|CSTM-00|2020|PDM|1850.00|99|0.00|AEG 9 (NO REV)
20|FH_F141447_0_0|CSTM-ALL|CSTM-00|2020|PDM|539.00|99|0.00|AEG 1 (NO REV)
20|FH_F141447_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|AEG 10 (NO REV)
20|FH_F141447_0_0|CSTM-ALL|CSTM-00|2020|PDM|825.00|99|0.00|AEG 3 (NO REV)
20|FH_F141471_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 5  (NO REV)
20|FH_F141471_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 6 (NO REV)
20|FH_F141471_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|AEG 1 (NO REV)
20|FH_F141471_0_0|SrvcGrp|107876|2022|PDM|2012.00|99|0.00|MECH REMV PERICATH MATL SEP
20|FH_F141471_0_0|SrvcGrp|107879|2022|PDM|2200.00|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT
20|FH_F141471_0_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F141471_0_0|SrvcGrp|113778|2022|PDM|5900.00|99|0.00|THROMBECTOMY
20|FH_F141471_0_0|SrvcGrp|12664|2022|PCT|1.05|99|0.00|IMPLANTS
20|FH_F141507_0_0|CSTM-ALL|CSTM-00|2020|PDM|1110.00|99|0.00|AEG 10 (NO REV)
20|FH_F141507_0_0|CSTM-ALL|CSTM-00|2020|PDM|1490.00|99|0.00|AEG 6 (NO REV)
20|FH_F141507_0_0|CSTM-ALL|CSTM-00|2020|PDM|1728.00|99|0.00|AEG 8 (NO REV)
20|FH_F141507_0_0|SrvcGrp|111136|2022|PDM|200.00|99|0.00|PHENYLEPHRINE KETOROLAC INJECTION
20|FH_F141507_0_0|SrvcGrp|114518|2022|PDM|5000.00|99|0.00|INSERTION DRAINAGE DEVICE
20|FH_F141507_0_0|SrvcGrp|46890|2022|PDM|4000.00|99|0.00|IMPLANT EYE SHUNT
20|FH_F141511_0_0|SrvcGrp|30089|2022|PDM|425.00|99|0.00|HEMODIALYSIS SERVICES
20|FH_F141511_0_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS
20|FH_F141651_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F141651_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|AEG 1 (NO REV)
20|FH_F141651_0_0|CSTM-ALL|CSTM-00|2020|PDM|782.00|99|0.00|AEG 3 (NO REV)
20|FH_F141651_0_0|CSTM-ALL|CSTM-00|2020|PDM|902.00|99|0.00|AEG 5  (NO REV)
20|FH_F141651_0_0|SrvcGrp|111552|2022|PDM|2200.00|99|0.00|REMOVAL OF INTRANASAL LESION
20|FH_F141651_0_0|SrvcGrp|65402|2022|PDM|3300.00|99|0.00|CPT 42145
20|FH_F141651_0_0|SrvcGrp|65403|2022|PDM|2200.00|99|0.00|CPT 42830
20|FH_F141651_0_0|SrvcGrp|78097|2022|PDM|2310.00|99|0.00|AETNA NASAL ENDOSCOPY
20|FH_F141651_0_0|SrvcGrp|89884|2022|PDM|1100.00|99|0.00|AETNA ABLATE TURBINATE SUBMUC
20|FH_F141651_0_0|SrvcGrp|98402|2022|PDM|3850.00|99|0.00|RHINO INCL MJR SEPTAL RPR
20|FH_F141707_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F141707_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F141707_0_0|CSTM-ALL|CSTM-00|2020|PDM|1050.00|99|0.00|AEG 2 (NO REV)
20|FH_F141707_0_0|CSTM-ALL|CSTM-00|2020|PDM|2800.00|99|0.00|AEG 8 (NO REV)
20|FH_F141837_0_0|SrvcGrp|107353|2022|PDM|1000.00|99|0.00|AMB SRVC NEONAT TRNSPRT BS RATE EMERG 1 WAY (HCFA)
20|FH_F141837_0_0|SrvcGrp|13262|2022|PDM|11.25|99|0.00|GROUND MILEAGE, PER STATUTE MILE
20|FH_F141837_0_0|SrvcGrp|13422|2022|PDM|450.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC
20|FH_F141837_0_0|SrvcGrp|13595|2022|PDM|750.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC
20|FH_F141837_0_0|SrvcGrp|13681|2022|PDM|600.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT
20|FH_F141837_0_0|SrvcGrp|13683|2022|PDM|900.00|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2
20|FH_F39740_0_0|SrvcGrp|701|2022|PDM|3025.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F39753_0_0|CSTM-ALL|CSTM-00|2020|PDM|1702.00|99|0.00|ACUTE IP MED SVCS
20|FH_F39753_0_0|SrvcGrp|1245|2022|PCT|0.90|99|0.00|POSTERIOR LUMBAR FUSION
20|FH_F39753_0_0|SrvcGrp|177|2022|PDM|2251.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F39753_0_0|SrvcGrp|38|2022|PDM|2797.00|99|0.00|NORMAL DELIVERY
20|FH_F39753_0_0|SrvcGrp|6|2022|PCT|0.82|99|0.00|OP SURGERY
20|FH_F39756_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39756_0_0|CSTM-ALL|CSTM-00|2020|PDM|1170.40|99|0.00|CUMBERLAND SURGERY - ASPG VIII
20|FH_F39756_0_0|CSTM-ALL|CSTM-00|2020|PDM|302.50|99|0.00|DENTAL PROCEDURES - CHILD
20|FH_F39756_0_0|CSTM-ALL|CSTM-00|2020|PDM|412.50|99|0.00|DENTAL PROCEDURES - CHILD
20|FH_F39756_0_0|CSTM-ALL|CSTM-00|2020|PDM|440.00|99|0.00|CUMBERLAND SURGERY CTR - CARVE OUTS
20|FH_F39756_0_0|CSTM-ALL|CSTM-00|2020|PDM|71.50|99|0.00|NOMINAL FEE CODES
20|FH_F39783_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39801_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F39819_0_0|CSTM-ALL|CSTM-00|2020|PDM|15040.00|99|0.00|NY DRG 121 ONLY
20|FH_F39819_0_0|CSTM-ALL|CSTM-00|2020|PDM|21467.00|99|0.00|NY DRG 209 ONLY
20|FH_F39819_0_0|CSTM-ALL|CSTM-00|2020|PDM|21654.00|99|0.00|NY DRG 584 ONLY
20|FH_F39819_0_0|CSTM-ALL|CSTM-00|2020|PDM|3415.00|99|0.00|NY DRG 373 ONLY
20|FH_F39819_0_0|CSTM-ALL|CSTM-00|2020|PDM|4412.00|99|0.00|NY DRG 139 ONLY
20|FH_F39819_0_0|CSTM-ALL|CSTM-00|2020|PDM|5172.00|99|0.00|NY DRG 371 ONLY
20|FH_F39819_0_0|CSTM-ALL|CSTM-00|2020|PDM|5222.00|99|0.00|NY DRG 832 ONLY
20|FH_F39819_0_0|CSTM-ALL|CSTM-00|2020|PDM|5299.00|99|0.00|NY DRG 494 ONLY
20|FH_F39819_0_0|CSTM-ALL|CSTM-00|2020|PDM|5396.00|99|0.00|NY DRG 167 ONLY
20|FH_F39819_0_0|CSTM-ALL|CSTM-00|2020|PDM|6861.00|99|0.00|NY DRG 182 ONLY
20|FH_F39819_0_0|CSTM-ALL|CSTM-00|2020|PDM|7016.00|99|0.00|NY DRG 138 ONLY
20|FH_F39819_0_0|CSTM-ALL|CSTM-00|2020|PDM|7190.00|99|0.00|NY DRG 088 ONLY
20|FH_F39819_0_0|SrvcGrp|9510|2022|PDM|300.00|99|0.00|SKILLED NURSING CARE
20|FH_F39838_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39839_0_0|SrvcGrp|3029|2022|PDM|300.00|99|0.00|NEWBORN NURSERY
20|FH_F39844_0_0|CSTM-ALL|CSTM-00|2020|PDM|7426.00|99|0.00|MS DRG 243-244
20|FH_F39844_0_0|SrvcGrp|11336|2022|PCT|0.70|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F39844_0_0|SrvcGrp|16|2022|PDM|690.00|99|0.00|ACUTE REHABILITATION
20|FH_F39844_0_0|SrvcGrp|360|2022|PDM|796.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F39844_0_0|SrvcGrp|361|2022|PDM|1273.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F39844_0_0|SrvcGrp|941|2022|PDM|1485.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F39849_0_0|CSTM-ALL|CSTM-00|2020|PCT|74.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39855_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F39857_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|NUCLEAR MEDICINE / PROSTATE SEED IMPLANTS
20|FH_F39857_0_0|CSTM-ALL|CSTM-00|2020|PDM|780.00|99|0.00|ACUTE PSYCH
20|FH_F39857_0_0|SrvcGrp|109|2022|PDM|780.00|99|0.00|CD - DETOX
20|FH_F39857_0_0|SrvcGrp|115|2022|PDM|468.00|99|0.00|SKILLED NURSING CARE
20|FH_F39857_0_0|SrvcGrp|72|2022|PDM|468.00|99|0.00|NEWBORN NURSERY
20|FH_F39866_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|CHEMOTHERAPY DRUGS
20|FH_F39866_0_0|SrvcGrp|12342|2022|PCT|0.70|99|0.00|IMPLANTS
20|FH_F39866_0_0|SrvcGrp|701|2022|PDM|1800.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F39889_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F39892_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39893_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F39893_0_0|SrvcGrp|16|2022|PDM|600.00|99|0.00|ACUTE REHABILITATION
20|FH_F39893_0_0|SrvcGrp|38|2022|PDM|1800.00|99|0.00|NORMAL DELIVERY
20|FH_F39893_0_0|SrvcGrp|439|2022|PDM|1500.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F39894_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|OP SVCS
20|FH_F39907_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39910_0_0|SrvcGrp|24703|2022|PDM|392.00|99|0.00|NEWBORN NURSERY
20|FH_F39910_0_0|SrvcGrp|38|2022|PDM|2864.00|99|0.00|NORMAL DELIVERY
20|FH_F39912_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SURGERY
20|FH_F39912_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS
20|FH_F39917_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F39917_0_0|SrvcGrp|13632|2022|PDM|120.00|99|0.00|CPT 99215
20|FH_F39917_0_0|SrvcGrp|20070|2022|PDM|120.00|99|0.00|HCPCS S9083
20|FH_F39917_0_0|SrvcGrp|3403|2022|PDM|120.00|99|0.00|CPT 99203
20|FH_F39919_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F39919_0_0|CSTM-ALL|CSTM-00|2020|PDM|338.50|99|0.00|ASPG I
20|FH_F39919_0_0|CSTM-ALL|CSTM-00|2020|PDM|640.40|99|0.00|ASPG X
20|FH_F39919_0_0|CSTM-ALL|CSTM-00|2020|PDM|986.58|99|0.00|ASPG VIII
20|FH_F39920_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39920_0_0|SrvcGrp|24703|2022|PDM|450.00|99|0.00|NEWBORN NURSERY
20|FH_F39920_0_0|SrvcGrp|65|2022|PDM|1450.00|99|0.00|OBSTETRICAL CARE
20|FH_F39925_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F39925_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F39925_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F39939_0_0|SrvcGrp|10667|2022|PDM|800.00|99|0.00|BOARDER BABY SVCS
20|FH_F39939_0_0|SrvcGrp|10701|2022|PDM|2620.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F39939_0_0|SrvcGrp|9774|2022|PDM|2940.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F39943_0_0|SrvcGrp|439|2022|PDM|1850.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F39943_0_0|SrvcGrp|6|2022|PCT|0.90|99|0.00|OP SURGERY
20|FH_F39943_0_0|SrvcGrp|97|2022|PDM|3000.00|99|0.00|C-SECTION
20|FH_F39945_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F39956_0_0|SrvcGrp|115|2022|PDM|489.00|99|0.00|SKILLED NURSING CARE
20|FH_F39956_0_0|SrvcGrp|701|2022|PDM|1442.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F39956_0_0|SrvcGrp|97|2022|PDM|3090.00|99|0.00|C-SECTION
20|FH_F39967_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F39967_0_0|SrvcGrp|12674|2022|PCT|0.65|99|0.00|IMPLANTS
20|FH_F39967_0_0|SrvcGrp|705|2022|PCT|0.65|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F141837_0_0|SrvcGrp|2067|2022|PDM|1275.00|99|0.00|SPECIALTY CARE TRANSPORT
20|FH_F141861_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F141861_0_0|CSTM-ALL|CSTM-00|2020|PDM|732.00|99|0.00|AEG 4 (NO REV)
20|FH_F141873_0_0|SrvcGrp|46903|2022|PDM|702.00|99|0.00|RESIDENTIAL TREATMENT
20|FH_F141874_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F141874_0_0|SrvcGrp|14494|2022|PDM|1271.47|99|0.00|CONTINUOUS HOMECARE
20|FH_F141877_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F141877_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F141877_0_0|CSTM-ALL|CSTM-00|2020|PDM|564.00|99|0.00|AEG 9 (NO REV)
20|FH_F141877_0_0|CSTM-ALL|CSTM-00|2020|PDM|581.00|99|0.00|AEG 4 (NO REV)
20|FH_F141877_0_0|CSTM-ALL|CSTM-00|2020|PDM|774.00|99|0.00|AEG 6 (NO REV)
20|FH_F141877_0_0|CSTM-ALL|CSTM-00|2020|PDM|910.00|99|0.00|AEG 8 (NO REV)
20|FH_F141901_0_0|CSTM-ALL|CSTM-00|2020|PDM|535.46|99|0.00|ASPG II
20|FH_F141901_0_0|CSTM-ALL|CSTM-00|2020|PDM|612.29|99|0.00|ASPG III
20|FH_F141901_0_0|CSTM-ALL|CSTM-00|2020|PDM|756.36|99|0.00|ASPG IV
20|FH_F141901_0_0|CSTM-ALL|CSTM-00|2020|PDM|756.36|99|0.00|ASPG X
20|FH_F141901_0_0|CSTM-ALL|CSTM-00|2020|PDM|860.81|99|0.00|ASPG V
20|FH_F141901_0_0|CSTM-ALL|CSTM-00|2020|PDM|991.68|99|0.00|ASPG VI
20|FH_F142007_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F142007_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F142007_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|HSS ASC
20|FH_F142070_0_0|SrvcGrp|107748|2022|PDM|700.00|99|0.00|HEMODIALYSIS IN CENTER
20|FH_F142073_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F142073_0_0|CSTM-ALL|CSTM-00|2020|PDM|1795.00|99|0.00|AEG 7 (NO REV)
20|FH_F142073_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|AEG 10 (NO REV)
20|FH_F142073_0_0|SrvcGrp|106146|2022|PDM|11900.00|99|0.00|REVERSE HIP JOINT
20|FH_F142073_0_0|SrvcGrp|106166|2022|PDM|1800.00|99|0.00|REPAIR WRIST JOINT(S)
20|FH_F142073_0_0|SrvcGrp|111810|2022|PDM|11900.00|99|0.00|REVISION OF KNEE JOINT
20|FH_F142073_0_0|SrvcGrp|113862|2022|PDM|5980.00|99|0.00|RELIEVE SPINAL CORD PRESSURE
20|FH_F142073_0_0|SrvcGrp|113863|2022|PDM|5980.00|99|0.00|SPINAL CRD DECOMP->2 THORAC
20|FH_F142073_0_0|SrvcGrp|35667|2022|PDM|1060.00|99|0.00|CPT 20680
20|FH_F142073_0_0|SrvcGrp|47526|2022|PDM|1000.00|99|0.00|CORRECTION, HAMMERTOE
20|FH_F142073_0_0|SrvcGrp|64761|2022|PDM|5980.00|99|0.00|DISCECTOMY
20|FH_F142073_0_0|SrvcGrp|67065|2022|PDM|11900.00|99|0.00|CERVICAL SURGERY
20|FH_F142073_0_0|SrvcGrp|76602|2022|PDM|990.00|99|0.00|CPT 25000
20|FH_F142073_0_0|SrvcGrp|84318|2022|PDM|5980.00|99|0.00|SPINE INFUSION
20|FH_F142073_0_0|SrvcGrp|88157|2022|PDM|11900.00|99|0.00|TOTAL HIP ARTHROPLASTY
20|FH_F142073_0_0|SrvcGrp|88160|2022|PDM|5980.00|99|0.00|LAMINECTOMY W/FACETECTOMY
20|FH_F142073_0_0|SrvcGrp|89857|2022|PDM|5980.00|99|0.00|REMOVAL OF SPINAL LAMINA
20|FH_F142073_0_0|SrvcGrp|92411|2022|PDM|5980.00|99|0.00|RELIEVE SPINAL CORD PRESSURE
20|FH_F142073_0_0|SrvcGrp|92414|2022|PDM|5980.00|99|0.00|SPINAL CRD DECOMP->2 LUMBAR
20|FH_F142073_0_0|SrvcGrp|93431|2022|PDM|11900.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT
20|FH_F142073_0_0|SrvcGrp|96350|2022|PDM|11900.00|99|0.00|SHOULDER JOINT
20|FH_F142073_0_0|SrvcGrp|96979|2022|PDM|2300.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F142073_0_0|SrvcGrp|97099|2022|PDM|5980.00|99|0.00|SPINAL DISK SURGERY ADD-ON
20|FH_F142073_0_0|SrvcGrp|97119|2022|PDM|5980.00|99|0.00|NECK SPINE DISK SURGERY
20|FH_F142073_0_0|SrvcGrp|97139|2022|PDM|5980.00|99|0.00|LAMINECTOMY W/FACETECTOMY
20|FH_F142073_0_0|SrvcGrp|97239|2022|PDM|5980.00|99|0.00|DISKECTOMY CERVICAL SINGLE
20|FH_F142073_0_0|SrvcGrp|98593|2022|PDM|5980.00|99|0.00|REMOVAL OF SPINAL LAMINA
20|FH_F142073_0_0|SrvcGrp|98594|2022|PDM|5980.00|99|0.00|SPINAL CRD DECOMP->2 CERVIC
20|FH_F142073_0_0|SrvcGrp|98600|2022|PDM|5980.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON
20|FH_F142087_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F142087_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.11|99|0.00|OP SVCS
20|FH_F142087_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F142087_0_0|SrvcGrp|108094|2022|PDM|15500.00|99|0.00|REVISE KNEE
20|FH_F142087_0_0|SrvcGrp|113855|2022|PDM|3000.00|99|0.00|SPINE FIXATION
20|FH_F142087_0_0|SrvcGrp|113856|2022|PDM|6000.00|99|0.00|SPINE PROCEDURES
20|FH_F142087_0_0|SrvcGrp|113857|2022|PDM|6000.00|99|0.00|SPINE PROCEDURES
20|FH_F142087_0_0|SrvcGrp|89842|2022|PDM|15000.00|99|0.00|LUMBAR
20|FH_F142087_0_0|SrvcGrp|98497|2022|PDM|12000.00|99|0.00|ARTHRODESIS POSTERIOR TECH
20|FH_F142327_0_0|SrvcGrp|48380|2022|PDM|1000.00|99|0.00|CARVE OUT V2788
20|FH_F142327_0_0|SrvcGrp|62740|2022|PDM|2800.00|99|0.00|SURGERY CARVE OUTS
20|FH_F142332_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F142332_0_0|SrvcGrp|73524|2022|PDM|70.00|99|0.00|PHYSICAL THERAPY
20|FH_F142370_0_0|SrvcGrp|113173|2022|PDM|16.94|99|0.00|COVID-19 IMMUN ADMIN 1ST DOSE - PFIZER
20|FH_F142370_0_0|SrvcGrp|113177|2022|PDM|16.94|99|0.00|COVID-19 IMMUN ADMIN 1ST DOSE - ASTRAZENECA
20|FH_F142370_0_0|SrvcGrp|113545|2022|PDM|7.00|99|0.00|COVID-19 SPECIMEN HANDLING OFFICE-LAB
20|FH_F142370_0_0|SrvcGrp|113546|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB
20|FH_F142370_0_0|SrvcGrp|113551|2022|PDM|75.00|99|0.00|COVID-19 AMP PRB HGH THRUPUT
20|FH_F142370_0_0|SrvcGrp|113919|2022|PDM|1450.00|99|0.00|AIR FLUID BEDS
20|FH_F142370_0_0|SrvcGrp|73485|2022|PDM|990.00|99|0.00|AETNA REHAB
20|FH_F142376_0_0|CSTM-ALL|CSTM-00|2020|PDM|1010.00|99|0.00|AEG 2 (NO REV)
20|FH_F142376_0_0|CSTM-ALL|CSTM-00|2020|PDM|2020.00|99|0.00|AEG 7 (NO REV)
20|FH_F142376_0_0|SrvcGrp|101301|2022|PDM|9873.00|99|0.00|SPINE FUSION EXTRA SEGMENT
20|FH_F142376_0_0|SrvcGrp|107495|2022|PDM|1459.00|99|0.00|AETNA - ARTHROSCOPY OF JOINT
20|FH_F142376_0_0|SrvcGrp|113729|2022|PDM|17800.00|99|0.00|INSJ STABLJ DEV W/DCMPRN
20|FH_F142376_0_0|SrvcGrp|113971|2022|PDM|462.00|99|0.00|SPINAL FLUID TAP DIAGNO 5
20|FH_F142376_0_0|SrvcGrp|113979|2022|PDM|3511.00|99|0.00|REMOVE VAGUS NERVE
20|FH_F142376_0_0|SrvcGrp|113983|2022|PDM|1051.00|99|0.00|NJX AA&/STRD TFRM EPI C/T
20|FH_F142376_0_0|SrvcGrp|68742|2022|PDM|26208.00|99|0.00|CRANIAL DEVICE INSERTION/REPLACEMENT
20|FH_F39988_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F39988_0_0|SrvcGrp|13551|2022|PDM|549.00|99|0.00|NEWBORN NURSERY
20|FH_F39988_0_0|SrvcGrp|701|2022|PDM|2031.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F39992_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39992_0_0|SrvcGrp|13703|2022|PDM|26.75|99|0.00|LICENSED PRACTICAL NURSE- HOURLY
20|FH_F39992_0_0|SrvcGrp|9829|2022|PDM|85.50|99|0.00|PT SVCS
20|FH_F39995_0_0|SrvcGrp|38|2022|PDM|2100.00|99|0.00|NORMAL DELIVERY
20|FH_F39995_0_0|SrvcGrp|72|2022|PDM|375.00|99|0.00|NEWBORN NURSERY
20|FH_F39996_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F39996_0_0|SrvcGrp|16|2022|PDM|450.00|99|0.00|ACUTE REHABILITATION
20|FH_F40008_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F40011_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OBSTETRICAL CARE
20|FH_F40022_0_0|CSTM-ALL|CSTM-00|2020|PCT|57.00|99|0.00|OP SVCS
20|FH_F40026_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F40026_0_0|CSTM-ALL|CSTM-00|2020|PDM|975.00|99|0.00|BRAIN INJURY SERVICES
20|FH_F40026_0_0|SrvcGrp|229|2022|PCT|0.73|99|0.00|COMPUTED TOMOGRAPHY (CT SCAN)
20|FH_F40026_0_0|SrvcGrp|958|2022|PDM|1114.00|99|0.00|VENTILATOR SERVICES
20|FH_F40030_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F40030_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F40032_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40043_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.76|99|0.00|OP SVCS
20|FH_F40043_0_0|CSTM-ALL|CSTM-00|2020|PDM|1685.00|99|0.00|ACUTE IP MED SVCS
20|FH_F40043_0_0|CSTM-ALL|CSTM-00|2020|PDM|5990.00|99|0.00|MS DRG 285
20|FH_F40043_0_0|CSTM-ALL|CSTM-00|2020|PDM|5990.00|99|0.00|MSDRG 286-287 CARDIAC CATH
20|FH_F40043_0_0|SrvcGrp|13641|2022|PDM|1920.00|99|0.00|TELEMETRY/STEP DOWN UNIT
20|FH_F40043_0_0|SrvcGrp|13651|2022|PDM|2267.00|99|0.00|TELEMETRY/STEP DOWN UNIT (SURGICAL)
20|FH_F40043_0_0|SrvcGrp|14654|2022|PCT|0.76|99|0.00|HIP REVISION
20|FH_F40043_0_0|SrvcGrp|30458|2022|PCT|0.76|99|0.00|DRUGS
20|FH_F40043_0_0|SrvcGrp|33263|2022|PDM|1082.00|99|0.00|GA ASPG III
20|FH_F40043_0_0|SrvcGrp|33266|2022|PDM|1825.00|99|0.00|GA ASPG VI
20|FH_F40043_0_0|SrvcGrp|360|2022|PDM|1920.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F40046_0_0|SrvcGrp|10545|2022|PDM|165.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F40056_0_0|SrvcGrp|38|2022|PDM|3600.00|99|0.00|NORMAL DELIVERY
20|FH_F40066_0_0|SrvcGrp|24703|2022|PDM|675.00|99|0.00|NEWBORN NURSERY
20|FH_F40073_0_0|SrvcGrp|17067|2022|PDM|1419.00|99|0.00|ASPG II
20|FH_F40073_0_0|SrvcGrp|17081|2022|PCT|0.70|99|0.00|ASPG IX
20|FH_F40073_0_0|SrvcGrp|17083|2022|PCT|0.70|99|0.00|ASPG X
20|FH_F40084_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|GENERAL ACUTE CARE
20|FH_F40088_0_0|SrvcGrp|439|2022|PDM|1273.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F40089_0_0|SrvcGrp|16746|2022|PDM|50.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F40089_0_0|SrvcGrp|31949|2022|PDM|50.00|99|0.00|SPEECH THERAPY
20|FH_F40091_0_0|SrvcGrp|17069|2022|PCT|0.70|99|0.00|ASPG III
20|FH_F40099_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE
20|FH_F40099_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F40115_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40118_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40144_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|COMPUTED TOMOGRAPHY (CT SCAN)
20|FH_F40144_0_0|CSTM-ALL|CSTM-00|2020|PDM|919.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40144_0_0|SrvcGrp|3066|2022|PCT|0.73|99|0.00|HIGH-COST DRUGS
20|FH_F40144_0_0|SrvcGrp|31753|2022|PDM|975.00|99|0.00|SPINAL CORD CARE
20|FH_F40144_0_0|SrvcGrp|997|2022|PCT|0.73|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F40149_0_0|SrvcGrp|701|2022|PDM|1678.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F40154_0_0|SrvcGrp|12280|2022|PCT|0.80|99|0.00|IMPLANTS
20|FH_F40154_0_0|SrvcGrp|439|2022|PDM|1837.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F40176_0_0|CSTM-ALL|CSTM-00|2020|PDM|55.00|99|0.00|HOME HEALTH AIDE
20|FH_F40186_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F40186_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|CAROLINA DIGESTIVE ENDOSCOPY FH RATES
20|FH_F40191_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MSDRG 242-244, 258-262 PACEMAKER INSERTION/REVISION
20|FH_F40191_0_0|CSTM-ALL|CSTM-00|2020|PDM|2667.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F40191_0_0|CSTM-ALL|CSTM-00|2020|PDM|2945.00|99|0.00|MS DRG 767-768, 774-775 NORMAL DELIVERY
20|FH_F40191_0_0|SrvcGrp|12014|2022|PDM|607.00|99|0.00|SKILLED NURSING SVCS
20|FH_F40191_0_0|SrvcGrp|3087|2022|PDM|633.00|99|0.00|CD - DETOX
20|FH_F40191_0_0|SrvcGrp|80|2022|PDM|633.00|99|0.00|ACUTE PSYCH
20|FH_F40193_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.30|99|0.00|OP SVCS
20|FH_F40198_0_0|SrvcGrp|701|2022|PDM|1590.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F40203_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40203_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|PEDIATRIC REHABILITATION
20|FH_F40203_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|SPINAL CORD REHAB
20|FH_F40203_0_0|SrvcGrp|16|2022|PDM|660.00|99|0.00|ACUTE REHABILITATION
20|FH_F40205_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS
20|FH_F40207_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP LAPAROSCOPIC SURGERY
20|FH_F40207_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40207_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F40256_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40256_0_0|SrvcGrp|10632|2022|PCT|0.90|99|0.00|OP MRI
20|FH_F40256_0_0|SrvcGrp|3029|2022|PDM|200.00|99|0.00|NEWBORN NURSERY
20|FH_F40258_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40258_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F40260_0_0|SrvcGrp|360|2022|PDM|1600.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F40260_0_0|SrvcGrp|439|2022|PDM|1600.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F40266_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE
20|FH_F40266_0_0|SrvcGrp|269|2022|PCT|0.75|99|0.00|OP LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F40286_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F142376_0_0|SrvcGrp|80139|2022|PDM|24151.00|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F142376_0_0|SrvcGrp|87119|2022|PDM|7851.00|99|0.00|PERQ VERTEBRAL AUGMENTATION
20|FH_F142376_0_0|SrvcGrp|93741|2022|PDM|6482.00|99|0.00|REVISE SPINE ELECTRODE PERCUTANEOUS ARRAY
20|FH_F142376_0_0|SrvcGrp|96349|2022|PDM|17545.00|99|0.00|NECK SPINE FUSE
20|FH_F142376_0_0|SrvcGrp|97279|2022|PDM|1159.00|99|0.00|REMOVE SPINE ELTRD PERQ ARAY
20|FH_F142376_0_0|SrvcGrp|98560|2022|PDM|18590.00|99|0.00|LUMBAR
20|FH_F142376_0_0|SrvcGrp|98565|2022|PDM|17545.00|99|0.00|LUMBAR SPINE FUSION COMBINED
20|FH_F142376_0_0|SrvcGrp|98604|2022|PDM|5091.00|99|0.00|IMPLANT SPINAL CANAL
20|FH_F142454_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F142454_0_0|CSTM-ALL|CSTM-00|2020|PDM|1093.00|99|0.00|AEG 7 (NO REV)
20|FH_F142454_0_0|CSTM-ALL|CSTM-00|2020|PDM|1449.00|99|0.00|AEG 9 (NO REV)
20|FH_F142454_0_0|CSTM-ALL|CSTM-00|2020|PDM|788.00|99|0.00|AEG 5  (NO REV)
20|FH_F142454_0_0|SrvcGrp|110845|2022|PDM|2795.00|99|0.00|REPAIR OF ECTROPION
20|FH_F142454_0_0|SrvcGrp|113938|2022|PDM|3400.00|99|0.00|INJECT ANT CHAMB MEDICATION
20|FH_F142454_0_0|SrvcGrp|113940|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F142454_0_0|SrvcGrp|42429|2022|PDM|635.00|99|0.00|OP SURGERY CPT 66761
20|FH_F142454_0_0|SrvcGrp|99073|2022|PDM|1.24|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F142587_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F142587_0_0|SrvcGrp|22596|2022|PDM|177.81|99|0.00|HOSPICE CARE
20|FH_F142587_0_0|SrvcGrp|92501|2022|PDM|415.30|99|0.00|HOSPICE IP RESPITE CARE
20|FH_F142655_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F142673_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F142673_0_0|CSTM-ALL|CSTM-00|2020|PDM|1296.00|99|0.00|AEG 2 (NO REV)
20|FH_F142673_0_0|SrvcGrp|113988|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F142694_0_0|SrvcGrp|87077|2022|PDM|250.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F142710_0_0|SrvcGrp|80920|2022|PDM|500.00|99|0.00|HOSPICE SERVICES
20|FH_F142785_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F142826_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE
20|FH_F142894_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F142894_0_0|SrvcGrp|33722|2022|PDM|25.00|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F142894_0_0|SrvcGrp|82223|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F142894_0_0|SrvcGrp|83857|2022|PDM|475.00|99|0.00|IP HOSPICE SVCS
20|FH_F142930_0_0|SrvcGrp|80920|2022|PDM|100.00|99|0.00|HOSPICE SERVICES
20|FH_F142930_0_0|SrvcGrp|82222|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F142992_0_0|SrvcGrp|87077|2022|PDM|250.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F143035_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F143050_0_0|SrvcGrp|12868|2022|PDM|31500.00|99|0.00|AIR AMBULANCE
20|FH_F143067_0_0|SrvcGrp|105470|2022|PDM|74.28|99|0.00|TRAINING INCL A TREATMENT
20|FH_F143067_0_0|SrvcGrp|114009|2022|PDM|437.00|99|0.00|DIALYSIS PATIENT TRAINING
20|FH_F143201_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F143289_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F143297_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F143297_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F143297_0_0|CSTM-ALL|CSTM-00|2020|PDM|1138.00|99|0.00|AEG 9 (NO REV)
20|FH_F143297_0_0|CSTM-ALL|CSTM-00|2020|PDM|1171.00|99|0.00|AEG 4 (NO REV)
20|FH_F143297_0_0|CSTM-ALL|CSTM-00|2020|PDM|1421.00|99|0.00|AEG 5  (NO REV)
20|FH_F143297_0_0|CSTM-ALL|CSTM-00|2020|PDM|1855.00|99|0.00|AEG 7 (NO REV)
20|FH_F143297_0_0|SrvcGrp|46890|2022|PDM|2245.00|99|0.00|IMPLANT EYE SHUNT
20|FH_F143335_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE
20|FH_F143388_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F143388_0_0|SrvcGrp|29155|2022|PDM|100.00|99|0.00|HOSPICE SVCS
20|FH_F143450_0_0|CSTM-ALL|CSTM-00|2020|PDM|642.00|99|0.00|AEG 10 (NO REV)
20|FH_F143450_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F143450_0_0|SrvcGrp|87187|2022|PDM|727.00|99|0.00|CPT 43259
20|FH_F143467_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F143467_0_0|CSTM-ALL|CSTM-00|2020|PDM|1430.00|99|0.00|AEG 6 (NO REV)
20|FH_F143467_0_0|CSTM-ALL|CSTM-00|2020|PDM|1612.60|99|0.00|AEG 8 (NO REV)
20|FH_F143467_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|AEG 5  (NO REV)
20|FH_F143467_0_0|CSTM-ALL|CSTM-00|2020|PDM|770.00|99|0.00|AEG 1 (NO REV)
20|FH_F143467_0_0|SrvcGrp|100044|2022|PDM|4435.00|99|0.00|INCISION OF HEEL BONE
20|FH_F143467_0_0|SrvcGrp|114045|2022|PDM|3140.00|99|0.00|FUSION OF BIG TOE JOINT
20|FH_F143467_0_0|SrvcGrp|114046|2022|PCT|0.00|99|0.00|PROSTHETICS/ORTHOPEDICS
20|FH_F143467_0_0|SrvcGrp|33984|2022|PDM|1424.00|99|0.00|HAMMERTOE CORRECTION
20|FH_F143467_0_0|SrvcGrp|35667|2022|PDM|1067.00|99|0.00|CPT 20680
20|FH_F143487_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F143509_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F143509_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE
20|FH_F143509_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F143528_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F143528_0_0|CSTM-ALL|CSTM-00|2020|PDM|1050.00|99|0.00|AEG 1 (NO REV)
20|FH_F143528_0_0|CSTM-ALL|CSTM-00|2020|PDM|1942.50|99|0.00|AEG 10 (NO REV)
20|FH_F143528_0_0|CSTM-ALL|CSTM-00|2020|PDM|2100.00|99|0.00|AEG 4 (NO REV) W/O SURGERY
20|FH_F143528_0_0|CSTM-ALL|CSTM-00|2020|PDM|2625.00|99|0.00|AEG 9 (NO REV)
20|FH_F143528_0_0|SrvcGrp|100007|2022|PDM|7680.75|99|0.00|FUSION OF ANKLE JOINT
20|FH_F143528_0_0|SrvcGrp|102481|2022|PDM|2625.00|99|0.00|CPT 29898
20|FH_F143528_0_0|SrvcGrp|103542|2022|PDM|4476.15|99|0.00|ANKLE ARTHROSCOPY/SURGERY
20|FH_F143528_0_0|SrvcGrp|104007|2022|PDM|4861.50|99|0.00|ENDOSCOPIC DCMPR 1
20|FH_F143528_0_0|SrvcGrp|104008|2022|PDM|3452.40|99|0.00|CORRECTION HALUX RIDGUS W IMPLANTS
20|FH_F143528_0_0|SrvcGrp|104170|2022|PDM|2625.00|99|0.00|AETNA ARTHROSCOPY SURGERY
20|FH_F143528_0_0|SrvcGrp|107170|2022|PDM|4076.10|99|0.00|EXCISION OF NECK CYST
20|FH_F143528_0_0|SrvcGrp|109966|2022|PDM|5250.00|99|0.00|DECOMPRESS SPINE CORD ADD-ON
20|FH_F40294_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.93|99|0.00|OP SVCS
20|FH_F40297_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|NEWBORN NURSERY
20|FH_F40302_0_0|SrvcGrp|439|2022|PDM|2180.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F40304_0_0|SrvcGrp|3099|2022|PCT|0.77|99|0.00|OP SURGERY
20|FH_F40318_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F40318_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F40331_0_0|SrvcGrp|15|2022|PDM|3441.00|99|0.00|PEDIATRIC INTENSIVE CARE UNIT
20|FH_F40332_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F40332_0_0|SrvcGrp|3029|2022|PDM|220.00|99|0.00|NEWBORN NURSERY
20|FH_F40333_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40333_0_0|CSTM-ALL|CSTM-00|2020|PDM|1450.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F40333_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|MS DRG 765-766 C-SECTION
20|FH_F40333_0_0|SrvcGrp|3029|2022|PDM|350.00|99|0.00|NEWBORN NURSERY
20|FH_F40333_0_0|SrvcGrp|9774|2022|PDM|2000.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F40340_0_0|CSTM-ALL|CSTM-00|2020|PDM|927.00|99|0.00|SPINAL CORD INJURY
20|FH_F40340_0_0|SrvcGrp|16|2022|PDM|720.00|99|0.00|ACUTE REHABILITATION
20|FH_F40345_0_0|SrvcGrp|65|2022|PDM|1339.00|99|0.00|OBSTETRICAL CARE
20|FH_F40346_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|ASPG III
20|FH_F40346_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40346_0_0|CSTM-ALL|CSTM-00|2020|PDM|1355.00|99|0.00|ASPG V
20|FH_F40346_0_0|SrvcGrp|12179|2022|PCT|0.75|99|0.00|CPT CODES 70000-79999 (RAD)
20|FH_F40346_0_0|SrvcGrp|13526|2022|PCT|0.75|99|0.00|CPT CODES 80000-89999 - (LAB)
20|FH_F40346_0_0|SrvcGrp|3950|2022|PCT|0.75|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F40346_0_0|SrvcGrp|9795|2022|PDM|975.00|99|0.00|SUBACUTE REHAB
20|FH_F40347_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F40347_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|MS DRG 765-766 C-SECTION
20|FH_F40347_0_0|SrvcGrp|9795|2022|PDM|975.00|99|0.00|SUBACUTE REHAB
20|FH_F40350_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F40350_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|MS DRG 765-766 C-SECTION
20|FH_F40350_0_0|SrvcGrp|9795|2022|PDM|975.00|99|0.00|SUBACUTE REHAB
20|FH_F40358_0_0|CSTM-ALL|CSTM-00|2020|PDM|2800.00|99|0.00|MS DRG 767-768, 774-775  NORMAL DELIVERY
20|FH_F40358_0_0|SrvcGrp|3029|2022|PDM|350.00|99|0.00|NEWBORN NURSERY
20|FH_F40370_0_0|CSTM-ALL|CSTM-00|2020|PDM|882.00|99|0.00|ACUTE PSYCH
20|FH_F40370_0_0|SrvcGrp|110|2022|PDM|674.00|99|0.00|CD - REHABILITATION
20|FH_F40374_0_0|CSTM-ALL|CSTM-00|2020|PCT|57.00|99|0.00|OP SVCS
20|FH_F40388_0_0|SrvcGrp|109|2022|PDM|550.00|99|0.00|CD - DETOX
20|FH_F40393_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F40399_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40402_0_0|CSTM-ALL|CSTM-00|2020|PDM|530.00|99|0.00|SUB-ACUTE SKILLED NURSING CARE
20|FH_F40402_0_0|SrvcGrp|97|2022|PDM|1273.00|99|0.00|C-SECTION
20|FH_F40403_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS
20|FH_F40409_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40409_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|OP SVCS
20|FH_F40416_0_0|CSTM-ALL|CSTM-00|2020|PDM|1209.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40416_0_0|SrvcGrp|38|2022|PDM|2822.00|99|0.00|NORMAL DELIVERY
20|FH_F40417_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40418_0_0|SrvcGrp|13551|2022|PDM|500.00|99|0.00|NEWBORN NURSERY
20|FH_F40421_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F40421_0_0|SrvcGrp|10400|2022|PDM|2300.00|99|0.00|IP SURGERY
20|FH_F40421_0_0|SrvcGrp|9793|2022|PDM|390.00|99|0.00|NEWBORN NURSERY
20|FH_F40423_0_0|SrvcGrp|32550|2022|PDM|385.00|99|0.00|NEWBORN NURSERY
20|FH_F40427_0_0|SrvcGrp|88|2022|PCT|0.65|99|0.00|OP LITHOTRIPSY
20|FH_F40427_0_0|SrvcGrp|97|2022|PDM|3356.00|99|0.00|C-SECTION
20|FH_F40431_0_0|CSTM-ALL|CSTM-00|2020|PDM|1010.00|99|0.00|PULMONARY SVCS
20|FH_F40431_0_0|CSTM-ALL|CSTM-00|2020|PDM|1010.00|99|0.00|SPINAL CORD CARE
20|FH_F40431_0_0|CSTM-ALL|CSTM-00|2020|PDM|925.00|99|0.00|CVA (STROKE)
20|FH_F40438_0_0|SrvcGrp|3069|2022|PCT|0.60|99|0.00|IMPLANTS
20|FH_F40442_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F40446_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|ACUTE PSYCH
20|FH_F40446_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F40446_0_0|SrvcGrp|439|2022|PDM|1300.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F40465_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F40465_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|TRAUMA CARE
20|FH_F40465_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F40465_0_0|CSTM-ALL|CSTM-00|2020|PDM|12000.00|99|0.00|DRG 116 ONLY OTH CARDIAC PACEMKR (552)
20|FH_F40465_0_0|CSTM-ALL|CSTM-00|2020|PDM|13850.00|99|0.00|DRG 527 PERC CV PX W/O CC (DRG 558)
20|FH_F40465_0_0|CSTM-ALL|CSTM-00|2020|PDM|17050.00|99|0.00|DRG 526 PERC CV PROCW/DRUG-ELUTING STENT W/AMI (DRG 557)
20|FH_F40465_0_0|CSTM-ALL|CSTM-00|2020|PDM|18750.00|99|0.00|DRG 110 ONLY MAJOR CARDIOVASCULAR PROCEDURE W/CC
20|FH_F40465_0_0|CSTM-ALL|CSTM-00|2020|PDM|21500.00|99|0.00|DRG 109 ONLY CORONARY BYPASS
20|FH_F40465_0_0|CSTM-ALL|CSTM-00|2020|PDM|28500.00|99|0.00|DRG 108 ONLY OTHER CARDIOTHORACIC PROC
20|FH_F40465_0_0|CSTM-ALL|CSTM-00|2020|PDM|63650.00|99|0.00|DRG 525 OTHER HEART ASSIST SYSTEM IMPLANT
20|FH_F40465_0_0|SrvcGrp|6|2022|PCT|0.75|99|0.00|OP SURGERY
20|FH_F40465_0_0|SrvcGrp|762|2022|PCT|0.75|99|0.00|AIR AMBULANCE SVCS
20|FH_F40471_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40471_0_0|CSTM-ALL|CSTM-00|2020|PDM|556.00|99|0.00|ASC II ENDOSCOPY CTR CENTRAL PA
20|FH_F40472_0_0|SrvcGrp|16746|2022|PDM|70.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F40497_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40501_0_0|CSTM-ALL|CSTM-00|2020|PDM|263.00|99|0.00|OP PSYCHIATRIC TREATMENT (8-12 HRS)
20|FH_F40507_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS
20|FH_F40515_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F40515_0_0|SrvcGrp|30941|2022|PDM|287.00|99|0.00|NEWBORN NURSERY
20|FH_F40521_0_0|SrvcGrp|14197|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F143528_0_0|SrvcGrp|114082|2022|PDM|1518.30|99|0.00|EXPLORE/TREAT EYE SOCKET
20|FH_F143528_0_0|SrvcGrp|114083|2022|PDM|1914.15|99|0.00|EXCISION OF NECK CYST
20|FH_F143528_0_0|SrvcGrp|114084|2022|PDM|1518.30|99|0.00|REVISE EYE MUSCLE
20|FH_F143528_0_0|SrvcGrp|114088|2022|PDM|2730.00|99|0.00|HERNIA REPAIR
20|FH_F143528_0_0|SrvcGrp|12491|2022|PCT|0.00|99|0.00|PACEMAKER
20|FH_F143528_0_0|SrvcGrp|26275|2022|PDM|3150.00|99|0.00|CPT 29826
20|FH_F143528_0_0|SrvcGrp|35668|2022|PDM|4305.00|99|0.00|CPT 29824
20|FH_F143528_0_0|SrvcGrp|67066|2022|PDM|10500.00|99|0.00|CERVICAL SURGERY
20|FH_F143528_0_0|SrvcGrp|67068|2022|PDM|10500.00|99|0.00|LUMBAR SPINE FUSION COMBINED
20|FH_F143528_0_0|SrvcGrp|67279|2022|PDM|10500.00|99|0.00|CERVICAL SURGERY
20|FH_F143528_0_0|SrvcGrp|70749|2022|PDM|3150.00|99|0.00|CPT 29823
20|FH_F143528_0_0|SrvcGrp|82720|2022|PDM|3491.25|99|0.00|WRIST ENDOSCOPY/SURGERY
20|FH_F143528_0_0|SrvcGrp|83644|2022|PDM|4076.10|99|0.00|CPT 30465
20|FH_F143528_0_0|SrvcGrp|84318|2022|PDM|5250.00|99|0.00|SPINE INFUSION
20|FH_F143528_0_0|SrvcGrp|88159|2022|PDM|5250.00|99|0.00|LOW BACK DISK SURGERY
20|FH_F143528_0_0|SrvcGrp|88597|2022|PDM|5250.00|99|0.00|INTERNAL FIX FOR FRACT/INSTA
20|FH_F143528_0_0|SrvcGrp|88824|2022|PDM|4076.10|99|0.00|CPT 69631
20|FH_F143528_0_0|SrvcGrp|89861|2022|PDM|3360.00|99|0.00|LUMBAR LAMINOTOMY
20|FH_F143528_0_0|SrvcGrp|89883|2022|PDM|4861.50|99|0.00|AETNA TREAT HUMERUS FRACTURE
20|FH_F143528_0_0|SrvcGrp|90369|2022|PDM|1518.30|99|0.00|PROBE NASOLACRIMAL DUCT
20|FH_F143528_0_0|SrvcGrp|90795|2022|PDM|1914.15|99|0.00|EXCISION INFERIOR TURBINATE
20|FH_F143528_0_0|SrvcGrp|92364|2022|PDM|6517.35|99|0.00|ARTHRODESIS SACROILIAC JOINT
20|FH_F143528_0_0|SrvcGrp|97471|2022|PDM|3980.55|99|0.00|REMOVAL OF THYROID DUCT LESION
20|FH_F143528_0_0|SrvcGrp|99171|2022|PDM|4361.70|99|0.00|CPT 28485
20|FH_F143530_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F143530_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F143530_0_0|SrvcGrp|82222|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F143539_0_0|CSTM-ALL|CSTM-00|2020|PDM|1042.00|99|0.00|AEG 2 (NO REV)
20|FH_F143539_0_0|CSTM-ALL|CSTM-00|2020|PDM|1423.00|99|0.00|AEG 4 (NO REV)
20|FH_F143539_0_0|CSTM-ALL|CSTM-00|2020|PDM|1448.00|99|0.00|AEG 5  (NO REV)
20|FH_F143539_0_0|SrvcGrp|42550|2022|PDM|6642.00|99|0.00|OP SURGERY CPT 66984
20|FH_F143539_0_0|SrvcGrp|84934|2022|PDM|6427.00|99|0.00|REMOVAL OF EYE LESION
20|FH_F143542_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F143542_0_0|CSTM-ALL|CSTM-00|2020|PDM|781.00|99|0.00|AEG 1 (NO REV)
20|FH_F143542_0_0|SrvcGrp|109346|2022|PDM|4590.00|99|0.00|EXCISION OF CHALAZION DIFFERENT LIDS
20|FH_F143542_0_0|SrvcGrp|109758|2022|PDM|11475.00|99|0.00|COLLAGEN CROSSLINKING CORNEA
20|FH_F143542_0_0|SrvcGrp|109759|2022|PDM|5738.00|99|0.00|REMOVAL CORNEAL EPITHELIUM
20|FH_F143542_0_0|SrvcGrp|109763|2022|PDM|2869.00|99|0.00|TREAT EYELID LESION
20|FH_F143542_0_0|SrvcGrp|45583|2022|PDM|9754.00|99|0.00|CPT 65730
20|FH_F143542_0_0|SrvcGrp|78046|2022|PCT|1.00|99|0.00|AETNA AQUEOUS SHUNT
20|FH_F143542_0_0|SrvcGrp|82570|2022|PDM|4590.00|99|0.00|REVISION EYELID/EXCESS SKIN
20|FH_F143542_0_0|SrvcGrp|84278|2022|PDM|9754.00|99|0.00|CORNEAL TRANSPLANT
20|FH_F143542_0_0|SrvcGrp|85966|2022|PDM|7459.00|99|0.00|EXTRACAPSULAR CATARACT
20|FH_F143564_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 5  (NO REV)
20|FH_F143564_0_0|CSTM-ALL|CSTM-00|2020|PDM|1243.00|99|0.00|AEG 6 (NO REV)
20|FH_F143564_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|AEG 8 (NO REV)
20|FH_F143564_0_0|CSTM-ALL|CSTM-00|2020|PDM|2100.00|99|0.00|AEG 9 (NO REV)
20|FH_F143564_0_0|CSTM-ALL|CSTM-00|2020|PDM|798.00|99|0.00|AEG 3 (NO REV)
20|FH_F143564_0_0|CSTM-ALL|CSTM-00|2020|PDM|902.00|99|0.00|AEG 4 (NO REV)
20|FH_F143564_0_0|SrvcGrp|87841|2022|PDM|7500.00|99|0.00|LAPAROSCOPE PROCEDURE - STOMACH
20|FH_F143564_0_0|SrvcGrp|87844|2022|PDM|4488.00|99|0.00|LAPARASCOPY - GASTRIC
20|FH_F143571_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F143571_0_0|SrvcGrp|103846|2022|PDM|87.23|99|0.00|HOSPICE CARE
20|FH_F143571_0_0|SrvcGrp|113451|2022|PDM|87.23|99|0.00|HOSPICE CARE
20|FH_F143571_0_0|SrvcGrp|90477|2022|PDM|153.00|99|0.00|HOSPICE
20|FH_F143580_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F143648_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F143648_0_0|CSTM-ALL|CSTM-00|2020|PDM|1088.00|99|0.00|AEG 6 (NO REV)
20|FH_F143648_0_0|CSTM-ALL|CSTM-00|2020|PDM|1311.00|99|0.00|AEG 7 (NO REV)
20|FH_F143648_0_0|CSTM-ALL|CSTM-00|2020|PDM|675.00|99|0.00|AEG 3 (NO REV)
20|FH_F143648_0_0|CSTM-ALL|CSTM-00|2020|PDM|831.00|99|0.00|AEG 4 (NO REV)
20|FH_F143648_0_0|CSTM-ALL|CSTM-00|2020|PDM|945.00|99|0.00|AEG 5  (NO REV)
20|FH_F143648_0_0|SrvcGrp|113888|2022|PDM|1008.00|99|0.00|SURGERY FOR VULVA LESION
20|FH_F143648_0_0|SrvcGrp|16732|2022|PDM|8200.00|99|0.00|HYSTEROSCOPY ABLATION
20|FH_F143650_0_0|SrvcGrp|100008|2022|PDM|4000.00|99|0.00|RECONSTRUCT ELBOW LAT LIGMNT
20|FH_F143650_0_0|SrvcGrp|104002|2022|PDM|1800.00|99|0.00|ELBOW ARTHROSCOPY
20|FH_F143650_0_0|SrvcGrp|105658|2022|PDM|2800.00|99|0.00|REPAIR FRACTURE OF RADIUS
20|FH_F143650_0_0|SrvcGrp|11663|2022|PCT|0.50|99|0.00|IMPLANTS
20|FH_F143650_0_0|SrvcGrp|26277|2022|PDM|1800.00|99|0.00|CPT 29874
20|FH_F143650_0_0|SrvcGrp|27261|2022|PDM|4100.00|99|0.00|CPT 27446
20|FH_F143650_0_0|SrvcGrp|33724|2022|PDM|1800.00|99|0.00|ARTHROSCOPY
20|FH_F143650_0_0|SrvcGrp|34606|2022|PDM|2800.00|99|0.00|CPT 29827
20|FH_F143650_0_0|SrvcGrp|35921|2022|PDM|4000.00|99|0.00|BARIATRIC SURGERY
20|FH_F143650_0_0|SrvcGrp|72990|2022|PDM|700.00|99|0.00|AEG 1
20|FH_F143650_0_0|SrvcGrp|72998|2022|PDM|2500.00|99|0.00|AEG 5
20|FH_F143650_0_0|SrvcGrp|73002|2022|PDM|3400.00|99|0.00|AEG 7
20|FH_F143650_0_0|SrvcGrp|89883|2022|PDM|2500.00|99|0.00|AETNA TREAT HUMERUS FRACTURE
20|FH_F143668_0_0|SrvcGrp|114058|2022|PDM|60.00|99|0.00|PNEUMATIC COMPRESSOR (MOD RR)
20|FH_F143668_0_0|SrvcGrp|114063|2022|PDM|35.00|99|0.00|SEGMENTAL PNEUMATIC CHEST (MOD RR)
20|FH_F143668_0_0|SrvcGrp|114064|2022|PDM|350.00|99|0.00|SEGMENTAL PNEUMATIC CHEST (MOD NU)
20|FH_F143668_0_0|SrvcGrp|114065|2022|PDM|22.00|99|0.00|SEGMENTAL PNEUMATIC (MOD RR)
20|FH_F40526_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F40527_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F40535_0_0|SrvcGrp|6|2022|PCT|0.85|99|0.00|OP SURGERY
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|1097.84|99|0.00|DELAWARE VALLEY- ASC 8
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|1125.47|99|0.00|DELAWARE VALLEY- ASC 701
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|117.45|99|0.00|DELAWARE VALLEY- ASC 308
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|144.13|99|0.00|DELAWARE VALLEY- ASC 118
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|144.40|99|0.00|DELAWARE VALLEY- ASC 218
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|1517.70|99|0.00|DELAWARE VALLEY- ASC 9
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|208.36|99|0.00|DELAWARE VALLEY- ASC 111
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|237.44|99|0.00|DELAWARE VALLEY- ASC 110
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|267.97|99|0.00|DELAWARE VALLEY- ASC 108
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|272.03|99|0.00|DELAWARE VALLEY- ASC 107
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|285.09|99|0.00|DELAWARE VALLEY- ASC 105
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|339.18|99|0.00|DELAWARE VALLEY- ASC 104
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|354.21|99|0.00|DELAWARE VALLEY- ASC 210
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|366.43|99|0.00|DELAWARE VALLEY- ASC 304
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|398.89|99|0.00|DELAWARE VALLEY- ASC 206
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|42.52|99|0.00|DELAWARE VALLEY- ASC 224
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|452.52|99|0.00|DELAWARE VALLEY- ASC 203
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|452.52|99|0.00|DELAWARE VALLEY- ASC 403
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|474.34|99|0.00|DELAWARE VALLEY- ASC 201
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|526.10|99|0.00|DELAWARE VALLEY- ASC 401
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|76.07|99|0.00|DELAWARE VALLEY- ASC 223
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|812.69|99|0.00|DELAWARE VALLEY- ASC 5
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|1371.00|99|0.00|HAPA EPA ASC 55
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|144.00|99|0.00|HAPA EPA ASC 23
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|144.00|99|0.00|HAPA EPA ASC 24
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|195.00|99|0.00|HAPA EPA ASC 29
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|200.00|99|0.00|HAPA EPA ASC 30
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|229.00|99|0.00|HAPA EPA ASC 31
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|262.00|99|0.00|HAPA EPA ASC 34
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|327.00|99|0.00|HAPA EPA ASC 38
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|341.00|99|0.00|HAPA EPA ASC 40
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|341.00|99|0.00|HAPA EPA ASC 41
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|364.00|99|0.00|HAPA EPA ASC 1
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|427.00|99|0.00|HAPA EPA ASC 47
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|462.00|99|0.00|HAPA EPA ASC 52
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|487.00|99|0.00|HAPA EPA ASC 2
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|557.00|99|0.00|HAPA EPA ASC 3
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|783.00|99|0.00|HAPA EPA ASC 5
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|95.00|99|0.00|HAPA EPA ASC 15
20|FH_F40554_0_0|SrvcGrp|350|2022|PCT|0.65|99|0.00|SURGICAL CARE
20|FH_F40560_0_0|SrvcGrp|439|2022|PDM|1000.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F40564_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F40566_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40567_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40590_0_0|CSTM-ALL|CSTM-00|2020|PDM|1081.00|99|0.00|SPINAL CORD REHAB
20|FH_F40591_0_0|CSTM-ALL|CSTM-00|2020|PDM|3770.00|99|0.00|MS DRG 765-766 C-SECTION
20|FH_F40591_0_0|CSTM-ALL|CSTM-00|2020|PDM|5175.00|99|0.00|MSDRG 246-251 ANGIOPLASTY
20|FH_F40591_0_0|CSTM-ALL|CSTM-00|2020|PDM|928.00|99|0.00|MULTIPLE BIRTH
20|FH_F40591_0_0|SrvcGrp|29|2022|PCT|0.85|99|0.00|ELECTROPHYSIOLOGY
20|FH_F40591_0_0|SrvcGrp|33087|2022|PDM|8500.00|99|0.00|ROBOTIC ASSISTED SURGERY
20|FH_F40593_0_0|SrvcGrp|471|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F40593_0_0|SrvcGrp|474|2022|PDM|275.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F40599_0_0|CSTM-ALL|CSTM-00|2020|PDM|33990.00|99|0.00|CV SURGERY (MS DRG 216-227, 231-236, 248-251)
20|FH_F40599_0_0|SrvcGrp|18076|2022|PDM|515.00|99|0.00|MRI
20|FH_F40599_0_0|SrvcGrp|411|2022|PDM|3852.00|99|0.00|OP CARDIAC CATH
20|FH_F40600_0_0|SrvcGrp|10107|2022|PCT|0.70|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F40600_0_0|SrvcGrp|12214|2022|PCT|0.70|99|0.00|DRUGS
20|FH_F40600_0_0|SrvcGrp|12840|2022|PCT|0.70|99|0.00|PACEMAKER
20|FH_F40600_0_0|SrvcGrp|13551|2022|PDM|687.00|99|0.00|NEWBORN NURSERY
20|FH_F40600_0_0|SrvcGrp|38|2022|PDM|4574.00|99|0.00|NORMAL DELIVERY
20|FH_F40603_0_0|SrvcGrp|3403|2022|PDM|140.00|99|0.00|CPT 99203
20|FH_F40615_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F40624_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F40624_0_0|CSTM-ALL|CSTM-00|2020|PDM|6519.00|99|0.00|MS DRG 765-766 C-SECTION
20|FH_F40624_0_0|SrvcGrp|11000|2022|PCT|0.60|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F40624_0_0|SrvcGrp|16|2022|PDM|965.00|99|0.00|ACUTE REHABILITATION
20|FH_F40624_0_0|SrvcGrp|19661|2022|PDM|46977.00|99|0.00|MS DRG 216-218 ONLY CARDIAC VALVE PROCEDURE W/CARDIAC CATH
20|FH_F40624_0_0|SrvcGrp|20900|2022|PDM|18909.00|99|0.00|MS DRG 248 ONLY
20|FH_F40624_0_0|SrvcGrp|30546|2022|PDM|18909.00|99|0.00|MS DRG 246-247 ONLY
20|FH_F40624_0_0|SrvcGrp|31038|2022|PDM|36409.00|99|0.00|MS DRG 233-234 ONLY
20|FH_F40627_0_0|CSTM-ALL|CSTM-00|2020|PDM|2460.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F40627_0_0|CSTM-ALL|CSTM-00|2020|PDM|3420.00|99|0.00|MS DRG 767-768, 774-775 NORMAL DELIVERY
20|FH_F40627_0_0|SrvcGrp|3409|2022|PDM|926.00|99|0.00|NEWBORN NURSERY
20|FH_F40627_0_0|SrvcGrp|9510|2022|PDM|1208.00|99|0.00|SKILLED NURSING CARE
20|FH_F40634_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TRANSPORTATION SERVICES
20|FH_F40634_0_0|SrvcGrp|3409|2022|PDM|292.00|99|0.00|NEWBORN NURSERY
20|FH_F40634_0_0|SrvcGrp|38|2022|PDM|2122.00|99|0.00|NORMAL DELIVERY
20|FH_F40634_0_0|SrvcGrp|39|2022|PCT|0.70|99|0.00|TISSUE PLASMINOGEN ACTIVATOR
20|FH_F40635_0_0|SrvcGrp|16|2022|PDM|795.00|99|0.00|ACUTE REHABILITATION
20|FH_F40643_0_0|SrvcGrp|705|2022|PCT|0.60|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F40644_0_0|CSTM-ALL|CSTM-00|2020|PDM|905.00|99|0.00|ACUTE PSYCH
20|FH_F40644_0_0|SrvcGrp|10107|2022|PCT|0.80|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F40644_0_0|SrvcGrp|11283|2022|PCT|0.80|99|0.00|HYPERBARIC CHAMBER
20|FH_F40644_0_0|SrvcGrp|12280|2022|PCT|0.80|99|0.00|IMPLANTS
20|FH_F40644_0_0|SrvcGrp|16|2022|PDM|1035.00|99|0.00|ACUTE REHABILITATION
20|FH_F40644_0_0|SrvcGrp|701|2022|PDM|1552.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F40645_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE
20|FH_F40647_0_0|CSTM-ALL|CSTM-00|2020|PDM|1060.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40649_0_0|CSTM-ALL|CSTM-00|2020|PDM|2260.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F40653_0_0|CSTM-ALL|CSTM-00|2020|PDM|1270.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40653_0_0|CSTM-ALL|CSTM-00|2020|PDM|410.00|99|0.00|MULTIPLE BIRTH
20|FH_F40653_0_0|SrvcGrp|97|2022|PDM|5150.00|99|0.00|C-SECTION
20|FH_F40659_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F40661_0_0|CSTM-ALL|CSTM-00|2020|PDM|569.00|99|0.00|ADOLESCENT PSYCHIATRIC
20|FH_F40661_0_0|SrvcGrp|109|2022|PDM|487.00|99|0.00|CD - DETOX
20|FH_F40661_0_0|SrvcGrp|269|2022|PDM|2500.00|99|0.00|OP LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F40661_0_0|SrvcGrp|3029|2022|PDM|314.00|99|0.00|NEWBORN NURSERY
20|FH_F40661_0_0|SrvcGrp|439|2022|PDM|1786.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F40685_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.84|99|0.00|OP SVCS
20|FH_F40685_0_0|CSTM-ALL|CSTM-00|2020|PDM|988.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40689_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.00|99|0.00|OP SVCS
20|FH_F40690_0_0|SrvcGrp|33486|2022|PCT|0.80|99|0.00|ELECTRO CONVULSIVE THERAPY
20|FH_F40690_0_0|SrvcGrp|9518|2022|PCT|0.92|99|0.00|EMERGENCY ROOM
20|FH_F40694_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40698_0_0|SrvcGrp|3403|2022|PDM|100.00|99|0.00|CPT 99203
20|FH_F40702_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40702_0_0|SrvcGrp|13631|2022|PDM|110.00|99|0.00|CPT 99213
20|FH_F40702_0_0|SrvcGrp|13640|2022|PDM|110.00|99|0.00|CPT 99202
20|FH_F40710_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40718_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40718_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F40725_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS
20|FH_F40734_0_0|SrvcGrp|30733|2022|PDM|350.00|99|0.00|SKILLED NURSING CARE
20|FH_F40738_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F40739_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F40739_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|ACUTE PSYCH
20|FH_F40765_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F40780_0_0|SrvcGrp|170|2022|PDM|530.00|99|0.00|CD (ADOLESCENT) - REHAB
20|FH_F40780_0_0|SrvcGrp|196|2022|PDM|585.00|99|0.00|CD (ADOLESCENT) - DETOX
20|FH_F40783_0_0|CSTM-ALL|CSTM-00|2020|PDM|988.00|99|0.00|SPINAL CORD REHABILITATION
20|FH_F40786_0_0|CSTM-ALL|CSTM-00|2020|PDM|618.00|99|0.00|ACUTE PSYCH
20|FH_F40799_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS
20|FH_F40800_0_0|SrvcGrp|38|2022|PDM|1600.00|99|0.00|NORMAL DELIVERY
20|FH_F40812_0_0|CSTM-ALL|CSTM-00|2020|PDM|613.00|99|0.00|ACUTE PSYCH
20|FH_F40834_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|CHEMICAL DEPENDENCY
20|FH_F40834_0_0|SrvcGrp|12969|2022|PDM|393.00|99|0.00|NEWBORN NURSERY
20|FH_F40834_0_0|SrvcGrp|299|2022|PCT|0.85|99|0.00|GAMMA KNIFE
20|FH_F40834_0_0|SrvcGrp|3102|2022|PCT|0.85|99|0.00|IMPLANTS
20|FH_F40834_0_0|SrvcGrp|361|2022|PDM|2146.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F40834_0_0|SrvcGrp|8950|2022|PDM|1910.00|99|0.00|INTERMEDIATE ICU/CCU
20|FH_F40838_0_0|SrvcGrp|3029|2022|PDM|375.00|99|0.00|NEWBORN NURSERY
20|FH_F40838_0_0|SrvcGrp|439|2022|PDM|1300.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F40840_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40850_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F40853_0_0|SrvcGrp|115|2022|PDM|220.00|99|0.00|SKILLED NURSING CARE
20|FH_F40855_0_0|CSTM-ALL|CSTM-00|2020|PDM|1066.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40855_0_0|CSTM-ALL|CSTM-00|2020|PDM|478.00|99|0.00|ACUTE PSYCH
20|FH_F40855_0_0|SrvcGrp|38|2022|PDM|1981.00|99|0.00|NORMAL DELIVERY
20|FH_F40890_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40903_0_0|SrvcGrp|13422|2022|PDM|209.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC
20|FH_F40903_0_0|SrvcGrp|13595|2022|PDM|330.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC
20|FH_F40903_0_0|SrvcGrp|13597|2022|PDM|174.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT
20|FH_F40904_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40906_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F40906_0_0|SrvcGrp|13595|2022|PDM|330.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC
20|FH_F40906_0_0|SrvcGrp|2067|2022|PDM|538.00|99|0.00|SPECIALTY CARE TRANSPORT
20|FH_F40917_0_0|CSTM-ALL|CSTM-00|2020|PDM|1015.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40919_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS
20|FH_F40943_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40943_0_0|SrvcGrp|43283|2022|PDM|71.00|99|0.00|PHYSICAL THERAPY
20|FH_F40943_0_0|SrvcGrp|43284|2022|PDM|71.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F40953_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40972_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|SPINAL CORD REHABILITATION
20|FH_F40979_0_0|SrvcGrp|10365|2022|PDM|500.00|99|0.00|CPT CODE 99285
20|FH_F40980_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|TRANSPLANT SVCS
20|FH_F40980_0_0|CSTM-ALL|CSTM-00|2020|PDM|15469.00|99|0.00|MS DRG 258-259 CARDIAC PACE DEV REPL
20|FH_F40980_0_0|CSTM-ALL|CSTM-00|2020|PDM|15469.00|99|0.00|MS DRG 260-262 CARDIAC PACEMAKER REVISION
20|FH_F40980_0_0|CSTM-ALL|CSTM-00|2020|PDM|2052.00|99|0.00|ACUTE PSYCH
20|FH_F40980_0_0|CSTM-ALL|CSTM-00|2020|PDM|20625.00|99|0.00|MSDRG 250-251 PERCUTANEOUS CARDIO PROC
20|FH_F40980_0_0|CSTM-ALL|CSTM-00|2020|PDM|215.00|99|0.00|NEWBORN HEARING SCREENING
20|FH_F40980_0_0|CSTM-ALL|CSTM-00|2020|PDM|46408.00|99|0.00|MS DRG 237
20|FH_F40980_0_0|CSTM-ALL|CSTM-00|2020|PDM|59298.00|99|0.00|MS DRG 233
20|FH_F40980_0_0|CSTM-ALL|CSTM-00|2020|PDM|64454.00|99|0.00|MSDRG 228-230
20|FH_F40980_0_0|CSTM-ALL|CSTM-00|2020|PDM|77346.00|99|0.00|MSDRG 224-225 CARDIAC DEFIB W/O AMI/HF SHOCK
20|FH_F40980_0_0|CSTM-ALL|CSTM-00|2020|PDM|922.00|99|0.00|PSYCH FULL DAY
20|FH_F40980_0_0|SrvcGrp|13482|2022|PDM|5274.00|99|0.00|INTERMEDIATE CARDIAC CARE UNIT
20|FH_F40980_0_0|SrvcGrp|16551|2022|PDM|5151.00|99|0.00|NEUROSCIENCE SVCS
20|FH_F40980_0_0|SrvcGrp|360|2022|PDM|5274.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F40980_0_0|SrvcGrp|38|2022|PDM|12155.00|99|0.00|NORMAL DELIVERY
20|FH_F40980_0_0|SrvcGrp|63|2022|PDM|3627.00|99|0.00|SUBACUTE CARE
20|FH_F40983_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40983_0_0|CSTM-ALL|CSTM-00|2020|PDM|640.40|99|0.00|ASPG IV
20|FH_F40991_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40994_0_0|SrvcGrp|3029|2022|PDM|220.00|99|0.00|NEWBORN NURSERY
20|FH_F40994_0_0|SrvcGrp|38|2022|PDM|1600.00|99|0.00|NORMAL DELIVERY
20|FH_F40994_0_0|SrvcGrp|7|2022|PDM|1000.00|99|0.00|NEONATAL INTENSIVE
20|FH_F41015_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F41015_0_0|SrvcGrp|471|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F41021_0_0|SrvcGrp|17065|2022|PDM|1803.00|99|0.00|ASPG I
20|FH_F41021_0_0|SrvcGrp|17077|2022|PDM|6738.00|99|0.00|ASPG VII
20|FH_F41033_0_0|SrvcGrp|17065|2022|PDM|366.00|99|0.00|ASPG I
20|FH_F41033_0_0|SrvcGrp|17067|2022|PDM|491.00|99|0.00|ASPG II
20|FH_F41033_0_0|SrvcGrp|17077|2022|PDM|1095.00|99|0.00|ASPG VII
20|FH_F41035_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F41035_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F41035_0_0|SrvcGrp|27315|2022|PDM|900.00|99|0.00|TENDON REPAIR
20|FH_F41035_0_0|SrvcGrp|72992|2022|PDM|500.00|99|0.00|AEG 2
20|FH_F41059_0_0|CSTM-ALL|CSTM-00|2020|PDM|332.00|99|0.00|OP ADULT RESIDENTIAL TREATMENT
20|FH_F41059_0_0|CSTM-ALL|CSTM-00|2020|PDM|332.00|99|0.00|OP CHILD RESIDENTIAL TREATMENT
20|FH_F41059_0_0|SrvcGrp|110|2022|PDM|459.00|99|0.00|CD - REHABILITATION
20|FH_F41133_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE
20|FH_F41133_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F41133_0_0|CSTM-ALL|CSTM-00|2020|PDM|714.00|99|0.00|ADOLESCENT PSYCHIATRIC
20|FH_F41135_0_0|SrvcGrp|17071|2022|PDM|608.96|99|0.00|ASPG IV
20|FH_F41135_0_0|SrvcGrp|17073|2022|PDM|692.55|99|0.00|ASPG V
20|FH_F41142_0_0|CSTM-ALL|CSTM-00|2020|PDM|153.00|99|0.00|ADULT PSYCH HALF DAY (4-7 HRS)
20|FH_F41142_0_0|CSTM-ALL|CSTM-00|2020|PDM|168.00|99|0.00|CHILD PHYCH HALF DAY (4-7 HRS)
20|FH_F41142_0_0|CSTM-ALL|CSTM-00|2020|PDM|204.00|99|0.00|CD - ADULT FULL DAY
20|FH_F41142_0_0|CSTM-ALL|CSTM-00|2020|PDM|281.00|99|0.00|CD - ADOLESCENT FULL DAY
20|FH_F41142_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|ADOLESCENT PSYCHIATRIC
20|FH_F41142_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|CHILD PSYCHIATRIC
20|FH_F41142_0_0|SrvcGrp|166|2022|PDM|535.00|99|0.00|CD (ADULT) - DETOXIFICATION
20|FH_F41158_0_0|SrvcGrp|109|2022|PDM|450.00|99|0.00|CD - DETOX
20|FH_F41161_0_0|SrvcGrp|1306|2022|PDM|273.00|99|0.00|OP PSYCH PARTIAL HOSP
20|FH_F41161_0_0|SrvcGrp|13811|2022|PDM|273.00|99|0.00|PSYCH PARTIAL HOSP
20|FH_F41166_0_0|CSTM-ALL|CSTM-00|2020|PDM|65.00|99|0.00|OP SVCS
20|FH_F41166_0_0|SrvcGrp|11606|2022|PDM|510.00|99|0.00|ACUTE CARE (MEDICAL & SURGICAL)
20|FH_F41166_0_0|SrvcGrp|207|2022|PDM|303.00|99|0.00|OP REHAB PROGRAM
20|FH_F41173_0_0|CSTM-ALL|CSTM-00|2020|PDM|655.00|99|0.00|ACUTE PSYCH
20|FH_F41178_0_0|CSTM-ALL|CSTM-00|2020|PDM|258.00|99|0.00|CD PARTIAL HOSPITALIZATION
20|FH_F41178_0_0|SrvcGrp|110|2022|PDM|581.00|99|0.00|CD - REHABILITATION
20|FH_F41181_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F41181_0_0|SrvcGrp|10107|2022|PCT|0.65|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F41181_0_0|SrvcGrp|13551|2022|PDM|468.00|99|0.00|NEWBORN NURSERY
20|FH_F41181_0_0|SrvcGrp|705|2022|PCT|0.65|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F41200_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F41200_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|ACUTE PSYCH
20|FH_F41201_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41201_0_0|SrvcGrp|701|2022|PDM|2600.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F41202_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41202_0_0|SrvcGrp|32108|2022|PDM|450.00|99|0.00|NEWBORN NURSERY
20|FH_F41229_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F41229_0_0|CSTM-ALL|CSTM-00|2020|PDM|735.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41254_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|OP SVCS
20|FH_F41263_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41275_0_0|CSTM-ALL|CSTM-00|2020|PDM|150.00|99|0.00|IP PARTIAL HOSPITALIZATION (4-7 HOURS)
20|FH_F41275_0_0|CSTM-ALL|CSTM-00|2020|PDM|250.00|99|0.00|IP PARTIAL HOSPITALIZATION (8-12 HOURS)
20|FH_F41275_0_0|CSTM-ALL|CSTM-00|2020|PDM|275.00|99|0.00|IP ADOLESCENT PARTIAL HOSPITALIZATION FULL DAY  (8-12 HOURS)
20|FH_F41275_0_0|CSTM-ALL|CSTM-00|2020|PDM|275.00|99|0.00|OP ADOLESCENT PARTIAL HOSPITALIZATION FULL DAY  (8-12 HOURS)
20|FH_F41275_0_0|CSTM-ALL|CSTM-00|2020|PDM|325.00|99|0.00|PSYCHIATRIC RESIDENTIAL TREATMENT
20|FH_F41275_0_0|SrvcGrp|913|2022|PDM|325.00|99|0.00|ELECTROSHOCK TREATMENT
20|FH_F41276_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F41314_0_0|CSTM-ALL|CSTM-00|2020|PDM|820.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41314_0_0|SrvcGrp|65|2022|PDM|1435.00|99|0.00|OBSTETRICAL CARE
20|FH_F41320_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.93|99|0.00|OP SVCS
20|FH_F41320_0_0|SrvcGrp|9916|2022|PDM|830.00|99|0.00|OBSERVATION SVCS
20|FH_F41339_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F41342_0_0|CSTM-ALL|CSTM-00|2020|PDM|625.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41347_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F41348_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F41348_0_0|CSTM-ALL|CSTM-00|2020|PDM|205.00|99|0.00|OP ADULT PARTIAL HOSPITALIZATION (CD)
20|FH_F41348_0_0|CSTM-ALL|CSTM-00|2020|PDM|238.00|99|0.00|OP ADULT PSYCHIATRIC PARTIAL HOSP
20|FH_F41348_0_0|CSTM-ALL|CSTM-00|2020|PDM|250.00|99|0.00|OP ADOLESCENT PSYCHIATRIC PARTIAL HOSP.
20|FH_F41348_0_0|CSTM-ALL|CSTM-00|2020|PDM|475.00|99|0.00|ADULT PSYCHIATRIC
20|FH_F41374_0_0|SrvcGrp|1306|2022|PDM|250.00|99|0.00|OP PSYCH PARTIAL HOSP
20|FH_F41374_0_0|SrvcGrp|13811|2022|PDM|250.00|99|0.00|PSYCH PARTIAL HOSP
20|FH_F41377_0_0|CSTM-ALL|CSTM-00|2020|PDM|875.00|99|0.00|ACUTE IP MED SVCS
20|FH_F41426_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41426_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F41429_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F41429_0_0|SrvcGrp|110|2022|PDM|392.00|99|0.00|CD - REHABILITATION
20|FH_F41433_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41433_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F41433_0_0|SrvcGrp|12403|2022|PDM|34.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F41438_0_0|SrvcGrp|12403|2022|PDM|34.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F41438_0_0|SrvcGrp|22954|2022|PDM|140.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F41438_0_0|SrvcGrp|9263|2022|PDM|145.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F41441_0_0|SrvcGrp|10425|2022|PDM|266.00|99|0.00|NEWBORN NURSERY
20|FH_F41452_0_0|CSTM-ALL|CSTM-00|2020|PDM|1460.80|99|0.00|ASPG 9- PROGRESSIVE SURG
20|FH_F41452_0_0|CSTM-ALL|CSTM-00|2020|PDM|621.50|99|0.00|ASPG 11- PROGRESSIVE SURG- UNGROUPED
20|FH_F41456_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41457_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F41457_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|ACUTE IP MED SVCS
20|FH_F41457_0_0|CSTM-ALL|CSTM-00|2020|PDM|460.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC
20|FH_F41457_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|SPECIALTY CARE TRANSPORT
20|FH_F41457_0_0|SrvcGrp|34343|2022|PDM|2750.00|99|0.00|OP LITHOTRIPSY
20|FH_F41461_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F41461_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|SKILLED NURSING CARE
20|FH_F41461_0_0|SrvcGrp|526|2022|PDM|1350.00|99|0.00|CARDIAC CARE UNIT
20|FH_F41461_0_0|SrvcGrp|97|2022|PDM|2800.00|99|0.00|C-SECTION
20|FH_F41474_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE
20|FH_F41481_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F41481_0_0|SrvcGrp|17073|2022|PDM|788.00|99|0.00|ASPG V
20|FH_F41484_0_0|CSTM-ALL|CSTM-00|2020|PDM|321.40|99|0.00|ASPG I
20|FH_F41484_0_0|CSTM-ALL|CSTM-00|2020|PDM|492.54|99|0.00|ASPG X
20|FH_F41484_0_0|CSTM-ALL|CSTM-00|2020|PDM|608.96|99|0.00|ASPG IV
20|FH_F41484_0_0|CSTM-ALL|CSTM-00|2020|PDM|692.55|99|0.00|ASPG V
20|FH_F41484_0_0|CSTM-ALL|CSTM-00|2020|PDM|944.29|99|0.00|ASPG VIII
20|FH_F41489_0_0|SrvcGrp|350|2022|PDM|1000.00|99|0.00|SURGICAL CARE
20|FH_F41491_0_0|CSTM-ALL|CSTM-00|2020|PDM|902.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41491_0_0|SrvcGrp|115|2022|PDM|477.00|99|0.00|SKILLED NURSING CARE
20|FH_F41491_0_0|SrvcGrp|3029|2022|PDM|244.00|99|0.00|NEWBORN NURSERY
20|FH_F41494_0_0|SrvcGrp|38|2022|PDM|3230.00|99|0.00|NORMAL DELIVERY
20|FH_F41516_0_0|SrvcGrp|6|2022|PCT|0.75|99|0.00|OP SURGERY
20|FH_F41519_0_0|SrvcGrp|38|2022|PDM|2200.00|99|0.00|NORMAL DELIVERY
20|FH_F41535_0_0|SrvcGrp|177|2022|PDM|950.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F41539_0_0|SrvcGrp|28818|2022|PCT|0.45|99|0.00|SUPPLIES AND DEVICES
20|FH_F41539_0_0|SrvcGrp|33823|2022|PDM|315.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG I
20|FH_F41539_0_0|SrvcGrp|33824|2022|PDM|421.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG 2
20|FH_F41539_0_0|SrvcGrp|33832|2022|PDM|482.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG 10
20|FH_F41540_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F41540_0_0|SrvcGrp|33824|2022|PDM|866.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG 2
20|FH_F41594_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41594_0_0|SrvcGrp|76092|2022|PDM|86.00|99|0.00|SPEECH THERAPY INITIAL EVALUATION
20|FH_F41596_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F41596_0_0|SrvcGrp|65|2022|PCT|0.85|99|0.00|OBSTETRICAL CARE
20|FH_F41602_0_0|SrvcGrp|16173|2022|PDM|334.00|99|0.00|PARTIAL HOSPITALIZATION
20|FH_F41605_0_0|CSTM-ALL|CSTM-00|2020|PDM|1298.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41605_0_0|SrvcGrp|13551|2022|PDM|379.00|99|0.00|NEWBORN NURSERY
20|FH_F41605_0_0|SrvcGrp|38|2022|PDM|2704.00|99|0.00|NORMAL DELIVERY
20|FH_F41652_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|CD SVCS
20|FH_F41652_0_0|SrvcGrp|109|2022|PDM|389.00|99|0.00|CD - DETOX
20|FH_F41660_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|HOSPICE SVCS
20|FH_F41661_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F41663_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41678_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|ACUTE PSYCH
20|FH_F41692_0_0|CSTM-ALL|CSTM-00|2020|PCT|67.00|99|0.00|OP SVCS
20|FH_F41695_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F41695_0_0|SrvcGrp|474|2022|PDM|250.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F41738_0_0|CSTM-ALL|CSTM-00|2020|PDM|1140.00|99|0.00|COVENTRY ENHANCED GROUPER 8
20|FH_F41738_0_0|CSTM-ALL|CSTM-00|2020|PDM|968.00|99|0.00|COVENTRY ENHANCED GROUPER 6
20|FH_F41739_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|BLOOD AND BLOOD PRODUCTS
20|FH_F41739_0_0|CSTM-ALL|CSTM-00|2020|PDM|19260.00|99|0.00|DRG 808
20|FH_F41739_0_0|CSTM-ALL|CSTM-00|2020|PDM|19581.00|99|0.00|DRG 002 ONLY CRANIOTOMY W/O CC
20|FH_F41739_0_0|CSTM-ALL|CSTM-00|2020|PDM|33330.00|99|0.00|DRG 001 ONLY CRANIOTOMY W/CC
20|FH_F41739_0_0|CSTM-ALL|CSTM-00|2020|PDM|34240.00|99|0.00|DRG 475 (565/566) ONLY
20|FH_F41739_0_0|CSTM-ALL|CSTM-00|2020|PDM|36380.00|99|0.00|DRG 116 ONLY OTH CARDIAC PACEMKR (552)
20|FH_F41739_0_0|CSTM-ALL|CSTM-00|2020|PDM|37450.00|99|0.00|DRG 120 ONLY
20|FH_F41739_0_0|CSTM-ALL|CSTM-00|2020|PDM|42800.00|99|0.00|DRG 105 ONLY CARDIAC VLV PROC W/O CA CAT
20|FH_F41739_0_0|CSTM-ALL|CSTM-00|2020|PDM|43870.00|99|0.00|DRG 106 ONLY CORONARY BYPASS W/ PTCA
20|FH_F41739_0_0|SrvcGrp|13551|2022|PDM|642.00|99|0.00|NEWBORN NURSERY
20|FH_F41739_0_0|SrvcGrp|14951|2022|PDM|31672.00|99|0.00|DRG 123 ONLY - CIRCULATORY DISORDERS
20|FH_F41739_0_0|SrvcGrp|27791|2022|PDM|28569.00|99|0.00|DRG 121 ONLY
20|FH_F41739_0_0|SrvcGrp|9571|2022|PDM|39590.00|99|0.00|DRG 550 ONLY
20|FH_F41749_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|ACUTE PSYCH
20|FH_F41795_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41795_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F41795_0_0|SrvcGrp|28068|2022|PDM|70.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F41801_0_0|CSTM-ALL|CSTM-00|2020|PDM|275.00|99|0.00|ADULT RESIDENTIAL TREATMENT
20|FH_F41801_0_0|CSTM-ALL|CSTM-00|2020|PDM|275.00|99|0.00|RESIDENTIAL PSYCH / CD (ADOLESCENT)
20|FH_F41801_0_0|SrvcGrp|439|2022|PDM|550.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F41803_0_0|SrvcGrp|34871|2022|PCT|0.80|99|0.00|CORNEAL TISSUE TRANSPLANT
20|FH_F41804_0_0|SrvcGrp|115|2022|PDM|464.00|99|0.00|SKILLED NURSING CARE
20|FH_F41808_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41808_0_0|SrvcGrp|26001|2022|PDM|139.76|99|0.00|HOSPICE RESPITE SVCS
20|FH_F41814_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.76|99|0.00|GENERAL ACUTE CARE
20|FH_F41814_0_0|SrvcGrp|11023|2022|PDM|3827.00|99|0.00|NORMAL DELIVERY
20|FH_F41814_0_0|SrvcGrp|12099|2022|PDM|5382.00|99|0.00|CAESAREAN SECTION
20|FH_F41814_0_0|SrvcGrp|9226|2022|PCT|0.45|99|0.00|MED/SURG OTHER SUPPLIES/DEVICES
20|FH_F41814_0_0|SrvcGrp|9774|2022|PDM|2093.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F41845_0_0|CSTM-ALL|CSTM-00|2020|PDM|378.00|99|0.00|CD DAY TREATMENT
20|FH_F41845_0_0|CSTM-ALL|CSTM-00|2020|PDM|475.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41874_0_0|CSTM-ALL|CSTM-00|2020|PDM|1015.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41874_0_0|SrvcGrp|109|2022|PDM|505.00|99|0.00|CD - DETOX
20|FH_F41885_0_0|SrvcGrp|3029|2022|PDM|220.00|99|0.00|NEWBORN NURSERY
20|FH_F41885_0_0|SrvcGrp|350|2022|PDM|950.00|99|0.00|SURGICAL CARE
20|FH_F41885_0_0|SrvcGrp|701|2022|PDM|1600.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F41934_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|ASPG I - CPD 1281588
20|FH_F41962_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|HOME HEALTH CARE
20|FH_F41976_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F41976_0_0|CSTM-ALL|CSTM-00|2020|PDM|360.00|99|0.00|COLORECTAL CANCER SCREENING
20|FH_F41989_0_0|CSTM-ALL|CSTM-00|2020|PDM|179.00|99|0.00|ADOLESCENT PSYCH DAY OP SERVICES
20|FH_F41989_0_0|CSTM-ALL|CSTM-00|2020|PDM|179.00|99|0.00|ADULT PSYCH SERVICES
20|FH_F41989_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|ACUTE PSYCH
20|FH_F41989_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41999_0_0|SrvcGrp|35142|2022|PDM|1825.00|99|0.00|DELIVERY
20|FH_F42001_0_0|CSTM-ALL|CSTM-00|2020|PDM|115.00|99|0.00|OP SVCS
20|FH_F42003_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42005_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|GASTRO ASSOC OF  ORANGEBURG GI PROCEDURES 350
20|FH_F42016_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS
20|FH_F42019_0_0|CSTM-ALL|CSTM-00|2020|PDM|875.00|99|0.00|ACUTE IP MED SVCS
20|FH_F42019_0_0|SrvcGrp|38|2022|PDM|1600.00|99|0.00|NORMAL DELIVERY
20|FH_F42024_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F42024_0_0|CSTM-ALL|CSTM-00|2020|PDM|3540.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42024_0_0|CSTM-ALL|CSTM-00|2020|PDM|3540.00|99|0.00|SPINAL SURGERY & FUSION
20|FH_F42024_0_0|CSTM-ALL|CSTM-00|2020|PDM|4900.00|99|0.00|MS DRGS 258-262 PACEMAKER REVISION OR REPLACEMENT
20|FH_F42024_0_0|SrvcGrp|13249|2022|PDM|756.00|99|0.00|MRI
20|FH_F42024_0_0|SrvcGrp|14617|2022|PDM|145.00|99|0.00|CLINIC VISIT
20|FH_F42024_0_0|SrvcGrp|29314|2022|PCT|0.75|99|0.00|CPT CODES 80000-89999 - (LAB)
20|FH_F42024_0_0|SrvcGrp|72265|2022|PCT|0.75|99|0.00|RADIOLOGY
20|FH_F42026_0_0|CSTM-ALL|CSTM-00|2020|PDM|273.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F42026_0_0|CSTM-ALL|CSTM-00|2020|PDM|273.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42026_0_0|SrvcGrp|109|2022|PDM|393.00|99|0.00|CD - DETOX
20|FH_F42098_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42098_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F42098_0_0|CSTM-ALL|CSTM-00|2020|PDM|26.00|99|0.00|HOME HEALTH MOD TD
20|FH_F42098_0_0|CSTM-ALL|CSTM-00|2020|PDM|40.00|99|0.00|SKILLED LPN VISIT
20|FH_F42098_0_0|CSTM-ALL|CSTM-00|2020|PDM|65.00|99|0.00|PEDIATRIC RN ROUTINE NURSING
20|FH_F42098_0_0|SrvcGrp|11069|2022|PDM|50.00|99|0.00|OT SVCS
20|FH_F42098_0_0|SrvcGrp|11074|2022|PDM|55.00|99|0.00|NURSING CARE
20|FH_F42098_0_0|SrvcGrp|11080|2022|PDM|65.00|99|0.00|NURSING CARE
20|FH_F42098_0_0|SrvcGrp|11090|2022|PDM|60.00|99|0.00|NURSING CARE
20|FH_F42098_0_0|SrvcGrp|11796|2022|PDM|65.00|99|0.00|DIETICIAN
20|FH_F42098_0_0|SrvcGrp|15071|2022|PDM|112.00|99|0.00|PHOTOTHERAPY (BILIRUBIN)
20|FH_F42098_0_0|SrvcGrp|24286|2022|PDM|35.00|99|0.00|SKILLED NURSING CARE
20|FH_F42098_0_0|SrvcGrp|28285|2022|PDM|65.00|99|0.00|IV NURSE UP TO 2 HRS 99601 MOD SD
20|FH_F42098_0_0|SrvcGrp|28286|2022|PDM|35.00|99|0.00|IV NURSE EA ADD HR  99602 MOD SD
20|FH_F42105_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42105_0_0|SrvcGrp|13551|2022|PDM|350.00|99|0.00|NEWBORN NURSERY
20|FH_F42117_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42117_0_0|SrvcGrp|38004|2022|PDM|4000.00|99|0.00|CPT CODE 59400
20|FH_F42117_0_0|SrvcGrp|38006|2022|PDM|1000.00|99|0.00|CPT CODE 59426
20|FH_F42130_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42138_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42138_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F42138_0_0|SrvcGrp|16016|2022|PDM|28.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|1085.00|99|0.00|HAPA EPA ASC 7
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|139.00|99|0.00|HAPA EPA ASC 21
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|152.00|99|0.00|HAPA EPA ASC 25
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|158.00|99|0.00|HAPA EPA ASC 26
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|164.00|99|0.00|HAPA EPA ASC 27
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|257.00|99|0.00|HAPA EPA ASC 33
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|262.00|99|0.00|HAPA EPA ASC 34
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|274.00|99|0.00|HAPA EPA ASC 37
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|41.00|99|0.00|HAPA EPA ASC 10
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|436.00|99|0.00|HAPA EPA ASC 49
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|447.00|99|0.00|HAPA EPA ASC 50
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|486.00|99|0.00|HAPA EPA ASC 2
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|52.00|99|0.00|HAPA EPA ASC 11
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|79.00|99|0.00|HAPA EPA ASC 14
20|FH_F42145_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42153_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|DEPAUL MS DRGS
20|FH_F42153_0_0|CSTM-ALL|CSTM-00|2020|PDM|1849.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42153_0_0|CSTM-ALL|CSTM-00|2020|PDM|3195.00|99|0.00|NICU LEVEL V
20|FH_F42153_0_0|SrvcGrp|16|2022|PDM|1127.00|99|0.00|ACUTE REHABILITATION
20|FH_F42153_0_0|SrvcGrp|31771|2022|PCT|0.80|99|0.00|MS DRG 417-419 ONLY  LAP CHOLE
20|FH_F42153_0_0|SrvcGrp|360|2022|PDM|1387.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F42153_0_0|SrvcGrp|361|2022|PDM|2311.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F42153_0_0|SrvcGrp|47250|2022|PDM|867.00|99|0.00|MS DRG 876, 880-887 ONLY
20|FH_F42156_0_0|SrvcGrp|38|2022|PDM|1591.00|99|0.00|NORMAL DELIVERY
20|FH_F42159_0_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|MS DRG 765-766 ONLY C-SECTION
20|FH_F42159_0_0|SrvcGrp|12117|2022|PCT|0.95|99|0.00|MAGNETIC RESONANCE IMAGING
20|FH_F42159_0_0|SrvcGrp|177|2022|PDM|925.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F42159_0_0|SrvcGrp|20534|2022|PCT|0.95|99|0.00|SKILLED NURSING
20|FH_F42159_0_0|SrvcGrp|31007|2022|PDM|210.00|99|0.00|MS DRG 795 ONLY & REV CODES 170-171 NORMAL NEWBORN
20|FH_F42161_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OP SVCS
20|FH_F42161_0_0|SrvcGrp|31007|2022|PDM|210.00|99|0.00|MS DRG 795 ONLY & REV CODES 170-171 NORMAL NEWBORN
20|FH_F42165_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE
20|FH_F42165_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|ACUTE IP MED SVCS
20|FH_F42165_0_0|SrvcGrp|177|2022|PDM|1100.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F42165_0_0|SrvcGrp|20534|2022|PCT|0.85|99|0.00|SKILLED NURSING
20|FH_F42165_0_0|SrvcGrp|20801|2022|PCT|0.85|99|0.00|HOME HEALTH
20|FH_F42168_0_0|SrvcGrp|12117|2022|PDM|790.00|99|0.00|MAGNETIC RESONANCE IMAGING
20|FH_F42169_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|PEDIATRIC IP SVCS
20|FH_F42169_0_0|SrvcGrp|177|2022|PDM|1100.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F42169_0_0|SrvcGrp|20534|2022|PCT|0.85|99|0.00|SKILLED NURSING
20|FH_F42169_0_0|SrvcGrp|29817|2022|PDM|2000.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F42169_0_0|SrvcGrp|31007|2022|PDM|210.00|99|0.00|MS DRG 795 ONLY & REV CODES 170-171 NORMAL NEWBORN
20|FH_F42176_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|ECHOCARDIOGRAM
20|FH_F42176_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OP SVCS
20|FH_F42176_0_0|SrvcGrp|12146|2022|PDM|1700.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F42177_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F42177_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|ACUTE IP MED SVCS
20|FH_F42177_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|PEDIATRIC IP SVCS
20|FH_F42177_0_0|SrvcGrp|19595|2022|PCT|1.10|99|0.00|IMPLANTS
20|FH_F42177_0_0|SrvcGrp|22461|2022|PCT|0.85|99|0.00|INPATIENT HOSPICE SVCS
20|FH_F42177_0_0|SrvcGrp|29817|2022|PDM|2300.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F42244_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F42244_0_0|CSTM-ALL|CSTM-00|2020|PDM|1009.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42244_0_0|SrvcGrp|25|2022|PCT|0.70|99|0.00|LITHOTRIPSY
20|FH_F42244_0_0|SrvcGrp|88|2022|PCT|0.70|99|0.00|OP LITHOTRIPSY
20|FH_F42255_0_0|CSTM-ALL|CSTM-00|2020|PDM|492.54|99|0.00|ASPG III
20|FH_F42255_0_0|CSTM-ALL|CSTM-00|2020|PDM|492.54|99|0.00|ASPG IX
20|FH_F42255_0_0|CSTM-ALL|CSTM-00|2020|PDM|802.00|99|0.00|ASPG VI
20|FH_F42255_0_0|SrvcGrp|26421|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F42258_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42258_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|NICU INTENSIVE CARE LEVEL II
20|FH_F42258_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|ACUTE PSYCH
20|FH_F42258_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F42258_0_0|SrvcGrp|360|2022|PDM|900.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F42258_0_0|SrvcGrp|588|2022|PDM|1400.00|99|0.00|CORONARY CARE UNIT
20|FH_F42260_0_0|CSTM-ALL|CSTM-00|2020|PDM|1393.00|99|0.00|COVENTRY ENHANCED GROUPER 7
20|FH_F42260_0_0|CSTM-ALL|CSTM-00|2020|PDM|466.00|99|0.00|COVENTRY ENHANCED GROUPER 1 MOD 50
20|FH_F42260_0_0|CSTM-ALL|CSTM-00|2020|PDM|624.00|99|0.00|COVENTRY ENHANCED GROUPER 2
20|FH_F42260_0_0|CSTM-ALL|CSTM-00|2020|PDM|624.00|99|0.00|COVENTRY ENHANCED GROUPER 2 MOD 50
20|FH_F42260_0_0|CSTM-ALL|CSTM-00|2020|PDM|882.00|99|0.00|COVENTRY ENHANCED GROUPER 4 MOD 50
20|FH_F42272_0_0|CSTM-ALL|CSTM-00|2020|PDM|401.00|99|0.00|ASPG II
20|FH_F42272_0_0|CSTM-ALL|CSTM-00|2020|PDM|459.00|99|0.00|ASPG III
20|FH_F42272_0_0|CSTM-ALL|CSTM-00|2020|PDM|567.00|99|0.00|ASPG IV
20|FH_F42282_0_0|SrvcGrp|109|2022|PDM|510.00|99|0.00|CD - DETOX
20|FH_F42312_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F42312_0_0|CSTM-ALL|CSTM-00|2020|PDM|196.00|99|0.00|CD DAY TREATMENT
20|FH_F42332_0_0|SrvcGrp|33237|2022|PCT|0.70|99|0.00|AMBULATORY SURG W/LAPAROSCOPIC
20|FH_F42333_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F42342_0_0|SrvcGrp|12401|2022|PDM|105.00|99|0.00|RN VISIT
20|FH_F42342_0_0|SrvcGrp|13703|2022|PDM|36.75|99|0.00|LICENSED PRACTICAL NURSE- HOURLY
20|FH_F42342_0_0|SrvcGrp|8962|2022|PDM|131.25|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F42342_0_0|SrvcGrp|9828|2022|PDM|47.25|99|0.00|HOME HEALTH AIDE
20|FH_F42342_0_0|SrvcGrp|9829|2022|PDM|131.25|99|0.00|PT SVCS
20|FH_F42343_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F42343_0_0|CSTM-ALL|CSTM-00|2020|PDM|517.00|99|0.00|ACUTE PSYCH
20|FH_F42352_0_0|SrvcGrp|24|2022|PDM|2912.00|99|0.00|CARDIAC CATH
20|FH_F42352_0_0|SrvcGrp|3069|2022|PCT|0.55|99|0.00|IMPLANTS
20|FH_F42352_0_0|SrvcGrp|411|2022|PCT|0.65|99|0.00|OP CARDIAC CATH
20|FH_F42355_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|CD SVCS
20|FH_F42355_0_0|SrvcGrp|109|2022|PDM|420.00|99|0.00|CD - DETOX
20|FH_F42363_0_0|CSTM-ALL|CSTM-00|2020|PDM|120.00|99|0.00|OP SVCS
20|FH_F42363_0_0|SrvcGrp|35950|2022|PDM|400.00|99|0.00|CD DETOX
20|FH_F42368_0_0|CSTM-ALL|CSTM-00|2020|PCT|52.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42377_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F42377_0_0|CSTM-ALL|CSTM-00|2020|PDM|552.00|99|0.00|ACUTE PSYCH
20|FH_F42377_0_0|CSTM-ALL|CSTM-00|2020|PDM|552.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42395_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F42396_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42402_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|MS DRG 765-766 ONLY C-SECTION
20|FH_F42402_0_0|SrvcGrp|12146|2022|PDM|1700.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F42402_0_0|SrvcGrp|31007|2022|PDM|450.00|99|0.00|MS DRG 795 ONLY & REV CODES 170-171 NORMAL NEWBORN
20|FH_F42420_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F42420_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|ACUTE PSYCH
20|FH_F42423_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|COVENTRY ENHANCED GROUPER 6
20|FH_F42423_0_0|SrvcGrp|36273|2022|PDM|284.50|99|0.00|INTRAOCULAR LENS
20|FH_F42426_0_0|SrvcGrp|110|2022|PDM|400.00|99|0.00|CD - REHABILITATION
20|FH_F42429_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F42429_0_0|CSTM-ALL|CSTM-00|2020|PDM|5702.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42433_0_0|SrvcGrp|472|2022|PDM|380.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F42438_0_0|CSTM-ALL|CSTM-00|2020|PDM|691.00|99|0.00|COVENTRY ENHANCED GROUPER 2
20|FH_F42438_0_0|CSTM-ALL|CSTM-00|2020|PDM|791.00|99|0.00|COVENTRY ENHANCED GROUPER 3
20|FH_F42438_0_0|SrvcGrp|40147|2022|PDM|977.00|99|0.00|CVTY ENHANCED UNGROUPED
20|FH_F42453_0_0|CSTM-ALL|CSTM-00|2020|PDM|614.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42453_0_0|CSTM-ALL|CSTM-00|2020|PDM|827.00|99|0.00|HEAD INJURY REHABILITATION
20|FH_F42453_0_0|SrvcGrp|115|2022|PDM|269.00|99|0.00|SKILLED NURSING CARE
20|FH_F42453_0_0|SrvcGrp|16|2022|PDM|614.00|99|0.00|ACUTE REHABILITATION
20|FH_F42453_0_0|SrvcGrp|166|2022|PDM|500.00|99|0.00|CD (ADULT) - DETOXIFICATION
20|FH_F42466_0_0|CSTM-ALL|CSTM-00|2020|PDM|902.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42466_0_0|SrvcGrp|97|2022|PDM|2864.00|99|0.00|C-SECTION
20|FH_F42467_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F42467_0_0|CSTM-ALL|CSTM-00|2020|PDM|875.00|99|0.00|ACUTE IP MED SVCS
20|FH_F42467_0_0|SrvcGrp|701|2022|PDM|1600.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F42473_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42473_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F42521_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F42538_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F42538_0_0|SrvcGrp|12403|2022|PDM|36.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F42538_0_0|SrvcGrp|26001|2022|PDM|153.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F42539_0_0|SrvcGrp|22954|2022|PDM|137.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F42539_0_0|SrvcGrp|26001|2022|PDM|145.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F42557_0_0|SrvcGrp|12682|2022|PDM|135.00|99|0.00|GROUP THERAPY
20|FH_F42557_0_0|SrvcGrp|15159|2022|PDM|215.00|99|0.00|INITIAL EVALUATION
20|FH_F42622_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F42626_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F42633_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|NEWBORN NURSERY
20|FH_F42640_0_0|SrvcGrp|28145|2022|PDM|275.00|99|0.00|SKILLED NURSING
20|FH_F42640_0_0|SrvcGrp|28146|2022|PDM|340.00|99|0.00|SKILLED NURSING
20|FH_F42646_0_0|CSTM-ALL|CSTM-00|2020|PDM|875.00|99|0.00|ACUTE IP MED SVCS
20|FH_F42646_0_0|SrvcGrp|38|2022|PDM|1600.00|99|0.00|NORMAL DELIVERY
20|FH_F42688_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|BURN INTENSIVE CARE
20|FH_F42690_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F42706_0_0|CSTM-ALL|CSTM-00|2020|PDM|1330.05|99|0.00|ASPG IX
20|FH_F42706_0_0|CSTM-ALL|CSTM-00|2020|PDM|330.77|99|0.00|ASPG I
20|FH_F42706_0_0|CSTM-ALL|CSTM-00|2020|PDM|506.59|99|0.00|ASPG X
20|FH_F42706_0_0|CSTM-ALL|CSTM-00|2020|PDM|988.35|99|0.00|ASPG VII
20|FH_F42706_0_0|SrvcGrp|3477|2022|PDM|145.00|99|0.00|CLINIC VISIT
20|FH_F42708_0_0|SrvcGrp|13811|2022|PDM|311.00|99|0.00|PSYCH PARTIAL HOSP
20|FH_F42719_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.60|99|0.00|OP SVCS
20|FH_F42722_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42722_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F42722_0_0|SrvcGrp|28145|2022|PDM|330.00|99|0.00|SKILLED NURSING
20|FH_F42722_0_0|SrvcGrp|28146|2022|PDM|401.00|99|0.00|SKILLED NURSING
20|FH_F42744_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|PSYCHIATRIC RESIDENTIAL TREATMENT
20|FH_F42746_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42746_0_0|CSTM-ALL|CSTM-00|2020|PDM|50.00|99|0.00|PT & OT
20|FH_F42746_0_0|CSTM-ALL|CSTM-00|2020|PDM|50.00|99|0.00|SPEECH THERAPY SVCS
20|FH_F42746_0_0|SrvcGrp|16746|2022|PDM|55.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F42748_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42748_0_0|SrvcGrp|109|2022|PDM|650.00|99|0.00|CD - DETOX
20|FH_F42754_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|PSYCHIATRIC OP SVCS
20|FH_F42754_0_0|SrvcGrp|109|2022|PDM|400.00|99|0.00|CD - DETOX
20|FH_F42755_0_0|CSTM-ALL|CSTM-00|2020|PDM|275.00|99|0.00|CD RESIDENTIAL TREATMENT
20|FH_F42755_0_0|CSTM-ALL|CSTM-00|2020|PDM|585.00|99|0.00|ACUTE PSYCH
20|FH_F42775_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE
20|FH_F42775_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F42803_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42803_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|ACUTE PSYCH
20|FH_F42803_0_0|SrvcGrp|6|2022|PCT|0.75|99|0.00|OP SURGERY
20|FH_F42807_0_0|SrvcGrp|11663|2022|PCT|0.75|99|0.00|IMPLANTS
20|FH_F42807_0_0|SrvcGrp|13187|2022|PCT|0.75|99|0.00|INTRAOCULAR LENSES
20|FH_F42807_0_0|SrvcGrp|3029|2022|PDM|468.00|99|0.00|NEWBORN NURSERY
20|FH_F42807_0_0|SrvcGrp|97|2022|PDM|5616.00|99|0.00|C-SECTION
20|FH_F42822_0_0|CSTM-ALL|CSTM-00|2020|PDM|225.00|99|0.00|ADOLOESCENT PARTIAL HOSPITALIZATION
20|FH_F42822_0_0|CSTM-ALL|CSTM-00|2020|PDM|595.00|99|0.00|ADOLESCENT PSYCHIATRIC
20|FH_F42822_0_0|SrvcGrp|167|2022|PDM|350.00|99|0.00|CD (ADULT) - REHABILITATION
20|FH_F42822_0_0|SrvcGrp|196|2022|PDM|567.00|99|0.00|CD (ADOLESCENT) - DETOX
20|FH_F42896_0_0|CSTM-ALL|CSTM-00|2020|PCT|58.40|99|0.00|OP SVCS
20|FH_F42902_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.00|99|0.00|OP SVCS
20|FH_F42905_0_0|SrvcGrp|115|2022|PDM|300.00|99|0.00|SKILLED NURSING CARE
20|FH_F42913_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F42917_0_0|SrvcGrp|12290|2022|PDM|920.00|99|0.00|DETOXIFICATION
20|FH_F42917_0_0|SrvcGrp|30222|2022|PDM|400.00|99|0.00|PSYCH - PARTIAL HOSPITALIZATION
20|FH_F42921_0_0|CSTM-ALL|CSTM-00|2020|PCT|71.60|99|0.00|GENERAL ACUTE CARE
20|FH_F42929_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.70|99|0.00|GENERAL ACUTE CARE
20|FH_F42931_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42931_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F42935_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42935_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|OP SVCS
20|FH_F42941_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F42943_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F42947_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F42948_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42952_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS
20|FH_F42952_0_0|CSTM-ALL|CSTM-00|2020|PDM|1299.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42979_0_0|CSTM-ALL|CSTM-00|2020|PDM|610.00|99|0.00|ACUTE PSYCH
20|FH_F42979_0_0|CSTM-ALL|CSTM-00|2020|PDM|610.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42979_0_0|CSTM-ALL|CSTM-00|2020|PDM|74.00|99|0.00|CPT 90805
20|FH_F42979_0_0|CSTM-ALL|CSTM-00|2020|PDM|74.00|99|0.00|CPT 96100 PSYCHOLOGICAL TESTING
20|FH_F42979_0_0|SrvcGrp|3393|2022|PDM|101.00|99|0.00|CPT 90807 IND PSYCHOTHERAPY W/ E&M
20|FH_F42979_0_0|SrvcGrp|3398|2022|PDM|42.00|99|0.00|CPT 90853 GROUP PSYCHOTHERAPY
20|FH_F42979_0_0|SrvcGrp|3405|2022|PDM|54.00|99|0.00|CPT 99212
20|FH_F42980_0_0|SrvcGrp|50206|2022|PDM|125.00|99|0.00|CPT 99215
20|FH_F42984_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F42984_0_0|CSTM-ALL|CSTM-00|2020|PDM|584.00|99|0.00|CHILD PSYCHIATRIC
20|FH_F42985_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|OP SVCS
20|FH_F42985_0_0|SrvcGrp|110|2022|PDM|360.00|99|0.00|CD - REHABILITATION
20|FH_F42992_0_0|CSTM-ALL|CSTM-00|2020|PDM|1476.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42992_0_0|SrvcGrp|37018|2022|PDM|250.00|99|0.00|BOARDER BABY
20|FH_F42992_0_0|SrvcGrp|40820|2022|PDM|1900.00|99|0.00|ICU/CCU
20|FH_F43000_0_0|CSTM-ALL|CSTM-00|2020|PDM|75.00|99|0.00|SOCIAL WORKER
20|FH_F43000_0_0|CSTM-ALL|CSTM-00|2020|PDM|75.00|99|0.00|SPEECH THERAPY
20|FH_F43004_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.40|99|0.00|GENERAL ACUTE CARE
20|FH_F43007_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|CD SVCS
20|FH_F43007_0_0|CSTM-ALL|CSTM-00|2020|PDM|191.00|99|0.00|CD DAY TREATMENT
20|FH_F43007_0_0|CSTM-ALL|CSTM-00|2020|PDM|267.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43008_0_0|CSTM-ALL|CSTM-00|2020|PDM|3611.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43018_0_0|SrvcGrp|30623|2022|PDM|7680.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788
20|FH_F43078_0_0|SrvcGrp|9483|2022|PDM|130.00|99|0.00|RESIDENTIAL HOSPICE SVCS
20|FH_F43081_0_0|CSTM-ALL|CSTM-00|2020|PDM|399.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43081_0_0|SrvcGrp|13811|2022|PDM|186.00|99|0.00|PSYCH PARTIAL HOSP
20|FH_F43113_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43113_0_0|SrvcGrp|8962|2022|PDM|77.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F43123_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43123_0_0|CSTM-ALL|CSTM-00|2020|PDM|149.00|99|0.00|OP SVCS
20|FH_F43135_0_0|CSTM-ALL|CSTM-00|2020|PDM|820.00|99|0.00|SPINAL CORD REHABILITATION
20|FH_F43136_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43136_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F43140_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43140_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F43147_0_0|CSTM-ALL|CSTM-00|2020|PDM|225.00|99|0.00|PSYCH PARTIAL HOSPITALIZATION
20|FH_F43156_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|ACUTE PSYCH
20|FH_F43156_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F43156_0_0|SrvcGrp|16|2022|PDM|600.00|99|0.00|ACUTE REHABILITATION
20|FH_F43156_0_0|SrvcGrp|526|2022|PDM|1100.00|99|0.00|CARDIAC CARE UNIT
20|FH_F43164_0_0|CSTM-ALL|CSTM-00|2020|PDM|412.00|99|0.00|SKILLED NURSING CARE
20|FH_F43164_0_0|CSTM-ALL|CSTM-00|2020|PDM|464.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F43164_0_0|CSTM-ALL|CSTM-00|2020|PDM|876.00|99|0.00|HEAD INJURY REHAB
20|FH_F43164_0_0|SrvcGrp|16|2022|PDM|773.00|99|0.00|ACUTE REHABILITATION
20|FH_F43167_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|CHILD PSYCH RESIDENTIAL TREAT
20|FH_F43167_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|PARTIAL HOSPITALIZATION (<=17 YRS)
20|FH_F43167_0_0|SrvcGrp|12290|2022|PDM|450.00|99|0.00|DETOXIFICATION
20|FH_F43169_0_0|SrvcGrp|3809|2022|PDM|584.00|99|0.00|HOSPICE CARE
20|FH_F43171_0_0|CSTM-ALL|CSTM-00|2020|PDM|105.00|99|0.00|INTENSIVE PSYCH OP SERVICES
20|FH_F43172_0_0|SrvcGrp|16|2022|PDM|1500.00|99|0.00|ACUTE REHABILITATION
20|FH_F43196_0_0|CSTM-ALL|CSTM-00|2020|PDM|75.00|99|0.00|OP SVCS
20|FH_F43199_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F43201_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43201_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F43210_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F43236_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43236_0_0|SrvcGrp|31134|2022|PDM|950.00|99|0.00|SURGICAL - ADULT/PEDIATRIC
20|FH_F43237_0_0|SrvcGrp|31134|2022|PDM|2315.00|99|0.00|SURGICAL - ADULT/PEDIATRIC
20|FH_F43237_0_0|SrvcGrp|31931|2022|PDM|2178.00|99|0.00|SKILLED NURSING CARE
20|FH_F43241_0_0|CSTM-ALL|CSTM-00|2020|PDM|1083.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43242_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.46|99|0.00|OP SVCS
20|FH_F43242_0_0|CSTM-ALL|CSTM-00|2020|PDM|1284.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43242_0_0|SrvcGrp|31931|2022|PDM|1241.00|99|0.00|SKILLED NURSING CARE
20|FH_F43243_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS
20|FH_F43246_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F43246_0_0|SrvcGrp|31134|2022|PDM|820.00|99|0.00|SURGICAL - ADULT/PEDIATRIC
20|FH_F43249_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.54|99|0.00|ADULT CD OUTPATIENT SVCS
20|FH_F43249_0_0|CSTM-ALL|CSTM-00|2020|PDM|1521.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43249_0_0|CSTM-ALL|CSTM-00|2020|PDM|744.00|99|0.00|ACUTE PSYCH
20|FH_F43249_0_0|SrvcGrp|13248|2022|PCT|0.54|99|0.00|OP SURGERY
20|FH_F43249_0_0|SrvcGrp|3069|2022|PCT|0.54|99|0.00|IMPLANTS
20|FH_F43249_0_0|SrvcGrp|31134|2022|PDM|2104.00|99|0.00|SURGICAL - ADULT/PEDIATRIC
20|FH_F43249_0_0|SrvcGrp|37018|2022|PDM|584.00|99|0.00|BOARDER BABY
20|FH_F43260_0_0|CSTM-ALL|CSTM-00|2020|PDM|175.00|99|0.00|CD RESIDENTIAL TREATMENT (ADULT)
20|FH_F43274_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43293_0_0|CSTM-ALL|CSTM-00|2020|PDM|875.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43293_0_0|SrvcGrp|16|2022|PDM|550.00|99|0.00|ACUTE REHABILITATION
20|FH_F43293_0_0|SrvcGrp|40820|2022|PDM|1150.00|99|0.00|ICU/CCU
20|FH_F43294_0_0|SrvcGrp|18932|2022|PDM|2800.00|99|0.00|MS DRG 774 REPLACEMENT MS DRG 805-806
20|FH_F43295_0_0|CSTM-ALL|CSTM-00|2020|PDM|222.00|99|0.00|CD SVCS (ADULT)
20|FH_F43295_0_0|SrvcGrp|30623|2022|PDM|3663.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788
20|FH_F43295_0_0|SrvcGrp|40820|2022|PDM|1499.00|99|0.00|ICU/CCU
20|FH_F43295_0_0|SrvcGrp|9539|2022|PDM|555.00|99|0.00|SUBACUTE CARE
20|FH_F43296_0_0|SrvcGrp|109234|2022|PDM|450.00|99|0.00|BOARDER BABY
20|FH_F43296_0_0|SrvcGrp|16684|2022|PCT|0.50|99|0.00|DRUGS
20|FH_F43296_0_0|SrvcGrp|31134|2022|PDM|2095.00|99|0.00|SURGICAL - ADULT/PEDIATRIC
20|FH_F43296_0_0|SrvcGrp|40820|2022|PDM|2515.00|99|0.00|ICU/CCU
20|FH_F43296_0_0|SrvcGrp|89337|2022|PDM|1045.00|99|0.00|DETOXIFICATION
20|FH_F43330_0_0|SrvcGrp|11085|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE
20|FH_F43333_0_0|CSTM-ALL|CSTM-00|2020|PDM|875.00|99|0.00|ACUTE IP MED SVCS
20|FH_F43352_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43352_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F43352_0_0|CSTM-ALL|CSTM-00|2020|PDM|1005.00|99|0.00|WELLPATH PROPIETARY ASC IV
20|FH_F43352_0_0|CSTM-ALL|CSTM-00|2020|PDM|1335.00|99|0.00|WELLPATH PROPIETARY ASC VI
20|FH_F43352_0_0|CSTM-ALL|CSTM-00|2020|PDM|814.00|99|0.00|WELLPATH PROPIETARY ASC III
20|FH_F43411_0_0|CSTM-ALL|CSTM-00|2020|PDM|5265.00|99|0.00|MS DRG 765-766 C-SECTION
20|FH_F43411_0_0|SrvcGrp|15363|2022|PCT|0.60|99|0.00|DME/ORTHOTICS/PROSTHETICS/IMPLANTS
20|FH_F43411_0_0|SrvcGrp|20305|2022|PCT|0.75|99|0.00|BARIATRIC SURGERY
20|FH_F43411_0_0|SrvcGrp|37018|2022|PDM|480.00|99|0.00|BOARDER BABY
20|FH_F43412_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F43418_0_0|SrvcGrp|18932|2022|PDM|1500.00|99|0.00|MS DRG 774 REPLACEMENT MS DRG 805-806
20|FH_F43418_0_0|SrvcGrp|31134|2022|PDM|1040.00|99|0.00|SURGICAL - ADULT/PEDIATRIC
20|FH_F43418_0_0|SrvcGrp|9539|2022|PDM|300.00|99|0.00|SUBACUTE CARE
20|FH_F43421_0_0|CSTM-ALL|CSTM-00|2020|PDM|489.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43436_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F43443_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F43443_0_0|CSTM-ALL|CSTM-00|2020|PDM|230.00|99|0.00|PSYCH PARTIAL HOSPITALIZATION
20|FH_F43443_0_0|CSTM-ALL|CSTM-00|2020|PDM|357.00|99|0.00|RESIDENTIAL TREATMENT SVCS
20|FH_F43446_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43485_0_0|CSTM-ALL|CSTM-00|2020|PCT|57.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43486_0_0|SrvcGrp|4109|2022|PDM|1551.00|99|0.00|ACUTE PSYCH
20|FH_F43503_0_0|CSTM-ALL|CSTM-00|2020|PDM|1704.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43503_0_0|SrvcGrp|701|2022|PDM|2369.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F43503_0_0|SrvcGrp|97|2022|PDM|2369.00|99|0.00|C-SECTION
20|FH_F43513_0_0|CSTM-ALL|CSTM-00|2020|PCT|86.60|99|0.00|GENERAL ACUTE CARE
20|FH_F43536_0_0|SrvcGrp|177|2022|PDM|2831.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F43536_0_0|SrvcGrp|941|2022|PCT|0.77|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F43612_0_0|CSTM-ALL|CSTM-00|2020|PDM|670.00|99|0.00|ADULT PSYCHIATRIC
20|FH_F43612_0_0|CSTM-ALL|CSTM-00|2020|PDM|670.00|99|0.00|CHILD PSYCHIATRIC
20|FH_F43613_0_0|SrvcGrp|6|2022|PCT|0.85|99|0.00|OP SURGERY
20|FH_F43653_0_0|SrvcGrp|16|2022|PDM|500.00|99|0.00|ACUTE REHABILITATION
20|FH_F43665_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F43665_0_0|CSTM-ALL|CSTM-00|2020|PDM|331.00|99|0.00|SKILLED NURSING CARE
20|FH_F43679_0_0|CSTM-ALL|CSTM-00|2020|PDM|210.00|99|0.00|CD DAY TREATMENT
20|FH_F43679_0_0|CSTM-ALL|CSTM-00|2020|PDM|310.00|99|0.00|CD RESIDENTIAL TREATMENT
20|FH_F43679_0_0|SrvcGrp|555|2022|PDM|115.00|99|0.00|INTENSIVE OP SVCS
20|FH_F43693_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F43693_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|ACUTE PSYCH
20|FH_F43693_0_0|SrvcGrp|13811|2022|PDM|257.00|99|0.00|PSYCH PARTIAL HOSP
20|FH_F43694_0_0|SrvcGrp|12591|2022|PDM|160.00|99|0.00|CD FULL DAY
20|FH_F43694_0_0|SrvcGrp|33813|2022|PDM|650.00|99|0.00|CD - DETOX
20|FH_F43696_0_0|SrvcGrp|3066|2022|PCT|0.50|99|0.00|HIGH-COST DRUGS
20|FH_F43698_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F43698_0_0|CSTM-ALL|CSTM-00|2020|PDM|225.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43717_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F43717_0_0|CSTM-ALL|CSTM-00|2020|PDM|816.00|99|0.00|ACUTE IP MED SVCS
20|FH_F43774_0_0|CSTM-ALL|CSTM-00|2020|PDM|50.00|99|0.00|HOME HEALTH AIDE
20|FH_F43774_0_0|SrvcGrp|12157|2022|PDM|105.00|99|0.00|RN VISIT
20|FH_F43774_0_0|SrvcGrp|12401|2022|PDM|110.00|99|0.00|RN VISIT
20|FH_F43779_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|NITRIC OXIDE
20|FH_F43779_0_0|SrvcGrp|1121|2022|PCT|0.75|99|0.00|OP PTCA ANGIOPLASTY
20|FH_F43779_0_0|SrvcGrp|115|2022|PDM|733.00|99|0.00|SKILLED NURSING CARE
20|FH_F43779_0_0|SrvcGrp|16|2022|PDM|1071.00|99|0.00|ACUTE REHABILITATION
20|FH_F43779_0_0|SrvcGrp|24|2022|PCT|0.75|99|0.00|CARDIAC CATH
20|FH_F43779_0_0|SrvcGrp|38|2022|PDM|4506.00|99|0.00|NORMAL DELIVERY
20|FH_F43779_0_0|SrvcGrp|903|2022|PCT|0.75|99|0.00|PTC ANGIOPLASTY
20|FH_F43779_0_0|SrvcGrp|958|2022|PDM|2887.00|99|0.00|VENTILATOR SERVICES
20|FH_F43801_0_0|CSTM-ALL|CSTM-00|2020|PDM|961.00|99|0.00|HEAD INJURY REHABILITATION
20|FH_F43832_0_0|SrvcGrp|26798|2022|PDM|93.00|99|0.00|LICENSED PRACTICAL NURSE
20|FH_F43832_0_0|SrvcGrp|8962|2022|PDM|120.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F43837_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F43837_0_0|CSTM-ALL|CSTM-00|2020|PDM|1050.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43837_0_0|SrvcGrp|16116|2022|PDM|120.00|99|0.00|PT/OT/ST
20|FH_F43858_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F43859_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F43859_0_0|CSTM-ALL|CSTM-00|2020|PDM|25.00|99|0.00|SKILLED LPN HOURLY
20|FH_F43859_0_0|SrvcGrp|37404|2022|PDM|90.00|99|0.00|PT SVCS
20|FH_F43859_0_0|SrvcGrp|37406|2022|PDM|90.00|99|0.00|SPEECH THERAPY SVCS
20|FH_F43860_0_0|SrvcGrp|35468|2022|PDM|75.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F43861_0_0|SrvcGrp|27725|2022|PDM|40.00|99|0.00|SKILLED RN HOURLY
20|FH_F43861_0_0|SrvcGrp|30955|2022|PDM|115.00|99|0.00|SKILLED RN VISIT
20|FH_F43861_0_0|SrvcGrp|30958|2022|PDM|65.00|99|0.00|SKILLED LPN VISIT
20|FH_F43861_0_0|SrvcGrp|30961|2022|PDM|12.50|99|0.00|HOME HEALTH AIDE
20|FH_F43862_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE
20|FH_F43862_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F43862_0_0|SrvcGrp|27725|2022|PDM|40.00|99|0.00|SKILLED RN HOURLY
20|FH_F43862_0_0|SrvcGrp|30958|2022|PDM|65.00|99|0.00|SKILLED LPN VISIT
20|FH_F43862_0_0|SrvcGrp|30961|2022|PDM|12.50|99|0.00|HOME HEALTH AIDE
20|FH_F43863_0_0|SrvcGrp|37403|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE
20|FH_F43863_0_0|SrvcGrp|37406|2022|PDM|90.00|99|0.00|SPEECH THERAPY SVCS
20|FH_F43865_0_0|CSTM-ALL|CSTM-00|2020|PDM|25.00|99|0.00|SKILLED LPN HOURLY
20|FH_F43865_0_0|SrvcGrp|30958|2022|PDM|65.00|99|0.00|SKILLED LPN VISIT
20|FH_F43865_0_0|SrvcGrp|37405|2022|PDM|90.00|99|0.00|OT SVCS
20|FH_F43867_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE
20|FH_F43867_0_0|SrvcGrp|27725|2022|PDM|40.00|99|0.00|SKILLED RN HOURLY
20|FH_F43867_0_0|SrvcGrp|30958|2022|PDM|65.00|99|0.00|SKILLED LPN VISIT
20|FH_F43872_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F43872_0_0|SrvcGrp|12496|2022|PDM|717.00|99|0.00|ACUTE REHABILITATION
20|FH_F43895_0_0|SrvcGrp|3157|2022|PDM|966.00|99|0.00|ACUTE REHABILITATION
20|FH_F43913_0_0|SrvcGrp|13739|2022|PDM|350.00|99|0.00|COCHLEAR IMPLANTS
20|FH_F43934_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F43953_0_0|CSTM-ALL|CSTM-00|2020|PDM|2301.00|99|0.00|OBSERVATION SERVICES
20|FH_F43953_0_0|CSTM-ALL|CSTM-00|2020|PDM|4548.00|99|0.00|IP SURGICAL SERVICES
20|FH_F43953_0_0|SrvcGrp|3224|2022|PCT|0.66|99|0.00|EMERGENCY ROOM SVCS
20|FH_F43953_0_0|SrvcGrp|38002|2022|PDM|4123.00|99|0.00|SURGICAL DAY CARE
20|FH_F43953_0_0|SrvcGrp|38422|2022|PCT|0.70|99|0.00|INTERLUKEN II & DRUGS (OP))
20|FH_F43974_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44023_0_0|SrvcGrp|38422|2022|PCT|0.69|99|0.00|INTERLUKEN II & DRUGS (OP))
20|FH_F44025_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F44025_0_0|CSTM-ALL|CSTM-00|2020|PDM|639.00|99|0.00|CD - DETOXIFICATION
20|FH_F44025_0_0|CSTM-ALL|CSTM-00|2020|PDM|639.00|99|0.00|CD - REHABILITATION
20|FH_F44025_0_0|CSTM-ALL|CSTM-00|2020|PDM|639.00|99|0.00|CD RESIDENTIAL TREATMENT
20|FH_F44042_0_0|CSTM-ALL|CSTM-00|2020|PDM|975.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44048_0_0|CSTM-ALL|CSTM-00|2020|PDM|260.00|99|0.00|PSYCH PARTIAL HOSPITALIZATION
20|FH_F44048_0_0|CSTM-ALL|CSTM-00|2020|PDM|609.00|99|0.00|CHILD PSYCHIATRIC
20|FH_F44073_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44073_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F44075_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44075_0_0|CSTM-ALL|CSTM-00|2020|PDM|591.80|99|0.00|ASPG III
20|FH_F44075_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|ASPG X
20|FH_F44075_0_0|CSTM-ALL|CSTM-00|2020|PDM|831.60|99|0.00|ASPG V
20|FH_F44075_0_0|CSTM-ALL|CSTM-00|2020|PDM|973.50|99|0.00|ASPG VI
20|FH_F44093_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|NEWBORN NURSERY
20|FH_F44097_0_0|CSTM-ALL|CSTM-00|2020|PDM|325.00|99|0.00|RESIDENTIAL TREATMENT SVCS
20|FH_F44097_0_0|CSTM-ALL|CSTM-00|2020|PDM|468.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F44097_0_0|CSTM-ALL|CSTM-00|2020|PDM|520.00|99|0.00|ACUTE PSYCH
20|FH_F44097_0_0|CSTM-ALL|CSTM-00|2020|PDM|520.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44113_0_0|SrvcGrp|20801|2022|PCT|0.80|99|0.00|HOME HEALTH
20|FH_F44113_0_0|SrvcGrp|58432|2022|PDM|900.00|99|0.00|MAGNETIC RESONANCE IMAGING (MRI)
20|FH_F44132_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F44134_0_0|CSTM-ALL|CSTM-00|2020|PDM|1145.83|99|0.00|COVENTRY ENHANCED GROUPER 6
20|FH_F44134_0_0|CSTM-ALL|CSTM-00|2020|PDM|1347.70|99|0.00|COVENTRY ENHANCED GROUPER 8
20|FH_F44134_0_0|CSTM-ALL|CSTM-00|2020|PDM|1838.81|99|0.00|COVENTRY ENHANCED GROUPER 9
20|FH_F44134_0_0|SrvcGrp|14614|2022|PDM|4400.00|99|0.00|LITHOTRIPSY
20|FH_F44134_0_0|SrvcGrp|60816|2022|PCT|1.10|99|0.00|IMPLANTS/PROSTHETICS/DEVICES
20|FH_F44177_0_0|SrvcGrp|12359|2022|PDM|1786.00|99|0.00|TELEMETRY SVCS
20|FH_F44177_0_0|SrvcGrp|20752|2022|PDM|16200.00|99|0.00|MSDRG 619-621 ONLY BARIATRIC SURGERY
20|FH_F44177_0_0|SrvcGrp|30031|2022|PDM|3149.00|99|0.00|PTCA + CATH
20|FH_F44177_0_0|SrvcGrp|360|2022|PDM|618.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F44177_0_0|SrvcGrp|43|2022|PCT|0.55|99|0.00|IMPLANTS
20|FH_F44194_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F44195_0_0|CSTM-ALL|CSTM-00|2020|PDM|365.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F44198_0_0|SrvcGrp|13422|2022|PDM|236.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC
20|FH_F44198_0_0|SrvcGrp|13595|2022|PDM|357.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC
20|FH_F44198_0_0|SrvcGrp|13683|2022|PDM|480.00|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2
20|FH_F44198_0_0|SrvcGrp|14557|2022|PDM|40.00|99|0.00|AMBULANCE SVCS - WHEELCHAIR VAN
20|FH_F44198_0_0|SrvcGrp|18071|2022|PDM|50.00|99|0.00|AMBULANCE RESPONSE/TREATMENT - NO TRANSPORT
20|FH_F44198_0_0|SrvcGrp|18539|2022|PDM|1.50|99|0.00|ADDITIONAL MILEAGE - WHEELCHAIR VAN
20|FH_F44218_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE
20|FH_F44225_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|ACUTE IP MED SVCS
20|FH_F44225_0_0|SrvcGrp|14566|2022|PDM|1000.00|99|0.00|MAGNETIC RESONANCE IMAGING (MRI)
20|FH_F44225_0_0|SrvcGrp|20534|2022|PCT|0.90|99|0.00|SKILLED NURSING
20|FH_F44241_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|ASPG X
20|FH_F44241_0_0|CSTM-ALL|CSTM-00|2020|PDM|3822.00|99|0.00|CYSTOSCOPY
20|FH_F44241_0_0|CSTM-ALL|CSTM-00|2020|PDM|3875.00|99|0.00|ASPG IX
20|FH_F44241_0_0|CSTM-ALL|CSTM-00|2020|PDM|963.00|99|0.00|ASPG I
20|FH_F44241_0_0|SrvcGrp|36991|2022|PCT|0.75|99|0.00|IMPLANTS
20|FH_F44255_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F44255_0_0|CSTM-ALL|CSTM-00|2020|PDM|583.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44257_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|CV SURGERY 104-107 AND 109
20|FH_F44257_0_0|CSTM-ALL|CSTM-00|2020|PDM|522.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F44257_0_0|SrvcGrp|17019|2022|PDM|1854.00|99|0.00|ICU/CCU
20|FH_F44257_0_0|SrvcGrp|3029|2022|PDM|249.00|99|0.00|NEWBORN NURSERY
20|FH_F44272_0_0|CSTM-ALL|CSTM-00|2020|PDM|170.00|99|0.00|OP SVCS
20|FH_F44278_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE
20|FH_F44278_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|HOSPICE
20|FH_F44278_0_0|SrvcGrp|15302|2022|PDM|600.00|99|0.00|COMPUTED TOMOGRAPHY (CT SCAN)
20|FH_F44279_0_0|SrvcGrp|38439|2022|PDM|200.00|99|0.00|DIAGNOSTIC TESTING
20|FH_F44279_0_0|SrvcGrp|9866|2022|PDM|600.00|99|0.00|IP OBSERVATION SVCS
20|FH_F44293_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.70|99|0.00|OP SVCS
20|FH_F44299_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44299_0_0|SrvcGrp|10543|2022|PDM|65.00|99|0.00|SPEECH THERAPY SVCS
20|FH_F44312_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F44312_0_0|CSTM-ALL|CSTM-00|2020|PDM|240.00|99|0.00|CD PARTIAL HOSPITALIZATION
20|FH_F44312_0_0|SrvcGrp|109|2022|PDM|550.00|99|0.00|CD - DETOX
20|FH_F44314_0_0|SrvcGrp|26742|2022|PDM|46.00|99|0.00|PT
20|FH_F44334_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F44334_0_0|SrvcGrp|12045|2022|PDM|302.07|99|0.00|SLEEP STUDIES
20|FH_F44336_0_0|CSTM-ALL|CSTM-00|2020|PDM|250.00|99|0.00|CD PARTIAL HOSP - DAY TREATMENT
20|FH_F44336_0_0|SrvcGrp|166|2022|PDM|411.00|99|0.00|CD (ADULT) - DETOXIFICATION
20|FH_F44341_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F44341_0_0|CSTM-ALL|CSTM-00|2020|PDM|225.00|99|0.00|CD PARTIAL HOSPITALIZATION
20|FH_F44341_0_0|SrvcGrp|110|2022|PDM|362.00|99|0.00|CD - REHABILITATION
20|FH_F44342_0_0|CSTM-ALL|CSTM-00|2020|PDM|250.00|99|0.00|PSYCH PARTIAL HOSPITALIZATION
20|FH_F44342_0_0|CSTM-ALL|CSTM-00|2020|PDM|680.00|99|0.00|ADOLESCENT PSYCHIATRIC
20|FH_F44350_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F44350_0_0|CSTM-ALL|CSTM-00|2020|PDM|300.00|99|0.00|CD PARTIAL HOSPITALIZATION
20|FH_F44350_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|ACUTE PSYCH
20|FH_F44350_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44350_0_0|SrvcGrp|1306|2022|PDM|300.00|99|0.00|OP PSYCH PARTIAL HOSP
20|FH_F44354_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|ACUTE PSYCH
20|FH_F44383_0_0|CSTM-ALL|CSTM-00|2020|PDM|82.50|99|0.00|OP SVCS
20|FH_F44396_0_0|CSTM-ALL|CSTM-00|2020|PDM|259.00|99|0.00|OP SVCS
20|FH_F44396_0_0|CSTM-ALL|CSTM-00|2020|PDM|259.00|99|0.00|PSYCHIATRIC RESIDENTIAL TREATMENT
20|FH_F44396_0_0|SrvcGrp|1306|2022|PDM|260.00|99|0.00|OP PSYCH PARTIAL HOSP
20|FH_F44414_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F44435_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44435_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.15|99|0.00|OP SVCS
20|FH_F44435_0_0|CSTM-ALL|CSTM-00|2020|PDM|1900.00|99|0.00|AEG 4 (NO REV)
20|FH_F44435_0_0|CSTM-ALL|CSTM-00|2020|PDM|3400.00|99|0.00|AEG 9 (NO REV)
20|FH_F44435_0_0|CSTM-ALL|CSTM-00|2020|PDM|915.00|99|0.00|AEG 2 (NO REV)
20|FH_F44435_0_0|SrvcGrp|27347|2022|PDM|1850.00|99|0.00|CPT 58558
20|FH_F44438_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F44438_0_0|CSTM-ALL|CSTM-00|2020|PDM|1676.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F44438_0_0|SrvcGrp|16|2022|PDM|991.00|99|0.00|ACUTE REHABILITATION
20|FH_F44476_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44495_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44495_0_0|CSTM-ALL|CSTM-00|2020|PDM|45.00|99|0.00|SKILLED NURSING (ADDITIONAL HOURS)
20|FH_F44540_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F44582_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|ASPG III
20|FH_F44582_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F44582_0_0|CSTM-ALL|CSTM-00|2020|PDM|2150.00|99|0.00|MS DRG 765-766 C-SECTION
20|FH_F44582_0_0|CSTM-ALL|CSTM-00|2020|PDM|32000.00|99|0.00|CV SURGERY
20|FH_F44582_0_0|SrvcGrp|12258|2022|PCT|0.70|99|0.00|CARDIAC CATHETERIZATION
20|FH_F44582_0_0|SrvcGrp|13293|2022|PCT|0.65|99|0.00|HIGH-COST DRUGS
20|FH_F44582_0_0|SrvcGrp|13881|2022|PCT|1.10|99|0.00|PACEMAKER DEVICE
20|FH_F44582_0_0|SrvcGrp|15132|2022|PDM|2600.00|99|0.00|ACUTE IP MEDICAL SVCS
20|FH_F44582_0_0|SrvcGrp|9518|2022|PCT|0.70|99|0.00|EMERGENCY ROOM
20|FH_F44601_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.87|99|0.00|GENERAL ACUTE CARE
20|FH_F44601_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.87|99|0.00|OP SVCS
20|FH_F44606_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|HOME SLEEP TEST (TYPE IV)
20|FH_F44638_0_0|CSTM-ALL|CSTM-00|2020|PDM|190.00|99|0.00|CD PARTIAL HOSPITALIZATION - ADOLESCENT
20|FH_F44638_0_0|SrvcGrp|170|2022|PDM|425.00|99|0.00|CD (ADOLESCENT) - REHAB
20|FH_F44660_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|ACUTE MEDICAL/SURGICAL SVCS
20|FH_F44700_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44700_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F44701_0_0|CSTM-ALL|CSTM-00|2020|PDM|1115.00|99|0.00|ASPG VI
20|FH_F44701_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|ASPG I
20|FH_F44701_0_0|SrvcGrp|38908|2022|PDM|750.00|99|0.00|CPT 67025 - INJECTION OF VITREOUS SUBSTITUTE
20|FH_F44754_0_0|SrvcGrp|10542|2022|PDM|70.00|99|0.00|OCCUPATIONAL THERAPY SVCS
20|FH_F44754_0_0|SrvcGrp|15385|2022|PDM|80.00|99|0.00|SKILLED NURSING NON IV RELATED
20|FH_F44755_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.60|99|0.00|GENERAL ACUTE CARE
20|FH_F44813_0_0|CSTM-ALL|CSTM-00|2020|PDM|205.00|99|0.00|PSYCH DAY TREATMENT
20|FH_F44952_0_0|SrvcGrp|12403|2022|PDM|788.55|99|0.00|CONTINUOUS HOMECARE
20|FH_F44952_0_0|SrvcGrp|3809|2022|PDM|601.02|99|0.00|HOSPICE CARE
20|FH_F44992_0_0|CSTM-ALL|CSTM-00|2020|PDM|1233.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F44992_0_0|SrvcGrp|13472|2022|PDM|1650.00|99|0.00|ICU/CCU
20|FH_F44992_0_0|SrvcGrp|8950|2022|PDM|1318.00|99|0.00|INTERMEDIATE ICU/CCU
20|FH_F45093_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|GENERAL ACUTE CARE
20|FH_F45113_0_0|CSTM-ALL|CSTM-00|2020|PCT|44.90|99|0.00|OP SVCS
20|FH_F45120_0_0|CSTM-ALL|CSTM-00|2020|PDM|1838.00|99|0.00|COVENTRY ENHANCED GROUPER 9
20|FH_F45120_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|GENERAL ACUTE CARE
20|FH_F45120_0_0|SrvcGrp|30455|2022|PCT|0.21|99|0.00|IMPLANTS
20|FH_F45166_0_0|CSTM-ALL|CSTM-00|2020|PDM|60.00|99|0.00|OP SVCS
20|FH_F45174_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.69|99|0.00|GENERAL ACUTE CARE
20|FH_F45176_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F45176_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|LAPAROSCOPY
20|FH_F45176_0_0|CSTM-ALL|CSTM-00|2020|PDM|680.00|99|0.00|ASPG I
20|FH_F45176_0_0|SrvcGrp|39604|2022|PDM|2400.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F45176_0_0|SrvcGrp|39608|2022|PDM|2500.00|99|0.00|CATARACT SURGERY
20|FH_F45176_0_0|SrvcGrp|39672|2022|PCT|1.05|99|0.00|IMPLANTABLES/PROS/ORTHO
20|FH_F45179_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F45200_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F45200_0_0|CSTM-ALL|CSTM-00|2020|PDM|643.00|99|0.00|GENERAL ACUTE CARE
20|FH_F45212_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F45303_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|CARDIAC CATH LAB SVCS
20|FH_F45312_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OP SVCS
20|FH_F45312_0_0|SrvcGrp|39773|2022|PCT|0.75|99|0.00|KIDNEY TRANSPLANT
20|FH_F45317_0_0|CSTM-ALL|CSTM-00|2020|PCT|35.00|99|0.00|GENERAL ACUTE CARE
20|FH_F45372_0_0|CSTM-ALL|CSTM-00|2020|PDM|1046.00|99|0.00|GENERAL ACUTE CARE
20|FH_F45372_0_0|SrvcGrp|269|2022|PDM|4600.00|99|0.00|OP LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F45372_0_0|SrvcGrp|38797|2022|PDM|255.00|99|0.00|PSYCHIATRIC PARTIAL HOSPITALIZATION - IP
20|FH_F45392_0_0|SrvcGrp|3029|2022|PDM|325.00|99|0.00|NEWBORN NURSERY
20|FH_F45392_0_0|SrvcGrp|9774|2022|PDM|1600.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F45435_0_0|SrvcGrp|13703|2022|PDM|35.00|99|0.00|LICENSED PRACTICAL NURSE- HOURLY
20|FH_F45435_0_0|SrvcGrp|26798|2022|PDM|90.00|99|0.00|LICENSED PRACTICAL NURSE
20|FH_F45435_0_0|SrvcGrp|8962|2022|PDM|100.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F45436_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE
20|FH_F45436_0_0|SrvcGrp|12263|2022|PDM|27.50|99|0.00|HOME HEALTH AIDE- HOURLY
20|FH_F45436_0_0|SrvcGrp|12702|2022|PDM|65.00|99|0.00|RN, INTERMITTENT VISIT
20|FH_F45436_0_0|SrvcGrp|13703|2022|PDM|35.00|99|0.00|LICENSED PRACTICAL NURSE- HOURLY
20|FH_F45436_0_0|SrvcGrp|17766|2022|PDM|120.00|99|0.00|HOME HEALTH - PT/OT/ST
20|FH_F45513_0_0|CSTM-ALL|CSTM-00|2020|PDM|1347.70|99|0.00|COVENTRY ENHANCED GROUPER 8
20|FH_F45513_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.37|99|0.00|COVENTRY ENHANCED GROUPER 10
20|FH_F45513_0_0|SrvcGrp|41334|2022|PDM|3400.00|99|0.00|TOTAL KNEE
20|FH_F45513_0_0|SrvcGrp|41335|2022|PDM|3400.00|99|0.00|TOTAL HIP
20|FH_F45513_0_0|SrvcGrp|41337|2022|PDM|3000.00|99|0.00|LAPAROSCOPIC PROCEDURES
20|FH_F45516_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F45535_0_0|CSTM-ALL|CSTM-00|2020|PDM|499.00|99|0.00|ASPG II - GNADEN HUETTEN
20|FH_F45752_0_0|CSTM-ALL|CSTM-00|2020|PDM|1320.00|99|0.00|ASPG VI
20|FH_F45752_0_0|CSTM-ALL|CSTM-00|2020|PDM|1605.00|99|0.00|ASPG VIII
20|FH_F45752_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|ASPG IX
20|FH_F45752_0_0|CSTM-ALL|CSTM-00|2020|PDM|50.00|99|0.00|INTRAOCULAR LENS
20|FH_F45752_0_0|SrvcGrp|30401|2022|PCT|1.10|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F45793_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F45798_0_0|CSTM-ALL|CSTM-00|2020|PDM|11200.00|99|0.00|DRG 234 OTHER MSCLSKLTL &  CON PROC WO CC
20|FH_F45798_0_0|CSTM-ALL|CSTM-00|2020|PDM|22600.00|99|0.00|DRG 519 ONLY
20|FH_F45798_0_0|CSTM-ALL|CSTM-00|2020|PDM|27000.00|99|0.00|DRG 471 BILATERAL OR MULTIPLE MAJOR JOINT PX LOWER EXTREMITY
20|FH_F45798_0_0|CSTM-ALL|CSTM-00|2020|PDM|27000.00|99|0.00|DRG 551 PERMANENT CARDIAC PACEMAKER
20|FH_F45798_0_0|SrvcGrp|16173|2022|PDM|603.00|99|0.00|PARTIAL HOSPITALIZATION
20|FH_F45798_0_0|SrvcGrp|3480|2022|PDM|9300.00|99|0.00|DRG 125 CIRCULATORY DISORDER W/ CC W/O COMP DX
20|FH_F45798_0_0|SrvcGrp|537|2022|PDM|2650.00|99|0.00|OBSERVATION SERVICES
20|FH_F45856_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F45915_0_0|SrvcGrp|33164|2022|PDM|400.00|99|0.00|SKILLED NURSING - LEVEL I
20|FH_F45915_0_0|SrvcGrp|33165|2022|PDM|550.00|99|0.00|SKILLED NURSING - LEVEL II
20|FH_F45932_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F45973_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F46001_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F46097_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F46113_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OP SVCS
20|FH_F46113_0_0|SrvcGrp|13368|2022|PCT|0.88|99|0.00|OP SURGERY
20|FH_F46158_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F46158_0_0|SrvcGrp|17067|2022|PCT|0.65|99|0.00|ASPG II
20|FH_F46158_0_0|SrvcGrp|17069|2022|PCT|0.65|99|0.00|ASPG III
20|FH_F46158_0_0|SrvcGrp|17075|2022|PCT|0.65|99|0.00|ASPG VI
20|FH_F46173_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F46192_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F46192_0_0|SrvcGrp|30623|2022|PDM|2392.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788
20|FH_F46192_0_0|SrvcGrp|9774|2022|PDM|3120.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F46281_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F46284_0_0|SrvcGrp|9937|2022|PDM|147.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F46286_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F46333_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|IMPLANTS
20|FH_F46333_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F46352_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F46352_0_0|SrvcGrp|24639|2022|PDM|147.00|99|0.00|SPEECH THERAPY SERVICES
20|FH_F46352_0_0|SrvcGrp|26742|2022|PDM|147.00|99|0.00|PT
20|FH_F46352_0_0|SrvcGrp|3809|2022|PDM|1325.00|99|0.00|HOSPICE CARE
20|FH_F46352_0_0|SrvcGrp|40582|2022|PCT|0.85|99|0.00|HOSPICE SVCS
20|FH_F46352_0_0|SrvcGrp|9937|2022|PDM|147.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F46354_0_0|CSTM-ALL|CSTM-00|2020|PDM|346.92|99|0.00|COVENTRY ENHANCED GROUPER 1
20|FH_F46354_0_0|SrvcGrp|38367|2022|PDM|3480.00|99|0.00|LITHO MOD 51
20|FH_F46357_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F46357_0_0|CSTM-ALL|CSTM-00|2020|PDM|1094.93|99|0.00|COVENTRY ENHANCED GROUPER 5
20|FH_F46357_0_0|SrvcGrp|14614|2022|PDM|3800.00|99|0.00|LITHOTRIPSY
20|FH_F46357_0_0|SrvcGrp|26216|2022|PDM|1750.00|99|0.00|ARTHROSCOPY
20|FH_F46359_0_0|CSTM-ALL|CSTM-00|2020|PDM|158.00|99|0.00|SKILLED NURSING CARE
20|FH_F46359_0_0|CSTM-ALL|CSTM-00|2020|PDM|158.00|99|0.00|SOCIAL WORKER
20|FH_F46359_0_0|SrvcGrp|24639|2022|PDM|147.00|99|0.00|SPEECH THERAPY SERVICES
20|FH_F46359_0_0|SrvcGrp|9828|2022|PDM|63.00|99|0.00|HOME HEALTH AIDE
20|FH_F46359_0_0|SrvcGrp|9937|2022|PDM|147.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F46372_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE
20|FH_F46372_0_0|SrvcGrp|34168|2022|PCT|0.85|99|0.00|BURN SERVICES MS DRG
20|FH_F46473_0_0|CSTM-ALL|CSTM-00|2020|PDM|936.00|99|0.00|ASPG III
20|FH_F46473_0_0|SrvcGrp|12995|2022|PDM|485.00|99|0.00|DIALYSIS
20|FH_F46492_0_0|CSTM-ALL|CSTM-00|2020|PDM|1158.00|99|0.00|ASPG IV
20|FH_F46492_0_0|CSTM-ALL|CSTM-00|2020|PDM|611.00|99|0.00|ASPG I
20|FH_F46612_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE
20|FH_F46612_0_0|CSTM-ALL|CSTM-00|2020|PDM|166.00|99|0.00|SOCIAL WORKER
20|FH_F46612_0_0|SrvcGrp|12403|2022|PDM|76.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F46612_0_0|SrvcGrp|40582|2022|PCT|0.80|99|0.00|HOSPICE SVCS
20|FH_F46672_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F46672_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F46672_0_0|CSTM-ALL|CSTM-00|2020|PDM|105.00|99|0.00|PT / OT / ST
20|FH_F46672_0_0|CSTM-ALL|CSTM-00|2020|PDM|125.00|99|0.00|MEDICAL SOCIAL WORKER VISIT
20|FH_F46672_0_0|SrvcGrp|9828|2022|PDM|36.00|99|0.00|HOME HEALTH AIDE
20|FH_F46732_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE
20|FH_F46732_0_0|SrvcGrp|10544|2022|PDM|144.00|99|0.00|ENTEROSTOMAL THERAPY SERVICES
20|FH_F46732_0_0|SrvcGrp|10623|2022|PDM|144.00|99|0.00|SPEECH THERAPY SERVICES
20|FH_F46732_0_0|SrvcGrp|13703|2022|PDM|40.00|99|0.00|LICENSED PRACTICAL NURSE- HOURLY
20|FH_F46732_0_0|SrvcGrp|26001|2022|PDM|142.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F46772_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE
20|FH_F46815_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F46854_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F46854_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F46874_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F46874_0_0|CSTM-ALL|CSTM-00|2020|PDM|1265.00|99|0.00|ASPG V
20|FH_F46874_0_0|CSTM-ALL|CSTM-00|2020|PDM|785.00|99|0.00|ASPG II
20|FH_F46914_0_0|SrvcGrp|24639|2022|PDM|147.00|99|0.00|SPEECH THERAPY SERVICES
20|FH_F46914_0_0|SrvcGrp|42762|2022|PDM|158.00|99|0.00|NURSING CARE
20|FH_F46918_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F46918_0_0|CSTM-ALL|CSTM-00|2020|PDM|102.00|99|0.00|SKILLED NURSING
20|FH_F46918_0_0|CSTM-ALL|CSTM-00|2020|PDM|45.00|99|0.00|LPN HI TECH - HOURLY
20|FH_F46918_0_0|SrvcGrp|10407|2022|PDM|55.00|99|0.00|HOME INFUSION
20|FH_F46918_0_0|SrvcGrp|10543|2022|PDM|110.00|99|0.00|SPEECH THERAPY SVCS
20|FH_F46938_0_0|SrvcGrp|10527|2022|PDM|100.00|99|0.00|HOSPICE SVCS
20|FH_F46941_0_0|SrvcGrp|10528|2022|PDM|45.00|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F46972_0_0|SrvcGrp|42046|2022|PDM|595.00|99|0.00|HOSPICE CARE
20|FH_F47037_0_0|SrvcGrp|10541|2022|PDM|92.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F47037_0_0|SrvcGrp|10545|2022|PDM|90.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F47037_0_0|SrvcGrp|14080|2022|PDM|92.00|99|0.00|HOME VISIT - PRENATAL
20|FH_F47037_0_0|SrvcGrp|16302|2022|PDM|42.00|99|0.00|VENIPUNCTURE
20|FH_F47037_0_0|SrvcGrp|22387|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F47056_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F47113_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F47113_0_0|CSTM-ALL|CSTM-00|2020|PDM|436.00|99|0.00|AEG 1 (NO REV)
20|FH_F47113_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 2 (NO REV)
20|FH_F47113_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|AEG 10 (NO REV)
20|FH_F47128_0_0|CSTM-ALL|CSTM-00|2020|PDM|2100.00|99|0.00|GENERAL ACUTE CARE
20|FH_F47130_0_0|CSTM-ALL|CSTM-00|2020|PDM|2884.00|99|0.00|GENERAL ACUTE CARE
20|FH_F47140_0_0|CSTM-ALL|CSTM-00|2020|PDM|387.50|99|0.00|SLEEP STUDIES CPT 95807 W/MODIFIER TC
20|FH_F47140_0_0|CSTM-ALL|CSTM-00|2020|PDM|441.25|99|0.00|SLEEP STUDIES CPT 95808 W/MODIFIER TC
20|FH_F47140_0_0|CSTM-ALL|CSTM-00|2020|PDM|558.11|99|0.00|SLEEP STUDIES CPT 95810 W/MODIFIER TC
20|FH_F47140_0_0|CSTM-ALL|CSTM-00|2020|PDM|76.05|99|0.00|SLEEP STUDIES CPT 95806 W/MODIFIER 26
20|FH_F47140_0_0|SrvcGrp|12045|2022|PDM|564.97|99|0.00|SLEEP STUDIES
20|FH_F47140_0_0|SrvcGrp|13621|2022|PDM|563.56|99|0.00|SLEEP STUDIES
20|FH_F47152_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.69|99|0.00|OP SVCS
20|FH_F47152_0_0|SrvcGrp|39542|2022|PDM|155000.00|99|0.00|MS DRG 005-006 LIVER TRANSPLANT - LIVE DONOR
20|FH_F47233_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|WELLPATH PROPRIETARY ASC NON-GROUPED
20|FH_F47233_0_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|WELLPATH PROPIETARY ASC VII
20|FH_F47245_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F47245_0_0|SrvcGrp|30733|2022|PDM|564.00|99|0.00|SKILLED NURSING CARE
20|FH_F47248_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F47319_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F47341_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F47356_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F47356_0_0|CSTM-ALL|CSTM-00|2020|PDM|155.00|99|0.00|OP SVCS
20|FH_F47359_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS
20|FH_F47370_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F47370_0_0|CSTM-ALL|CSTM-00|2020|PDM|60.00|99|0.00|OP SVCS
20|FH_F47421_0_0|CSTM-ALL|CSTM-00|2020|PDM|1275.00|99|0.00|ASPG VI
20|FH_F47421_0_0|CSTM-ALL|CSTM-00|2020|PDM|1495.00|99|0.00|ASPG VII
20|FH_F47421_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|ASPG I
20|FH_F47421_0_0|CSTM-ALL|CSTM-00|2020|PDM|975.00|99|0.00|ASPG IV
20|FH_F47424_0_0|SrvcGrp|12403|2022|PDM|955.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F47424_0_0|SrvcGrp|26001|2022|PDM|170.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F47424_0_0|SrvcGrp|40582|2022|PDM|185.00|99|0.00|HOSPICE SVCS
20|FH_F47462_0_0|CSTM-ALL|CSTM-00|2020|PDM|130.00|99|0.00|PHYSICAL THERAPY SVCS- RE EVAL
20|FH_F47499_0_0|SrvcGrp|13927|2022|PDM|619.00|99|0.00|DAY HOSPITAL FULL DAY
20|FH_F47539_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F47552_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|IMPLANTS
20|FH_F47552_0_0|CSTM-ALL|CSTM-00|2020|PDM|1389.00|99|0.00|ASPG V
20|FH_F47552_0_0|CSTM-ALL|CSTM-00|2020|PDM|846.00|99|0.00|ASPG II
20|FH_F47552_0_0|CSTM-ALL|CSTM-00|2020|PDM|990.00|99|0.00|ASPG III
20|FH_F47573_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F47573_0_0|SrvcGrp|42828|2022|PDM|158.00|99|0.00|SPEECH THERAPY VISIT
20|FH_F47573_0_0|SrvcGrp|42830|2022|PDM|178.00|99|0.00|MEDICAL SOCIAL WORKER VISIT
20|FH_F47605_0_0|SrvcGrp|43323|2022|PDM|90.00|99|0.00|GROUP THERAPY
20|FH_F47605_0_0|SrvcGrp|86607|2022|PDM|1200.00|99|0.00|COMPREHENSIVE PAIN EVALUATION
20|FH_F47636_0_0|SrvcGrp|12403|2022|PDM|32.33|99|0.00|CONTINUOUS HOMECARE
20|FH_F47640_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|GENERAL ACUTE CARE
20|FH_F47640_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|OP SVCS
20|FH_F47656_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE
20|FH_F47656_0_0|SrvcGrp|361|2022|PCT|0.80|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F47659_0_0|CSTM-ALL|CSTM-00|2020|PDM|6100.00|99|0.00|CV SURGERY
20|FH_F47659_0_0|SrvcGrp|16|2022|PCT|0.80|99|0.00|ACUTE REHABILITATION
20|FH_F47679_0_0|SrvcGrp|42782|2022|PDM|40.12|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|1059.00|99|0.00|GA RETINA SURG CTR ASC 25
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|1068.00|99|0.00|GA RETINA SURG CTR ASC 26
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|1455.00|99|0.00|GA RETINA SURG CTR ASC 30
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|234.00|99|0.00|GA RETINA SURG CTR ASC 7
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|298.00|99|0.00|GA RETINA SURG CTR ASC 10
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|772.00|99|0.00|GA RETINA SURG CTR ASC 16
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|941.00|99|0.00|GA RETINA SURG CTR ASC 21
20|FH_F47694_0_0|SrvcGrp|14210|2022|PDM|320.00|99|0.00|PSYCH INTENSIVE OUTPATIENT
20|FH_F47694_0_0|SrvcGrp|58762|2022|PDM|1295.00|99|0.00|RESIDENTIAL TREATMENT - PSYCH
20|FH_F47717_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE
20|FH_F47717_0_0|SrvcGrp|3205|2022|PDM|1248.00|99|0.00|ACUTE REHAB
20|FH_F47727_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE
20|FH_F47795_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F47819_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F47836_0_0|CSTM-ALL|CSTM-00|2020|PDM|1850.00|99|0.00|ENT SURG CTR -CVTY ENHANCED GROUP 7
20|FH_F47836_0_0|SrvcGrp|56225|2022|PCT|1.10|99|0.00|IMPLANTS
20|FH_F47857_0_0|SrvcGrp|68510|2022|PDM|130.00|99|0.00|CD - EVENING HOSPITALIZATION
20|FH_F47884_0_0|SrvcGrp|11000|2022|PCT|0.50|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F47884_0_0|SrvcGrp|11049|2022|PDM|4812.00|99|0.00|OP LITHOTRIPSY
20|FH_F47884_0_0|SrvcGrp|11259|2022|PCT|0.50|99|0.00|DRUGS
20|FH_F47952_0_0|SrvcGrp|42975|2022|PDM|95.00|99|0.00|PHYSICAL THERAPIST
20|FH_F47952_0_0|SrvcGrp|43957|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE
20|FH_F47969_0_0|SrvcGrp|12403|2022|PDM|25.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F47970_0_0|SrvcGrp|97505|2022|PDM|525.00|99|0.00|UPPER GI ENDOSCOPY PROCEDURES
20|FH_F47999_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F47999_0_0|SrvcGrp|42825|2022|PDM|52.80|99|0.00|HOME HEALTH AIDE VISIT
20|FH_F47999_0_0|SrvcGrp|42828|2022|PDM|104.50|99|0.00|SPEECH THERAPY VISIT
20|FH_F48034_0_0|SrvcGrp|3392|2022|PDM|125.00|99|0.00|CPT 90806
20|FH_F48057_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F48092_0_0|SrvcGrp|14112|2022|PDM|28.75|99|0.00|OCCUPATIONAL THERAPY SVCS
20|FH_F48092_0_0|SrvcGrp|184|2022|PDM|1600.00|99|0.00|MEDICAL INTENSIVE CARE
20|FH_F48092_0_0|SrvcGrp|19610|2022|PDM|1200.00|99|0.00|GENERAL ACUTE CARE LEVEL II
20|FH_F48092_0_0|SrvcGrp|23130|2022|PDM|22.00|99|0.00|1:1 SUPERVISION
20|FH_F48092_0_0|SrvcGrp|41368|2022|PDM|1400.00|99|0.00|TELEMETRY
20|FH_F48133_0_0|SrvcGrp|42871|2022|PDM|40.12|99|0.00|SPEECH THERAPY VISIT
20|FH_F48192_0_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F48192_0_0|SrvcGrp|472|2022|PDM|480.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F48192_0_0|SrvcGrp|592|2022|PDM|550.00|99|0.00|SUB-ACUTE CARE
20|FH_F48215_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F48215_0_0|SrvcGrp|12264|2022|PDM|60.75|99|0.00|DIETICIAN OR LPN SERVICES
20|FH_F48215_0_0|SrvcGrp|12856|2022|PDM|42.25|99|0.00|NURSING CARE
20|FH_F48215_0_0|SrvcGrp|9829|2022|PDM|85.50|99|0.00|PT SVCS
20|FH_F48254_0_0|SrvcGrp|44302|2022|PDM|60.00|99|0.00|PT & OT (VISIT LVL) PT MOD GP
20|FH_F48258_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F48292_0_0|SrvcGrp|44247|2022|PDM|192.00|99|0.00|CAPD TRAINING
20|FH_F48292_0_0|SrvcGrp|44249|2022|PDM|192.00|99|0.00|CAPD TRAINING
20|FH_F48295_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F48295_0_0|CSTM-ALL|CSTM-00|2020|PDM|85.00|99|0.00|NURSING CARE (VISIT LVL)
20|FH_F48302_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F48315_0_0|CSTM-ALL|CSTM-00|2020|PDM|2149.00|99|0.00|GENERAL ACUTE CARE
20|FH_F48346_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS
20|FH_F48355_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F48357_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F48418_0_0|CSTM-ALL|CSTM-00|2020|PDM|130.00|99|0.00|OP SVCS
20|FH_F48459_0_0|SrvcGrp|76207|2022|PDM|60.00|99|0.00|SPEECH THERAPY (VISIT LVL) MOD GN
20|FH_F48473_0_0|SrvcGrp|12694|2022|PDM|93.50|99|0.00|PT SVCS
20|FH_F48475_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F48475_0_0|SrvcGrp|474|2022|PDM|489.50|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F48476_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F48476_0_0|SrvcGrp|36066|2022|PDM|26.00|99|0.00|NURSING CARE
20|FH_F48476_0_0|SrvcGrp|36068|2022|PDM|45.00|99|0.00|SKILLED NURSING NON IV RELATED
20|FH_F48476_0_0|SrvcGrp|42046|2022|PDM|595.00|99|0.00|HOSPICE CARE
20|FH_F48476_0_0|SrvcGrp|42973|2022|PDM|100.00|99|0.00|SPEECH  THERAPIST
20|FH_F48476_0_0|SrvcGrp|42974|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPIST
20|FH_F48476_0_0|SrvcGrp|42976|2022|PDM|100.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F48476_0_0|SrvcGrp|43957|2022|PDM|35.00|99|0.00|HOME HEALTH AIDE
20|FH_F48476_0_0|SrvcGrp|43958|2022|PDM|90.00|99|0.00|ENTEROSTOMAL THERAPY SERVICES
20|FH_F48617_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|OP SVCS
20|FH_F48695_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F48695_0_0|SrvcGrp|11258|2022|PCT|0.50|99|0.00|DRUGS
20|FH_F48695_0_0|SrvcGrp|30089|2022|PDM|650.00|99|0.00|HEMODIALYSIS SERVICES
20|FH_F48695_0_0|SrvcGrp|472|2022|PDM|1600.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F48695_0_0|SrvcGrp|474|2022|PDM|1230.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F48752_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F48752_0_0|SrvcGrp|42869|2022|PDM|45.00|99|0.00|PHYSICAL THERAPY VISIT
20|FH_F48752_0_0|SrvcGrp|9539|2022|PDM|250.00|99|0.00|SUBACUTE CARE
20|FH_F48855_0_0|SrvcGrp|44326|2022|PDM|70.00|99|0.00|PT & OT (VISIT LVL) OT MOD GO
20|FH_F48857_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F48915_0_0|CSTM-ALL|CSTM-00|2020|PDM|60.00|99|0.00|OCCUPATIONAL THERAPY SERVICES
20|FH_F48915_0_0|CSTM-ALL|CSTM-00|2020|PDM|60.00|99|0.00|SPEECH THERAPY
20|FH_F48927_0_0|SrvcGrp|72|2022|PDM|600.00|99|0.00|NEWBORN NURSERY
20|FH_F48929_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F48929_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F48929_0_0|CSTM-ALL|CSTM-00|2020|PDM|60.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F48929_0_0|SrvcGrp|42785|2022|PDM|60.00|99|0.00|SPEECH THERAPY  SRVCS
20|FH_F48935_0_0|SrvcGrp|474|2022|PDM|360.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F48937_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F48937_0_0|SrvcGrp|10545|2022|PDM|65.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F48937_0_0|SrvcGrp|27968|2022|PDM|40.00|99|0.00|SKILLED NURSING LPN
20|FH_F48937_0_0|SrvcGrp|29303|2022|PDM|65.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F48994_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F48994_0_0|CSTM-ALL|CSTM-00|2020|PDM|1119.00|99|0.00|ASPG V
20|FH_F48994_0_0|CSTM-ALL|CSTM-00|2020|PDM|1119.00|99|0.00|ASPG V- MOD 50
20|FH_F48994_0_0|CSTM-ALL|CSTM-00|2020|PDM|1553.00|99|0.00|ASPG VII
20|FH_F48994_0_0|CSTM-ALL|CSTM-00|2020|PDM|1553.00|99|0.00|ASPG VII- MOD 50
20|FH_F48994_0_0|CSTM-ALL|CSTM-00|2020|PDM|696.00|99|0.00|ASPG II
20|FH_F48994_0_0|CSTM-ALL|CSTM-00|2020|PDM|955.00|99|0.00|ASPG III
20|FH_F48994_0_0|CSTM-ALL|CSTM-00|2020|PDM|955.00|99|0.00|ASPG III- MOD 50
20|FH_F48998_0_0|SrvcGrp|473|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F49005_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F49005_0_0|CSTM-ALL|CSTM-00|2020|PDM|200.00|99|0.00|PT / OT / ST
20|FH_F49005_0_0|CSTM-ALL|CSTM-00|2020|PDM|75.00|99|0.00|SKILLED NURSING (ADDITIONAL HOURS)
20|FH_F49016_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|MEDICAL SUPPLIES
20|FH_F49016_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F49016_0_0|SrvcGrp|10400|2022|PDM|1450.00|99|0.00|IP SURGERY
20|FH_F49016_0_0|SrvcGrp|10905|2022|PDM|550.00|99|0.00|EMERGENCY ROOM LEVEL III
20|FH_F49016_0_0|SrvcGrp|42830|2022|PDM|60.00|99|0.00|MEDICAL SOCIAL WORKER VISIT
20|FH_F49027_0_0|SrvcGrp|21594|2022|PDM|335.00|99|0.00|SKILLED NURSING
20|FH_F49029_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F49029_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F49033_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F49033_0_0|SrvcGrp|21594|2022|PDM|335.00|99|0.00|SKILLED NURSING
20|FH_F49037_0_0|SrvcGrp|45148|2022|PDM|90.00|99|0.00|SPEECH THERAPY
20|FH_F49039_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F49042_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F49042_0_0|SrvcGrp|43785|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY SERVICES
20|FH_F49042_0_0|SrvcGrp|45148|2022|PDM|90.00|99|0.00|SPEECH THERAPY
20|FH_F49044_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F49044_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F49044_0_0|SrvcGrp|43785|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY SERVICES
20|FH_F49046_0_0|SrvcGrp|43785|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY SERVICES
20|FH_F49049_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F49051_0_0|SrvcGrp|43785|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY SERVICES
20|FH_F49093_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F49279_0_0|CSTM-ALL|CSTM-00|2020|PDM|552.00|99|0.00|ASPG I
20|FH_F49287_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE
20|FH_F49299_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F49299_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F49299_0_0|SrvcGrp|471|2022|PDM|660.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F49299_0_0|SrvcGrp|472|2022|PDM|460.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F49299_0_0|SrvcGrp|474|2022|PDM|360.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F49300_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F49300_0_0|SrvcGrp|32189|2022|PDM|35.00|99|0.00|RESPITE CARE
20|FH_F49300_0_0|SrvcGrp|42976|2022|PDM|100.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F49329_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F49329_0_0|CSTM-ALL|CSTM-00|2020|PDM|45.00|99|0.00|SKILLED NURSING (ADDITIONAL HOURS)
20|FH_F49329_0_0|SrvcGrp|44703|2022|PDM|108.00|99|0.00|NURSING CARE
20|FH_F49329_0_0|SrvcGrp|44709|2022|PDM|179.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F49452_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS
20|FH_F49458_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F49459_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F49459_0_0|SrvcGrp|38223|2022|PDM|762.00|99|0.00|ADULT DETOX
20|FH_F49459_0_0|SrvcGrp|80|2022|PDM|762.00|99|0.00|ACUTE PSYCH
20|FH_F49476_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F49478_0_0|CSTM-ALL|CSTM-00|2020|PDM|1099.00|99|0.00|COVENTRY ENHANCED GROUPER 7
20|FH_F49478_0_0|CSTM-ALL|CSTM-00|2020|PDM|1480.00|99|0.00|COVENTRY ENHANCED GROUPER 9
20|FH_F49478_0_0|CSTM-ALL|CSTM-00|2020|PDM|564.00|99|0.00|COVENTRY ENHANCED GROUPER 3
20|FH_F49478_0_0|CSTM-ALL|CSTM-00|2020|PDM|954.00|99|0.00|COVENTRY ENHANCED GROUPER 6
20|FH_F49478_0_0|SrvcGrp|45863|2022|PDM|1405.00|99|0.00|CPT 65730
20|FH_F49489_0_0|CSTM-ALL|CSTM-00|2020|PDM|1065.85|99|0.00|ASPG II
20|FH_F49489_0_0|CSTM-ALL|CSTM-00|2020|PDM|1222.30|99|0.00|ASPG III
20|FH_F49489_0_0|CSTM-ALL|CSTM-00|2020|PDM|2459.23|99|0.00|ASPG VIII
20|FH_F49489_0_0|CSTM-ALL|CSTM-00|2020|PDM|767.58|99|0.00|ASPG I
20|FH_F49535_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F49554_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F49572_0_0|SrvcGrp|9774|2022|PDM|1500.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F49598_0_0|CSTM-ALL|CSTM-00|2020|PDM|3183.00|99|0.00|CV SURGERY (MS DRG)
20|FH_F49598_0_0|SrvcGrp|16|2022|PDM|796.00|99|0.00|ACUTE REHABILITATION
20|FH_F49598_0_0|SrvcGrp|23477|2022|PDM|6365.00|99|0.00|MSDRG 286-287 ONLY CARDIAC CATH
20|FH_F49598_0_0|SrvcGrp|3277|2022|PDM|478.00|99|0.00|SKILLED NURSING CARE
20|FH_F49601_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F49601_0_0|CSTM-ALL|CSTM-00|2020|PDM|325.00|99|0.00|OP SURGERY MOD SG
20|FH_F49732_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS
20|FH_F49735_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F49735_0_0|SrvcGrp|16|2022|PDM|950.00|99|0.00|ACUTE REHABILITATION
20|FH_F49776_0_0|SrvcGrp|12263|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE- HOURLY
20|FH_F49776_0_0|SrvcGrp|13703|2022|PDM|40.00|99|0.00|LICENSED PRACTICAL NURSE- HOURLY
20|FH_F49776_0_0|SrvcGrp|42824|2022|PDM|88.00|99|0.00|SKILLED NURSING VISIT
20|FH_F49776_0_0|SrvcGrp|42825|2022|PDM|42.00|99|0.00|HOME HEALTH AIDE VISIT
20|FH_F49776_0_0|SrvcGrp|43430|2022|PDM|80.00|99|0.00|LPN HOME VISIT
20|FH_F49832_0_0|SrvcGrp|24029|2022|PDM|45.00|99|0.00|RN HOURLY
20|FH_F49853_0_0|SrvcGrp|474|2022|PDM|275.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F49913_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F49914_0_0|SrvcGrp|45148|2022|PDM|90.00|99|0.00|SPEECH THERAPY
20|FH_F49932_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|OP SVCS
20|FH_F49942_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.00|99|0.00|GENERAL ACUTE CARE
20|FH_F49942_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.00|99|0.00|OP SVCS
20|FH_F49943_0_0|SrvcGrp|42971|2022|PDM|105.00|99|0.00|SKN RN
20|FH_F49943_0_0|SrvcGrp|45944|2022|PDM|36.00|99|0.00|HOME HEALTH AIDE SVCS
20|FH_F49943_0_0|SrvcGrp|45945|2022|PDM|105.00|99|0.00|RN NURSING SVCS
20|FH_F49954_0_0|SrvcGrp|21594|2022|PDM|335.00|99|0.00|SKILLED NURSING
20|FH_F49996_0_0|CSTM-ALL|CSTM-00|2020|PDM|1289.00|99|0.00|ASPG VI
20|FH_F49996_0_0|CSTM-ALL|CSTM-00|2020|PDM|1289.00|99|0.00|ASPG VI- MOD 50
20|FH_F49996_0_0|CSTM-ALL|CSTM-00|2020|PDM|1518.00|99|0.00|ASPG VIII- MOD 50
20|FH_F49996_0_0|CSTM-ALL|CSTM-00|2020|PDM|2089.00|99|0.00|ASPG IX
20|FH_F49996_0_0|CSTM-ALL|CSTM-00|2020|PDM|520.00|99|0.00|ASPG I
20|FH_F49996_0_0|CSTM-ALL|CSTM-00|2020|PDM|520.00|99|0.00|ASPG I- MOD 50
20|FH_F49996_0_0|CSTM-ALL|CSTM-00|2020|PDM|983.00|99|0.00|ASPG IV- MOD 50
20|FH_F50013_0_0|SrvcGrp|16|2022|PDM|1212.00|99|0.00|ACUTE REHABILITATION
20|FH_F50100_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F50100_0_0|SrvcGrp|22954|2022|PDM|183.42|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F50100_0_0|SrvcGrp|46109|2022|PDM|110.64|99|0.00|HI-TECH NURSING (1 HOUR)
20|FH_F50100_0_0|SrvcGrp|46114|2022|PDM|110.64|99|0.00|OT VISIT
20|FH_F50100_0_0|SrvcGrp|46115|2022|PDM|110.64|99|0.00|ST VISIT
20|FH_F50100_0_0|SrvcGrp|46116|2022|PDM|110.64|99|0.00|MEDICAL SOCIAL WORKER VISIT
20|FH_F50100_0_0|SrvcGrp|46183|2022|PCT|0.82|99|0.00|WOUND CARE / MEDICAL SUPPLIES
20|FH_F50137_0_0|CSTM-ALL|CSTM-00|2020|PDM|105.00|99|0.00|HIGH TECH SKILLED NURSING
20|FH_F50137_0_0|CSTM-ALL|CSTM-00|2020|PDM|120.00|99|0.00|HOME VISIT RESPIRATORY THERAPY CARE
20|FH_F50137_0_0|SrvcGrp|24345|2022|PDM|120.00|99|0.00|RESPIRATORY THERAPY VISIT
20|FH_F50137_0_0|SrvcGrp|45944|2022|PDM|26.00|99|0.00|HOME HEALTH AIDE SVCS
20|FH_F50163_0_0|CSTM-ALL|CSTM-00|2020|PDM|250.00|99|0.00|CD - FULL DAY (8-12 HR)
20|FH_F50163_0_0|SrvcGrp|3449|2022|PDM|375.00|99|0.00|ELECTRO CONVULSIVE THERAPY
20|FH_F50218_0_0|CSTM-ALL|CSTM-00|2020|PDM|105.00|99|0.00|SKILLED NURSING HOME VISIT OR PROCEDURE
20|FH_F50218_0_0|CSTM-ALL|CSTM-00|2020|PDM|120.00|99|0.00|HOME VISIT NEWBORN CARE
20|FH_F50218_0_0|CSTM-ALL|CSTM-00|2020|PDM|120.00|99|0.00|HOME VISIT STOMA/COLOSTOMY/CYSTOSTOMY CARE
20|FH_F50218_0_0|SrvcGrp|15070|2022|PDM|120.00|99|0.00|HOME HEALTH (NEWBORN CARE)
20|FH_F50218_0_0|SrvcGrp|46248|2022|PDM|60.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F50237_0_0|SrvcGrp|14174|2022|PDM|650.00|99|0.00|MRI
20|FH_F50237_0_0|SrvcGrp|29817|2022|PDM|3000.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F50237_0_0|SrvcGrp|30623|2022|PDM|4250.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788
20|FH_F50240_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F50297_0_0|SrvcGrp|22954|2022|PDM|112.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F50297_0_0|SrvcGrp|42971|2022|PDM|87.00|99|0.00|SKN RN
20|FH_F50334_0_0|SrvcGrp|12403|2022|PDM|30.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F50336_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|COMPREHENSIVE DAY TREATMENT
20|FH_F50372_0_0|SrvcGrp|46584|2022|PDM|140.00|99|0.00|CPT 99203
20|FH_F143668_0_0|SrvcGrp|114067|2022|PDM|28.00|99|0.00|SEGMENTAL PNEUMATIC (MOD RR)
20|FH_F143668_0_0|SrvcGrp|114069|2022|PDM|11.00|99|0.00|SEGMENTAL PNEUMATIC (MOD RR)
20|FH_F143668_0_0|SrvcGrp|37161|2022|PDM|330.00|99|0.00|PNEUMATIC COMPRESSOR (MOD RR)
20|FH_F143684_0_0|CSTM-ALL|CSTM-00|2020|PDM|1340.00|99|0.00|AEG 10 (NO REV)
20|FH_F143684_0_0|CSTM-ALL|CSTM-00|2020|PDM|1769.00|99|0.00|AEG 6 (NO REV)
20|FH_F143684_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F143684_0_0|SrvcGrp|93807|2022|PDM|6291.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY
20|FH_F143771_0_0|SrvcGrp|113620|2022|PDM|136.00|99|0.00|HOSPICE CARE
20|FH_F143771_0_0|SrvcGrp|82223|2022|PDM|133.00|99|0.00|HOSPICE CARE
20|FH_F143783_0_0|SrvcGrp|113451|2022|PDM|105.00|99|0.00|HOSPICE CARE
20|FH_F143783_0_0|SrvcGrp|65720|2022|PDM|105.00|99|0.00|RESPITE CARE
20|FH_F143783_0_0|SrvcGrp|87799|2022|PDM|105.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)
20|FH_F143783_0_0|SrvcGrp|90707|2022|PDM|105.00|99|0.00|AETNA HOSPICE CARE
20|FH_F143783_0_0|SrvcGrp|94780|2022|PDM|105.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)
20|FH_F143783_0_0|SrvcGrp|95660|2022|PDM|105.00|99|0.00|HOSPICE SERVICES (HCFA)
20|FH_F143783_0_0|SrvcGrp|97506|2022|PDM|105.00|99|0.00|AETNA HOSPICE ALL OTHER CARE
20|FH_F143783_0_0|SrvcGrp|97507|2022|PDM|105.00|99|0.00|AETNA HOSPICE
20|FH_F143793_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F143832_0_0|CSTM-ALL|CSTM-00|2020|PDM|1314.82|99|0.00|AEG 3 (NO REV)
20|FH_F143832_0_0|CSTM-ALL|CSTM-00|2020|PDM|1378.75|99|0.00|AEG 4 (NO REV)
20|FH_F143832_0_0|CSTM-ALL|CSTM-00|2020|PDM|2805.28|99|0.00|AEG 9 (NO REV)
20|FH_F143832_0_0|CSTM-ALL|CSTM-00|2020|PDM|705.98|99|0.00|AEG 1 (NO REV)
20|FH_F143832_0_0|SrvcGrp|104098|2022|PDM|3133.75|99|0.00|INTRO CATH DIALYSIS CIRCUIT
20|FH_F143832_0_0|SrvcGrp|106798|2022|PDM|3102.72|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT
20|FH_F143832_0_0|SrvcGrp|108115|2022|PDM|1908.90|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT
20|FH_F143832_0_0|SrvcGrp|108175|2022|PDM|2232.73|99|0.00|TIB/PER REVASC W/TLA
20|FH_F143832_0_0|SrvcGrp|113987|2022|PDM|2232.73|99|0.00|VASC EMBOLIZE/OCCLUDE VENOUS
20|FH_F143832_0_0|SrvcGrp|113988|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F143832_0_0|SrvcGrp|2738|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F143848_0_0|SrvcGrp|73485|2022|PDM|2776.00|99|0.00|AETNA REHAB
20|FH_F143848_0_0|SrvcGrp|73606|2022|PDM|1963.00|99|0.00|AETNA SKILLED NURSING CARE
20|FH_F143848_0_0|SrvcGrp|79720|2022|PDM|2776.00|99|0.00|ACUTE REHAB II
20|FH_F143850_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F143850_0_0|SrvcGrp|82981|2022|PDM|90.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F143898_0_0|SrvcGrp|82222|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F144014_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F144021_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F144021_0_0|SrvcGrp|107748|2022|PDM|475.00|99|0.00|HEMODIALYSIS IN CENTER
20|FH_F144021_0_0|SrvcGrp|107749|2022|PDM|213.00|99|0.00|CAPD/CCPD
20|FH_F144021_0_0|SrvcGrp|108082|2022|PDM|25.38|99|0.00|DIALYSIS PT TRAINING INCL HELPER
20|FH_F144029_0_0|SrvcGrp|108043|2022|PDM|214.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD
20|FH_F144029_0_0|SrvcGrp|113580|2022|PDM|150.00|99|0.00|DIALYSIS PATIENT TRAINING
20|FH_F144039_0_0|CSTM-ALL|CSTM-00|2020|PDM|1078.00|99|0.00|AEG 2 (NO REV)
20|FH_F144039_0_0|CSTM-ALL|CSTM-00|2020|PDM|1473.00|99|0.00|AEG 10 (NO REV)
20|FH_F144039_0_0|CSTM-ALL|CSTM-00|2020|PDM|1473.00|99|0.00|AEG 4 (NO REV)
20|FH_F144039_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F144039_0_0|SrvcGrp|109348|2022|PDM|2869.00|99|0.00|EXCISION OF LESION OF EYELID
20|FH_F144039_0_0|SrvcGrp|109759|2022|PDM|5738.00|99|0.00|REMOVAL CORNEAL EPITHELIUM
20|FH_F144039_0_0|SrvcGrp|109762|2022|PDM|4590.00|99|0.00|REMOVE EYELID LESION(S)
20|FH_F144039_0_0|SrvcGrp|109765|2022|PDM|1721.00|99|0.00|CLOSURE OF LACRIMAL PUNCTUM
20|FH_F144039_0_0|SrvcGrp|109766|2022|PDM|2869.00|99|0.00|COVER EYE W/ MEMBRANE
20|FH_F144039_0_0|SrvcGrp|109768|2022|PDM|2433.00|99|0.00|COVER EYE W/ MEMBRANE SUTURE
20|FH_F144039_0_0|SrvcGrp|114443|2022|PDM|10328.00|99|0.00|EXTRACAPSULAR CATARACT REMOVAL, INSERT LENS
20|FH_F144039_0_0|SrvcGrp|42429|2022|PDM|1721.00|99|0.00|OP SURGERY CPT 66761
20|FH_F144039_0_0|SrvcGrp|42550|2022|PDM|5738.00|99|0.00|OP SURGERY CPT 66984
20|FH_F144039_0_0|SrvcGrp|42551|2022|PDM|1721.00|99|0.00|OP SURGERY
20|FH_F144039_0_0|SrvcGrp|45583|2022|PDM|9754.00|99|0.00|CPT 65730
20|FH_F144039_0_0|SrvcGrp|62740|2022|PDM|5738.00|99|0.00|SURGERY CARVE OUTS
20|FH_F144039_0_0|SrvcGrp|95107|2022|PDM|5738.00|99|0.00|INTRAOCULAR LENS PROSTHESIS
20|FH_F144191_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F144191_0_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|AEG 3 (NO REV)
20|FH_F144191_0_0|CSTM-ALL|CSTM-00|2020|PDM|1450.00|99|0.00|AEG 4 W/O GRAFT PROCEDURE (NO REV)
20|FH_F144191_0_0|CSTM-ALL|CSTM-00|2020|PDM|1600.00|99|0.00|AEG 6 (NO REV)
20|FH_F144191_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|AEG 9 (NO REV)
20|FH_F144191_0_0|CSTM-ALL|CSTM-00|2020|PDM|785.00|99|0.00|AEG 1 (NO REV)
20|FH_F144191_0_0|SrvcGrp|113940|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F144191_0_0|SrvcGrp|27261|2022|PDM|9875.00|99|0.00|CPT 27446
20|FH_F144191_0_0|SrvcGrp|76604|2022|PDM|3183.00|99|0.00|CPT 25447
20|FH_F144191_0_0|SrvcGrp|92823|2022|PDM|3700.00|99|0.00|REVISE KNUCKLE WITH IMPLANT
20|FH_F144228_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F144228_0_0|CSTM-ALL|CSTM-00|2020|PDM|2921.00|99|0.00|AEG 10 (NO REV)
20|FH_F144228_0_0|CSTM-ALL|CSTM-00|2020|PDM|3802.00|99|0.00|AEG 5  (NO REV)
20|FH_F144228_0_0|SrvcGrp|104978|2022|PDM|4711.00|99|0.00|REPAIR METATARSAL FRACTURE
20|FH_F144228_0_0|SrvcGrp|113988|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F144228_0_0|SrvcGrp|114144|2022|PDM|3617.00|99|0.00|KNEE ARTHROSCOPY
20|FH_F144228_0_0|SrvcGrp|114145|2022|PDM|7161.00|99|0.00|RHINOPLASTY
20|FH_F144228_0_0|SrvcGrp|114146|2022|PDM|7161.00|99|0.00|NASAL STENOSIS REPAIR
20|FH_F144228_0_0|SrvcGrp|114148|2022|PDM|1982.00|99|0.00|CONTROL THROAT BLEEDING
20|FH_F144228_0_0|SrvcGrp|114150|2022|PDM|1203.00|99|0.00|SIGMOIDOSCOPY
20|FH_F50372_0_0|SrvcGrp|46587|2022|PDM|50.00|99|0.00|CPT 99211
20|FH_F50372_0_0|SrvcGrp|46591|2022|PDM|140.00|99|0.00|CPT 99213
20|FH_F50432_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F50432_0_0|CSTM-ALL|CSTM-00|2020|PDM|1158.00|99|0.00|COVENTRY ENHANCED GROUPER 5 MOD 50
20|FH_F50432_0_0|CSTM-ALL|CSTM-00|2020|PDM|1607.00|99|0.00|COVENTRY ENHANCED GROUPER 7 MOD 50
20|FH_F50432_0_0|CSTM-ALL|CSTM-00|2020|PDM|988.00|99|0.00|COVENTRY ENHANCED GROUPER 3 MOD 50
20|FH_F50459_0_0|SrvcGrp|11258|2022|PCT|0.60|99|0.00|DRUGS
20|FH_F50462_0_0|SrvcGrp|27969|2022|PDM|36.00|99|0.00|HOME HEALTH AIDE
20|FH_F50462_0_0|SrvcGrp|44428|2022|PDM|140.00|99|0.00|OCCUPATIONAL THERAPY SVCS (VISIT LVL)
20|FH_F50462_0_0|SrvcGrp|44430|2022|PDM|140.00|99|0.00|SPEECH THERAPY SVCS (VISIT LVL)
20|FH_F50462_0_0|SrvcGrp|46691|2022|PDM|36.00|99|0.00|HOME HEALTH AID SERVICES
20|FH_F50475_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F50475_0_0|CSTM-ALL|CSTM-00|2020|PDM|1205.00|99|0.00|ASPG V - FH SW CUSTOM GROUPERS
20|FH_F50475_0_0|CSTM-ALL|CSTM-00|2020|PDM|1675.00|99|0.00|ASPG VIII - FH SW CUSTOM GROUPERS
20|FH_F50475_0_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|ASPG VII - FH SW CUSTOM GROUPERS
20|FH_F50475_0_0|CSTM-ALL|CSTM-00|2020|PDM|640.00|99|0.00|ASPG I - FH SW CUSTOM GROUPERS
20|FH_F50475_0_0|CSTM-ALL|CSTM-00|2020|PDM|760.00|99|0.00|ASPG II - FH SW CUSTOM GROUPERS
20|FH_F50475_0_0|SrvcGrp|36991|2022|PCT|1.10|99|0.00|IMPLANTS
20|FH_F50475_0_0|SrvcGrp|82096|2022|PDM|1020.00|99|0.00|ASPG X - FH SW CUSTOM GROUPERS
20|FH_F50477_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F50490_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F50493_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.00|99|0.00|GENERAL ACUTE CARE
20|FH_F50494_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.00|99|0.00|OP SVCS
20|FH_F50495_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F50495_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F50498_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS
20|FH_F50515_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F50515_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F50519_0_0|CSTM-ALL|CSTM-00|2020|PDM|90.00|99|0.00|CPT CODE 96101 PER VISIT
20|FH_F50519_0_0|SrvcGrp|46766|2022|PDM|45.00|99|0.00|CPT CODE 90804 PER VISIT
20|FH_F50535_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F50535_0_0|CSTM-ALL|CSTM-00|2020|PDM|1172.00|99|0.00|COVENTRY ENHANCED GROUPER 8
20|FH_F50535_0_0|CSTM-ALL|CSTM-00|2020|PDM|401.00|99|0.00|COVENTRY ENHANCED GROUPER 1
20|FH_F50578_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F50583_0_0|SrvcGrp|472|2022|PDM|1000.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F50583_0_0|SrvcGrp|474|2022|PDM|600.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F50615_0_0|SrvcGrp|21594|2022|PDM|335.00|99|0.00|SKILLED NURSING
20|FH_F50615_0_0|SrvcGrp|43785|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY SERVICES
20|FH_F50621_0_0|CSTM-ALL|CSTM-00|2020|PCT|91.00|99|0.00|GENERAL ACUTE CARE
20|FH_F50635_0_0|SrvcGrp|3259|2022|PDM|610.00|99|0.00|ACUTE REHABILITATION
20|FH_F50652_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|OP SVCS
20|FH_F50654_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F50654_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|ASPG III
20|FH_F50654_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|ASPG V
20|FH_F50654_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|ASPG VI
20|FH_F50654_0_0|SrvcGrp|46884|2022|PCT|1.00|99|0.00|REPAIR EYELID DEFECT
20|FH_F50654_0_0|SrvcGrp|46885|2022|PCT|1.00|99|0.00|REPAIR BROW DEFECT
20|FH_F50654_0_0|SrvcGrp|46890|2022|PCT|1.00|99|0.00|IMPLANT EYE SHUNT
20|FH_F50673_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|GENERAL ACUTE CARE
20|FH_F50673_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|MS DRG 216-221, 231-232 CV SURGERY
20|FH_F50873_0_0|SrvcGrp|42827|2022|PDM|75.00|99|0.00|OCCUPATIONAL THERAPY VISIT
20|FH_F50875_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F50875_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F50952_0_0|SrvcGrp|82137|2022|PCT|0.80|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F50976_0_0|CSTM-ALL|CSTM-00|2020|PCT|74.00|99|0.00|GENERAL ACUTE CARE
20|FH_F51015_0_0|CSTM-ALL|CSTM-00|2020|PCT|67.00|99|0.00|GENERAL ACUTE CARE
20|FH_F51016_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F51016_0_0|SrvcGrp|43892|2022|PDM|90.00|99|0.00|PHYSICAL THERAPY VISIT
20|FH_F51021_0_0|CSTM-ALL|CSTM-00|2020|PCT|67.00|99|0.00|OP SVCS
20|FH_F51021_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|TRANSPLANT SVCS
20|FH_F51074_0_0|SrvcGrp|10667|2022|PDM|701.00|99|0.00|BOARDER BABY SVCS
20|FH_F51074_0_0|SrvcGrp|16|2022|PDM|935.00|99|0.00|ACUTE REHABILITATION
20|FH_F51074_0_0|SrvcGrp|3409|2022|PDM|392.00|99|0.00|NEWBORN NURSERY
20|FH_F51074_0_0|SrvcGrp|80|2022|PDM|607.00|99|0.00|ACUTE PSYCH
20|FH_F51074_0_0|SrvcGrp|9510|2022|PDM|545.00|99|0.00|SKILLED NURSING CARE
20|FH_F51115_0_0|SrvcGrp|22954|2022|PDM|133.87|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F51115_0_0|SrvcGrp|42763|2022|PDM|120.98|99|0.00|SKILLED NURSING CARE VISIT
20|FH_F51115_0_0|SrvcGrp|42828|2022|PDM|108.24|99|0.00|SPEECH THERAPY VISIT
20|FH_F51120_0_0|SrvcGrp|22954|2022|PDM|157.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F51121_0_0|SrvcGrp|22954|2022|PDM|148.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F51123_0_0|SrvcGrp|10519|2022|PDM|141.75|99|0.00|MEDICAL SOCIAL WORKER VISIT
20|FH_F51123_0_0|SrvcGrp|10623|2022|PDM|120.75|99|0.00|SPEECH THERAPY SERVICES
20|FH_F51123_0_0|SrvcGrp|11796|2022|PDM|115.00|99|0.00|DIETICIAN
20|FH_F51123_0_0|SrvcGrp|22954|2022|PDM|160.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F51123_0_0|SrvcGrp|26001|2022|PDM|150.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F51123_0_0|SrvcGrp|26160|2022|PDM|38.00|99|0.00|HOME HEALTH AIDE VISIT
20|FH_F51123_0_0|SrvcGrp|29406|2022|PDM|124.00|99|0.00|PHYSICAL THERAPY
20|FH_F51123_0_0|SrvcGrp|40582|2022|PDM|250.00|99|0.00|HOSPICE SVCS
20|FH_F51124_0_0|CSTM-ALL|CSTM-00|2020|PDM|146.00|99|0.00|HI TECH NURSING
20|FH_F51124_0_0|SrvcGrp|10519|2022|PDM|141.75|99|0.00|MEDICAL SOCIAL WORKER VISIT
20|FH_F51124_0_0|SrvcGrp|10623|2022|PDM|120.75|99|0.00|SPEECH THERAPY SERVICES
20|FH_F144228_0_0|SrvcGrp|11663|2022|PCT|1.10|99|0.00|IMPLANTS
20|FH_F144228_0_0|SrvcGrp|22915|2022|PDM|2647.00|99|0.00|CPT CODE 42820
20|FH_F144228_0_0|SrvcGrp|64735|2022|PDM|936.00|99|0.00|CPT 43235
20|FH_F144228_0_0|SrvcGrp|64744|2022|PDM|926.00|99|0.00|CPT 45331
20|FH_F144228_0_0|SrvcGrp|85985|2022|PDM|1637.00|99|0.00|CPT 11404
20|FH_F144228_0_0|SrvcGrp|96349|2022|PDM|17085.00|99|0.00|NECK SPINE FUSE
20|FH_F144228_0_0|SrvcGrp|99073|2022|PCT|0.00|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F144248_0_0|CSTM-ALL|CSTM-00|2020|PDM|1473.00|99|0.00|AEG 10 (NO REV)
20|FH_F144248_0_0|CSTM-ALL|CSTM-00|2020|PDM|1499.00|99|0.00|AEG 5  (NO REV)
20|FH_F144248_0_0|CSTM-ALL|CSTM-00|2020|PDM|4590.00|99|0.00|IMPLANTS
20|FH_F144248_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F144248_0_0|SrvcGrp|109346|2022|PDM|4590.00|99|0.00|EXCISION OF CHALAZION DIFFERENT LIDS
20|FH_F144248_0_0|SrvcGrp|109760|2022|PDM|6885.00|99|0.00|TRANSLUM DIL EYE CANAL
20|FH_F144248_0_0|SrvcGrp|109761|2022|PDM|4590.00|99|0.00|REMOVE EYELID LESIONS
20|FH_F144248_0_0|SrvcGrp|46886|2022|PDM|4590.00|99|0.00|REMOVAL OF EYELID LESION
20|FH_F144248_0_0|SrvcGrp|77507|2022|PCT|1.04|99|0.00|AETNA CORNEAL TISSUE HANDLING
20|FH_F144248_0_0|SrvcGrp|84280|2022|PDM|9754.00|99|0.00|CORNEAL TRANSPLANT
20|FH_F144248_0_0|SrvcGrp|84934|2022|PDM|6885.00|99|0.00|REMOVAL OF EYE LESION
20|FH_F144248_0_0|SrvcGrp|91759|2022|PCT|1.04|99|0.00|OCULAR IMPLANT
20|FH_F144291_0_0|SrvcGrp|107748|2022|PDM|424.00|99|0.00|HEMODIALYSIS IN CENTER
20|FH_F144327_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F144327_0_0|SrvcGrp|87077|2022|PDM|138.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F144648_0_0|SrvcGrp|107749|2022|PDM|182.00|99|0.00|CAPD/CCPD
20|FH_F144648_0_0|SrvcGrp|108043|2022|PDM|182.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD
20|FH_F144651_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F144651_0_0|SrvcGrp|113843|2022|PDM|15500.00|99|0.00|REVISE KNEE
20|FH_F144651_0_0|SrvcGrp|114174|2022|PDM|6600.00|99|0.00|REMOVE/REINSER SPINE FIXATION DEVICE
20|FH_F144651_0_0|SrvcGrp|96350|2022|PDM|15000.00|99|0.00|SHOULDER JOINT
20|FH_F144651_0_0|SrvcGrp|98565|2022|PDM|15000.00|99|0.00|LUMBAR SPINE FUSION COMBINED
20|FH_F144651_0_0|SrvcGrp|98566|2022|PDM|15000.00|99|0.00|ARTHRDSIS LAT MINI DISKECT
20|FH_F144769_0_0|SrvcGrp|11336|2022|PCT|0.21|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F144769_0_0|SrvcGrp|16|2022|PDM|2002.00|99|0.00|ACUTE REHABILITATION
20|FH_F144769_0_0|SrvcGrp|361|2022|PDM|2309.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F144769_0_0|SrvcGrp|4035|2022|PDM|15400.00|99|0.00|DRG 334 MAJ MALE PELVIC PROC  W/CC
20|FH_F144769_0_0|SrvcGrp|4040|2022|PDM|12320.00|99|0.00|DRG 335 MAJ MALE PELVIC PROC W/O CC
20|FH_F144769_0_0|SrvcGrp|73559|2022|PDM|3390.00|99|0.00|AETNA INTENSIVE CARE
20|FH_F144808_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F144808_0_0|CSTM-ALL|CSTM-00|2020|PDM|1155.00|99|0.00|AEG 1 (NO REV)
20|FH_F144808_0_0|CSTM-ALL|CSTM-00|2020|PDM|2133.00|99|0.00|AEG 4 (NO REV)
20|FH_F144808_0_0|SrvcGrp|35669|2022|PDM|4812.00|99|0.00|CPT 63650
20|FH_F144808_0_0|SrvcGrp|36591|2022|PDM|4812.00|99|0.00|CPT 63685
20|FH_F144808_0_0|SrvcGrp|67065|2022|PDM|7699.00|99|0.00|CERVICAL SURGERY
20|FH_F144808_0_0|SrvcGrp|74039|2022|PDM|7215.00|99|0.00|LAMINECTOMY
20|FH_F144808_0_0|SrvcGrp|78096|2022|PDM|2888.00|99|0.00|AETNA ARTHROSCOPY BICEPS
20|FH_F144808_0_0|SrvcGrp|88164|2022|PDM|7699.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR
20|FH_F144808_0_0|SrvcGrp|88491|2022|PDM|7215.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR
20|FH_F144808_0_0|SrvcGrp|90343|2022|PDM|7215.00|99|0.00|CERVICE CORPECTOMY 1 LEVEL
20|FH_F144808_0_0|SrvcGrp|95559|2022|PDM|7215.00|99|0.00|HIP JOINT
20|FH_F144808_0_0|SrvcGrp|98495|2022|PDM|7699.00|99|0.00|ARTHRODESIS POSTERIOR TECH
20|FH_F144828_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F144828_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F144828_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|AEG 5  (NO REV)
20|FH_F144828_0_0|SrvcGrp|104946|2022|PDM|2241.00|99|0.00|REMOVAL OF BREAST CAPSULE
20|FH_F144828_0_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS
20|FH_F144828_0_0|SrvcGrp|114192|2022|PDM|2970.00|99|0.00|FLAPS AND GRAFTS PROCEDURES
20|FH_F144828_0_0|SrvcGrp|114196|2022|PDM|1176.00|99|0.00|SKIN TISSUE REARRANGEMENT
20|FH_F144828_0_0|SrvcGrp|114197|2022|PDM|1100.00|99|0.00|REPAIR NASAL SEPTAL FRACTURE
20|FH_F144848_0_0|CSTM-ALL|CSTM-00|2020|PDM|474.00|99|0.00|AEG 2 (NO REV)
20|FH_F144848_0_0|CSTM-ALL|CSTM-00|2020|PDM|842.00|99|0.00|AEG 3 (NO REV)
20|FH_F144848_0_0|SrvcGrp|93741|2022|PDM|5825.00|99|0.00|REVISE SPINE ELECTRODE PERCUTANEOUS ARRAY
20|FH_F144848_0_0|SrvcGrp|98360|2022|PDM|3700.00|99|0.00|AETNA LAMINECTOMY W/FACE-LUMBAR
20|FH_F144848_0_0|SrvcGrp|98584|2022|PDM|16065.00|99|0.00|TOTAL DISC ARTHROPLASTY
20|FH_F145188_0_0|CSTM-ALL|CSTM-00|2020|PDM|1080.00|99|0.00|AEG 8 (NO REV)
20|FH_F145188_0_0|CSTM-ALL|CSTM-00|2020|PDM|1104.00|99|0.00|AEG 7 (NO REV)
20|FH_F145188_0_0|CSTM-ALL|CSTM-00|2020|PDM|369.00|99|0.00|AEG 1 (NO REV)
20|FH_F145188_0_0|CSTM-ALL|CSTM-00|2020|PDM|699.00|99|0.00|AEG 4 (NO REV)
20|FH_F145268_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.35|99|0.00|HSS ASC
20|FH_F145448_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F145448_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 10 (NO REV)
20|FH_F145448_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|AEG 7 (NO REV)
20|FH_F145448_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS
20|FH_F145508_0_0|SrvcGrp|82222|2022|PDM|181.21|99|0.00|HOSPICE CARE
20|FH_F145543_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F145543_0_0|CSTM-ALL|CSTM-00|2020|PDM|425.00|99|0.00|AEG 2 (NO REV)
20|FH_F145543_0_0|SrvcGrp|104723|2022|PDM|931.00|99|0.00|REPAIR EYELID DEFECT
20|FH_F145543_0_0|SrvcGrp|113195|2022|PDM|770.00|99|0.00|REINFORCE/GRAFT EYE WALL
20|FH_F145563_0_0|SrvcGrp|87077|2022|PDM|150.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F145567_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|OP SVCS
20|FH_F145568_0_0|SrvcGrp|46903|2022|PDM|660.00|99|0.00|RESIDENTIAL TREATMENT
20|FH_F145587_0_0|CSTM-ALL|CSTM-00|2020|PDM|1262.70|99|0.00|RELEASE OF TOE JOINT
20|FH_F51124_0_0|SrvcGrp|15385|2022|PDM|141.75|99|0.00|SKILLED NURSING NON IV RELATED
20|FH_F51124_0_0|SrvcGrp|26001|2022|PDM|150.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F51124_0_0|SrvcGrp|29406|2022|PDM|124.00|99|0.00|PHYSICAL THERAPY
20|FH_F51129_0_0|CSTM-ALL|CSTM-00|2020|PDM|3657.00|99|0.00|MS DRG 765-766 C-SECTION
20|FH_F51129_0_0|CSTM-ALL|CSTM-00|2020|PDM|6000.00|99|0.00|IP SURGERY
20|FH_F51129_0_0|SrvcGrp|14727|2022|PCT|0.92|99|0.00|TRAUMA CARE
20|FH_F51129_0_0|SrvcGrp|17969|2022|PCT|0.55|99|0.00|INVESTIGATIONAL DEVICES
20|FH_F51129_0_0|SrvcGrp|30063|2022|PCT|0.55|99|0.00|HIGH COST DRUGS
20|FH_F51129_0_0|SrvcGrp|30067|2022|PCT|0.75|99|0.00|LASER BRONCHOSCOPY
20|FH_F51135_0_0|SrvcGrp|22954|2022|PDM|148.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F51136_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.69|99|0.00|OP SVCS
20|FH_F51136_0_0|SrvcGrp|14938|2022|PDM|1575.00|99|0.00|PROGRESSIVE TELEMETRY
20|FH_F51136_0_0|SrvcGrp|3142|2022|PDM|1775.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F51138_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F51138_0_0|SrvcGrp|22954|2022|PDM|157.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F51192_0_0|SrvcGrp|33165|2022|PDM|450.00|99|0.00|SKILLED NURSING - LEVEL II
20|FH_F51258_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE
20|FH_F51258_0_0|SrvcGrp|43284|2022|PDM|81.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F51272_0_0|CSTM-ALL|CSTM-00|2020|PDM|28000.00|99|0.00|STEREOTACTIC RADIOSURGERY
20|FH_F51272_0_0|SrvcGrp|33751|2022|PCT|0.65|99|0.00|OP SURGERY
20|FH_F51272_0_0|SrvcGrp|3418|2022|PDM|5500.00|99|0.00|NEONATAL INTENSIVE CARE UNIT
20|FH_F51272_0_0|SrvcGrp|36138|2022|PDM|6500.00|99|0.00|ACUTE IP SURGICAL SVCS - FIRST DAY
20|FH_F51272_0_0|SrvcGrp|4109|2022|PDM|1200.00|99|0.00|ACUTE PSYCH
20|FH_F51358_0_0|SrvcGrp|44428|2022|PDM|125.00|99|0.00|OCCUPATIONAL THERAPY SVCS (VISIT LVL)
20|FH_F51358_0_0|SrvcGrp|45949|2022|PDM|125.00|99|0.00|OCCUPATIONAL THERAPY SVCS
20|FH_F51374_0_0|CSTM-ALL|CSTM-00|2020|PCT|69.00|99|0.00|OP SVCS
20|FH_F51478_0_0|SrvcGrp|40222|2022|PDM|80.00|99|0.00|OP SVCS
20|FH_F51492_0_0|SrvcGrp|44131|2022|PDM|75.00|99|0.00|SPEECH THERAPY VISIT
20|FH_F51518_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F51541_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|OP SVCS
20|FH_F51545_0_0|SrvcGrp|42824|2022|PDM|135.00|99|0.00|SKILLED NURSING VISIT
20|FH_F51545_0_0|SrvcGrp|42827|2022|PDM|150.00|99|0.00|OCCUPATIONAL THERAPY VISIT
20|FH_F51545_0_0|SrvcGrp|42830|2022|PDM|190.00|99|0.00|MEDICAL SOCIAL WORKER VISIT
20|FH_F51545_0_0|SrvcGrp|43429|2022|PDM|145.00|99|0.00|RN HOURLY, HIGH TECH PEDS
20|FH_F51545_0_0|SrvcGrp|45784|2022|PDM|160.00|99|0.00|NUTRITIONAL SERVICES (RD)
20|FH_F51548_0_0|SrvcGrp|10540|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE
20|FH_F51548_0_0|SrvcGrp|10545|2022|PDM|125.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F51572_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.80|99|0.00|GENERAL ACUTE CARE
20|FH_F51572_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.80|99|0.00|OP SVCS
20|FH_F51658_0_0|SrvcGrp|44427|2022|PDM|105.00|99|0.00|PHYSICAL THERAPY SVCS (VISIT LVL)
20|FH_F51674_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE
20|FH_F51733_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F51733_0_0|SrvcGrp|44427|2022|PDM|105.00|99|0.00|PHYSICAL THERAPY SVCS (VISIT LVL)
20|FH_F51733_0_0|SrvcGrp|45924|2022|PDM|46.00|99|0.00|HOME HEALTH AIDE
20|FH_F51733_0_0|SrvcGrp|45949|2022|PDM|105.00|99|0.00|OCCUPATIONAL THERAPY SVCS
20|FH_F51934_0_0|SrvcGrp|46424|2022|PDM|100.00|99|0.00|HI TECH SKILLED NURSING SERVICES
20|FH_F51934_0_0|SrvcGrp|48394|2022|PDM|55.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F51934_0_0|SrvcGrp|48397|2022|PDM|110.00|99|0.00|PT SERVICES
20|FH_F52112_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F52172_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F52276_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F52278_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F52278_0_0|CSTM-ALL|CSTM-00|2020|PDM|765.00|99|0.00|ASPG II
20|FH_F52278_0_0|CSTM-ALL|CSTM-00|2020|PDM|765.00|99|0.00|ASPG X
20|FH_F52393_0_0|CSTM-ALL|CSTM-00|2020|PDM|4600.00|99|0.00|HEARING AID
20|FH_F52393_0_0|SrvcGrp|49103|2022|PDM|950.00|99|0.00|HEARING AID
20|FH_F52452_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F52513_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F52516_0_0|SrvcGrp|3327|2022|PDM|139.76|99|0.00|HOSPICE SERVICE - IP RESPITE
20|FH_F52534_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F52614_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F52653_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F52713_0_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|ACUTE PSYCH
20|FH_F52713_0_0|CSTM-ALL|CSTM-00|2020|PDM|5000.00|99|0.00|OP SVCS
20|FH_F52713_0_0|SrvcGrp|14552|2022|PDM|9103.00|99|0.00|LITHOTRIPSY
20|FH_F52713_0_0|SrvcGrp|20293|2022|PDM|46751.00|99|0.00|MS DRG 235-236 ONLY CV SURGERY
20|FH_F52713_0_0|SrvcGrp|20299|2022|PDM|61273.00|99|0.00|MS DRG 228-230 ONLY OTHER CARDIOTHORACIC PROC
20|FH_F52713_0_0|SrvcGrp|28002|2022|PDM|28429.00|99|0.00|MS DRG 253-254 ONLY
20|FH_F52713_0_0|SrvcGrp|30623|2022|PDM|10075.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788
20|FH_F52713_0_0|SrvcGrp|360|2022|PDM|4000.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F52713_0_0|SrvcGrp|38980|2022|PDM|29283.00|99|0.00|MSDRG 246-249 ONLY
20|FH_F52713_0_0|SrvcGrp|41367|2022|PDM|34802.00|99|0.00|MS DRG 242-244 ONLY
20|FH_F52713_0_0|SrvcGrp|42782|2022|PDM|240.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F52713_0_0|SrvcGrp|42785|2022|PDM|240.00|99|0.00|SPEECH THERAPY  SRVCS
20|FH_F52713_0_0|SrvcGrp|49064|2022|PCT|0.65|99|0.00|OP BRACHYTHERAPY
20|FH_F52713_0_0|SrvcGrp|49462|2022|PDM|250.00|99|0.00|HOMECARE
20|FH_F52713_0_0|SrvcGrp|50062|2022|PCT|0.60|99|0.00|IMRT
20|FH_F52713_0_0|SrvcGrp|51643|2022|PDM|4000.00|99|0.00|LABORATORY
20|FH_F52713_0_0|SrvcGrp|62153|2022|PDM|4000.00|99|0.00|RADIOLOGY SVCS
20|FH_F52713_0_0|SrvcGrp|70241|2022|PCT|0.32|99|0.00|DIALYSIS
20|FH_F52713_0_0|SrvcGrp|9984|2022|PDM|247.00|99|0.00|URGENT CARE
20|FH_F52753_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|ASPG II
20|FH_F52753_0_0|SrvcGrp|36991|2022|PCT|1.10|99|0.00|IMPLANTS
20|FH_F52753_0_0|SrvcGrp|49204|2022|PDM|1700.00|99|0.00|VITRECTOMY
20|FH_F52753_0_0|SrvcGrp|49206|2022|PDM|1700.00|99|0.00|CORNEAL TRANSPLANTS
20|FH_F52754_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|GENERAL ACUTE CARE
20|FH_F52754_0_0|CSTM-ALL|CSTM-00|2020|PDM|95.00|99|0.00|PHYSICAL THERAPY VISIT
20|FH_F52772_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F52772_0_0|SrvcGrp|473|2022|PDM|550.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F52795_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE
20|FH_F52795_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS
20|FH_F52872_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F52872_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F52872_0_0|CSTM-ALL|CSTM-00|2020|PDM|1066.00|99|0.00|WILLS COMM SURG SVC ASC 11
20|FH_F52872_0_0|CSTM-ALL|CSTM-00|2020|PDM|1125.00|99|0.00|WILLS COMM SURG SVC ASC 4
20|FH_F52872_0_0|CSTM-ALL|CSTM-00|2020|PDM|1304.00|99|0.00|WILLS COMM SURG SVC ASC 5
20|FH_F52872_0_0|CSTM-ALL|CSTM-00|2020|PDM|1779.00|99|0.00|WILLS COMM SURG SVC ASC 7
20|FH_F52872_0_0|CSTM-ALL|CSTM-00|2020|PDM|2255.00|99|0.00|WILLS COMM SURG SVC ASC 9
20|FH_F52956_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F52956_0_0|SrvcGrp|12709|2022|PDM|167.68|99|0.00|OP DIALYSIS
20|FH_F52992_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F53094_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F53373_0_0|CSTM-ALL|CSTM-00|2020|PDM|435.00|99|0.00|ASPG I
20|FH_F53373_0_0|CSTM-ALL|CSTM-00|2020|PDM|580.00|99|0.00|ASPG II
20|FH_F53592_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE
20|FH_F53932_0_0|CSTM-ALL|CSTM-00|2020|PCT|53.00|99|0.00|GENERAL ACUTE CARE
20|FH_F53932_0_0|CSTM-ALL|CSTM-00|2020|PCT|53.00|99|0.00|OP SVCS
20|FH_F54052_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F54056_0_0|SrvcGrp|3809|2022|PDM|601.02|99|0.00|HOSPICE CARE
20|FH_F54172_0_0|SrvcGrp|14254|2022|PDM|52.00|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F54212_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS
20|FH_F54272_0_0|CSTM-ALL|CSTM-00|2020|PDM|1075.00|99|0.00|ASPG I
20|FH_F54272_0_0|CSTM-ALL|CSTM-00|2020|PDM|1225.00|99|0.00|ASPG II
20|FH_F54272_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|ASPG X
20|FH_F54272_0_0|CSTM-ALL|CSTM-00|2020|PDM|2041.00|99|0.00|ASPG VII
20|FH_F54272_0_0|CSTM-ALL|CSTM-00|2020|PDM|2122.00|99|0.00|ASPG VIII
20|FH_F54272_0_0|SrvcGrp|10708|2022|PDM|125.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F54272_0_0|SrvcGrp|12019|2022|PDM|125.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F54272_0_0|SrvcGrp|409|2022|PDM|590.00|99|0.00|ER SVCS
20|FH_F54272_0_0|SrvcGrp|9541|2022|PDM|125.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F54293_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F54372_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F54372_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F54432_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS
20|FH_F54513_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F54513_0_0|SrvcGrp|10537|2022|PDM|85.00|99|0.00|NURSING CARE
20|FH_F54513_0_0|SrvcGrp|10545|2022|PDM|110.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F54513_0_0|SrvcGrp|22387|2022|PDM|55.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F54513_0_0|SrvcGrp|44423|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE (VISIT LVL)
20|FH_F54532_0_0|CSTM-ALL|CSTM-00|2020|PDM|973.00|99|0.00|ACUTE PSYCHIATRIC
20|FH_F54532_0_0|SrvcGrp|24090|2022|PDM|973.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F54572_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F54572_0_0|SrvcGrp|10393|2022|PDM|1900.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F54614_0_0|SrvcGrp|50903|2022|PDM|75.00|99|0.00|SOCIAL WORKER
20|FH_F54652_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F54652_0_0|CSTM-ALL|CSTM-00|2020|PDM|1046.08|99|0.00|ASPG VII
20|FH_F54752_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F54752_0_0|CSTM-ALL|CSTM-00|2020|PDM|446.00|99|0.00|ASPG II
20|FH_F54752_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|ASPG X
20|FH_F54752_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|ASPG VI
20|FH_F54752_0_0|CSTM-ALL|CSTM-00|2020|PDM|973.00|99|0.00|ASPG VIII
20|FH_F55054_0_0|SrvcGrp|28074|2022|PCT|0.65|99|0.00|HIGH COST PHARMACEUTICALS
20|FH_F55054_0_0|SrvcGrp|360|2022|PDM|2465.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F55054_0_0|SrvcGrp|51276|2022|PCT|0.70|99|0.00|TRANSPLANT
20|FH_F55054_0_0|SrvcGrp|941|2022|PDM|3245.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F55113_0_0|SrvcGrp|3069|2022|PCT|0.60|99|0.00|IMPLANTS
20|FH_F55113_0_0|SrvcGrp|361|2022|PDM|3270.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F55113_0_0|SrvcGrp|51269|2022|PDM|29400.00|99|0.00|GAMMA
20|FH_F55113_0_0|SrvcGrp|9939|2022|PDM|1500.00|99|0.00|ACUTE MEDICAL SVCS
20|FH_F55212_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F55212_0_0|CSTM-ALL|CSTM-00|2020|PDM|655.00|99|0.00|GENERAL ACUTE CARE
20|FH_F55212_0_0|SrvcGrp|27253|2022|PDM|78.00|99|0.00|INDIVIDUAL PSYCHOTHERAPY
20|FH_F55212_0_0|SrvcGrp|3390|2022|PDM|130.00|99|0.00|CPT 90801
20|FH_F55212_0_0|SrvcGrp|3398|2022|PDM|43.00|99|0.00|CPT 90853 GROUP PSYCHOTHERAPY
20|FH_F55212_0_0|SrvcGrp|51122|2022|PDM|22.00|99|0.00|THERAPEUTIC BEHAVIORAL SERVICES
20|FH_F55453_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F55532_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F55532_0_0|SrvcGrp|472|2022|PDM|775.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F55552_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|IMPLANTS/PROSTHETICS/DEVICES
20|FH_F55552_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F55574_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.86|99|0.00|GENERAL ACUTE CARE
20|FH_F55574_0_0|SrvcGrp|9511|2022|PCT|0.86|99|0.00|OBSERVATION SVCS
20|FH_F55577_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F55634_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS
20|FH_F55653_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F55694_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.64|99|0.00|OP SVCS
20|FH_F55694_0_0|CSTM-ALL|CSTM-00|2020|PDM|7187.00|99|0.00|MS DRG 765-766 C-SECTION
20|FH_F55694_0_0|SrvcGrp|19846|2022|PDM|20847.00|99|0.00|MS DRG 249 ONLY
20|FH_F55694_0_0|SrvcGrp|19961|2022|PDM|51792.00|99|0.00|MS DRG 231-232 ONLY CORONARY BYPASS W/ PTCA
20|FH_F55694_0_0|SrvcGrp|20293|2022|PDM|40140.00|99|0.00|MS DRG 235-236 ONLY CV SURGERY
20|FH_F55694_0_0|SrvcGrp|20900|2022|PDM|20847.00|99|0.00|MS DRG 248 ONLY
20|FH_F55694_0_0|SrvcGrp|28170|2022|PDM|3497.00|99|0.00|ICU/CCU
20|FH_F55694_0_0|SrvcGrp|31038|2022|PDM|40140.00|99|0.00|MS DRG 233-234 ONLY
20|FH_F55694_0_0|SrvcGrp|3409|2022|PDM|441.00|99|0.00|NEWBORN NURSERY
20|FH_F55694_0_0|SrvcGrp|360|2022|PDM|744.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F55694_0_0|SrvcGrp|361|2022|PDM|965.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F55694_0_0|SrvcGrp|941|2022|PDM|3087.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F55812_0_0|SrvcGrp|10542|2022|PDM|70.00|99|0.00|OCCUPATIONAL THERAPY SVCS
20|FH_F55812_0_0|SrvcGrp|10545|2022|PDM|70.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F55812_0_0|SrvcGrp|53746|2022|PDM|35.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F55872_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F55874_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F55893_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F55893_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F55895_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F56054_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|PROFESSIONAL FEES ON UB04
20|FH_F56054_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F56054_0_0|CSTM-ALL|CSTM-00|2020|PCT|9000.00|99|0.00|TIMELY FILING
20|FH_F56112_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|GENERAL ACUTE CARE
20|FH_F56136_0_0|SrvcGrp|17379|2022|PCT|0.92|99|0.00|CCPD TRAINING
20|FH_F56136_0_0|SrvcGrp|19661|2022|PCT|0.85|99|0.00|MS DRG 216-218 ONLY CARDIAC VALVE PROCEDURE W/CARDIAC CATH
20|FH_F56136_0_0|SrvcGrp|20752|2022|PCT|0.85|99|0.00|MSDRG 619-621 ONLY BARIATRIC SURGERY
20|FH_F56136_0_0|SrvcGrp|21354|2022|PCT|0.85|99|0.00|MS DRG 250-251 ONLY
20|FH_F56136_0_0|SrvcGrp|22812|2022|PCT|0.92|99|0.00|ENDOSCOPY
20|FH_F56136_0_0|SrvcGrp|22814|2022|PCT|0.92|99|0.00|LAPAROSCOPIC APPENDECTOMY
20|FH_F56136_0_0|SrvcGrp|22818|2022|PCT|0.92|99|0.00|ACL
20|FH_F56136_0_0|SrvcGrp|22822|2022|PCT|0.92|99|0.00|CPAP
20|FH_F56136_0_0|SrvcGrp|3029|2022|PDM|603.00|99|0.00|NEWBORN NURSERY
20|FH_F56136_0_0|SrvcGrp|30623|2022|PDM|2039.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788
20|FH_F56136_0_0|SrvcGrp|31038|2022|PCT|0.85|99|0.00|MS DRG 233-234 ONLY
20|FH_F56136_0_0|SrvcGrp|3224|2022|PCT|0.92|99|0.00|EMERGENCY ROOM SVCS
20|FH_F56136_0_0|SrvcGrp|38980|2022|PCT|0.85|99|0.00|MSDRG 246-249 ONLY
20|FH_F56136_0_0|SrvcGrp|63|2022|PDM|803.00|99|0.00|SUBACUTE CARE
20|FH_F56276_0_0|SrvcGrp|26777|2022|PDM|85.00|99|0.00|CPT 90806
20|FH_F56276_0_0|SrvcGrp|52243|2022|PDM|135.00|99|0.00|METH MAINTENANCE
20|FH_F56276_0_0|SrvcGrp|52245|2022|PDM|160.00|99|0.00|INTENSIVE OUTPATIENT
20|FH_F56276_0_0|SrvcGrp|52955|2022|PDM|175.00|99|0.00|HISTORY AND PHYSICAL
20|FH_F56472_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F56472_0_0|SrvcGrp|29406|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY
20|FH_F56472_0_0|SrvcGrp|36068|2022|PDM|40.00|99|0.00|SKILLED NURSING NON IV RELATED
20|FH_F56472_0_0|SrvcGrp|46605|2022|PDM|85.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES
20|FH_F56512_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F56512_0_0|SrvcGrp|42871|2022|PDM|60.00|99|0.00|SPEECH THERAPY VISIT
20|FH_F56573_0_0|SrvcGrp|10708|2022|PDM|60.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F56573_0_0|SrvcGrp|9541|2022|PDM|60.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F56693_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F56813_0_0|SrvcGrp|103730|2022|PDM|171.00|99|0.00|PHYSICAL THERAPY
20|FH_F56813_0_0|SrvcGrp|103731|2022|PDM|171.00|99|0.00|SPEECH THERAPY
20|FH_F56813_0_0|SrvcGrp|31970|2022|PDM|200.00|99|0.00|OP THERAPY SERVICES (INITIAL EVAL)
20|FH_F56833_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F56952_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE
20|FH_F56972_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F56972_0_0|SrvcGrp|23401|2022|PDM|18.00|99|0.00|RT/PT/ST/OT
20|FH_F57032_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F57032_0_0|SrvcGrp|53482|2022|PDM|70.00|99|0.00|GLUCOSE METER
20|FH_F57032_0_0|SrvcGrp|53483|2022|PDM|34.00|99|0.00|TEST STRIPS
20|FH_F57073_0_0|CSTM-ALL|CSTM-00|2020|PDM|1292.00|99|0.00|ACUTE IP MED SVCS
20|FH_F57073_0_0|SrvcGrp|16|2022|PDM|1140.00|99|0.00|ACUTE REHABILITATION
20|FH_F57073_0_0|SrvcGrp|3081|2022|PCT|0.75|99|0.00|OBSERVATION SVCS
20|FH_F57073_0_0|SrvcGrp|72|2022|PDM|267.00|99|0.00|NEWBORN NURSERY
20|FH_F57073_0_0|SrvcGrp|997|2022|PCT|0.75|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F57093_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F57093_0_0|SrvcGrp|3087|2022|PDM|652.00|99|0.00|CD - DETOX
20|FH_F57093_0_0|SrvcGrp|3934|2022|PDM|170.00|99|0.00|INTENSIVE ADULT DUAL DIAGNOSIS
20|FH_F57093_0_0|SrvcGrp|80|2022|PDM|652.00|99|0.00|ACUTE PSYCH
20|FH_F57312_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|GENERAL ACUTE CARE
20|FH_F57372_0_0|SrvcGrp|45882|2022|PDM|110.00|99|0.00|PT
20|FH_F57372_0_0|SrvcGrp|53743|2022|PDM|1560.00|99|0.00|ICU (VENT DEPENDENT MEDICALLY COMPLEX)
20|FH_F57372_0_0|SrvcGrp|53744|2022|PDM|1275.00|99|0.00|MEDICAL/SURGICAL
20|FH_F57396_0_0|SrvcGrp|46586|2022|PDM|160.00|99|0.00|CPT 99205
20|FH_F57396_0_0|SrvcGrp|46588|2022|PDM|80.00|99|0.00|CPT 99212
20|FH_F57396_0_0|SrvcGrp|46591|2022|PDM|100.00|99|0.00|CPT 99213
20|FH_F57396_0_0|SrvcGrp|46593|2022|PDM|160.00|99|0.00|CPT 99215
20|FH_F57592_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.67|99|0.00|OP SVCS
20|FH_F57592_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|FORM H MOD 26
20|FH_F57592_0_0|CSTM-ALL|CSTM-00|2020|PDM|10000.00|99|0.00|ACUTE IP SVCS ONE DAY STAY
20|FH_F57592_0_0|SrvcGrp|11000|2022|PCT|0.50|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F57592_0_0|SrvcGrp|20914|2022|PDM|91500.00|99|0.00|MS DRG 233 ONLY
20|FH_F57592_0_0|SrvcGrp|20968|2022|PDM|27500.00|99|0.00|MS DRG 480 ONLY
20|FH_F57592_0_0|SrvcGrp|31020|2022|PDM|18000.00|99|0.00|MS DRG 470 ONLY
20|FH_F57592_0_0|SrvcGrp|33789|2022|PDM|2200.00|99|0.00|MS DRG 880-887 ONLY
20|FH_F57592_0_0|SrvcGrp|34557|2022|PDM|2200.00|99|0.00|MS DRG 894-897 ONLY CHEM DEP
20|FH_F57592_0_0|SrvcGrp|53962|2022|PDM|201471.00|99|0.00|LIVER TRANSPLANT SURGERY
20|FH_F57592_0_0|SrvcGrp|9517|2022|PDM|250.00|99|0.00|MAMMOGRAPHY
20|FH_F57592_0_0|SrvcGrp|9793|2022|PDM|800.00|99|0.00|NEWBORN NURSERY
20|FH_F57834_0_0|SrvcGrp|9774|2022|PDM|1628.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F57853_0_0|CSTM-ALL|CSTM-00|2020|PCT|68.80|99|0.00|GENERAL ACUTE CARE
20|FH_F57956_0_0|CSTM-ALL|CSTM-00|2020|PCT|76.00|99|0.00|OP SVCS
20|FH_F58014_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F58053_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F58053_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F58173_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F58215_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F58252_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F58252_0_0|SrvcGrp|46605|2022|PDM|35.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES
20|FH_F58252_0_0|SrvcGrp|48394|2022|PDM|8.50|99|0.00|SKILLED NURSING SERVICES
20|FH_F58272_0_0|SrvcGrp|44326|2022|PDM|60.00|99|0.00|PT & OT (VISIT LVL) OT MOD GO
20|FH_F58292_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F58313_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|OP SVCS
20|FH_F58514_0_0|SrvcGrp|44302|2022|PDM|60.00|99|0.00|PT & OT (VISIT LVL) PT MOD GP
20|FH_F58636_0_0|CSTM-ALL|CSTM-00|2020|PCT|81.00|99|0.00|OP SVCS
20|FH_F58692_0_0|SrvcGrp|3066|2022|PCT|0.50|99|0.00|HIGH-COST DRUGS
20|FH_F58713_0_0|CSTM-ALL|CSTM-00|2020|PDM|1171.00|99|0.00|ASPG V
20|FH_F58713_0_0|CSTM-ALL|CSTM-00|2020|PDM|728.00|99|0.00|ASPG II
20|FH_F58713_0_0|CSTM-ALL|CSTM-00|2020|PDM|833.00|99|0.00|ASPG III
20|FH_F58713_0_0|SrvcGrp|15472|2022|PDM|544.00|99|0.00|CPT CODE 62284
20|FH_F58856_0_0|CSTM-ALL|CSTM-00|2020|PDM|1725.00|99|0.00|CD SERVICES
20|FH_F58856_0_0|CSTM-ALL|CSTM-00|2020|PDM|32500.00|99|0.00|MS DRG 237 ONLY
20|FH_F58856_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|MS DRG 774-775, 767-768 NORMAL DELIVERY (MS DRG ONLY)
20|FH_F58856_0_0|SrvcGrp|17967|2022|PDM|3125.00|99|0.00|ICU / CCU
20|FH_F58856_0_0|SrvcGrp|20912|2022|PDM|28750.00|99|0.00|MS DRG 236 ONLY
20|FH_F58856_0_0|SrvcGrp|28164|2022|PDM|43750.00|99|0.00|MS DRG 224 ONLY
20|FH_F58856_0_0|SrvcGrp|29757|2022|PDM|17250.00|99|0.00|MS DRG 251 ONLY
20|FH_F58856_0_0|SrvcGrp|361|2022|PDM|2000.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F58856_0_0|SrvcGrp|54966|2022|PCT|0.50|99|0.00|IMPLANTS/PROSTHETICS/HIGH COST DRUGS
20|FH_F58856_0_0|SrvcGrp|54975|2022|PDM|42500.00|99|0.00|MS DRG 223 ONLY
20|FH_F58856_0_0|SrvcGrp|9939|2022|PDM|1725.00|99|0.00|ACUTE MEDICAL SVCS
20|FH_F58973_0_0|CSTM-ALL|CSTM-00|2020|PDM|1750.00|99|0.00|COVENTRY ENHANCED GROUPER 7
20|FH_F58973_0_0|CSTM-ALL|CSTM-00|2020|PDM|1758.00|99|0.00|COVENTRY ENHANCED GROUPER 8
20|FH_F58973_0_0|CSTM-ALL|CSTM-00|2020|PDM|2355.00|99|0.00|COVENTRY ENHANCED GROUPER 9
20|FH_F58973_0_0|CSTM-ALL|CSTM-00|2020|PDM|784.00|99|0.00|COVENTRY ENHANCED GROUPER 2
20|FH_F58974_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F59274_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F59274_0_0|SrvcGrp|17139|2022|PDM|600.00|99|0.00|HOSPICE CARE
20|FH_F59274_0_0|SrvcGrp|46604|2022|PDM|35.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES
20|FH_F59274_0_0|SrvcGrp|48393|2022|PDM|18.00|99|0.00|SKILLED NURSING SERVICES (PER HOUR)
20|FH_F59274_0_0|SrvcGrp|48396|2022|PDM|32.00|99|0.00|OT SERVICES
20|FH_F59312_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F59312_0_0|SrvcGrp|43283|2022|PDM|74.00|99|0.00|PHYSICAL THERAPY
20|FH_F59312_0_0|SrvcGrp|43284|2022|PDM|74.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F59312_0_0|SrvcGrp|472|2022|PDM|359.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F59333_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F59652_0_0|SrvcGrp|3577|2022|PDM|300.00|99|0.00|PARTIAL HOSPITALIZATION
20|FH_F59992_0_0|SrvcGrp|55677|2022|PDM|2500.00|99|0.00|VAGINAL DELIVERY ONLY
20|FH_F60019_0_0|CSTM-ALL|CSTM-00|2020|PDM|1342.00|99|0.00|GENERAL ACUTE CARE
20|FH_F60019_0_0|SrvcGrp|14497|2022|PCT|0.75|99|0.00|COGNITIVE REMEDIATION PROGRAM
20|FH_F60019_0_0|SrvcGrp|9861|2022|PDM|1845.00|99|0.00|ACUTE REHABILITATION
20|FH_F60041_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F60041_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F60072_0_0|CSTM-ALL|CSTM-00|2020|PDM|47250.00|99|0.00|MS DRG 216-238, 242-244, 246-249, 258-262, 286-287
20|FH_F60072_0_0|SrvcGrp|10393|2022|PDM|4000.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F60072_0_0|SrvcGrp|360|2022|PDM|1400.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F60072_0_0|SrvcGrp|361|2022|PDM|3000.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F60072_0_0|SrvcGrp|9438|2022|PCT|0.70|99|0.00|TRAUMA CARE
20|FH_F60073_0_0|CSTM-ALL|CSTM-00|2020|PDM|1683.00|99|0.00|GENERAL ACUTE CARE
20|FH_F60232_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F60252_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F60273_0_0|CSTM-ALL|CSTM-00|2020|PDM|1061.05|99|0.00|ASPG VI
20|FH_F60273_0_0|CSTM-ALL|CSTM-00|2020|PDM|1278.20|99|0.00|ASPG VII
20|FH_F60273_0_0|CSTM-ALL|CSTM-00|2020|PDM|570.01|99|0.00|ASPG II
20|FH_F60273_0_0|SrvcGrp|14614|2022|PDM|3333.96|99|0.00|LITHOTRIPSY
20|FH_F60273_0_0|SrvcGrp|56463|2022|PDM|4321.80|99|0.00|CPT 53852
20|FH_F60276_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F60276_0_0|CSTM-ALL|CSTM-00|2020|PDM|314.00|99|0.00|ASPG I
20|FH_F60276_0_0|CSTM-ALL|CSTM-00|2020|PDM|422.00|99|0.00|ASPG II
20|FH_F60276_0_0|CSTM-ALL|CSTM-00|2020|PDM|941.00|99|0.00|ASPG VII
20|FH_F60292_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F60292_0_0|SrvcGrp|474|2022|PDM|300.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F60296_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F60812_0_0|SrvcGrp|3259|2022|PDM|3453.00|99|0.00|ACUTE REHABILITATION
20|FH_F60836_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.06|99|0.00|ASPG V
20|FH_F60836_0_0|CSTM-ALL|CSTM-00|2020|PDM|1357.13|99|0.00|ASPG VIII
20|FH_F60836_0_0|CSTM-ALL|CSTM-00|2020|PDM|464.46|99|0.00|ASPG I
20|FH_F61072_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F61072_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F61072_0_0|SrvcGrp|42824|2022|PDM|100.00|99|0.00|SKILLED NURSING VISIT
20|FH_F61072_0_0|SrvcGrp|42825|2022|PDM|32.00|99|0.00|HOME HEALTH AIDE VISIT
20|FH_F61292_0_0|CSTM-ALL|CSTM-00|2020|PDM|1708.00|99|0.00|ASPG III - FH SW CUSTOM GROUPERS
20|FH_F61292_0_0|CSTM-ALL|CSTM-00|2020|PDM|2168.00|99|0.00|GENERAL ACUTE CARE
20|FH_F61292_0_0|CSTM-ALL|CSTM-00|2020|PDM|308.00|99|0.00|CD SVCS HALF DAY
20|FH_F61292_0_0|CSTM-ALL|CSTM-00|2020|PDM|3272.00|99|0.00|ASPG VI - FH SW CUSTOM GROUPERS
20|FH_F61292_0_0|CSTM-ALL|CSTM-00|2020|PDM|4186.00|99|0.00|MS DRG 774-775, 767-768 NORMAL DELIVERY (MS DRG ONLY)
20|FH_F61292_0_0|SrvcGrp|109976|2022|PDM|14708.00|99|0.00|OTHER MAJOR CARDIOVASCULAR PROC W/MCC
20|FH_F61292_0_0|SrvcGrp|12154|2022|PDM|6724.00|99|0.00|LITHOTRIPSY
20|FH_F61292_0_0|SrvcGrp|12543|2022|PDM|5726.00|99|0.00|LAPAROSCOPIC HYSTERECTOMY
20|FH_F61292_0_0|SrvcGrp|12580|2022|PDM|2908.00|99|0.00|OP LAPAROSCOPIC PROCEDURE
20|FH_F61292_0_0|SrvcGrp|12591|2022|PDM|523.00|99|0.00|CD FULL DAY
20|FH_F61292_0_0|SrvcGrp|16|2022|PDM|1271.00|99|0.00|ACUTE REHABILITATION
20|FH_F61292_0_0|SrvcGrp|20075|2022|PDM|8746.00|99|0.00|MS DRG 286 ONLY
20|FH_F61292_0_0|SrvcGrp|20077|2022|PDM|38952.00|99|0.00|MS DRG 226-227 ONLY CARDIAC DEFIBRILLATOR
20|FH_F61292_0_0|SrvcGrp|20293|2022|PDM|31050.00|99|0.00|MS DRG 235-236 ONLY CV SURGERY
20|FH_F61292_0_0|SrvcGrp|20744|2022|PDM|21578.00|99|0.00|MS DRG 242 ONLY
20|FH_F61292_0_0|SrvcGrp|20902|2022|PDM|14535.00|99|0.00|MS DRG 249 ONLY
20|FH_F61292_0_0|SrvcGrp|20906|2022|PDM|18371.00|99|0.00|MS DRG 243-244 ONLY CARDIAC PACEMAKER
20|FH_F61292_0_0|SrvcGrp|21350|2022|PDM|8746.00|99|0.00|MS DRG 287 ONLY
20|FH_F61292_0_0|SrvcGrp|290|2022|PDM|5726.00|99|0.00|IP LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F61292_0_0|SrvcGrp|31038|2022|PDM|32286.00|99|0.00|MS DRG 233-234 ONLY
20|FH_F61292_0_0|SrvcGrp|361|2022|PDM|2150.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F61292_0_0|SrvcGrp|3950|2022|PDM|5726.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F61292_0_0|SrvcGrp|48085|2022|PDM|105.00|99|0.00|SPEECH PATHOLOGY VISIT
20|FH_F61292_0_0|SrvcGrp|48183|2022|PCT|0.49|99|0.00|RADIOLOGY
20|FH_F61292_0_0|SrvcGrp|57222|2022|PDM|23802.00|99|0.00|GAMMA KNIFE RADIOSURGERY
20|FH_F61292_0_0|SrvcGrp|9511|2022|PDM|2168.00|99|0.00|OBSERVATION SVCS
20|FH_F61813_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F62092_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F62172_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F62252_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F62333_0_0|SrvcGrp|17140|2022|PDM|160.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F62394_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE
20|FH_F62432_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F62432_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F62513_0_0|CSTM-ALL|CSTM-00|2020|PDM|1947.61|99|0.00|ASPG IX
20|FH_F62513_0_0|CSTM-ALL|CSTM-00|2020|PDM|1947.61|99|0.00|ASPG V
20|FH_F62513_0_0|CSTM-ALL|CSTM-00|2020|PDM|902.53|99|0.00|ASPG I
20|FH_F62577_0_0|SrvcGrp|58455|2022|PDM|786.00|99|0.00|ASPG II
20|FH_F62577_0_0|SrvcGrp|58459|2022|PDM|1641.00|99|0.00|ASPG VI
20|FH_F62577_0_0|SrvcGrp|58460|2022|PDM|1966.00|99|0.00|ASPG VII
20|FH_F62577_0_0|SrvcGrp|58461|2022|PDM|1951.00|99|0.00|ASPG VIII
20|FH_F62577_0_0|SrvcGrp|58462|2022|PDM|2615.00|99|0.00|ASPG IX
20|FH_F62582_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE
20|FH_F62600_0_0|CSTM-ALL|CSTM-00|2020|PDM|1557.00|99|0.00|ASPG VIII
20|FH_F62600_0_0|CSTM-ALL|CSTM-00|2020|PDM|533.00|99|0.00|ASPG I
20|FH_F62600_0_0|CSTM-ALL|CSTM-00|2020|PDM|714.00|99|0.00|ASPG II
20|FH_F62601_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE
20|FH_F62601_0_0|SrvcGrp|46424|2022|PDM|30.00|99|0.00|HI TECH SKILLED NURSING SERVICES
20|FH_F62601_0_0|SrvcGrp|46604|2022|PDM|31.25|99|0.00|CLINICAL SOCIAL WORKER SERVICES
20|FH_F62601_0_0|SrvcGrp|48385|2022|PDM|30.00|99|0.00|SPEECH THERAPY
20|FH_F62601_0_0|SrvcGrp|48399|2022|PDM|30.00|99|0.00|SPEECH THERAPY
20|FH_F62609_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F62614_0_0|SrvcGrp|46424|2022|PDM|30.00|99|0.00|HI TECH SKILLED NURSING SERVICES
20|FH_F62614_0_0|SrvcGrp|48394|2022|PDM|6.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F62614_0_0|SrvcGrp|48396|2022|PDM|30.00|99|0.00|OT SERVICES
20|FH_F62614_0_0|SrvcGrp|48397|2022|PDM|30.00|99|0.00|PT SERVICES
20|FH_F62624_0_0|SrvcGrp|11577|2022|PDM|600.00|99|0.00|DIALYSIS
20|FH_F62624_0_0|SrvcGrp|229|2022|PDM|350.00|99|0.00|COMPUTED TOMOGRAPHY (CT SCAN)
20|FH_F62624_0_0|SrvcGrp|31539|2022|PCT|1.07|99|0.00|IMPLANTS
20|FH_F62624_0_0|SrvcGrp|33793|2022|PDM|6450.00|99|0.00|MSDRG 246-251 ONLY ANGIOPLASTY
20|FH_F62624_0_0|SrvcGrp|58515|2022|PDM|6465.00|99|0.00|OP PTCA
20|FH_F62624_0_0|SrvcGrp|58519|2022|PDM|19000.00|99|0.00|MS DRG 231-238 ONLY
20|FH_F62624_0_0|SrvcGrp|9774|2022|PDM|2700.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F62627_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|EMERGENCY ROOM SVCS
20|FH_F62681_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE
20|FH_F62691_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F62700_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F62700_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F62703_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F62713_0_0|SrvcGrp|12403|2022|PDM|788.55|99|0.00|CONTINUOUS HOMECARE
20|FH_F62713_0_0|SrvcGrp|26001|2022|PDM|139.76|99|0.00|HOSPICE RESPITE SVCS
20|FH_F62713_0_0|SrvcGrp|3809|2022|PDM|601.02|99|0.00|HOSPICE CARE
20|FH_F62719_0_0|SrvcGrp|17139|2022|PDM|675.00|99|0.00|HOSPICE CARE
20|FH_F62719_0_0|SrvcGrp|17140|2022|PDM|150.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F62719_0_0|SrvcGrp|37403|2022|PDM|40.50|99|0.00|HOME HEALTH AIDE
20|FH_F62719_0_0|SrvcGrp|44713|2022|PDM|108.00|99|0.00|SPEECH THERAPY SVCS
20|FH_F62732_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F62750_0_0|SrvcGrp|15132|2022|PDM|1400.00|99|0.00|ACUTE IP MEDICAL SVCS
20|FH_F62802_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F62802_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F62802_0_0|CSTM-ALL|CSTM-00|2020|PDM|1415.00|99|0.00|ASPG VII
20|FH_F62802_0_0|CSTM-ALL|CSTM-00|2020|PDM|1680.00|99|0.00|ASPG IX
20|FH_F62802_0_0|SrvcGrp|58508|2022|PDM|1350.00|99|0.00|UNLISTED CODES OP SURGERY
20|FH_F62816_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F62853_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F62867_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F62869_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F62876_0_0|CSTM-ALL|CSTM-00|2020|PCT|50.00|99|0.00|GENERAL ACUTE CARE
20|FH_F62892_0_0|SrvcGrp|10537|2022|PDM|55.00|99|0.00|NURSING CARE
20|FH_F62892_0_0|SrvcGrp|10540|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE
20|FH_F62892_0_0|SrvcGrp|10541|2022|PDM|95.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F62892_0_0|SrvcGrp|10542|2022|PDM|95.00|99|0.00|OCCUPATIONAL THERAPY SVCS
20|FH_F62892_0_0|SrvcGrp|10545|2022|PDM|95.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F62892_0_0|SrvcGrp|22387|2022|PDM|55.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F62920_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F62922_0_0|SrvcGrp|3577|2022|PDM|300.00|99|0.00|PARTIAL HOSPITALIZATION
20|FH_F62974_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F62974_0_0|SrvcGrp|1168|2022|PDM|32.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F62974_0_0|SrvcGrp|3810|2022|PDM|98.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F62977_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|ASPG III
20|FH_F62977_0_0|SrvcGrp|11000|2022|PCT|1.00|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F62978_0_0|SrvcGrp|11000|2022|PCT|1.20|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F62980_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.90|99|0.00|OP SVCS
20|FH_F62982_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63020_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F63054_0_0|SrvcGrp|20074|2022|PDM|400.00|99|0.00|HYPERBARIC CHAMBER
20|FH_F63083_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F63095_0_0|SrvcGrp|16|2022|PDM|2441.00|99|0.00|ACUTE REHABILITATION
20|FH_F63095_0_0|SrvcGrp|29121|2022|PCT|0.65|99|0.00|LABORATORY
20|FH_F63095_0_0|SrvcGrp|9518|2022|PCT|0.65|99|0.00|EMERGENCY ROOM
20|FH_F63102_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63102_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F63114_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE
20|FH_F63114_0_0|SrvcGrp|46604|2022|PDM|25.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES
20|FH_F63114_0_0|SrvcGrp|48395|2022|PDM|30.00|99|0.00|OT SERVICES
20|FH_F63117_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS
20|FH_F63124_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F63124_0_0|SrvcGrp|42975|2022|PDM|145.00|99|0.00|PHYSICAL THERAPIST
20|FH_F63124_0_0|SrvcGrp|44430|2022|PDM|145.00|99|0.00|SPEECH THERAPY SVCS (VISIT LVL)
20|FH_F63124_0_0|SrvcGrp|45950|2022|PDM|145.00|99|0.00|SPEECH THERAPY
20|FH_F63129_0_0|SrvcGrp|48385|2022|PDM|30.00|99|0.00|SPEECH THERAPY
20|FH_F63129_0_0|SrvcGrp|48397|2022|PDM|30.00|99|0.00|PT SERVICES
20|FH_F63129_0_0|SrvcGrp|48398|2022|PDM|30.00|99|0.00|PT SERVICES
20|FH_F63131_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63131_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F63141_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F63145_0_0|SrvcGrp|27325|2022|PCT|0.77|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F63153_0_0|CSTM-ALL|CSTM-00|2020|PCT|42.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63178_0_0|CSTM-ALL|CSTM-00|2020|PDM|1614.00|99|0.00|COVENTRY ENHANCED GROUPER 9
20|FH_F63182_0_0|CSTM-ALL|CSTM-00|2020|PDM|1038.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63182_0_0|SrvcGrp|12682|2022|PDM|448.00|99|0.00|GROUP THERAPY
20|FH_F63185_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F63185_0_0|SrvcGrp|46350|2022|PDM|30.00|99|0.00|HI TECH SKILLED NURSING SERVICES
20|FH_F63185_0_0|SrvcGrp|48393|2022|PDM|6.50|99|0.00|SKILLED NURSING SERVICES (PER HOUR)
20|FH_F63185_0_0|SrvcGrp|48394|2022|PDM|6.50|99|0.00|SKILLED NURSING SERVICES
20|FH_F63185_0_0|SrvcGrp|48395|2022|PDM|30.00|99|0.00|OT SERVICES
20|FH_F63185_0_0|SrvcGrp|48397|2022|PDM|30.00|99|0.00|PT SERVICES
20|FH_F63185_0_0|SrvcGrp|48399|2022|PDM|30.00|99|0.00|SPEECH THERAPY
20|FH_F63190_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63195_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F63197_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F63229_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F63229_0_0|SrvcGrp|44247|2022|PDM|385.00|99|0.00|CAPD TRAINING
20|FH_F63235_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63235_0_0|SrvcGrp|15473|2022|PDM|2005.00|99|0.00|CPT CODE 42820
20|FH_F63235_0_0|SrvcGrp|73000|2022|PDM|2311.00|99|0.00|AEG 6
20|FH_F63244_0_0|SrvcGrp|33164|2022|PDM|275.00|99|0.00|SKILLED NURSING - LEVEL I
20|FH_F63249_0_0|SrvcGrp|27968|2022|PDM|25.00|99|0.00|SKILLED NURSING LPN
20|FH_F63249_0_0|SrvcGrp|52782|2022|PDM|42.00|99|0.00|VENIPUNCTURE PER VISIT
20|FH_F63250_0_0|SrvcGrp|27968|2022|PDM|28.00|99|0.00|SKILLED NURSING LPN
20|FH_F63250_0_0|SrvcGrp|43567|2022|PDM|105.00|99|0.00|SKILLED NURSING - POSTNATAL
20|FH_F63250_0_0|SrvcGrp|59414|2022|PDM|105.00|99|0.00|PHYSICAL THERAPY SVCS EXCLD MOD GP
20|FH_F63250_0_0|SrvcGrp|59415|2022|PDM|105.00|99|0.00|OCCUPATIONAL THERAPY SVCS EXCLD MOD GO
20|FH_F63256_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS
20|FH_F63275_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63275_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F63275_0_0|SrvcGrp|22954|2022|PDM|130.61|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F63276_0_0|SrvcGrp|42827|2022|PDM|140.00|99|0.00|OCCUPATIONAL THERAPY VISIT
20|FH_F63276_0_0|SrvcGrp|42830|2022|PDM|150.00|99|0.00|MEDICAL SOCIAL WORKER VISIT
20|FH_F63281_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63297_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F63297_0_0|SrvcGrp|59425|2022|PDM|35.00|99|0.00|HOME HEALTH AIDE
20|FH_F63312_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F63312_0_0|SrvcGrp|12401|2022|PDM|80.00|99|0.00|RN VISIT
20|FH_F63312_0_0|SrvcGrp|12403|2022|PDM|24.50|99|0.00|CONTINUOUS HOMECARE
20|FH_F63312_0_0|SrvcGrp|16302|2022|PDM|42.00|99|0.00|VENIPUNCTURE
20|FH_F63312_0_0|SrvcGrp|18025|2022|PDM|60.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F63312_0_0|SrvcGrp|3809|2022|PDM|525.00|99|0.00|HOSPICE CARE
20|FH_F63317_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63317_0_0|CSTM-ALL|CSTM-00|2020|PDM|560.00|99|0.00|SKILLED NURSING
20|FH_F63385_0_0|CSTM-ALL|CSTM-00|2020|PDM|1456.00|99|0.00|ASPG VI
20|FH_F63387_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63387_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS
20|FH_F63391_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63398_0_0|SrvcGrp|12591|2022|PDM|150.00|99|0.00|CD FULL DAY
20|FH_F63398_0_0|SrvcGrp|38223|2022|PDM|575.00|99|0.00|ADULT DETOX
20|FH_F63414_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63417_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE
20|FH_F63417_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F63417_0_0|SrvcGrp|473|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F63417_0_0|SrvcGrp|474|2022|PDM|360.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F63422_0_0|SrvcGrp|3087|2022|PDM|525.00|99|0.00|CD - DETOX
20|FH_F63422_0_0|SrvcGrp|3259|2022|PDM|428.00|99|0.00|ACUTE REHABILITATION
20|FH_F63432_0_0|SrvcGrp|71779|2022|PDM|563.00|99|0.00|SLEEP STUDY (95800-95801, 95806, G0398-G0399)
20|FH_F63444_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|OP SVCS
20|FH_F63444_0_0|SrvcGrp|3934|2022|PDM|250.00|99|0.00|INTENSIVE ADULT DUAL DIAGNOSIS
20|FH_F63456_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63457_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63458_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F63459_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|ADV ORTHO MRI
20|FH_F63462_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63462_0_0|CSTM-ALL|CSTM-00|2020|PDM|617.00|99|0.00|ASPG I
20|FH_F63462_0_0|SrvcGrp|40826|2022|PDM|250.00|99|0.00|DISPOSABLE DRUG DELIVERY SYSTEM
20|FH_F63481_0_0|SrvcGrp|26233|2022|PDM|425.00|99|0.00|SLEEP STUDIES
20|FH_F63514_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63514_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F63514_0_0|SrvcGrp|17139|2022|PDM|627.34|99|0.00|HOSPICE CARE
20|FH_F63535_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63541_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63541_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F63543_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63543_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS
20|FH_F63556_0_0|SrvcGrp|16|2022|PDM|2000.00|99|0.00|ACUTE REHABILITATION
20|FH_F63556_0_0|SrvcGrp|37389|2022|PDM|4000.00|99|0.00|MS DRG 286-287 ONLY CARDIAC CATH
20|FH_F63580_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63618_0_0|CSTM-ALL|CSTM-00|2020|PDM|27000.00|99|0.00|ORTHOPEDIC SURGERY
20|FH_F63618_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63618_0_0|CSTM-ALL|CSTM-00|2020|PDM|45000.00|99|0.00|CV SURGERY
20|FH_F63618_0_0|SrvcGrp|30623|2022|PDM|6500.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788
20|FH_F63618_0_0|SrvcGrp|60112|2022|PDM|6000.00|99|0.00|ICU/CCU 200-203, 208-213, 219
20|FH_F63618_0_0|SrvcGrp|675|2022|PDM|3000.00|99|0.00|PEDIATRIC INPATIENT SVCS
20|FH_F63618_0_0|SrvcGrp|8|2022|PDM|6000.00|99|0.00|BURN INTENSIVE CARE
20|FH_F63625_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|99|0.00|OP SVCS
20|FH_F63625_0_0|CSTM-ALL|CSTM-00|2020|PDM|4630.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63625_0_0|SrvcGrp|12343|2022|PCT|0.80|99|0.00|PET SCAN
20|FH_F63625_0_0|SrvcGrp|14079|2022|PCT|0.68|99|0.00|RADIOACTIVE SEED
20|FH_F63625_0_0|SrvcGrp|39579|2022|PCT|0.60|99|0.00|TPA
20|FH_F63625_0_0|SrvcGrp|39871|2022|PCT|0.80|99|0.00|MS DRG 619-621 ONLY OTLR
20|FH_F63701_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F63881_0_0|SrvcGrp|16703|2022|PDM|325.00|99|0.00|HEMO/HOME DIALYSIS SVCS
20|FH_F63881_0_0|SrvcGrp|59353|2022|PDM|325.00|99|0.00|HEMODIALYSIS - HOME TRAINING
20|FH_F63881_0_0|SrvcGrp|59357|2022|PDM|140.00|99|0.00|CAPD TRAINING
20|FH_F63899_0_0|CSTM-ALL|CSTM-00|2020|PCT|68.00|99|0.00|GENERAL ACUTE CARE
20|FH_F64142_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F64142_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F64160_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F64160_0_0|SrvcGrp|26001|2022|PDM|189.98|99|0.00|HOSPICE RESPITE SVCS
20|FH_F64180_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F64180_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F64440_0_0|SrvcGrp|108691|2022|PDM|930.00|99|0.00|MRI/MRA W/ CONTRAST
20|FH_F64440_0_0|SrvcGrp|108695|2022|PDM|1058.00|99|0.00|OP SLEEP STUDIES (MOD TC) (UB)
20|FH_F64441_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F64441_0_0|SrvcGrp|12023|2022|PDM|147.00|99|0.00|HOSPICE RESPITE SERVICES
20|FH_F64441_0_0|SrvcGrp|17140|2022|PDM|155.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F64441_0_0|SrvcGrp|3810|2022|PDM|147.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F64739_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F64739_0_0|SrvcGrp|60857|2022|PDM|167.20|99|0.00|HOSPICE SERVICE -  INPATIENT RESPITE CARE
20|FH_F64739_0_0|SrvcGrp|60858|2022|PDM|605.00|99|0.00|HOSPICE SERVICE -  GENERAL INPATIENT CARE NON RESPITE
20|FH_F64779_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F64779_0_0|SrvcGrp|42828|2022|PDM|163.00|99|0.00|SPEECH THERAPY VISIT
20|FH_F64799_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F64879_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F64879_0_0|SrvcGrp|44326|2022|PDM|60.00|99|0.00|PT & OT (VISIT LVL) OT MOD GO
20|FH_F145587_0_0|SrvcGrp|82113|2022|PDM|1262.70|99|0.00|KNEE ARTHROSCOPY SURGERY
20|FH_F145587_0_0|SrvcGrp|83639|2022|PDM|1262.70|99|0.00|CPT 29886
20|FH_F145587_0_0|SrvcGrp|83640|2022|PDM|2784.62|99|0.00|CPT 29887
20|FH_F145587_0_0|SrvcGrp|83643|2022|PDM|3607.84|99|0.00|CPT 29885
20|FH_F145599_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F145664_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.62|99|0.00|OP SVCS
20|FH_F145689_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F145689_0_0|CSTM-ALL|CSTM-00|2020|PCT|2.25|99|0.00|HSS ASC
20|FH_F145690_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F145721_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F145721_0_0|SrvcGrp|29155|2022|PDM|135.00|99|0.00|HOSPICE SVCS
20|FH_F145721_0_0|SrvcGrp|84185|2022|PDM|135.00|99|0.00|RESPITE CARE
20|FH_F145722_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F145739_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F145739_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|AEG 1 (NO REV)
20|FH_F145762_0_0|CSTM-ALL|CSTM-00|2020|PDM|1243.00|99|0.00|AEG 8 (NO REV)
20|FH_F145762_0_0|CSTM-ALL|CSTM-00|2020|PDM|1715.00|99|0.00|AEG 9 (NO REV)
20|FH_F145762_0_0|CSTM-ALL|CSTM-00|2020|PDM|815.00|99|0.00|AEG 4 (NO REV)
20|FH_F145762_0_0|CSTM-ALL|CSTM-00|2020|PDM|910.00|99|0.00|AEG 5  (NO REV)
20|FH_F145762_0_0|SrvcGrp|112581|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F145781_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F145781_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|AEG 1 (NO REV)
20|FH_F145781_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|AEG 4 (NO REV)
20|FH_F145781_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|AEG 10 (NO REV)
20|FH_F145781_0_0|SrvcGrp|10986|2022|PDM|3100.00|99|0.00|ARTHROSCOPIC KNEE REPAIR
20|FH_F145781_0_0|SrvcGrp|114307|2022|PDM|1150.00|99|0.00|XCAPSL CTRC REMVL W/O ECP
20|FH_F145781_0_0|SrvcGrp|114309|2022|PDM|1400.00|99|0.00|EXPLORE/TREAT EYE SOCKET
20|FH_F145781_0_0|SrvcGrp|114310|2022|PDM|1400.00|99|0.00|INSERT EYE SOCKET IMPLT
20|FH_F145781_0_0|SrvcGrp|114311|2022|PDM|1500.00|99|0.00|REVISE/GRAFT EYELID LINING
20|FH_F145781_0_0|SrvcGrp|41334|2022|PDM|11000.00|99|0.00|TOTAL KNEE
20|FH_F145781_0_0|SrvcGrp|90063|2022|PDM|3000.00|99|0.00|REPAIR BICEPS TENDON RUPTURE
20|FH_F145781_0_0|SrvcGrp|99073|2022|PDM|1.28|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F145784_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F145784_0_0|CSTM-ALL|CSTM-00|2020|PDM|1076.00|99|0.00|AEG 3 (NO REV)
20|FH_F145784_0_0|CSTM-ALL|CSTM-00|2020|PDM|1583.00|99|0.00|AEG 5  (NO REV)
20|FH_F145784_0_0|CSTM-ALL|CSTM-00|2020|PDM|1750.00|99|0.00|AEG 4 (NO REV)
20|FH_F145784_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|AEG 6 (NO REV)
20|FH_F145784_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|AEG 1 (NO REV)
20|FH_F145784_0_0|SrvcGrp|11663|2022|PCT|1.05|99|0.00|IMPLANTS
20|FH_F145863_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.00|99|0.00|GENERAL ACUTE CARE
20|FH_F145870_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F145870_0_0|CSTM-ALL|CSTM-00|2020|PDM|1083.00|99|0.00|AEG 10 (NO REV)
20|FH_F145870_0_0|CSTM-ALL|CSTM-00|2020|PDM|1503.00|99|0.00|AEG 7 (NO REV)
20|FH_F145870_0_0|CSTM-ALL|CSTM-00|2020|PDM|674.00|99|0.00|AEG 2 (NO REV)
20|FH_F145870_0_0|CSTM-ALL|CSTM-00|2020|PDM|771.00|99|0.00|AEG 3 (NO REV)
20|FH_F145877_0_0|SrvcGrp|13188|2022|PCT|0.34|99|0.00|DRUGS
20|FH_F145877_0_0|SrvcGrp|3142|2022|PDM|1695.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F145885_0_0|CSTM-ALL|CSTM-00|2020|PCT|2.25|99|0.00|HSS ASC
20|FH_F145920_0_0|CSTM-ALL|CSTM-00|2020|PDM|2958.00|99|0.00|AEG 9 (NO REV)
20|FH_F145920_0_0|SrvcGrp|33967|2022|PDM|3300.00|99|0.00|CPT 47562
20|FH_F145920_0_0|SrvcGrp|78283|2022|PDM|3433.00|99|0.00|CPT 49505
20|FH_F145920_0_0|SrvcGrp|79589|2022|PDM|1931.00|99|0.00|UPPER GI
20|FH_F145920_0_0|SrvcGrp|79595|2022|PDM|1893.00|99|0.00|CPT 45385
20|FH_F146013_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F146013_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F146117_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F146117_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F146117_0_0|CSTM-ALL|CSTM-00|2020|PDM|1950.00|99|0.00|AEG 2 (NO REV)
20|FH_F146117_0_0|CSTM-ALL|CSTM-00|2020|PDM|3118.00|99|0.00|AEG 6 (NO REV)
20|FH_F146117_0_0|CSTM-ALL|CSTM-00|2020|PDM|3428.00|99|0.00|AEG 7 (NO REV)
20|FH_F146117_0_0|SrvcGrp|113576|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F146117_0_0|SrvcGrp|113637|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES
20|FH_F146117_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F146117_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F146117_0_0|SrvcGrp|86233|2022|PDM|2804.00|99|0.00|AETNA RECONSTRUCT ANKLE JOINT
20|FH_F146117_0_0|SrvcGrp|88157|2022|PDM|3118.00|99|0.00|TOTAL HIP ARTHROPLASTY
20|FH_F146125_0_0|CSTM-ALL|CSTM-00|2020|PDM|1153.00|99|0.00|AEG 10 (NO REV)
20|FH_F146125_0_0|CSTM-ALL|CSTM-00|2020|PDM|1340.00|99|0.00|AEG 3 (NO REV)
20|FH_F146125_0_0|CSTM-ALL|CSTM-00|2020|PDM|1534.00|99|0.00|AEG 7 (NO REV)
20|FH_F146125_0_0|CSTM-ALL|CSTM-00|2020|PDM|2137.00|99|0.00|AEG 9 (NO REV)
20|FH_F146125_0_0|SrvcGrp|104750|2022|PDM|2405.00|99|0.00|REPAIR BLADDER & VAGINA
20|FH_F146125_0_0|SrvcGrp|26274|2022|PDM|3150.00|99|0.00|CPT 29877
20|FH_F146125_0_0|SrvcGrp|75182|2022|PCT|1.00|99|0.00|AETNA IMPLANTS
20|FH_F146125_0_0|SrvcGrp|82115|2022|PDM|3147.00|99|0.00|REPAIR UMBIL HERNIA
20|FH_F146125_0_0|SrvcGrp|82720|2022|PDM|3150.00|99|0.00|WRIST ENDOSCOPY/SURGERY
20|FH_F146204_0_0|CSTM-ALL|CSTM-00|2020|PDM|1197.00|99|0.00|AEG 6 (NO REV)
20|FH_F146204_0_0|CSTM-ALL|CSTM-00|2020|PDM|1410.00|99|0.00|AEG 8 (NO REV)
20|FH_F146204_0_0|CSTM-ALL|CSTM-00|2020|PDM|748.00|99|0.00|AEG 3 (NO REV)
20|FH_F146204_0_0|SrvcGrp|101523|2022|PDM|1500.00|99|0.00|CERCLAGE OF CERVIX
20|FH_F146204_0_0|SrvcGrp|110676|2022|PDM|2376.00|99|0.00|LAPAROSCOPIC TREAT OF ECTOP
20|FH_F146204_0_0|SrvcGrp|114509|2022|PDM|1500.00|99|0.00|D&C AFTER DELIVERY
20|FH_F146204_0_0|SrvcGrp|27347|2022|PDM|1500.00|99|0.00|CPT 58558
20|FH_F64900_0_0|CSTM-ALL|CSTM-00|2020|PDM|80.00|99|0.00|OP SVCS
20|FH_F64940_0_0|SrvcGrp|17140|2022|PDM|145.20|99|0.00|HOSPICE RESPITE SVCS
20|FH_F64943_0_0|CSTM-ALL|CSTM-00|2020|PDM|614.00|99|0.00|PARTIAL HOSPITALIZATION
20|FH_F64943_0_0|CSTM-ALL|CSTM-00|2020|PDM|626.00|99|0.00|ADOLESCENT SA PARTIAL HOSPITALIZATION
20|FH_F64943_0_0|CSTM-ALL|CSTM-00|2020|PDM|654.00|99|0.00|EATING DISORDER PARTIAL HOSPITAL
20|FH_F64943_0_0|SrvcGrp|51102|2022|PDM|733.00|99|0.00|ADULT EATING DISORDER RESIDENTIAL TREATMENT
20|FH_F64943_0_0|SrvcGrp|61039|2022|PDM|783.00|99|0.00|ELECTROCONVULSIVE THERAPY (ECT)
20|FH_F64943_0_0|SrvcGrp|61637|2022|PDM|480.00|99|0.00|CRISIS EVALUATION
20|FH_F65100_0_0|SrvcGrp|76207|2022|PDM|60.00|99|0.00|SPEECH THERAPY (VISIT LVL) MOD GN
20|FH_F65103_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F65103_0_0|SrvcGrp|76207|2022|PDM|60.00|99|0.00|SPEECH THERAPY (VISIT LVL) MOD GN
20|FH_F65182_0_0|SrvcGrp|43893|2022|PDM|80.00|99|0.00|OCCUPATIONAL THERAPY VISIT
20|FH_F65200_0_0|SrvcGrp|44326|2022|PDM|60.00|99|0.00|PT & OT (VISIT LVL) OT MOD GO
20|FH_F65239_0_0|CSTM-ALL|CSTM-00|2020|PDM|1867.00|99|0.00|AEG 9 (NO REV)
20|FH_F65239_0_0|CSTM-ALL|CSTM-00|2020|PDM|921.00|99|0.00|AEG 10 (NO REV)
20|FH_F65239_0_0|CSTM-ALL|CSTM-00|2020|PDM|921.00|99|0.00|AEG 4 (NO REV)
20|FH_F65239_0_0|SrvcGrp|11000|2022|PCT|1.00|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F65239_0_0|SrvcGrp|61358|2022|PDM|1147.00|99|0.00|SURGICAL CARVEOUTS (3)
20|FH_F65440_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F65440_0_0|CSTM-ALL|CSTM-00|2020|PDM|1459.00|99|0.00|COVENTRY ENHANCED GROUPER 6
20|FH_F65440_0_0|CSTM-ALL|CSTM-00|2020|PDM|587.00|99|0.00|COVENTRY ENHANCED GROUPER 1
20|FH_F65440_0_0|CSTM-ALL|CSTM-00|2020|PDM|794.00|99|0.00|COVENTRY ENHANCED GROUPER 2
20|FH_F65440_0_0|SrvcGrp|27346|2022|PDM|2571.00|99|0.00|REPAIR BLADDER DEFECT
20|FH_F65559_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F65719_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F65719_0_0|SrvcGrp|111994|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES
20|FH_F65979_0_0|SrvcGrp|61556|2022|PDM|2660.00|99|0.00|MUSCULOSKELETAL SURGERY
20|FH_F65979_0_0|SrvcGrp|61558|2022|PDM|1450.00|99|0.00|MUSCULOSKELETAL SURGERY
20|FH_F66220_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F66220_0_0|SrvcGrp|471|2022|PDM|625.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F66259_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F66388_0_0|SrvcGrp|44106|2022|PDM|48.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F66388_0_0|SrvcGrp|472|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F66388_0_0|SrvcGrp|473|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F66388_0_0|SrvcGrp|474|2022|PDM|290.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F66403_0_0|SrvcGrp|33164|2022|PDM|350.00|99|0.00|SKILLED NURSING - LEVEL I
20|FH_F66404_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F66405_0_0|SrvcGrp|33164|2022|PDM|350.00|99|0.00|SKILLED NURSING - LEVEL I
20|FH_F66405_0_0|SrvcGrp|33166|2022|PDM|500.00|99|0.00|SKILLED NURSING - LEVEL III
20|FH_F66406_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F66406_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F66408_0_0|SrvcGrp|33164|2022|PDM|350.00|99|0.00|SKILLED NURSING - LEVEL I
20|FH_F66409_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F66410_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F66411_0_0|SrvcGrp|33165|2022|PDM|425.00|99|0.00|SKILLED NURSING - LEVEL II
20|FH_F66411_0_0|SrvcGrp|33166|2022|PDM|500.00|99|0.00|SKILLED NURSING - LEVEL III
20|FH_F66422_0_0|SrvcGrp|44107|2022|PDM|48.00|99|0.00|SPEECH THERAPY
20|FH_F66422_0_0|SrvcGrp|472|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F66422_0_0|SrvcGrp|474|2022|PDM|290.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F66430_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F66430_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F66439_0_0|CSTM-ALL|CSTM-00|2020|PCT|56.00|99|0.00|OP SVCS
20|FH_F66469_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F66469_0_0|CSTM-ALL|CSTM-00|2020|PDM|1119.00|99|0.00|2006 MEDICARE ASPG VIII
20|FH_F66469_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|2006 MEDICARE ASPG VI
20|FH_F66469_0_0|SrvcGrp|61999|2022|PDM|2600.00|99|0.00|LITHOTRIPSY
20|FH_F66480_0_0|CSTM-ALL|CSTM-00|2020|PDM|157.00|99|0.00|HOME HEALTH PRIVATE DUTY NURSING - RN
20|FH_F66481_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F66481_0_0|SrvcGrp|42975|2022|PDM|100.00|99|0.00|PHYSICAL THERAPIST
20|FH_F66541_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING
20|FH_F66541_0_0|CSTM-ALL|CSTM-00|2020|PCT|30000.00|99|0.00|HEMO/HOME DIALYSIS SVCS
20|FH_F66545_0_0|SrvcGrp|32978|2022|PDM|110.00|99|0.00|SPEECH THERAPY
20|FH_F66545_0_0|SrvcGrp|62097|2022|PDM|35.00|99|0.00|HOME HEALTH AIDE
20|FH_F66569_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F66569_0_0|SrvcGrp|471|2022|PDM|570.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F66569_0_0|SrvcGrp|47225|2022|PDM|85.00|99|0.00|OT RC434, CPT97003-97004
20|FH_F66569_0_0|SrvcGrp|62259|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY
20|FH_F66569_0_0|SrvcGrp|62361|2022|PDM|85.00|99|0.00|SPEECH THERAPY EVAL AND RE-EVAL
20|FH_F66630_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE
20|FH_F66630_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F66630_0_0|SrvcGrp|1306|2022|PDM|300.00|99|0.00|OP PSYCH PARTIAL HOSP
20|FH_F66630_0_0|SrvcGrp|31702|2022|PDM|200.00|99|0.00|INTENSIVE OUTPATIENT
20|FH_F66649_0_0|CSTM-ALL|CSTM-00|2020|PCT|50.90|99|0.00|OP SVCS
20|FH_F66687_0_0|SrvcGrp|19661|2022|PCT|0.85|99|0.00|MS DRG 216-218 ONLY CARDIAC VALVE PROCEDURE W/CARDIAC CATH
20|FH_F66687_0_0|SrvcGrp|20900|2022|PDM|48868.00|99|0.00|MS DRG 248 ONLY
20|FH_F66687_0_0|SrvcGrp|20912|2022|PDM|60342.00|99|0.00|MS DRG 236 ONLY
20|FH_F66687_0_0|SrvcGrp|20914|2022|PDM|89142.00|99|0.00|MS DRG 233 ONLY
20|FH_F66687_0_0|SrvcGrp|29607|2022|PDM|86529.00|99|0.00|MS DRG 221 ONLY
20|FH_F66687_0_0|SrvcGrp|54973|2022|PCT|0.85|99|0.00|MS DRG 225 ONLY
20|FH_F66687_0_0|SrvcGrp|62295|2022|PDM|8603.00|99|0.00|CORONARY ANGIOGRAPHY
20|FH_F66705_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F66705_0_0|SrvcGrp|62538|2022|PDM|70.00|99|0.00|PHYSICAL THERAPY
20|FH_F66711_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE
20|FH_F66711_0_0|SrvcGrp|42763|2022|PDM|85.00|99|0.00|SKILLED NURSING CARE VISIT
20|FH_F66711_0_0|SrvcGrp|43428|2022|PDM|25.00|99|0.00|RN HOURLY
20|FH_F66711_0_0|SrvcGrp|43432|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE HOURLY
20|FH_F66711_0_0|SrvcGrp|44392|2022|PDM|40.00|99|0.00|HOME HEALTH AIDE
20|FH_F66712_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F66760_0_0|SrvcGrp|63445|2022|PDM|115.00|99|0.00|RHGAM FULL DOSE
20|FH_F66760_0_0|SrvcGrp|63457|2022|PDM|125.00|99|0.00|ULTRASOUND
20|FH_F66765_0_0|SrvcGrp|60057|2022|PDM|125.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F66765_0_0|SrvcGrp|62539|2022|PDM|100.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F66835_0_0|SrvcGrp|12290|2022|PDM|630.00|99|0.00|DETOXIFICATION
20|FH_F66835_0_0|SrvcGrp|12682|2022|PDM|150.00|99|0.00|GROUP THERAPY
20|FH_F66835_0_0|SrvcGrp|16|2022|PDM|630.00|99|0.00|ACUTE REHABILITATION
20|FH_F66835_0_0|SrvcGrp|23587|2022|PDM|425.00|99|0.00|RESIDENTIAL TREATMENT - PSYCH
20|FH_F66835_0_0|SrvcGrp|3178|2022|PDM|630.00|99|0.00|ACUTE PSYCH
20|FH_F66961_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F66961_0_0|SrvcGrp|44326|2022|PDM|60.00|99|0.00|PT & OT (VISIT LVL) OT MOD GO
20|FH_F66970_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F66970_0_0|CSTM-ALL|CSTM-00|2020|PDM|1150.00|99|0.00|ASPG VI
20|FH_F67025_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|ASPG X
20|FH_F67025_0_0|CSTM-ALL|CSTM-00|2020|PDM|1050.00|99|0.00|ASPG V
20|FH_F67025_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|ASPG VII
20|FH_F67025_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|ASPG I
20|FH_F67025_0_0|CSTM-ALL|CSTM-00|2020|PDM|735.00|99|0.00|ASPG II
20|FH_F67025_0_0|CSTM-ALL|CSTM-00|2020|PDM|825.00|99|0.00|ASPG III
20|FH_F67065_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|GENERAL ACUTE CARE
20|FH_F67065_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|OP SVCS
20|FH_F67086_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F67086_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F67086_0_0|SrvcGrp|3810|2022|PDM|135.11|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F67101_0_0|SrvcGrp|12124|2022|PCT|1.00|99|0.00|ORGAN TRANSPLANT SERVICES
20|FH_F67101_0_0|SrvcGrp|69521|2022|PCT|1.00|99|0.00|BONEMARROW SEARCH TESTING AND ACQUISITION
20|FH_F67136_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F67136_0_0|SrvcGrp|21354|2022|PDM|8427.00|99|0.00|MS DRG 250-251 ONLY
20|FH_F67136_0_0|SrvcGrp|62720|2022|PDM|8427.00|99|0.00|CARDIAC MSDRG ONLY
20|FH_F67136_0_0|SrvcGrp|62721|2022|PDM|8427.00|99|0.00|ICU SERVICES
20|FH_F67147_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|GENERAL ACUTE CARE
20|FH_F67148_0_0|CSTM-ALL|CSTM-00|2020|PCT|69.00|99|0.00|OP SVCS
20|FH_F67173_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F67173_0_0|CSTM-ALL|CSTM-00|2020|PDM|1150.00|99|0.00|ASPG V - FH SW CUSTOM GROUPERS
20|FH_F67173_0_0|CSTM-ALL|CSTM-00|2020|PDM|1270.00|99|0.00|ASPG VI - FH SW CUSTOM GROUPERS
20|FH_F67173_0_0|CSTM-ALL|CSTM-00|2020|PDM|830.00|99|0.00|ASPG III - FH SW CUSTOM GROUPERS
20|FH_F67180_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F67182_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F67207_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F67207_0_0|SrvcGrp|44105|2022|PDM|48.00|99|0.00|PHYSICAL THERAPY
20|FH_F67207_0_0|SrvcGrp|472|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F67207_0_0|SrvcGrp|473|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F67207_0_0|SrvcGrp|474|2022|PDM|300.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F67281_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F67300_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F67302_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE
20|FH_F67305_0_0|SrvcGrp|9518|2022|PCT|0.75|99|0.00|EMERGENCY ROOM
20|FH_F67306_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE
20|FH_F67319_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F67319_0_0|SrvcGrp|42973|2022|PDM|95.00|99|0.00|SPEECH  THERAPIST
20|FH_F67319_0_0|SrvcGrp|42974|2022|PDM|95.00|99|0.00|OCCUPATIONAL THERAPIST
20|FH_F67319_0_0|SrvcGrp|63537|2022|PDM|35.00|99|0.00|RESPITE CARE
20|FH_F67379_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.74|99|0.00|OP SVCS
20|FH_F67379_0_0|CSTM-ALL|CSTM-00|2020|PDM|1024.00|99|0.00|ACUTE PSYCH
20|FH_F67379_0_0|CSTM-ALL|CSTM-00|2020|PDM|8476.00|99|0.00|MS DRG 037-039
20|FH_F67379_0_0|SrvcGrp|20075|2022|PDM|6357.00|99|0.00|MS DRG 286 ONLY
20|FH_F67379_0_0|SrvcGrp|20908|2022|PDM|11300.00|99|0.00|MS DRG 247 ONLY
20|FH_F67379_0_0|SrvcGrp|31145|2022|PDM|8476.00|99|0.00|MS DRG 281-282 ONLY
20|FH_F67379_0_0|SrvcGrp|39870|2022|PDM|19000.00|99|0.00|MS DRG 619-621 ONLY
20|FH_F67379_0_0|SrvcGrp|40589|2022|PDM|8476.00|99|0.00|MS DRG 028-030 ONLY SPINE SURGERY
20|FH_F67379_0_0|SrvcGrp|63184|2022|PDM|1270.00|99|0.00|R&B
20|FH_F67381_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F67383_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F67423_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.00|99|0.00|GENERAL ACUTE CARE
20|FH_F67424_0_0|SrvcGrp|473|2022|PDM|315.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F67425_0_0|SrvcGrp|10425|2022|PDM|550.00|99|0.00|NEWBORN NURSERY
20|FH_F67425_0_0|SrvcGrp|16|2022|PDM|1565.00|99|0.00|ACUTE REHABILITATION
20|FH_F67425_0_0|SrvcGrp|21826|2022|PDM|3149.00|99|0.00|PTCA (MS DRG ONLY)
20|FH_F67425_0_0|SrvcGrp|23477|2022|PDM|2733.00|99|0.00|MSDRG 286-287 ONLY CARDIAC CATH
20|FH_F67425_0_0|SrvcGrp|29817|2022|PDM|2200.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F67425_0_0|SrvcGrp|43|2022|PCT|0.55|99|0.00|IMPLANTS
20|FH_F67504_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F67560_0_0|SrvcGrp|17065|2022|PCT|0.83|99|0.00|ASPG I
20|FH_F67560_0_0|SrvcGrp|17071|2022|PCT|0.83|99|0.00|ASPG IV
20|FH_F67560_0_0|SrvcGrp|17075|2022|PCT|0.83|99|0.00|ASPG VI
20|FH_F67639_0_0|CSTM-ALL|CSTM-00|2020|PDM|321.40|99|0.00|ASPG I
20|FH_F67639_0_0|CSTM-ALL|CSTM-00|2020|PDM|430.85|99|0.00|ASPG II
20|FH_F67639_0_0|CSTM-ALL|CSTM-00|2020|PDM|608.96|99|0.00|ASPG IV
20|FH_F67639_0_0|SrvcGrp|14614|2022|PDM|2800.00|99|0.00|LITHOTRIPSY
20|FH_F67639_0_0|SrvcGrp|27346|2022|PDM|1600.00|99|0.00|REPAIR BLADDER DEFECT
20|FH_F67639_0_0|SrvcGrp|38364|2022|PDM|3371.00|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F67639_0_0|SrvcGrp|63462|2022|PDM|1025.00|99|0.00|CPT 64595
20|FH_F67639_0_0|SrvcGrp|63465|2022|PDM|800.00|99|0.00|CPT 52214
20|FH_F67680_0_0|SrvcGrp|50842|2022|PDM|135.00|99|0.00|GENERAL ACUTE CARE
20|FH_F67683_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F67683_0_0|SrvcGrp|26596|2022|PDM|250.00|99|0.00|PARTIAL HOSP PSYCH/CD (HALF DAY)
20|FH_F67683_0_0|SrvcGrp|43526|2022|PDM|300.00|99|0.00|INTENSIVE OUTPATIENT PROGRAM - SUBSTANCE ABUSE
20|FH_F67741_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F67742_0_0|CSTM-ALL|CSTM-00|2020|PCT|68.00|99|0.00|OP SVCS
20|FH_F67763_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F67763_0_0|SrvcGrp|44244|2022|PDM|375.00|99|0.00|HEMODIALYSIS - HOME TRAINING
20|FH_F67764_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F67764_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F67803_0_0|SrvcGrp|45783|2022|PDM|110.00|99|0.00|SKILLED NURSING VISIT
20|FH_F67861_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F67861_0_0|SrvcGrp|11336|2022|PCT|0.60|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F67861_0_0|SrvcGrp|11577|2022|PDM|850.00|99|0.00|DIALYSIS
20|FH_F67861_0_0|SrvcGrp|24806|2022|PCT|0.60|99|0.00|PHYSICAL THERAPY
20|FH_F67861_0_0|SrvcGrp|27271|2022|PDM|17600.00|99|0.00|GASTRIC BYPASS
20|FH_F67861_0_0|SrvcGrp|30623|2022|PDM|4950.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788
20|FH_F67861_0_0|SrvcGrp|3418|2022|PDM|1650.00|99|0.00|NEONATAL INTENSIVE CARE UNIT
20|FH_F67861_0_0|SrvcGrp|3448|2022|PCT|0.60|99|0.00|MRI
20|FH_F67861_0_0|SrvcGrp|73980|2022|PDM|13200.00|99|0.00|OP SLEEVE GASTRECTOMY
20|FH_F67861_0_0|SrvcGrp|8950|2022|PDM|2530.00|99|0.00|INTERMEDIATE ICU/CCU
20|FH_F67861_0_0|SrvcGrp|9911|2022|PCT|0.75|99|0.00|EMERGENCY ROOM SVCS
20|FH_F67861_0_0|SrvcGrp|9939|2022|PDM|2200.00|99|0.00|ACUTE MEDICAL SVCS
20|FH_F67887_0_0|SrvcGrp|12263|2022|PDM|22.00|99|0.00|HOME HEALTH AIDE- HOURLY
20|FH_F67887_0_0|SrvcGrp|12702|2022|PDM|55.00|99|0.00|RN, INTERMITTENT VISIT
20|FH_F67887_0_0|SrvcGrp|42825|2022|PDM|44.00|99|0.00|HOME HEALTH AIDE VISIT
20|FH_F67888_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F67888_0_0|SrvcGrp|64636|2022|PDM|33.75|99|0.00|HOSPICE CONTINUOUS HOME CARE
20|FH_F67923_0_0|CSTM-ALL|CSTM-00|2020|PCT|69.00|99|0.00|GENERAL ACUTE CARE
20|FH_F67923_0_0|CSTM-ALL|CSTM-00|2020|PCT|69.00|99|0.00|OP SVCS
20|FH_F67924_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F67924_0_0|SrvcGrp|24028|2022|PDM|46.00|99|0.00|LICENSED PRACTICAL NURSE
20|FH_F67924_0_0|SrvcGrp|42824|2022|PDM|120.00|99|0.00|SKILLED NURSING VISIT
20|FH_F67924_0_0|SrvcGrp|42828|2022|PDM|125.00|99|0.00|SPEECH THERAPY VISIT
20|FH_F67984_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F67984_0_0|SrvcGrp|14494|2022|PDM|30.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F67984_0_0|SrvcGrp|64202|2022|PDM|100.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F67984_0_0|SrvcGrp|64203|2022|PDM|100.00|99|0.00|PHYSICAL THERAPY
20|FH_F67999_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F68040_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F68043_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F68121_0_0|SrvcGrp|64318|2022|PDM|100.00|99|0.00|PHYSICAL THERAPY EVAL/ RE-EVAL
20|FH_F68124_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F68161_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F68161_0_0|CSTM-ALL|CSTM-00|2020|PDM|1407.00|99|0.00|COVENTRY ENHANCED GROUPER 2
20|FH_F68161_0_0|CSTM-ALL|CSTM-00|2020|PDM|2923.00|99|0.00|COVENTRY ENHANCED GROUPER 9
20|FH_F68161_0_0|SrvcGrp|11663|2022|PCT|0.55|99|0.00|IMPLANTS
20|FH_F68251_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F68251_0_0|SrvcGrp|33165|2022|PDM|375.00|99|0.00|SKILLED NURSING - LEVEL II
20|FH_F68251_0_0|SrvcGrp|43892|2022|PDM|80.00|99|0.00|PHYSICAL THERAPY VISIT
20|FH_F68251_0_0|SrvcGrp|44131|2022|PDM|80.00|99|0.00|SPEECH THERAPY VISIT
20|FH_F68301_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F68301_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F68309_0_0|CSTM-ALL|CSTM-00|2020|PDM|637.00|99|0.00|AEG 10 (NO REV)
20|FH_F68309_0_0|SrvcGrp|11000|2022|PCT|1.00|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F68322_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F68322_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS
20|FH_F68322_0_0|SrvcGrp|17065|2022|PDM|585.00|99|0.00|ASPG I
20|FH_F68341_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F68341_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F68363_0_0|SrvcGrp|13630|2022|PDM|190.00|99|0.00|CPT 99204
20|FH_F68363_0_0|SrvcGrp|13632|2022|PDM|210.00|99|0.00|CPT 99215
20|FH_F68363_0_0|SrvcGrp|3403|2022|PDM|137.00|99|0.00|CPT 99203
20|FH_F68365_0_0|CSTM-ALL|CSTM-00|2020|PDM|1281.00|99|0.00|COVENTRY ENHANCED GROUPER 8
20|FH_F68365_0_0|CSTM-ALL|CSTM-00|2020|PDM|1304.00|99|0.00|COVENTRY ENHANCED GROUPER 7
20|FH_F68365_0_0|CSTM-ALL|CSTM-00|2020|PDM|436.00|99|0.00|COVENTRY ENHANCED GROUPER 1
20|FH_F68365_0_0|SrvcGrp|65627|2022|PCT|1.00|99|0.00|HCPC IMPLANTS (L8600 - L8690)
20|FH_F68442_0_0|SrvcGrp|33166|2022|PDM|475.00|99|0.00|SKILLED NURSING - LEVEL III
20|FH_F68442_0_0|SrvcGrp|44131|2022|PDM|80.00|99|0.00|SPEECH THERAPY VISIT
20|FH_F68460_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F68481_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|ASPG IX
20|FH_F68481_0_0|CSTM-ALL|CSTM-00|2020|PDM|785.00|99|0.00|ASPG II
20|FH_F68562_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|GENERAL ACUTE CARE
20|FH_F68562_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|OP SVCS
20|FH_F68626_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE
20|FH_F68660_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F68719_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F68782_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.40|99|0.00|OP SVCS
20|FH_F68823_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F68823_0_0|SrvcGrp|44302|2022|PDM|60.00|99|0.00|PT & OT (VISIT LVL) PT MOD GP
20|FH_F68826_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F68826_0_0|SrvcGrp|81059|2022|PDM|65.00|99|0.00|PT & OT (VISIT LVL) PT MOD GP
20|FH_F68826_0_0|SrvcGrp|81097|2022|PDM|65.00|99|0.00|PT & OT (MOD GO) VISIT LVL
20|FH_F68831_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F68831_0_0|SrvcGrp|14494|2022|PDM|35.20|99|0.00|CONTINUOUS HOMECARE
20|FH_F68831_0_0|SrvcGrp|22954|2022|PDM|148.50|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F68831_0_0|SrvcGrp|9828|2022|PDM|49.50|99|0.00|HOME HEALTH AIDE
20|FH_F68831_0_0|SrvcGrp|9830|2022|PDM|99.00|99|0.00|OT SVCS
20|FH_F68835_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE
20|FH_F68844_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|AMBULANCE SERVICES
20|FH_F68846_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F68853_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F68856_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F68868_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|99|0.00|OP SVCS
20|FH_F68868_0_0|SrvcGrp|12299|2022|PCT|0.68|99|0.00|PROSTHETICS/IMPLANTS/DEVICES
20|FH_F68868_0_0|SrvcGrp|20752|2022|PDM|19390.00|99|0.00|MSDRG 619-621 ONLY BARIATRIC SURGERY
20|FH_F68868_0_0|SrvcGrp|30623|2022|PDM|2720.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788
20|FH_F68888_0_0|SrvcGrp|44106|2022|PDM|48.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F68944_0_0|SrvcGrp|10951|2022|PCT|0.70|99|0.00|PARTIAL HOSPITALIZATION PSYCH/CD
20|FH_F68944_0_0|SrvcGrp|14366|2022|PDM|3500.00|99|0.00|ICU/PICU/CCU
20|FH_F68944_0_0|SrvcGrp|23206|2022|PCT|0.70|99|0.00|PTCA
20|FH_F68944_0_0|SrvcGrp|23477|2022|PDM|4819.00|99|0.00|MSDRG 286-287 ONLY CARDIAC CATH
20|FH_F68944_0_0|SrvcGrp|3208|2022|PDM|1236.00|99|0.00|SUBACUTE CARE
20|FH_F68944_0_0|SrvcGrp|9511|2022|PCT|0.70|99|0.00|OBSERVATION SVCS
20|FH_F68947_0_0|CSTM-ALL|CSTM-00|2020|PDM|1600.00|99|0.00|COVENTRY ENHANCED GROUPER 2
20|FH_F68947_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|COVENTRY ENHANCED GROUPER 7
20|FH_F68947_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|COVENTRY ENHANCED GROUPER 8
20|FH_F68947_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|COVENTRY ENHANCED GROUPER 9
20|FH_F68947_0_0|SrvcGrp|15473|2022|PDM|4865.08|99|0.00|CPT CODE 42820
20|FH_F68947_0_0|SrvcGrp|65403|2022|PDM|4653.17|99|0.00|CPT 42830
20|FH_F68947_0_0|SrvcGrp|65404|2022|PDM|2991.00|99|0.00|CPT 69421
20|FH_F68947_0_0|SrvcGrp|79758|2022|PDM|900.00|99|0.00|ANESTHESIA
20|FH_F68950_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F68950_0_0|CSTM-ALL|CSTM-00|2020|PDM|1154.15|99|0.00|ASPG III
20|FH_F68950_0_0|SrvcGrp|25518|2022|PDM|3472.88|99|0.00|LAPAROSCOPY SURGICAL CHOLECYSTECTOMY
20|FH_F68950_0_0|SrvcGrp|29718|2022|PCT|0.70|99|0.00|SUPPLIES/DEVICES/IMPLANTABLES
20|FH_F68966_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|OP SVCS
20|FH_F68968_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|GENERAL ACUTE CARE
20|FH_F68972_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|GENERAL ACUTE CARE
20|FH_F69023_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F69063_0_0|SrvcGrp|24739|2022|PDM|35.00|99|0.00|RESPITE CARE
20|FH_F69063_0_0|SrvcGrp|27968|2022|PDM|27.50|99|0.00|SKILLED NURSING LPN
20|FH_F69063_0_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE
20|FH_F69063_0_0|SrvcGrp|36068|2022|PDM|55.00|99|0.00|SKILLED NURSING NON IV RELATED
20|FH_F69063_0_0|SrvcGrp|43956|2022|PDM|55.00|99|0.00|NURSING CARE
20|FH_F69063_0_0|SrvcGrp|47764|2022|PDM|120.00|99|0.00|HOSPICE CARE/ IN HOME S9126 VISIT LEVEL
20|FH_F69071_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F69071_0_0|SrvcGrp|13595|2022|PDM|598.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC
20|FH_F69071_0_0|SrvcGrp|18071|2022|PDM|80.29|99|0.00|AMBULANCE RESPONSE/TREATMENT - NO TRANSPORT
20|FH_F69084_0_0|CSTM-ALL|CSTM-00|2020|PDM|1103.00|99|0.00|AEG 8 (NO REV)
20|FH_F69084_0_0|CSTM-ALL|CSTM-00|2020|PDM|1126.00|99|0.00|AEG 7 (NO REV)
20|FH_F69084_0_0|CSTM-ALL|CSTM-00|2020|PDM|576.00|99|0.00|AEG 10 (NO REV)
20|FH_F69084_0_0|CSTM-ALL|CSTM-00|2020|PDM|714.00|99|0.00|AEG 4 (NO REV)
20|FH_F69084_0_0|CSTM-ALL|CSTM-00|2020|PDM|811.00|99|0.00|AEG 5  (NO REV)
20|FH_F69084_0_0|SrvcGrp|37202|2022|PDM|742.00|99|0.00|ENDOSCOPY
20|FH_F69108_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F69108_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F69122_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F69202_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.90|99|0.00|ASPG IX
20|FH_F69202_0_0|SrvcGrp|19961|2022|PDM|41000.00|99|0.00|MS DRG 231-232 ONLY CORONARY BYPASS W/ PTCA
20|FH_F69202_0_0|SrvcGrp|28002|2022|PDM|13200.00|99|0.00|MS DRG 253-254 ONLY
20|FH_F69202_0_0|SrvcGrp|39522|2022|PDM|43600.00|99|0.00|MS DRG 216-218 ONLY
20|FH_F69202_0_0|SrvcGrp|41367|2022|PDM|19800.00|99|0.00|MS DRG 242-244 ONLY
20|FH_F69202_0_0|SrvcGrp|88|2022|PDM|6050.00|99|0.00|OP LITHOTRIPSY
20|FH_F69202_0_0|SrvcGrp|9511|2022|PDM|150.00|99|0.00|OBSERVATION SVCS
20|FH_F69205_0_0|SrvcGrp|10518|2022|PDM|180.51|99|0.00|ENTEROSTOMAL VISIT F/U VISIT
20|FH_F69205_0_0|SrvcGrp|10623|2022|PDM|172.80|99|0.00|SPEECH THERAPY SERVICES
20|FH_F69205_0_0|SrvcGrp|11798|2022|PDM|204.20|99|0.00|HOME INFUSION NURSING SVCS
20|FH_F69205_0_0|SrvcGrp|36971|2022|PDM|184.02|99|0.00|MISC INFUSION THERAPY
20|FH_F69242_0_0|SrvcGrp|42974|2022|PDM|95.00|99|0.00|OCCUPATIONAL THERAPIST
20|FH_F69242_0_0|SrvcGrp|43955|2022|PDM|90.00|99|0.00|NURSING CARE
20|FH_F69242_0_0|SrvcGrp|43956|2022|PDM|55.00|99|0.00|NURSING CARE
20|FH_F69242_0_0|SrvcGrp|43957|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE
20|FH_F69242_0_0|SrvcGrp|43958|2022|PDM|73.00|99|0.00|ENTEROSTOMAL THERAPY SERVICES
20|FH_F69290_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F69322_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE
20|FH_F69322_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F69322_0_0|CSTM-ALL|CSTM-00|2020|PDM|362.00|99|0.00|ADOLESCENT PSYCH PARTIAL HOSP
20|FH_F69322_0_0|SrvcGrp|12778|2022|PDM|321.00|99|0.00|ADULT PSYCH PARTIAL HOSP
20|FH_F69322_0_0|SrvcGrp|166|2022|PDM|760.00|99|0.00|CD (ADULT) - DETOXIFICATION
20|FH_F69423_0_0|CSTM-ALL|CSTM-00|2020|PDM|1505.00|99|0.00|AEG 8 (NO REV)
20|FH_F69423_0_0|CSTM-ALL|CSTM-00|2020|PDM|684.00|99|0.00|AEG 2 (NO REV)
20|FH_F69423_0_0|CSTM-ALL|CSTM-00|2020|PDM|968.00|99|0.00|AEG 4 (NO REV)
20|FH_F69423_0_0|SrvcGrp|26281|2022|PDM|2601.00|99|0.00|CPT 58353
20|FH_F69504_0_0|SrvcGrp|48396|2022|PDM|23.00|99|0.00|OT SERVICES
20|FH_F69583_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F69647_0_0|SrvcGrp|17069|2022|PDM|900.00|99|0.00|ASPG III
20|FH_F69648_0_0|SrvcGrp|48385|2022|PDM|11.25|99|0.00|SPEECH THERAPY
20|FH_F69648_0_0|SrvcGrp|48396|2022|PDM|11.25|99|0.00|OT SERVICES
20|FH_F69648_0_0|SrvcGrp|66005|2022|PDM|11.25|99|0.00|SKILLED NURSING HCPC
20|FH_F69651_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F69651_0_0|SrvcGrp|24739|2022|PDM|35.00|99|0.00|RESPITE CARE
20|FH_F69651_0_0|SrvcGrp|44423|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE (VISIT LVL)
20|FH_F69685_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|GENERAL ACUTE CARE
20|FH_F69694_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|GENERAL ACUTE CARE
20|FH_F69703_0_0|CSTM-ALL|CSTM-00|2020|PDM|1050.00|99|0.00|COVENTRY ENHANCED GROUPER 5
20|FH_F69703_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|COVENTRY ENHANCED GROUPER 1
20|FH_F69703_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|COVENTRY ENHANCED GROUPER 4
20|FH_F69750_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F69751_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F69785_0_0|SrvcGrp|42976|2022|PDM|80.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F69785_0_0|SrvcGrp|88620|2022|PDM|80.00|99|0.00|SKILLED NURSING RN
20|FH_F69787_0_0|SrvcGrp|33662|2022|PDM|8500.00|99|0.00|CYBERKNIFE
20|FH_F69805_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE
20|FH_F69807_0_0|CSTM-ALL|CSTM-00|2020|PCT|56.56|99|0.00|GENERAL ACUTE CARE
20|FH_F69845_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE
20|FH_F69965_0_0|SrvcGrp|59426|2022|PDM|110.00|99|0.00|PT
20|FH_F69965_0_0|SrvcGrp|66360|2022|PDM|110.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F69971_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F69971_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AEG 6 DUBUQUE ENDOSCOPY CENTER (NO REV)
20|FH_F69971_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AEG 7 DUBUQUE ENDOSCOPY CENTER (NO REV)
20|FH_F69971_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AEG 9 DUBUQUE ENDOSCOPY CENTER (NO REV)
20|FH_F70005_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 3 (NO REV)
20|FH_F70005_0_0|CSTM-ALL|CSTM-00|2020|PDM|1370.00|99|0.00|AEG 4 (NO REV)
20|FH_F70005_0_0|CSTM-ALL|CSTM-00|2020|PDM|1816.00|99|0.00|AEG 6 (NO REV)
20|FH_F70005_0_0|SrvcGrp|17000|2022|PDM|1100.00|99|0.00|OUTPATIENT SURGERY
20|FH_F70104_0_0|CSTM-ALL|CSTM-00|2020|PDM|12.00|99|0.00|SKILLED NURSING HCPC
20|FH_F70104_0_0|SrvcGrp|10517|2022|PDM|7.00|99|0.00|HOME HEALTH AIDE VISIT
20|FH_F70104_0_0|SrvcGrp|48385|2022|PDM|12.00|99|0.00|SPEECH THERAPY
20|FH_F70104_0_0|SrvcGrp|48398|2022|PDM|12.00|99|0.00|PT SERVICES
20|FH_F70126_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F70163_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F70165_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F70182_0_0|SrvcGrp|43893|2022|PDM|125.00|99|0.00|OCCUPATIONAL THERAPY VISIT
20|FH_F70182_0_0|SrvcGrp|45541|2022|PDM|125.00|99|0.00|SPEECH THERAPY
20|FH_F70331_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|GENERAL ACUTE CARE
20|FH_F70510_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F70531_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F70545_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F70545_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F70546_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F70603_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F70606_0_0|SrvcGrp|472|2022|PDM|650.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F70606_0_0|SrvcGrp|474|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F70645_0_0|SrvcGrp|9937|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F70805_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F71002_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F71005_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F71027_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F71027_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|GENERAL ACUTE CARE
20|FH_F71042_0_0|SrvcGrp|68040|2022|PDM|700.00|99|0.00|RESIDENTIAL COMMUNITY RE-ENTRY PROGRAMMING
20|FH_F71065_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.00|99|0.00|OP SVCS
20|FH_F71067_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|OP SVCS
20|FH_F71070_0_0|CSTM-ALL|CSTM-00|2020|PDM|1325.00|99|0.00|COVENTRY ENHANCED GROUPER 3
20|FH_F71070_0_0|CSTM-ALL|CSTM-00|2020|PDM|2100.00|99|0.00|COVENTRY ENHANCED GROUPER 7
20|FH_F71070_0_0|SrvcGrp|3932|2022|PDM|4400.00|99|0.00|LITHOTRIPSY
20|FH_F71070_0_0|SrvcGrp|68048|2022|PDM|4100.00|99|0.00|CPT 64581
20|FH_F71070_0_0|SrvcGrp|68051|2022|PDM|1200.00|99|0.00|CPT 52005
20|FH_F71070_0_0|SrvcGrp|68056|2022|PDM|1000.00|99|0.00|CPT 55700
20|FH_F71103_0_0|SrvcGrp|42782|2022|PDM|90.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F71105_0_0|SrvcGrp|32153|2022|PDM|70.00|99|0.00|PT/OT/ST
20|FH_F71145_0_0|SrvcGrp|44242|2022|PDM|375.00|99|0.00|HEMO/HOME DIALYSIS SVCS
20|FH_F71145_0_0|SrvcGrp|44244|2022|PDM|395.00|99|0.00|HEMODIALYSIS - HOME TRAINING
20|FH_F71145_0_0|SrvcGrp|44246|2022|PDM|165.00|99|0.00|CAPD TRAINING
20|FH_F71145_0_0|SrvcGrp|44247|2022|PDM|165.00|99|0.00|CAPD TRAINING
20|FH_F71145_0_0|SrvcGrp|44250|2022|PDM|165.00|99|0.00|CCPD TRAINING
20|FH_F71229_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F71268_0_0|SrvcGrp|9947|2022|PCT|0.50|99|0.00|DRUGS
20|FH_F71271_0_0|SrvcGrp|68262|2022|PDM|12.00|99|0.00|SPEECH THERAPY
20|FH_F71282_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F71282_0_0|CSTM-ALL|CSTM-00|2020|PCT|50.00|99|0.00|HIGH COST DRUGS
20|FH_F71342_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F71342_0_0|CSTM-ALL|CSTM-00|2020|PDM|1582.00|99|0.00|AEG 4 (NO REV)
20|FH_F71342_0_0|CSTM-ALL|CSTM-00|2020|PDM|1625.00|99|0.00|AEG 2 (NO REV)
20|FH_F71345_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F71345_0_0|SrvcGrp|22954|2022|PDM|163.48|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F71345_0_0|SrvcGrp|8962|2022|PDM|105.37|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F71345_0_0|SrvcGrp|9828|2022|PDM|46.45|99|0.00|HOME HEALTH AIDE
20|FH_F71345_0_0|SrvcGrp|9829|2022|PDM|110.03|99|0.00|PT SVCS
20|FH_F71346_0_0|SrvcGrp|17140|2022|PDM|131.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F71364_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING
20|FH_F71364_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F71365_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F71365_0_0|SrvcGrp|66480|2022|PDM|75.00|99|0.00|RN VISIT
20|FH_F71365_0_0|SrvcGrp|66481|2022|PDM|75.00|99|0.00|SOCIAL WORKER
20|FH_F71386_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F71386_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.40|99|0.00|OP SVCS
20|FH_F71443_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F71465_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F71465_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F71484_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F71543_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE
20|FH_F71543_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS
20|FH_F71625_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F71628_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F71628_0_0|SrvcGrp|48396|2022|PDM|15.00|99|0.00|OT SERVICES
20|FH_F71628_0_0|SrvcGrp|48398|2022|PDM|15.00|99|0.00|PT SERVICES
20|FH_F71634_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F71647_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F71647_0_0|SrvcGrp|12163|2022|PCT|0.60|99|0.00|DRUGS
20|FH_F71647_0_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F71665_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F71686_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|GENERAL ACUTE CARE
20|FH_F71686_0_0|SrvcGrp|14566|2022|PDM|900.00|99|0.00|MAGNETIC RESONANCE IMAGING (MRI)
20|FH_F71686_0_0|SrvcGrp|3409|2022|PDM|300.00|99|0.00|NEWBORN NURSERY
20|FH_F71686_0_0|SrvcGrp|38452|2022|PCT|0.75|99|0.00|DAY SURGERY SERVICES
20|FH_F71702_0_0|CSTM-ALL|CSTM-00|2020|PDM|492.54|99|0.00|ASPG III
20|FH_F71702_0_0|CSTM-ALL|CSTM-00|2020|PDM|492.54|99|0.00|ASPG X
20|FH_F71702_0_0|CSTM-ALL|CSTM-00|2020|PDM|608.96|99|0.00|ASPG IV
20|FH_F71704_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|GENERAL ACUTE CARE
20|FH_F71747_0_0|SrvcGrp|42782|2022|PDM|60.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F71747_0_0|SrvcGrp|42784|2022|PDM|60.00|99|0.00|OCCUPATIONAL THERAPY  SRVCS
20|FH_F71747_0_0|SrvcGrp|42785|2022|PDM|60.00|99|0.00|SPEECH THERAPY  SRVCS
20|FH_F71748_0_0|SrvcGrp|17139|2022|PDM|746.29|99|0.00|HOSPICE CARE
20|FH_F71786_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS
20|FH_F71829_0_0|SrvcGrp|12403|2022|PDM|39.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F71848_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F71848_0_0|SrvcGrp|68779|2022|PDM|183.00|99|0.00|IMMUNOHISTO ANTIBODY STAIN
20|FH_F71863_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F71863_0_0|SrvcGrp|9828|2022|PDM|49.50|99|0.00|HOME HEALTH AIDE
20|FH_F71866_0_0|SrvcGrp|68846|2022|PDM|700.00|99|0.00|SKILLED NURSING
20|FH_F71905_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F71905_0_0|SrvcGrp|59428|2022|PDM|75.00|99|0.00|ST
20|FH_F71923_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F71923_0_0|SrvcGrp|10510|2022|PDM|318.27|99|0.00|CPT CODE 90945
20|FH_F71923_0_0|SrvcGrp|12041|2022|PDM|212.18|99|0.00|DIALYSIS
20|FH_F71923_0_0|SrvcGrp|68900|2022|PDM|583.50|99|0.00|DIALYSIS TRAINING
20|FH_F71927_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE
20|FH_F71927_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F71984_0_0|CSTM-ALL|CSTM-00|2020|PCT|71.81|99|0.00|GENERAL ACUTE CARE
20|FH_F72024_0_0|SrvcGrp|17140|2022|PDM|155.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F72049_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72049_0_0|SrvcGrp|17140|2022|PDM|160.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F72049_0_0|SrvcGrp|3810|2022|PDM|156.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F72065_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F72085_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F72085_0_0|SrvcGrp|44244|2022|PDM|420.00|99|0.00|HEMODIALYSIS - HOME TRAINING
20|FH_F72086_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F72090_0_0|SrvcGrp|17139|2022|PDM|704.00|99|0.00|HOSPICE CARE
20|FH_F72143_0_0|SrvcGrp|360|2022|PDM|2800.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F72143_0_0|SrvcGrp|37018|2022|PDM|450.00|99|0.00|BOARDER BABY
20|FH_F72206_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.66|99|0.00|OP SVCS
20|FH_F72222_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72262_0_0|SrvcGrp|10391|2022|PDM|1600.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F72302_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72302_0_0|CSTM-ALL|CSTM-00|2020|PDM|498.00|99|0.00|AEG 2 (NO REV)
20|FH_F72302_0_0|CSTM-ALL|CSTM-00|2020|PDM|919.00|99|0.00|AEG 6 (NO REV)
20|FH_F72302_0_0|SrvcGrp|14614|2022|PDM|2300.00|99|0.00|LITHOTRIPSY
20|FH_F72306_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|COVENTRY ENHANCED GROUPER 8
20|FH_F72306_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|COVENTRY ENHANCED GROUPER 9
20|FH_F72306_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|COVENTRY ENHANCED GROUPER 2
20|FH_F72387_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F72387_0_0|SrvcGrp|1306|2022|PDM|350.00|99|0.00|OP PSYCH PARTIAL HOSP
20|FH_F72387_0_0|SrvcGrp|3934|2022|PDM|220.00|99|0.00|INTENSIVE ADULT DUAL DIAGNOSIS
20|FH_F72387_0_0|SrvcGrp|80|2022|PDM|550.00|99|0.00|ACUTE PSYCH
20|FH_F72390_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F72390_0_0|CSTM-ALL|CSTM-00|2020|PDM|2266.00|99|0.00|ASPG III
20|FH_F72390_0_0|CSTM-ALL|CSTM-00|2020|PDM|3679.00|99|0.00|ASPG VI
20|FH_F72390_0_0|CSTM-ALL|CSTM-00|2020|PDM|5947.00|99|0.00|ASPG IX
20|FH_F72390_0_0|SrvcGrp|27316|2022|PDM|3553.00|99|0.00|TONSILS & ADENOIDS (42820)
20|FH_F72404_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 10 (NO REV)
20|FH_F72404_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 4 (NO REV)
20|FH_F72404_0_0|CSTM-ALL|CSTM-00|2020|PDM|1895.00|99|0.00|AEG 7 (NO REV)
20|FH_F72404_0_0|CSTM-ALL|CSTM-00|2020|PDM|2524.00|99|0.00|AEG 9 (NO REV)
20|FH_F72404_0_0|CSTM-ALL|CSTM-00|2020|PDM|635.00|99|0.00|AEG 1 (NO REV)
20|FH_F72407_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING
20|FH_F72407_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72416_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.41|99|0.00|GENERAL ACUTE CARE
20|FH_F72427_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F72523_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F72542_0_0|SrvcGrp|12122|2022|PCT|0.80|99|0.00|GAMMA KNIFE
20|FH_F72542_0_0|SrvcGrp|25535|2022|PDM|1400.00|99|0.00|ICU
20|FH_F72543_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F72543_0_0|SrvcGrp|46112|2022|PDM|50.67|99|0.00|MATERNAL/CHILD HEALTH (ADDITIONAL HOUR)
20|FH_F72584_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F72584_0_0|SrvcGrp|12263|2022|PDM|17.00|99|0.00|HOME HEALTH AIDE- HOURLY
20|FH_F72584_0_0|SrvcGrp|42826|2022|PDM|130.00|99|0.00|PHYSICAL THERAPY VISIT
20|FH_F72584_0_0|SrvcGrp|42830|2022|PDM|140.00|99|0.00|MEDICAL SOCIAL WORKER VISIT
20|FH_F72590_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F72606_0_0|SrvcGrp|1306|2022|PDM|450.00|99|0.00|OP PSYCH PARTIAL HOSP
20|FH_F72606_0_0|SrvcGrp|15663|2022|PCT|0.85|99|0.00|TRAUMA CARE
20|FH_F72606_0_0|SrvcGrp|20752|2022|PDM|18000.00|99|0.00|MSDRG 619-621 ONLY BARIATRIC SURGERY
20|FH_F72606_0_0|SrvcGrp|21826|2022|PDM|9525.00|99|0.00|PTCA (MS DRG ONLY)
20|FH_F72606_0_0|SrvcGrp|30216|2022|PCT|0.85|99|0.00|ECMO
20|FH_F72606_0_0|SrvcGrp|3087|2022|PDM|2500.00|99|0.00|CD - DETOX
20|FH_F72606_0_0|SrvcGrp|3418|2022|PDM|4500.00|99|0.00|NEONATAL INTENSIVE CARE UNIT
20|FH_F72606_0_0|SrvcGrp|69683|2022|PDM|9525.00|99|0.00|CARDIOVASCULAR SURGERY MS DRG ONLY
20|FH_F72606_0_0|SrvcGrp|9911|2022|PCT|0.85|99|0.00|EMERGENCY ROOM SVCS
20|FH_F72648_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F72648_0_0|SrvcGrp|44244|2022|PDM|340.00|99|0.00|HEMODIALYSIS - HOME TRAINING
20|FH_F72664_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F72664_0_0|SrvcGrp|68381|2022|PDM|75.00|99|0.00|SPEECH THERAPY
20|FH_F72664_0_0|SrvcGrp|68382|2022|PDM|75.00|99|0.00|SOCIAL WORKER
20|FH_F72664_0_0|SrvcGrp|90558|2022|PDM|90.00|99|0.00|RN VISIT
20|FH_F72666_0_0|SrvcGrp|29|2022|PDM|5939.00|99|0.00|ELECTROPHYSIOLOGY
20|FH_F72666_0_0|SrvcGrp|30661|2022|PDM|4620.00|99|0.00|LITHOTRIPSY SVCS
20|FH_F72666_0_0|SrvcGrp|40682|2022|PCT|0.75|99|0.00|LITHOTRIPSY
20|FH_F72666_0_0|SrvcGrp|43986|2022|PDM|4614.00|99|0.00|CARDIAC PACEMAKER (MS DRG 242-244, 258-262 ONLY)
20|FH_F72666_0_0|SrvcGrp|69679|2022|PDM|4614.00|99|0.00|AICD MS DRG ONLY
20|FH_F72702_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F72702_0_0|CSTM-ALL|CSTM-00|2020|PDM|485.00|99|0.00|AEG 4 (NO REV)
20|FH_F72702_0_0|CSTM-ALL|CSTM-00|2020|PDM|485.00|99|0.00|AEG 5  (NO REV)
20|FH_F72702_0_0|CSTM-ALL|CSTM-00|2020|PDM|485.00|99|0.00|AEG 8 (NO REV)
20|FH_F72702_0_0|CSTM-ALL|CSTM-00|2020|PDM|743.00|99|0.00|AEG 3 (NO REV)
20|FH_F72704_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F72704_0_0|SrvcGrp|43893|2022|PDM|80.00|99|0.00|OCCUPATIONAL THERAPY VISIT
20|FH_F72746_0_0|SrvcGrp|26001|2022|PDM|159.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F72764_0_0|SrvcGrp|8950|2022|PDM|1730.00|99|0.00|INTERMEDIATE ICU/CCU
20|FH_F72765_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.59|99|0.00|OP SVCS
20|FH_F72765_0_0|SrvcGrp|8950|2022|PDM|1730.00|99|0.00|INTERMEDIATE ICU/CCU
20|FH_F72766_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|99|0.00|OP SVCS
20|FH_F72784_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F72784_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F72784_0_0|SrvcGrp|12290|2022|PDM|787.40|99|0.00|DETOXIFICATION
20|FH_F72784_0_0|SrvcGrp|70134|2022|PCT|0.65|99|0.00|IMPLANTS
20|FH_F72785_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.79|99|0.00|OP SVCS
20|FH_F72785_0_0|CSTM-ALL|CSTM-00|2020|PDM|1673.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F72785_0_0|SrvcGrp|29817|2022|PDM|5589.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F72785_0_0|SrvcGrp|30623|2022|PDM|10964.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788
20|FH_F72788_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.74|99|0.00|OP SVCS
20|FH_F72788_0_0|CSTM-ALL|CSTM-00|2020|PDM|1475.00|99|0.00|ACUTE PSYCH
20|FH_F72823_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F72823_0_0|SrvcGrp|33165|2022|PDM|425.00|99|0.00|SKILLED NURSING - LEVEL II
20|FH_F72830_0_0|CSTM-ALL|CSTM-00|2020|PDM|2115.00|99|0.00|OBSTETRICAL CARE
20|FH_F72830_0_0|SrvcGrp|13811|2022|PDM|263.00|99|0.00|PSYCH PARTIAL HOSP
20|FH_F72830_0_0|SrvcGrp|70041|2022|PDM|1100.00|99|0.00|CVTY ENHANCED + REV CODE ASPG 1
20|FH_F72830_0_0|SrvcGrp|70047|2022|PDM|2900.00|99|0.00|CVTY ENHANCED + REV CODE ASPG 7
20|FH_F72830_0_0|SrvcGrp|70050|2022|PDM|3300.00|99|0.00|CVTY ENHANCED + REV CODE ASPG 10
20|FH_F72830_0_0|SrvcGrp|70080|2022|PCT|0.40|99|0.00|RADIOLOGY WITH REV CODE 320, 339
20|FH_F72842_0_0|SrvcGrp|29817|2022|PDM|5157.10|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F72842_0_0|SrvcGrp|3029|2022|PDM|755.00|99|0.00|NEWBORN NURSERY
20|FH_F72842_0_0|SrvcGrp|3271|2022|PDM|5018.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F72845_0_0|SrvcGrp|30623|2022|PDM|11394.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788
20|FH_F72845_0_0|SrvcGrp|3271|2022|PDM|5751.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F72850_0_0|SrvcGrp|3418|2022|PCT|0.68|99|0.00|NEONATAL INTENSIVE CARE UNIT
20|FH_F72859_0_0|CSTM-ALL|CSTM-00|2020|PDM|14.40|99|0.00|TOTAL PARENTERAL NUTRITION
20|FH_F72859_0_0|CSTM-ALL|CSTM-00|2020|PDM|20.97|99|0.00|TOTAL PARENTERAL NUTRITION
20|FH_F146204_0_0|SrvcGrp|38708|2022|PDM|1922.00|99|0.00|HYSTEROSCOPY
20|FH_F146204_0_0|SrvcGrp|67991|2022|PDM|2376.00|99|0.00|CPT 59150
20|FH_F146204_0_0|SrvcGrp|73495|2022|PDM|2376.00|99|0.00|AETNA MYOMECTOMY
20|FH_F146204_0_0|SrvcGrp|83817|2022|PDM|2376.00|99|0.00|LAPAROSCOPY LYSIS ADHESIONS
20|FH_F146217_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F146217_0_0|SrvcGrp|104226|2022|PDM|178.66|99|0.00|HOSPICE CARE (HCFA)
20|FH_F146217_0_0|SrvcGrp|104228|2022|PDM|178.66|99|0.00|HOSPICE CARE (HCFA)
20|FH_F146217_0_0|SrvcGrp|104229|2022|PDM|141.22|99|0.00|HOSPICE IN HOME (HCFA)
20|FH_F146217_0_0|SrvcGrp|104230|2022|PDM|141.22|99|0.00|RESPITE CARE (HCFA)
20|FH_F146217_0_0|SrvcGrp|80918|2022|PDM|423.55|99|0.00|RESPITE CARE
20|FH_F146217_0_0|SrvcGrp|80920|2022|PDM|913.07|99|0.00|HOSPICE SERVICES
20|FH_F146255_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.90|99|0.00|GENERAL ACUTE CARE
20|FH_F146256_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|OP SVCS
20|FH_F146261_0_0|CSTM-ALL|CSTM-00|2020|PCT|71.80|99|0.00|OP SVCS
20|FH_F146266_0_0|SrvcGrp|100001|2022|PDM|6944.00|99|0.00|WRIST REPLACEMNT TOT WRIST
20|FH_F146266_0_0|SrvcGrp|111325|2022|PDM|8444.00|99|0.00|SPINAL CORD DECOMPRESS-CERVICAL
20|FH_F146266_0_0|SrvcGrp|113988|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F146266_0_0|SrvcGrp|114014|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES
20|FH_F146266_0_0|SrvcGrp|11673|2022|PDM|4785.00|99|0.00|CPT 29888
20|FH_F146266_0_0|SrvcGrp|26274|2022|PDM|2685.00|99|0.00|CPT 29877
20|FH_F146266_0_0|SrvcGrp|26278|2022|PDM|2770.00|99|0.00|CPT 29881
20|FH_F146266_0_0|SrvcGrp|26432|2022|PDM|1840.00|99|0.00|OP SURGICAL SERVICES
20|FH_F146266_0_0|SrvcGrp|35667|2022|PDM|2100.00|99|0.00|CPT 20680
20|FH_F146266_0_0|SrvcGrp|41334|2022|PDM|14900.00|99|0.00|TOTAL KNEE
20|FH_F146266_0_0|SrvcGrp|54965|2022|PDM|7167.00|99|0.00|APPLICATION OF AMULTIPLAN
20|FH_F146266_0_0|SrvcGrp|58638|2022|PDM|1095.00|99|0.00|CPT 63688
20|FH_F146266_0_0|SrvcGrp|58993|2022|PDM|7892.00|99|0.00|DISKECTOMY
20|FH_F146266_0_0|SrvcGrp|82107|2022|PDM|2500.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F146266_0_0|SrvcGrp|82112|2022|PDM|3323.00|99|0.00|KNEE ARTHROSCOPY SURGERY
20|FH_F146266_0_0|SrvcGrp|82113|2022|PDM|2150.00|99|0.00|KNEE ARTHROSCOPY SURGERY
20|FH_F146266_0_0|SrvcGrp|82720|2022|PDM|1840.00|99|0.00|WRIST ENDOSCOPY/SURGERY
20|FH_F146266_0_0|SrvcGrp|84939|2022|PDM|13000.00|99|0.00|SHOULDER JOINT
20|FH_F146266_0_0|SrvcGrp|87679|2022|PDM|2063.00|99|0.00|LUMBAR OR SACRAL SURGERY
20|FH_F146266_0_0|SrvcGrp|88158|2022|PDM|6699.00|99|0.00|NECK SPINE DISK SURGERY
20|FH_F146266_0_0|SrvcGrp|88164|2022|PDM|20512.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR
20|FH_F146266_0_0|SrvcGrp|88980|2022|PDM|4650.00|99|0.00|NURSERY NEWBORN
20|FH_F146266_0_0|SrvcGrp|89404|2022|PDM|16100.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F146266_0_0|SrvcGrp|89861|2022|PDM|6188.00|99|0.00|LUMBAR LAMINOTOMY
20|FH_F146266_0_0|SrvcGrp|90063|2022|PDM|5425.00|99|0.00|REPAIR BICEPS TENDON RUPTURE
20|FH_F146266_0_0|SrvcGrp|90343|2022|PDM|9720.00|99|0.00|CERVICE CORPECTOMY 1 LEVEL
20|FH_F146266_0_0|SrvcGrp|92010|2022|PDM|1900.00|99|0.00|LESION OF TENDON SHEATH OR JOINT CAPSULE
20|FH_F146266_0_0|SrvcGrp|92013|2022|PDM|2175.00|99|0.00|REPAIR OF COLLATERAL LIGAMENT
20|FH_F146266_0_0|SrvcGrp|92366|2022|PDM|2950.00|99|0.00|REPAIR ACHILLES TENDON
20|FH_F146266_0_0|SrvcGrp|92416|2022|PDM|5971.00|99|0.00|CERVICAL LAMINOTOMY
20|FH_F146266_0_0|SrvcGrp|93059|2022|PDM|5914.00|99|0.00|SPINAL BONE AUTOGRAFT
20|FH_F146266_0_0|SrvcGrp|93071|2022|PDM|5783.00|99|0.00|POSTERIOR SEGMENTAL INSTRU
20|FH_F146266_0_0|SrvcGrp|97730|2022|PDM|7945.00|99|0.00|REVERSE HIP JOINT
20|FH_F146266_0_0|SrvcGrp|97741|2022|PDM|10213.00|99|0.00|REVISE KNEE
20|FH_F146266_0_0|SrvcGrp|98347|2022|PDM|5123.00|99|0.00|HIP ARTHROSCOPY / SURGERY
20|FH_F146266_0_0|SrvcGrp|98498|2022|PDM|6699.00|99|0.00|TRANSPEDICULAR 1 SEG THORACIC
20|FH_F146266_0_0|SrvcGrp|99067|2022|PDM|5527.00|99|0.00|SPINE PROSTH DEVICE
20|FH_F146266_0_0|SrvcGrp|99073|2022|PDM|1.35|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F146266_0_0|SrvcGrp|99162|2022|PDM|15452.00|99|0.00|CPT 24366
20|FH_F146266_0_0|SrvcGrp|99168|2022|PDM|1076.00|99|0.00|CPT 22899
20|FH_F146286_0_0|CSTM-ALL|CSTM-00|2020|PDM|2419.00|99|0.00|GENERAL ACUTE CARE
20|FH_F146287_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.53|99|0.00|OP SVCS
20|FH_F146287_0_0|CSTM-ALL|CSTM-00|2020|PDM|2419.00|99|0.00|GENERAL ACUTE CARE
20|FH_F146288_0_0|CSTM-ALL|CSTM-00|2020|PDM|2419.00|99|0.00|GENERAL ACUTE CARE
20|FH_F146369_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F146399_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F146399_0_0|SrvcGrp|108043|2022|PDM|182.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD
20|FH_F146569_0_0|SrvcGrp|30609|2022|PDM|25.00|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F146569_0_0|SrvcGrp|63297|2022|PDM|100.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F146569_0_0|SrvcGrp|90707|2022|PDM|100.00|99|0.00|AETNA HOSPICE CARE
20|FH_F146595_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F146622_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F146622_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC
20|FH_F146642_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.18|99|0.00|HSS ASC
20|FH_F146645_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F146645_0_0|CSTM-ALL|CSTM-00|2020|PCT|2.00|99|0.00|HSS ASC
20|FH_F146659_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|HSS ASC
20|FH_F146760_0_0|SrvcGrp|108042|2022|PDM|424.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD
20|FH_F146765_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F146765_0_0|SrvcGrp|113620|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F146765_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F146765_0_0|SrvcGrp|83857|2022|PDM|475.00|99|0.00|IP HOSPICE SVCS
20|FH_F146790_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F146790_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 1 (NO REV)
20|FH_F146790_0_0|CSTM-ALL|CSTM-00|2020|PDM|3600.00|99|0.00|AEG 9 (NO REV)
20|FH_F146790_0_0|SrvcGrp|74585|2022|PCT|0.00|99|0.00|AETNA OP IMPLANTS
20|FH_F146792_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F146792_0_0|CSTM-ALL|CSTM-00|2020|PDM|1970.00|99|0.00|AEG 3 (NO REV)
20|FH_F146792_0_0|CSTM-ALL|CSTM-00|2020|PDM|3846.00|99|0.00|AEG 7 (NO REV)
20|FH_F146803_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|AEG 3 (NO REV)
20|FH_F146803_0_0|CSTM-ALL|CSTM-00|2020|PDM|2750.00|99|0.00|AEG 7 (NO REV)
20|FH_F146803_0_0|SrvcGrp|74585|2022|PCT|0.00|99|0.00|AETNA OP IMPLANTS
20|FH_F146807_28655_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE
20|FH_F146807_28655_0|SrvcGrp|103913|2022|PCT|0.85|99|0.00|OP DIALYSIS
20|FH_F146807_28655_0|SrvcGrp|109057|2022|PCT|0.85|99|0.00|CARDIAC STUDIES
20|FH_F146807_28655_0|SrvcGrp|3378|2022|PCT|0.85|99|0.00|OBSERVATION SVCS
20|FH_F146859_0_0|CSTM-ALL|CSTM-00|2020|PDM|1101.00|99|0.00|AEG 10 (NO REV)
20|FH_F146859_0_0|CSTM-ALL|CSTM-00|2020|PDM|1765.00|99|0.00|AEG 7 (NO REV)
20|FH_F146859_0_0|CSTM-ALL|CSTM-00|2020|PDM|2087.00|99|0.00|AEG 9 (NO REV)
20|FH_F146859_0_0|CSTM-ALL|CSTM-00|2020|PDM|2091.00|99|0.00|AEG 8 (NO REV)
20|FH_F146859_0_0|CSTM-ALL|CSTM-00|2020|PDM|563.00|99|0.00|AEG 1 (NO REV)
20|FH_F146859_0_0|SrvcGrp|101845|2022|PDM|1465.00|99|0.00|OPEN TREATMENT OF DISTAL RADIAL 3 OR MORE FRAGMENTS
20|FH_F146859_0_0|SrvcGrp|104097|2022|PDM|2700.00|99|0.00|INCISION OF TENDON & MUSCLE
20|FH_F146859_0_0|SrvcGrp|114014|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES
20|FH_F146859_0_0|SrvcGrp|114841|2022|PDM|1096.00|99|0.00|HANDS/FINGERS PROCEDURES
20|FH_F146859_0_0|SrvcGrp|114842|2022|PDM|549.00|99|0.00|INJECTION PARAVERTEBRAL FACET JOINT C/T LEV 1
20|FH_F146859_0_0|SrvcGrp|114843|2022|PDM|565.00|99|0.00|INJECTION PARAVERTEBRAL FACET JOINT L/S LEV 1
20|FH_F146859_0_0|SrvcGrp|114849|2022|PDM|3411.00|99|0.00|SUBTALAR ARTHRO W/ FUSION
20|FH_F146859_0_0|SrvcGrp|114854|2022|PDM|565.00|99|0.00|INJECT SPINE C/T
20|FH_F146859_0_0|SrvcGrp|114856|2022|PDM|3045.00|99|0.00|SP BONE ALGRFT MORSEL
20|FH_F146859_0_0|SrvcGrp|114857|2022|PDM|2155.00|99|0.00|KNEE ARTHROSCOPY
20|FH_F146859_0_0|SrvcGrp|16472|2022|PDM|1765.00|99|0.00|HAND PROCEDURE
20|FH_F146859_0_0|SrvcGrp|47526|2022|PDM|2150.00|99|0.00|CORRECTION, HAMMERTOE
20|FH_F146859_0_0|SrvcGrp|73610|2022|PCT|1.00|99|0.00|AETNA IMPLANTS
20|FH_F146859_0_0|SrvcGrp|77485|2022|PDM|1739.00|99|0.00|AETNA REMOVAL OF IMPLANT
20|FH_F146859_0_0|SrvcGrp|87123|2022|PDM|549.00|99|0.00|DESTROY LUMB/SAC FACET JNT
20|FH_F146859_0_0|SrvcGrp|87125|2022|PDM|565.00|99|0.00|INJ FOR SACROILIAC JT ANEST
20|FH_F146859_0_0|SrvcGrp|98203|2022|PDM|2150.00|99|0.00|BUNION CORRECTION
20|FH_F146885_0_0|SrvcGrp|108484|2022|PDM|650.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY
20|FH_F146904_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F146933_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F146933_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F146986_0_0|SrvcGrp|82981|2022|PDM|174.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F147009_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F147161_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|OP SVCS
20|FH_F147211_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F147211_0_0|SrvcGrp|110537|2022|PDM|422.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F147211_0_0|SrvcGrp|14048|2022|PCT|0.60|99|0.00|EXTRA CORPOREAL MEMBRANE OXYGEN
20|FH_F147211_0_0|SrvcGrp|28221|2022|PDM|950.00|99|0.00|COMPUTED TOMOGRAPHY (CT)
20|FH_F147211_0_0|SrvcGrp|42622|2022|PDM|775.00|99|0.00|SUBACUTE - LEVEL IV
20|FH_F147212_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F147212_0_0|SrvcGrp|11442|2022|PDM|740.00|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)
20|FH_F147212_0_0|SrvcGrp|13720|2022|PDM|180.00|99|0.00|RESIDENTIAL HOSPICE SVCS
20|FH_F147212_0_0|SrvcGrp|80098|2022|PDM|41.00|99|0.00|AETNA HOSPICE CONTINUOUS HOME CARE
20|FH_F147340_0_0|SrvcGrp|105470|2022|PDM|1550.00|99|0.00|TRAINING INCL A TREATMENT
20|FH_F147372_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F147372_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F147372_0_0|SrvcGrp|75419|2022|PDM|533.00|99|0.00|OP PARTIAL HOSPITALIZATION
20|FH_F147372_0_0|SrvcGrp|89337|2022|PDM|1300.00|99|0.00|DETOXIFICATION
20|FH_F147403_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F147403_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F147418_0_0|CSTM-ALL|CSTM-00|2020|PDM|1475.00|99|0.00|AEG 2 (NO REV)
20|FH_F147418_0_0|CSTM-ALL|CSTM-00|2020|PDM|930.00|99|0.00|AEG 1 (NO REV)
20|FH_F147418_0_0|SrvcGrp|115019|2022|PDM|5500.00|99|0.00|PERQ NJX ALGC FLUOR LMBR 1ST
20|FH_F147502_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F147502_0_0|SrvcGrp|29347|2022|PDM|18.00|99|0.00|HOME HEALTH AIDE
20|FH_F147502_0_0|SrvcGrp|48385|2022|PDM|85.00|99|0.00|SPEECH THERAPY
20|FH_F147502_0_0|SrvcGrp|88620|2022|PDM|100.00|99|0.00|SKILLED NURSING RN
20|FH_F147502_0_0|SrvcGrp|88621|2022|PDM|100.00|99|0.00|SKILLED NURSING LPN
20|FH_F147532_0_0|SrvcGrp|103846|2022|PDM|87.23|99|0.00|HOSPICE CARE
20|FH_F147532_0_0|SrvcGrp|113613|2022|PDM|87.23|99|0.00|HOSPICE CARE (HCFA)
20|FH_F147532_0_0|SrvcGrp|65720|2022|PDM|144.84|99|0.00|RESPITE CARE
20|FH_F147532_0_0|SrvcGrp|73656|2022|PDM|622.00|99|0.00|AETNA HOSPICE SVCS
20|FH_F147532_0_0|SrvcGrp|83519|2022|PDM|144.84|99|0.00|HOSPICE CARE (ALL OTHER)
20|FH_F147532_0_0|SrvcGrp|89781|2022|PDM|144.84|99|0.00|RESPITE CARE (HCFA)
20|FH_F147661_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F147661_0_0|CSTM-ALL|CSTM-00|2020|PDM|1280.00|99|0.00|AEG 8 (NO REV)
20|FH_F147661_0_0|CSTM-ALL|CSTM-00|2020|PDM|383.00|99|0.00|AEG 1 (NO REV)
20|FH_F147661_0_0|CSTM-ALL|CSTM-00|2020|PDM|760.00|99|0.00|AEG 4 (NO REV)
20|FH_F147661_0_0|CSTM-ALL|CSTM-00|2020|PDM|798.00|99|0.00|AEG 10 (NO REV)
20|FH_F147661_0_0|SrvcGrp|114930|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F147745_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE
20|FH_F147800_0_0|CSTM-ALL|CSTM-00|2020|PDM|1099.00|99|0.00|AEG 7 (NO REV)
20|FH_F147800_0_0|CSTM-ALL|CSTM-00|2020|PDM|1480.00|99|0.00|AEG 10 (NO REV)
20|FH_F147800_0_0|CSTM-ALL|CSTM-00|2020|PDM|792.00|99|0.00|AEG 5  (NO REV)
20|FH_F72859_0_0|CSTM-ALL|CSTM-00|2020|PDM|38.63|99|0.00|TOTAL PARENTERAL NUTRITION
20|FH_F72859_0_0|CSTM-ALL|CSTM-00|2020|PDM|5.62|99|0.00|TOTAL PARENTERAL NUTRITION
20|FH_F72859_0_0|SrvcGrp|10542|2022|PDM|102.63|99|0.00|OCCUPATIONAL THERAPY SVCS
20|FH_F72859_0_0|SrvcGrp|10648|2022|PDM|15.00|99|0.00|HOME INFUSION
20|FH_F72859_0_0|SrvcGrp|11795|2022|PDM|21.00|99|0.00|HOME INFUSION THERAPY
20|FH_F72859_0_0|SrvcGrp|12401|2022|PDM|80.00|99|0.00|RN VISIT
20|FH_F72859_0_0|SrvcGrp|12856|2022|PDM|85.00|99|0.00|NURSING CARE
20|FH_F72859_0_0|SrvcGrp|15403|2022|PDM|111.54|99|0.00|SPEECH THERAPY SVCS INITIAL EVAL
20|FH_F72859_0_0|SrvcGrp|15596|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY
20|FH_F72859_0_0|SrvcGrp|9263|2022|PDM|119.74|99|0.00|HOSPICE RESPITE SVCS
20|FH_F72863_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F72883_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F72887_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72887_0_0|SrvcGrp|33165|2022|PDM|422.00|99|0.00|SKILLED NURSING - LEVEL II
20|FH_F72887_0_0|SrvcGrp|33166|2022|PDM|500.00|99|0.00|SKILLED NURSING - LEVEL III
20|FH_F72887_0_0|SrvcGrp|61516|2022|PDM|51.00|99|0.00|THERAPY PER VISIT
20|FH_F72889_0_0|SrvcGrp|9438|2022|PCT|0.85|99|0.00|TRAUMA CARE
20|FH_F72909_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72923_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72923_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F72934_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.71|99|0.00|OP SVCS
20|FH_F72934_0_0|SrvcGrp|9438|2022|PCT|0.85|99|0.00|TRAUMA CARE
20|FH_F72935_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72935_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F72939_0_0|SrvcGrp|9438|2022|PCT|0.85|99|0.00|TRAUMA CARE
20|FH_F72940_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F72940_0_0|SrvcGrp|9438|2022|PCT|0.85|99|0.00|TRAUMA CARE
20|FH_F72941_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS
20|FH_F72943_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72944_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72945_0_0|CSTM-ALL|CSTM-00|2020|PCT|66.00|99|0.00|OP SVCS
20|FH_F72971_0_0|SrvcGrp|8|2022|PCT|0.85|99|0.00|BURN INTENSIVE CARE
20|FH_F72973_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|OP SVCS
20|FH_F72980_0_0|SrvcGrp|13262|2022|PDM|7.03|99|0.00|GROUND MILEAGE, PER STATUTE MILE
20|FH_F72980_0_0|SrvcGrp|13422|2022|PDM|272.43|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC
20|FH_F72980_0_0|SrvcGrp|13681|2022|PDM|363.25|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT
20|FH_F73024_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F73024_0_0|SrvcGrp|48385|2022|PDM|30.00|99|0.00|SPEECH THERAPY
20|FH_F73024_0_0|SrvcGrp|48394|2022|PDM|13.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F73024_0_0|SrvcGrp|48396|2022|PDM|30.00|99|0.00|OT SERVICES
20|FH_F73025_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F73025_0_0|SrvcGrp|46424|2022|PDM|30.00|99|0.00|HI TECH SKILLED NURSING SERVICES
20|FH_F73025_0_0|SrvcGrp|48385|2022|PDM|30.00|99|0.00|SPEECH THERAPY
20|FH_F73025_0_0|SrvcGrp|48394|2022|PDM|13.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F73084_0_0|SrvcGrp|68986|2022|PDM|72.00|99|0.00|PT VISIT
20|FH_F73128_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F73142_0_0|SrvcGrp|70445|2022|PDM|825.00|99|0.00|MRI/MRA
20|FH_F73202_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F73209_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F73228_0_0|SrvcGrp|17065|2022|PDM|2295.00|99|0.00|ASPG I
20|FH_F73228_0_0|SrvcGrp|17071|2022|PDM|4342.00|99|0.00|ASPG IV
20|FH_F73228_0_0|SrvcGrp|17075|2022|PDM|5693.00|99|0.00|ASPG VI
20|FH_F73230_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE
20|FH_F73230_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS
20|FH_F73244_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F73244_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F73342_0_0|CSTM-ALL|CSTM-00|2020|PDM|1625.00|99|0.00|ASPG 4 PIEDMONT OUTPATIENT SURGERY CENTER
20|FH_F73342_0_0|CSTM-ALL|CSTM-00|2020|PDM|2040.00|99|0.00|ASPG 8 PIEDMONT OUTPATIENT SURGERY CENTER
20|FH_F73342_0_0|CSTM-ALL|CSTM-00|2020|PDM|2680.00|99|0.00|ASPG 9 PIEDMONT OUTPATIENT SURGERY CENTER
20|FH_F73342_0_0|SrvcGrp|21342|2022|PCT|1.10|99|0.00|IMPLANTS
20|FH_F73402_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F73403_0_0|SrvcGrp|43431|2022|PDM|45.00|99|0.00|LPN
20|FH_F73403_0_0|SrvcGrp|62539|2022|PDM|130.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F73485_0_0|SrvcGrp|48385|2022|PDM|15.00|99|0.00|SPEECH THERAPY
20|FH_F73502_0_0|SrvcGrp|3809|2022|PDM|425.00|99|0.00|HOSPICE CARE
20|FH_F73505_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE
20|FH_F73505_0_0|CSTM-ALL|CSTM-00|2020|PDM|1133.00|99|0.00|ASPG 7 SURGICAL EYE CENTER
20|FH_F73505_0_0|CSTM-ALL|CSTM-00|2020|PDM|508.00|99|0.00|ASPG 2 SURGICAL EYE CENTER
20|FH_F73505_0_0|CSTM-ALL|CSTM-00|2020|PDM|581.00|99|0.00|ASPG 3 SURGICAL EYE CENTER
20|FH_F73626_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F73643_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F73643_0_0|SrvcGrp|22954|2022|PDM|132.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F73662_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F73662_0_0|CSTM-ALL|CSTM-00|2020|PDM|1183.00|99|0.00|ASPG V
20|FH_F73662_0_0|CSTM-ALL|CSTM-00|2020|PDM|1605.00|99|0.00|ASPG VIII
20|FH_F73662_0_0|CSTM-ALL|CSTM-00|2020|PDM|2209.00|99|0.00|ASPG IX
20|FH_F73662_0_0|CSTM-ALL|CSTM-00|2020|PDM|549.00|99|0.00|ASPG I
20|FH_F73662_0_0|CSTM-ALL|CSTM-00|2020|PDM|841.00|99|0.00|ASPG III
20|FH_F73662_0_0|SrvcGrp|15473|2022|PDM|1183.00|99|0.00|CPT CODE 42820
20|FH_F73684_0_0|SrvcGrp|12591|2022|PDM|250.00|99|0.00|CD FULL DAY
20|FH_F73684_0_0|SrvcGrp|1306|2022|PDM|450.00|99|0.00|OP PSYCH PARTIAL HOSP
20|FH_F73705_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|GENERAL ACUTE CARE
20|FH_F73705_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|ASPG VIII
20|FH_F73705_0_0|SrvcGrp|10393|2022|PDM|1825.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F73705_0_0|SrvcGrp|16|2022|PDM|1100.00|99|0.00|ACUTE REHABILITATION
20|FH_F73705_0_0|SrvcGrp|42871|2022|PDM|75.00|99|0.00|SPEECH THERAPY VISIT
20|FH_F73705_0_0|SrvcGrp|56313|2022|PDM|125.00|99|0.00|HYPERBARIC THERAPY
20|FH_F73705_0_0|SrvcGrp|8950|2022|PDM|1740.00|99|0.00|INTERMEDIATE ICU/CCU
20|FH_F73742_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F73842_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|OP SVCS
20|FH_F73864_0_0|SrvcGrp|48396|2022|PDM|12.00|99|0.00|OT SERVICES
20|FH_F73923_0_0|CSTM-ALL|CSTM-00|2020|PDM|825.00|99|0.00|AEG 5  (NO REV)
20|FH_F73967_0_0|SrvcGrp|12023|2022|PDM|147.00|99|0.00|HOSPICE RESPITE SERVICES
20|FH_F73967_0_0|SrvcGrp|42784|2022|PDM|68.00|99|0.00|OCCUPATIONAL THERAPY  SRVCS
20|FH_F74026_0_0|CSTM-ALL|CSTM-00|2020|PCT|50.00|99|0.00|OP SVCS
20|FH_F74092_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F74092_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F74102_0_0|SrvcGrp|11073|2022|PDM|95.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F74102_0_0|SrvcGrp|11080|2022|PDM|105.00|99|0.00|NURSING CARE
20|FH_F74102_0_0|SrvcGrp|11085|2022|PDM|28.00|99|0.00|HOME HEALTH AIDE
20|FH_F74102_0_0|SrvcGrp|26001|2022|PDM|164.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F74163_0_0|SrvcGrp|10411|2022|PDM|18.00|99|0.00|RESPIRATORY THERAPY SVCS
20|FH_F74163_0_0|SrvcGrp|471|2022|PDM|660.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F74163_0_0|SrvcGrp|474|2022|PDM|360.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F74187_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F74263_0_0|CSTM-ALL|CSTM-00|2020|PDM|1531.00|99|0.00|SURGICAL SPECIALTY CENTER  ASC GROUPER 8
20|FH_F74283_0_0|CSTM-ALL|CSTM-00|2020|PDM|20.59|99|0.00|VACCINE
20|FH_F74283_0_0|SrvcGrp|17139|2022|PDM|540.00|99|0.00|HOSPICE CARE
20|FH_F74283_0_0|SrvcGrp|3810|2022|PDM|75.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F74305_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F74305_0_0|CSTM-ALL|CSTM-00|2020|PDM|1070.00|99|0.00|ASPG VIII
20|FH_F74305_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|ASPG III
20|FH_F74305_0_0|CSTM-ALL|CSTM-00|2020|PDM|789.00|99|0.00|ASPG V
20|FH_F74307_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS
20|FH_F74424_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F74424_0_0|SrvcGrp|48003|2022|PDM|371.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F74463_0_0|CSTM-ALL|CSTM-00|2020|PDM|1600.00|99|0.00|COVENTRY ENHANCED GROUPER 6
20|FH_F74463_0_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|COVENTRY ENHANCED GROUPER 7
20|FH_F74463_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|COVENTRY ENHANCED GROUPER 2
20|FH_F74463_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|COVENTRY ENHANCED GROUPER 3
20|FH_F74463_0_0|SrvcGrp|71668|2022|PDM|3100.00|99|0.00|SURGERY CARVE OUTS
20|FH_F74465_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE
20|FH_F74465_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS
20|FH_F74467_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS
20|FH_F74562_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|OP SVCS
20|FH_F74562_0_0|SrvcGrp|3029|2022|PDM|295.00|99|0.00|NEWBORN NURSERY
20|FH_F74583_0_0|SrvcGrp|46424|2022|PDM|14.00|99|0.00|HI TECH SKILLED NURSING SERVICES
20|FH_F74583_0_0|SrvcGrp|48396|2022|PDM|14.00|99|0.00|OT SERVICES
20|FH_F74622_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F74622_0_0|CSTM-ALL|CSTM-00|2020|PDM|640.00|99|0.00|COVENTRY ENHANCED GROUPER 3
20|FH_F74622_0_0|SrvcGrp|14271|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F74648_0_0|CSTM-ALL|CSTM-00|2020|PCT|44.00|99|0.00|OP SVCS
20|FH_F74663_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F74670_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F74670_0_0|SrvcGrp|11577|2022|PDM|440.00|99|0.00|DIALYSIS
20|FH_F74670_0_0|SrvcGrp|15477|2022|PDM|110.00|99|0.00|PHYSICAL THERAPY SVCS INITIAL EVAL
20|FH_F74765_0_0|CSTM-ALL|CSTM-00|2020|PDM|806.00|99|0.00|COVENTRY ENHANCED GROUPER 10
20|FH_F74825_0_0|SrvcGrp|472|2022|PDM|460.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F74844_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F74844_0_0|SrvcGrp|42870|2022|PDM|60.00|99|0.00|OCCUPATIONAL THERAPY VISIT
20|FH_F74845_0_0|CSTM-ALL|CSTM-00|2020|PDM|524.00|99|0.00|MULTIPLE BIRTHS
20|FH_F74845_0_0|SrvcGrp|12184|2022|PCT|1.15|99|0.00|IMPLANTS
20|FH_F74845_0_0|SrvcGrp|360|2022|PCT|0.85|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F74845_0_0|SrvcGrp|59839|2022|PCT|1.15|99|0.00|TPA
20|FH_F74845_0_0|SrvcGrp|903|2022|PCT|0.75|99|0.00|PTC ANGIOPLASTY
20|FH_F74883_0_0|SrvcGrp|72041|2022|PDM|130.00|99|0.00|OFFICE VISIT
20|FH_F74883_0_0|SrvcGrp|72042|2022|PDM|110.00|99|0.00|OFFICE VISIT
20|FH_F74947_0_0|SrvcGrp|33166|2022|PDM|650.00|99|0.00|SKILLED NURSING - LEVEL III
20|FH_F75084_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F75087_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F75087_0_0|CSTM-ALL|CSTM-00|2020|PDM|1600.00|99|0.00|COVENTRY ENHANCED GROUPER 5
20|FH_F75087_0_0|SrvcGrp|27346|2022|PDM|4000.00|99|0.00|REPAIR BLADDER DEFECT
20|FH_F75087_0_0|SrvcGrp|27402|2022|PDM|2700.00|99|0.00|LASER PROCEDURES
20|FH_F75087_0_0|SrvcGrp|44067|2022|PDM|1200.00|99|0.00|CPT 52240
20|FH_F75087_0_0|SrvcGrp|72286|2022|PDM|1500.00|99|0.00|CYSTOURETHROSCOPY
20|FH_F75185_0_0|SrvcGrp|473|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F75185_0_0|SrvcGrp|474|2022|PDM|360.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F75205_0_0|SrvcGrp|45967|2022|PDM|45.00|99|0.00|HOME HEALTH AIDE
20|FH_F75205_0_0|SrvcGrp|62539|2022|PDM|130.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F75207_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F75207_0_0|SrvcGrp|16703|2022|PDM|325.00|99|0.00|HEMO/HOME DIALYSIS SVCS
20|FH_F75207_0_0|SrvcGrp|47999|2022|PDM|120.00|99|0.00|CAPD SUPPLEMENT DAY
20|FH_F75243_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F75243_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F75243_0_0|SrvcGrp|12591|2022|PDM|123.00|99|0.00|CD FULL DAY
20|FH_F75243_0_0|SrvcGrp|9811|2022|PDM|410.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F75307_0_0|SrvcGrp|43567|2022|PDM|105.00|99|0.00|SKILLED NURSING - POSTNATAL
20|FH_F75307_0_0|SrvcGrp|46104|2022|PDM|99.00|99|0.00|HOME VISIT - PRENATAL
20|FH_F75425_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F75425_0_0|SrvcGrp|33165|2022|PDM|550.00|99|0.00|SKILLED NURSING - LEVEL II
20|FH_F75489_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F75542_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F75542_0_0|SrvcGrp|3810|2022|PDM|145.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F75606_0_0|SrvcGrp|20752|2022|PDM|19390.00|99|0.00|MSDRG 619-621 ONLY BARIATRIC SURGERY
20|FH_F75606_0_0|SrvcGrp|29817|2022|PDM|2836.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F75606_0_0|SrvcGrp|3029|2022|PDM|567.00|99|0.00|NEWBORN NURSERY
20|FH_F75722_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|GENERAL ACUTE CARE
20|FH_F75764_0_0|CSTM-ALL|CSTM-00|2020|PDM|105.00|99|0.00|OP SVCS
20|FH_F75786_0_0|CSTM-ALL|CSTM-00|2020|PDM|498.00|99|0.00|COVENTRY ENHANCED GROUPER 3
20|FH_F75786_0_0|CSTM-ALL|CSTM-00|2020|PDM|615.00|99|0.00|COVENTRY ENHANCED GROUPER 10
20|FH_F75786_0_0|CSTM-ALL|CSTM-00|2020|PDM|810.00|99|0.00|COVENTRY ENHANCED GROUPER 6
20|FH_F75793_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS
20|FH_F75803_0_0|SrvcGrp|11259|2022|PCT|0.70|99|0.00|DRUGS
20|FH_F75803_0_0|SrvcGrp|12290|2022|PDM|801.00|99|0.00|DETOXIFICATION
20|FH_F75803_0_0|SrvcGrp|13236|2022|PDM|2529.00|99|0.00|ICU/CCU
20|FH_F75803_0_0|SrvcGrp|16|2022|PDM|969.00|99|0.00|ACUTE REHABILITATION
20|FH_F75803_0_0|SrvcGrp|23259|2022|PDM|676.00|99|0.00|MS DRG 789-795 ONLY NEONATAL
20|FH_F75803_0_0|SrvcGrp|30623|2022|PDM|2529.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788
20|FH_F75803_0_0|SrvcGrp|4109|2022|PDM|801.00|99|0.00|ACUTE PSYCH
20|FH_F75803_0_0|SrvcGrp|63|2022|PDM|591.00|99|0.00|SUBACUTE CARE
20|FH_F75804_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|PROFESSIONAL FEES ON UB04
20|FH_F75804_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS
20|FH_F75806_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F75806_0_0|SrvcGrp|10541|2022|PDM|216.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F75806_0_0|SrvcGrp|10545|2022|PDM|332.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F75826_0_0|SrvcGrp|10431|2022|PDM|50.00|99|0.00|SPEECH THERAPY
20|FH_F75862_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F75862_0_0|SrvcGrp|3809|2022|PDM|681.00|99|0.00|HOSPICE CARE
20|FH_F75944_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|INTRAOCULAR LENS
20|FH_F75944_0_0|SrvcGrp|68187|2022|PDM|983.00|99|0.00|CVTY ENHANCED + REV CODES ASPG 3
20|FH_F75944_0_0|SrvcGrp|68189|2022|PDM|1381.00|99|0.00|CVTY ENHANCED + REV CODES ASPG 5
20|FH_F75944_0_0|SrvcGrp|68192|2022|PDM|1874.00|99|0.00|CVTY ENHANCED + REV CODES ASPG 8
20|FH_F75963_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F75963_0_0|SrvcGrp|48398|2022|PDM|18.00|99|0.00|PT SERVICES
20|FH_F75963_0_0|SrvcGrp|66005|2022|PDM|18.00|99|0.00|SKILLED NURSING HCPC
20|FH_F75963_0_0|SrvcGrp|73141|2022|PDM|18.00|99|0.00|SPEECH THERAPY SERVICES
20|FH_F76022_0_0|SrvcGrp|11258|2022|PCT|0.85|99|0.00|DRUGS
20|FH_F76028_0_0|SrvcGrp|43431|2022|PDM|45.00|99|0.00|LPN
20|FH_F76028_0_0|SrvcGrp|45966|2022|PDM|140.00|99|0.00|SOCIAL WORKER
20|FH_F76028_0_0|SrvcGrp|62538|2022|PDM|130.00|99|0.00|PHYSICAL THERAPY
20|FH_F76063_0_0|SrvcGrp|73284|2022|PCT|0.55|99|0.00|AMBULATORY SURGERY
20|FH_F76074_0_0|SrvcGrp|40222|2022|PDM|90.00|99|0.00|OP SVCS
20|FH_F76124_0_0|SrvcGrp|12496|2022|PDM|753.00|99|0.00|ACUTE REHABILITATION
20|FH_F76124_0_0|SrvcGrp|473|2022|PDM|318.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F76124_0_0|SrvcGrp|474|2022|PDM|260.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F76146_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|INTRAOCULAR LENS
20|FH_F76146_0_0|SrvcGrp|68185|2022|PDM|583.00|99|0.00|CVTY ENHANCED + REV CODES ASPG 1
20|FH_F76146_0_0|SrvcGrp|68190|2022|PDM|1446.00|99|0.00|CVTY ENHANCED + REV CODES ASPG 6
20|FH_F76146_0_0|SrvcGrp|68193|2022|PDM|2337.00|99|0.00|CVTY ENHANCED + REV CODES ASPG 9
20|FH_F76146_0_0|SrvcGrp|68362|2022|PDM|985.00|99|0.00|COVENTRY ENHANCED GROUPER 10 WITH REV CODES
20|FH_F76163_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F76163_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F76171_0_0|CSTM-ALL|CSTM-00|2020|PDM|11.00|99|0.00|LVN HIGH TECH HOURLY
20|FH_F76171_0_0|SrvcGrp|47991|2022|PDM|172.00|99|0.00|THERAPY SERVICES VISIT
20|FH_F76222_0_0|CSTM-ALL|CSTM-00|2020|PDM|3822.00|99|0.00|GENERAL ACUTE CARE
20|FH_F76284_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F76285_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F76285_0_0|SrvcGrp|47991|2022|PDM|172.00|99|0.00|THERAPY SERVICES VISIT
20|FH_F76285_0_0|SrvcGrp|48381|2022|PDM|250.00|99|0.00|ST SVCS INITIAL EVAL 92506 VISIT LEVEL
20|FH_F76285_0_0|SrvcGrp|48645|2022|PDM|126.00|99|0.00|OP SKILLED NURSING
20|FH_F76285_0_0|SrvcGrp|52803|2022|PDM|172.00|99|0.00|OT SVCS INITIAL EVAL 97003 VISIT LEVEL
20|FH_F76285_0_0|SrvcGrp|53145|2022|PDM|80.00|99|0.00|SOCIAL WORKER
20|FH_F76285_0_0|SrvcGrp|73301|2022|PDM|73.00|99|0.00|PHYSICAL THERAPY HOURLY
20|FH_F76303_0_0|SrvcGrp|48645|2022|PDM|18.00|99|0.00|OP SKILLED NURSING
20|FH_F76303_0_0|SrvcGrp|73523|2022|PDM|18.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F76402_0_0|CSTM-ALL|CSTM-00|2020|PCT|56650.00|99|0.00|HOME HEMODIALYSIS
20|FH_F76522_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|COVENTRY ENHANCED GROUPER 10
20|FH_F76522_0_0|CSTM-ALL|CSTM-00|2020|PDM|1859.00|99|0.00|COVENTRY ENHANCED GROUPER 3
20|FH_F76544_0_0|CSTM-ALL|CSTM-00|2020|PDM|1529.00|99|0.00|GENERAL ACUTE CARE
20|FH_F76544_0_0|CSTM-ALL|CSTM-00|2020|PDM|516.00|99|0.00|REHABILITATION HALF DAY
20|FH_F76586_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F76586_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F76588_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F76588_0_0|SrvcGrp|48645|2022|PDM|18.00|99|0.00|OP SKILLED NURSING
20|FH_F76588_0_0|SrvcGrp|53145|2022|PDM|18.00|99|0.00|SOCIAL WORKER
20|FH_F76624_0_0|CSTM-ALL|CSTM-00|2020|PDM|1473.00|99|0.00|ASPG V - IOWA
20|FH_F76624_0_0|CSTM-ALL|CSTM-00|2020|PDM|681.00|99|0.00|ASPG I - IOWA
20|FH_F76662_0_0|SrvcGrp|14494|2022|PDM|38.51|99|0.00|CONTINUOUS HOMECARE
20|FH_F76662_0_0|SrvcGrp|3810|2022|PDM|178.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F76662_0_0|SrvcGrp|59427|2022|PDM|85.00|99|0.00|OT
20|FH_F76662_0_0|SrvcGrp|66481|2022|PDM|85.00|99|0.00|SOCIAL WORKER
20|FH_F76782_0_0|SrvcGrp|26001|2022|PDM|160.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F76824_0_0|SrvcGrp|47342|2022|PDM|100.00|99|0.00|SKN HOURLY
20|FH_F76824_0_0|SrvcGrp|47343|2022|PDM|80.00|99|0.00|LPN HOURLY
20|FH_F76864_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F76864_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F77025_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F77025_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F77025_0_0|CSTM-ALL|CSTM-00|2020|PDM|2432.00|99|0.00|COVENTRY ENHANCED GROUPER 8
20|FH_F77025_0_0|SrvcGrp|74120|2022|PDM|2223.00|99|0.00|ARTHROSCOPY
20|FH_F77042_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F77042_0_0|SrvcGrp|471|2022|PDM|660.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F77042_0_0|SrvcGrp|472|2022|PDM|460.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F77042_0_0|SrvcGrp|473|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F77042_0_0|SrvcGrp|74382|2022|PDM|18.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F77082_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F77082_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.77|99|0.00|GENERAL ACUTE CARE
20|FH_F77082_0_0|CSTM-ALL|CSTM-00|2020|PDM|7737.00|99|0.00|2007 MEDICARE ASPG IV
20|FH_F77082_0_0|CSTM-ALL|CSTM-00|2020|PDM|8465.00|99|0.00|2007 MEDICARE ASPG V
20|FH_F77082_0_0|CSTM-ALL|CSTM-00|2020|PDM|9367.00|99|0.00|2007 MEDICARE ASPG VI
20|FH_F77082_0_0|SrvcGrp|10966|2022|PDM|7306.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F77082_0_0|SrvcGrp|29817|2022|PDM|4088.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F77082_0_0|SrvcGrp|30623|2022|PDM|7089.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788
20|FH_F77082_0_0|SrvcGrp|41367|2022|PDM|61837.00|99|0.00|MS DRG 242-244 ONLY
20|FH_F77082_0_0|SrvcGrp|47252|2022|PDM|61837.00|99|0.00|MS DRG 216-237 ONLY
20|FH_F77184_0_0|SrvcGrp|46424|2022|PDM|18.00|99|0.00|HI TECH SKILLED NURSING SERVICES
20|FH_F77184_0_0|SrvcGrp|48398|2022|PDM|18.00|99|0.00|PT SERVICES
20|FH_F77234_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F77234_0_0|SrvcGrp|17065|2022|PDM|1383.00|99|0.00|ASPG I
20|FH_F77234_0_0|SrvcGrp|17075|2022|PDM|2379.00|99|0.00|ASPG VI
20|FH_F77234_0_0|SrvcGrp|17081|2022|PDM|3876.00|99|0.00|ASPG IX
20|FH_F77234_0_0|SrvcGrp|33311|2022|PDM|1383.00|99|0.00|CPT 62284
20|FH_F77234_0_0|SrvcGrp|33312|2022|PDM|2075.00|99|0.00|CPT 42820
20|FH_F77234_0_0|SrvcGrp|705|2022|PCT|0.50|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F77302_0_0|CSTM-ALL|CSTM-00|2020|PCT|40.90|99|0.00|OP SVCS
20|FH_F77404_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F77404_0_0|SrvcGrp|57968|2022|PDM|34.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F77462_0_0|SrvcGrp|24740|2022|PDM|610.00|99|0.00|HOSPICE CARE
20|FH_F77462_0_0|SrvcGrp|27969|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE
20|FH_F77462_0_0|SrvcGrp|42974|2022|PDM|110.00|99|0.00|OCCUPATIONAL THERAPIST
20|FH_F77462_0_0|SrvcGrp|42975|2022|PDM|110.00|99|0.00|PHYSICAL THERAPIST
20|FH_F77462_0_0|SrvcGrp|74546|2022|PDM|141.00|99|0.00|HOSPICE SERVICES
20|FH_F77463_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F77463_0_0|SrvcGrp|33164|2022|PDM|275.00|99|0.00|SKILLED NURSING - LEVEL I
20|FH_F77463_0_0|SrvcGrp|33166|2022|PDM|375.00|99|0.00|SKILLED NURSING - LEVEL III
20|FH_F77463_0_0|SrvcGrp|44122|2022|PDM|500.00|99|0.00|SUB-ACUTE REHB - LEVEL  V
20|FH_F77482_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.40|99|0.00|OP SVCS
20|FH_F77484_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.67|99|0.00|OP SVCS
20|FH_F77504_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|ACUTE PSYCH
20|FH_F77504_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F77504_0_0|SrvcGrp|16|2022|PDM|650.00|99|0.00|ACUTE REHABILITATION
20|FH_F77504_0_0|SrvcGrp|27826|2022|PDM|450.00|99|0.00|CHEMOTHERAPY
20|FH_F77504_0_0|SrvcGrp|33232|2022|PCT|1.00|99|0.00|TAKE HOME DRUGS
20|FH_F77544_0_0|SrvcGrp|22954|2022|PDM|120.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F77585_0_0|SrvcGrp|3259|2022|PDM|495.00|99|0.00|ACUTE REHABILITATION
20|FH_F77625_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F77625_0_0|SrvcGrp|12401|2022|PDM|90.00|99|0.00|RN VISIT
20|FH_F77662_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F77662_0_0|SrvcGrp|42871|2022|PDM|65.00|99|0.00|SPEECH THERAPY VISIT
20|FH_F77663_0_0|SrvcGrp|14210|2022|PDM|120.00|99|0.00|PSYCH INTENSIVE OUTPATIENT
20|FH_F77663_0_0|SrvcGrp|23587|2022|PDM|300.00|99|0.00|RESIDENTIAL TREATMENT - PSYCH
20|FH_F77665_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F77665_0_0|SrvcGrp|10534|2022|PDM|120.00|99|0.00|NURSING CARE
20|FH_F77665_0_0|SrvcGrp|10657|2022|PDM|50.00|99|0.00|CPT CODE 99350
20|FH_F77665_0_0|SrvcGrp|11796|2022|PDM|50.00|99|0.00|DIETICIAN
20|FH_F77665_0_0|SrvcGrp|15385|2022|PDM|60.00|99|0.00|SKILLED NURSING NON IV RELATED
20|FH_F77665_0_0|SrvcGrp|26336|2022|PDM|60.00|99|0.00|T1001
20|FH_F77763_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F77763_0_0|SrvcGrp|10540|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE
20|FH_F77763_0_0|SrvcGrp|10543|2022|PDM|85.00|99|0.00|SPEECH THERAPY SVCS
20|FH_F77822_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F77822_0_0|SrvcGrp|472|2022|PDM|546.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F77822_0_0|SrvcGrp|474|2022|PDM|390.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F77862_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F77862_0_0|SrvcGrp|22954|2022|PDM|151.22|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F77862_0_0|SrvcGrp|29898|2022|PDM|105.78|99|0.00|RN VISIT
20|FH_F77862_0_0|SrvcGrp|45539|2022|PDM|105.78|99|0.00|OCCUPATIONAL THERAPY
20|FH_F77883_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F77883_0_0|SrvcGrp|74925|2022|PDM|206.66|99|0.00|PHYSICAL THERAPY
20|FH_F77883_0_0|SrvcGrp|74933|2022|PDM|48.44|99|0.00|HOMEMAKER
20|FH_F77903_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|COVENTRY ENHANCED GROUPER 1
20|FH_F77903_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|COVENTRY ENHANCED GROUPER 2
20|FH_F77903_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|COVENTRY ENHANCED GROUPER 3
20|FH_F77903_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|COVENTRY ENHANCED GROUPER 4
20|FH_F77903_0_0|SrvcGrp|10944|2022|PCT|0.85|99|0.00|EMERGENCY ROOM
20|FH_F77903_0_0|SrvcGrp|12804|2022|PDM|1274.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F77903_0_0|SrvcGrp|29817|2022|PDM|1274.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F77903_0_0|SrvcGrp|30623|2022|PDM|1274.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788
20|FH_F77903_0_0|SrvcGrp|31074|2022|PDM|319.00|99|0.00|MS DRG 795 ONLY
20|FH_F77903_0_0|SrvcGrp|997|2022|PCT|0.60|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F77923_0_0|SrvcGrp|46631|2022|PDM|45.00|99|0.00|PHYSICAL THERAPY
20|FH_F77923_0_0|SrvcGrp|473|2022|PDM|245.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F77923_0_0|SrvcGrp|474|2022|PDM|245.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F77925_0_0|SrvcGrp|13217|2022|PCT|0.53|99|0.00|ORTHOTICS/PROSTHETICS/IMPLANTS
20|FH_F77925_0_0|SrvcGrp|17987|2022|PCT|0.80|99|0.00|CARDIAC CATH
20|FH_F77925_0_0|SrvcGrp|21306|2022|PDM|8600.00|99|0.00|PEDIATRIC INTENSIVE CARE SERVICES
20|FH_F77925_0_0|SrvcGrp|38650|2022|PCT|0.53|99|0.00|DRUGS / INJECTABLES
20|FH_F77925_0_0|SrvcGrp|8968|2022|PDM|7560.00|99|0.00|NICU LEVEL III & IV
20|FH_F77943_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.67|99|0.00|GENERAL ACUTE CARE
20|FH_F77943_0_0|SrvcGrp|19961|2022|PDM|84127.83|99|0.00|MS DRG 231-232 ONLY CORONARY BYPASS W/ PTCA
20|FH_F77943_0_0|SrvcGrp|20077|2022|PDM|75720.24|99|0.00|MS DRG 226-227 ONLY CARDIAC DEFIBRILLATOR
20|FH_F77943_0_0|SrvcGrp|20297|2022|PDM|79409.73|99|0.00|MS DRG 219-221 ONLY CARDIAC VALVE PROC
20|FH_F77943_0_0|SrvcGrp|23477|2022|PDM|15675.39|99|0.00|MSDRG 286-287 ONLY CARDIAC CATH
20|FH_F77943_0_0|SrvcGrp|26165|2022|PCT|0.70|99|0.00|HOME HEALTH SERVICES
20|FH_F77943_0_0|SrvcGrp|29755|2022|PDM|55799.50|99|0.00|MS DRG 245 ONLY
20|FH_F77943_0_0|SrvcGrp|3029|2022|PDM|1310.18|99|0.00|NEWBORN NURSERY
20|FH_F77943_0_0|SrvcGrp|43986|2022|PDM|29508.64|99|0.00|CARDIAC PACEMAKER (MS DRG 242-244, 258-262 ONLY)
20|FH_F77943_0_0|SrvcGrp|701|2022|PDM|6736.88|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F77943_0_0|SrvcGrp|9937|2022|PCT|0.70|99|0.00|OCCUPATIONAL THERAPY
20|FH_F78003_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE
20|FH_F78003_0_0|SrvcGrp|30095|2022|PDM|45.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F78003_0_0|SrvcGrp|474|2022|PDM|245.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F78009_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE
20|FH_F78009_0_0|SrvcGrp|30094|2022|PDM|45.00|99|0.00|PHYSICAL THERAPY
20|FH_F78009_0_0|SrvcGrp|471|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F78009_0_0|SrvcGrp|472|2022|PDM|360.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F78009_0_0|SrvcGrp|473|2022|PDM|245.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F78022_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F78022_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F78022_0_0|SrvcGrp|75080|2022|PDM|200.00|99|0.00|NURSERY
20|FH_F78023_0_0|SrvcGrp|471|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F78023_0_0|SrvcGrp|474|2022|PDM|245.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F78048_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE
20|FH_F78048_0_0|SrvcGrp|30094|2022|PDM|45.00|99|0.00|PHYSICAL THERAPY
20|FH_F78165_0_0|SrvcGrp|30095|2022|PDM|45.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F78165_0_0|SrvcGrp|35964|2022|PDM|45.00|99|0.00|SPEECH THERAPY
20|FH_F78167_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE
20|FH_F78167_0_0|SrvcGrp|30094|2022|PDM|45.00|99|0.00|PHYSICAL THERAPY
20|FH_F78204_0_0|CSTM-ALL|CSTM-00|2020|PDM|492.54|99|0.00|ASPG X
20|FH_F78243_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|DIGESTIVE SURGERY
20|FH_F78343_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F78343_0_0|SrvcGrp|472|2022|PDM|360.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F78343_0_0|SrvcGrp|473|2022|PDM|245.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F78385_0_0|SrvcGrp|75502|2022|PDM|45.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F78446_0_0|SrvcGrp|75501|2022|PDM|45.00|99|0.00|PHYSICAL THERAPY
20|FH_F78446_0_0|SrvcGrp|75502|2022|PDM|45.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F78446_0_0|SrvcGrp|75503|2022|PDM|45.00|99|0.00|SPEECH THERAPY
20|FH_F78447_0_0|SrvcGrp|471|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F78447_0_0|SrvcGrp|75501|2022|PDM|45.00|99|0.00|PHYSICAL THERAPY
20|FH_F78447_0_0|SrvcGrp|75502|2022|PDM|45.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F78524_0_0|CSTM-ALL|CSTM-00|2020|PDM|90.00|99|0.00|OP SVCS
20|FH_F78542_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE
20|FH_F78603_0_0|SrvcGrp|177|2022|PDM|3689.05|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F78603_0_0|SrvcGrp|19633|2022|PDM|66875.99|99|0.00|MS DRG 226 ONLY
20|FH_F78603_0_0|SrvcGrp|20744|2022|PDM|36897.02|99|0.00|MS DRG 242 ONLY
20|FH_F78603_0_0|SrvcGrp|20912|2022|PDM|35841.45|99|0.00|MS DRG 236 ONLY
20|FH_F78603_0_0|SrvcGrp|20926|2022|PDM|56509.28|99|0.00|MS DRG 235 ONLY
20|FH_F78603_0_0|SrvcGrp|21102|2022|PDM|80041.16|99|0.00|MS DRG 219 ONLY
20|FH_F78603_0_0|SrvcGrp|22781|2022|PDM|19987.07|99|0.00|MS DRG 244 ONLY
20|FH_F78603_0_0|SrvcGrp|26690|2022|PDM|122076.18|99|0.00|MS DRG 215 ONLY
20|FH_F78603_0_0|SrvcGrp|29127|2022|PDM|22015.17|99|0.00|MSDRG 265 ONLY
20|FH_F78603_0_0|SrvcGrp|29606|2022|PDM|54016.77|99|0.00|MS DRG 218 ONLY
20|FH_F78603_0_0|SrvcGrp|29607|2022|PDM|43712.36|99|0.00|MS DRG 221 ONLY
20|FH_F78603_0_0|SrvcGrp|50169|2022|PDM|49781.36|99|0.00|MSDRG 227 ONLY
20|FH_F78603_0_0|SrvcGrp|55194|2022|PDM|28224.05|99|0.00|MS DRG 258 ONLY
20|FH_F78603_0_0|SrvcGrp|65|2022|PDM|2867.32|99|0.00|OBSTETRICAL CARE
20|FH_F78762_0_0|SrvcGrp|23703|2022|PCT|0.71|99|0.00|IP/OP TRAUMA
20|FH_F78852_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|OP SVCS
20|FH_F78887_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS
20|FH_F78922_0_0|SrvcGrp|11853|2022|PCT|0.20|99|0.00|DRUGS
20|FH_F78922_0_0|SrvcGrp|76093|2022|PCT|0.20|99|0.00|HIGH COST DRUGS
20|FH_F78928_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS
20|FH_F78945_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F79007_0_0|CSTM-ALL|CSTM-00|2020|PCT|49.00|99|0.00|GENERAL ACUTE CARE
20|FH_F79007_0_0|CSTM-ALL|CSTM-00|2020|PCT|49.00|99|0.00|OP SVCS
20|FH_F79025_0_0|SrvcGrp|471|2022|PDM|945.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F79245_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F79245_0_0|SrvcGrp|59426|2022|PDM|75.00|99|0.00|PT
20|FH_F79427_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|GENERAL ACUTE CARE
20|FH_F79427_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS
20|FH_F79427_0_0|CSTM-ALL|CSTM-00|2020|PDM|1877.00|99|0.00|ASPG VIII
20|FH_F79427_0_0|CSTM-ALL|CSTM-00|2020|PDM|2229.00|99|0.00|ASPG IX
20|FH_F79427_0_0|CSTM-ALL|CSTM-00|2020|PDM|586.00|99|0.00|ASPG I
20|FH_F79429_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F79429_0_0|SrvcGrp|12403|2022|PDM|30.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F79429_0_0|SrvcGrp|66480|2022|PDM|75.00|99|0.00|RN VISIT
20|FH_F79483_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|GENERAL ACUTE CARE
20|FH_F79483_0_0|SrvcGrp|89276|2022|PDM|435.00|99|0.00|PORTABLE SLEEP STUDY TYPE III
20|FH_F79542_0_0|CSTM-ALL|CSTM-00|2020|PCT|59.40|99|0.00|OP SVCS
20|FH_F79551_0_0|CSTM-ALL|CSTM-00|2020|PDM|1242.00|99|0.00|AEG 7 (NO REV)
20|FH_F79551_0_0|CSTM-ALL|CSTM-00|2020|PDM|636.00|99|0.00|AEG 10 (NO REV)
20|FH_F79551_0_0|CSTM-ALL|CSTM-00|2020|PDM|895.00|99|0.00|AEG 5  (NO REV)
20|FH_F79584_0_0|CSTM-ALL|CSTM-00|2020|PDM|1614.00|99|0.00|COVENTRY ENHANCED GROUPER 9
20|FH_F79623_0_0|SrvcGrp|72990|2022|PDM|2250.00|99|0.00|AEG 1
20|FH_F79623_0_0|SrvcGrp|72996|2022|PDM|4404.00|99|0.00|AEG 4
20|FH_F79623_0_0|SrvcGrp|73000|2022|PDM|5803.00|99|0.00|AEG 6
20|FH_F79624_0_0|SrvcGrp|76321|2022|PCT|0.61|99|0.00|AETNA ALL INPATIENT SERVICES
20|FH_F79625_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F79645_0_0|SrvcGrp|62261|2022|PDM|85.00|99|0.00|SPEECH THERAPY
20|FH_F79645_0_0|SrvcGrp|76927|2022|PCT|0.70|99|0.00|MEDICAL EQUIPMENT
20|FH_F79704_0_0|SrvcGrp|12403|2022|PDM|32.61|99|0.00|CONTINUOUS HOMECARE
20|FH_F79704_0_0|SrvcGrp|76531|2022|PDM|32.61|99|0.00|HOSPICE IN HOME
20|FH_F79904_0_0|SrvcGrp|26001|2022|PDM|126.35|99|0.00|HOSPICE RESPITE SVCS
20|FH_F79904_0_0|SrvcGrp|76094|2022|PDM|118.14|99|0.00|HOSPICE ROUTINE HOME CARE
20|FH_F79923_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F79923_0_0|SrvcGrp|46632|2022|PDM|45.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F79923_0_0|SrvcGrp|46633|2022|PDM|45.00|99|0.00|SPEECH THERAPY
20|FH_F79923_0_0|SrvcGrp|474|2022|PDM|245.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F79927_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F80064_0_0|SrvcGrp|29930|2022|PDM|400.00|99|0.00|DIALYSIS
20|FH_F80083_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|OP SVCS
20|FH_F80084_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F80185_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F80185_0_0|SrvcGrp|44107|2022|PDM|48.00|99|0.00|SPEECH THERAPY
20|FH_F80185_0_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F80185_0_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F80224_0_0|SrvcGrp|31125|2022|PDM|1543.00|99|0.00|MS DRG 789-794 ONLY SICK BABY
20|FH_F80224_0_0|SrvcGrp|3273|2022|PCT|0.76|99|0.00|IMPLANTS
20|FH_F80455_0_0|CSTM-ALL|CSTM-00|2020|PDM|1078.00|99|0.00|AEG 8 (NO REV)
20|FH_F80455_0_0|CSTM-ALL|CSTM-00|2020|PDM|915.20|99|0.00|AEG 6 (NO REV)
20|FH_F80455_0_0|SrvcGrp|78046|2022|PDM|665.50|99|0.00|AETNA AQUEOUS SHUNT
20|FH_F80511_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|OP SVCS
20|FH_F80511_0_0|SrvcGrp|74603|2022|PCT|0.57|99|0.00|AETNA CARDIAC CATHETERIZATION
20|FH_F80511_0_0|SrvcGrp|76321|2022|PCT|0.60|99|0.00|AETNA ALL INPATIENT SERVICES
20|FH_F80513_0_0|SrvcGrp|21108|2022|PDM|11995.00|99|0.00|MS DRG 243 ONLY
20|FH_F80513_0_0|SrvcGrp|21358|2022|PDM|12038.00|99|0.00|MS DRG 258-259 ONLY
20|FH_F80513_0_0|SrvcGrp|21360|2022|PDM|11241.00|99|0.00|MS DRG 472-473 ONLY
20|FH_F80513_0_0|SrvcGrp|29757|2022|PDM|14236.00|99|0.00|MS DRG 251 ONLY
20|FH_F80513_0_0|SrvcGrp|39870|2022|PDM|15026.00|99|0.00|MS DRG 619-621 ONLY
20|FH_F80513_0_0|SrvcGrp|53153|2022|PDM|10849.00|99|0.00|MS DRG 261 ONLY
20|FH_F80513_0_0|SrvcGrp|87309|2022|PDM|19882.00|99|0.00|MSDRG 272 ONLY
20|FH_F80532_0_0|SrvcGrp|12403|2022|PDM|30.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F80532_0_0|SrvcGrp|3809|2022|PDM|540.00|99|0.00|HOSPICE CARE
20|FH_F80532_0_0|SrvcGrp|64838|2022|PDM|130.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F80731_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F80771_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F80771_0_0|CSTM-ALL|CSTM-00|2020|PDM|759.00|99|0.00|COVENTRY ENHANCED GROUPER 4
20|FH_F80771_0_0|CSTM-ALL|CSTM-00|2020|PDM|864.00|99|0.00|COVENTRY ENHANCED DEFAULT 10021-69990
20|FH_F80855_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F80855_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F80855_0_0|SrvcGrp|15473|2022|PDM|1100.00|99|0.00|CPT CODE 42820
20|FH_F80855_0_0|SrvcGrp|27347|2022|PDM|2650.00|99|0.00|CPT 58558
20|FH_F80855_0_0|SrvcGrp|27348|2022|PDM|2625.00|99|0.00|OP SURGERY (CPT 58662)
20|FH_F80855_0_0|SrvcGrp|73008|2022|PDM|825.00|99|0.00|AEG 10
20|FH_F80855_0_0|SrvcGrp|78095|2022|PDM|2625.00|99|0.00|AETNA LAPARO HERNIA REPAIR
20|FH_F80855_0_0|SrvcGrp|78096|2022|PDM|2200.00|99|0.00|AETNA ARTHROSCOPY BICEPS
20|FH_F80855_0_0|SrvcGrp|78098|2022|PDM|1100.00|99|0.00|AETNA REMOVAL OF TONSILS
20|FH_F80855_0_0|SrvcGrp|79101|2022|PDM|1660.00|99|0.00|AETNA NASAL ENDOSCOPY
20|FH_F81115_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F81152_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F81152_0_0|SrvcGrp|76501|2022|PDM|315.00|99|0.00|SUB-ACUTE - LEVEL I
20|FH_F81172_0_0|SrvcGrp|33164|2022|PDM|350.00|99|0.00|SKILLED NURSING - LEVEL I
20|FH_F81272_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F81272_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F81312_0_0|CSTM-ALL|CSTM-00|2020|PDM|5883.00|99|0.00|GENERAL ACUTE CARE
20|FH_F81312_0_0|SrvcGrp|12342|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F81312_0_0|SrvcGrp|29121|2022|PCT|0.65|99|0.00|LABORATORY
20|FH_F81312_0_0|SrvcGrp|3259|2022|PDM|3332.00|99|0.00|ACUTE REHABILITATION
20|FH_F81313_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F81313_0_0|SrvcGrp|33166|2022|PDM|450.00|99|0.00|SKILLED NURSING - LEVEL III
20|FH_F81313_0_0|SrvcGrp|44106|2022|PDM|48.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F81313_0_0|SrvcGrp|78537|2022|PDM|48.00|99|0.00|PHYSICAL THERAPY
20|FH_F81377_0_0|CSTM-ALL|CSTM-00|2020|PDM|1141.00|99|0.00|AEG 7 (NO REV)
20|FH_F81377_0_0|CSTM-ALL|CSTM-00|2020|PDM|1535.00|99|0.00|AEG 9 (NO REV)
20|FH_F81377_0_0|SrvcGrp|47545|2022|PDM|2750.00|99|0.00|INSERTION/REPLACEMENT OF PERIPHERAL/GASTRIC NEUROSTIMULATOR
20|FH_F81377_0_0|SrvcGrp|70069|2022|PDM|1760.00|99|0.00|CPT 49505
20|FH_F81377_0_0|SrvcGrp|70073|2022|PDM|2604.00|99|0.00|LAPAROSCOPY CPT 49650
20|FH_F81393_0_0|CSTM-ALL|CSTM-00|2020|PDM|1044.75|99|0.00|AEG 7 (NO REV)
20|FH_F81393_0_0|CSTM-ALL|CSTM-00|2020|PDM|468.30|99|0.00|AEG 2 (NO REV)
20|FH_F81393_0_0|CSTM-ALL|CSTM-00|2020|PDM|661.50|99|0.00|AEG 4 (NO REV)
20|FH_F81393_0_0|CSTM-ALL|CSTM-00|2020|PDM|867.30|99|0.00|AEG 6 (NO REV)
20|FH_F81481_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F81481_0_0|SrvcGrp|75479|2022|PDM|945.00|99|0.00|AEG 1
20|FH_F81494_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|99|0.00|OP SVCS
20|FH_F81494_0_0|SrvcGrp|14101|2022|PCT|1.00|99|0.00|DRUGS
20|FH_F81494_0_0|SrvcGrp|16615|2022|PDM|144.00|99|0.00|RN VISIT
20|FH_F81494_0_0|SrvcGrp|27726|2022|PCT|0.68|99|0.00|OP SURGERY
20|FH_F81494_0_0|SrvcGrp|3029|2022|PDM|861.00|99|0.00|NEWBORN NURSERY
20|FH_F81494_0_0|SrvcGrp|3069|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F81494_0_0|SrvcGrp|537|2022|PDM|93.00|99|0.00|OBSERVATION SERVICES
20|FH_F81494_0_0|SrvcGrp|63|2022|PDM|1006.00|99|0.00|SUBACUTE CARE
20|FH_F81494_0_0|SrvcGrp|8950|2022|PDM|2514.00|99|0.00|INTERMEDIATE ICU/CCU
20|FH_F81494_0_0|SrvcGrp|9518|2022|PDM|575.00|99|0.00|EMERGENCY ROOM
20|FH_F81563_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|AETNA AMBULATORY SURGERY (NO REV)
20|FH_F81656_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.50|99|0.00|OP SVCS
20|FH_F81657_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE
20|FH_F81737_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.00|99|0.00|GENERAL ACUTE CARE
20|FH_F81763_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.50|99|0.00|OP SVCS
20|FH_F81771_0_0|SrvcGrp|57968|2022|PDM|30.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F81823_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F81823_0_0|SrvcGrp|66481|2022|PDM|75.00|99|0.00|SOCIAL WORKER
20|FH_F81823_0_0|SrvcGrp|66482|2022|PDM|35.00|99|0.00|HOME HEALTH AID
20|FH_F81823_0_0|SrvcGrp|79952|2022|PDM|11.00|99|0.00|INFLUENZA ADMINISTRATION
20|FH_F81835_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F81835_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F81835_0_0|SrvcGrp|74663|2022|PDM|627.24|99|0.00|AETNA SLEEP STUDIES
20|FH_F81853_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F82033_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F82114_0_0|SrvcGrp|75327|2022|PDM|179.56|99|0.00|SLEEP STUDY CPT 95806
20|FH_F82195_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F82197_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F82198_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F82198_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F82199_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F82215_0_0|SrvcGrp|80140|2022|PDM|675.00|99|0.00|END STATE RENAL DIALYSIS
20|FH_F82235_0_0|SrvcGrp|72992|2022|PDM|490.60|99|0.00|AEG 2
20|FH_F82235_0_0|SrvcGrp|73000|2022|PDM|908.60|99|0.00|AEG 6
20|FH_F82235_0_0|SrvcGrp|73008|2022|PDM|693.00|99|0.00|AEG 10
20|FH_F82381_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F82382_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F82393_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F82393_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|99|0.00|OP SVCS
20|FH_F82432_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F82432_0_0|SrvcGrp|80918|2022|PDM|105.00|99|0.00|RESPITE CARE
20|FH_F82432_0_0|SrvcGrp|80919|2022|PDM|105.00|99|0.00|HOSPICE CARE (ALL OTHER)
20|FH_F82571_0_0|CSTM-ALL|CSTM-00|2020|PDM|356.00|99|0.00|COVENTRY ENHANCED GROUPER 1
20|FH_F82571_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|COVENTRY ENHANCED GROUPER 10
20|FH_F82572_0_0|SrvcGrp|47994|2022|PDM|80.00|99|0.00|PHYSICAL THERAPY VISIT
20|FH_F82572_0_0|SrvcGrp|80533|2022|PDM|70.00|99|0.00|SPEECH THERAPY
20|FH_F82591_0_0|SrvcGrp|79562|2022|PCT|0.35|99|0.00|AETNA AMBULATORY SURGERY
20|FH_F82671_0_0|CSTM-ALL|CSTM-00|2020|PDM|1119.00|99|0.00|COVENTRY ENHANCED GROUPER 6
20|FH_F82671_0_0|CSTM-ALL|CSTM-00|2020|PDM|1319.00|99|0.00|COVENTRY ENHANCED GROUPER 8
20|FH_F82671_0_0|CSTM-ALL|CSTM-00|2020|PDM|1362.00|99|0.00|COVENTRY ENHANCED GROUPER 10
20|FH_F82671_0_0|CSTM-ALL|CSTM-00|2020|PDM|1362.00|99|0.00|COVENTRY ENHANCED GROUPER 7
20|FH_F82671_0_0|CSTM-ALL|CSTM-00|2020|PDM|698.00|99|0.00|OP SVCS
20|FH_F82691_0_0|SrvcGrp|33165|2022|PDM|300.00|99|0.00|SKILLED NURSING - LEVEL II
20|FH_F82691_0_0|SrvcGrp|44106|2022|PDM|48.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F82771_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F82771_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F82771_0_0|CSTM-ALL|CSTM-00|2020|PDM|1890.00|99|0.00|AEG 4 (NO REV)
20|FH_F82771_0_0|CSTM-ALL|CSTM-00|2020|PDM|1995.00|99|0.00|AEG 5  (NO REV)
20|FH_F82771_0_0|CSTM-ALL|CSTM-00|2020|PDM|2310.00|99|0.00|AEG 9 (NO REV)
20|FH_F82771_0_0|SrvcGrp|35669|2022|PDM|1575.00|99|0.00|CPT 63650
20|FH_F82779_0_0|CSTM-ALL|CSTM-00|2020|PDM|1058.00|99|0.00|COVENTRY ENHANCED GROUPER 7
20|FH_F82779_0_0|CSTM-ALL|CSTM-00|2020|PDM|542.00|99|0.00|OP SVCS
20|FH_F82779_0_0|CSTM-ALL|CSTM-00|2020|PDM|869.00|99|0.00|COVENTRY ENHANCED GROUPER 6
20|FH_F82813_0_0|SrvcGrp|72990|2022|PDM|477.00|99|0.00|AEG 1
20|FH_F82813_0_0|SrvcGrp|72992|2022|PDM|694.00|99|0.00|AEG 2
20|FH_F82813_0_0|SrvcGrp|72998|2022|PDM|1044.00|99|0.00|AEG 5
20|FH_F82813_0_0|SrvcGrp|74587|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F82894_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F82894_0_0|SrvcGrp|80285|2022|PDM|126.00|99|0.00|HOSPICE ROUTINE HOME CARE
20|FH_F82973_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F82973_0_0|CSTM-ALL|CSTM-00|2020|PDM|1428.00|99|0.00|AEG 9 (NO REV)
20|FH_F82973_0_0|CSTM-ALL|CSTM-00|2020|PDM|418.00|99|0.00|AEG 1 (NO REV)
20|FH_F82973_0_0|CSTM-ALL|CSTM-00|2020|PDM|556.00|99|0.00|AEG 2 (NO REV)
20|FH_F82973_0_0|CSTM-ALL|CSTM-00|2020|PDM|858.00|99|0.00|AEG 6 (NO REV)
20|FH_F83035_0_0|SrvcGrp|26001|2022|PDM|126.33|99|0.00|HOSPICE RESPITE SVCS
20|FH_F83035_0_0|SrvcGrp|76094|2022|PDM|118.14|99|0.00|HOSPICE ROUTINE HOME CARE
20|FH_F83053_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F83053_0_0|SrvcGrp|73002|2022|PDM|6127.00|99|0.00|AEG 7
20|FH_F83152_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F83152_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|AETNA INPATIENT SERVICES
20|FH_F83231_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F83231_0_0|SrvcGrp|17735|2022|PDM|400.00|99|0.00|DIALYSIS
20|FH_F83231_0_0|SrvcGrp|69044|2022|PDM|1800.00|99|0.00|SUB-ACUTE REHAB I
20|FH_F83231_0_0|SrvcGrp|69048|2022|PDM|1400.00|99|0.00|SUB-ACUTE REHAB III
20|FH_F83294_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F83294_0_0|SrvcGrp|10540|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE
20|FH_F83294_0_0|SrvcGrp|10545|2022|PDM|85.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F83294_0_0|SrvcGrp|22387|2022|PDM|85.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F83294_0_0|SrvcGrp|42974|2022|PDM|85.00|99|0.00|OCCUPATIONAL THERAPIST
20|FH_F83431_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.46|99|0.00|GENERAL ACUTE CARE
20|FH_F83451_0_0|CSTM-ALL|CSTM-00|2020|PDM|1036.00|99|0.00|AEG 6 (NO REV)
20|FH_F83451_0_0|CSTM-ALL|CSTM-00|2020|PDM|1219.00|99|0.00|AEG 8 (NO REV)
20|FH_F83451_0_0|SrvcGrp|112112|2022|PDM|6000.00|99|0.00|LUMBAR SPINE CODES
20|FH_F83451_0_0|SrvcGrp|81561|2022|PDM|1250.00|99|0.00|REPAIR PARAVAGINAL DEFECT
20|FH_F83451_0_0|SrvcGrp|81563|2022|PDM|3500.00|99|0.00|ABLATION ONE OR MORE
20|FH_F83451_0_0|SrvcGrp|81565|2022|PDM|1625.00|99|0.00|ARTHOSCOPY SHOULDER
20|FH_F83451_0_0|SrvcGrp|81568|2022|PDM|1575.00|99|0.00|COCHLEAR IMPLANTS
20|FH_F83451_0_0|SrvcGrp|81571|2022|PDM|2200.00|99|0.00|NASAL ENDOSCOPY W/ SINUS OSTIA DILATION
20|FH_F83451_0_0|SrvcGrp|99073|2022|PDM|1.28|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F83472_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F83472_0_0|CSTM-ALL|CSTM-00|2020|PDM|537.89|99|0.00|AEG 10 (NO REV)
20|FH_F83475_0_0|CSTM-ALL|CSTM-00|2020|PCT|69.50|99|0.00|OP SVCS
20|FH_F83514_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.20|99|0.00|OP SVCS
20|FH_F83534_0_0|CSTM-ALL|CSTM-00|2020|PCT|12000.00|99|0.00|TIMELY FILING
20|FH_F83621_0_0|CSTM-ALL|CSTM-00|2020|PDM|2665.00|99|0.00|AEG 9 (NO REV)
20|FH_F83621_0_0|CSTM-ALL|CSTM-00|2020|PDM|3088.00|99|0.00|AEG 5  (NO REV)
20|FH_F83635_0_0|CSTM-ALL|CSTM-00|2020|PCT|91.60|99|0.00|OP SVCS
20|FH_F83754_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.86|99|0.00|PROCRIT/ERYTHROPOIETIN (EPOETIN)
20|FH_F83754_0_0|SrvcGrp|19661|2022|PCT|0.81|99|0.00|MS DRG 216-218 ONLY CARDIAC VALVE PROCEDURE W/CARDIAC CATH
20|FH_F83754_0_0|SrvcGrp|19961|2022|PCT|0.81|99|0.00|MS DRG 231-232 ONLY CORONARY BYPASS W/ PTCA
20|FH_F83754_0_0|SrvcGrp|21813|2022|PCT|0.86|99|0.00|ARENESP
20|FH_F83754_0_0|SrvcGrp|3029|2022|PDM|1165.00|99|0.00|NEWBORN NURSERY
20|FH_F83754_0_0|SrvcGrp|3069|2022|PCT|0.63|99|0.00|IMPLANTS
20|FH_F83754_0_0|SrvcGrp|76947|2022|PDM|1553.00|99|0.00|SKILLED NURSING
20|FH_F83792_0_0|SrvcGrp|78377|2022|PDM|683.00|99|0.00|AETNA IP DETOX (BHIPDETOX)
20|FH_F83792_0_0|SrvcGrp|80123|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F83871_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F83871_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F83871_0_0|CSTM-ALL|CSTM-00|2020|PDM|465.00|99|0.00|AEG 1 (NO REV)
20|FH_F83938_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE
20|FH_F83938_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS
20|FH_F83939_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE
20|FH_F83939_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS
20|FH_F83951_0_0|CSTM-ALL|CSTM-00|2020|PCT|58.00|99|0.00|OP SVCS
20|FH_F84015_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F84058_0_0|SrvcGrp|82448|2022|PDM|437.37|99|0.00|AMBULANCE SVC ADV LIFE SUPPORT EMERGENCY
20|FH_F84058_0_0|SrvcGrp|82450|2022|PDM|633.03|99|0.00|ADVANCED LIFE SUPPORT LEVEL II
20|FH_F84091_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.20|99|0.00|OP SVCS
20|FH_F84135_0_0|SrvcGrp|107746|2022|PCT|0.90|99|0.00|PARSABIV
20|FH_F84135_0_0|SrvcGrp|108082|2022|PDM|952.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER
20|FH_F84135_0_0|SrvcGrp|108180|2022|PDM|927.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD
20|FH_F84159_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F84215_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F84215_0_0|SrvcGrp|37317|2022|PDM|4015.00|99|0.00|LITHOTRIPSY
20|FH_F84215_0_0|SrvcGrp|72998|2022|PDM|877.00|99|0.00|AEG 5
20|FH_F84215_0_0|SrvcGrp|73006|2022|PDM|1623.00|99|0.00|AEG 9
20|FH_F84215_0_0|SrvcGrp|82571|2022|PDM|3642.00|99|0.00|PERCUTANEOUS IMPLANT OF NEURO ELECTRODES
20|FH_F84372_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F84413_0_0|SrvcGrp|16526|2022|PDM|180.00|99|0.00|DIALYSIS
20|FH_F84413_0_0|SrvcGrp|25688|2022|PDM|420.00|99|0.00|HOME HEMODIALYSIS
20|FH_F84433_0_0|SrvcGrp|26160|2022|PDM|16.97|99|0.00|HOME HEALTH AIDE VISIT
20|FH_F84433_0_0|SrvcGrp|43567|2022|PDM|107.00|99|0.00|SKILLED NURSING - POSTNATAL
20|FH_F84433_0_0|SrvcGrp|46424|2022|PDM|110.00|99|0.00|HI TECH SKILLED NURSING SERVICES
20|FH_F84433_0_0|SrvcGrp|48398|2022|PDM|114.00|99|0.00|PT SERVICES
20|FH_F84446_0_0|CSTM-ALL|CSTM-00|2020|PCT|41.00|99|0.00|GENERAL ACUTE CARE
20|FH_F147800_0_0|SrvcGrp|110570|2022|PDM|880.00|99|0.00|NERVE BLOCK INJECTION 7
20|FH_F147800_0_0|SrvcGrp|115019|2022|PDM|11000.00|99|0.00|PERQ NJX ALGC FLUOR LMBR 1ST
20|FH_F147800_0_0|SrvcGrp|115142|2022|PDM|660.00|99|0.00|NJX AA&/STRD GNCLR NRV BRNCH
20|FH_F147800_0_0|SrvcGrp|115147|2022|PDM|138.00|99|0.00|DRAIN/INJ JOINT/BURSA W/US
20|FH_F147800_0_0|SrvcGrp|115150|2022|PDM|55.00|99|0.00|SINGLE TENDON INJECTIONS
20|FH_F147800_0_0|SrvcGrp|115176|2022|PDM|468.00|99|0.00|INJ ANES AGT; SUP HYPOGASTR
20|FH_F147800_0_0|SrvcGrp|53066|2022|PDM|458.00|99|0.00|INJECTION(S), LUMBAR OR SACRAL, EACH ADDITIONAL LEVEL
20|FH_F147800_0_0|SrvcGrp|58638|2022|PDM|4675.00|99|0.00|CPT 63688
20|FH_F147800_0_0|SrvcGrp|88487|2022|PDM|4510.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION
20|FH_F147800_0_0|SrvcGrp|93724|2022|PDM|1650.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY
20|FH_F147800_0_0|SrvcGrp|96799|2022|PDM|885.00|99|0.00|DESTROY C/TH FACET JNT ADDL
20|FH_F147800_0_0|SrvcGrp|98104|2022|PDM|55.00|99|0.00|INJ SINGLE/MX TRIGGER POINT1
20|FH_F147800_0_0|SrvcGrp|98105|2022|PDM|110.00|99|0.00|DRAIN INJ JOINT/BURSA W/O U
20|FH_F147899_0_0|SrvcGrp|113170|2022|PDM|1790.00|99|0.00|UPPER GI OPTIC ENDOMICROSCOPY
20|FH_F147899_0_0|SrvcGrp|115220|2022|PDM|6000.00|99|0.00|IMPLANT NEUROELECTRODES (HCFA)
20|FH_F147980_0_0|SrvcGrp|104228|2022|PDM|95.00|99|0.00|HOSPICE CARE (HCFA)
20|FH_F147980_0_0|SrvcGrp|82222|2022|PDM|20.00|99|0.00|HOSPICE CARE
20|FH_F147980_0_0|SrvcGrp|95660|2022|PDM|450.00|99|0.00|HOSPICE SERVICES (HCFA)
20|FH_F147980_0_0|SrvcGrp|95661|2022|PDM|95.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F147994_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F147994_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F148008_0_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS
20|FH_F148008_0_0|SrvcGrp|472|2022|PDM|528.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F148020_0_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS
20|FH_F148103_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F148103_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F148166_0_0|SrvcGrp|22596|2022|PDM|190.00|99|0.00|HOSPICE CARE
20|FH_F148166_0_0|SrvcGrp|92501|2022|PDM|515.00|99|0.00|HOSPICE IP RESPITE CARE
20|FH_F148181_0_0|SrvcGrp|30609|2022|PDM|48.00|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F148181_0_0|SrvcGrp|87799|2022|PDM|155.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)
20|FH_F148181_0_0|SrvcGrp|90707|2022|PDM|155.00|99|0.00|AETNA HOSPICE CARE
20|FH_F148181_0_0|SrvcGrp|93098|2022|PDM|155.00|99|0.00|HOSPICE CARE
20|FH_F148186_0_0|SrvcGrp|107353|2022|PDM|345.00|99|0.00|AMB SRVC NEONAT TRNSPRT BS RATE EMERG 1 WAY (HCFA)
20|FH_F148186_0_0|SrvcGrp|13262|2022|PDM|6.00|99|0.00|GROUND MILEAGE, PER STATUTE MILE
20|FH_F148186_0_0|SrvcGrp|13597|2022|PDM|250.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT
20|FH_F148243_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F148243_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F148243_0_0|CSTM-ALL|CSTM-00|2020|PDM|1124.00|99|0.00|AEG 8 (NO REV)
20|FH_F148243_0_0|CSTM-ALL|CSTM-00|2020|PDM|1169.00|99|0.00|AEG 9 (NO REV)
20|FH_F148243_0_0|CSTM-ALL|CSTM-00|2020|PDM|508.00|99|0.00|AEG 2 (NO REV)
20|FH_F148243_0_0|CSTM-ALL|CSTM-00|2020|PDM|580.00|99|0.00|AEG 3 (NO REV)
20|FH_F148243_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|AEG 10 (NO REV)
20|FH_F148243_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|AEG 4 (NO REV)
20|FH_F148243_0_0|CSTM-ALL|CSTM-00|2020|PDM|816.00|99|0.00|AEG 5  (NO REV)
20|FH_F148243_0_0|SrvcGrp|100923|2022|PDM|400.00|99|0.00|DRUGS
20|FH_F148243_0_0|SrvcGrp|107986|2022|PDM|800.00|99|0.00|REMOVAL OF FOOT LESION
20|FH_F148243_0_0|SrvcGrp|36608|2022|PDM|234.00|99|0.00|SIGMOIDOSCOPY
20|FH_F148243_0_0|SrvcGrp|70746|2022|PDM|1450.00|99|0.00|CPT 28292
20|FH_F148243_0_0|SrvcGrp|71221|2022|PDM|879.00|99|0.00|EGD W/BALLOON DIALATION CPT 43249
20|FH_F148243_0_0|SrvcGrp|79593|2022|PDM|650.00|99|0.00|CPT 45378
20|FH_F148243_0_0|SrvcGrp|82300|2022|PDM|500.00|99|0.00|SIGMOIDOSCOPY
20|FH_F148243_0_0|SrvcGrp|92408|2022|PDM|3000.00|99|0.00|PERQ VERTEBRAL AUGMENTATION
20|FH_F148243_0_0|SrvcGrp|93807|2022|PDM|5000.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY
20|FH_F148243_0_0|SrvcGrp|98469|2022|PDM|1450.00|99|0.00|AMPUTATION METATARSAL
20|FH_F148243_0_0|SrvcGrp|98470|2022|PDM|1450.00|99|0.00|AMPUTATION TOE
20|FH_F148260_0_0|CSTM-ALL|CSTM-00|2020|PDM|10850.00|99|0.00|AEG 5  (NO REV) W/O FEMALE GENITAL PROCEDURES
20|FH_F148260_0_0|CSTM-ALL|CSTM-00|2020|PDM|1352.00|99|0.00|AEG 1 (NO REV) W/O URODYNAMIC PROCEDURE
20|FH_F148260_0_0|CSTM-ALL|CSTM-00|2020|PDM|13777.00|99|0.00|AEG 6 (NO REV) W/O LAPAROSCOPIC/HYSTEROSCOPIC
20|FH_F148260_0_0|CSTM-ALL|CSTM-00|2020|PDM|3926.00|99|0.00|AEG 3 (NO REV)
20|FH_F148260_0_0|CSTM-ALL|CSTM-00|2020|PDM|8815.00|99|0.00|AEG 10 (NO REV)
20|FH_F148260_0_0|CSTM-ALL|CSTM-00|2020|PDM|9173.00|99|0.00|AEG 4 (NO REV)
20|FH_F148260_0_0|SrvcGrp|115349|2022|PDM|14871.00|99|0.00|HYSTERECTOMY
20|FH_F148260_0_0|SrvcGrp|78286|2022|PDM|8669.00|99|0.00|CPT 49322
20|FH_F148267_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F148267_0_0|SrvcGrp|57968|2022|PDM|37.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F148267_0_0|SrvcGrp|92501|2022|PDM|162.59|99|0.00|HOSPICE IP RESPITE CARE
20|FH_F148267_0_0|SrvcGrp|92502|2022|PDM|683.95|99|0.00|HOSPICE GENERAL IP CARE
20|FH_F148325_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F148325_0_0|SrvcGrp|104620|2022|PDM|169.46|99|0.00|HOSPICE IN INPATIENT HOME
20|FH_F148326_0_0|CSTM-ALL|CSTM-00|2020|PDM|1082.00|99|0.00|AEG 1 (NO REV)
20|FH_F148326_0_0|CSTM-ALL|CSTM-00|2020|PDM|1217.00|99|0.00|AEG 2 (NO REV)
20|FH_F148326_0_0|CSTM-ALL|CSTM-00|2020|PDM|2198.00|99|0.00|AEG 4 (NO REV)
20|FH_F148326_0_0|CSTM-ALL|CSTM-00|2020|PDM|2399.33|99|0.00|AEG 5  (NO REV)
20|FH_F148326_0_0|CSTM-ALL|CSTM-00|2020|PDM|3555.72|99|0.00|AEG 9 (NO REV)
20|FH_F148326_0_0|SrvcGrp|115169|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F148326_0_0|SrvcGrp|35670|2022|PDM|12485.00|99|0.00|SPINAL NEUROSTIMULATORS PROCEDURE
20|FH_F148345_0_0|CSTM-ALL|CSTM-00|2020|PDM|591.00|99|0.00|AEG 1 (NO REV)
20|FH_F148345_0_0|CSTM-ALL|CSTM-00|2020|PDM|908.00|99|0.00|AEG 3 (NO REV)
20|FH_F148345_0_0|SrvcGrp|99073|2022|PDM|1.55|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F148346_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F148346_0_0|SrvcGrp|43525|2022|PDM|627.00|99|0.00|INTENSIVE OUTPATIENT PROGRAM - PSYCHIATRIC
20|FH_F148346_0_0|SrvcGrp|73849|2022|PDM|878.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP - REV 913
20|FH_F148347_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F148347_0_0|CSTM-ALL|CSTM-00|2020|PDM|1040.00|99|0.00|AEG 5  (NO REV)
20|FH_F148347_0_0|CSTM-ALL|CSTM-00|2020|PDM|1442.00|99|0.00|AEG 7 (NO REV)
20|FH_F148347_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AEG 1 (NO REV)
20|FH_F148347_0_0|SrvcGrp|109476|2022|PDM|3765.00|99|0.00|ENDOVENOUS ABLATION THERAPY
20|FH_F148347_0_0|SrvcGrp|109799|2022|PDM|2018.55|99|0.00|REPAIR OF RECTUM
20|FH_F148347_0_0|SrvcGrp|80063|2022|PDM|1932.00|99|0.00|HEMORRHOIDECTOMY
20|FH_F148347_0_0|SrvcGrp|82298|2022|PDM|12778.00|99|0.00|AETNA LAP SLEEVE GASTRECTOMY
20|FH_F148347_0_0|SrvcGrp|82301|2022|PDM|2338.00|99|0.00|HEMORRHOIDECTOMY
20|FH_F148347_0_0|SrvcGrp|87842|2022|PDM|14056.00|99|0.00|LAPAROSCOPY - GASTRIC
20|FH_F148429_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F148439_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F148439_0_0|SrvcGrp|104330|2022|PDM|1500.00|99|0.00|AETNA ACUTE REHAB II
20|FH_F148439_0_0|SrvcGrp|73483|2022|PCT|0.00|99|0.00|AETNA SUBACUTE III
20|FH_F148488_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F148488_0_0|SrvcGrp|108484|2022|PDM|440.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY
20|FH_F148489_0_0|SrvcGrp|108484|2022|PDM|600.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY
20|FH_F148489_0_0|SrvcGrp|89337|2022|PDM|1040.00|99|0.00|DETOXIFICATION
20|FH_F148494_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.11|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE
20|FH_F148494_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.50|99|0.00|HSS ASC
20|FH_F148494_0_0|SrvcGrp|101114|2022|PDM|15000.00|99|0.00|ARTHOPLASTY
20|FH_F148494_0_0|SrvcGrp|114170|2022|PDM|10000.00|99|0.00|LUMB ARTIF DISKECTOMY ADDL
20|FH_F148494_0_0|SrvcGrp|98560|2022|PDM|15000.00|99|0.00|LUMBAR
20|FH_F148494_0_0|SrvcGrp|98561|2022|PDM|12000.00|99|0.00|ARTHRODESIS POSTERIOR TECH
20|FH_F148494_0_0|SrvcGrp|98564|2022|PDM|15000.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR
20|FH_F148499_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F148499_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|OP SVCS
20|FH_F148499_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|HSS ASC INVOICE
20|FH_F148521_0_0|CSTM-ALL|CSTM-00|2020|PDM|334.00|99|0.00|AEG 1 (NO REV)
20|FH_F148521_0_0|CSTM-ALL|CSTM-00|2020|PDM|439.00|99|0.00|AEG 2 (NO REV)
20|FH_F148546_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F148546_0_0|SrvcGrp|16|2022|PDM|970.00|99|0.00|ACUTE REHABILITATION
20|FH_F148555_0_0|CSTM-ALL|CSTM-00|2020|PDM|417.00|99|0.00|AEG 1 (NO REV)
20|FH_F148555_0_0|CSTM-ALL|CSTM-00|2020|PDM|712.00|99|0.00|AEG 10 (NO REV)
20|FH_F148555_0_0|SrvcGrp|115448|2022|PDM|3090.00|99|0.00|REMOVE & REPLACE PM GEN SINGLE
20|FH_F148555_0_0|SrvcGrp|115450|2022|PDM|4120.00|99|0.00|REMOVE & REPLACE PM GEN MULTI LEADS
20|FH_F148555_0_0|SrvcGrp|115463|2022|PDM|3605.00|99|0.00|INSERT SUBQ CAR RHYTHM MONITOR
20|FH_F148555_0_0|SrvcGrp|115497|2022|PDM|5522.00|99|0.00|EP & ABLATE VENTRIC TACHY
20|FH_F148555_0_0|SrvcGrp|115500|2022|PDM|3914.00|99|0.00|ELECTROPHYS MAP, 3D, ADD-ON
20|FH_F148601_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F148601_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.32|99|0.00|HSS ASC
20|FH_F148639_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F148639_0_0|SrvcGrp|114930|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F148639_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F148639_0_0|SrvcGrp|11669|2022|PDM|2800.00|99|0.00|OP SURG
20|FH_F148639_0_0|SrvcGrp|27343|2022|PDM|2887.00|99|0.00|OP SURGERY (CPT 25607 - 25609)
20|FH_F148639_0_0|SrvcGrp|58634|2022|PDM|3495.00|99|0.00|NEUROELECTRODES IMPLANT
20|FH_F148639_0_0|SrvcGrp|82720|2022|PDM|1025.00|99|0.00|WRIST ENDOSCOPY/SURGERY
20|FH_F148639_0_0|SrvcGrp|88739|2022|PDM|3593.00|99|0.00|IMPLANT SPINAL CANAL
20|FH_F148645_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F148645_0_0|CSTM-ALL|CSTM-00|2020|PDM|3400.00|99|0.00|AEG 10 (NO REV)
20|FH_F148667_0_0|CSTM-ALL|CSTM-00|2020|PDM|1434.00|99|0.00|AEG 5  (NO REV)
20|FH_F148667_0_0|CSTM-ALL|CSTM-00|2020|PDM|1687.00|99|0.00|AEG 9 (NO REV)
20|FH_F148667_0_0|CSTM-ALL|CSTM-00|2020|PDM|617.00|99|0.00|AEG 1 (NO REV)
20|FH_F148667_0_0|CSTM-ALL|CSTM-00|2020|PDM|811.00|99|0.00|AEG 2 (NO REV)
20|FH_F148667_0_0|SrvcGrp|103570|2022|PDM|2856.00|99|0.00|ARTHROSCOPIC FRACTURE
20|FH_F148667_0_0|SrvcGrp|35668|2022|PDM|2856.00|99|0.00|CPT 29824
20|FH_F148667_0_0|SrvcGrp|54943|2022|PDM|2856.00|99|0.00|REPAIR OF SLAP LESION
20|FH_F148667_0_0|SrvcGrp|67072|2022|PDM|3410.00|99|0.00|CPT 22845
20|FH_F148667_0_0|SrvcGrp|82113|2022|PDM|2856.00|99|0.00|KNEE ARTHROSCOPY SURGERY
20|FH_F148667_0_0|SrvcGrp|82114|2022|PDM|2856.00|99|0.00|MENISCUS REPAIR MED OR LAT
20|FH_F148667_0_0|SrvcGrp|83641|2022|PDM|4400.00|99|0.00|CPT 29889
20|FH_F148667_0_0|SrvcGrp|84939|2022|PDM|11000.00|99|0.00|SHOULDER JOINT
20|FH_F148667_0_0|SrvcGrp|85778|2022|PDM|2727.00|99|0.00|REPAIR OF ANKLE FRACTURE
20|FH_F148667_0_0|SrvcGrp|92009|2022|PDM|2856.00|99|0.00|CARPAL SCAPHOID FRACTURE
20|FH_F148667_0_0|SrvcGrp|98003|2022|PDM|2727.00|99|0.00|BIMALLEOLAR ANKLE FRACTURE
20|FH_F148700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F148700_0_0|SrvcGrp|109036|2022|PDM|1015.00|99|0.00|PARTIAL HOSPITALIZATION
20|FH_F148700_0_0|SrvcGrp|74668|2022|PDM|416.00|99|0.00|AETNA INTENSIVE OUTPATIENT
20|FH_F148700_0_0|SrvcGrp|75419|2022|PDM|743.00|99|0.00|OP PARTIAL HOSPITALIZATION
20|FH_F148700_0_0|SrvcGrp|98701|2022|PDM|587.00|99|0.00|AETNA OP EATING DISORDERS
20|FH_F148719_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F148720_0_0|SrvcGrp|103550|2022|PDM|325.00|99|0.00|HEMODIALYSIS SVCS
20|FH_F148720_0_0|SrvcGrp|115637|2022|PDM|325.00|99|0.00|HEMODIALYSIS SVCS (HCFA)
20|FH_F148720_0_0|SrvcGrp|115638|2022|PDM|325.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD (HCFA)
20|FH_F84450_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE
20|FH_F84450_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F84454_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|OP SVCS
20|FH_F84532_0_0|SrvcGrp|72994|2022|PDM|1412.00|99|0.00|AEG 3
20|FH_F84532_0_0|SrvcGrp|73004|2022|PDM|2281.00|99|0.00|AEG 8
20|FH_F84532_0_0|SrvcGrp|78680|2022|PDM|6550.00|99|0.00|AETNA CARDIAC CATH
20|FH_F84532_0_0|SrvcGrp|82806|2022|PDM|1178.00|99|0.00|PAIN MANAGEMENT CARVEOUTS
20|FH_F84532_0_0|SrvcGrp|82807|2022|PDM|3694.00|99|0.00|ARTHROSCOPIC CARVEOUTS
20|FH_F84535_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F84535_0_0|CSTM-ALL|CSTM-00|2020|PCT|58.00|99|0.00|OP SVCS
20|FH_F84535_0_0|CSTM-ALL|CSTM-00|2020|PCT|9500.00|99|0.00|TIMELY FILING
20|FH_F84591_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|OP SVCS
20|FH_F84712_0_0|SrvcGrp|16301|2022|PDM|6307.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F84712_0_0|SrvcGrp|45582|2022|PDM|33.00|99|0.00|CPT 85610
20|FH_F84712_0_0|SrvcGrp|66517|2022|PCT|0.00|99|0.00|NICU
20|FH_F84712_0_0|SrvcGrp|73004|2022|PDM|4794.00|99|0.00|AEG 8
20|FH_F84712_0_0|SrvcGrp|73006|2022|PDM|6686.00|99|0.00|AEG 9
20|FH_F84712_0_0|SrvcGrp|73381|2022|PDM|13876.00|99|0.00|GAMMA KNIFE
20|FH_F84712_0_0|SrvcGrp|73485|2022|PDM|1388.00|99|0.00|AETNA REHAB
20|FH_F84712_0_0|SrvcGrp|73601|2022|PDM|4415.00|99|0.00|AETNA INTERMEDIATE ICU/CCU
20|FH_F84712_0_0|SrvcGrp|74586|2022|PCT|0.33|99|0.00|AETNA OP HIGH COST DRUGS
20|FH_F84712_0_0|SrvcGrp|78448|2022|PCT|0.74|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F84712_0_0|SrvcGrp|78646|2022|PDM|170.00|99|0.00|AETNA DUAL - ENERGY X-RAY ABSORBTION
20|FH_F84712_0_0|SrvcGrp|79300|2022|PDM|59.00|99|0.00|AETNA SCREENING MAMMOGRAPHY
20|FH_F84712_0_0|SrvcGrp|81403|2022|PDM|125.00|99|0.00|COMPREHEN METABOLIC PANEL
20|FH_F84712_0_0|SrvcGrp|81859|2022|PDM|3911.00|99|0.00|AETNA CARDIAC CATH
20|FH_F84712_0_0|SrvcGrp|82741|2022|PDM|190.00|99|0.00|XRAY EXAM CHEST TWO VIEWS
20|FH_F84712_0_0|SrvcGrp|82744|2022|PDM|59.00|99|0.00|URINE CULTURE COLONY COUNT
20|FH_F84712_0_0|SrvcGrp|82751|2022|PDM|24.00|99|0.00|GONADOTROIN CHORINIC (HCG) QUANTITATIVE
20|FH_F84712_0_0|SrvcGrp|82754|2022|PDM|33.00|99|0.00|ASSAY THYROID STIM HORMONE
20|FH_F84712_0_0|SrvcGrp|82755|2022|PDM|39.00|99|0.00|ASSAY BLOOD MAGNESIUM
20|FH_F84712_0_0|SrvcGrp|82758|2022|PDM|54.00|99|0.00|CHEMISTRY
20|FH_F84712_0_0|SrvcGrp|82762|2022|PDM|19.00|99|0.00|URINALYSIS AUTO W/ SCOPE
20|FH_F84712_0_0|SrvcGrp|83061|2022|PDM|14507.00|99|0.00|INTRACRANIAL EMBOLIZATION
20|FH_F84712_0_0|SrvcGrp|87963|2022|PDM|8842.00|99|0.00|GASTRIC SLEEVE
20|FH_F84712_0_0|SrvcGrp|87965|2022|PDM|10316.00|99|0.00|GASTRIC SLEEVE W/ HERINA REPAIR
20|FH_F84774_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F84774_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F84774_0_0|SrvcGrp|16325|2022|PDM|393.75|99|0.00|HEMODIALYSIS SVCS
20|FH_F84778_0_0|SrvcGrp|11000|2022|PCT|1.00|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F84778_0_0|SrvcGrp|72990|2022|PDM|1155.00|99|0.00|AEG 1
20|FH_F84778_0_0|SrvcGrp|72992|2022|PDM|1260.00|99|0.00|AEG 2
20|FH_F84778_0_0|SrvcGrp|72998|2022|PDM|1680.00|99|0.00|AEG 5
20|FH_F84778_0_0|SrvcGrp|73006|2022|PDM|2205.00|99|0.00|AEG 9
20|FH_F84855_0_0|CSTM-ALL|CSTM-00|2020|PDM|1799.00|99|0.00|COVENTRY ENHANCED GROUPER 6
20|FH_F84855_0_0|CSTM-ALL|CSTM-00|2020|PDM|2309.00|99|0.00|COVENTRY ENHANCED GROUPER 9
20|FH_F84894_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.00|99|0.00|GENERAL ACUTE CARE
20|FH_F84911_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|HOME HEALTH CARE
20|FH_F84912_0_0|SrvcGrp|13631|2022|PDM|67.67|99|0.00|CPT 99213
20|FH_F84912_0_0|SrvcGrp|3403|2022|PDM|100.23|99|0.00|CPT 99203
20|FH_F84912_0_0|SrvcGrp|3405|2022|PDM|39.92|99|0.00|CPT 99212
20|FH_F84912_0_0|SrvcGrp|3406|2022|PDM|105.97|99|0.00|CPT 99214
20|FH_F84994_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F85012_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F85012_0_0|SrvcGrp|17100|2022|PCT|0.00|99|0.00|SKILLED NURSING
20|FH_F85014_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F85039_0_0|SrvcGrp|75485|2022|PDM|693.00|99|0.00|AEG 4
20|FH_F85039_0_0|SrvcGrp|75487|2022|PDM|788.00|99|0.00|AEG 5
20|FH_F85039_0_0|SrvcGrp|75497|2022|PDM|366.00|99|0.00|AEG 10
20|FH_F85055_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F85055_0_0|SrvcGrp|72992|2022|PDM|600.00|99|0.00|AEG 2
20|FH_F85055_0_0|SrvcGrp|73000|2022|PDM|950.00|99|0.00|AEG 6
20|FH_F85055_0_0|SrvcGrp|73002|2022|PDM|1625.00|99|0.00|AEG 7
20|FH_F85055_0_0|SrvcGrp|73004|2022|PDM|1050.00|99|0.00|AEG 8
20|FH_F85055_0_0|SrvcGrp|73008|2022|PDM|525.00|99|0.00|AEG 10
20|FH_F85091_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F85132_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING
20|FH_F85132_0_0|CSTM-ALL|CSTM-00|2020|PCT|62.00|99|0.00|AETNA REHAB
20|FH_F85211_0_0|SrvcGrp|19921|2022|PDM|3465.00|99|0.00|ARTHROSCOPICALLY LIGAMENT REPAIR
20|FH_F85211_0_0|SrvcGrp|40002|2022|PDM|12100.00|99|0.00|TOTAL HIP
20|FH_F85211_0_0|SrvcGrp|72992|2022|PDM|611.60|99|0.00|AEG 2
20|FH_F85211_0_0|SrvcGrp|72998|2022|PDM|984.50|99|0.00|AEG 5
20|FH_F85211_0_0|SrvcGrp|73000|2022|PDM|1136.30|99|0.00|AEG 6
20|FH_F85211_0_0|SrvcGrp|83627|2022|PDM|4042.50|99|0.00|SPINE SURGERY
20|FH_F85211_0_0|SrvcGrp|84161|2022|PDM|2079.00|99|0.00|AETNA ARTHROSCOPY SVCS
20|FH_F85257_0_0|SrvcGrp|131|2022|PCT|0.55|99|0.00|PACEMAKER DEVICE
20|FH_F85257_0_0|SrvcGrp|220|2022|PCT|0.55|99|0.00|INTRAOCULAR LENSES
20|FH_F85257_0_0|SrvcGrp|83545|2022|PCT|0.55|99|0.00|NUCLEAR MEDICINE
20|FH_F85291_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F85291_0_0|SrvcGrp|472|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F85291_0_0|SrvcGrp|75545|2022|PDM|320.00|99|0.00|SUB-ACUTE - LEVEL I AND II
20|FH_F85295_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F85295_0_0|CSTM-ALL|CSTM-00|2020|PDM|1900.00|99|0.00|AEG 3 (NO REV)
20|FH_F85295_0_0|CSTM-ALL|CSTM-00|2020|PDM|1900.00|99|0.00|AEG 8 (NO REV)
20|FH_F85295_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|AEG 4 (NO REV)
20|FH_F85295_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|AEG 6 (NO REV)
20|FH_F85295_0_0|CSTM-ALL|CSTM-00|2020|PDM|2100.00|99|0.00|AEG 5  (NO REV)
20|FH_F85295_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F85295_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F85295_0_0|SrvcGrp|82138|2022|PDM|950.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F85314_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F85314_0_0|CSTM-ALL|CSTM-00|2020|PDM|409.00|99|0.00|AEG 1 (NO REV)
20|FH_F85314_0_0|SrvcGrp|24954|2022|PDM|409.00|99|0.00|SIGMOIDOSCOPY
20|FH_F85314_0_0|SrvcGrp|73610|2022|PCT|1.00|99|0.00|AETNA IMPLANTS
20|FH_F85393_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F85393_0_0|SrvcGrp|42974|2022|PDM|75.00|99|0.00|OCCUPATIONAL THERAPIST
20|FH_F85492_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F85492_0_0|SrvcGrp|22529|2022|PCT|0.00|99|0.00|DAY HOSPITAL HALF DAY
20|FH_F85492_0_0|SrvcGrp|84502|2022|PDM|1465.00|99|0.00|LEVEL 1 ADULT REHAB
20|FH_F85674_0_0|CSTM-ALL|CSTM-00|2020|PDM|110.01|99|0.00|AETNA SLEEP STUDIES
20|FH_F85674_0_0|CSTM-ALL|CSTM-00|2020|PDM|179.56|99|0.00|AETNA SLEEP STUDY CPT 95806
20|FH_F85674_0_0|CSTM-ALL|CSTM-00|2020|PDM|540.34|99|0.00|AETNA POLYSOMNOGRAPHY
20|FH_F85674_0_0|CSTM-ALL|CSTM-00|2020|PDM|633.74|99|0.00|AETNA SLEEP STUDY CPT 95810
20|FH_F85674_0_0|CSTM-ALL|CSTM-00|2020|PDM|78.56|99|0.00|AETNA SLEEP STUDY (MOD 26)
20|FH_F85713_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F85757_0_0|SrvcGrp|29155|2022|PDM|105.00|99|0.00|HOSPICE SVCS
20|FH_F85757_0_0|SrvcGrp|82223|2022|PDM|105.00|99|0.00|HOSPICE CARE
20|FH_F85772_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F85772_0_0|CSTM-ALL|CSTM-00|2020|PDM|1259.00|99|0.00|AEG 5  (NO REV)
20|FH_F85772_0_0|CSTM-ALL|CSTM-00|2020|PDM|1580.00|99|0.00|AEG 10 (NO REV)
20|FH_F85772_0_0|CSTM-ALL|CSTM-00|2020|PDM|2349.00|99|0.00|AEG 9 (NO REV)
20|FH_F85772_0_0|SrvcGrp|84181|2022|PDM|2214.00|99|0.00|AETNA IMMEDIATE BREAST PROSTHESIS
20|FH_F85772_0_0|SrvcGrp|84183|2022|PDM|1639.00|99|0.00|AETNA SURGERY OF BREAST CAPSULE
20|FH_F85911_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F85911_0_0|CSTM-ALL|CSTM-00|2020|PCT|9000.00|99|0.00|TIMELY FILING
20|FH_F86033_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS
20|FH_F86091_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|GENERAL ACUTE CARE
20|FH_F86098_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F86103_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F86103_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F86137_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F86252_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F86293_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F86293_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F86293_0_0|CSTM-ALL|CSTM-00|2020|PDM|664.00|99|0.00|AEG 1 (NO REV)
20|FH_F86293_0_0|SrvcGrp|26278|2022|PDM|2714.00|99|0.00|CPT 29881
20|FH_F86293_0_0|SrvcGrp|27402|2022|PDM|2888.00|99|0.00|LASER PROCEDURES
20|FH_F86293_0_0|SrvcGrp|33982|2022|PDM|2625.00|99|0.00|CPT 28296
20|FH_F86293_0_0|SrvcGrp|33984|2022|PDM|2048.00|99|0.00|HAMMERTOE CORRECTION
20|FH_F86294_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F86294_0_0|CSTM-ALL|CSTM-00|2020|PDM|1443.00|99|0.00|2006 MEDICARE ASPG VII
20|FH_F86294_0_0|CSTM-ALL|CSTM-00|2020|PDM|605.00|99|0.00|2006 MEDICARE ASPG II
20|FH_F86294_0_0|CSTM-ALL|CSTM-00|2020|PDM|825.00|99|0.00|2006 MEDICARE ASPG III
20|FH_F86315_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|COVENTRY ENHANCED GROUPER 5
20|FH_F86315_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|COVENTRY ENHANCED GROUPER 6
20|FH_F86315_0_0|SrvcGrp|28243|2022|PCT|0.50|99|0.00|SUPPLIES AND DEVICES
20|FH_F86375_0_0|SrvcGrp|47411|2022|PDM|105.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F86375_0_0|SrvcGrp|82222|2022|PDM|105.00|99|0.00|HOSPICE CARE
20|FH_F86377_0_0|SrvcGrp|57968|2022|PDM|28.73|99|0.00|CONTINUOUS HOMECARE
20|FH_F86377_0_0|SrvcGrp|76094|2022|PDM|118.16|99|0.00|HOSPICE ROUTINE HOME CARE
20|FH_F86394_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F86394_0_0|SrvcGrp|46482|2022|PDM|140.00|99|0.00|S9083 PER VISIT
20|FH_F86416_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE
20|FH_F86434_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|AEG 6 (NO REV)
20|FH_F86434_0_0|CSTM-ALL|CSTM-00|2020|PDM|1900.00|99|0.00|AEG 7 (NO REV)
20|FH_F86434_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 3 (NO REV)
20|FH_F86434_0_0|SrvcGrp|96104|2022|PDM|5000.00|99|0.00|IMPLANTABLE NEUROSTIMULATOR
20|FH_F86452_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F86452_0_0|CSTM-ALL|CSTM-00|2020|PDM|1101.00|99|0.00|2007 MEDICARE ASPG IV
20|FH_F86452_0_0|CSTM-ALL|CSTM-00|2020|PDM|1253.00|99|0.00|2007 MEDICARE ASPG V
20|FH_F86452_0_0|CSTM-ALL|CSTM-00|2020|PDM|1741.00|99|0.00|2007 MEDICARE ASPG VII
20|FH_F86452_0_0|SrvcGrp|15473|2022|PDM|1253.00|99|0.00|CPT CODE 42820
20|FH_F86551_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F86551_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F86552_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F86552_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F86552_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|AEG 10 (NO REV)
20|FH_F86552_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|AEG 6 (NO REV)
20|FH_F86552_0_0|CSTM-ALL|CSTM-00|2020|PDM|2400.00|99|0.00|AEG 8 (NO REV)
20|FH_F86552_0_0|SrvcGrp|35669|2022|PDM|6000.00|99|0.00|CPT 63650
20|FH_F86611_0_0|CSTM-ALL|CSTM-00|2020|PDM|197.00|99|0.00|OP SVCS
20|FH_F86655_0_0|CSTM-ALL|CSTM-00|2020|PDM|583.03|99|0.00|AEG 2 (NO REV)
20|FH_F86655_0_0|CSTM-ALL|CSTM-00|2020|PDM|824.05|99|0.00|AEG 4 (NO REV)
20|FH_F148720_0_0|SrvcGrp|90489|2022|PDM|115.00|99|0.00|PNEUMOCOCCAL VACCINE
20|FH_F148839_0_0|CSTM-ALL|CSTM-00|2020|PDM|1001.00|99|0.00|AEG 7 (NO REV)
20|FH_F148839_0_0|CSTM-ALL|CSTM-00|2020|PDM|449.00|99|0.00|AEG 2 (NO REV)
20|FH_F148859_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F148859_0_0|CSTM-ALL|CSTM-00|2020|PDM|788.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F148859_0_0|SrvcGrp|114930|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F148859_0_0|SrvcGrp|115537|2022|PDM|788.00|99|0.00|SUSPENSION OF TESTIS
20|FH_F148859_0_0|SrvcGrp|47529|2022|PDM|890.00|99|0.00|CYSTOURETHROSCOPY, WITH REMOVAL OF FOREIGN BODY
20|FH_F148860_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F148860_0_0|SrvcGrp|115169|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F148860_0_0|SrvcGrp|3932|2022|PDM|5900.00|99|0.00|LITHOTRIPSY
20|FH_F148865_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F148865_0_0|SrvcGrp|30609|2022|PDM|30.00|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F148865_0_0|SrvcGrp|80918|2022|PDM|140.00|99|0.00|RESPITE CARE
20|FH_F148883_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F148887_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F148892_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F148892_0_0|CSTM-ALL|CSTM-00|2020|PDM|1029.60|99|0.00|AEG 5  (NO REV)
20|FH_F148892_0_0|CSTM-ALL|CSTM-00|2020|PDM|1428.57|99|0.00|AEG 7 (NO REV)
20|FH_F148892_0_0|CSTM-ALL|CSTM-00|2020|PDM|1923.35|99|0.00|AEG 9 (NO REV)
20|FH_F148892_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F148892_0_0|SrvcGrp|13187|2022|PCT|0.00|99|0.00|INTRAOCULAR LENSES
20|FH_F148892_0_0|SrvcGrp|87679|2022|PDM|1293.00|99|0.00|LUMBAR OR SACRAL SURGERY
20|FH_F148892_0_0|SrvcGrp|92405|2022|PDM|2133.00|99|0.00|PERQ LUMBOSACRAL INJECTION
20|FH_F148892_0_0|SrvcGrp|92408|2022|PDM|4704.00|99|0.00|PERQ VERTEBRAL AUGMENTATION
20|FH_F148892_0_0|SrvcGrp|92409|2022|PDM|2133.00|99|0.00|PERQ CERVICOTHORACIC INJECT
20|FH_F148900_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F148900_0_0|CSTM-ALL|CSTM-00|2020|PDM|1428.57|99|0.00|AEG 7 (NO REV)
20|FH_F148900_0_0|CSTM-ALL|CSTM-00|2020|PDM|1923.35|99|0.00|AEG 9 (NO REV)
20|FH_F148900_0_0|CSTM-ALL|CSTM-00|2020|PDM|640.64|99|0.00|AEG 2 (NO REV)
20|FH_F148900_0_0|CSTM-ALL|CSTM-00|2020|PDM|732.16|99|0.00|AEG 3 (NO REV)
20|FH_F148900_0_0|SrvcGrp|103236|2022|PDM|19580.00|99|0.00|AETNA INSJ STABLJ DEV
20|FH_F148900_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F148900_0_0|SrvcGrp|110570|2022|PDM|668.00|99|0.00|NERVE BLOCK INJECTION 7
20|FH_F148900_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F148900_0_0|SrvcGrp|13187|2022|PCT|0.00|99|0.00|INTRAOCULAR LENSES
20|FH_F148900_0_0|SrvcGrp|87677|2022|PDM|1293.00|99|0.00|CERVICAL OR THORACIC SURGERY
20|FH_F148900_0_0|SrvcGrp|87679|2022|PDM|1293.00|99|0.00|LUMBAR OR SACRAL SURGERY
20|FH_F148900_0_0|SrvcGrp|90976|2022|PDM|668.00|99|0.00|INJECTION PARAVERTEBRAL FACET JOINT
20|FH_F148900_0_0|SrvcGrp|92405|2022|PDM|2133.00|99|0.00|PERQ LUMBOSACRAL INJECTION
20|FH_F148901_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.70|99|0.00|OP SVCS
20|FH_F148927_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F148927_0_0|CSTM-ALL|CSTM-00|2020|PDM|1494.00|99|0.00|AEG 3 (NO REV)
20|FH_F148927_0_0|CSTM-ALL|CSTM-00|2020|PDM|2300.00|99|0.00|AEG 6 (NO REV)
20|FH_F148927_0_0|CSTM-ALL|CSTM-00|2020|PDM|2575.00|99|0.00|AEG 7 (NO REV)
20|FH_F148927_0_0|SrvcGrp|16301|2022|PDM|6896.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F148981_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F148981_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING
20|FH_F149024_0_0|CSTM-ALL|CSTM-00|2020|PDM|1246.30|99|0.00|AEG 5  (NO REV)
20|FH_F149024_0_0|CSTM-ALL|CSTM-00|2020|PDM|2328.70|99|0.00|AEG 9 (NO REV)
20|FH_F149024_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F149028_0_0|SrvcGrp|82981|2022|PDM|158.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F149028_0_0|SrvcGrp|87077|2022|PDM|155.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F149029_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F149060_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.50|99|0.00|OP SVCS
20|FH_F149083_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F149085_0_0|SrvcGrp|22529|2022|PCT|0.00|99|0.00|DAY HOSPITAL HALF DAY
20|FH_F149085_0_0|SrvcGrp|79720|2022|PDM|1350.00|99|0.00|ACUTE REHAB II
20|FH_F149085_0_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE
20|FH_F149086_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F149086_0_0|SrvcGrp|83857|2022|PDM|675.00|99|0.00|IP HOSPICE SVCS
20|FH_F149119_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F149119_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F149120_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F149120_0_0|SrvcGrp|82981|2022|PDM|145.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F149179_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 10 (NO REV)
20|FH_F149179_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|AEG 3 (NO REV)
20|FH_F149179_0_0|CSTM-ALL|CSTM-00|2020|PDM|2600.00|99|0.00|AEG 6 (NO REV)
20|FH_F149179_0_0|CSTM-ALL|CSTM-00|2020|PDM|3121.00|99|0.00|AEG 9 (NO REV)
20|FH_F149179_0_0|CSTM-ALL|CSTM-00|2020|PDM|3200.00|99|0.00|AEG 7 (NO REV)
20|FH_F149179_0_0|CSTM-ALL|CSTM-00|2020|PDM|3200.00|99|0.00|AEG 8 (NO REV)
20|FH_F149179_0_0|SrvcGrp|107793|2022|PDM|9180.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE
20|FH_F149179_0_0|SrvcGrp|115606|2022|PDM|5098.00|99|0.00|REVISE CERV ARTIFIC DISC
20|FH_F149179_0_0|SrvcGrp|115607|2022|PDM|3519.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F149179_0_0|SrvcGrp|115608|2022|PDM|5100.00|99|0.00|REPAIR BICEPS TENDON RUPTURE
20|FH_F149179_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F149179_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F149179_0_0|SrvcGrp|27343|2022|PDM|3500.00|99|0.00|OP SURGERY (CPT 25607 - 25609)
20|FH_F149179_0_0|SrvcGrp|89404|2022|PDM|6800.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F149239_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F149239_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F149239_0_0|SrvcGrp|104745|2022|PDM|155.60|99|0.00|HOSPICE
20|FH_F149239_0_0|SrvcGrp|14494|2022|PDM|37.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F149239_0_0|SrvcGrp|92501|2022|PDM|162.59|99|0.00|HOSPICE IP RESPITE CARE
20|FH_F149239_0_0|SrvcGrp|92502|2022|PDM|683.95|99|0.00|HOSPICE GENERAL IP CARE
20|FH_F149240_0_0|SrvcGrp|83857|2022|PDM|622.00|99|0.00|IP HOSPICE SVCS
20|FH_F149242_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F149263_0_0|CSTM-ALL|CSTM-00|2020|PDM|2600.00|99|0.00|AEG 6 (NO REV)
20|FH_F149263_0_0|CSTM-ALL|CSTM-00|2020|PDM|2705.00|99|0.00|AEG 5  (NO REV)
20|FH_F149263_0_0|SrvcGrp|114930|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F149263_0_0|SrvcGrp|115605|2022|PDM|4900.00|99|0.00|NECK SPINE FUSE
20|FH_F149263_0_0|SrvcGrp|115610|2022|PDM|4488.00|99|0.00|VENTRAL HERN INIT REPAIR
20|FH_F149263_0_0|SrvcGrp|115614|2022|PDM|3900.00|99|0.00|LAMINOTOMY/LAMINECTOMY
20|FH_F149263_0_0|SrvcGrp|13990|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F149263_0_0|SrvcGrp|35670|2022|PDM|4058.00|99|0.00|SPINAL NEUROSTIMULATORS PROCEDURE
20|FH_F149263_0_0|SrvcGrp|75181|2022|PCT|1.00|99|0.00|AETNA IMPLANTS
20|FH_F149267_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F149267_0_0|CSTM-ALL|CSTM-00|2020|PDM|1573.00|99|0.00|AEG 3 (NO REV)
20|FH_F149267_0_0|CSTM-ALL|CSTM-00|2020|PDM|2217.00|99|0.00|AEG 4 (NO REV)
20|FH_F149267_0_0|CSTM-ALL|CSTM-00|2020|PDM|2587.00|99|0.00|AEG 10 (NO REV)
20|FH_F149267_0_0|CSTM-ALL|CSTM-00|2020|PDM|3946.00|99|0.00|AEG 9 (NO REV)
20|FH_F149267_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F149271_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F149273_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F149273_0_0|CSTM-ALL|CSTM-00|2020|PDM|1530.00|99|0.00|AEG 1 (NO REV)
20|FH_F149273_0_0|CSTM-ALL|CSTM-00|2020|PDM|2705.00|99|0.00|AEG 5  (NO REV)
20|FH_F149273_0_0|CSTM-ALL|CSTM-00|2020|PDM|3329.00|99|0.00|AEG 8 (NO REV)
20|FH_F149273_0_0|SrvcGrp|115605|2022|PDM|4998.00|99|0.00|NECK SPINE FUSE
20|FH_F149273_0_0|SrvcGrp|115611|2022|PDM|7140.00|99|0.00|CATH DIALYSIS CIRCUIT
20|FH_F149273_0_0|SrvcGrp|13990|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F149273_0_0|SrvcGrp|75181|2022|PCT|1.00|99|0.00|AETNA IMPLANTS
20|FH_F149344_0_0|SrvcGrp|13422|2022|PDM|188.89|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC
20|FH_F149344_0_0|SrvcGrp|13595|2022|PDM|198.55|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC
20|FH_F149344_0_0|SrvcGrp|13681|2022|PDM|172.33|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT
20|FH_F149344_0_0|SrvcGrp|13683|2022|PDM|594.21|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2
20|FH_F149373_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F149373_0_0|CSTM-ALL|CSTM-00|2020|PDM|1392.00|99|0.00|RESIDENT TRTMNT-EATING DISORDERS
20|FH_F149373_0_0|SrvcGrp|114008|2022|PDM|439.00|99|0.00|PARTIAL HOSPITAL PSYCHIATRIC
20|FH_F149373_0_0|SrvcGrp|98701|2022|PDM|384.00|99|0.00|AETNA OP EATING DISORDERS
20|FH_F149401_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F149404_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F149404_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|HSS ASC
20|FH_F149439_0_0|SrvcGrp|11442|2022|PDM|980.00|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)
20|FH_F149439_0_0|SrvcGrp|13722|2022|PDM|190.00|99|0.00|HOSPICE SERVICE - ROUTINE HOME CARE
20|FH_F149439_0_0|SrvcGrp|80098|2022|PDM|56.00|99|0.00|AETNA HOSPICE CONTINUOUS HOME CARE
20|FH_F149442_0_0|SrvcGrp|111927|2022|PDM|95.00|99|0.00|COVID-19 NON CDC
20|FH_F149442_0_0|SrvcGrp|111928|2022|PDM|95.00|99|0.00|COVID-19 BARTONELLA
20|FH_F149442_0_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB
20|FH_F149513_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F149517_0_0|SrvcGrp|65720|2022|PDM|194.00|99|0.00|RESPITE CARE
20|FH_F149517_0_0|SrvcGrp|90707|2022|PDM|194.00|99|0.00|AETNA HOSPICE CARE
20|FH_F149517_0_0|SrvcGrp|93098|2022|PDM|194.00|99|0.00|HOSPICE CARE
20|FH_F149517_0_0|SrvcGrp|95661|2022|PDM|692.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F149523_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F149523_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.50|99|0.00|HSS ASC
20|FH_F149523_0_0|SrvcGrp|114171|2022|PDM|1250.00|99|0.00|STENT PACEMT ANTE COROTID
20|FH_F149523_0_0|SrvcGrp|114172|2022|PDM|3000.00|99|0.00|SPINE FIXATION
20|FH_F149523_0_0|SrvcGrp|40003|2022|PDM|15000.00|99|0.00|TOTAL KNEE
20|FH_F149523_0_0|SrvcGrp|96350|2022|PDM|15000.00|99|0.00|SHOULDER JOINT
20|FH_F149523_0_0|SrvcGrp|96353|2022|PDM|16400.00|99|0.00|RECONSTRUCT ANKLE JOINT
20|FH_F149523_0_0|SrvcGrp|96899|2022|PDM|15000.00|99|0.00|LUMBAR ARTIF DISCECTOMY
20|FH_F149528_0_0|SrvcGrp|108484|2022|PDM|730.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY
20|FH_F149528_0_0|SrvcGrp|90854|2022|PDM|1150.00|99|0.00|AETNA IP DETOXIFICATION SERVICES
20|FH_F149543_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F149581_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F149581_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F149603_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.25|99|0.00|OP SVCS
20|FH_F149660_0_0|SrvcGrp|107193|2022|PDM|6.50|99|0.00|PATIENT ATTENDANT/ESCORT
20|FH_F149660_0_0|SrvcGrp|115764|2022|PDM|2.79|99|0.00|NON-EMERGENCY TRANSPORTATION STRETCHER VAN
20|FH_F149660_0_0|SrvcGrp|13597|2022|PDM|208.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT
20|FH_F149660_0_0|SrvcGrp|13683|2022|PDM|595.00|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2
20|FH_F149661_0_0|SrvcGrp|11606|2022|PDM|800.00|99|0.00|ACUTE CARE (MEDICAL & SURGICAL)
20|FH_F149679_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F149679_0_0|SrvcGrp|106300|2022|PDM|172.33|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT (HCFA)
20|FH_F149679_0_0|SrvcGrp|13597|2022|PDM|166.11|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT
20|FH_F149679_0_0|SrvcGrp|84284|2022|PDM|248.94|99|0.00|AMBULANCE SVC NEONATAL EMERG TRANSPORT
20|FH_F149699_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F149699_0_0|SrvcGrp|3327|2022|PDM|475.00|99|0.00|HOSPICE SERVICE - IP RESPITE
20|FH_F149699_0_0|SrvcGrp|80098|2022|PDM|58.00|99|0.00|AETNA HOSPICE CONTINUOUS HOME CARE
20|FH_F149701_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F149701_0_0|SrvcGrp|16|2022|PDM|900.00|99|0.00|ACUTE REHABILITATION
20|FH_F149701_0_0|SrvcGrp|87537|2022|PCT|0.00|99|0.00|MED REHAB DAY PROGRAM (FULL)
20|FH_F149719_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F149719_0_0|SrvcGrp|107748|2022|PDM|550.00|99|0.00|HEMODIALYSIS IN CENTER
20|FH_F149779_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|AEG 3 (NO REV)
20|FH_F149779_0_0|CSTM-ALL|CSTM-00|2020|PDM|2716.00|99|0.00|AEG 4 (NO REV)
20|FH_F149779_0_0|CSTM-ALL|CSTM-00|2020|PDM|3126.00|99|0.00|AEG 8 (NO REV)
20|FH_F149779_0_0|SrvcGrp|115169|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F149779_0_0|SrvcGrp|14188|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F149868_0_0|SrvcGrp|80317|2022|PDM|705.00|99|0.00|RESPITE CARE
20|FH_F149868_0_0|SrvcGrp|93099|2022|PDM|692.00|99|0.00|HOSPICE CARE PROVIDED IN INPATIENT HOSPICE FACILITY
20|FH_F149882_0_0|SrvcGrp|82981|2022|PDM|90.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F149899_0_0|CSTM-ALL|CSTM-00|2020|PDM|720.00|99|0.00|AEG 2 (NO REV)
20|FH_F149899_0_0|SrvcGrp|109199|2022|PDM|950.00|99|0.00|GI ENDOSCOPY/COLONOSCOPY
20|FH_F149959_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F149980_0_0|CSTM-ALL|CSTM-00|2020|PDM|1273.00|99|0.00|AEG 5  (NO REV)
20|FH_F149980_0_0|CSTM-ALL|CSTM-00|2020|PDM|1809.00|99|0.00|AEG 8 (NO REV)
20|FH_F149980_0_0|SrvcGrp|104719|2022|PDM|1921.00|99|0.00|RELIEVE INNER EYE PRESSURE
20|FH_F149980_0_0|SrvcGrp|115792|2022|PDM|1921.00|99|0.00|INCISION OF EYE
20|FH_F150025_0_0|SrvcGrp|30609|2022|PDM|25.00|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F150025_0_0|SrvcGrp|63297|2022|PDM|100.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F150060_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F150060_0_0|SrvcGrp|46903|2022|PDM|800.00|99|0.00|RESIDENTIAL TREATMENT
20|FH_F150102_0_0|CSTM-ALL|CSTM-00|2020|PDM|2167.00|99|0.00|AEG 3 (NO REV)
20|FH_F150102_0_0|CSTM-ALL|CSTM-00|2020|PDM|2343.00|99|0.00|AEG 4 (NO REV)
20|FH_F150164_0_0|SrvcGrp|90707|2022|PDM|100.00|99|0.00|AETNA HOSPICE CARE
20|FH_F150200_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F150200_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F150200_0_0|CSTM-ALL|CSTM-00|2020|PDM|1.00|99|0.00|AEG 7 (NO REV)
20|FH_F150200_0_0|CSTM-ALL|CSTM-00|2020|PDM|1.02|99|0.00|AEG 8 (NO REV)
20|FH_F150200_0_0|CSTM-ALL|CSTM-00|2020|PDM|1380.00|99|0.00|AEG 3 (NO REV)
20|FH_F150200_0_0|SrvcGrp|115762|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F150200_0_0|SrvcGrp|35669|2022|PDM|4590.00|99|0.00|CPT 63650
20|FH_F150200_0_0|SrvcGrp|67068|2022|PDM|10000.00|99|0.00|LUMBAR SPINE FUSION COMBINED
20|FH_F150200_0_0|SrvcGrp|88065|2022|PDM|10000.00|99|0.00|TOTAL DISC ARTHROPLASTY
20|FH_F150200_0_0|SrvcGrp|88163|2022|PDM|9690.00|99|0.00|LUMBAR SPINE FUSION
20|FH_F150220_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F150220_0_0|CSTM-ALL|CSTM-00|2020|PDM|1003.00|99|0.00|AEG 1 (NO REV)
20|FH_F150220_0_0|CSTM-ALL|CSTM-00|2020|PDM|2968.00|99|0.00|AEG 8 (NO REV)
20|FH_F150220_0_0|CSTM-ALL|CSTM-00|2020|PDM|4111.00|99|0.00|AEG 9 (NO REV)
20|FH_F150224_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F150224_0_0|SrvcGrp|92502|2022|PDM|650.00|99|0.00|HOSPICE GENERAL IP CARE
20|FH_F150226_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F150226_0_0|SrvcGrp|13422|2022|PDM|188.89|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC
20|FH_F150226_0_0|SrvcGrp|13681|2022|PDM|172.33|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT
20|FH_F150226_0_0|SrvcGrp|13683|2022|PDM|594.21|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2
20|FH_F150226_0_0|SrvcGrp|84284|2022|PDM|248.94|99|0.00|AMBULANCE SVC NEONATAL EMERG TRANSPORT
20|FH_F150280_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F150280_0_0|SrvcGrp|87536|2022|PDM|437.00|99|0.00|MED REHAB DAY PROGRAM (HALF)
20|FH_F150314_0_0|SrvcGrp|108484|2022|PDM|600.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY
20|FH_F150520_0_0|CSTM-ALL|CSTM-00|2020|PDM|536.00|99|0.00|AEG 1 (NO REV)
20|FH_F150520_0_0|CSTM-ALL|CSTM-00|2020|PDM|543.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F150521_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F150536_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F150599_0_0|CSTM-ALL|CSTM-00|2020|PDM|667.00|99|0.00|AEG 2 (NO REV)
20|FH_F150619_0_0|SrvcGrp|114926|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES
20|FH_F150663_0_0|SrvcGrp|75419|2022|PDM|464.00|99|0.00|OP PARTIAL HOSPITALIZATION
20|FH_F150699_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F150699_0_0|SrvcGrp|104009|2022|PDM|9450.00|99|0.00|REMOVE AND REPLACE PM GEN SINGL
20|FH_F150699_0_0|SrvcGrp|109505|2022|PDM|22004.00|99|0.00|REMV & REPLC PM GEN MULT LEADS
20|FH_F150699_0_0|SrvcGrp|109508|2022|PDM|9639.00|99|0.00|REMOVAL OF PM GENERATOR
20|FH_F150699_0_0|SrvcGrp|92407|2022|PDM|28897.00|99|0.00|REMOVAL & REPLACE PULSE GEN 2 LEAD
20|FH_F150699_0_0|SrvcGrp|96380|2022|PDM|38826.00|99|0.00|AETNA INS/REP SUBQ DEFIBRILLATOR
20|FH_F150759_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F150759_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 1 (NO REV)
20|FH_F150759_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|AEG 4 (NO REV)
20|FH_F150759_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|AEG 6 (NO REV)
20|FH_F150763_0_0|CSTM-ALL|CSTM-00|2020|PDM|1682.00|99|0.00|AEG 2 (NO REV)
20|FH_F150763_0_0|SrvcGrp|11000|2022|PCT|1.00|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F150763_0_0|SrvcGrp|114925|2022|PDM|3698.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F150781_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F150906_0_0|SrvcGrp|115867|2022|PDM|161.00|99|0.00|HOSPICE  HOME CARE
20|FH_F150910_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.11|99|0.00|OP SVCS
20|FH_F150910_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F150910_0_0|SrvcGrp|108094|2022|PDM|10950.00|99|0.00|REVISE KNEE
20|FH_F150910_0_0|SrvcGrp|113851|2022|PDM|10500.00|99|0.00|ARTHRDSIS LAT MINI DISKECT
20|FH_F150910_0_0|SrvcGrp|113852|2022|PDM|1125.00|99|0.00|STENT PACEMT ANTE COROTID
20|FH_F150910_0_0|SrvcGrp|113857|2022|PDM|6000.00|99|0.00|SPINE PROCEDURES
20|FH_F150910_0_0|SrvcGrp|88157|2022|PDM|10950.00|99|0.00|TOTAL HIP ARTHROPLASTY
20|FH_F150910_0_0|SrvcGrp|93063|2022|PDM|10500.00|99|0.00|LUMBAR ARTIF DISKECTOMY
20|FH_F150910_0_0|SrvcGrp|93065|2022|PDM|9000.00|99|0.00|LUMB ARTIF DISKECTOMY ADDL
20|FH_F150936_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F150939_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F150939_0_0|SrvcGrp|100239|2022|PCT|0.00|99|0.00|GLUCOSE
20|FH_F150939_0_0|SrvcGrp|100241|2022|PCT|0.00|99|0.00|IMMUNOLOGY
20|FH_F150939_0_0|SrvcGrp|100247|2022|PDM|24.30|99|0.00|NASAL FLU VACCINE
20|FH_F150939_0_0|SrvcGrp|100249|2022|PDM|12.00|99|0.00|REMOVAL OF SKIN TAGS
20|FH_F150939_0_0|SrvcGrp|100252|2022|PDM|54.00|99|0.00|REPAIR SUPERFICIAL WOUND(S) (7.6 - 12.5 CM)
20|FH_F150939_0_0|SrvcGrp|100256|2022|PDM|45.00|99|0.00|REPAIR SUPERFICIAL WOUND(S) (2.6 - 5.0 CM)
20|FH_F150939_0_0|SrvcGrp|100258|2022|PDM|98.00|99|0.00|REPAIR SUPERFICIAL WOUND(S) (12.6 - 20.0 CM)
20|FH_F150939_0_0|SrvcGrp|100261|2022|PDM|135.00|99|0.00|TREAT WOUND DEHISCENCE
20|FH_F150939_0_0|SrvcGrp|100262|2022|PDM|100.00|99|0.00|TREAT DEHISCENCE W/ PACKING
20|FH_F150939_0_0|SrvcGrp|100263|2022|PDM|59.00|99|0.00|DESTRUCT LESION, 15 OR MORE
20|FH_F150939_0_0|SrvcGrp|100267|2022|PDM|6.50|99|0.00|URINE BACTERIA CULTURE
20|FH_F150939_0_0|SrvcGrp|100270|2022|PDM|16.30|99|0.00|IIV3 VACC NO PRSV 0.25 ML IM
20|FH_F150939_0_0|SrvcGrp|100272|2022|PDM|9.50|99|0.00|IIV3 VACCINE SPLT 0.25 ML IM
20|FH_F150939_0_0|SrvcGrp|100273|2022|PDM|62.50|99|0.00|MEASLES MUMPS&RUBELLA VAC LI
20|FH_F150939_0_0|SrvcGrp|100276|2022|PDM|121.00|99|0.00|MCV4 MENACWY VACCINE IM
20|FH_F150939_0_0|SrvcGrp|101743|2022|PDM|10.00|99|0.00|IM ADMIN 1ST/ONLY COMPONENT
20|FH_F150939_0_0|SrvcGrp|109210|2022|PDM|28.37|99|0.00|CCIIV4 VACC ABX FREE IM
20|FH_F150939_0_0|SrvcGrp|110158|2022|PDM|72.61|99|0.00|INCISION
20|FH_F150939_0_0|SrvcGrp|110583|2022|PDM|32.91|99|0.00|REMOVAL PROCEDURES ON EYE
20|FH_F150939_0_0|SrvcGrp|111061|2022|PDM|65.26|99|0.00|TOXOIDS VACCINES
20|FH_F150939_0_0|SrvcGrp|112229|2022|PDM|26.88|99|0.00|LAIV4 VACINE INTRANASAL
20|FH_F150939_0_0|SrvcGrp|25385|2022|PDM|80.00|99|0.00|CPT 10060
20|FH_F150939_0_0|SrvcGrp|36668|2022|PDM|188.00|99|0.00|ZOSTER (SHINGLES VACCINE)
20|FH_F150939_0_0|SrvcGrp|82745|2022|PDM|7.00|99|0.00|CULT BACT NO URINE/BLD/STOOL
20|FH_F150939_0_0|SrvcGrp|82757|2022|PDM|4.00|99|0.00|ASSAY BLOOD CREATININE
20|FH_F150939_0_0|SrvcGrp|85260|2022|PCT|0.00|99|0.00|INITIAL EVALUATION
20|FH_F150939_0_0|SrvcGrp|95103|2022|PDM|48.00|99|0.00|LASER SURGERY
20|FH_F150948_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.43|99|0.00|HSS ASC
20|FH_F150948_0_0|SrvcGrp|108094|2022|PDM|10950.00|99|0.00|REVISE KNEE
20|FH_F150948_0_0|SrvcGrp|113855|2022|PDM|3000.00|99|0.00|SPINE FIXATION
20|FH_F150948_0_0|SrvcGrp|113856|2022|PDM|10000.00|99|0.00|SPINE PROCEDURES
20|FH_F150948_0_0|SrvcGrp|113857|2022|PDM|6000.00|99|0.00|SPINE PROCEDURES
20|FH_F150948_0_0|SrvcGrp|80617|2022|PDM|10500.00|99|0.00|ARTHOPLASTY
20|FH_F150949_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F150949_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.40|99|0.00|HSS ASC
20|FH_F150949_0_0|SrvcGrp|108094|2022|PDM|10950.00|99|0.00|REVISE KNEE
20|FH_F150949_0_0|SrvcGrp|113852|2022|PDM|1125.00|99|0.00|STENT PACEMT ANTE COROTID
20|FH_F150949_0_0|SrvcGrp|80617|2022|PDM|10500.00|99|0.00|ARTHOPLASTY
20|FH_F150949_0_0|SrvcGrp|88157|2022|PDM|10950.00|99|0.00|TOTAL HIP ARTHROPLASTY
20|FH_F150949_0_0|SrvcGrp|93063|2022|PDM|10500.00|99|0.00|LUMBAR ARTIF DISKECTOMY
20|FH_F150951_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F150951_0_0|SrvcGrp|29155|2022|PDM|100.00|99|0.00|HOSPICE SVCS
20|FH_F150951_0_0|SrvcGrp|84185|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F150959_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F150959_0_0|CSTM-ALL|CSTM-00|2020|PDM|1612.60|99|0.00|AEG 8 (NO REV)
20|FH_F150980_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F150980_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|OP SVCS
20|FH_F150980_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F150982_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F150982_0_0|CSTM-ALL|CSTM-00|2020|PDM|1486.00|99|0.00|AEG 5  (NO REV)
20|FH_F150982_0_0|SrvcGrp|100067|2022|PDM|3854.00|99|0.00|ANKLE ARTHROSCOPY SURGERY
20|FH_F150982_0_0|SrvcGrp|100919|2022|PDM|3303.00|99|0.00|SPINE PROSTH DEVICE
20|FH_F150982_0_0|SrvcGrp|100921|2022|PDM|3303.00|99|0.00|SPI  PROSTH DEVICE
20|FH_F150982_0_0|SrvcGrp|101519|2022|PDM|2527.00|99|0.00|T1H UTERUS (<250G)
20|FH_F150982_0_0|SrvcGrp|102481|2022|PDM|3854.00|99|0.00|CPT 29898
20|FH_F150982_0_0|SrvcGrp|104112|2022|PDM|5200.00|99|0.00|REPAIR OF ANKLE FRACTURE
20|FH_F150982_0_0|SrvcGrp|104258|2022|PDM|1382.00|99|0.00|SKIN TISSUE REARRANGEMENT
20|FH_F150982_0_0|SrvcGrp|104555|2022|PDM|2211.00|99|0.00|HYSTEROSCOPY REMOVE FB
20|FH_F150982_0_0|SrvcGrp|105286|2022|PDM|4235.00|99|0.00|LAP VENT/ABD HERN PROC COMP
20|FH_F150982_0_0|SrvcGrp|107868|2022|PDM|3664.00|99|0.00|AETNA LAPAROSCOPY SURGICAL
20|FH_F150982_0_0|SrvcGrp|110096|2022|PDM|2759.00|99|0.00|LAPAROSCOPY SURGICAL COLPOPE
20|FH_F150982_0_0|SrvcGrp|110676|2022|PDM|2527.00|99|0.00|LAPAROSCOPIC TREAT OF ECTOP
20|FH_F150982_0_0|SrvcGrp|111802|2022|PDM|1322.00|99|0.00|REVISION OF PENIS
20|FH_F150982_0_0|SrvcGrp|114924|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F150982_0_0|SrvcGrp|116048|2022|PDM|4451.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F150982_0_0|SrvcGrp|11673|2022|PDM|3854.00|99|0.00|CPT 29888
20|FH_F150982_0_0|SrvcGrp|26273|2022|PDM|2202.00|99|0.00|CPT 29880
20|FH_F150982_0_0|SrvcGrp|26275|2022|PDM|3303.00|99|0.00|CPT 29826
20|FH_F150982_0_0|SrvcGrp|27344|2022|PDM|2753.00|99|0.00|OP SURGERY (CPT 42821)
20|FH_F150982_0_0|SrvcGrp|27347|2022|PDM|3303.00|99|0.00|CPT 58558
20|FH_F150982_0_0|SrvcGrp|33724|2022|PDM|2202.00|99|0.00|ARTHROSCOPY
20|FH_F111163_0_0|CSTM-ALL|CSTM-00|2020|PDM|1110.00|99|0.00|AEG 7 (NO REV)
20|FH_F111163_0_0|CSTM-ALL|CSTM-00|2020|PDM|683.00|99|0.00|AEG 3 (NO REV)
20|FH_F111163_0_0|SrvcGrp|35669|2022|PDM|6375.00|99|0.00|CPT 63650
20|FH_F111163_0_0|SrvcGrp|84912|2022|PDM|4200.00|99|0.00|PERQ VERTEBRAL AUGMENTATION
20|FH_F111180_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F111207_0_0|SrvcGrp|104337|2022|PCT|0.70|99|0.00|DIALYSIS
20|FH_F111207_0_0|SrvcGrp|25695|2022|PDM|1300.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F111207_0_0|SrvcGrp|47260|2022|PCT|0.70|99|0.00|IMPLANTS 274-276, 278  LINE LEVEL
20|FH_F111260_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F111260_0_0|SrvcGrp|87077|2022|PDM|175.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F111269_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F111282_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F111288_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.72|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F111288_0_0|SrvcGrp|106265|2022|PDM|4199.00|99|0.00|NSL/SINS NDSC TOTAL
20|FH_F111288_0_0|SrvcGrp|109003|2022|PCT|0.40|99|0.00|LAPAROSCOPE PROC, STOM
20|FH_F111288_0_0|SrvcGrp|113481|2022|PDM|8670.00|99|0.00|LAPAROSCOPY
20|FH_F111288_0_0|SrvcGrp|11673|2022|PDM|8312.00|99|0.00|CPT 29888
20|FH_F111288_0_0|SrvcGrp|26273|2022|PDM|3569.00|99|0.00|CPT 29880
20|FH_F111288_0_0|SrvcGrp|26278|2022|PDM|2849.00|99|0.00|CPT 29881
20|FH_F111288_0_0|SrvcGrp|33967|2022|PDM|8670.00|99|0.00|CPT 47562
20|FH_F111288_0_0|SrvcGrp|35668|2022|PDM|4565.00|99|0.00|CPT 29824
20|FH_F111288_0_0|SrvcGrp|67064|2022|PDM|862.00|99|0.00|MUSCULOSKELETAL SYSTEM
20|FH_F111288_0_0|SrvcGrp|67066|2022|PDM|6144.00|99|0.00|CERVICAL SURGERY
20|FH_F111288_0_0|SrvcGrp|84318|2022|PDM|1551.00|99|0.00|SPINE INFUSION
20|FH_F111288_0_0|SrvcGrp|85778|2022|PDM|7676.00|99|0.00|REPAIR OF ANKLE FRACTURE
20|FH_F111288_0_0|SrvcGrp|92366|2022|PDM|6016.00|99|0.00|REPAIR ACHILLES TENDON
20|FH_F111316_0_0|SrvcGrp|73842|2022|PDM|200.00|99|0.00|AETNA INTENSIVE OUTPATIENT
20|FH_F111316_0_0|SrvcGrp|86722|2022|PDM|200.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)
20|FH_F111316_0_0|SrvcGrp|89149|2022|PDM|200.00|99|0.00|OP INTENSIVE
20|FH_F111320_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 3 (NO REV)
20|FH_F111320_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 4 (NO REV)
20|FH_F111320_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|AEG 6 (NO REV)
20|FH_F111320_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|AEG 7 (NO REV)
20|FH_F111320_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|AEG 1 (NO REV)
20|FH_F111320_0_0|SrvcGrp|90369|2022|PDM|1000.00|99|0.00|PROBE NASOLACRIMAL DUCT
20|FH_F111349_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F111349_0_0|SrvcGrp|73482|2022|PDM|934.00|99|0.00|AETNA SUBACUTE IV
20|FH_F111500_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F111593_0_0|SrvcGrp|11663|2022|PCT|0.00|99|0.00|IMPLANTS
20|FH_F111593_0_0|SrvcGrp|72992|2022|PDM|1980.00|99|0.00|AEG 2
20|FH_F111593_0_0|SrvcGrp|72996|2022|PDM|1562.00|99|0.00|AEG 4
20|FH_F111593_0_0|SrvcGrp|72998|2022|PDM|1760.00|99|0.00|AEG 5
20|FH_F111593_0_0|SrvcGrp|73002|2022|PDM|2404.60|99|0.00|AEG 7
20|FH_F111593_0_0|SrvcGrp|73008|2022|PDM|3135.00|99|0.00|AEG 10
20|FH_F111593_0_0|SrvcGrp|77449|2022|PDM|2915.00|99|0.00|CPT 52352
20|FH_F111593_0_0|SrvcGrp|77461|2022|PDM|4372.50|99|0.00|CPT 52356
20|FH_F111593_0_0|SrvcGrp|86583|2022|PCT|0.00|99|0.00|AETNA LITHOTRIPSY ESWL INCIDENTAL CODES
20|FH_F111593_0_0|SrvcGrp|87026|2022|PDM|1870.00|99|0.00|CYSTOSCOPY AND TREATMENT
20|FH_F111593_0_0|SrvcGrp|87055|2022|PDM|3245.00|99|0.00|CYSTOURETHROSCOPY W/STENT INSERTION
20|FH_F111594_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F111594_0_0|CSTM-ALL|CSTM-00|2020|PDM|2133.00|99|0.00|AEG 4 (NO REV)
20|FH_F111594_0_0|CSTM-ALL|CSTM-00|2020|PDM|2409.00|99|0.00|AEG 7 (NO REV)
20|FH_F111594_0_0|CSTM-ALL|CSTM-00|2020|PDM|2887.00|99|0.00|AEG 9 (NO REV)
20|FH_F111594_0_0|SrvcGrp|11000|2022|PCT|1.00|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F111594_0_0|SrvcGrp|27261|2022|PDM|8661.00|99|0.00|CPT 27446
20|FH_F111594_0_0|SrvcGrp|35669|2022|PDM|4812.00|99|0.00|CPT 63650
20|FH_F111594_0_0|SrvcGrp|35670|2022|PDM|7699.00|99|0.00|SPINAL NEUROSTIMULATORS PROCEDURE
20|FH_F111594_0_0|SrvcGrp|58993|2022|PDM|7215.00|99|0.00|DISKECTOMY
20|FH_F111594_0_0|SrvcGrp|67068|2022|PDM|7699.00|99|0.00|LUMBAR SPINE FUSION COMBINED
20|FH_F111594_0_0|SrvcGrp|71666|2022|PDM|6737.00|99|0.00|CPT 63655
20|FH_F111594_0_0|SrvcGrp|88157|2022|PDM|7215.00|99|0.00|TOTAL HIP ARTHROPLASTY
20|FH_F111594_0_0|SrvcGrp|88158|2022|PDM|7215.00|99|0.00|NECK SPINE DISK SURGERY
20|FH_F111594_0_0|SrvcGrp|88159|2022|PDM|7215.00|99|0.00|LOW BACK DISK SURGERY
20|FH_F111594_0_0|SrvcGrp|98495|2022|PDM|7699.00|99|0.00|ARTHRODESIS POSTERIOR TECH
20|FH_F111594_0_0|SrvcGrp|98498|2022|PDM|7215.00|99|0.00|TRANSPEDICULAR 1 SEG THORACIC
20|FH_F111625_0_0|SrvcGrp|73485|2022|PDM|850.00|99|0.00|AETNA REHAB
20|FH_F111625_0_0|SrvcGrp|79720|2022|PDM|965.00|99|0.00|ACUTE REHAB II
20|FH_F111661_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F111661_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 2 (NO REV)
20|FH_F111826_0_0|SrvcGrp|72990|2022|PDM|880.00|99|0.00|AEG 1
20|FH_F111826_0_0|SrvcGrp|72998|2022|PDM|1100.00|99|0.00|AEG 5
20|FH_F111826_0_0|SrvcGrp|73004|2022|PDM|1540.00|99|0.00|AEG 8
20|FH_F111835_0_0|CSTM-ALL|CSTM-00|2020|PDM|1138.65|99|0.00|ASPG V
20|FH_F111835_0_0|CSTM-ALL|CSTM-00|2020|PDM|1311.75|99|0.00|ASPG VI
20|FH_F111835_0_0|CSTM-ALL|CSTM-00|2020|PDM|528.83|99|0.00|ASPG I
20|FH_F111840_0_0|SrvcGrp|75491|2022|PDM|995.00|99|0.00|AEG 7
20|FH_F111840_0_0|SrvcGrp|75497|2022|PDM|630.00|99|0.00|AEG 10
20|FH_F111840_0_0|SrvcGrp|93121|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F111862_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F111885_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F111885_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F111885_0_0|CSTM-ALL|CSTM-00|2020|PDM|1144.00|99|0.00|AEG 1 (NO REV)
20|FH_F150982_0_0|SrvcGrp|33984|2022|PDM|1976.00|99|0.00|HAMMERTOE CORRECTION
20|FH_F150982_0_0|SrvcGrp|34606|2022|PDM|3303.00|99|0.00|CPT 29827
20|FH_F150982_0_0|SrvcGrp|35667|2022|PDM|1802.00|99|0.00|CPT 20680
20|FH_F150982_0_0|SrvcGrp|37317|2022|PDM|6386.00|99|0.00|LITHOTRIPSY
20|FH_F150982_0_0|SrvcGrp|38909|2022|PDM|2392.00|99|0.00|CPT 67036 - VITRECTOMY, MECHANICAL
20|FH_F150982_0_0|SrvcGrp|41334|2022|PDM|22021.00|99|0.00|TOTAL KNEE
20|FH_F150982_0_0|SrvcGrp|46887|2022|PDM|2392.00|99|0.00|REPAIR DETACHED RETINA
20|FH_F150982_0_0|SrvcGrp|54943|2022|PDM|3303.00|99|0.00|REPAIR OF SLAP LESION
20|FH_F150982_0_0|SrvcGrp|55071|2022|PDM|3303.00|99|0.00|ARTHROSCOPY SHOULDER
20|FH_F150982_0_0|SrvcGrp|58671|2022|PDM|1101.00|99|0.00|ASC CARVE OUT 64721
20|FH_F150982_0_0|SrvcGrp|63460|2022|PDM|2753.00|99|0.00|CPT 55040
20|FH_F150982_0_0|SrvcGrp|63466|2022|PDM|1652.00|99|0.00|CPT 52005
20|FH_F150982_0_0|SrvcGrp|63471|2022|PDM|8320.00|99|0.00|CPT 64590
20|FH_F150982_0_0|SrvcGrp|67065|2022|PDM|13213.00|99|0.00|CERVICAL SURGERY
20|FH_F150982_0_0|SrvcGrp|67066|2022|PDM|8368.00|99|0.00|CERVICAL SURGERY
20|FH_F150982_0_0|SrvcGrp|67279|2022|PDM|8258.00|99|0.00|CERVICAL SURGERY
20|FH_F150982_0_0|SrvcGrp|68000|2022|PDM|4625.00|99|0.00|CPT 58561
20|FH_F150982_0_0|SrvcGrp|68543|2022|PDM|2202.00|99|0.00|CPT 36561
20|FH_F150982_0_0|SrvcGrp|69502|2022|PDM|1382.00|99|0.00|CPT 54150
20|FH_F150982_0_0|SrvcGrp|74039|2022|PDM|6607.00|99|0.00|LAMINECTOMY
20|FH_F150982_0_0|SrvcGrp|77449|2022|PDM|3028.00|99|0.00|CPT 52352
20|FH_F150982_0_0|SrvcGrp|77461|2022|PDM|3176.00|99|0.00|CPT 52356
20|FH_F150982_0_0|SrvcGrp|78911|2022|PDM|4404.00|99|0.00|LAPARO HERNIA REPAIR RECUR
20|FH_F150982_0_0|SrvcGrp|80617|2022|PDM|15689.00|99|0.00|ARTHOPLASTY
20|FH_F150982_0_0|SrvcGrp|82108|2022|PDM|3303.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F150982_0_0|SrvcGrp|83641|2022|PDM|3854.00|99|0.00|CPT 29889
20|FH_F150982_0_0|SrvcGrp|83817|2022|PDM|2527.00|99|0.00|LAPAROSCOPY LYSIS ADHESIONS
20|FH_F150982_0_0|SrvcGrp|84313|2022|PDM|1802.00|99|0.00|TENDON REPAIR
20|FH_F150982_0_0|SrvcGrp|87053|2022|PDM|2532.00|99|0.00|CYSTOSCOPY AND TREATMENT
20|FH_F150982_0_0|SrvcGrp|88164|2022|PDM|9909.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR
20|FH_F150982_0_0|SrvcGrp|89853|2022|PDM|2753.00|99|0.00|NASAL/SINUS ENDOSCOPY-SURG
20|FH_F150982_0_0|SrvcGrp|89869|2022|PDM|2973.00|99|0.00|SPONTANEOUS ABORTION
20|FH_F150982_0_0|SrvcGrp|89989|2022|PDM|5200.00|99|0.00|FUSION OF BIG TOE JOINT
20|FH_F150982_0_0|SrvcGrp|90157|2022|PDM|2532.00|99|0.00|AETNA REMOVAL OF TONSILS
20|FH_F150982_0_0|SrvcGrp|90365|2022|PDM|1976.00|99|0.00|REPAIR METACARPAL FRACTURE
20|FH_F150982_0_0|SrvcGrp|90367|2022|PDM|1927.00|99|0.00|NASAL/SINUS ENDOSCOPY
20|FH_F150982_0_0|SrvcGrp|90799|2022|PDM|3303.00|99|0.00|REPAIR VENTRAL HERNIA INI BLOCK
20|FH_F150982_0_0|SrvcGrp|91940|2022|PDM|1382.00|99|0.00|TYMPANIC MEMBRANE REPAIR
20|FH_F150982_0_0|SrvcGrp|92409|2022|PDM|5284.00|99|0.00|PERQ CERVICOTHORACIC INJECT
20|FH_F150982_0_0|SrvcGrp|92820|2022|PDM|16516.00|99|0.00|HIP ARTHOSCOPY ACETABULOPLASTY
20|FH_F150982_0_0|SrvcGrp|94883|2022|PDM|2753.00|99|0.00|NASAL/SINUS ENDOSCOPY
20|FH_F150982_0_0|SrvcGrp|95559|2022|PDM|27527.00|99|0.00|HIP JOINT
20|FH_F150982_0_0|SrvcGrp|98005|2022|PDM|1976.00|99|0.00|DISTAL PHALANGEAL FRACTURE
20|FH_F150982_0_0|SrvcGrp|98404|2022|PDM|2202.00|99|0.00|ARTHROSCOPIC FRACTURE TX
20|FH_F151002_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F151002_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F151002_0_0|SrvcGrp|13187|2022|PCT|0.00|99|0.00|INTRAOCULAR LENSES
20|FH_F151084_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE
20|FH_F151084_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS
20|FH_F151139_0_0|SrvcGrp|115962|2022|PDM|4250.00|99|0.00|NON-EMERGENT AIR TRANSPORT 1 WAY (MOD NE)
20|FH_F151143_0_0|SrvcGrp|100960|2022|PDM|79.00|99|0.00|FIXED WING AIR MILEAGE
20|FH_F151156_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F151156_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F151156_0_0|CSTM-ALL|CSTM-00|2020|PDM|36.00|99|0.00|AEG 10 (NO REV)
20|FH_F151156_0_0|CSTM-ALL|CSTM-00|2020|PDM|857.00|99|0.00|AEG 2 (NO REV)
20|FH_F151157_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F151157_0_0|CSTM-ALL|CSTM-00|2020|PDM|35.00|99|0.00|AEG 10 (NO REV) W/ GASTROESOPHOGEAL
20|FH_F151157_0_0|SrvcGrp|103861|2022|PDM|2000.00|99|0.00|GASTROESOPHOGEAL STUDY
20|FH_F151158_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F151158_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS
20|FH_F151202_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F151202_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F151225_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F151225_0_0|SrvcGrp|10527|2022|PDM|204.00|99|0.00|HOSPICE SVCS
20|FH_F151399_0_0|SrvcGrp|100960|2022|PDM|79.04|99|0.00|FIXED WING AIR MILEAGE
20|FH_F151399_0_0|SrvcGrp|2067|2022|PDM|3945.00|99|0.00|SPECIALTY CARE TRANSPORT
20|FH_F151400_0_0|CSTM-ALL|CSTM-00|2020|PDM|3685.00|99|0.00|AEG 9 (NO REV)
20|FH_F151400_0_0|CSTM-ALL|CSTM-00|2020|PDM|4093.00|99|0.00|AEG 7 (NO REV)
20|FH_F151400_0_0|SrvcGrp|87120|2022|PDM|4600.00|99|0.00|PERQ VERTEBRAL AUGMENTATION
20|FH_F151400_0_0|SrvcGrp|98569|2022|PDM|2215.00|99|0.00|POSTERIOR NON-SEGMENTAL INST
20|FH_F151407_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING
20|FH_F151407_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|OP SVCS
20|FH_F151423_0_0|CSTM-ALL|CSTM-00|2020|PCT|12000.00|99|0.00|TIMELY FILING
20|FH_F151500_0_0|CSTM-ALL|CSTM-00|2020|PCT|12000.00|99|0.00|TIMELY FILING
20|FH_F151517_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F151559_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F151559_0_0|SrvcGrp|104464|2022|PDM|2000.00|99|0.00|VAGINAL DELIVERY (W/ OR W/O EPISIOTOMY)
20|FH_F151559_0_0|SrvcGrp|116055|2022|PDM|800.00|99|0.00|SAME DAY NEWBORN DISCHARGE
20|FH_F151559_0_0|SrvcGrp|79238|2022|PDM|625.00|99|0.00|TRANSFER
20|FH_F151663_0_0|CSTM-ALL|CSTM-00|2020|PCT|12000.00|99|0.00|TIMELY FILING
20|FH_F111925_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F111925_0_0|CSTM-ALL|CSTM-00|2020|PDM|1366.00|99|0.00|AEG 5  (NO REV)
20|FH_F111925_0_0|CSTM-ALL|CSTM-00|2020|PDM|1576.00|99|0.00|AEG 7 (NO REV)
20|FH_F111925_0_0|CSTM-ALL|CSTM-00|2020|PDM|672.00|99|0.00|AEG 2 (NO REV)
20|FH_F111925_0_0|SrvcGrp|73610|2022|PCT|1.00|99|0.00|AETNA IMPLANTS
20|FH_F111925_0_0|SrvcGrp|90564|2022|PDM|1602.00|99|0.00|REPAIR DETACHED RETINA
20|FH_F111986_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F111986_0_0|SrvcGrp|104110|2022|PDM|927.00|99|0.00|REMOVAL OF SKIN LESION
20|FH_F111986_0_0|SrvcGrp|104118|2022|PDM|3605.00|99|0.00|OPEN TREATMENT OF DISTAL
20|FH_F111986_0_0|SrvcGrp|104120|2022|PDM|1442.00|99|0.00|CYSTOURETHROSCOPY
20|FH_F111986_0_0|SrvcGrp|104121|2022|PDM|3605.00|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F111986_0_0|SrvcGrp|104123|2022|PDM|1442.00|99|0.00|REMOVE TONSILS AND ADENOIDS
20|FH_F111986_0_0|SrvcGrp|14614|2022|PDM|3296.00|99|0.00|LITHOTRIPSY
20|FH_F111986_0_0|SrvcGrp|25518|2022|PDM|2163.00|99|0.00|LAPAROSCOPY SURGICAL CHOLECYSTECTOMY
20|FH_F111986_0_0|SrvcGrp|27918|2022|PDM|2472.00|99|0.00|CPT 23410, 23412
20|FH_F111986_0_0|SrvcGrp|33966|2022|PDM|3605.00|99|0.00|CPT 29866
20|FH_F111986_0_0|SrvcGrp|35669|2022|PDM|2575.00|99|0.00|CPT 63650
20|FH_F111986_0_0|SrvcGrp|42472|2022|PDM|2472.00|99|0.00|CPT 58670
20|FH_F111986_0_0|SrvcGrp|63466|2022|PDM|1442.00|99|0.00|CPT 52005
20|FH_F111986_0_0|SrvcGrp|63468|2022|PDM|1133.00|99|0.00|CPT 52281
20|FH_F111986_0_0|SrvcGrp|65625|2022|PDM|1442.00|99|0.00|CPT 30520
20|FH_F111986_0_0|SrvcGrp|72992|2022|PDM|603.00|99|0.00|AEG 2
20|FH_F111986_0_0|SrvcGrp|78284|2022|PDM|1236.00|99|0.00|CPT 46200
20|FH_F111986_0_0|SrvcGrp|84180|2022|PDM|3811.00|99|0.00|AETNA DELAYED BREAST PROSTHESIS
20|FH_F111986_0_0|SrvcGrp|84910|2022|PDM|1854.00|99|0.00|ENDOSCOPY
20|FH_F111986_0_0|SrvcGrp|87055|2022|PDM|1442.00|99|0.00|CYSTOURETHROSCOPY W/STENT INSERTION
20|FH_F111986_0_0|SrvcGrp|88824|2022|PDM|2472.00|99|0.00|CPT 69631
20|FH_F111986_0_0|SrvcGrp|97480|2022|PDM|1236.00|99|0.00|BASAL/SINUS ENDOSCOPY
20|FH_F111986_0_0|SrvcGrp|98003|2022|PDM|2472.00|99|0.00|BIMALLEOLAR ANKLE FRACTURE
20|FH_F112024_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F112080_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F112080_0_0|SrvcGrp|72994|2022|PDM|739.00|99|0.00|AEG 3
20|FH_F112080_0_0|SrvcGrp|72998|2022|PDM|1040.00|99|0.00|AEG 5
20|FH_F112080_0_0|SrvcGrp|73002|2022|PDM|1442.00|99|0.00|AEG 7
20|FH_F112080_0_0|SrvcGrp|73004|2022|PDM|1410.00|99|0.00|AEG 8
20|FH_F112089_0_0|CSTM-ALL|CSTM-00|2020|PDM|1480.00|99|0.00|AEG 4 (NO REV)
20|FH_F112089_0_0|CSTM-ALL|CSTM-00|2020|PDM|2245.00|99|0.00|AEG 9 (NO REV)
20|FH_F112133_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F112133_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|AEG 4 (NO REV)
20|FH_F112153_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|AEG 10 (NO REV)
20|FH_F112153_0_0|CSTM-ALL|CSTM-00|2020|PDM|525.00|99|0.00|AEG 2 (NO REV)
20|FH_F112163_0_0|SrvcGrp|24739|2022|PDM|222.40|99|0.00|RESPITE CARE
20|FH_F112163_0_0|SrvcGrp|47411|2022|PDM|222.40|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F112163_0_0|SrvcGrp|97507|2022|PDM|948.00|99|0.00|AETNA HOSPICE
20|FH_F112165_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F112165_0_0|SrvcGrp|72994|2022|PDM|2800.00|99|0.00|AEG 3
20|FH_F112165_0_0|SrvcGrp|72998|2022|PDM|2350.00|99|0.00|AEG 5
20|FH_F112165_0_0|SrvcGrp|73008|2022|PDM|2350.00|99|0.00|AEG 10
20|FH_F112263_0_0|CSTM-ALL|CSTM-00|2020|PDM|1410.00|99|0.00|AEG 8 (NO REV)
20|FH_F112263_0_0|SrvcGrp|36591|2022|PDM|7150.00|99|0.00|CPT 63685
20|FH_F112272_0_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS
20|FH_F112272_0_0|SrvcGrp|79804|2022|PDM|1456.00|99|0.00|AETNA MEDICAL/SURGICAL
20|FH_F112325_0_0|SrvcGrp|63297|2022|PDM|100.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F112374_0_0|SrvcGrp|10393|2022|PDM|1560.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F112374_0_0|SrvcGrp|8950|2022|PDM|1456.00|99|0.00|INTERMEDIATE ICU/CCU
20|FH_F112377_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F112408_0_0|SrvcGrp|75545|2022|PDM|245.00|99|0.00|SUB-ACUTE - LEVEL I AND II
20|FH_F112408_0_0|SrvcGrp|96201|2022|PDM|45.00|99|0.00|PT/OT/ST
20|FH_F112448_0_0|CSTM-ALL|CSTM-00|2020|PDM|1475.00|99|0.00|GENERAL ACUTE CARE
20|FH_F112452_0_0|CSTM-ALL|CSTM-00|2020|PDM|440.00|99|0.00|AEG 1 (NO REV)
20|FH_F112453_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F112453_0_0|SrvcGrp|63297|2022|PDM|105.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F112453_0_0|SrvcGrp|65720|2022|PDM|105.00|99|0.00|RESPITE CARE
20|FH_F112468_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F112468_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F112468_0_0|SrvcGrp|72990|2022|PDM|530.00|99|0.00|AEG 1
20|FH_F112468_0_0|SrvcGrp|72992|2022|PDM|637.00|99|0.00|AEG 2
20|FH_F112468_0_0|SrvcGrp|73004|2022|PDM|1114.00|99|0.00|AEG 8
20|FH_F112468_0_0|SrvcGrp|73008|2022|PDM|796.00|99|0.00|AEG 10
20|FH_F112508_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F112508_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F112508_0_0|SrvcGrp|471|2022|PDM|832.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F112508_0_0|SrvcGrp|472|2022|PDM|832.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F112508_0_0|SrvcGrp|8950|2022|PDM|1456.00|99|0.00|INTERMEDIATE ICU/CCU
20|FH_F112526_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F112526_0_0|SrvcGrp|80317|2022|PDM|105.00|99|0.00|RESPITE CARE
20|FH_F112526_0_0|SrvcGrp|90477|2022|PDM|105.00|99|0.00|HOSPICE
20|FH_F112545_0_0|CSTM-ALL|CSTM-00|2020|PCT|68.00|99|0.00|GENERAL ACUTE CARE
20|FH_F112568_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F112568_0_0|SrvcGrp|33722|2022|PDM|59.87|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F112568_0_0|SrvcGrp|80920|2022|PDM|1047.73|99|0.00|HOSPICE SERVICES
20|FH_F112568_0_0|SrvcGrp|95660|2022|PDM|1047.73|99|0.00|HOSPICE SERVICES (HCFA)
20|FH_F112631_0_0|SrvcGrp|73002|2022|PDM|1114.00|99|0.00|AEG 7
20|FH_F112631_0_0|SrvcGrp|93759|2022|PCT|0.00|99|0.00|CARDIAC CATH
20|FH_F151751_0_0|CSTM-ALL|CSTM-00|2020|PDM|1377.00|99|0.00|AEG 4 (NO REV)
20|FH_F151751_0_0|CSTM-ALL|CSTM-00|2020|PDM|1750.00|99|0.00|AEG 9 (NO REV)
20|FH_F151751_0_0|SrvcGrp|116019|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F31003_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F31029_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31053_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31053_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS
20|FH_F31056_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|ST FRANCIS MS DRGS
20|FH_F31056_0_0|SrvcGrp|3029|2022|PDM|578.00|99|0.00|NEWBORN NURSERY
20|FH_F31056_0_0|SrvcGrp|3271|2022|PDM|3195.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F31056_0_0|SrvcGrp|361|2022|PDM|2311.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F31056_0_0|SrvcGrp|65|2022|PDM|2641.00|99|0.00|OBSTETRICAL CARE
20|FH_F31056_0_0|SrvcGrp|941|2022|PDM|3195.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F31087_0_0|SrvcGrp|3809|2022|PDM|586.00|99|0.00|HOSPICE CARE
20|FH_F31087_0_0|SrvcGrp|472|2022|PDM|387.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F31111_0_0|SrvcGrp|112105|2022|PDM|87.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HCFA)
20|FH_F31111_0_0|SrvcGrp|58436|2022|PCT|1.00|99|0.00|HEARING SERVICES
20|FH_F31139_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F31150_0_0|SrvcGrp|177|2022|PDM|1400.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F31164_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31164_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F31166_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31181_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31184_0_0|CSTM-ALL|CSTM-00|2020|PDM|14300.00|99|0.00|PERCUTANEOUS CARDIO PROCEDURE MS DRG 250-251
20|FH_F31184_0_0|CSTM-ALL|CSTM-00|2020|PDM|1900.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31184_0_0|CSTM-ALL|CSTM-00|2020|PDM|21500.00|99|0.00|MS DRG 236
20|FH_F31184_0_0|CSTM-ALL|CSTM-00|2020|PDM|31300.00|99|0.00|MS DRG 219-221
20|FH_F31184_0_0|SrvcGrp|18791|2022|PDM|61500.00|99|0.00|MS DRG 215
20|FH_F31184_0_0|SrvcGrp|9774|2022|PDM|2700.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F31204_0_0|SrvcGrp|109|2022|PDM|692.00|99|0.00|CD - DETOX
20|FH_F31204_0_0|SrvcGrp|13811|2022|PDM|275.00|99|0.00|PSYCH PARTIAL HOSP
20|FH_F31218_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31225_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31225_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F31229_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F31244_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31253_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31253_0_0|SrvcGrp|115|2022|PDM|600.00|99|0.00|SKILLED NURSING CARE
20|FH_F31253_0_0|SrvcGrp|1259|2022|PDM|1200.00|99|0.00|INTERMEDIATE INTENSIVE CARE UNIT
20|FH_F31309_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|OP SVCS
20|FH_F31319_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31340_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31369_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F31405_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F31433_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|AIR AMBULANCE SVCS
20|FH_F31433_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31446_0_0|CSTM-ALL|CSTM-00|2020|PDM|120.00|99|0.00|CD DAY TREATMENT - ADULT
20|FH_F31446_0_0|CSTM-ALL|CSTM-00|2020|PDM|225.00|99|0.00|CD DAY TREATMENT - ADULT
20|FH_F31446_0_0|SrvcGrp|212|2022|PDM|295.00|99|0.00|CD (ADULT) - DAY TREATMENT
20|FH_F31466_0_0|CSTM-ALL|CSTM-00|2020|PDM|366.00|99|0.00|ADULT PSYCH PARTIAL HOSP
20|FH_F31466_0_0|CSTM-ALL|CSTM-00|2020|PDM|694.00|99|0.00|ACUTE PSYCH
20|FH_F31466_0_0|SrvcGrp|14210|2022|PDM|265.00|99|0.00|PSYCH INTENSIVE OUTPATIENT
20|FH_F31481_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F31486_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F31504_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31504_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F31508_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31525_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F31525_0_0|CSTM-ALL|CSTM-00|2020|PDM|1745.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31525_0_0|CSTM-ALL|CSTM-00|2020|PDM|595.00|99|0.00|ACUTE PSYCH
20|FH_F31530_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|OP SVCS
20|FH_F31530_0_0|SrvcGrp|473|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F31540_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F31542_0_0|CSTM-ALL|CSTM-00|2020|PDM|1687.00|99|0.00|ASPG V
20|FH_F31542_0_0|SrvcGrp|88|2022|PDM|4500.00|99|0.00|OP LITHOTRIPSY
20|FH_F31542_0_0|SrvcGrp|9511|2022|PDM|42.00|99|0.00|OBSERVATION SVCS
20|FH_F31542_0_0|SrvcGrp|9937|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F31542_0_0|SrvcGrp|9938|2022|PDM|90.00|99|0.00|SPEECH THERAPY
20|FH_F31579_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F31594_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F31595_0_0|SrvcGrp|12401|2022|PDM|85.00|99|0.00|RN VISIT
20|FH_F31595_0_0|SrvcGrp|12857|2022|PDM|30.00|99|0.00|HOME HEALTH AID
20|FH_F31595_0_0|SrvcGrp|3477|2022|PCT|0.93|99|0.00|CLINIC VISIT
20|FH_F31595_0_0|SrvcGrp|360|2022|PCT|0.95|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F31595_0_0|SrvcGrp|9832|2022|PDM|85.00|99|0.00|ST SVCS
20|FH_F31597_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31600_0_0|CSTM-ALL|CSTM-00|2020|PCT|91.00|99|0.00|OP SVCS
20|FH_F31609_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31609_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS
20|FH_F31643_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F31709_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31709_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F31783_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F31783_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F86658_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F86660_0_0|CSTM-ALL|CSTM-00|2020|PDM|1795.00|99|0.00|COVENTRY ENHANCED GROUPER 3
20|FH_F86660_0_0|CSTM-ALL|CSTM-00|2020|PDM|3085.00|99|0.00|COVENTRY ENHANCED GROUPER 7
20|FH_F86660_0_0|CSTM-ALL|CSTM-00|2020|PDM|3157.00|99|0.00|COVENTRY ENHANCED GROUPER 9
20|FH_F86660_0_0|SrvcGrp|11663|2022|PCT|0.55|99|0.00|IMPLANTS
20|FH_F86660_0_0|SrvcGrp|12491|2022|PCT|0.55|99|0.00|PACEMAKER
20|FH_F86752_0_0|SrvcGrp|75483|2022|PDM|669.00|99|0.00|AEG 3
20|FH_F86752_0_0|SrvcGrp|75489|2022|PDM|1202.00|99|0.00|AEG 6
20|FH_F86752_0_0|SrvcGrp|75493|2022|PDM|1516.00|99|0.00|AEG 8
20|FH_F86815_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F86815_0_0|CSTM-ALL|CSTM-00|2020|PDM|985.00|99|0.00|AEG 5  (NO REV)
20|FH_F86836_0_0|SrvcGrp|11259|2022|PCT|0.50|99|0.00|DRUGS
20|FH_F86836_0_0|SrvcGrp|11606|2022|PDM|3800.00|99|0.00|ACUTE CARE (MEDICAL & SURGICAL)
20|FH_F86836_0_0|SrvcGrp|3095|2022|PDM|2850.00|99|0.00|ROOM AND BOARD PRIVATE
20|FH_F86953_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F87012_0_0|SrvcGrp|72992|2022|PDM|760.59|99|0.00|AEG 2
20|FH_F87012_0_0|SrvcGrp|72998|2022|PDM|1221.96|99|0.00|AEG 5
20|FH_F87012_0_0|SrvcGrp|73004|2022|PDM|1645.77|99|0.00|AEG 8
20|FH_F87031_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F87031_0_0|SrvcGrp|72992|2022|PDM|695.00|99|0.00|AEG 2
20|FH_F87031_0_0|SrvcGrp|78878|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F87053_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F87053_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F87053_0_0|SrvcGrp|72990|2022|PDM|369.00|99|0.00|AEG 1
20|FH_F87054_0_0|SrvcGrp|72994|2022|PDM|998.00|99|0.00|AEG 3
20|FH_F87054_0_0|SrvcGrp|77507|2022|PCT|1.00|99|0.00|AETNA CORNEAL TISSUE HANDLING
20|FH_F87054_0_0|SrvcGrp|84932|2022|PDM|2111.00|99|0.00|VITRECTOMY
20|FH_F87054_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F87219_0_0|CSTM-ALL|CSTM-00|2020|PDM|156.40|99|0.00|AETNA POLYSOMNOGRAPHY (MOD 26)
20|FH_F87219_0_0|CSTM-ALL|CSTM-00|2020|PDM|211.56|99|0.00|SLEEP STUDY CPT 95800
20|FH_F87219_0_0|CSTM-ALL|CSTM-00|2020|PDM|423.22|99|0.00|AETNA SLEEP STUDIES
20|FH_F87219_0_0|CSTM-ALL|CSTM-00|2020|PDM|731.22|99|0.00|AETNA SLEEP STUDIES W/O MOD 26 & TC
20|FH_F87254_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F87254_0_0|SrvcGrp|104613|2022|PDM|2000.00|99|0.00|REMOVE ARMPIT LYMPH NODES
20|FH_F87254_0_0|SrvcGrp|38364|2022|PDM|1200.00|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F87254_0_0|SrvcGrp|63466|2022|PDM|1100.00|99|0.00|CPT 52005
20|FH_F87254_0_0|SrvcGrp|63472|2022|PDM|1200.00|99|0.00|CPT 64581
20|FH_F87254_0_0|SrvcGrp|68000|2022|PDM|1600.00|99|0.00|CPT 58561
20|FH_F87254_0_0|SrvcGrp|72990|2022|PDM|489.00|99|0.00|AEG 1
20|FH_F87254_0_0|SrvcGrp|73002|2022|PDM|1870.00|99|0.00|AEG 7
20|FH_F87254_0_0|SrvcGrp|77461|2022|PDM|1800.00|99|0.00|CPT 52356
20|FH_F87254_0_0|SrvcGrp|80063|2022|PDM|1100.00|99|0.00|HEMORRHOIDECTOMY
20|FH_F87254_0_0|SrvcGrp|98526|2022|PDM|1100.00|99|0.00|CYSTOURETHROSCOPY
20|FH_F87333_0_0|SrvcGrp|72990|2022|PDM|560.71|99|0.00|AEG 1
20|FH_F87333_0_0|SrvcGrp|72996|2022|PDM|1321.92|99|0.00|AEG 4
20|FH_F87333_0_0|SrvcGrp|73002|2022|PDM|1922.29|99|0.00|AEG 7
20|FH_F87333_0_0|SrvcGrp|73006|2022|PDM|2161.34|99|0.00|AEG 9
20|FH_F87333_0_0|SrvcGrp|73008|2022|PDM|1087.28|99|0.00|AEG 10
20|FH_F87333_0_0|SrvcGrp|86088|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F87333_0_0|SrvcGrp|86312|2022|PCT|0.00|99|0.00|CARDIAC CATH
20|FH_F87411_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F87411_0_0|CSTM-ALL|CSTM-00|2020|PDM|121.07|99|0.00|AETNA SLEEP STUDIES
20|FH_F87411_0_0|CSTM-ALL|CSTM-00|2020|PDM|719.25|99|0.00|AETNA SLEEP STUDIES W/O MOD 26 & TC
20|FH_F87411_0_0|CSTM-ALL|CSTM-00|2020|PDM|857.08|99|0.00|POLYSOM W/O MOD 26 & TC
20|FH_F87411_0_0|SrvcGrp|83881|2022|PDM|43.49|99|0.00|AETNA SLEEP STUDY (MOD 26)
20|FH_F87411_0_0|SrvcGrp|83884|2022|PDM|137.27|99|0.00|AETNA POLYSOMNOGRAPHY (MOD 26)
20|FH_F87432_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F87480_0_0|CSTM-ALL|CSTM-00|2020|PDM|693.00|99|0.00|AEG 4 (NO REV)
20|FH_F87480_0_0|SrvcGrp|41334|2022|PDM|7500.00|99|0.00|TOTAL KNEE
20|FH_F87480_0_0|SrvcGrp|76847|2022|PDM|1800.00|99|0.00|AETNA ARTHROSCOPY
20|FH_F87480_0_0|SrvcGrp|79937|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F87480_0_0|SrvcGrp|84939|2022|PDM|7500.00|99|0.00|SHOULDER JOINT
20|FH_F87480_0_0|SrvcGrp|86234|2022|PDM|1800.00|99|0.00|AETHA IMPLANT SPINAL CANAL CATH
20|FH_F87482_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE
20|FH_F87538_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F87541_0_0|SrvcGrp|72994|2022|PDM|615.00|99|0.00|AEG 3
20|FH_F87541_0_0|SrvcGrp|73002|2022|PDM|1199.00|99|0.00|AEG 7
20|FH_F87541_0_0|SrvcGrp|73004|2022|PDM|1172.00|99|0.00|AEG 8
20|FH_F87559_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F87559_0_0|CSTM-ALL|CSTM-00|2020|PDM|163.34|99|0.00|AETNA SLEEP STUDY
20|FH_F87559_0_0|CSTM-ALL|CSTM-00|2020|PDM|314.01|99|0.00|CPT 95805 (W/MOD TC)
20|FH_F87559_0_0|CSTM-ALL|CSTM-00|2020|PDM|367.68|99|0.00|AETNA SLEEP STUDIES W/O MOD 26 & TC
20|FH_F87559_0_0|CSTM-ALL|CSTM-00|2020|PDM|53.67|99|0.00|CPT 95805 (W/MOD 26)
20|FH_F87559_0_0|CSTM-ALL|CSTM-00|2020|PDM|585.51|99|0.00|AETNA SLEEP STUDIES
20|FH_F87559_0_0|CSTM-ALL|CSTM-00|2020|PDM|591.78|99|0.00|AETNA SLEEP STUDIES W/O MOD 26 & TC
20|FH_F87559_0_0|CSTM-ALL|CSTM-00|2020|PDM|591.79|99|0.00|AETNA POLYSOMNOGRAPHY (MOD 26 AND TC)
20|FH_F87559_0_0|SrvcGrp|86476|2022|PDM|45.79|99|0.00|AETNA SLEEP STUDY (MOD 26)
20|FH_F87571_0_0|SrvcGrp|10905|2022|PDM|550.00|99|0.00|EMERGENCY ROOM LEVEL III
20|FH_F87571_0_0|SrvcGrp|22106|2022|PDM|650.00|99|0.00|CAT SCAN
20|FH_F87571_0_0|SrvcGrp|22809|2022|PDM|1250.00|99|0.00|INPATIENT SURGICAL
20|FH_F87571_0_0|SrvcGrp|30623|2022|PDM|2860.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788
20|FH_F31783_0_0|CSTM-ALL|CSTM-00|2020|PDM|13650.00|99|0.00|MS DRG 238
20|FH_F31783_0_0|CSTM-ALL|CSTM-00|2020|PDM|14070.00|99|0.00|MS DRG 249
20|FH_F31783_0_0|CSTM-ALL|CSTM-00|2020|PDM|26460.00|99|0.00|MSDRG 233-234 CORONARY BYPASS
20|FH_F31783_0_0|CSTM-ALL|CSTM-00|2020|PDM|8610.00|99|0.00|MS DRG 252
20|FH_F31783_0_0|SrvcGrp|1121|2022|PCT|0.70|99|0.00|OP PTCA ANGIOPLASTY
20|FH_F31798_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F31798_0_0|CSTM-ALL|CSTM-00|2020|PDM|524.00|99|0.00|MULTIPLE BIRTHS
20|FH_F31798_0_0|SrvcGrp|11258|2022|PCT|0.75|99|0.00|DRUGS
20|FH_F31798_0_0|SrvcGrp|177|2022|PDM|3680.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F31798_0_0|SrvcGrp|3029|2022|PDM|524.00|99|0.00|NEWBORN NURSERY
20|FH_F31798_0_0|SrvcGrp|361|2022|PCT|0.85|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F31815_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31815_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F31819_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31826_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31840_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F31843_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F31861_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS
20|FH_F31863_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31871_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31872_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F31881_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31882_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS
20|FH_F31884_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31890_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31890_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F31916_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F31928_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|CAESAREAN SECTION
20|FH_F31928_0_0|SrvcGrp|9527|2022|PDM|1300.00|99|0.00|NORMAL DELIVERY
20|FH_F31936_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31944_0_0|CSTM-ALL|CSTM-00|2020|PDM|75.00|99|0.00|SPEECH THERAPY
20|FH_F31944_0_0|SrvcGrp|13380|2022|PDM|75.00|99|0.00|RN VISIT
20|FH_F31944_0_0|SrvcGrp|13385|2022|PDM|75.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F31957_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31957_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS
20|FH_F31959_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|EMERGENCY MEDICAL SERVICES (EMS)
20|FH_F31960_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31970_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31982_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F31990_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31991_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F32007_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32007_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F32033_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32034_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32034_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F32073_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F32073_0_0|CSTM-ALL|CSTM-00|2020|PDM|1295.00|99|0.00|STROKE REHAB
20|FH_F32080_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F32090_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32093_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32108_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32112_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32114_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F32116_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32141_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32150_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F32156_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|ACUTE PSYCH
20|FH_F32165_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32167_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32167_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS
20|FH_F32189_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F32204_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32204_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F32211_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32212_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F32215_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F32222_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32228_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS
20|FH_F32232_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32232_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F32260_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32275_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32281_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F32284_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F32285_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32292_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32292_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F32305_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F32324_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32324_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|OP SVCS
20|FH_F32325_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32327_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|OP SVCS
20|FH_F32336_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.50|99|0.00|GENERAL ACUTE CARE
20|FH_F32358_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32358_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F87571_0_0|SrvcGrp|3178|2022|PDM|550.00|99|0.00|ACUTE PSYCH
20|FH_F87595_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F87595_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.64|99|0.00|OP SVCS
20|FH_F87618_0_0|CSTM-ALL|CSTM-00|2020|PCT|67.00|99|0.00|GENERAL ACUTE CARE
20|FH_F87619_0_0|SrvcGrp|72990|2022|PDM|417.00|99|0.00|AEG 1
20|FH_F87619_0_0|SrvcGrp|72994|2022|PDM|640.00|99|0.00|AEG 3
20|FH_F87619_0_0|SrvcGrp|72998|2022|PDM|901.00|99|0.00|AEG 5
20|FH_F87716_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F87716_0_0|SrvcGrp|16|2022|PDM|933.00|99|0.00|ACUTE REHABILITATION
20|FH_F87716_0_0|SrvcGrp|30461|2022|PDM|637.00|99|0.00|SUBACUTE CARE/SKILLED NURSING
20|FH_F87716_0_0|SrvcGrp|30623|2022|PDM|4668.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788
20|FH_F87815_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE
20|FH_F87816_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F87822_0_0|SrvcGrp|25688|2022|PDM|481.95|99|0.00|HOME HEMODIALYSIS
20|FH_F87856_0_0|SrvcGrp|75495|2022|PDM|1739.00|99|0.00|AEG 9
20|FH_F87856_0_0|SrvcGrp|75497|2022|PDM|891.00|99|0.00|AEG 10
20|FH_F87856_0_0|SrvcGrp|83839|2022|PDM|4000.00|99|0.00|BREAST RECONSTRUCTION
20|FH_F87856_0_0|SrvcGrp|86462|2022|PDM|1218.00|99|0.00|AREOLA RECONSTRUCTION
20|FH_F87856_0_0|SrvcGrp|86463|2022|PDM|1000.00|99|0.00|FRACTURE NASAL INFERIOR
20|FH_F87915_0_0|SrvcGrp|12043|2022|PDM|1187.00|99|0.00|CPT 99205
20|FH_F87915_0_0|SrvcGrp|13631|2022|PDM|154.00|99|0.00|CPT 99213
20|FH_F87915_0_0|SrvcGrp|13640|2022|PDM|154.00|99|0.00|CPT 99202
20|FH_F87993_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F87993_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F87993_0_0|CSTM-ALL|CSTM-00|2020|PDM|696.00|99|0.00|AEG 4 (NO REV)
20|FH_F87993_0_0|CSTM-ALL|CSTM-00|2020|PDM|913.00|99|0.00|AEG 6 (NO REV)
20|FH_F88057_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS
20|FH_F88096_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F88096_0_0|CSTM-ALL|CSTM-00|2020|PDM|1600.00|99|0.00|AEG 6 (NO REV)
20|FH_F88096_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 1 (NO REV)
20|FH_F88096_0_0|SrvcGrp|35669|2022|PDM|1325.00|99|0.00|CPT 63650
20|FH_F88096_0_0|SrvcGrp|86606|2022|PDM|1000.00|99|0.00|INTRAOCULAR LENS
20|FH_F88171_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F88274_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F88277_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.20|99|0.00|GENERAL ACUTE CARE
20|FH_F88277_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.20|99|0.00|OP SVCS
20|FH_F88355_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F88355_0_0|CSTM-ALL|CSTM-00|2020|PDM|432.00|99|0.00|AEG 2 (NO REV)
20|FH_F88355_0_0|CSTM-ALL|CSTM-00|2020|PDM|611.00|99|0.00|AEG 4 (NO REV)
20|FH_F88355_0_0|CSTM-ALL|CSTM-00|2020|PDM|805.00|99|0.00|AEG 6 (NO REV)
20|FH_F88355_0_0|SrvcGrp|78045|2022|PCT|1.00|99|0.00|AETNA AMNIOTIC MEMBRANE
20|FH_F88357_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F88357_0_0|CSTM-ALL|CSTM-00|2020|PDM|805.00|99|0.00|AEG 6 (NO REV)
20|FH_F88451_0_0|SrvcGrp|43285|2022|PDM|126.00|99|0.00|SPEECH THERAPY
20|FH_F88456_0_0|CSTM-ALL|CSTM-00|2020|PDM|1569.00|99|0.00|AEG 7 (NO REV)
20|FH_F88456_0_0|SrvcGrp|107441|2022|PDM|3403.00|99|0.00|AETNA CYSTOSCOPY PROSTATIC IMPLANTS
20|FH_F88456_0_0|SrvcGrp|111858|2022|PDM|1232.00|99|0.00|CYSTOSCOPY
20|FH_F88456_0_0|SrvcGrp|38364|2022|PDM|3291.00|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F88456_0_0|SrvcGrp|56464|2022|PDM|8010.00|99|0.00|CPT 55873
20|FH_F88456_0_0|SrvcGrp|73610|2022|PCT|0.00|99|0.00|AETNA IMPLANTS
20|FH_F88456_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F88456_0_0|SrvcGrp|93186|2022|PDM|629.00|99|0.00|AETNA CYSTOURETHROSCOPY PROCEDURES
20|FH_F88483_0_0|CSTM-ALL|CSTM-00|2020|PDM|1329.00|99|0.00|AEG 9 (NO REV)
20|FH_F88483_0_0|CSTM-ALL|CSTM-00|2020|PDM|443.00|99|0.00|AEG 10 (NO REV)
20|FH_F88483_0_0|CSTM-ALL|CSTM-00|2020|PDM|623.00|99|0.00|AEG 4 (NO REV)
20|FH_F88483_0_0|CSTM-ALL|CSTM-00|2020|PDM|821.00|99|0.00|AEG 6 (NO REV)
20|FH_F88511_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F88616_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 2 (NO REV)
20|FH_F88672_0_0|CSTM-ALL|CSTM-00|2020|PDM|1026.00|99|0.00|AEG 8 (NO REV)
20|FH_F88672_0_0|CSTM-ALL|CSTM-00|2020|PDM|1050.00|99|0.00|AEG 7 (NO REV)
20|FH_F88672_0_0|CSTM-ALL|CSTM-00|2020|PDM|756.00|99|0.00|AEG 5  (NO REV)
20|FH_F88694_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F88733_0_0|SrvcGrp|73606|2022|PDM|525.00|99|0.00|AETNA SKILLED NURSING CARE
20|FH_F88733_0_0|SrvcGrp|87537|2022|PDM|525.00|99|0.00|MED REHAB DAY PROGRAM (FULL)
20|FH_F88740_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F88740_0_0|CSTM-ALL|CSTM-00|2020|PDM|1262.00|99|0.00|AEG 5  (NO REV)
20|FH_F88740_0_0|CSTM-ALL|CSTM-00|2020|PDM|585.00|99|0.00|AEG 1 (NO REV)
20|FH_F88753_0_0|CSTM-ALL|CSTM-00|2020|PCT|12000.00|99|0.00|TIMELY FILING
20|FH_F88816_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F88816_0_0|SrvcGrp|471|2022|PDM|462.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F88816_0_0|SrvcGrp|472|2022|PDM|385.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F88818_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F88818_0_0|SrvcGrp|28557|2022|PDM|3700.00|99|0.00|CPT 19318
20|FH_F88818_0_0|SrvcGrp|75481|2022|PDM|400.00|99|0.00|AEG 2
20|FH_F88818_0_0|SrvcGrp|75485|2022|PDM|549.00|99|0.00|AEG 4
20|FH_F88818_0_0|SrvcGrp|75487|2022|PDM|650.00|99|0.00|AEG 5
20|FH_F88818_0_0|SrvcGrp|75493|2022|PDM|600.00|99|0.00|AEG 8
20|FH_F88818_0_0|SrvcGrp|87817|2022|PDM|300.00|99|0.00|REMOVAL OF SKIN LESION
20|FH_F88818_0_0|SrvcGrp|87822|2022|PDM|2170.00|99|0.00|SUSPENSION OF BREAST
20|FH_F88893_0_0|CSTM-ALL|CSTM-00|2020|PDM|1162.46|99|0.00|AEG 8 (NO REV)
20|FH_F88893_0_0|CSTM-ALL|CSTM-00|2020|PDM|1599.80|99|0.00|AEG 9 (NO REV)
20|FH_F88893_0_0|CSTM-ALL|CSTM-00|2020|PDM|985.71|99|0.00|AEG 6 (NO REV)
20|FH_F88893_0_0|SrvcGrp|84908|2022|PDM|3850.00|99|0.00|LAPAROSCOPY
20|FH_F88893_0_0|SrvcGrp|87841|2022|PDM|11897.00|99|0.00|LAPAROSCOPE PROCEDURE - STOMACH
20|FH_F88893_0_0|SrvcGrp|87843|2022|PDM|5940.00|99|0.00|REVISE STOMACH - BOWEL FUSION
20|FH_F88893_0_0|SrvcGrp|87844|2022|PDM|4400.00|99|0.00|LAPARASCOPY - GASTRIC
20|FH_F88933_0_0|CSTM-ALL|CSTM-00|2020|PDM|1575.00|99|0.00|AEG 7 (NO REV)
20|FH_F88933_0_0|SrvcGrp|112909|2022|PDM|1351.00|99|0.00|REMOVAL OF TISSUE FOR GRAFT
20|FH_F88933_0_0|SrvcGrp|112910|2022|PDM|8610.00|99|0.00|NECK-SPINE FUSION
20|FH_F88933_0_0|SrvcGrp|112912|2022|PDM|10609.00|99|0.00|REMOVAL OF PACEMAKER
20|FH_F88933_0_0|SrvcGrp|3932|2022|PDM|3278.00|99|0.00|LITHOTRIPSY
20|FH_F88933_0_0|SrvcGrp|87520|2022|PDM|2814.00|99|0.00|AETNA ARTHROSCOPY PROCEDURES
20|FH_F88933_0_0|SrvcGrp|87527|2022|PDM|11255.00|99|0.00|AETNA RECONSTRUCT SHOULDER JOINT
20|FH_F88935_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F88935_0_0|SrvcGrp|3809|2022|PDM|576.45|99|0.00|HOSPICE CARE
20|FH_F88935_0_0|SrvcGrp|57968|2022|PDM|31.38|99|0.00|CONTINUOUS HOMECARE
20|FH_F89037_0_0|SrvcGrp|72998|2022|PDM|864.22|99|0.00|AEG 5
20|FH_F89071_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F89173_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F89173_0_0|CSTM-ALL|CSTM-00|2020|PDM|1228.00|99|0.00|AEG 7 (NO REV)
20|FH_F89173_0_0|CSTM-ALL|CSTM-00|2020|PDM|1652.00|99|0.00|AEG 9 (NO REV)
20|FH_F89173_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 2 (NO REV)
20|FH_F89173_0_0|CSTM-ALL|CSTM-00|2020|PDM|885.00|99|0.00|AEG 5  (NO REV)
20|FH_F89176_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F89176_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F89233_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F89233_0_0|SrvcGrp|12837|2022|PCT|0.76|99|0.00|INTRAOCULAR LENSES
20|FH_F89233_0_0|SrvcGrp|86582|2022|PCT|0.85|99|0.00|AETNA CARDIAC CATHERTERIZATION
20|FH_F89233_0_0|SrvcGrp|88138|2022|PCT|0.75|99|0.00|OR PROCEDURE FOR OBESITY
20|FH_F89273_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 10 (NO REV)
20|FH_F89273_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|AEG 4 (NO REV)
20|FH_F89273_0_0|SrvcGrp|80263|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F89273_0_0|SrvcGrp|84121|2022|PDM|275.00|99|0.00|OCULAR IMPLANTS
20|FH_F89273_0_0|SrvcGrp|88244|2022|PDM|850.00|99|0.00|EYE SURGERY
20|FH_F89273_0_0|SrvcGrp|88245|2022|PDM|1600.00|99|0.00|EYE SURGERY
20|FH_F89273_0_0|SrvcGrp|88263|2022|PDM|595.00|99|0.00|AETNA AMNIOTIC MEMBRANE (HCFA)
20|FH_F89273_0_0|SrvcGrp|88267|2022|PDM|595.00|99|0.00|CONNECTIVE TISSUE
20|FH_F89273_0_0|SrvcGrp|88268|2022|PDM|595.00|99|0.00|CONNECTIVE TISSUE (HCFA)
20|FH_F89311_0_0|CSTM-ALL|CSTM-00|2020|PDM|441.00|99|0.00|COVENTRY ENHANCED GROUPER 1
20|FH_F89311_0_0|CSTM-ALL|CSTM-00|2020|PDM|767.00|99|0.00|COVENTRY ENHANCED GROUPER 4
20|FH_F89340_0_0|CSTM-ALL|CSTM-00|2020|PDM|1025.00|99|0.00|AEG 5  (NO REV)
20|FH_F89340_0_0|CSTM-ALL|CSTM-00|2020|PDM|1914.00|99|0.00|AEG 9 (NO REV)
20|FH_F89340_0_0|SrvcGrp|14614|2022|PDM|4180.00|99|0.00|LITHOTRIPSY
20|FH_F89340_0_0|SrvcGrp|55084|2022|PDM|2200.00|99|0.00|CPT 52648
20|FH_F89340_0_0|SrvcGrp|63467|2022|PDM|1430.00|99|0.00|CPT 64585
20|FH_F89363_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.64|99|0.00|GENERAL ACUTE CARE
20|FH_F89372_0_0|SrvcGrp|106065|2022|PDM|324.00|99|0.00|TRANSCRANIAL MAGNETIC STIMULATION
20|FH_F89372_0_0|SrvcGrp|14886|2022|PCT|1.00|99|0.00|TRANSPORTATION
20|FH_F89372_0_0|SrvcGrp|23703|2022|PCT|0.71|99|0.00|IP/OP TRAUMA
20|FH_F89372_0_0|SrvcGrp|63381|2022|PCT|0.71|99|0.00|OP SURGERY
20|FH_F89372_0_0|SrvcGrp|73806|2022|PCT|0.59|99|0.00|AETNA ER
20|FH_F89372_0_0|SrvcGrp|79678|2022|PCT|0.71|99|0.00|BURN SERVICES
20|FH_F89372_0_0|SrvcGrp|90004|2022|PDM|46354.00|99|0.00|MS DRG ONLY
20|FH_F89495_0_0|SrvcGrp|23585|2022|PCT|0.45|99|0.00|IMPLANTS
20|FH_F89495_0_0|SrvcGrp|29985|2022|PCT|0.45|99|0.00|SUPPLIES
20|FH_F89495_0_0|SrvcGrp|36591|2022|PDM|1530.00|99|0.00|CPT 63685
20|FH_F89495_0_0|SrvcGrp|72994|2022|PDM|529.00|99|0.00|AEG 3
20|FH_F89495_0_0|SrvcGrp|72998|2022|PDM|743.00|99|0.00|AEG 5
20|FH_F89495_0_0|SrvcGrp|73002|2022|PDM|1032.00|99|0.00|AEG 7
20|FH_F89495_0_0|SrvcGrp|73008|2022|PDM|653.00|99|0.00|AEG 10
20|FH_F89538_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F89538_0_0|CSTM-ALL|CSTM-00|2020|PDM|1505.48|99|0.00|AEG 7 (NO REV)
20|FH_F89538_0_0|CSTM-ALL|CSTM-00|2020|PDM|2025.96|99|0.00|AEG 9 (NO REV)
20|FH_F89538_0_0|CSTM-ALL|CSTM-00|2020|PDM|503.84|99|0.00|AEG 1 (NO REV)
20|FH_F89574_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F89574_0_0|SrvcGrp|73485|2022|PDM|840.00|99|0.00|AETNA REHAB
20|FH_F89574_0_0|SrvcGrp|79720|2022|PDM|1050.00|99|0.00|ACUTE REHAB II
20|FH_F89580_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.61|99|0.00|OP SVCS
20|FH_F89580_0_0|SrvcGrp|10944|2022|PCT|0.66|99|0.00|EMERGENCY ROOM
20|FH_F89580_0_0|SrvcGrp|12724|2022|PDM|4920.00|99|0.00|ONCOLOGY CARE
20|FH_F89580_0_0|SrvcGrp|13903|2022|PDM|6485.00|99|0.00|PEDIATRIC IP SVCS
20|FH_F89580_0_0|SrvcGrp|16632|2022|PDM|8972.00|99|0.00|TRAUMA SVCS
20|FH_F89580_0_0|SrvcGrp|16718|2022|PCT|0.46|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F89580_0_0|SrvcGrp|86582|2022|PCT|0.66|99|0.00|AETNA CARDIAC CATHERTERIZATION
20|FH_F89580_0_0|SrvcGrp|88420|2022|PDM|6485.00|99|0.00|CICU
20|FH_F89580_0_0|SrvcGrp|88424|2022|PCT|1.00|99|0.00|OP REFERENCE LABORATORY
20|FH_F89582_0_0|SrvcGrp|11442|2022|PDM|577.85|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)
20|FH_F89582_0_0|SrvcGrp|3327|2022|PDM|134.37|99|0.00|HOSPICE SERVICE - IP RESPITE
20|FH_F89582_0_0|SrvcGrp|76094|2022|PDM|149.93|99|0.00|HOSPICE ROUTINE HOME CARE
20|FH_F89732_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F89732_0_0|SrvcGrp|42822|2022|PDM|715.00|99|0.00|RESPIRATORY THERAPY
20|FH_F89732_0_0|SrvcGrp|88426|2022|PCT|0.48|99|0.00|AETNA IMPLANTS/HIGH COST DRUGS
20|FH_F89734_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F89734_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F89736_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F89778_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F89778_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F89778_0_0|CSTM-ALL|CSTM-00|2020|PDM|854.00|99|0.00|AEG 3 (NO REV)
20|FH_F89778_0_0|SrvcGrp|15473|2022|PDM|1099.69|99|0.00|CPT CODE 42820
20|FH_F89778_0_0|SrvcGrp|27344|2022|PDM|2107.64|99|0.00|OP SURGERY (CPT 42821)
20|FH_F89778_0_0|SrvcGrp|33987|2022|PDM|1043.18|99|0.00|CPT 57522
20|FH_F89778_0_0|SrvcGrp|63461|2022|PDM|1178.04|99|0.00|CPT 52235
20|FH_F89778_0_0|SrvcGrp|65403|2022|PDM|2107.64|99|0.00|CPT 42830
20|FH_F89778_0_0|SrvcGrp|67994|2022|PDM|1043.18|99|0.00|CPT 58120
20|FH_F89778_0_0|SrvcGrp|69964|2022|PDM|1470.32|99|0.00|CPT 23120
20|FH_F89778_0_0|SrvcGrp|77450|2022|PDM|663.96|99|0.00|CPT 54161
20|FH_F89778_0_0|SrvcGrp|83646|2022|PDM|1735.13|99|0.00|CPT 31276
20|FH_F89778_0_0|SrvcGrp|87055|2022|PDM|1178.04|99|0.00|CYSTOURETHROSCOPY W/STENT INSERTION
20|FH_F89778_0_0|SrvcGrp|88598|2022|PDM|711.71|99|0.00|NASAL/SINUS ENDOSCOPY
20|FH_F89778_0_0|SrvcGrp|88821|2022|PDM|1135.88|99|0.00|CPT 31536
20|FH_F89779_0_0|SrvcGrp|11673|2022|PDM|4000.00|99|0.00|CPT 29888
20|FH_F89779_0_0|SrvcGrp|41334|2022|PDM|20500.00|99|0.00|TOTAL KNEE
20|FH_F89779_0_0|SrvcGrp|41335|2022|PDM|20500.00|99|0.00|TOTAL HIP
20|FH_F89779_0_0|SrvcGrp|70749|2022|PDM|3200.00|99|0.00|CPT 29823
20|FH_F89779_0_0|SrvcGrp|72990|2022|PDM|1300.00|99|0.00|AEG 1
20|FH_F89779_0_0|SrvcGrp|73006|2022|PDM|3500.00|99|0.00|AEG 9
20|FH_F89779_0_0|SrvcGrp|73008|2022|PDM|1500.00|99|0.00|AEG 10
20|FH_F89779_0_0|SrvcGrp|74039|2022|PDM|12500.00|99|0.00|LAMINECTOMY
20|FH_F89779_0_0|SrvcGrp|84939|2022|PDM|17000.00|99|0.00|SHOULDER JOINT
20|FH_F89799_0_0|SrvcGrp|82981|2022|PDM|115.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F89952_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|AEG 3 (NO REV)
20|FH_F89952_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|AEG 4 (NO REV)
20|FH_F90136_0_0|SrvcGrp|29155|2022|PDM|100.00|99|0.00|HOSPICE SVCS
20|FH_F90157_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F90157_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F90157_0_0|SrvcGrp|73485|2022|PDM|1243.00|99|0.00|AETNA REHAB
20|FH_F90157_0_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE
20|FH_F90184_0_0|CSTM-ALL|CSTM-00|2020|PDM|576.00|99|0.00|ASPG II
20|FH_F90184_0_0|SrvcGrp|89669|2022|PCT|1.00|99|0.00|IMPLANTS HCPCS
20|FH_F90354_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F90354_0_0|SrvcGrp|92501|2022|PDM|144.24|99|0.00|HOSPICE IP RESPITE CARE
20|FH_F90362_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F90362_0_0|CSTM-ALL|CSTM-00|2020|PDM|1273.00|99|0.00|REMOVAL OF TISSUE FOR GRAFT
20|FH_F90362_0_0|SrvcGrp|41335|2022|PDM|12731.00|99|0.00|TOTAL HIP
20|FH_F90362_0_0|SrvcGrp|69964|2022|PDM|1697.00|99|0.00|CPT 23120
20|FH_F90362_0_0|SrvcGrp|72990|2022|PDM|389.00|99|0.00|AEG 1
20|FH_F90362_0_0|SrvcGrp|72998|2022|PDM|821.00|99|0.00|AEG 5
20|FH_F90362_0_0|SrvcGrp|73000|2022|PDM|1119.00|99|0.00|AEG 6
20|FH_F90362_0_0|SrvcGrp|73008|2022|PDM|721.00|99|0.00|AEG 10
20|FH_F90362_0_0|SrvcGrp|89941|2022|PDM|1109.00|99|0.00|ARTHROSCOPY PROCEDURES
20|FH_F90362_0_0|SrvcGrp|89942|2022|PDM|1948.00|99|0.00|PERCUTANEOUS INTRADISCAL
20|FH_F90362_0_0|SrvcGrp|89943|2022|PDM|1299.00|99|0.00|NEUROSTIMULATOR TRIAL
20|FH_F90362_0_0|SrvcGrp|89946|2022|PDM|1667.00|99|0.00|REPAIR OF KNEE LIGAMENT
20|FH_F90362_0_0|SrvcGrp|89947|2022|PDM|1667.00|99|0.00|LIGAMENT REPAIR KNEE
20|FH_F90362_0_0|SrvcGrp|89948|2022|PDM|1667.00|99|0.00|LIGAMENT RECONSTRUCTION
20|FH_F90362_0_0|SrvcGrp|89949|2022|PDM|4509.00|99|0.00|HIP ARTHOSCOPY
20|FH_F90362_0_0|SrvcGrp|89950|2022|PDM|1273.00|99|0.00|PACEMAKER UPGRADE REMOVE REPLACE LEAD
20|FH_F90422_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F90422_0_0|SrvcGrp|13722|2022|PDM|85.00|99|0.00|HOSPICE SERVICE - ROUTINE HOME CARE
20|FH_F90453_65203_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F90453_65203_0|SrvcGrp|73485|2022|PDM|941.00|99|0.00|AETNA REHAB
20|FH_F90455_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F90455_0_0|SrvcGrp|46104|2022|PDM|128.00|99|0.00|HOME VISIT - PRENATAL
20|FH_F90455_0_0|SrvcGrp|65645|2022|PDM|128.00|99|0.00|NURSING CARE IN HOME - S9123
20|FH_F90455_0_0|SrvcGrp|90064|2022|PDM|69.50|99|0.00|PHOTOTHERAPY
20|FH_F90455_0_0|SrvcGrp|9263|2022|PDM|151.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F90559_0_0|SrvcGrp|72990|2022|PDM|500.00|99|0.00|AEG 1
20|FH_F90559_0_0|SrvcGrp|72992|2022|PDM|671.00|99|0.00|AEG 2
20|FH_F90564_0_0|CSTM-ALL|CSTM-00|2020|PCT|66.60|99|0.00|GENERAL ACUTE CARE
20|FH_F90653_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F90653_0_0|SrvcGrp|25697|2022|PDM|750.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F90653_0_0|SrvcGrp|471|2022|PDM|1800.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F90654_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F90654_0_0|SrvcGrp|25696|2022|PDM|950.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F90654_0_0|SrvcGrp|25697|2022|PDM|750.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F90654_0_0|SrvcGrp|58764|2022|PCT|0.70|99|0.00|PHYSICIANS FEES
20|FH_F90691_0_0|SrvcGrp|72994|2022|PDM|570.00|99|0.00|AEG 3
20|FH_F90691_0_0|SrvcGrp|72996|2022|PDM|699.00|99|0.00|AEG 4
20|FH_F90698_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F90698_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 1 (NO REV)
20|FH_F90700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F90700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F90700_0_0|SrvcGrp|3809|2022|PDM|1637.00|99|0.00|HOSPICE CARE
20|FH_F90714_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F90714_0_0|SrvcGrp|11663|2022|PCT|0.50|99|0.00|IMPLANTS
20|FH_F90714_0_0|SrvcGrp|73000|2022|PDM|915.00|99|0.00|AEG 6
20|FH_F90811_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F90811_0_0|CSTM-ALL|CSTM-00|2020|PDM|958.50|99|0.00|AEG 4 (NO REV)
20|FH_F90811_0_0|SrvcGrp|11663|2022|PCT|0.50|99|0.00|IMPLANTS
20|FH_F90811_0_0|SrvcGrp|83838|2022|PDM|1850.00|99|0.00|SUSPENSION OF BREAST
20|FH_F90811_0_0|SrvcGrp|84180|2022|PDM|2800.00|99|0.00|AETNA DELAYED BREAST PROSTHESIS
20|FH_F90811_0_0|SrvcGrp|90376|2022|PDM|10000.00|99|0.00|REVISION OF KNEE JOINTLANT
20|FH_F90811_0_0|SrvcGrp|90421|2022|PDM|4000.00|99|0.00|REPAIR OF ANKLE FRACTURE
20|FH_F90811_0_0|SrvcGrp|90422|2022|PDM|3500.00|99|0.00|REPAIR GRAFT RADIUS OR ULNA
20|FH_F90811_0_0|SrvcGrp|90427|2022|PDM|6500.00|99|0.00|CERVICAL SPINAL FUSION
20|FH_F90811_0_0|SrvcGrp|90434|2022|PDM|2000.00|99|0.00|BREAST RECONSTRUCTION
20|FH_F90811_0_0|SrvcGrp|90436|2022|PDM|10000.00|99|0.00|TOTAL HIP ARTHROPLASTY
20|FH_F90811_0_0|SrvcGrp|90437|2022|PDM|2700.00|99|0.00|ANKLE SURGICAL PROCEDURES
20|FH_F90817_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F90817_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 4 (NO REV)
20|FH_F90817_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 1 (NO REV)
20|FH_F90817_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|AEG 3 (NO REV)
20|FH_F90817_0_0|SrvcGrp|41325|2022|PDM|7520.00|99|0.00|OP SURGERY CPT 24342
20|FH_F90817_0_0|SrvcGrp|82720|2022|PDM|1607.00|99|0.00|WRIST ENDOSCOPY/SURGERY
20|FH_F90817_0_0|SrvcGrp|83644|2022|PDM|1880.00|99|0.00|CPT 30465
20|FH_F90817_0_0|SrvcGrp|87769|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F90817_0_0|SrvcGrp|90063|2022|PDM|2096.00|99|0.00|REPAIR BICEPS TENDON RUPTURE
20|FH_F90817_0_0|SrvcGrp|90357|2022|PDM|2293.00|99|0.00|REPAIR OF ANKLE FRACTURE
20|FH_F90817_0_0|SrvcGrp|90363|2022|PDM|2650.00|99|0.00|REVISE/IMPLANT FINGER JOINT
20|FH_F90817_0_0|SrvcGrp|90370|2022|PDM|1057.00|99|0.00|REVISE EXTERNAL EAR
20|FH_F90817_0_0|SrvcGrp|90373|2022|PDM|2280.00|99|0.00|SHOULDER ARTHROSCOPY/SURGERY
20|FH_F90817_0_0|SrvcGrp|90376|2022|PDM|6580.00|99|0.00|REVISION OF KNEE JOINTLANT
20|FH_F90817_0_0|SrvcGrp|90379|2022|PDM|2280.00|99|0.00|SHOULDER ARTHROSCOPY/SURGERY
20|FH_F90817_0_0|SrvcGrp|90381|2022|PDM|2280.00|99|0.00|KNEE ARTHROSCOPY SURGICAL
20|FH_F90817_0_0|SrvcGrp|90383|2022|PDM|7520.00|99|0.00|RECONSTRUCT SHOULDER JOINT
20|FH_F90817_0_0|SrvcGrp|91005|2022|PDM|1198.00|99|0.00|FUSION OF FINGER JOINT (HCFA)
20|FH_F90817_0_0|SrvcGrp|91012|2022|PDM|2280.00|99|0.00|ARTHROSCOPIC FRACTURE TX (HCFA)
20|FH_F90817_0_0|SrvcGrp|91014|2022|PDM|1574.00|99|0.00|KNEE ARTHROSCOPY/SURGERY (HCFA)
20|FH_F90817_0_0|SrvcGrp|91017|2022|PDM|1692.00|99|0.00|NASAL/SINUS ENDOSCOPY (HCFA)
20|FH_F90817_0_0|SrvcGrp|91019|2022|PDM|1692.00|99|0.00|EXPLORE/DRAIN EYE SOCKET (HCFA)
20|FH_F90817_0_0|SrvcGrp|91023|2022|PDM|2096.00|99|0.00|REBUILD OUTER EAR CANAL (HCFA)
20|FH_F90817_0_0|SrvcGrp|91038|2022|PDM|1880.00|99|0.00|REPAIR NASAL STENOSIS (HCFA)
20|FH_F90817_0_0|SrvcGrp|91040|2022|PDM|1692.00|99|0.00|REPAIR WRIST JOINT(S) (HCFA)
20|FH_F90817_0_0|SrvcGrp|91041|2022|PDM|1607.00|99|0.00|WRIST ENDOSCOPY/SURGERY (HCFA)
20|FH_F90817_0_0|SrvcGrp|91043|2022|PDM|1574.00|99|0.00|ARTHROSCOPY/SURGERY (HCFA)
20|FH_F90817_0_0|SrvcGrp|91049|2022|PDM|2096.00|99|0.00|REPAIR BICEPS TENDON RUPTURE (HCFA)
20|FH_F90818_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F90818_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 3 (NO REV)
20|FH_F90818_0_0|CSTM-ALL|CSTM-00|2020|PDM|1345.00|99|0.00|AEG 5  (NO REV)
20|FH_F90818_0_0|CSTM-ALL|CSTM-00|2020|PDM|2515.00|99|0.00|AEG 9 (NO REV)
20|FH_F90818_0_0|SrvcGrp|11673|2022|PDM|7500.00|99|0.00|CPT 29888
20|FH_F90818_0_0|SrvcGrp|33967|2022|PDM|4600.00|99|0.00|CPT 47562
20|FH_F90818_0_0|SrvcGrp|59840|2022|PDM|2500.00|99|0.00|TYMPANOSTOMY
20|FH_F90818_0_0|SrvcGrp|76243|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F90818_0_0|SrvcGrp|78098|2022|PDM|3050.00|99|0.00|AETNA REMOVAL OF TONSILS
20|FH_F90818_0_0|SrvcGrp|79595|2022|PDM|1625.00|99|0.00|CPT 45385
20|FH_F90818_0_0|SrvcGrp|89885|2022|PDM|4100.00|99|0.00|AETNA REPAIR HERNIA
20|FH_F90818_0_0|SrvcGrp|89888|2022|PDM|4100.00|99|0.00|AETNA SUSPENSION OF TESTIS
20|FH_F90818_0_0|SrvcGrp|90815|2022|PDM|3125.00|99|0.00|REPAIR UMBILICAL HERNIA (>5 YRS)
20|FH_F90818_0_0|SrvcGrp|90816|2022|PDM|4100.00|99|0.00|REPAIR HERNIA INIT (>5 YRS)
20|FH_F90831_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F90839_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F90839_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F90840_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F90840_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F90840_0_0|CSTM-ALL|CSTM-00|2020|PDM|1563.00|99|0.00|AEG 7 (NO REV)
20|FH_F90840_0_0|CSTM-ALL|CSTM-00|2020|PDM|2103.00|99|0.00|AEG 9 (NO REV)
20|FH_F90840_0_0|CSTM-ALL|CSTM-00|2020|PDM|701.00|99|0.00|AEG 2 (NO REV)
20|FH_F90840_0_0|CSTM-ALL|CSTM-00|2020|PDM|989.00|99|0.00|AEG 4 (NO REV)
20|FH_F90840_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F90852_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F90852_0_0|SrvcGrp|79458|2022|PDM|0.10|99|0.00|MED RECORD COPY
20|FH_F90940_0_0|SrvcGrp|82981|2022|PDM|137.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F90958_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F91056_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F91067_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F91067_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F91067_0_0|SrvcGrp|39906|2022|PDM|2500.00|99|0.00|MASTECTOMY, SIMPLE, COMPLETE
20|FH_F91067_0_0|SrvcGrp|64517|2022|PDM|2500.00|99|0.00|REDUCE MANMMAPLASTY
20|FH_F91067_0_0|SrvcGrp|72994|2022|PDM|630.00|99|0.00|AEG 3
20|FH_F91067_0_0|SrvcGrp|73000|2022|PDM|1019.00|99|0.00|AEG 6
20|FH_F91067_0_0|SrvcGrp|73002|2022|PDM|1229.00|99|0.00|AEG 7
20|FH_F91067_0_0|SrvcGrp|73004|2022|PDM|1202.00|99|0.00|AEG 8
20|FH_F91073_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.90|99|0.00|OP SVCS
20|FH_F91077_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS
20|FH_F91111_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F91171_0_0|CSTM-ALL|CSTM-00|2020|PDM|888.00|99|0.00|AEG 5  (NO REV)
20|FH_F91171_0_0|SrvcGrp|65625|2022|PDM|1202.00|99|0.00|CPT 30520
20|FH_F91259_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F91284_0_0|CSTM-ALL|CSTM-00|2020|PDM|1985.00|99|0.00|AEG 5  (NO REV)
20|FH_F91331_0_0|CSTM-ALL|CSTM-00|2020|PDM|1192.52|99|0.00|ASPG VII
20|FH_F91331_0_0|CSTM-ALL|CSTM-00|2020|PDM|1604.81|99|0.00|ASPG IX
20|FH_F91331_0_0|CSTM-ALL|CSTM-00|2020|PDM|989.98|99|0.00|ASPG VI
20|FH_F91412_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F91412_0_0|CSTM-ALL|CSTM-00|2020|PDM|932.78|99|0.00|AEG 3 (NO REV)
20|FH_F91412_0_0|SrvcGrp|87058|2022|PDM|4435.31|99|0.00|LOW BACK DISK SURGERY
20|FH_F91412_0_0|SrvcGrp|88490|2022|PDM|1619.20|99|0.00|AETNA SPINE INJECTIONS
20|FH_F91451_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F91451_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F91572_30076_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE
20|FH_F91572_30076_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F91575_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F91594_0_0|SrvcGrp|75399|2022|PDM|0.10|99|0.00|MED RECORD COPY
20|FH_F91617_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F91617_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F91634_0_0|CSTM-ALL|CSTM-00|2020|PDM|1923.00|99|0.00|AEG 9 (NO REV)
20|FH_F91634_0_0|CSTM-ALL|CSTM-00|2020|PDM|636.00|99|0.00|AEG 2 (NO REV)
20|FH_F91634_0_0|SrvcGrp|11663|2022|PCT|0.50|99|0.00|IMPLANTS
20|FH_F91635_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.30|99|0.00|GENERAL ACUTE CARE
20|FH_F91635_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.10|99|0.00|OP SVCS
20|FH_F91636_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE
20|FH_F91641_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F91641_0_0|CSTM-ALL|CSTM-00|2020|PDM|2350.26|99|0.00|AEG 7 (NO REV)
20|FH_F91641_0_0|SrvcGrp|111992|2022|PDM|1560.60|99|0.00|CARDIAC CATHETERIZATION
20|FH_F91739_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F91752_0_0|SrvcGrp|80285|2022|PDM|133.40|99|0.00|HOSPICE ROUTINE HOME CARE
20|FH_F91772_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F91787_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F91819_0_0|CSTM-ALL|CSTM-00|2020|PDM|973.00|99|0.00|COVENTRY ENHANCED GROUPER 8
20|FH_F91819_0_0|SrvcGrp|28243|2022|PCT|0.50|99|0.00|SUPPLIES AND DEVICES
20|FH_F91835_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|GENERAL ACUTE CARE
20|FH_F91876_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F91876_0_0|SrvcGrp|11663|2022|PCT|1.05|99|0.00|IMPLANTS
20|FH_F91876_0_0|SrvcGrp|28551|2022|PDM|2345.00|99|0.00|REPAIR OF COMPLEX RETINAL DETACHMENT
20|FH_F91876_0_0|SrvcGrp|46890|2022|PDM|2200.00|99|0.00|IMPLANT EYE SHUNT
20|FH_F91876_0_0|SrvcGrp|70749|2022|PDM|2010.00|99|0.00|CPT 29823
20|FH_F91876_0_0|SrvcGrp|72990|2022|PDM|604.00|99|0.00|AEG 1
20|FH_F91876_0_0|SrvcGrp|73000|2022|PDM|2217.00|99|0.00|AEG 6
20|FH_F91876_0_0|SrvcGrp|73002|2022|PDM|2671.00|99|0.00|AEG 7
20|FH_F91898_0_0|CSTM-ALL|CSTM-00|2020|PDM|10138.00|99|0.00|AETNA SURGICAL CARE MS DRG
20|FH_F91898_0_0|CSTM-ALL|CSTM-00|2020|PDM|13099.00|99|0.00|AEG 6 (NO REV)
20|FH_F91898_0_0|CSTM-ALL|CSTM-00|2020|PDM|15072.00|99|0.00|AEG 7 (NO REV)
20|FH_F91898_0_0|CSTM-ALL|CSTM-00|2020|PDM|6206.00|99|0.00|AEG 1 (NO REV)
20|FH_F91898_0_0|CSTM-ALL|CSTM-00|2020|PDM|8772.00|99|0.00|AEG 3 (NO REV)
20|FH_F91898_0_0|SrvcGrp|14048|2022|PCT|0.95|99|0.00|EXTRA CORPOREAL MEMBRANE OXYGEN
20|FH_F91898_0_0|SrvcGrp|14066|2022|PCT|0.80|99|0.00|HOSPICE SVCS
20|FH_F91898_0_0|SrvcGrp|27251|2022|PDM|338.00|99|0.00|CRISIS INTERVENTION
20|FH_F91898_0_0|SrvcGrp|47250|2022|PDM|2855.00|99|0.00|MS DRG 876, 880-887 ONLY
20|FH_F91898_0_0|SrvcGrp|73485|2022|PDM|3693.00|99|0.00|AETNA REHAB
20|FH_F91898_0_0|SrvcGrp|73602|2022|PDM|1644.00|99|0.00|AETNA NEWBORN NURSERY I
20|FH_F91898_0_0|SrvcGrp|941|2022|PDM|7435.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F91900_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|COVENTRY ENHANCED GROUPER 10
20|FH_F91900_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE
20|FH_F91900_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F91900_0_0|CSTM-ALL|CSTM-00|2020|PDM|1025.00|99|0.00|COVENTRY ENHANCED GROUPER 8
20|FH_F91900_0_0|CSTM-ALL|CSTM-00|2020|PDM|1060.00|99|0.00|COVENTRY ENHANCED GROUPER 7
20|FH_F91900_0_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|COVENTRY ENHANCED GROUPER 9
20|FH_F91900_0_0|CSTM-ALL|CSTM-00|2020|PDM|475.00|99|0.00|COVENTRY ENHANCED GROUPER 2
20|FH_F91900_0_0|CSTM-ALL|CSTM-00|2020|PDM|875.00|99|0.00|COVENTRY ENHANCED GROUPER 6
20|FH_F91900_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F91912_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F91912_0_0|SrvcGrp|73605|2022|PDM|1064.00|99|0.00|AETNA ACUTE PSYCH
20|FH_F91912_0_0|SrvcGrp|87441|2022|PDM|431.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY (HCFA)
20|FH_F91912_0_0|SrvcGrp|90388|2022|PDM|431.00|99|0.00|ELECTROCONVULSIVE THERAPY (HCFA)
20|FH_F91913_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F91913_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F91913_0_0|SrvcGrp|72998|2022|PDM|717.00|99|0.00|AEG 5
20|FH_F91940_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F91940_0_0|CSTM-ALL|CSTM-00|2020|PDM|1197.00|99|0.00|AEG 10 (NO REV)
20|FH_F91973_0_0|CSTM-ALL|CSTM-00|2020|PDM|1481.00|99|0.00|AEG 3 (NO REV)
20|FH_F91973_0_0|CSTM-ALL|CSTM-00|2020|PDM|2506.00|99|0.00|AEG 5  (NO REV)
20|FH_F91973_0_0|CSTM-ALL|CSTM-00|2020|PDM|830.00|99|0.00|AEG 2 (NO REV)
20|FH_F91973_0_0|SrvcGrp|74585|2022|PCT|0.85|99|0.00|AETNA OP IMPLANTS
20|FH_F91975_0_0|CSTM-ALL|CSTM-00|2020|PDM|335.00|99|0.00|AEG 10 (NO REV)
20|FH_F91975_0_0|CSTM-ALL|CSTM-00|2020|PDM|993.00|99|0.00|AEG 7 (NO REV)
20|FH_F91975_0_0|SrvcGrp|91862|2022|PDM|452.00|99|0.00|COLONOSCOPY PROCEDURES 2
20|FH_F91994_0_0|SrvcGrp|13990|2022|PCT|1.15|99|0.00|PACEMAKER
20|FH_F91994_0_0|SrvcGrp|44064|2022|PDM|1368.00|99|0.00|CPT 52351
20|FH_F91994_0_0|SrvcGrp|63471|2022|PDM|17842.00|99|0.00|CPT 64590
20|FH_F91994_0_0|SrvcGrp|72990|2022|PDM|500.00|99|0.00|AEG 1
20|FH_F91994_0_0|SrvcGrp|72994|2022|PDM|1200.00|99|0.00|AEG 3
20|FH_F91994_0_0|SrvcGrp|87026|2022|PDM|750.00|99|0.00|CYSTOSCOPY AND TREATMENT
20|FH_F91998_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F91998_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F91998_0_0|SrvcGrp|11673|2022|PDM|1020.00|99|0.00|CPT 29888
20|FH_F91998_0_0|SrvcGrp|58636|2022|PDM|1836.00|99|0.00|CPT 62362
20|FH_F91998_0_0|SrvcGrp|72990|2022|PDM|360.00|99|0.00|AEG 1
20|FH_F91998_0_0|SrvcGrp|73002|2022|PDM|1074.00|99|0.00|AEG 7
20|FH_F91998_0_0|SrvcGrp|73004|2022|PDM|1054.00|99|0.00|AEG 8
20|FH_F91998_0_0|SrvcGrp|73008|2022|PDM|679.00|99|0.00|AEG 10
20|FH_F91998_0_0|SrvcGrp|82107|2022|PDM|1224.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F91998_0_0|SrvcGrp|88739|2022|PDM|1224.00|99|0.00|IMPLANT SPINAL CANAL
20|FH_F91998_0_0|SrvcGrp|89569|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F91998_0_0|SrvcGrp|89636|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F91998_0_0|SrvcGrp|89946|2022|PDM|1750.00|99|0.00|REPAIR OF KNEE LIGAMENT
20|FH_F91998_0_0|SrvcGrp|90428|2022|PDM|4500.00|99|0.00|INSERT SPINE FIXATION DEVICE
20|FH_F91998_0_0|SrvcGrp|91886|2022|PDM|1100.00|99|0.00|REPAIR FLEXOR TENDON ZONE 2
20|FH_F91998_0_0|SrvcGrp|91891|2022|PDM|1075.00|99|0.00|REMOVAL OF LOOSE BODY
20|FH_F92034_0_0|SrvcGrp|103865|2022|PDM|1300.00|99|0.00|PT PRGRM FOR IMPLT NEUROSTIM
20|FH_F92034_0_0|SrvcGrp|72998|2022|PDM|945.00|99|0.00|AEG 5
20|FH_F92034_0_0|SrvcGrp|73004|2022|PDM|1282.00|99|0.00|AEG 8
20|FH_F92091_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F92091_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F92091_0_0|SrvcGrp|72992|2022|PDM|1090.00|99|0.00|AEG 2
20|FH_F92091_0_0|SrvcGrp|72994|2022|PDM|2100.00|99|0.00|AEG 3
20|FH_F92091_0_0|SrvcGrp|72996|2022|PDM|2725.00|99|0.00|AEG 4
20|FH_F92091_0_0|SrvcGrp|72998|2022|PDM|2925.00|99|0.00|AEG 5
20|FH_F92091_0_0|SrvcGrp|73000|2022|PDM|1750.00|99|0.00|AEG 6
20|FH_F92091_0_0|SrvcGrp|89980|2022|PDM|3800.00|99|0.00|OPEN TREATMENT OF DISTAL
20|FH_F92091_0_0|SrvcGrp|89981|2022|PDM|3600.00|99|0.00|SHOULDER ARTHROSCOPY / SURGERY
20|FH_F92119_0_0|CSTM-ALL|CSTM-00|2020|PDM|313.00|99|0.00|AEG 1 (NO REV)
20|FH_F92119_0_0|CSTM-ALL|CSTM-00|2020|PDM|591.00|99|0.00|AEG 4 (NO REV)
20|FH_F92119_0_0|CSTM-ALL|CSTM-00|2020|PDM|785.00|99|0.00|AEG 6 (NO REV)
20|FH_F92120_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F92120_0_0|CSTM-ALL|CSTM-00|2020|PDM|2544.00|99|0.00|AEG 9 (NO REV)
20|FH_F92120_0_0|SrvcGrp|89978|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F92188_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F92212_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F92212_0_0|CSTM-ALL|CSTM-00|2020|PDM|444.00|99|0.00|AEG 2 (NO REV)
20|FH_F92212_0_0|CSTM-ALL|CSTM-00|2020|PDM|508.00|99|0.00|AEG 3 (NO REV)
20|FH_F92212_0_0|CSTM-ALL|CSTM-00|2020|PDM|824.00|99|0.00|AEG 6 (NO REV)
20|FH_F92212_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F92212_0_0|SrvcGrp|90682|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F92212_0_0|SrvcGrp|92085|2022|PDM|1737.00|99|0.00|RETINA PROCEDURES
20|FH_F92392_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F92392_0_0|SrvcGrp|11336|2022|PCT|0.50|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F92392_0_0|SrvcGrp|79720|2022|PDM|3348.00|99|0.00|ACUTE REHAB II
20|FH_F92411_0_0|SrvcGrp|3809|2022|PDM|588.89|99|0.00|HOSPICE CARE
20|FH_F92454_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F92454_0_0|SrvcGrp|35669|2022|PDM|5900.00|99|0.00|CPT 63650
20|FH_F92454_0_0|SrvcGrp|90798|2022|PDM|6000.00|99|0.00|IMPLANT SPINE INFUSION PUMP19
20|FH_F92474_0_0|CSTM-ALL|CSTM-00|2020|PDM|1055.00|99|0.00|AEG 7 (NO REV)
20|FH_F92474_0_0|CSTM-ALL|CSTM-00|2020|PDM|1211.00|99|0.00|AEG 9 (NO REV)
20|FH_F92474_0_0|CSTM-ALL|CSTM-00|2020|PDM|785.00|99|0.00|AEG 5  (NO REV)
20|FH_F92474_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F92474_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F92477_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F92477_0_0|SrvcGrp|10391|2022|PDM|1260.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F92477_0_0|SrvcGrp|11199|2022|PDM|525.00|99|0.00|HYPERBARIC CHAMBER
20|FH_F92477_0_0|SrvcGrp|73485|2022|PDM|945.00|99|0.00|AETNA REHAB
20|FH_F92477_0_0|SrvcGrp|90101|2022|PDM|0.10|99|0.00|AETNA MED RECORD COPY
20|FH_F92493_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F92493_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F92493_0_0|CSTM-ALL|CSTM-00|2020|PDM|1073.00|99|0.00|AEG 2 (NO REV)
20|FH_F92493_0_0|CSTM-ALL|CSTM-00|2020|PDM|1640.10|99|0.00|AEG 4 (NO REV)
20|FH_F92493_0_0|CSTM-ALL|CSTM-00|2020|PDM|1718.20|99|0.00|AEG 5  (NO REV)
20|FH_F92493_0_0|CSTM-ALL|CSTM-00|2020|PDM|2524.83|99|0.00|AEG 9 (NO REV)
20|FH_F92493_0_0|SrvcGrp|11663|2022|PCT|1.10|99|0.00|IMPLANTS
20|FH_F92493_0_0|SrvcGrp|11673|2022|PDM|3899.28|99|0.00|CPT 29888
20|FH_F92493_0_0|SrvcGrp|26273|2022|PDM|3119.66|99|0.00|CPT 29880
20|FH_F92493_0_0|SrvcGrp|26274|2022|PDM|2601.06|99|0.00|CPT 29877
20|FH_F92493_0_0|SrvcGrp|26275|2022|PDM|2601.06|99|0.00|CPT 29826
20|FH_F92493_0_0|SrvcGrp|34609|2022|PDM|1949.64|99|0.00|PODIATRIC PROCEDURE CPT 28080
20|FH_F92493_0_0|SrvcGrp|35668|2022|PDM|2989.14|99|0.00|CPT 29824
20|FH_F92493_0_0|SrvcGrp|35670|2022|PDM|12311.20|99|0.00|SPINAL NEUROSTIMULATORS PROCEDURE
20|FH_F92493_0_0|SrvcGrp|41334|2022|PDM|20798.09|99|0.00|TOTAL KNEE
20|FH_F92493_0_0|SrvcGrp|67065|2022|PDM|20241.10|99|0.00|CERVICAL SURGERY
20|FH_F92493_0_0|SrvcGrp|82720|2022|PDM|3250.17|99|0.00|WRIST ENDOSCOPY/SURGERY
20|FH_F92493_0_0|SrvcGrp|84939|2022|PDM|12999.53|99|0.00|SHOULDER JOINT
20|FH_F92493_0_0|SrvcGrp|88157|2022|PDM|22098.62|99|0.00|TOTAL HIP ARTHROPLASTY
20|FH_F92493_0_0|SrvcGrp|88487|2022|PDM|9539.20|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION
20|FH_F92493_0_0|SrvcGrp|92363|2022|PDM|12999.53|99|0.00|OSTEOCHONDRAL ALLOGRAFT KNEE
20|FH_F92493_0_0|SrvcGrp|92366|2022|PDM|2730.42|99|0.00|REPAIR ACHILLES TENDON
20|FH_F92493_0_0|SrvcGrp|92369|2022|PDM|2601.06|99|0.00|REPAIR OF ANKLE LIGAMENTS
20|FH_F92493_0_0|SrvcGrp|92408|2022|PDM|9539.20|99|0.00|PERQ VERTEBRAL AUGMENTATION
20|FH_F92493_0_0|SrvcGrp|92409|2022|PDM|8263.20|99|0.00|PERQ CERVICOTHORACIC INJECT
20|FH_F92493_0_0|SrvcGrp|97730|2022|PDM|16193.10|99|0.00|REVERSE HIP JOINT
20|FH_F92493_0_0|SrvcGrp|97895|2022|PDM|16193.10|99|0.00|REVISE KNEE 2
20|FH_F92496_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE
20|FH_F92516_0_0|SrvcGrp|72994|2022|PDM|516.00|99|0.00|AEG 3
20|FH_F92516_0_0|SrvcGrp|72996|2022|PDM|636.00|99|0.00|AEG 4
20|FH_F92516_0_0|SrvcGrp|73008|2022|PDM|693.00|99|0.00|AEG 10
20|FH_F92531_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F92531_0_0|SrvcGrp|81859|2022|PDM|2408.00|99|0.00|AETNA CARDIAC CATH
20|FH_F92531_0_0|SrvcGrp|88162|2022|PDM|3383.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON
20|FH_F92531_0_0|SrvcGrp|91564|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F92599_0_0|SrvcGrp|75483|2022|PDM|733.00|99|0.00|AEG 3
20|FH_F92599_0_0|SrvcGrp|75495|2022|PDM|1926.00|99|0.00|AEG 9
20|FH_F92618_0_0|SrvcGrp|76094|2022|PDM|136.51|99|0.00|HOSPICE ROUTINE HOME CARE
20|FH_F92655_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 2 (NO REV)
20|FH_F92659_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F92659_0_0|CSTM-ALL|CSTM-00|2020|PDM|427.00|99|0.00|AEG 1 (NO REV)
20|FH_F92659_0_0|CSTM-ALL|CSTM-00|2020|PDM|570.00|99|0.00|AEG 2 (NO REV)
20|FH_F92659_0_0|SrvcGrp|68280|2022|PDM|1485.00|99|0.00|CPT 67040
20|FH_F92659_0_0|SrvcGrp|92548|2022|PDM|652.00|99|0.00|REMOVAL OF EYE LESION
20|FH_F92716_0_0|SrvcGrp|72992|2022|PDM|529.00|99|0.00|AEG 2
20|FH_F92760_0_0|CSTM-ALL|CSTM-00|2020|PDM|1752.00|99|0.00|OP SVCS
20|FH_F92792_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F92792_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F92792_0_0|CSTM-ALL|CSTM-00|2020|PDM|1054.90|99|0.00|AEG 4 (NO REV)
20|FH_F92792_0_0|CSTM-ALL|CSTM-00|2020|PDM|1201.20|99|0.00|GEORGIA EYE INSTITUTE AEG 05 (NO REV)
20|FH_F92792_0_0|CSTM-ALL|CSTM-00|2020|PDM|1645.60|99|0.00|AEG 8 (NO REV)
20|FH_F92792_0_0|CSTM-ALL|CSTM-00|2020|PDM|2242.90|99|0.00|AEG 9 (NO REV)
20|FH_F92792_0_0|CSTM-ALL|CSTM-00|2020|PDM|853.60|99|0.00|AEG 3 (NO REV)
20|FH_F92792_0_0|SrvcGrp|28547|2022|PDM|2200.00|99|0.00|VITRECTOMY
20|FH_F92792_0_0|SrvcGrp|28548|2022|PDM|1320.00|99|0.00|VITRECTOMY
20|FH_F92792_0_0|SrvcGrp|38907|2022|PDM|1320.00|99|0.00|CPT 66170 - FISTULIZATION OF SCLERA FOR GLAUCOMA
20|FH_F92792_0_0|SrvcGrp|38909|2022|PDM|1320.00|99|0.00|CPT 67036 - VITRECTOMY, MECHANICAL
20|FH_F92792_0_0|SrvcGrp|45583|2022|PDM|2200.00|99|0.00|CPT 65730
20|FH_F92792_0_0|SrvcGrp|46887|2022|PDM|2200.00|99|0.00|REPAIR DETACHED RETINA
20|FH_F92792_0_0|SrvcGrp|84280|2022|PDM|2200.00|99|0.00|CORNEAL TRANSPLANT
20|FH_F92792_0_0|SrvcGrp|87759|2022|PDM|1320.00|99|0.00|REINFORCE/GRAFT EYE WALL
20|FH_F92792_0_0|SrvcGrp|88154|2022|PDM|2200.00|99|0.00|LASER TREATMENT OLD RETINA
20|FH_F92833_0_0|CSTM-ALL|CSTM-00|2020|PDM|1338.00|99|0.00|AEG 4 (NO REV)
20|FH_F92833_0_0|CSTM-ALL|CSTM-00|2020|PDM|1752.00|99|0.00|AEG 6 (NO REV)
20|FH_F92833_0_0|SrvcGrp|23585|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F92833_0_0|SrvcGrp|26273|2022|PDM|2215.00|99|0.00|CPT 29880
20|FH_F92833_0_0|SrvcGrp|45583|2022|PDM|2992.00|99|0.00|CPT 65730
20|FH_F92833_0_0|SrvcGrp|84279|2022|PDM|2992.00|99|0.00|CORNEAL TRANSPLANT
20|FH_F92852_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OP IMAGING ENHANC. SUBSTANCES (IMAGENHANCE)
20|FH_F92852_0_0|CSTM-ALL|CSTM-00|2020|PDM|1201.20|99|0.00|AETNA GLENNVILLE 2016 AEG 5
20|FH_F92852_0_0|CSTM-ALL|CSTM-00|2020|PDM|1393.70|99|0.00|AETNA GLENNVILLE 2016 AEG 6
20|FH_F92852_0_0|CSTM-ALL|CSTM-00|2020|PDM|1870.00|99|0.00|AETNA GLENNVILLE 2016 AEG 7
20|FH_F92852_0_0|CSTM-ALL|CSTM-00|2020|PDM|2242.90|99|0.00|AETNA GLENNVILLE 2016 AEG 10
20|FH_F92852_0_0|SrvcGrp|28551|2022|PDM|2200.00|99|0.00|REPAIR OF COMPLEX RETINAL DETACHMENT
20|FH_F92871_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F92871_0_0|CSTM-ALL|CSTM-00|2020|PDM|1151.00|99|0.00|AEG 8 (NO REV)
20|FH_F92871_0_0|CSTM-ALL|CSTM-00|2020|PDM|1632.00|99|0.00|AEG 7 (NO REV)
20|FH_F92871_0_0|CSTM-ALL|CSTM-00|2020|PDM|404.00|99|0.00|AEG 1 (NO REV)
20|FH_F92871_0_0|SrvcGrp|77507|2022|PCT|1.00|99|0.00|AETNA CORNEAL TISSUE HANDLING
20|FH_F92871_0_0|SrvcGrp|86919|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH INCIDENTAL CODES
20|FH_F92912_0_0|CSTM-ALL|CSTM-00|2020|PCT|76.00|99|0.00|OP SVCS
20|FH_F92912_0_0|CSTM-ALL|CSTM-00|2020|PCT|9500.00|99|0.00|TIMELY FILING
20|FH_F92935_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|AEG 10 (NO REV)
20|FH_F92935_0_0|CSTM-ALL|CSTM-00|2020|PDM|1281.00|99|0.00|AEG 8 (NO REV)
20|FH_F92935_0_0|CSTM-ALL|CSTM-00|2020|PDM|584.00|99|0.00|AEG 2 (NO REV)
20|FH_F92935_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|AEG 4 (NO REV)
20|FH_F92959_0_0|SrvcGrp|22954|2022|PDM|131.37|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F92959_0_0|SrvcGrp|26001|2022|PDM|136.71|99|0.00|HOSPICE RESPITE SVCS
20|FH_F92959_0_0|SrvcGrp|3809|2022|PDM|585.52|99|0.00|HOSPICE CARE
20|FH_F92964_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F92972_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.63|99|0.00|GENERAL ACUTE CARE
20|FH_F92993_0_0|CSTM-ALL|CSTM-00|2020|PDM|288.96|99|0.00|CPT 95805 (W/MOD TC)
20|FH_F92993_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AETNA SLEEP STUDIES W/O MOD 26 & TC
20|FH_F92993_0_0|CSTM-ALL|CSTM-00|2020|PDM|73.56|99|0.00|AETNA SLEEP STUDY CPT 95801
20|FH_F92993_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|POLYSOMNOGRAPHY W/O MOD 26 & TC
20|FH_F92993_0_0|SrvcGrp|86480|2022|PDM|68.79|99|0.00|AETNA POLYSOMNOGRAPHY (MOD 26)
20|FH_F92993_0_0|SrvcGrp|92839|2022|PDM|63.00|99|0.00|AETNA SLEEP STUDY (MOD 26)
20|FH_F93119_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F93119_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F93119_0_0|SrvcGrp|471|2022|PDM|834.45|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F93119_0_0|SrvcGrp|472|2022|PDM|675.51|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F93119_0_0|SrvcGrp|93274|2022|PDM|675.51|99|0.00|SKILLED CARE LEVEL I AND II
20|FH_F93136_0_0|SrvcGrp|72998|2022|PDM|717.00|99|0.00|AEG 5
20|FH_F93136_0_0|SrvcGrp|73006|2022|PDM|1339.00|99|0.00|AEG 9
20|FH_F93138_0_0|SrvcGrp|82981|2022|PDM|105.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F93171_0_0|CSTM-ALL|CSTM-00|2020|PCT|12000.00|99|0.00|TIMELY FILING
20|FH_F93171_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|AETNA CARDIAC CATHETERIZATION
20|FH_F93171_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|CARDIAC CATHETERIZATION INJECTIONS
20|FH_F93172_0_0|CSTM-ALL|CSTM-00|2020|PCT|12000.00|99|0.00|TIMELY FILING
20|FH_F93172_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F93212_0_0|CSTM-ALL|CSTM-00|2020|PDM|1311.00|99|0.00|AEG 3 (NO REV)
20|FH_F93212_0_0|CSTM-ALL|CSTM-00|2020|PDM|2120.00|99|0.00|AEG 7 (NO REV)
20|FH_F93212_0_0|CSTM-ALL|CSTM-00|2020|PDM|832.00|99|0.00|AEG 1 (NO REV)
20|FH_F93232_0_0|SrvcGrp|42785|2022|PDM|45.00|99|0.00|SPEECH THERAPY  SRVCS
20|FH_F93232_0_0|SrvcGrp|473|2022|PDM|315.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F93237_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F93252_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F93252_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 6 (NO REV) 2016 BRANDON ASC
20|FH_F93252_0_0|CSTM-ALL|CSTM-00|2020|PDM|779.00|99|0.00|AEG 2 (NO REV) 2016 BRANDON ASC
20|FH_F93252_0_0|SrvcGrp|86426|2022|PDM|2500.00|99|0.00|REMOVE INT/EXT HEM GROUP 2
20|FH_F93252_0_0|SrvcGrp|88163|2022|PDM|2500.00|99|0.00|LUMBAR SPINE FUSION
20|FH_F93252_0_0|SrvcGrp|93012|2022|PDM|1500.00|99|0.00|GASTROENTEROLOGY PROCEDURES
20|FH_F93252_0_0|SrvcGrp|93014|2022|PDM|2500.00|99|0.00|ACL REPAIR
20|FH_F93252_0_0|SrvcGrp|93017|2022|PDM|8000.00|99|0.00|TOTAL HIP REPLACEMENT
20|FH_F93252_0_0|SrvcGrp|93018|2022|PDM|7000.00|99|0.00|PARTIAL KNEE REPLACEMENT
20|FH_F93252_0_0|SrvcGrp|93022|2022|PDM|3500.00|99|0.00|LUMBAR LAMINECTOMY
20|FH_F93252_0_0|SrvcGrp|93023|2022|PDM|1300.00|99|0.00|MENISCAL REPAIR
20|FH_F93252_0_0|SrvcGrp|93024|2022|PDM|2500.00|99|0.00|NEURO STIMULATOR
20|FH_F93252_0_0|SrvcGrp|93025|2022|PDM|4000.00|99|0.00|OSTEOCHONDRAL DEFECTS SURGERIES
20|FH_F93252_0_0|SrvcGrp|93030|2022|PDM|2000.00|99|0.00|UROLOGY SURGICAL PROCEDURES
20|FH_F93252_0_0|SrvcGrp|93031|2022|PDM|5000.00|99|0.00|SPINAL FUSION
20|FH_F93252_0_0|SrvcGrp|93119|2022|PDM|2000.00|99|0.00|BREAST TISSUE REMOVAL OR REPAIR
20|FH_F93254_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F93254_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F93254_0_0|SrvcGrp|76094|2022|PDM|140.09|99|0.00|HOSPICE ROUTINE HOME CARE
20|FH_F93268_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F93268_0_0|SrvcGrp|471|2022|PDM|668.30|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F93268_0_0|SrvcGrp|472|2022|PDM|522.75|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F93275_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F93275_0_0|CSTM-ALL|CSTM-00|2020|PDM|2600.00|99|0.00|AEG 10 (NO REV)
20|FH_F93275_0_0|CSTM-ALL|CSTM-00|2020|PDM|635.00|99|0.00|AEG 2 (NO REV)
20|FH_F93275_0_0|SrvcGrp|13187|2022|PCT|1.05|99|0.00|INTRAOCULAR LENSES
20|FH_F93275_0_0|SrvcGrp|705|2022|PCT|1.05|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F93279_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F93279_0_0|CSTM-ALL|CSTM-00|2020|PDM|1126.00|99|0.00|AEG 9 (NO REV)
20|FH_F93279_0_0|CSTM-ALL|CSTM-00|2020|PDM|960.00|99|0.00|AEG 6 (NO REV)
20|FH_F93279_0_0|SrvcGrp|87297|2022|PCT|0.00|99|0.00|HCPCS CODES
20|FH_F93281_0_0|CSTM-ALL|CSTM-00|2020|PDM|430.00|99|0.00|AEG 9 (NO REV)
20|FH_F93281_0_0|SrvcGrp|92676|2022|PCT|0.00|99|0.00|IMAGING ENHANCED SUBSTANCE
20|FH_F93287_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F93287_0_0|CSTM-ALL|CSTM-00|2020|PDM|395.00|99|0.00|AEG 1 (NO REV)
20|FH_F93287_0_0|CSTM-ALL|CSTM-00|2020|PDM|495.00|99|0.00|AEG 2 (NO REV)
20|FH_F93331_0_0|CSTM-ALL|CSTM-00|2020|PDM|1287.50|99|0.00|AEG 2 (NO REV)
20|FH_F93331_0_0|CSTM-ALL|CSTM-00|2020|PDM|2678.00|99|0.00|AEG 7 (NO REV)
20|FH_F93331_0_0|CSTM-ALL|CSTM-00|2020|PDM|2678.00|99|0.00|AEG 9 (NO REV)
20|FH_F93331_0_0|SrvcGrp|89569|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F93332_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F93332_0_0|CSTM-ALL|CSTM-00|2020|PDM|1854.00|99|0.00|AEG 9 (NO REV)
20|FH_F93332_0_0|CSTM-ALL|CSTM-00|2020|PDM|731.00|99|0.00|AEG 3 (NO REV)
20|FH_F93332_0_0|SrvcGrp|16289|2022|PDM|3090.00|99|0.00|CARPAL TUNNEL RELEASE
20|FH_F93332_0_0|SrvcGrp|58775|2022|PDM|7025.00|99|0.00|CORPECTOMY
20|FH_F93332_0_0|SrvcGrp|58993|2022|PDM|7416.00|99|0.00|DISKECTOMY
20|FH_F93332_0_0|SrvcGrp|83821|2022|PDM|1906.00|99|0.00|ALLOGRAFT SPINE SURG
20|FH_F93332_0_0|SrvcGrp|88161|2022|PDM|6386.00|99|0.00|LAMINECTOMY W/FACE-THORACIC
20|FH_F93332_0_0|SrvcGrp|88491|2022|PDM|7416.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR
20|FH_F93332_0_0|SrvcGrp|89569|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F93332_0_0|SrvcGrp|89842|2022|PDM|7416.00|99|0.00|LUMBAR
20|FH_F93332_0_0|SrvcGrp|93057|2022|PDM|1906.00|99|0.00|SPINAL BONE AUTOGRAFT
20|FH_F93332_0_0|SrvcGrp|93058|2022|PDM|1906.00|99|0.00|SPINAL BONE AUTOGRAFT (HCFA)
20|FH_F93332_0_0|SrvcGrp|93066|2022|PDM|7416.00|99|0.00|LUMB ARTIF DISKECTOMY ADDL (HCFA)
20|FH_F93332_0_0|SrvcGrp|93067|2022|PDM|7416.00|99|0.00|SPINE FUSION EXTRA SEGMENT
20|FH_F93332_0_0|SrvcGrp|93079|2022|PDM|7416.00|99|0.00|ARTHODESIS (HCFA)
20|FH_F93332_0_0|SrvcGrp|93080|2022|PDM|7416.00|99|0.00|LUMBAR (HCFA)
20|FH_F93332_0_0|SrvcGrp|93085|2022|PDM|7416.00|99|0.00|SPINAL DISK SURGERY ADD-ON (HCFA)
20|FH_F93332_0_0|SrvcGrp|93092|2022|PDM|7416.00|99|0.00|DISKECTOMY (HCFA)
20|FH_F93332_0_0|SrvcGrp|93093|2022|PDM|3090.00|99|0.00|REVISE ULNAR NERVE ELBOW (HCFA)
20|FH_F93333_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 4 (NO REV)
20|FH_F93333_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 1 (NO REV)
20|FH_F93333_0_0|SrvcGrp|35669|2022|PDM|3692.00|99|0.00|CPT 63650
20|FH_F93333_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F93354_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F93354_0_0|SrvcGrp|82981|2022|PDM|130.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F93375_0_0|SrvcGrp|73006|2022|PDM|1405.00|99|0.00|AEG 9
20|FH_F93377_0_0|SrvcGrp|29353|2022|PDM|110.00|99|0.00|HOSPICE SVCS
20|FH_F93377_0_0|SrvcGrp|80317|2022|PDM|120.00|99|0.00|RESPITE CARE
20|FH_F93384_0_0|SrvcGrp|42784|2022|PDM|45.00|99|0.00|OCCUPATIONAL THERAPY  SRVCS
20|FH_F93384_0_0|SrvcGrp|473|2022|PDM|315.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F93384_0_0|SrvcGrp|76501|2022|PDM|235.00|99|0.00|SUB-ACUTE - LEVEL I
20|FH_F93392_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F93392_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F93413_0_0|SrvcGrp|26001|2022|PDM|123.70|99|0.00|HOSPICE RESPITE SVCS
20|FH_F93413_0_0|SrvcGrp|57968|2022|PDM|29.09|99|0.00|CONTINUOUS HOMECARE
20|FH_F93413_0_0|SrvcGrp|76094|2022|PDM|138.02|99|0.00|HOSPICE ROUTINE HOME CARE
20|FH_F93421_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F93421_0_0|SrvcGrp|26001|2022|PDM|138.10|99|0.00|HOSPICE RESPITE SVCS
20|FH_F93421_0_0|SrvcGrp|3809|2022|PDM|591.08|99|0.00|HOSPICE CARE
20|FH_F93512_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F93512_0_0|CSTM-ALL|CSTM-00|2020|PDM|1022.00|99|0.00|AEG 8 (NO REV)
20|FH_F93512_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|AEG 10 (NO REV)
20|FH_F93512_0_0|CSTM-ALL|CSTM-00|2020|PDM|753.00|99|0.00|AEG 5  (NO REV)
20|FH_F93517_0_0|CSTM-ALL|CSTM-00|2020|PDM|1344.00|99|0.00|AEG 3 (NO REV)
20|FH_F93517_0_0|CSTM-ALL|CSTM-00|2020|PDM|1444.00|99|0.00|AEG 6 (NO REV)
20|FH_F93517_0_0|CSTM-ALL|CSTM-00|2020|PDM|1869.00|99|0.00|AEG 8 (NO REV)
20|FH_F93561_0_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F93592_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F93592_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F93592_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|AEG 10 (NO REV)
20|FH_F93592_0_0|SrvcGrp|93217|2022|PDM|2372.00|99|0.00|AETNA SHOULDER ARTHROSCOPY
20|FH_F93740_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F93740_0_0|SrvcGrp|91581|2022|PDM|11500.00|99|0.00|RENAL DIAGNOSTIC
20|FH_F93740_0_0|SrvcGrp|91585|2022|PDM|4000.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F93740_0_0|SrvcGrp|91586|2022|PDM|9000.00|99|0.00|ATHERECTOMY
20|FH_F93740_0_0|SrvcGrp|91587|2022|PDM|10500.00|99|0.00|VASCULAR EMBOLIZATION OR OCCLUSION
20|FH_F93740_0_0|SrvcGrp|91590|2022|PDM|6000.00|99|0.00|PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY (PTCA)
20|FH_F93740_0_0|SrvcGrp|91591|2022|PDM|6400.00|99|0.00|AORTOGRAPHY/ANGIOGRAPHY
20|FH_F93740_0_0|SrvcGrp|91594|2022|PDM|7000.00|99|0.00|PACEMAKER/ACID INSERTION & LV PACING
20|FH_F93740_0_0|SrvcGrp|91595|2022|PDM|5900.00|99|0.00|TRANSLUMINAL ANGIOPLASTY OPEN AND PERCUTANEOUS
20|FH_F93740_0_0|SrvcGrp|91596|2022|PDM|6900.00|99|0.00|TRANSCATHETER
20|FH_F93791_0_0|CSTM-ALL|CSTM-00|2020|PDM|1733.00|99|0.00|AEG 8 (NO REV)
20|FH_F93791_0_0|CSTM-ALL|CSTM-00|2020|PDM|1995.00|99|0.00|AEG 3 (NO REV)
20|FH_F93791_0_0|CSTM-ALL|CSTM-00|2020|PDM|945.00|99|0.00|AEG 2 (NO REV)
20|FH_F93791_0_0|SrvcGrp|11663|2022|PCT|1.03|99|0.00|IMPLANTS
20|FH_F93791_0_0|SrvcGrp|11673|2022|PDM|2520.00|99|0.00|CPT 29888
20|FH_F93791_0_0|SrvcGrp|12491|2022|PCT|1.03|99|0.00|PACEMAKER
20|FH_F93791_0_0|SrvcGrp|41334|2022|PDM|4200.00|99|0.00|TOTAL KNEE
20|FH_F93791_0_0|SrvcGrp|67066|2022|PDM|1050.00|99|0.00|CERVICAL SURGERY
20|FH_F93791_0_0|SrvcGrp|705|2022|PCT|1.03|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F93791_0_0|SrvcGrp|89404|2022|PDM|4200.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F93791_0_0|SrvcGrp|93598|2022|PDM|4200.00|99|0.00|REVISE RECONSTRUCT SHOULDER JOINT(HCFA)
20|FH_F93791_0_0|SrvcGrp|93604|2022|PDM|2520.00|99|0.00|KNEE ARTHO/ANT CRUCIATE LIG REPAIR(HCFA)
20|FH_F93805_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING
20|FH_F93909_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|OP SVCS
20|FH_F93911_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F93961_0_0|CSTM-ALL|CSTM-00|2020|PDM|448.00|99|0.00|AEG 2 (NO REV)
20|FH_F93961_0_0|CSTM-ALL|CSTM-00|2020|PDM|715.00|99|0.00|AEG 5  (NO REV)
20|FH_F93961_0_0|CSTM-ALL|CSTM-00|2020|PDM|987.00|99|0.00|AEG 8 (NO REV)
20|FH_F93961_0_0|SrvcGrp|79757|2022|PDM|926.00|99|0.00|ESOPHAGUS ENDOSCOPY REPAIR
20|FH_F93961_0_0|SrvcGrp|91564|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F93961_0_0|SrvcGrp|91859|2022|PDM|352.00|99|0.00|SIGMOIDOSCOPY W/ ENDOSCOPIC
20|FH_F93961_0_0|SrvcGrp|93750|2022|PDM|1090.00|99|0.00|ERCP REMOVE FOREIGN BODY DUCT
20|FH_F94060_0_0|CSTM-ALL|CSTM-00|2020|PCT|74.00|99|0.00|OP SVCS
20|FH_F94102_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.54|99|0.00|OP SVCS
20|FH_F94103_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|PROFESSIONAL SERVICES (CMS-1500)
20|FH_F94165_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|AETNA OP CHEMOTHERAPY DRUG
20|FH_F94165_0_0|SrvcGrp|73602|2022|PCT|0.85|99|0.00|AETNA NEWBORN NURSERY I
20|FH_F94165_0_0|SrvcGrp|73603|2022|PCT|0.85|99|0.00|AETNA NEWBORN NURSERY II & III
20|FH_F94165_0_0|SrvcGrp|73606|2022|PCT|0.85|99|0.00|AETNA SKILLED NURSING CARE
20|FH_F94165_0_0|SrvcGrp|76744|2022|PCT|0.85|99|0.00|VASCULAR DIAGNOSTIC STUDIES
20|FH_F94165_0_0|SrvcGrp|82037|2022|PCT|0.85|99|0.00|AETNA ICU
20|FH_F94165_0_0|SrvcGrp|83677|2022|PCT|0.85|99|0.00|AETNA CARDIAC CATH
20|FH_F94280_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F94280_0_0|CSTM-ALL|CSTM-00|2020|PDM|1127.00|99|0.00|AEG 1 (NO REV)
20|FH_F94300_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F94300_0_0|CSTM-ALL|CSTM-00|2020|PDM|1575.00|99|0.00|AEG 8 (NO REV)
20|FH_F94300_0_0|CSTM-ALL|CSTM-00|2020|PDM|2835.00|99|0.00|AEG 7 (NO REV)
20|FH_F94300_0_0|CSTM-ALL|CSTM-00|2020|PDM|683.00|99|0.00|AEG 1 (NO REV)
20|FH_F94300_0_0|SrvcGrp|11663|2022|PCT|1.03|99|0.00|IMPLANTS
20|FH_F94300_0_0|SrvcGrp|12491|2022|PCT|1.03|99|0.00|PACEMAKER
20|FH_F94300_0_0|SrvcGrp|36591|2022|PDM|1155.00|99|0.00|CPT 63685
20|FH_F94300_0_0|SrvcGrp|41334|2022|PDM|4200.00|99|0.00|TOTAL KNEE
20|FH_F94300_0_0|SrvcGrp|67066|2022|PDM|1050.00|99|0.00|CERVICAL SURGERY
20|FH_F94300_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F94300_0_0|SrvcGrp|84939|2022|PDM|4200.00|99|0.00|SHOULDER JOINT
20|FH_F94300_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F94300_0_0|SrvcGrp|93595|2022|PDM|4200.00|99|0.00|ARTHROPLASTY(HCFA)
20|FH_F94300_0_0|SrvcGrp|93599|2022|PDM|4200.00|99|0.00|PARTIAL HIP REPLACEMENT(HCFA)
20|FH_F94300_0_0|SrvcGrp|93605|2022|PDM|1050.00|99|0.00|CERVICAL SURGERY(HCFA)
20|FH_F94303_0_0|SrvcGrp|72990|2022|PDM|1008.00|99|0.00|AEG 1
20|FH_F94303_0_0|SrvcGrp|72996|2022|PDM|1624.00|99|0.00|AEG 4
20|FH_F94303_0_0|SrvcGrp|73000|2022|PDM|2251.00|99|0.00|AEG 6
20|FH_F94303_0_0|SrvcGrp|73004|2022|PDM|2251.00|99|0.00|AEG 8
20|FH_F94303_0_0|SrvcGrp|73008|2022|PDM|1008.00|99|0.00|AEG 10
20|FH_F94402_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F94402_0_0|CSTM-ALL|CSTM-00|2020|PDM|787.00|99|0.00|AEG 2 (NO REV)
20|FH_F94403_0_0|CSTM-ALL|CSTM-00|2020|PDM|1442.00|99|0.00|AEG 7 (NO REV)
20|FH_F94403_0_0|CSTM-ALL|CSTM-00|2020|PDM|739.00|99|0.00|AEG 3 (NO REV)
20|FH_F94403_0_0|SrvcGrp|44461|2022|PDM|7150.00|99|0.00|INSERTION / REPLACEMENT OF SPINAL NEUROSTIMULATOR GENERATOR
20|FH_F94403_0_0|SrvcGrp|58755|2022|PDM|5200.00|99|0.00|INJECTION PROC FOR JOINT
20|FH_F94481_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F94481_0_0|SrvcGrp|42784|2022|PDM|45.00|99|0.00|OCCUPATIONAL THERAPY  SRVCS
20|FH_F94481_0_0|SrvcGrp|42785|2022|PDM|45.00|99|0.00|SPEECH THERAPY  SRVCS
20|FH_F94481_0_0|SrvcGrp|473|2022|PDM|315.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F94581_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F94581_0_0|SrvcGrp|471|2022|PDM|676.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F94581_0_0|SrvcGrp|76501|2022|PDM|332.00|99|0.00|SUB-ACUTE - LEVEL I
20|FH_F94665_0_0|CSTM-ALL|CSTM-00|2020|PDM|1735.00|99|0.00|AEG 5  (NO REV)
20|FH_F94665_0_0|CSTM-ALL|CSTM-00|2020|PDM|2018.00|99|0.00|AEG 6 (NO REV)
20|FH_F94665_0_0|CSTM-ALL|CSTM-00|2020|PDM|2375.00|99|0.00|AEG 8 (NO REV)
20|FH_F94665_0_0|CSTM-ALL|CSTM-00|2020|PDM|2408.00|99|0.00|AEG 7 (NO REV)
20|FH_F94665_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F94862_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F94862_0_0|SrvcGrp|11663|2022|PCT|0.50|99|0.00|IMPLANTS
20|FH_F94862_0_0|SrvcGrp|72990|2022|PDM|480.00|99|0.00|AEG 1
20|FH_F94862_0_0|SrvcGrp|73004|2022|PDM|998.00|99|0.00|AEG 8
20|FH_F94942_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F94942_0_0|SrvcGrp|72998|2022|PDM|968.20|99|0.00|AEG 5
20|FH_F94942_0_0|SrvcGrp|73002|2022|PDM|1344.15|99|0.00|AEG 7
20|FH_F94942_0_0|SrvcGrp|94363|2022|PDM|1638.73|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F95021_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F95021_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F95021_0_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F95021_0_0|SrvcGrp|473|2022|PDM|315.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F95101_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F95101_0_0|SrvcGrp|42785|2022|PDM|45.00|99|0.00|SPEECH THERAPY  SRVCS
20|FH_F95101_0_0|SrvcGrp|76501|2022|PDM|235.00|99|0.00|SUB-ACUTE - LEVEL I
20|FH_F95221_0_0|SrvcGrp|72990|2022|PDM|349.00|99|0.00|AEG 1
20|FH_F95284_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F95284_0_0|SrvcGrp|11306|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F95440_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F95440_0_0|SrvcGrp|72990|2022|PDM|711.00|99|0.00|AEG 1
20|FH_F95440_0_0|SrvcGrp|73004|2022|PDM|2858.00|99|0.00|AEG 8
20|FH_F95440_0_0|SrvcGrp|93725|2022|PDM|4600.00|99|0.00|IMPLANT SPINE INFUSION PMP25
20|FH_F95482_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F95482_0_0|CSTM-ALL|CSTM-00|2020|PDM|1029.00|99|0.00|AEG 2 (NO REV)
20|FH_F95482_0_0|CSTM-ALL|CSTM-00|2020|PDM|1217.00|99|0.00|AEG 10 (NO REV)
20|FH_F95482_0_0|CSTM-ALL|CSTM-00|2020|PDM|1580.00|99|0.00|AEG 5  (NO REV)
20|FH_F95482_0_0|CSTM-ALL|CSTM-00|2020|PDM|2519.00|99|0.00|AEG 7 (NO REV)
20|FH_F95482_0_0|CSTM-ALL|CSTM-00|2020|PDM|2556.00|99|0.00|AEG 8 (NO REV)
20|FH_F95629_0_0|CSTM-ALL|CSTM-00|2020|PDM|1047.00|99|0.00|AEG 10 (NO REV)
20|FH_F95629_0_0|CSTM-ALL|CSTM-00|2020|PDM|1213.00|99|0.00|AEG 4 (NO REV)
20|FH_F95629_0_0|CSTM-ALL|CSTM-00|2020|PDM|1401.00|99|0.00|AEG 5  (NO REV)
20|FH_F95629_0_0|CSTM-ALL|CSTM-00|2020|PDM|1656.00|99|0.00|AEG 6 (NO REV)
20|FH_F95629_0_0|CSTM-ALL|CSTM-00|2020|PDM|493.00|99|0.00|AEG 1 (NO REV)
20|FH_F95629_0_0|CSTM-ALL|CSTM-00|2020|PDM|986.00|99|0.00|AEG 3 (NO REV)
20|FH_F95641_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F95641_0_0|SrvcGrp|42784|2022|PDM|45.00|99|0.00|OCCUPATIONAL THERAPY  SRVCS
20|FH_F95641_0_0|SrvcGrp|42785|2022|PDM|45.00|99|0.00|SPEECH THERAPY  SRVCS
20|FH_F95800_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F95800_0_0|CSTM-ALL|CSTM-00|2020|PDM|493.00|99|0.00|AEG 2 (NO REV)
20|FH_F95800_0_0|CSTM-ALL|CSTM-00|2020|PDM|780.00|99|0.00|AEG 10 (NO REV)
20|FH_F95800_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F95900_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F95900_0_0|CSTM-ALL|CSTM-00|2020|PDM|1128.00|99|0.00|AEG 7 (NO REV)
20|FH_F95900_0_0|CSTM-ALL|CSTM-00|2020|PDM|377.00|99|0.00|AEG 1 (NO REV)
20|FH_F95900_0_0|CSTM-ALL|CSTM-00|2020|PDM|813.00|99|0.00|AEG 5  (NO REV)
20|FH_F95900_0_0|SrvcGrp|73486|2022|PCT|0.00|99|0.00|AETNA CONTRAST AGENT
20|FH_F96182_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F96182_0_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F96321_0_0|CSTM-ALL|CSTM-00|2020|PDM|521.00|99|0.00|AEG 10 (NO REV)
20|FH_F96321_0_0|CSTM-ALL|CSTM-00|2020|PDM|643.00|99|0.00|AEG 4 (NO REV)
20|FH_F96321_0_0|CSTM-ALL|CSTM-00|2020|PDM|732.00|99|0.00|AEG 5  (NO REV)
20|FH_F96321_0_0|CSTM-ALL|CSTM-00|2020|PDM|851.00|99|0.00|AEG 6 (NO REV)
20|FH_F96321_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F96321_0_0|SrvcGrp|108770|2022|PDM|797.69|99|0.00|OPERATIVE UPPER GI ENDOSCOPY
20|FH_F96780_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F96780_0_0|CSTM-ALL|CSTM-00|2020|PDM|1069.00|99|0.00|AEG 6 (NO REV)
20|FH_F96780_0_0|CSTM-ALL|CSTM-00|2020|PDM|1551.00|99|0.00|AEG 9 (NO REV)
20|FH_F96780_0_0|CSTM-ALL|CSTM-00|2020|PDM|384.00|99|0.00|AEG 10 (NO REV)
20|FH_F96780_0_0|SrvcGrp|38909|2022|PDM|1761.00|99|0.00|CPT 67036 - VITRECTOMY, MECHANICAL
20|FH_F96780_0_0|SrvcGrp|77507|2022|PCT|1.00|99|0.00|AETNA CORNEAL TISSUE HANDLING
20|FH_F96780_0_0|SrvcGrp|88154|2022|PDM|1761.00|99|0.00|LASER TREATMENT OLD RETINA
20|FH_F96780_0_0|SrvcGrp|90568|2022|PDM|1761.00|99|0.00|TREATMENT OF RETINA
20|FH_F96902_0_0|SrvcGrp|24739|2022|PDM|165.00|99|0.00|RESPITE CARE
20|FH_F96902_0_0|SrvcGrp|90707|2022|PDM|165.00|99|0.00|AETNA HOSPICE CARE
20|FH_F97160_77436_0|SrvcGrp|108484|2022|PDM|674.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY
20|FH_F97160_77436_0|SrvcGrp|46903|2022|PDM|674.00|99|0.00|RESIDENTIAL TREATMENT
20|FH_F97160_77436_0|SrvcGrp|73841|2022|PDM|584.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP
20|FH_F97160_77436_0|SrvcGrp|90854|2022|PDM|955.00|99|0.00|AETNA IP DETOXIFICATION SERVICES
20|FH_F97161_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F97161_0_0|SrvcGrp|89569|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F97242_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F97700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F97700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F98161_0_0|SrvcGrp|72998|2022|PDM|825.00|99|0.00|AEG 5
20|FH_F98161_0_0|SrvcGrp|73004|2022|PDM|1119.00|99|0.00|AEG 8
20|FH_F98480_0_0|CSTM-ALL|CSTM-00|2020|PDM|579.00|99|0.00|AEG 3 (NO REV)
20|FH_F98480_0_0|SrvcGrp|95799|2022|PDM|953.00|99|0.00|ESOPHAGUS ENDOSCOPY REPAIR
20|FH_F98640_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F98640_0_0|CSTM-ALL|CSTM-00|2020|PDM|1243.00|99|0.00|AEG 3 (NO REV)
20|FH_F98640_0_0|CSTM-ALL|CSTM-00|2020|PDM|1558.00|99|0.00|AEG 4 (NO REV)
20|FH_F98640_0_0|CSTM-ALL|CSTM-00|2020|PDM|2090.00|99|0.00|AEG 6 (NO REV)
20|FH_F98640_0_0|SrvcGrp|109016|2022|PDM|1818.00|99|0.00|REMOVAL OF ADENOIDS
20|FH_F98640_0_0|SrvcGrp|11306|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F98640_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS
20|FH_F98640_0_0|SrvcGrp|65404|2022|PDM|1818.00|99|0.00|CPT 69421
20|FH_F98741_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F98741_0_0|SrvcGrp|87077|2022|PDM|130.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F99021_0_0|CSTM-ALL|CSTM-00|2020|PDM|448.00|99|0.00|AEG 2 (NO REV)
20|FH_F99021_0_0|CSTM-ALL|CSTM-00|2020|PDM|999.00|99|0.00|AEG 7 (NO REV)
20|FH_F99021_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F99100_0_0|CSTM-ALL|CSTM-00|2020|PDM|739.00|99|0.00|AEG 3 (NO REV)
20|FH_F99100_0_0|SrvcGrp|96100|2022|PDM|1801.47|99|0.00|DISECTOMY (HCFA)
20|FH_F99100_0_0|SrvcGrp|96101|2022|PDM|669.80|99|0.00|PERCUTANEOUS INTRADISCAL (HCFA)
20|FH_F99100_0_0|SrvcGrp|96104|2022|PDM|211.87|99|0.00|IMPLANTABLE NEUROSTIMULATOR
20|FH_F99161_0_0|SrvcGrp|75481|2022|PDM|1000.00|99|0.00|AEG 2
20|FH_F99161_0_0|SrvcGrp|75485|2022|PDM|1389.73|99|0.00|AEG 4
20|FH_F99161_0_0|SrvcGrp|75491|2022|PDM|1806.00|99|0.00|AEG 7
20|FH_F99161_0_0|SrvcGrp|75493|2022|PDM|1823.36|99|0.00|AEG 8
20|FH_F99161_0_0|SrvcGrp|75495|2022|PDM|2817.00|99|0.00|AEG 9
20|FH_F99441_0_0|CSTM-ALL|CSTM-00|2020|PDM|443.00|99|0.00|AEG 2 (NO REV)
20|FH_F99441_0_0|CSTM-ALL|CSTM-00|2020|PDM|637.00|99|0.00|AEG 4 (NO REV)
20|FH_F99520_0_0|CSTM-ALL|CSTM-00|2020|PCT|46.00|99|0.00|OP SVCS
20|FH_F99528_0_0|CSTM-ALL|CSTM-00|2020|PCT|48.00|99|0.00|GENERAL ACUTE CARE
20|FH_F99541_0_0|CSTM-ALL|CSTM-00|2020|PCT|47.00|99|0.00|GENERAL ACUTE CARE
20|FH_F99720_0_0|SrvcGrp|104744|2022|PDM|4608.00|99|0.00|RECONSTRUCT SHOULDER JOINT
20|FH_F99720_0_0|SrvcGrp|107546|2022|PDM|3072.00|99|0.00|TREATMENT OF JOINT
20|FH_F99720_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F99720_0_0|SrvcGrp|41327|2022|PDM|1434.00|99|0.00|OP SURGERY CPT 28308
20|FH_F99720_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F99720_0_0|SrvcGrp|72990|2022|PDM|1166.00|99|0.00|AEG 1
20|FH_F99720_0_0|SrvcGrp|72992|2022|PDM|1397.00|99|0.00|AEG 2
20|FH_F99720_0_0|SrvcGrp|73000|2022|PDM|2608.00|99|0.00|AEG 6
20|FH_F99720_0_0|SrvcGrp|73002|2022|PDM|3110.00|99|0.00|AEG 7
20|FH_F99720_0_0|SrvcGrp|88491|2022|PDM|3277.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR
20|FH_F99960_0_0|SrvcGrp|11669|2022|PDM|2180.00|99|0.00|OP SURG
20|FH_F99960_0_0|SrvcGrp|23585|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F99960_0_0|SrvcGrp|26273|2022|PDM|1174.00|99|0.00|CPT 29880
20|FH_F99960_0_0|SrvcGrp|26278|2022|PDM|1174.00|99|0.00|CPT 29881
20|FH_F99960_0_0|SrvcGrp|54943|2022|PDM|2180.00|99|0.00|REPAIR OF SLAP LESION
20|FH_F99960_0_0|SrvcGrp|72121|2022|PDM|2180.00|99|0.00|ARTHOSCOPY
20|FH_F99960_0_0|SrvcGrp|72992|2022|PDM|675.00|99|0.00|AEG 2
20|FH_F99960_0_0|SrvcGrp|73002|2022|PDM|1558.00|99|0.00|AEG 7
20|FH_F99960_0_0|SrvcGrp|78403|2022|PDM|1.00|99|0.00|AETNA MED RECORD
20|FH_F99960_0_0|SrvcGrp|85022|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F99960_0_0|SrvcGrp|92676|2022|PCT|0.00|99|0.00|IMAGING ENHANCED SUBSTANCE
20|FH_F32362_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|OP SVCS
20|FH_F32366_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32369_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32370_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32371_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS
20|FH_F32376_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS
20|FH_F32382_0_0|CSTM-ALL|CSTM-00|2020|PCT|86.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32384_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.50|99|0.00|GENERAL ACUTE CARE
20|FH_F32384_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.50|99|0.00|OP SVCS
20|FH_F32401_0_0|CSTM-ALL|CSTM-00|2020|PCT|46.00|99|0.00|OP SVCS
20|FH_F32405_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F32411_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F32471_0_0|CSTM-ALL|CSTM-00|2020|PCT|91.00|99|0.00|OP SVCS
20|FH_F32494_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32509_0_0|SrvcGrp|13052|2022|PCT|0.80|99|0.00|OP SURGERY
20|FH_F32509_0_0|SrvcGrp|14056|2022|PDM|12840.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F32509_0_0|SrvcGrp|14065|2022|PDM|11486.00|99|0.00|PTCA W/O STENT
20|FH_F32509_0_0|SrvcGrp|14271|2022|PCT|0.80|99|0.00|IMPLANTS
20|FH_F32512_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|OP SVCS
20|FH_F32521_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F32524_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.25|99|0.00|GENERAL ACUTE CARE
20|FH_F32529_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|OP SVCS
20|FH_F32530_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F32533_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F32571_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32571_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F32604_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.96|99|0.00|OP SVCS
20|FH_F32604_0_0|SrvcGrp|10540|2022|PDM|50.00|99|0.00|HOME HEALTH AIDE
20|FH_F32604_0_0|SrvcGrp|10541|2022|PDM|90.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F32604_0_0|SrvcGrp|10542|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY SVCS
20|FH_F32604_0_0|SrvcGrp|10543|2022|PDM|90.00|99|0.00|SPEECH THERAPY SVCS
20|FH_F32604_0_0|SrvcGrp|10545|2022|PDM|90.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F32618_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32620_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32627_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F32628_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F32683_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F32693_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32727_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32728_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32728_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|OP SVCS
20|FH_F32729_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32731_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS
20|FH_F32737_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F32739_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32742_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS
20|FH_F32751_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32758_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32758_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F32762_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32769_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F32770_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32771_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32772_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|GENERAL ACUTE CARE
20|FH_F32772_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|OP SVCS
20|FH_F32780_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F32786_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F32803_0_0|SrvcGrp|13768|2022|PDM|1599.00|99|0.00|NICU
20|FH_F32825_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|MS DRG 619-621
20|FH_F32825_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|MS DRG 481
20|FH_F32825_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|MS DRG 482
20|FH_F32825_0_0|CSTM-ALL|CSTM-00|2020|PDM|1146.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F32825_0_0|CSTM-ALL|CSTM-00|2020|PDM|15907.00|99|0.00|MS DRG 526-527 DRUG ELUTING STENT
20|FH_F32825_0_0|SrvcGrp|10111|2022|PCT|0.60|99|0.00|IMPLANTS
20|FH_F32825_0_0|SrvcGrp|3409|2022|PDM|393.00|99|0.00|NEWBORN NURSERY
20|FH_F32825_0_0|SrvcGrp|38|2022|PDM|2374.00|99|0.00|NORMAL DELIVERY
20|FH_F32825_0_0|SrvcGrp|705|2022|PCT|0.60|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F32838_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F32850_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS
20|FH_F32869_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F32869_0_0|CSTM-ALL|CSTM-00|2020|PDM|10000.00|99|0.00|BRACHYTHERAPY SVCS
20|FH_F32869_0_0|CSTM-ALL|CSTM-00|2020|PDM|12000.00|99|0.00|MS DRG 619-621
20|FH_F32869_0_0|CSTM-ALL|CSTM-00|2020|PDM|15000.00|99|0.00|MS DRG 242-244 PACEMAKER IMPLANT
20|FH_F32869_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|DUAL DIAGNOSIS
20|FH_F32869_0_0|CSTM-ALL|CSTM-00|2020|PDM|6000.00|99|0.00|MS DRG 260-262 CARDIAC PACEMAKER REVISION
20|FH_F32869_0_0|CSTM-ALL|CSTM-00|2020|PDM|8000.00|99|0.00|MS DRG 281-282, 249, 246-247 PTCA W/STENT
20|FH_F32869_0_0|SrvcGrp|9911|2022|PDM|650.00|99|0.00|EMERGENCY ROOM SVCS
20|FH_F32881_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F32888_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32906_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32910_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS
20|FH_F32916_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F32917_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32921_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32921_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F32930_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F32935_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|OP SVCS
20|FH_F32935_0_0|CSTM-ALL|CSTM-00|2020|PDM|968.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32935_0_0|SrvcGrp|3066|2022|PCT|0.35|99|0.00|HIGH-COST DRUGS
20|FH_F32936_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F32953_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F32963_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32978_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32987_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|OP SVCS
20|FH_F32995_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|ASPG X
20|FH_F32995_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F32995_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|MS DRG 767-768, 774-775 NORMAL DELIVERY
20|FH_F32995_0_0|CSTM-ALL|CSTM-00|2020|PDM|3275.00|99|0.00|MS DRG 765-766 C-SECTION
20|FH_F32995_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|NEWBORN NURSERY - BABY ONLY
20|FH_F32995_0_0|SrvcGrp|1259|2022|PDM|1275.00|99|0.00|INTERMEDIATE INTENSIVE CARE UNIT
20|FH_F32995_0_0|SrvcGrp|9511|2022|PDM|46.00|99|0.00|OBSERVATION SVCS
20|FH_F32995_0_0|SrvcGrp|9774|2022|PDM|1700.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F32996_0_0|SrvcGrp|6|2022|PCT|0.70|99|0.00|OP SURGERY
20|FH_F33015_0_0|SrvcGrp|3087|2022|PDM|515.00|99|0.00|CD - DETOX
20|FH_F33025_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33047_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33063_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|ACUTE PSYCH
20|FH_F33063_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F33067_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33067_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F33068_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33068_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS
20|FH_F33070_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|OP SVCS
20|FH_F33088_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F33096_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F33099_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33103_0_0|CSTM-ALL|CSTM-00|2020|PCT|99.00|99|0.00|OP SVCS
20|FH_F33113_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|OP SVCS
20|FH_F33175_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F33181_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F33183_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F33199_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F33220_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F33223_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33223_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F33233_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE
20|FH_F33233_0_0|SrvcGrp|14955|2022|PDM|132.30|99|0.00|PT/OT/ST
20|FH_F33233_0_0|SrvcGrp|15886|2022|PCT|1.00|99|0.00|PHARMACY SERVICES
20|FH_F33241_0_0|CSTM-ALL|CSTM-00|2020|PDM|2658.00|99|0.00|ASPG VIII
20|FH_F33241_0_0|CSTM-ALL|CSTM-00|2020|PDM|3200.00|99|0.00|MS DRG 765-766 C-SECTION
20|FH_F33241_0_0|CSTM-ALL|CSTM-00|2020|PDM|785.00|99|0.00|ASPG I
20|FH_F33241_0_0|SrvcGrp|14174|2022|PDM|750.00|99|0.00|MRI
20|FH_F33241_0_0|SrvcGrp|14610|2022|PDM|90.00|99|0.00|SPEECH PATHOLOGY VISIT
20|FH_F33241_0_0|SrvcGrp|3420|2022|PDM|4000.00|99|0.00|OP LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F33241_0_0|SrvcGrp|72|2022|PDM|250.00|99|0.00|NEWBORN NURSERY
20|FH_F33241_0_0|SrvcGrp|9911|2022|PDM|3500.00|99|0.00|EMERGENCY ROOM SVCS
20|FH_F33241_0_0|SrvcGrp|9937|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F33246_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F33285_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33287_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS
20|FH_F33303_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33303_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|OP SVCS
20|FH_F33316_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS
20|FH_F33316_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33322_0_0|SrvcGrp|913|2022|PCT|0.80|99|0.00|ELECTROSHOCK TREATMENT
20|FH_F33334_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33346_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|OP SVCS
20|FH_F33381_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|99|0.00|PTCA ANGIOPLASTY
20|FH_F33381_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F33381_0_0|SrvcGrp|14999|2022|PCT|0.68|99|0.00|CARDIOVASCULAR SURGERY
20|FH_F33381_0_0|SrvcGrp|15054|2022|PCT|0.68|99|0.00|CARDIAC CATH
20|FH_F33381_0_0|SrvcGrp|2741|2022|PCT|0.65|99|0.00|DRUGS
20|FH_F33381_0_0|SrvcGrp|360|2022|PDM|1580.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F33381_0_0|SrvcGrp|361|2022|PDM|2511.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F33389_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|NUCLEAR MEDICINE
20|FH_F33389_0_0|SrvcGrp|11199|2022|PCT|0.70|99|0.00|HYPERBARIC CHAMBER
20|FH_F33389_0_0|SrvcGrp|14886|2022|PCT|0.70|99|0.00|TRANSPORTATION
20|FH_F33389_0_0|SrvcGrp|9774|2022|PDM|1712.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F33390_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|DIALYSIS SVCS
20|FH_F33390_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|NUCLEAR MEDICINE
20|FH_F33390_0_0|CSTM-ALL|CSTM-00|2020|PDM|1502.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33390_0_0|SrvcGrp|13188|2022|PCT|0.75|99|0.00|DRUGS
20|FH_F33407_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33407_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F33421_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.10|99|0.00|OP SVCS
20|FH_F33427_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33427_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F33428_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33428_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS
20|FH_F33460_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33472_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33479_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33498_0_0|SrvcGrp|30379|2022|PCT|0.57|99|0.00|LABORATORY SERVICES
20|FH_F33500_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F33504_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|TRAUMA CARE
20|FH_F33509_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS
20|FH_F33512_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE
20|FH_F33522_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33522_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS
20|FH_F33530_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F33532_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33535_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|SKILLED NURSING CARE
20|FH_F33537_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33537_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F33554_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F33559_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33566_0_0|CSTM-ALL|CSTM-00|2020|PDM|1379.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33566_0_0|CSTM-ALL|CSTM-00|2020|PDM|434.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F33566_0_0|CSTM-ALL|CSTM-00|2020|PDM|715.00|99|0.00|ACUTE PSYCH
20|FH_F33566_0_0|SrvcGrp|19961|2022|PDM|37143.00|99|0.00|MS DRG 231-232 ONLY CORONARY BYPASS W/ PTCA
20|FH_F33566_0_0|SrvcGrp|701|2022|PDM|1750.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F33592_0_0|SrvcGrp|3810|2022|PDM|109.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F33612_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F33618_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|GENERAL ACUTE CARE
20|FH_F33629_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33630_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS
20|FH_F33634_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33634_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS
20|FH_F33639_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33639_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F33642_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 216-221, 231-232 CV SURGERY
20|FH_F33642_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 248-251, 246-247 CV SURGERY
20|FH_F33642_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 252-254 CV SURGERY
20|FH_F33642_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 459-460
20|FH_F33642_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MSDRG 242-244, 258-262 PACEMAKER INSERTION/REVISION
20|FH_F33642_0_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|OP SVCS
20|FH_F33642_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|ASPG IX
20|FH_F33642_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|ACUTE PSYCH
20|FH_F33642_0_0|SrvcGrp|13359|2022|PDM|750.00|99|0.00|EMERGENCY ROOM SVCS LEVEL I
20|FH_F33642_0_0|SrvcGrp|15369|2022|PCT|0.60|99|0.00|LABORATORY
20|FH_F33642_0_0|SrvcGrp|18204|2022|PCT|0.75|99|0.00|MS DRG 027
20|FH_F33642_0_0|SrvcGrp|9510|2022|PDM|575.00|99|0.00|SKILLED NURSING CARE
20|FH_F33642_0_0|SrvcGrp|9937|2022|PCT|0.75|99|0.00|OCCUPATIONAL THERAPY
20|FH_F33649_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|ADOLESCENT PSYCHIATRIC
20|FH_F33650_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F33659_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|OP SVCS
20|FH_F33659_0_0|SrvcGrp|15387|2022|PDM|95.00|99|0.00|RN VISIT
20|FH_F33659_0_0|SrvcGrp|15388|2022|PDM|95.00|99|0.00|SPEECH THERAPY
20|FH_F33659_0_0|SrvcGrp|15392|2022|PDM|95.00|99|0.00|PHYSICAL THERAPY
20|FH_F33664_0_0|CSTM-ALL|CSTM-00|2020|PDM|843.00|99|0.00|NEWBORN NURSERY - BABY ONLY
20|FH_F33664_0_0|SrvcGrp|6|2022|PCT|0.91|99|0.00|OP SURGERY
20|FH_F33672_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33685_0_0|CSTM-ALL|CSTM-00|2020|PDM|1830.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33712_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 020-022
20|FH_F33712_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 252-254 CV SURGERY
20|FH_F33712_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MSDRG 286-287 CARDIAC CATH
20|FH_F33712_0_0|CSTM-ALL|CSTM-00|2020|PDM|2900.00|99|0.00|ASPG VI
20|FH_F33712_0_0|SrvcGrp|12163|2022|PCT|0.60|99|0.00|DRUGS
20|FH_F33712_0_0|SrvcGrp|13715|2022|PCT|0.60|99|0.00|DME/ORTHOTICS/PROSTHETICS/IMPLANTS
20|FH_F33712_0_0|SrvcGrp|15399|2022|PCT|0.60|99|0.00|COMPUTED TOMOGRAPHY (CT)
20|FH_F33712_0_0|SrvcGrp|9511|2022|PCT|0.60|99|0.00|OBSERVATION SVCS
20|FH_F33719_0_0|SrvcGrp|109|2022|PDM|500.00|99|0.00|CD - DETOX
20|FH_F33719_0_0|SrvcGrp|3803|2022|PCT|0.80|99|0.00|TRAUMA CARE
20|FH_F33719_0_0|SrvcGrp|62|2022|PCT|0.80|99|0.00|HEART TRANSPLANT
20|FH_F33719_0_0|SrvcGrp|8968|2022|PDM|1830.00|99|0.00|NICU LEVEL III & IV
20|FH_F33719_0_0|SrvcGrp|91|2022|PCT|0.70|99|0.00|KIDNEY TRANSPLANT
20|FH_F33725_0_0|CSTM-ALL|CSTM-00|2020|PDM|75.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F33726_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.50|99|0.00|GENERAL ACUTE CARE
20|FH_F33726_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.50|99|0.00|OP SVCS
20|FH_F33728_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33744_0_0|SrvcGrp|3069|2022|PCT|0.50|99|0.00|IMPLANTS
20|FH_F33744_0_0|SrvcGrp|941|2022|PCT|0.75|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F33782_0_0|SrvcGrp|12159|2022|PDM|75.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F33782_0_0|SrvcGrp|3810|2022|PDM|109.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F33785_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|ADULT PSYCHIATRIC
20|FH_F33785_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|ACUTE IP MED SVCS
20|FH_F33785_0_0|SrvcGrp|14373|2022|PDM|5200.00|99|0.00|LITHOTRIPSY SVCS
20|FH_F33785_0_0|SrvcGrp|177|2022|PDM|1200.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F33785_0_0|SrvcGrp|3069|2022|PCT|0.75|99|0.00|IMPLANTS
20|FH_F33785_0_0|SrvcGrp|411|2022|PDM|2800.00|99|0.00|OP CARDIAC CATH
20|FH_F33785_0_0|SrvcGrp|6|2022|PCT|0.70|99|0.00|OP SURGERY
20|FH_F33788_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|ACUTE IP MED SVCS
20|FH_F33788_0_0|SrvcGrp|429|2022|PCT|0.70|99|0.00|OP LAPAROSCOPIC SURGERY
20|FH_F33789_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|OP SVCS
20|FH_F33791_0_0|SrvcGrp|1259|2022|PDM|1750.00|99|0.00|INTERMEDIATE INTENSIVE CARE UNIT
20|FH_F33791_0_0|SrvcGrp|675|2022|PDM|700.00|99|0.00|PEDIATRIC INPATIENT SVCS
20|FH_F33791_0_0|SrvcGrp|89297|2022|PDM|300.00|99|0.00|INPATIENT DETOXIFICATION SERVICES
20|FH_F33800_0_0|CSTM-ALL|CSTM-00|2020|PCT|76.40|99|0.00|OP SVCS
20|FH_F33825_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F33832_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33850_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.00|99|0.00|OP SVCS
20|FH_F33856_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F33856_0_0|SrvcGrp|115|2022|PCT|0.85|99|0.00|SKILLED NURSING CARE
20|FH_F33856_0_0|SrvcGrp|88|2022|PCT|0.85|99|0.00|OP LITHOTRIPSY
20|FH_F33865_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.63|99|0.00|GENERAL ACUTE CARE
20|FH_F33899_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33913_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33913_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS
20|FH_F33972_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33982_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33982_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F34048_0_0|SrvcGrp|43|2022|PCT|0.65|99|0.00|IMPLANTS
20|FH_F34048_0_0|SrvcGrp|6|2022|PCT|0.77|99|0.00|OP SURGERY
20|FH_F34048_0_0|SrvcGrp|997|2022|PCT|0.65|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F34057_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F34096_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34096_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|OP SVCS
20|FH_F34100_0_0|SrvcGrp|12512|2022|PDM|950.00|99|0.00|ACUTE REHABILITATION
20|FH_F34102_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.76|99|0.00|GENERAL ACUTE CARE
20|FH_F34112_0_0|SrvcGrp|12906|2022|PDM|4925.00|99|0.00|IP LITHOTRIPSY
20|FH_F34112_0_0|SrvcGrp|16197|2022|PDM|360.00|99|0.00|NEWBORN NURSERY
20|FH_F34112_0_0|SrvcGrp|290|2022|PDM|4550.00|99|0.00|IP LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F34112_0_0|SrvcGrp|360|2022|PDM|1025.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F34112_0_0|SrvcGrp|97|2022|PDM|3400.00|99|0.00|C-SECTION
20|FH_F34112_0_0|SrvcGrp|9926|2022|PDM|5675.00|99|0.00|DIRECTIONAL CORONARY ATHERECTOMY
20|FH_F34119_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|OP SVCS
20|FH_F34119_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34130_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F34138_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|PRO FEES EXCLUDED ON CMS1500
20|FH_F34138_0_0|SrvcGrp|26001|2022|PDM|132.40|99|0.00|HOSPICE RESPITE SVCS
20|FH_F34165_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34165_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|OP SVCS
20|FH_F34182_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|GENERAL ACUTE CARE
20|FH_F34182_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MSDRG 219-221 CARDIAC VLV PX+OTR MJR CARDIOTHORAIC W/CC OLR
20|FH_F34182_0_0|CSTM-ALL|CSTM-00|2020|PDM|11669.00|99|0.00|MSDRG 286-287 CARDIAC CATH
20|FH_F34182_0_0|CSTM-ALL|CSTM-00|2020|PDM|25963.00|99|0.00|MS DRG 461-462 BILATERAL MAJOR JOINT PX LOWER EXTREMITY
20|FH_F34182_0_0|CSTM-ALL|CSTM-00|2020|PDM|2729.00|99|0.00|MS DRG 247
20|FH_F34182_0_0|CSTM-ALL|CSTM-00|2020|PDM|2729.00|99|0.00|MS DRG 249
20|FH_F34182_0_0|CSTM-ALL|CSTM-00|2020|PDM|2729.00|99|0.00|MSDRG 226-227 CV SURG CARDIAC DEFIBRILLATOR
20|FH_F34182_0_0|CSTM-ALL|CSTM-00|2020|PDM|2729.00|99|0.00|MSDRG 250-251 PERCUTANEOUS CARDIO PROC
20|FH_F34182_0_0|CSTM-ALL|CSTM-00|2020|PDM|957.00|99|0.00|ACUTE PSYCH
20|FH_F34182_0_0|SrvcGrp|21077|2022|PDM|22932.00|99|0.00|MS DRG 037 ONLY
20|FH_F34189_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F34221_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F34241_0_0|CSTM-ALL|CSTM-00|2020|PDM|75.00|99|0.00|OP SVCS
20|FH_F34241_0_0|SrvcGrp|16349|2022|PDM|1000.00|99|0.00|ACUTE IP MED SVCS
20|FH_F34241_0_0|SrvcGrp|184|2022|PDM|1450.00|99|0.00|MEDICAL INTENSIVE CARE
20|FH_F34246_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.10|99|0.00|GENERAL ACUTE CARE
20|FH_F34272_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|OP SVCS
20|FH_F34280_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F34286_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34308_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34308_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F34311_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F34311_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34315_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34317_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F34319_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F34319_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34321_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F34351_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34353_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34353_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F34361_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.00|99|0.00|OP SVCS
20|FH_F34371_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F34371_0_0|SrvcGrp|10538|2022|PDM|26.00|99|0.00|NURSING CARE
20|FH_F34371_0_0|SrvcGrp|10539|2022|PDM|35.00|99|0.00|HOME HEALTH AIDE
20|FH_F34371_0_0|SrvcGrp|10545|2022|PDM|100.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F34371_0_0|SrvcGrp|15385|2022|PDM|45.00|99|0.00|SKILLED NURSING NON IV RELATED
20|FH_F34378_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34400_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS
20|FH_F34413_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F34413_0_0|SrvcGrp|15132|2022|PDM|975.00|99|0.00|ACUTE IP MEDICAL SVCS
20|FH_F34418_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F34418_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34422_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34454_0_0|SrvcGrp|12856|2022|PDM|42.25|99|0.00|NURSING CARE
20|FH_F34454_0_0|SrvcGrp|26001|2022|PDM|94.50|99|0.00|HOSPICE RESPITE SVCS
20|FH_F34454_0_0|SrvcGrp|3809|2022|PDM|483.00|99|0.00|HOSPICE CARE
20|FH_F34463_0_0|CSTM-ALL|CSTM-00|2020|PCT|54.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34463_0_0|CSTM-ALL|CSTM-00|2020|PCT|54.00|99|0.00|OP SVCS
20|FH_F34491_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34498_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34498_0_0|SrvcGrp|16703|2022|PDM|1348.00|99|0.00|HEMO/HOME DIALYSIS SVCS
20|FH_F34498_0_0|SrvcGrp|16704|2022|PDM|1364.00|99|0.00|HOME HEMO TRAINING
20|FH_F34503_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F34523_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34532_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F34532_0_0|SrvcGrp|12890|2022|PCT|0.48|99|0.00|LABORATORY
20|FH_F34535_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34546_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34546_0_0|SrvcGrp|6|2022|PDM|2200.00|99|0.00|OP SURGERY
20|FH_F34550_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F34550_0_0|CSTM-ALL|CSTM-00|2020|PDM|1091.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34550_0_0|CSTM-ALL|CSTM-00|2020|PDM|7072.00|99|0.00|ANGIOPLASTY
20|FH_F34550_0_0|SrvcGrp|360|2022|PDM|825.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F34550_0_0|SrvcGrp|97|2022|PDM|3293.00|99|0.00|C-SECTION
20|FH_F34603_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.55|99|0.00|GENERAL ACUTE CARE
20|FH_F34636_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MSDRG TRANSPLANT SERVICES
20|FH_F34641_0_0|CSTM-ALL|CSTM-00|2020|PDM|465.00|99|0.00|CD RESIDENTIAL TREATMENT
20|FH_F34641_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|ADULT PSYCH PARTIAL HOSP
20|FH_F34652_0_0|SrvcGrp|43|2022|PCT|0.60|99|0.00|IMPLANTS
20|FH_F34652_0_0|SrvcGrp|72|2022|PDM|851.00|99|0.00|NEWBORN NURSERY
20|FH_F34653_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.20|99|0.00|GENERAL ACUTE CARE
20|FH_F34653_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.20|99|0.00|OP SVCS
20|FH_F34658_0_0|CSTM-ALL|CSTM-00|2020|PCT|63.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34660_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F34661_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34675_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F34675_0_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34675_0_0|SrvcGrp|17093|2022|PCT|0.70|99|0.00|COCHLEAR IMPLANT SERVICES
20|FH_F34675_0_0|SrvcGrp|17107|2022|PCT|1.10|99|0.00|COCHLEAR IMPLANT DEVICE
20|FH_F34675_0_0|SrvcGrp|17109|2022|PCT|0.70|99|0.00|CORNEAL TRANSPLANT
20|FH_F34678_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34691_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|NUCLEAR MEDICINE
20|FH_F34691_0_0|CSTM-ALL|CSTM-00|2020|PDM|1710.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34691_0_0|SrvcGrp|12299|2022|PCT|0.75|99|0.00|PROSTHETICS/IMPLANTS/DEVICES
20|FH_F34691_0_0|SrvcGrp|9774|2022|PDM|1988.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F34710_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34739_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34747_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F34747_0_0|CSTM-ALL|CSTM-00|2020|PDM|1309.00|99|0.00|ASPG VII
20|FH_F34747_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|ASPG IX
20|FH_F34747_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|ASPG X
20|FH_F34747_0_0|CSTM-ALL|CSTM-00|2020|PDM|436.80|99|0.00|ASPG I
20|FH_F34747_0_0|CSTM-ALL|CSTM-00|2020|PDM|827.40|99|0.00|ASPG IV
20|FH_F34747_0_0|SrvcGrp|17327|2022|PDM|2024.00|99|0.00|HYSTEROSCOPY
20|FH_F34764_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.40|99|0.00|GENERAL ACUTE CARE
20|FH_F34777_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|OP SVCS
20|FH_F34777_0_0|CSTM-ALL|CSTM-00|2020|PDM|355.00|99|0.00|CD SERVICES
20|FH_F34777_0_0|CSTM-ALL|CSTM-00|2020|PDM|6367.00|99|0.00|MSDRG 242-244, 258-262 PACEMAKER INSERTION/REVISION
20|FH_F34777_0_0|SrvcGrp|109|2022|PDM|816.00|99|0.00|CD - DETOX
20|FH_F34777_0_0|SrvcGrp|17366|2022|PCT|0.85|99|0.00|TRANSPLANT SVCS
20|FH_F34777_0_0|SrvcGrp|360|2022|PDM|1070.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F34786_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34816_0_0|CSTM-ALL|CSTM-00|2020|PCT|69.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34817_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|OP SVCS
20|FH_F34831_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34843_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34852_0_0|SrvcGrp|3066|2022|PCT|0.70|99|0.00|HIGH-COST DRUGS
20|FH_F34854_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|ACUTE PSYCH
20|FH_F34854_0_0|SrvcGrp|17531|2022|PDM|600.00|99|0.00|ELECTRO CONVULSIVE TREATMENT
20|FH_F34854_0_0|SrvcGrp|555|2022|PDM|175.00|99|0.00|INTENSIVE OP SVCS
20|FH_F34899_0_0|SrvcGrp|6|2022|PCT|0.90|99|0.00|OP SURGERY
20|FH_F34918_0_0|CSTM-ALL|CSTM-00|2020|PDM|2391.00|99|0.00|ACUTE IP MED SVCS
20|FH_F34918_0_0|SrvcGrp|177|2022|PDM|2815.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F34918_0_0|SrvcGrp|6|2022|PCT|0.70|99|0.00|OP SURGERY
20|FH_F34918_0_0|SrvcGrp|65|2022|PDM|2188.00|99|0.00|OBSTETRICAL CARE
20|FH_F34924_0_0|SrvcGrp|115|2022|PDM|475.00|99|0.00|SKILLED NURSING CARE
20|FH_F34924_0_0|SrvcGrp|72|2022|PDM|460.00|99|0.00|NEWBORN NURSERY
20|FH_F34924_0_0|SrvcGrp|944|2022|PDM|26250.00|99|0.00|BARIATRIC SVCS
20|FH_F34938_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F34951_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F34963_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F34963_0_0|SrvcGrp|16304|2022|PDM|580.00|99|0.00|HOSPICE CARE
20|FH_F34998_0_0|SrvcGrp|360|2022|PDM|800.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F34998_0_0|SrvcGrp|6|2022|PCT|0.90|99|0.00|OP SURGERY
20|FH_F35010_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35019_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS
20|FH_F35042_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|BURN SVCS
20|FH_F35042_0_0|CSTM-ALL|CSTM-00|2020|PDM|3531.00|99|0.00|MS DRG 216-227, 231-236 CV SURGERY
20|FH_F35042_0_0|CSTM-ALL|CSTM-00|2020|PDM|683.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F35042_0_0|SrvcGrp|16|2022|PDM|1512.00|99|0.00|ACUTE REHABILITATION
20|FH_F35042_0_0|SrvcGrp|3987|2022|PCT|0.80|99|0.00|TRAUMA CARE
20|FH_F35042_0_0|SrvcGrp|701|2022|PDM|2514.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F35053_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35053_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F35056_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|ASPG II
20|FH_F35056_0_0|CSTM-ALL|CSTM-00|2020|PDM|3380.00|99|0.00|ASPG VI
20|FH_F35056_0_0|CSTM-ALL|CSTM-00|2020|PDM|3875.00|99|0.00|ASPG VII
20|FH_F35056_0_0|CSTM-ALL|CSTM-00|2020|PDM|4100.00|99|0.00|MS DRG 765-766 C-SECTION
20|FH_F35056_0_0|CSTM-ALL|CSTM-00|2020|PDM|4125.00|99|0.00|ASPG X
20|FH_F35056_0_0|CSTM-ALL|CSTM-00|2020|PDM|4500.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35056_0_0|SrvcGrp|9527|2022|PDM|2500.00|99|0.00|NORMAL DELIVERY
20|FH_F35069_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F35080_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35088_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|MS DRG 216-221, 231-236 CV SURGERY
20|FH_F35088_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|MULTIPLE BIRTH
20|FH_F35088_0_0|SrvcGrp|11200|2022|PCT|0.50|99|0.00|DRUGS
20|FH_F35088_0_0|SrvcGrp|3102|2022|PCT|0.50|99|0.00|IMPLANTS
20|FH_F35088_0_0|SrvcGrp|411|2022|PDM|3407.00|99|0.00|OP CARDIAC CATH
20|FH_F35088_0_0|SrvcGrp|72|2022|PDM|660.00|99|0.00|NEWBORN NURSERY
20|FH_F35123_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35128_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35128_0_0|CSTM-ALL|CSTM-00|2020|PDM|75.00|99|0.00|PHYSICAL/OCCUPATIONAL/SPEECH THERAPY
20|FH_F35133_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|MSDRG 216-218 CARDIAC VALVE PROCEDURE W/CARDIAC CATH OTLR
20|FH_F35133_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F35133_0_0|CSTM-ALL|CSTM-00|2020|PDM|13500.00|99|0.00|MS DRG 238
20|FH_F35133_0_0|CSTM-ALL|CSTM-00|2020|PDM|28200.00|99|0.00|MSDRG 226-227 CV SURG CARDIAC DEFIBRILLATOR
20|FH_F35133_0_0|CSTM-ALL|CSTM-00|2020|PDM|8100.00|99|0.00|MS DRG 286-287 CARDIAC CATH AND LAB
20|FH_F35133_0_0|CSTM-ALL|CSTM-00|2020|PDM|8100.00|99|0.00|MSDRG 250-251 PERCUTANEOUS CARDIO PROC
20|FH_F35133_0_0|SrvcGrp|17553|2022|PCT|0.60|99|0.00|IMPLANTS
20|FH_F35133_0_0|SrvcGrp|20297|2022|PDM|28200.00|99|0.00|MS DRG 219-221 ONLY CARDIAC VALVE PROC
20|FH_F35133_0_0|SrvcGrp|360|2022|PDM|1300.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F35133_0_0|SrvcGrp|701|2022|PDM|2250.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F35164_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35167_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|DRUGS
20|FH_F35167_0_0|SrvcGrp|115|2022|PDM|1430.00|99|0.00|SKILLED NURSING CARE
20|FH_F35167_0_0|SrvcGrp|20077|2022|PCT|0.65|99|0.00|MS DRG 226-227 ONLY CARDIAC DEFIBRILLATOR
20|FH_F35167_0_0|SrvcGrp|269|2022|PDM|8327.00|99|0.00|OP LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F35167_0_0|SrvcGrp|537|2022|PCT|0.66|99|0.00|OBSERVATION SERVICES
20|FH_F35167_0_0|SrvcGrp|65|2022|PDM|3475.00|99|0.00|OBSTETRICAL CARE
20|FH_F35174_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 216-237 CV SURGERY
20|FH_F35174_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.76|99|0.00|OP SVCS
20|FH_F35174_0_0|CSTM-ALL|CSTM-00|2020|PDM|1209.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F35174_0_0|CSTM-ALL|CSTM-00|2020|PDM|1380.00|99|0.00|SKILLED NURSING FACILITY
20|FH_F35174_0_0|SrvcGrp|10671|2022|PCT|0.75|99|0.00|CARDIAC CATHETERIZATION
20|FH_F35174_0_0|SrvcGrp|3818|2022|PDM|4507.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F35176_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35176_0_0|SrvcGrp|12263|2022|PDM|17.50|99|0.00|HOME HEALTH AIDE- HOURLY
20|FH_F35176_0_0|SrvcGrp|12264|2022|PDM|60.75|99|0.00|DIETICIAN OR LPN SERVICES
20|FH_F35176_0_0|SrvcGrp|22954|2022|PDM|94.50|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F35176_0_0|SrvcGrp|9832|2022|PDM|84.50|99|0.00|ST SVCS
20|FH_F35202_0_0|SrvcGrp|10410|2022|PDM|42.00|99|0.00|SKILLED NURSING CARE
20|FH_F35202_0_0|SrvcGrp|11442|2022|PDM|483.00|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)
20|FH_F35202_0_0|SrvcGrp|1168|2022|PDM|26.25|99|0.00|CONTINUOUS HOMECARE
20|FH_F35202_0_0|SrvcGrp|12263|2022|PDM|17.85|99|0.00|HOME HEALTH AIDE- HOURLY
20|FH_F35210_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|MS DRG 238 ONLY
20|FH_F35210_0_0|SrvcGrp|268|2022|PCT|0.65|99|0.00|HYPERBARIC CHAMBER
20|FH_F35210_0_0|SrvcGrp|418|2022|PCT|0.70|99|0.00|LAPAROSCOPIC HYSTERECTOMY
20|FH_F35210_0_0|SrvcGrp|72|2022|PDM|744.00|99|0.00|NEWBORN NURSERY
20|FH_F35210_0_0|SrvcGrp|997|2022|PCT|0.50|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F35212_0_0|SrvcGrp|12856|2022|PDM|42.25|99|0.00|NURSING CARE
20|FH_F35212_0_0|SrvcGrp|3809|2022|PDM|483.00|99|0.00|HOSPICE CARE
20|FH_F35212_0_0|SrvcGrp|8962|2022|PDM|82.50|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F35212_0_0|SrvcGrp|9828|2022|PDM|36.00|99|0.00|HOME HEALTH AIDE
20|FH_F35212_0_0|SrvcGrp|9829|2022|PDM|85.50|99|0.00|PT SVCS
20|FH_F35212_0_0|SrvcGrp|9832|2022|PDM|84.50|99|0.00|ST SVCS
20|FH_F35216_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|SPEECH THERAPY
20|FH_F35216_0_0|CSTM-ALL|CSTM-00|2020|PDM|10000.00|99|0.00|MS DRG 246-247, 249 PTCA W/STENT
20|FH_F35216_0_0|CSTM-ALL|CSTM-00|2020|PDM|11750.00|99|0.00|MS DRG 253
20|FH_F35216_0_0|CSTM-ALL|CSTM-00|2020|PDM|13500.00|99|0.00|MS DRG 242-245 OTHER PERMANENT CARDIAC PACEMAKER IMP W/O
20|FH_F35216_0_0|CSTM-ALL|CSTM-00|2020|PDM|13645.00|99|0.00|MS DRG 459
20|FH_F35216_0_0|CSTM-ALL|CSTM-00|2020|PDM|3100.00|99|0.00|MS DRG 765-766 C-SECTION
20|FH_F35216_0_0|CSTM-ALL|CSTM-00|2020|PDM|8500.00|99|0.00|MS DRGS 248, 250-251 (PTCA W/O STENT)
20|FH_F35216_0_0|SrvcGrp|21122|2022|PDM|16500.00|99|0.00|MS DRG 459 ONLY
20|FH_F35216_0_0|SrvcGrp|941|2022|PDM|1200.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F35217_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OP SVCS
20|FH_F35221_0_0|SrvcGrp|6|2022|PDM|3500.00|99|0.00|OP SURGERY
20|FH_F35245_0_0|SrvcGrp|13241|2022|PDM|70.00|99|0.00|SPEECH THERAPY
20|FH_F35259_0_0|SrvcGrp|20089|2022|PDM|12214.00|99|0.00|ANGIOPLASTY
20|FH_F35259_0_0|SrvcGrp|23703|2022|PCT|0.55|99|0.00|IP/OP TRAUMA
20|FH_F35259_0_0|SrvcGrp|290|2022|PDM|12214.00|99|0.00|IP LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F35259_0_0|SrvcGrp|3029|2022|PDM|923.00|99|0.00|NEWBORN NURSERY
20|FH_F35259_0_0|SrvcGrp|30618|2022|PCT|0.66|99|0.00|LEADS
20|FH_F35259_0_0|SrvcGrp|360|2022|PDM|3456.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F35259_0_0|SrvcGrp|4109|2022|PDM|1391.00|99|0.00|ACUTE PSYCH
20|FH_F35259_0_0|SrvcGrp|91|2022|PCT|0.68|99|0.00|KIDNEY TRANSPLANT
20|FH_F35259_0_0|SrvcGrp|941|2022|PDM|5624.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F35259_0_0|SrvcGrp|9826|2022|PCT|0.71|99|0.00|OP SURGERY
20|FH_F35263_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS
20|FH_F35271_0_0|SrvcGrp|14187|2022|PDM|850.00|99|0.00|MRI
20|FH_F35278_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35344_0_0|SrvcGrp|6|2022|PCT|0.75|99|0.00|OP SURGERY
20|FH_F35344_0_0|SrvcGrp|72|2022|PDM|500.00|99|0.00|NEWBORN NURSERY
20|FH_F35347_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35368_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F35368_0_0|CSTM-ALL|CSTM-00|2020|PDM|1590.00|99|0.00|ONE DAY SURGERY
20|FH_F35368_0_0|SrvcGrp|11971|2022|PCT|0.95|99|0.00|TRAUMA CARE
20|FH_F35368_0_0|SrvcGrp|12221|2022|PDM|6699.00|99|0.00|ELECTROPHYSIOLOGY
20|FH_F35368_0_0|SrvcGrp|24|2022|PDM|6416.00|99|0.00|CARDIAC CATH
20|FH_F35369_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F35369_0_0|SrvcGrp|3064|2022|PDM|2350.00|99|0.00|ICU/CCU
20|FH_F35381_0_0|CSTM-ALL|CSTM-00|2020|PDM|1491.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35381_0_0|SrvcGrp|14179|2022|PCT|1.00|99|0.00|ORTHOTICS/PROSTHETICS/IMPLANTS
20|FH_F35381_0_0|SrvcGrp|16|2022|PDM|1046.00|99|0.00|ACUTE REHABILITATION
20|FH_F35381_0_0|SrvcGrp|24|2022|PDM|1759.00|99|0.00|CARDIAC CATH
20|FH_F35381_0_0|SrvcGrp|6|2022|PCT|0.65|99|0.00|OP SURGERY
20|FH_F35384_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F35384_0_0|CSTM-ALL|CSTM-00|2020|PDM|3351.00|99|0.00|MS DRGS 215-221, 231-236 CV SURGERY
20|FH_F35384_0_0|SrvcGrp|14414|2022|PDM|467.00|99|0.00|NEWBORN NURSERY
20|FH_F35387_0_0|CSTM-ALL|CSTM-00|2020|PDM|1830.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35387_0_0|SrvcGrp|16|2022|PDM|1178.00|99|0.00|ACUTE REHABILITATION
20|FH_F35387_0_0|SrvcGrp|360|2022|PDM|1234.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F35387_0_0|SrvcGrp|80|2022|PDM|1000.00|99|0.00|ACUTE PSYCH
20|FH_F35387_0_0|SrvcGrp|8968|2022|PDM|1830.00|99|0.00|NICU LEVEL III & IV
20|FH_F35388_0_0|CSTM-ALL|CSTM-00|2020|PDM|1185.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F35388_0_0|SrvcGrp|17000|2022|PDM|1800.00|99|0.00|OUTPATIENT SURGERY
20|FH_F35404_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|IMPLANTS/PROSTHETICS/DEVICES
20|FH_F35404_0_0|SrvcGrp|11301|2022|PDM|1300.00|99|0.00|MAGNETIC RESONANCE IMAGING
20|FH_F35404_0_0|SrvcGrp|59453|2022|PDM|5155.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F35404_0_0|SrvcGrp|8968|2022|PDM|3000.00|99|0.00|NICU LEVEL III & IV
20|FH_F35404_0_0|SrvcGrp|9774|2022|PDM|3000.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F35404_0_0|SrvcGrp|9938|2022|PDM|120.00|99|0.00|SPEECH THERAPY
20|FH_F35404_0_0|SrvcGrp|9978|2022|PDM|2500.00|99|0.00|ACUTE INPATIENT MEDICAL SVCS
20|FH_F35405_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F35408_0_0|CSTM-ALL|CSTM-00|2020|PDM|275.00|99|0.00|ADVANCED LIFE SUPPORT (ALS) PARAMEDIC INTERCEPT
20|FH_F35408_0_0|SrvcGrp|16899|2022|PDM|211.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT
20|FH_F35408_0_0|SrvcGrp|16996|2022|PDM|55.00|99|0.00|AMBULANCE RESPONSE/TREATMENT - NO TRANSPORT
20|FH_F35411_0_0|CSTM-ALL|CSTM-00|2020|PDM|5299.00|99|0.00|MSDRG 286-287 CARDIAC CATH
20|FH_F35411_0_0|CSTM-ALL|CSTM-00|2020|PDM|8050.00|99|0.00|MS DRG 215 222-227 AICD IMPLANTATION/PROGRAMMING
20|FH_F35411_0_0|CSTM-ALL|CSTM-00|2020|PDM|8050.00|99|0.00|MSDRG 246-251 ANGIOPLASTY
20|FH_F35411_0_0|SrvcGrp|13127|2022|PDM|539.00|99|0.00|DIALYSIS
20|FH_F35411_0_0|SrvcGrp|13148|2022|PDM|5299.00|99|0.00|DIAGNOSTIC CARDIAC CATH
20|FH_F35411_0_0|SrvcGrp|2138|2022|PDM|1196.00|99|0.00|THERAPEUTIC PLASMAPHERESIS
20|FH_F35411_0_0|SrvcGrp|3069|2022|PCT|0.65|99|0.00|IMPLANTS
20|FH_F35411_0_0|SrvcGrp|9947|2022|PCT|0.65|99|0.00|DRUGS
20|FH_F35416_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F35416_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|ORGAN TRANSPLANT/PROCUREMENT
20|FH_F35416_0_0|CSTM-ALL|CSTM-00|2020|PDM|3420.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35416_0_0|SrvcGrp|15977|2022|PCT|0.80|99|0.00|PALLIDOTOMY
20|FH_F35416_0_0|SrvcGrp|51672|2022|PDM|4620.00|99|0.00|MS DRG 286-287 ONLY
20|FH_F35416_0_0|SrvcGrp|70342|2022|PDM|20700.00|99|0.00|THORACIC SURGERY
20|FH_F35416_0_0|SrvcGrp|8950|2022|PDM|3252.00|99|0.00|INTERMEDIATE ICU/CCU
20|FH_F35432_0_0|CSTM-ALL|CSTM-00|2020|PDM|1114.00|99|0.00|ACUTE IP MED SVCS
20|FH_F35432_0_0|SrvcGrp|16|2022|PDM|563.00|99|0.00|ACUTE REHABILITATION
20|FH_F35446_0_0|SrvcGrp|72|2022|PDM|574.00|99|0.00|NEWBORN NURSERY
20|FH_F35453_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F35458_0_0|CSTM-ALL|CSTM-00|2020|PDM|1460.00|99|0.00|ACUTE IP MEDICAL SERVICES
20|FH_F35458_0_0|CSTM-ALL|CSTM-00|2020|PDM|2950.00|99|0.00|ORTHOPEDIC SURGERY
20|FH_F35458_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|ASPG I
20|FH_F35458_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|ASPG VII
20|FH_F35458_0_0|CSTM-ALL|CSTM-00|2020|PDM|4750.00|99|0.00|MS DRG 765-766 C-SECTION
20|FH_F35458_0_0|SrvcGrp|12804|2022|PDM|2300.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F35458_0_0|SrvcGrp|9838|2022|PDM|1850.00|99|0.00|TRANSITIONAL CARE UNIT
20|FH_F35476_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.83|99|0.00|GENERAL ACUTE CARE
20|FH_F35476_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|TRAUMA EMERGENCY ROOM SVCS
20|FH_F35476_0_0|CSTM-ALL|CSTM-00|2020|PDM|15000.00|99|0.00|MS DRG 260-262 CARDIAC PACEMAKER REVISION
20|FH_F35476_0_0|SrvcGrp|12403|2022|PDM|681.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F35476_0_0|SrvcGrp|20299|2022|PDM|34498.00|99|0.00|MS DRG 228-230 ONLY OTHER CARDIOTHORACIC PROC
20|FH_F35476_0_0|SrvcGrp|3810|2022|PDM|158.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F35477_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35477_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|OP SVCS
20|FH_F35498_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F35509_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS
20|FH_F35513_0_0|CSTM-ALL|CSTM-00|2020|PDM|35.00|99|0.00|HOME HEALTH AIDE VISIT
20|FH_F35513_0_0|CSTM-ALL|CSTM-00|2020|PDM|75.00|99|0.00|RN VISIT
20|FH_F35513_0_0|CSTM-ALL|CSTM-00|2020|PDM|75.00|99|0.00|SPEECH THERAPY
20|FH_F35567_0_0|CSTM-ALL|CSTM-00|2020|PDM|690.00|99|0.00|MRI SERVICES
20|FH_F35571_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F35575_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS
20|FH_F35587_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS
20|FH_F35593_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS
20|FH_F35599_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35599_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F35615_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F35678_0_0|CSTM-ALL|CSTM-00|2020|PDM|16952.00|99|0.00|MS DRG 023
20|FH_F35678_0_0|CSTM-ALL|CSTM-00|2020|PDM|16952.00|99|0.00|MS DRG 032
20|FH_F35678_0_0|CSTM-ALL|CSTM-00|2020|PDM|16952.00|99|0.00|MS DRG 042
20|FH_F35678_0_0|CSTM-ALL|CSTM-00|2020|PDM|19000.00|99|0.00|MS DRG 619-621 GASTROPLASTY PROCEDURE OBESITY
20|FH_F35678_0_0|CSTM-ALL|CSTM-00|2020|PDM|6357.00|99|0.00|MS DRG 287
20|FH_F35678_0_0|CSTM-ALL|CSTM-00|2020|PDM|8476.00|99|0.00|MS DRG 029
20|FH_F35678_0_0|SrvcGrp|3029|2022|PDM|423.00|99|0.00|NEWBORN NURSERY
20|FH_F35716_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F35716_0_0|SrvcGrp|12403|2022|PDM|26.25|99|0.00|CONTINUOUS HOMECARE
20|FH_F35727_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35730_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35740_0_0|CSTM-ALL|CSTM-00|2020|PDM|425.00|99|0.00|ALBERMARLE GASTRO COLON MOD SU
20|FH_F35748_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F35748_0_0|CSTM-ALL|CSTM-00|2020|PDM|80.00|99|0.00|PHYSICAL THERAPY
20|FH_F35802_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35804_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS
20|FH_F35805_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS
20|FH_F35823_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35847_0_0|SrvcGrp|6|2022|PCT|0.66|99|0.00|OP SURGERY
20|FH_F35847_0_0|SrvcGrp|701|2022|PCT|0.63|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F35847_0_0|SrvcGrp|997|2022|PCT|0.63|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F35884_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35898_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35924_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F35929_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35930_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35966_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35966_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F35966_0_0|SrvcGrp|19607|2022|PDM|750.00|99|0.00|SPECIALTY CARE TRANSPORT
20|FH_F35975_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35982_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|ASPG X
20|FH_F35982_0_0|CSTM-ALL|CSTM-00|2020|PDM|495.00|99|0.00|ASPG II
20|FH_F35982_0_0|CSTM-ALL|CSTM-00|2020|PDM|693.00|99|0.00|ASPG IV
20|FH_F35982_0_0|CSTM-ALL|CSTM-00|2020|PDM|810.00|99|0.00|ASPG V
20|FH_F35982_0_0|CSTM-ALL|CSTM-00|2020|PDM|90.00|99|0.00|COLUMBIA EYE SURGE CENTER  CPT
20|FH_F35987_0_0|CSTM-ALL|CSTM-00|2020|PDM|1029.00|99|0.00|ACUTE PSYCH
20|FH_F35987_0_0|CSTM-ALL|CSTM-00|2020|PDM|1718.00|99|0.00|ACUTE IP MED SVCS
20|FH_F35987_0_0|CSTM-ALL|CSTM-00|2020|PDM|475.00|99|0.00|CD PARTIAL HOSPITALIZATION
20|FH_F35987_0_0|SrvcGrp|108|2022|PCT|0.75|99|0.00|EXTRA CORPOREAL MEMBRANE OXYGEN
20|FH_F35987_0_0|SrvcGrp|16679|2022|PDM|4743.00|99|0.00|LAPAROSCOPIC PROCEDURES
20|FH_F35987_0_0|SrvcGrp|177|2022|PDM|2111.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F35987_0_0|SrvcGrp|22147|2022|PDM|127.00|99|0.00|PSYCH PARTIAL HOSP (HALF DAY)
20|FH_F35987_0_0|SrvcGrp|3078|2022|PCT|0.60|99|0.00|DRUGS
20|FH_F35987_0_0|SrvcGrp|941|2022|PDM|2749.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F35990_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F35990_0_0|CSTM-ALL|CSTM-00|2020|PDM|1029.00|99|0.00|ACUTE PSYCH
20|FH_F35990_0_0|CSTM-ALL|CSTM-00|2020|PDM|475.00|99|0.00|CD PARTIAL HOSPITALIZATION
20|FH_F35990_0_0|SrvcGrp|22148|2022|PDM|261.00|99|0.00|PSYCH PARTIAL HOSP (FULL DAY)
20|FH_F35990_0_0|SrvcGrp|23477|2022|PDM|5219.00|99|0.00|MSDRG 286-287 ONLY CARDIAC CATH
20|FH_F35990_0_0|SrvcGrp|701|2022|PDM|3008.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F35990_0_0|SrvcGrp|941|2022|PDM|2749.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F36006_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F36034_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS
20|FH_F36036_0_0|SrvcGrp|22093|2022|PDM|15.00|99|0.00|HCPCS A4250
20|FH_F36036_0_0|SrvcGrp|57363|2022|PDM|1450.00|99|0.00|CPT CODE 93229
20|FH_F36039_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE
20|FH_F36039_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F36047_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS
20|FH_F36101_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F36118_0_0|SrvcGrp|3810|2022|PDM|120.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F36118_0_0|SrvcGrp|9828|2022|PDM|42.00|99|0.00|HOME HEALTH AIDE
20|FH_F36118_0_0|SrvcGrp|9830|2022|PDM|102.00|99|0.00|OT SVCS
20|FH_F36155_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|GENERAL ACUTE CARE
20|FH_F36170_0_0|CSTM-ALL|CSTM-00|2020|PDM|1236.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36171_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F36202_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F36202_0_0|SrvcGrp|16|2022|PDM|1756.00|99|0.00|ACUTE REHABILITATION
20|FH_F36207_0_0|SrvcGrp|16896|2022|PDM|550.00|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2
20|FH_F36207_0_0|SrvcGrp|16898|2022|PDM|495.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC
20|FH_F36207_0_0|SrvcGrp|16900|2022|PDM|325.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT
20|FH_F36225_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F36251_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36251_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS
20|FH_F36261_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F36274_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36274_0_0|SrvcGrp|12401|2022|PDM|90.00|99|0.00|RN VISIT
20|FH_F36274_0_0|SrvcGrp|14306|2022|PDM|50.00|99|0.00|WELL MOM/WELL BABY VISIT
20|FH_F36277_0_0|SrvcGrp|27210|2022|PDM|439.00|99|0.00|SKILLED NURSING LEVEL I
20|FH_F36280_0_0|CSTM-ALL|CSTM-00|2020|PDM|65.00|99|0.00|5781263-GA-PT/OT/ST-CPT
20|FH_F36299_0_0|SrvcGrp|21976|2022|PCT|0.75|99|0.00|LAPAROSCOPIC SERVICES
20|FH_F36299_0_0|SrvcGrp|22785|2022|PDM|592.00|99|0.00|SUBACUTE WITHOUT  VENTILATOR
20|FH_F36299_0_0|SrvcGrp|58|2022|PCT|0.85|99|0.00|IP LITHOTRIPSY SVCS
20|FH_F36323_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36323_0_0|SrvcGrp|474|2022|PDM|325.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F36338_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36341_0_0|CSTM-ALL|CSTM-00|2020|PDM|1336.00|99|0.00|ASPG IV
20|FH_F36341_0_0|CSTM-ALL|CSTM-00|2020|PDM|2370.00|99|0.00|ASPG VIII
20|FH_F36341_0_0|CSTM-ALL|CSTM-00|2020|PDM|706.00|99|0.00|ASPG I
20|FH_F36341_0_0|CSTM-ALL|CSTM-00|2020|PDM|945.00|99|0.00|ASPG II
20|FH_F36341_0_0|SrvcGrp|16876|2022|PDM|759.00|99|0.00|SLEEP STUDIES
20|FH_F36341_0_0|SrvcGrp|9911|2022|PCT|0.50|99|0.00|EMERGENCY ROOM SVCS
20|FH_F36348_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F36350_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|FALSE LABOR
20|FH_F36350_0_0|SrvcGrp|3069|2022|PCT|0.65|99|0.00|IMPLANTS
20|FH_F36350_0_0|SrvcGrp|701|2022|PDM|1618.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F36366_0_0|CSTM-ALL|CSTM-00|2020|PDM|1008.00|99|0.00|CPT 95811
20|FH_F36366_0_0|CSTM-ALL|CSTM-00|2020|PDM|555.00|99|0.00|CPT 95807
20|FH_F36366_0_0|CSTM-ALL|CSTM-00|2020|PDM|798.00|99|0.00|CPT 95810 (W/MOD TC)
20|FH_F36381_0_0|CSTM-ALL|CSTM-00|2020|PDM|200.00|99|0.00|BLOOD TRANSFUSION
20|FH_F36381_0_0|SrvcGrp|11258|2022|PDM|1000.00|99|0.00|DRUGS
20|FH_F36381_0_0|SrvcGrp|9460|2022|PDM|700.00|99|0.00|ACUTE REHABILITATION
20|FH_F36381_0_0|SrvcGrp|9861|2022|PDM|900.00|99|0.00|ACUTE REHABILITATION
20|FH_F36382_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F36384_0_0|CSTM-ALL|CSTM-00|2020|PCT|61.30|99|0.00|GENERAL ACUTE CARE
20|FH_F36397_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS
20|FH_F36403_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F36403_0_0|CSTM-ALL|CSTM-00|2020|PDM|81.00|99|0.00|THERAPY
20|FH_F36403_0_0|SrvcGrp|3259|2022|PDM|300.00|99|0.00|ACUTE REHABILITATION
20|FH_F36409_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F36409_0_0|SrvcGrp|3327|2022|PDM|94.50|99|0.00|HOSPICE SERVICE - IP RESPITE
20|FH_F36418_0_0|SrvcGrp|13123|2022|PCT|1.00|99|0.00|COMPUTED TOMOGRAPHY (CT)
20|FH_F36418_0_0|SrvcGrp|14174|2022|PCT|1.00|99|0.00|MRI
20|FH_F36420_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|BRACHY SEED IMPLANT
20|FH_F36420_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|PENILE IMPLANT
20|FH_F36420_0_0|SrvcGrp|38|2022|PDM|2700.00|99|0.00|NORMAL DELIVERY
20|FH_F36420_0_0|SrvcGrp|72|2022|PDM|500.00|99|0.00|NEWBORN NURSERY
20|FH_F36420_0_0|SrvcGrp|997|2022|PCT|0.80|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F36431_0_0|CSTM-ALL|CSTM-00|2020|PDM|828.24|99|0.00|ASPG III
20|FH_F36431_0_0|CSTM-ALL|CSTM-00|2020|PDM|946.56|99|0.00|ASPG X
20|FH_F36433_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.86|99|0.00|OP SVCS
20|FH_F36439_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36439_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|HEARING AIDS
20|FH_F36439_0_0|SrvcGrp|23001|2022|PDM|1300.00|99|0.00|V5260
20|FH_F36439_0_0|SrvcGrp|23004|2022|PDM|650.00|99|0.00|V5257
20|FH_F36439_0_0|SrvcGrp|23007|2022|PDM|800.00|99|0.00|V5254
20|FH_F36439_0_0|SrvcGrp|23008|2022|PDM|1300.00|99|0.00|V5253
20|FH_F36439_0_0|SrvcGrp|23011|2022|PDM|1600.00|99|0.00|V5250
20|FH_F36439_0_0|SrvcGrp|23015|2022|PDM|800.00|99|0.00|V5244
20|FH_F36450_0_0|CSTM-ALL|CSTM-00|2020|PDM|6225.00|99|0.00|LITHOTRIPSY
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|1461.94|99|0.00|SALLY BALIN,999182,ASC 902
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|153.53|99|0.00|SALLY BALIN,999182,ASC 117
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|175.49|99|0.00|SALLY BALIN,999182,ASC 308
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|214.05|99|0.00|SALLY BALIN,999182,ASC 112
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|214.05|99|0.00|SALLY BALIN,999182,ASC 307
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|243.91|99|0.00|SALLY BALIN,999182,ASC 111
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|275.28|99|0.00|SALLY BALIN,999182,ASC 109
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|279.45|99|0.00|SALLY BALIN,999182,ASC 108
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|279.45|99|0.00|SALLY BALIN,999182,ASC 216
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|281.51|99|0.00|SALLY BALIN,999182,ASC 215
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|348.43|99|0.00|SALLY BALIN,999182,ASC 105
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|363.37|99|0.00|SALLY BALIN,999182,ASC 213
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|363.87|99|0.00|SALLY BALIN,999182,ASC 212
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|409.77|99|0.00|SALLY BALIN,999182,ASC 304
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|43.68|99|0.00|SALLY BALIN,999182,ASC 228
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|434.24|99|0.00|SALLY BALIN,999182,ASC 405
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|464.86|99|0.00|SALLY BALIN,999182,ASC 205
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|540.44|99|0.00|SALLY BALIN,999182,ASC 402
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|593.83|99|0.00|SALLY BALIN,999182,ASC 301
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|78.14|99|0.00|SALLY BALIN,999182,ASC 227
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|834.86|99|0.00|SALLY BALIN,999182,ASC 501
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|84.39|99|0.00|SALLY BALIN,999182,ASC 124
20|FH_F36458_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|OP SVCS
20|FH_F36472_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|IMPLANTS
20|FH_F36472_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F36472_0_0|SrvcGrp|131|2022|PCT|0.73|99|0.00|PACEMAKER DEVICE
20|FH_F36479_0_0|SrvcGrp|72|2022|PDM|246.00|99|0.00|NEWBORN NURSERY
20|FH_F36492_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F36492_0_0|SrvcGrp|72990|2022|PDM|570.00|99|0.00|AEG 1
20|FH_F36492_0_0|SrvcGrp|72992|2022|PDM|764.00|99|0.00|AEG 2
20|FH_F36492_0_0|SrvcGrp|72994|2022|PDM|874.00|99|0.00|AEG 3
20|FH_F36492_0_0|SrvcGrp|72996|2022|PDM|1080.00|99|0.00|AEG 4
20|FH_F36492_0_0|SrvcGrp|72998|2022|PDM|1229.00|99|0.00|AEG 5
20|FH_F36492_0_0|SrvcGrp|73002|2022|PDM|1706.00|99|0.00|AEG 7
20|FH_F36521_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|ACUTE PSYCH
20|FH_F36521_0_0|SrvcGrp|701|2022|PDM|1600.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F36532_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS
20|FH_F36541_0_0|SrvcGrp|9978|2022|PDM|1800.00|99|0.00|ACUTE INPATIENT MEDICAL SVCS
20|FH_F36542_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36552_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36552_0_0|CSTM-ALL|CSTM-00|2020|PDM|29295.00|99|0.00|MS DRG 221
20|FH_F36552_0_0|CSTM-ALL|CSTM-00|2020|PDM|29840.00|99|0.00|MS DRG 229
20|FH_F36552_0_0|CSTM-ALL|CSTM-00|2020|PDM|37410.00|99|0.00|MS DRG 216
20|FH_F36552_0_0|CSTM-ALL|CSTM-00|2020|PDM|37915.00|99|0.00|MS DRG 231
20|FH_F36552_0_0|CSTM-ALL|CSTM-00|2020|PDM|6685.00|99|0.00|MS DRG 262
20|FH_F36552_0_0|CSTM-ALL|CSTM-00|2020|PDM|8005.00|99|0.00|MS DRG 258
20|FH_F36555_0_0|SrvcGrp|471|2022|PDM|660.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F36576_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|ORTHOPEDIC PROCEDURES
20|FH_F36576_0_0|SrvcGrp|16|2022|PDM|803.00|99|0.00|ACUTE REHABILITATION
20|FH_F36576_0_0|SrvcGrp|38|2022|PDM|2840.00|99|0.00|NORMAL DELIVERY
20|FH_F36590_0_0|CSTM-ALL|CSTM-00|2020|PDM|2780.00|99|0.00|MSDRG 216-221, 231-236 CV SURGERY
20|FH_F36590_0_0|CSTM-ALL|CSTM-00|2020|PDM|616.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F36590_0_0|SrvcGrp|115|2022|PDM|616.00|99|0.00|SKILLED NURSING CARE
20|FH_F36594_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36594_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F36594_0_0|CSTM-ALL|CSTM-00|2020|PDM|47.00|99|0.00|RN, INTERMITTENT VISIT
20|FH_F36594_0_0|SrvcGrp|12401|2022|PDM|88.00|99|0.00|RN VISIT
20|FH_F36594_0_0|SrvcGrp|3327|2022|PDM|90.00|99|0.00|HOSPICE SERVICE - IP RESPITE
20|FH_F36594_0_0|SrvcGrp|8962|2022|PDM|102.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F36594_0_0|SrvcGrp|9830|2022|PDM|102.00|99|0.00|OT SVCS
20|FH_F36594_0_0|SrvcGrp|9832|2022|PDM|102.00|99|0.00|ST SVCS
20|FH_F36596_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F36616_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36616_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS
20|FH_F36620_0_0|SrvcGrp|19984|2022|PDM|50.00|99|0.00|THERAPY
20|FH_F36620_0_0|SrvcGrp|473|2022|PDM|447.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F36620_0_0|SrvcGrp|474|2022|PDM|325.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F36634_0_0|CSTM-ALL|CSTM-00|2020|PDM|795.00|99|0.00|ACUTE PSYCH
20|FH_F36634_0_0|SrvcGrp|3029|2022|PDM|370.00|99|0.00|NEWBORN NURSERY
20|FH_F36634_0_0|SrvcGrp|360|2022|PDM|1352.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F36634_0_0|SrvcGrp|701|2022|PDM|1874.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F36646_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36646_0_0|SrvcGrp|472|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F36667_0_0|SrvcGrp|17000|2022|PCT|0.65|99|0.00|OUTPATIENT SURGERY
20|FH_F36669_0_0|SrvcGrp|3327|2022|PDM|136.71|99|0.00|HOSPICE SERVICE - IP RESPITE
20|FH_F36679_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F36683_0_0|CSTM-ALL|CSTM-00|2020|PDM|26758.00|99|0.00|MS DRG 231
20|FH_F36683_0_0|CSTM-ALL|CSTM-00|2020|PDM|27873.00|99|0.00|MS DRG 221
20|FH_F36683_0_0|CSTM-ALL|CSTM-00|2020|PDM|3010.00|99|0.00|MS DRG 287
20|FH_F36683_0_0|CSTM-ALL|CSTM-00|2020|PDM|31218.00|99|0.00|MS DRG 216
20|FH_F36683_0_0|SrvcGrp|701|2022|PDM|2077.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F36704_0_0|CSTM-ALL|CSTM-00|2020|PDM|619.00|99|0.00|ACUTE PSYCH
20|FH_F36704_0_0|SrvcGrp|6|2022|PCT|0.85|99|0.00|OP SURGERY
20|FH_F36704_0_0|SrvcGrp|8950|2022|PDM|1450.00|99|0.00|INTERMEDIATE ICU/CCU
20|FH_F36710_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F36715_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F36715_0_0|SrvcGrp|115|2022|PDM|646.00|99|0.00|SKILLED NURSING CARE
20|FH_F36732_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F36743_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|TRAUMA CARE
20|FH_F36743_0_0|CSTM-ALL|CSTM-00|2020|PDM|1170.00|99|0.00|ACUTE PSYCH
20|FH_F36743_0_0|SrvcGrp|23958|2022|PCT|0.65|99|0.00|PHARMACY
20|FH_F36743_0_0|SrvcGrp|290|2022|PDM|5900.00|99|0.00|IP LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F36743_0_0|SrvcGrp|359|2022|PDM|2100.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL I
20|FH_F36743_0_0|SrvcGrp|675|2022|PDM|1770.00|99|0.00|PEDIATRIC INPATIENT SVCS
20|FH_F36743_0_0|SrvcGrp|91|2022|PCT|0.90|99|0.00|KIDNEY TRANSPLANT
20|FH_F36743_0_0|SrvcGrp|97|2022|PDM|2100.00|99|0.00|C-SECTION
20|FH_F36750_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS
20|FH_F36766_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36787_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36787_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|OP SVCS
20|FH_F36789_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|OP SVCS
20|FH_F36803_0_0|SrvcGrp|97|2022|PDM|4025.00|99|0.00|C-SECTION
20|FH_F36822_0_0|CSTM-ALL|CSTM-00|2020|PDM|11814.00|99|0.00|MSDRG 246-251 ANGIOPLASTY
20|FH_F36822_0_0|CSTM-ALL|CSTM-00|2020|PDM|1823.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F36822_0_0|CSTM-ALL|CSTM-00|2020|PDM|774.00|99|0.00|ACUTE PSYCH
20|FH_F36835_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36854_0_0|CSTM-ALL|CSTM-00|2020|PDM|1842.00|99|0.00|ACUTE IP MED SVCS
20|FH_F36854_0_0|CSTM-ALL|CSTM-00|2020|PDM|880.00|99|0.00|ACUTE PSYCH
20|FH_F36854_0_0|SrvcGrp|177|2022|PDM|1842.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F36861_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36883_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.52|99|0.00|GENERAL ACUTE CARE
20|FH_F36883_0_0|SrvcGrp|69441|2022|PDM|25.00|99|0.00|CLINIC VISIT
20|FH_F36883_0_0|SrvcGrp|75505|2022|PCT|0.52|99|0.00|CARDIAC STUDIES
20|FH_F36883_0_0|SrvcGrp|75506|2022|PCT|0.52|99|0.00|VASCULAR DIAGNOSTIC STUDIES
20|FH_F36883_0_0|SrvcGrp|89149|2022|PDM|260.00|99|0.00|OP INTENSIVE
20|FH_F36883_0_0|SrvcGrp|89417|2022|PDM|312.50|99|0.00|PARTIAL HOSPITALIZATION
20|FH_F36883_0_0|SrvcGrp|98181|2022|PDM|484.64|99|0.00|OP BH OBSERVATION
20|FH_F36906_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36908_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS
20|FH_F36915_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36917_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36921_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36926_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36936_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36955_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36955_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F37001_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37001_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F37045_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37058_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37075_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|GENERAL ACUTE CARE
20|FH_F37077_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37081_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F37081_0_0|CSTM-ALL|CSTM-00|2020|PDM|20200.00|99|0.00|MS DRG 248
20|FH_F37081_0_0|CSTM-ALL|CSTM-00|2020|PDM|37700.00|99|0.00|MS DRG 453
20|FH_F37081_0_0|CSTM-ALL|CSTM-00|2020|PDM|42693.00|99|0.00|MS DRG 226
20|FH_F37081_0_0|CSTM-ALL|CSTM-00|2020|PDM|8150.00|99|0.00|MS DRG 491
20|FH_F37081_0_0|SrvcGrp|6|2022|PCT|0.70|99|0.00|OP SURGERY
20|FH_F37081_0_0|SrvcGrp|701|2022|PDM|2848.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F37092_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F37094_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.90|99|0.00|GENERAL ACUTE CARE
20|FH_F37100_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37104_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F37104_0_0|CSTM-ALL|CSTM-00|2020|PDM|1564.00|99|0.00|ASPG IX
20|FH_F37104_0_0|CSTM-ALL|CSTM-00|2020|PDM|389.00|99|0.00|ASPG I
20|FH_F37104_0_0|CSTM-ALL|CSTM-00|2020|PDM|521.00|99|0.00|ASPG II
20|FH_F37117_0_0|CSTM-ALL|CSTM-00|2020|PDM|70.00|99|0.00|PT/OT/ST
20|FH_F37152_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F37152_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|PSYCH PARTIAL DAY
20|FH_F37171_0_0|SrvcGrp|23387|2022|PDM|60.00|99|0.00|PT/OT/ST
20|FH_F37173_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37181_0_0|SrvcGrp|16|2022|PDM|1025.00|99|0.00|ACUTE REHABILITATION
20|FH_F37181_0_0|SrvcGrp|6|2022|PCT|0.87|99|0.00|OP SURGERY
20|FH_F37181_0_0|SrvcGrp|72|2022|PDM|487.00|99|0.00|NEWBORN NURSERY
20|FH_F37185_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37186_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37186_0_0|CSTM-ALL|CSTM-00|2020|PDM|50.00|99|0.00|OP SVCS
20|FH_F37187_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37190_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37192_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37198_0_0|SrvcGrp|11258|2022|PCT|0.40|99|0.00|DRUGS
20|FH_F37198_0_0|SrvcGrp|13402|2022|PCT|0.75|99|0.00|OP SURGERY
20|FH_F37198_0_0|SrvcGrp|47260|2022|PCT|0.40|99|0.00|IMPLANTS 274-276, 278  LINE LEVEL
20|FH_F37198_0_0|SrvcGrp|66459|2022|PDM|1000.00|99|0.00|CT SCAN
20|FH_F37198_0_0|SrvcGrp|69664|2022|PCT|0.75|99|0.00|PTCA / CARDIAC CATH
20|FH_F37198_0_0|SrvcGrp|9501|2022|PCT|0.75|99|0.00|ACUTE IP MED/SURG SVCS
20|FH_F37198_0_0|SrvcGrp|9774|2022|PCT|0.75|99|0.00|INTENSIVE CARE UNIT
20|FH_F37209_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F37227_0_0|CSTM-ALL|CSTM-00|2020|PDM|1149.00|99|0.00|ASPG VII
20|FH_F37227_0_0|CSTM-ALL|CSTM-00|2020|PDM|828.00|99|0.00|ASPG V
20|FH_F37227_0_0|CSTM-ALL|CSTM-00|2020|PDM|828.00|99|0.00|ASPG X
20|FH_F37230_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE
20|FH_F37230_0_0|SrvcGrp|15389|2022|PDM|117.00|99|0.00|SOCIAL WORKER (MEDICAL)
20|FH_F37230_0_0|SrvcGrp|15390|2022|PDM|54.00|99|0.00|HOME HEALTH AIDE VISIT
20|FH_F37244_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37257_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|ER SVCS
20|FH_F37267_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F37267_0_0|SrvcGrp|12403|2022|PDM|26.25|99|0.00|CONTINUOUS HOMECARE
20|FH_F37267_0_0|SrvcGrp|8962|2022|PDM|82.50|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F37285_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F37285_0_0|CSTM-ALL|CSTM-00|2020|PDM|1025.00|99|0.00|AEG 10 (NO REV)
20|FH_F37285_0_0|CSTM-ALL|CSTM-00|2020|PDM|1090.00|99|0.00|AEG 5  (NO REV)
20|FH_F37285_0_0|CSTM-ALL|CSTM-00|2020|PDM|1513.00|99|0.00|AEG 7 (NO REV)
20|FH_F37285_0_0|CSTM-ALL|CSTM-00|2020|PDM|2038.00|99|0.00|AEG 9 (NO REV)
20|FH_F37285_0_0|CSTM-ALL|CSTM-00|2020|PDM|501.00|99|0.00|AEG 1 (NO REV)
20|FH_F37285_0_0|CSTM-ALL|CSTM-00|2020|PDM|716.00|99|0.00|AEG 2 (NO REV)
20|FH_F37285_0_0|CSTM-ALL|CSTM-00|2020|PDM|825.00|99|0.00|AEG 3 (NO REV)
20|FH_F37292_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37294_0_0|SrvcGrp|3544|2022|PCT|1.00|99|0.00|COCHLEAR IMPLANTS
20|FH_F37364_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F37364_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37364_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F37364_0_0|SrvcGrp|26178|2022|PDM|3350.00|99|0.00|BURN-TRAUMA CARE
20|FH_F37364_0_0|SrvcGrp|26204|2022|PDM|700.00|99|0.00|SUB-ACUTE SKILLED NURSING CARE
20|FH_F37364_0_0|SrvcGrp|38|2022|PDM|3800.00|99|0.00|NORMAL DELIVERY
20|FH_F37364_0_0|SrvcGrp|8950|2022|PDM|1800.00|99|0.00|INTERMEDIATE ICU/CCU
20|FH_F37364_0_0|SrvcGrp|941|2022|PDM|2700.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F37364_0_0|SrvcGrp|97|2022|PDM|6500.00|99|0.00|C-SECTION
20|FH_F37365_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F37366_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37376_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37376_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F37385_0_0|SrvcGrp|15387|2022|PDM|125.00|99|0.00|RN VISIT
20|FH_F37385_0_0|SrvcGrp|15388|2022|PDM|125.00|99|0.00|SPEECH THERAPY
20|FH_F37385_0_0|SrvcGrp|15389|2022|PDM|125.00|99|0.00|SOCIAL WORKER (MEDICAL)
20|FH_F37385_0_0|SrvcGrp|15390|2022|PDM|55.00|99|0.00|HOME HEALTH AIDE VISIT
20|FH_F37385_0_0|SrvcGrp|15392|2022|PDM|125.00|99|0.00|PHYSICAL THERAPY
20|FH_F37394_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F37394_0_0|SrvcGrp|471|2022|PDM|950.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F37404_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37404_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SURGERY
20|FH_F37408_0_0|CSTM-ALL|CSTM-00|2020|PCT|67.89|99|0.00|GENERAL ACUTE CARE
20|FH_F37440_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ACTIVASE/ALTEPLASE
20|FH_F37440_0_0|SrvcGrp|13881|2022|PCT|1.00|99|0.00|PACEMAKER DEVICE
20|FH_F37443_0_0|SrvcGrp|3029|2022|PDM|780.00|99|0.00|NEWBORN NURSERY
20|FH_F37444_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37444_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F37444_0_0|SrvcGrp|16619|2022|PCT|0.72|99|0.00|OT SVCS
20|FH_F37444_0_0|SrvcGrp|3259|2022|PDM|900.00|99|0.00|ACUTE REHABILITATION
20|FH_F37444_0_0|SrvcGrp|9230|2022|PCT|0.72|99|0.00|HOME IV THERAPY SVCS
20|FH_F37478_0_0|SrvcGrp|72|2022|PDM|522.00|99|0.00|NEWBORN NURSERY
20|FH_F37487_0_0|SrvcGrp|16618|2022|PDM|80.00|99|0.00|ST SVCS
20|FH_F37487_0_0|SrvcGrp|9230|2022|PDM|79.00|99|0.00|HOME IV THERAPY SVCS
20|FH_F37487_0_0|SrvcGrp|997|2022|PCT|0.70|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F37490_0_0|CSTM-ALL|CSTM-00|2020|PDM|1413.03|99|0.00|ASPG VIII
20|FH_F37490_0_0|CSTM-ALL|CSTM-00|2020|PDM|647.57|99|0.00|ASPG II
20|FH_F37491_0_0|CSTM-ALL|CSTM-00|2020|PDM|90.00|99|0.00|INDIVIDUAL COUNSELING
20|FH_F37491_0_0|SrvcGrp|12682|2022|PDM|75.00|99|0.00|GROUP THERAPY
20|FH_F37493_0_0|CSTM-ALL|CSTM-00|2020|PDM|4617.00|99|0.00|CV SURGERY
20|FH_F37493_0_0|SrvcGrp|26328|2022|PCT|1.10|99|0.00|PROSTHETICS
20|FH_F37493_0_0|SrvcGrp|701|2022|PDM|3602.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F37494_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37494_0_0|CSTM-ALL|CSTM-00|2020|PDM|1575.16|99|0.00|ASPG VI
20|FH_F37494_0_0|CSTM-ALL|CSTM-00|2020|PDM|1898.97|99|0.00|ASPG VII
20|FH_F37494_0_0|CSTM-ALL|CSTM-00|2020|PDM|973.33|99|0.00|ASPG III
20|FH_F37554_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37554_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F37554_0_0|CSTM-ALL|CSTM-00|2020|PDM|670.00|99|0.00|MRI W/O CONTRAST
20|FH_F37565_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F37565_0_0|SrvcGrp|23387|2022|PDM|52.00|99|0.00|PT/OT/ST
20|FH_F37569_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F37569_0_0|SrvcGrp|3483|2022|PDM|2650.00|99|0.00|CPT CODE 59400
20|FH_F37573_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|OP SVCS
20|FH_F37573_0_0|CSTM-ALL|CSTM-00|2020|PDM|1223.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F37573_0_0|SrvcGrp|3069|2022|PCT|0.83|99|0.00|IMPLANTS
20|FH_F37590_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37590_0_0|CSTM-ALL|CSTM-00|2020|PDM|42.00|99|0.00|RN HOURLY HOME CARE
20|FH_F37590_0_0|SrvcGrp|12263|2022|PDM|17.85|99|0.00|HOME HEALTH AIDE- HOURLY
20|FH_F37593_0_0|SrvcGrp|64260|2022|PDM|113.96|99|0.00|OP SVCS
20|FH_F37605_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37605_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F37611_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37611_0_0|SrvcGrp|473|2022|PDM|325.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F37639_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F37639_0_0|SrvcGrp|13297|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F37644_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F37655_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F37659_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F37659_0_0|SrvcGrp|26991|2022|PDM|65881.00|99|0.00|LUNG - SINGLE TRANSPLANT
20|FH_F37679_0_0|SrvcGrp|13929|2022|PDM|15.00|99|0.00|GROWTH HORMONE
20|FH_F37679_0_0|SrvcGrp|17007|2022|PDM|61.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 6HRS
20|FH_F37679_0_0|SrvcGrp|17015|2022|PDM|15.00|99|0.00|HOME INFUSION THERAPY
20|FH_F37679_0_0|SrvcGrp|19741|2022|PDM|100.00|99|0.00|PICC LINE INSERT
20|FH_F37679_0_0|SrvcGrp|19742|2022|PDM|100.00|99|0.00|MID-LINE INSERTION
20|FH_F37679_0_0|SrvcGrp|22389|2022|PDM|15.00|99|0.00|HORMONAL INJECTION THERAPY
20|FH_F37679_0_0|SrvcGrp|22592|2022|PDM|61.00|99|0.00|CONTINUOUS ANTI-COAGULANTS
20|FH_F37679_0_0|SrvcGrp|24745|2022|PDM|61.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT
20|FH_F37679_0_0|SrvcGrp|24750|2022|PDM|15.00|99|0.00|ANTI-EMETICS INJECTION THERAPY
20|FH_F37679_0_0|SrvcGrp|24751|2022|PDM|15.00|99|0.00|INTERMITTENT ANTICOAGULANT THERAPY
20|FH_F37679_0_0|SrvcGrp|26848|2022|PDM|15.25|99|0.00|ANTI-HEMOPHILIC (MOD SJ)
20|FH_F37679_0_0|SrvcGrp|26851|2022|PDM|30.50|99|0.00|ANTI-EMETICS INFUSION THERAPY (MOD SH)
20|FH_F37679_0_0|SrvcGrp|26860|2022|PDM|15.25|99|0.00|DIURETIC IV THERAPY (MOD SJ)
20|FH_F37679_0_0|SrvcGrp|26864|2022|PDM|15.25|99|0.00|MISC INFUSION THERAPY (MOD SJ)
20|FH_F37679_0_0|SrvcGrp|27041|2022|PDM|27.50|99|0.00|TOTAL PARENTERAL NUTRITION;MORE THAN 3 LITERS (MOD SJ)
20|FH_F37679_0_0|SrvcGrp|27047|2022|PDM|15.25|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 8HRS (MOD SJ)
20|FH_F37679_0_0|SrvcGrp|27053|2022|PDM|15.25|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 3HRS(MOD SJ)
20|FH_F37679_0_0|SrvcGrp|27062|2022|PDM|30.50|99|0.00|HOME INFUSION THERAPY
20|FH_F37679_0_0|SrvcGrp|27072|2022|PDM|4.25|99|0.00|HOME INFUSION - DOUBLE / TRIPLE LUMEN (MOD SH)
20|FH_F37679_0_0|SrvcGrp|27073|2022|PDM|2.13|99|0.00|HOME INFUSION - DOUBLE / TRIPLE LUMEN (MOD SJ)
20|FH_F37679_0_0|SrvcGrp|27074|2022|PDM|40.00|99|0.00|HOME INFUSION THERAPY (MOD SH)
20|FH_F37679_0_0|SrvcGrp|27080|2022|PDM|50.00|99|0.00|PICC LINE INSERTION (MID-LINE) (MOD SH)
20|FH_F37679_0_0|SrvcGrp|27132|2022|PDM|7.50|99|0.00|GROWTH HORMONE (MOD SH)
20|FH_F113305_0_0|SrvcGrp|82981|2022|PDM|125.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F113390_0_0|CSTM-ALL|CSTM-00|2020|PDM|1673.10|99|0.00|AETNA AEG 3 W/O CPTS 69420, 69433 (NO REV)
20|FH_F113390_0_0|CSTM-ALL|CSTM-00|2020|PDM|3135.00|99|0.00|AETNA AEG 7 W/O CPT 60240 (NO REV)
20|FH_F113390_0_0|SrvcGrp|103965|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F113390_0_0|SrvcGrp|105233|2022|PDM|2475.00|99|0.00|REMOVAL OF THYROID
20|FH_F113390_0_0|SrvcGrp|105236|2022|PDM|1673.10|99|0.00|LARYNGOSCOPY
20|FH_F113390_0_0|SrvcGrp|105240|2022|PDM|1320.00|99|0.00|EXCISION OF TONGUE FOLD
20|FH_F113390_0_0|SrvcGrp|79586|2022|PDM|1320.00|99|0.00|CPT 43200
20|FH_F113390_0_0|SrvcGrp|88823|2022|PDM|2200.00|99|0.00|REPAIR OF EARDRUM
20|FH_F113390_0_0|SrvcGrp|91941|2022|PDM|2750.00|99|0.00|NASAL/SINUS ENDOSCOPY WITH DILATION
20|FH_F113392_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F113392_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|AEG 3 (NO REV)
20|FH_F113392_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|AEG 1 (NO REV)
20|FH_F113392_0_0|SrvcGrp|104257|2022|PDM|1650.00|99|0.00|SKIN TISSUE REARRANGEMENT
20|FH_F113392_0_0|SrvcGrp|83838|2022|PDM|2750.00|99|0.00|SUSPENSION OF BREAST
20|FH_F113392_0_0|SrvcGrp|84182|2022|PDM|1177.00|99|0.00|AETNA REMOVAL OF BREAST CAPSULE
20|FH_F113392_0_0|SrvcGrp|92541|2022|PDM|1650.00|99|0.00|MUSCLE FLAP
20|FH_F113410_0_0|SrvcGrp|100007|2022|PDM|4307.00|99|0.00|FUSION OF ANKLE JOINT
20|FH_F113410_0_0|SrvcGrp|100014|2022|PDM|3677.00|99|0.00|REPAIR RADIUS OR ULNA
20|FH_F113410_0_0|SrvcGrp|101525|2022|PDM|5463.00|99|0.00|MYOMECTOMY
20|FH_F113410_0_0|SrvcGrp|105247|2022|PDM|5253.00|99|0.00|LAPAROSCOPY
20|FH_F113410_0_0|SrvcGrp|105250|2022|PDM|2416.00|99|0.00|SINUS ENDOSCOPY
20|FH_F113410_0_0|SrvcGrp|105256|2022|PDM|1839.00|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F113410_0_0|SrvcGrp|27347|2022|PDM|2627.00|99|0.00|CPT 58558
20|FH_F113410_0_0|SrvcGrp|59840|2022|PDM|1576.00|99|0.00|TYMPANOSTOMY
20|FH_F113410_0_0|SrvcGrp|72121|2022|PDM|2627.00|99|0.00|ARTHOSCOPY
20|FH_F113410_0_0|SrvcGrp|79593|2022|PDM|683.00|99|0.00|CPT 45378
20|FH_F113410_0_0|SrvcGrp|84307|2022|PDM|2837.00|99|0.00|TENDON REPAIR
20|FH_F113426_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F113426_0_0|CSTM-ALL|CSTM-00|2020|PDM|1232.00|99|0.00|AEG 5  (NO REV)
20|FH_F113426_0_0|CSTM-ALL|CSTM-00|2020|PDM|1711.00|99|0.00|AEG 7 (NO REV)
20|FH_F113426_0_0|CSTM-ALL|CSTM-00|2020|PDM|877.00|99|0.00|AEG 3 (NO REV)
20|FH_F113487_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F113503_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F113503_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F113541_0_0|CSTM-ALL|CSTM-00|2020|PDM|1655.00|99|0.00|AEG 6 (NO REV)
20|FH_F113541_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F113541_0_0|SrvcGrp|104108|2022|PDM|1955.00|99|0.00|EXCISION OF BREAST LESION ID
20|FH_F113541_0_0|SrvcGrp|104948|2022|PDM|1955.00|99|0.00|MASTECTOMY FOR GYNECOMASTIA
20|FH_F113541_0_0|SrvcGrp|104953|2022|PDM|2580.00|99|0.00|DESIGN CUSTOM BREAST IMPLANT
20|FH_F113541_0_0|SrvcGrp|104956|2022|PDM|1625.00|99|0.00|EXTENDED RECOVERY/OBSERVATION (16-23 HRS)
20|FH_F113541_0_0|SrvcGrp|104969|2022|PDM|541.00|99|0.00|EXTENDED RECOVERY/OBSERVATION (5-7 HRS)(HCFA)
20|FH_F113541_0_0|SrvcGrp|104971|2022|PDM|1625.00|99|0.00|EXTENDED RECOVERY/OBSERVATION (16-23 HRS)(HCFA)
20|FH_F113541_0_0|SrvcGrp|64517|2022|PDM|3295.00|99|0.00|REDUCE MANMMAPLASTY
20|FH_F113541_0_0|SrvcGrp|83838|2022|PDM|2572.00|99|0.00|SUSPENSION OF BREAST
20|FH_F113541_0_0|SrvcGrp|84181|2022|PDM|6662.00|99|0.00|AETNA IMMEDIATE BREAST PROSTHESIS
20|FH_F113541_0_0|SrvcGrp|84184|2022|PDM|2580.00|99|0.00|AETNA REMOVAL OF BREAST IMPLANT
20|FH_F113541_0_0|SrvcGrp|90418|2022|PDM|6662.00|99|0.00|ENLARGE BREAST WITH IMPLANT
20|FH_F113546_0_0|SrvcGrp|48396|2022|PDM|90.00|99|0.00|OT SERVICES
20|FH_F113546_0_0|SrvcGrp|48398|2022|PDM|90.00|99|0.00|PT SERVICES
20|FH_F113546_0_0|SrvcGrp|88620|2022|PDM|90.00|99|0.00|SKILLED NURSING RN
20|FH_F113586_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F113586_0_0|SrvcGrp|104402|2022|PCT|0.00|99|0.00|IMAGING ENHANCE SUBSTANCE
20|FH_F113586_0_0|SrvcGrp|75483|2022|PDM|1277.00|99|0.00|AEG 3
20|FH_F113586_0_0|SrvcGrp|75487|2022|PDM|1428.00|99|0.00|AEG 5
20|FH_F113586_0_0|SrvcGrp|75493|2022|PDM|1158.00|99|0.00|AEG 8
20|FH_F113586_0_0|SrvcGrp|75497|2022|PDM|1020.00|99|0.00|AEG 10
20|FH_F113588_0_0|SrvcGrp|12403|2022|PDM|306.05|99|0.00|CONTINUOUS HOMECARE
20|FH_F113682_0_0|SrvcGrp|45183|2022|PDM|247.23|99|0.00|PHYSICAL THERAPY
20|FH_F113682_0_0|SrvcGrp|471|2022|PDM|982.21|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F113709_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F113765_0_0|SrvcGrp|46605|2022|PDM|85.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES
20|FH_F113765_0_0|SrvcGrp|48394|2022|PDM|25.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F113784_0_0|SrvcGrp|44042|2022|PDM|60.00|99|0.00|SKILLED NURSING - LPN
20|FH_F113784_0_0|SrvcGrp|45924|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE
20|FH_F113784_0_0|SrvcGrp|48385|2022|PDM|80.00|99|0.00|SPEECH THERAPY
20|FH_F113784_0_0|SrvcGrp|88621|2022|PDM|60.00|99|0.00|SKILLED NURSING LPN
20|FH_F113792_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F113792_0_0|SrvcGrp|42971|2022|PDM|85.00|99|0.00|SKN RN
20|FH_F113792_0_0|SrvcGrp|48385|2022|PDM|85.00|99|0.00|SPEECH THERAPY
20|FH_F113792_0_0|SrvcGrp|48394|2022|PDM|25.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F113794_0_0|SrvcGrp|46605|2022|PDM|80.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES
20|FH_F113794_0_0|SrvcGrp|48385|2022|PDM|80.00|99|0.00|SPEECH THERAPY
20|FH_F113794_0_0|SrvcGrp|88620|2022|PDM|85.00|99|0.00|SKILLED NURSING RN
20|FH_F113815_0_0|SrvcGrp|72992|2022|PDM|556.00|99|0.00|AEG 2
20|FH_F113815_0_0|SrvcGrp|73000|2022|PDM|233.00|99|0.00|AEG 6
20|FH_F113815_0_0|SrvcGrp|73002|2022|PDM|233.00|99|0.00|AEG 7
20|FH_F113866_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F113866_0_0|SrvcGrp|29353|2022|PDM|100.00|99|0.00|HOSPICE SVCS
20|FH_F113866_0_0|SrvcGrp|30609|2022|PDM|23.00|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F113866_0_0|SrvcGrp|80317|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F37679_0_0|SrvcGrp|27140|2022|PDM|7.50|99|0.00|HORMONAL INJECTION THERAPY (MOD SH)
20|FH_F37679_0_0|SrvcGrp|27143|2022|PDM|3.75|99|0.00|HOME INFUSION THERAPY (MOD SJ)
20|FH_F37679_0_0|SrvcGrp|27153|2022|PDM|15.25|99|0.00|HOME INFUSION THERAPY (MOD SJ)
20|FH_F37679_0_0|SrvcGrp|32704|2022|PDM|15.00|99|0.00|HOME INFUSION THERAPY
20|FH_F37679_0_0|SrvcGrp|32706|2022|PDM|3.75|99|0.00|HOME INFUSION THERAPY MOD ( SH )
20|FH_F37679_0_0|SrvcGrp|32707|2022|PDM|7.50|99|0.00|HOME INFUSION THERAPY  (MOD SJ)
20|FH_F37698_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F37698_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|ACUTE IP MED SVCS
20|FH_F37698_0_0|CSTM-ALL|CSTM-00|2020|PDM|1750.00|99|0.00|NEONATAL INTENSVE CARE LEVEL III
20|FH_F37698_0_0|SrvcGrp|105574|2022|PCT|0.50|99|0.00|TPA/THROMBOLYTIC AGENTS
20|FH_F37698_0_0|SrvcGrp|11151|2022|PDM|1800.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F37698_0_0|SrvcGrp|177|2022|PDM|1500.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F37698_0_0|SrvcGrp|27169|2022|PCT|0.90|99|0.00|IMPLANTS/PROSHETICS/ORTHOTICS
20|FH_F37703_0_0|SrvcGrp|3809|2022|PDM|550.00|99|0.00|HOSPICE CARE
20|FH_F37708_0_0|SrvcGrp|13640|2022|PDM|90.00|99|0.00|CPT 99202
20|FH_F37724_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.50|99|0.00|OP SVCS
20|FH_F37743_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37771_0_0|SrvcGrp|44326|2022|PDM|60.00|99|0.00|PT & OT (VISIT LVL) OT MOD GO
20|FH_F37777_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37777_0_0|CSTM-ALL|CSTM-00|2020|PDM|875.00|99|0.00|ORTHO / GENERAL
20|FH_F37777_0_0|SrvcGrp|36231|2022|PDM|500.00|99|0.00|SUB ACUTE
20|FH_F37778_0_0|CSTM-ALL|CSTM-00|2020|PDM|1240.00|99|0.00|ASPG V
20|FH_F37778_0_0|CSTM-ALL|CSTM-00|2020|PDM|1240.00|99|0.00|HERNIA REPAIR
20|FH_F37778_0_0|CSTM-ALL|CSTM-00|2020|PDM|895.00|99|0.00|ASPG III
20|FH_F37778_0_0|SrvcGrp|27311|2022|PDM|1749.00|99|0.00|EXCISION PAROTID GLAND/LESION
20|FH_F37778_0_0|SrvcGrp|27316|2022|PDM|1240.00|99|0.00|TONSILS & ADENOIDS (42820)
20|FH_F37809_0_0|CSTM-ALL|CSTM-00|2020|PDM|2703.00|99|0.00|ASPG IV
20|FH_F37809_0_0|CSTM-ALL|CSTM-00|2020|PDM|3074.00|99|0.00|ASPG VI
20|FH_F37809_0_0|CSTM-ALL|CSTM-00|2020|PDM|3286.00|99|0.00|ASPG VIII
20|FH_F37809_0_0|CSTM-ALL|CSTM-00|2020|PDM|3604.00|99|0.00|ASPG IX
20|FH_F37809_0_0|SrvcGrp|14614|2022|PDM|7950.00|99|0.00|LITHOTRIPSY
20|FH_F37809_0_0|SrvcGrp|27397|2022|PDM|5830.00|99|0.00|OP SURGERY
20|FH_F37809_0_0|SrvcGrp|27399|2022|PDM|5830.00|99|0.00|OP SURGERY
20|FH_F37812_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F37812_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|HOME HEALTH CARE
20|FH_F37847_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F37847_0_0|SrvcGrp|59713|2022|PDM|44.00|99|0.00|SKILLED RN HOURLY
20|FH_F37847_0_0|SrvcGrp|9830|2022|PDM|93.50|99|0.00|OT SVCS
20|FH_F37850_0_0|SrvcGrp|115|2022|PDM|650.00|99|0.00|SKILLED NURSING CARE
20|FH_F37850_0_0|SrvcGrp|24|2022|PCT|0.68|99|0.00|CARDIAC CATH
20|FH_F37850_0_0|SrvcGrp|3029|2022|PDM|541.00|99|0.00|NEWBORN NURSERY
20|FH_F37850_0_0|SrvcGrp|360|2022|PDM|1190.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F37850_0_0|SrvcGrp|361|2022|PDM|1892.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F37878_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37878_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F37878_0_0|SrvcGrp|10541|2022|PDM|80.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F37878_0_0|SrvcGrp|10545|2022|PDM|85.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F37901_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37901_0_0|SrvcGrp|16746|2022|PDM|45.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F37901_0_0|SrvcGrp|27173|2022|PDM|45.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F37909_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F37909_0_0|CSTM-ALL|CSTM-00|2020|PDM|60.00|99|0.00|SPEECH THERAPY SVCS
20|FH_F37909_0_0|SrvcGrp|15403|2022|PDM|70.00|99|0.00|SPEECH THERAPY SVCS INITIAL EVAL
20|FH_F37909_0_0|SrvcGrp|15478|2022|PDM|70.00|99|0.00|OCCUPATIONAL THERAPY SVCS INITIAL EVAL
20|FH_F37910_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|NEWBORN NURSERY - LEVEL I
20|FH_F37937_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37937_0_0|CSTM-ALL|CSTM-00|2020|PDM|100.00|99|0.00|SKILLED RN VISIT
20|FH_F37943_0_0|SrvcGrp|3810|2022|PDM|105.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F37960_0_0|CSTM-ALL|CSTM-00|2020|PDM|1010.00|99|0.00|CD RESIDENTIAL TREATMENT
20|FH_F37963_0_0|SrvcGrp|14210|2022|PDM|200.00|99|0.00|PSYCH INTENSIVE OUTPATIENT
20|FH_F37963_0_0|SrvcGrp|80|2022|PDM|650.00|99|0.00|ACUTE PSYCH
20|FH_F37987_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37987_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|ASPG VI
20|FH_F37996_0_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F38007_0_0|SrvcGrp|15|2022|PDM|3385.00|99|0.00|PEDIATRIC INTENSIVE CARE UNIT
20|FH_F38016_0_0|SrvcGrp|16|2022|PDM|811.00|99|0.00|ACUTE REHABILITATION
20|FH_F38016_0_0|SrvcGrp|20299|2022|PDM|3461.00|99|0.00|MS DRG 228-230 ONLY OTHER CARDIOTHORACIC PROC
20|FH_F38016_0_0|SrvcGrp|20906|2022|PDM|3245.00|99|0.00|MS DRG 243-244 ONLY CARDIAC PACEMAKER
20|FH_F38016_0_0|SrvcGrp|360|2022|PDM|541.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F38016_0_0|SrvcGrp|997|2022|PCT|0.60|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F38034_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|IP ELECTROPHYSIOLOGY + ANGIO
20|FH_F38034_0_0|SrvcGrp|11259|2022|PCT|0.60|99|0.00|DRUGS
20|FH_F38034_0_0|SrvcGrp|16|2022|PDM|2030.00|99|0.00|ACUTE REHABILITATION
20|FH_F38034_0_0|SrvcGrp|38|2022|PDM|2264.00|99|0.00|NORMAL DELIVERY
20|FH_F38037_0_0|SrvcGrp|9829|2022|PDM|88.00|99|0.00|PT SVCS
20|FH_F38037_0_0|SrvcGrp|9832|2022|PDM|82.50|99|0.00|ST SVCS
20|FH_F38039_0_0|SrvcGrp|8962|2022|PDM|82.50|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F38039_0_0|SrvcGrp|9828|2022|PDM|38.50|99|0.00|HOME HEALTH AIDE
20|FH_F38039_0_0|SrvcGrp|9829|2022|PDM|82.50|99|0.00|PT SVCS
20|FH_F38047_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38047_0_0|SrvcGrp|16|2022|PDM|679.00|99|0.00|ACUTE REHABILITATION
20|FH_F38047_0_0|SrvcGrp|97|2022|PDM|2994.00|99|0.00|C-SECTION
20|FH_F113866_0_0|SrvcGrp|89822|2022|PDM|100.00|99|0.00|HOSPICE ROUTINE HOME CARE
20|FH_F113866_0_0|SrvcGrp|90478|2022|PDM|100.00|99|0.00|HOSPICE
20|FH_F113866_0_0|SrvcGrp|93100|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F113866_0_0|SrvcGrp|95440|2022|PDM|23.00|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F113885_0_0|SrvcGrp|57968|2022|PDM|33.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F113903_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F113906_0_0|SrvcGrp|72992|2022|PDM|675.00|99|0.00|AEG 2
20|FH_F113906_0_0|SrvcGrp|73006|2022|PDM|665.00|99|0.00|AEG 9
20|FH_F113906_0_0|SrvcGrp|73008|2022|PDM|665.00|99|0.00|AEG 10
20|FH_F114002_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F114002_0_0|SrvcGrp|42973|2022|PDM|65.00|99|0.00|SPEECH  THERAPIST
20|FH_F114002_0_0|SrvcGrp|42975|2022|PDM|80.00|99|0.00|PHYSICAL THERAPIST
20|FH_F114024_0_0|SrvcGrp|103671|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F114024_0_0|SrvcGrp|75497|2022|PDM|521.00|99|0.00|AEG 10
20|FH_F114064_0_0|SrvcGrp|102419|2022|PDM|2205.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F114064_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F114064_0_0|SrvcGrp|72990|2022|PDM|420.00|99|0.00|AEG 1
20|FH_F114064_0_0|SrvcGrp|73004|2022|PDM|1237.00|99|0.00|AEG 8
20|FH_F114064_0_0|SrvcGrp|73008|2022|PDM|803.00|99|0.00|AEG 10
20|FH_F114145_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F114145_0_0|CSTM-ALL|CSTM-00|2020|PDM|1259.00|99|0.00|AEG 9 (NO REV)
20|FH_F114145_0_0|CSTM-ALL|CSTM-00|2020|PDM|524.00|99|0.00|AEG 2 (NO REV)
20|FH_F114145_0_0|CSTM-ALL|CSTM-00|2020|PDM|727.00|99|0.00|AEG 4 (NO REV)
20|FH_F114145_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F114151_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F114151_0_0|SrvcGrp|63297|2022|PDM|90.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F114166_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F114171_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F114171_0_0|CSTM-ALL|CSTM-00|2020|PDM|1111.00|99|0.00|AEG 8 (NO REV)
20|FH_F114171_0_0|CSTM-ALL|CSTM-00|2020|PDM|461.00|99|0.00|AEG 2 (NO REV)
20|FH_F114171_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F114171_0_0|SrvcGrp|114518|2022|PDM|1432.00|99|0.00|INSERTION DRAINAGE DEVICE
20|FH_F114171_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F114171_0_0|SrvcGrp|91759|2022|PCT|1.00|99|0.00|OCULAR IMPLANT
20|FH_F114267_0_0|CSTM-ALL|CSTM-00|2020|PDM|1537.00|99|0.00|AEG 9 (NO REV)
20|FH_F114267_0_0|CSTM-ALL|CSTM-00|2020|PDM|836.00|99|0.00|AEG 4 (NO REV)
20|FH_F114267_0_0|CSTM-ALL|CSTM-00|2020|PDM|946.00|99|0.00|AEG 6 (NO REV)
20|FH_F114267_0_0|SrvcGrp|36591|2022|PDM|2500.00|99|0.00|CPT 63685
20|FH_F114310_0_0|CSTM-ALL|CSTM-00|2020|PDM|1001.00|99|0.00|AEG 4 (NO REV)
20|FH_F114310_0_0|CSTM-ALL|CSTM-00|2020|PDM|1142.00|99|0.00|AEG 5  (NO REV)
20|FH_F114310_0_0|CSTM-ALL|CSTM-00|2020|PDM|1334.00|99|0.00|AEG 6 (NO REV)
20|FH_F114310_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F114310_0_0|SrvcGrp|27315|2022|PDM|3200.00|99|0.00|TENDON REPAIR
20|FH_F114310_0_0|SrvcGrp|59841|2022|PDM|1275.00|99|0.00|SUBMUCOUS RESECTION
20|FH_F114416_0_0|SrvcGrp|63119|2022|PDM|31.00|99|0.00|BASIC HOME HOSPICE CARE
20|FH_F114503_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F114511_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F114511_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F114519_0_0|SrvcGrp|705|2022|PCT|0.50|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F114572_0_0|CSTM-ALL|CSTM-00|2020|PDM|1197.00|99|0.00|AEG 6 (NO REV)
20|FH_F114572_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 4 (NO REV)
20|FH_F114572_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F114683_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F114683_0_0|SrvcGrp|72994|2022|PDM|1168.00|99|0.00|AEG 3
20|FH_F114683_0_0|SrvcGrp|73000|2022|PDM|1947.00|99|0.00|AEG 6
20|FH_F114683_0_0|SrvcGrp|73004|2022|PDM|1655.00|99|0.00|AEG 8
20|FH_F114683_0_0|SrvcGrp|80617|2022|PDM|6530.00|99|0.00|ARTHOPLASTY
20|FH_F114683_0_0|SrvcGrp|84939|2022|PDM|5900.00|99|0.00|SHOULDER JOINT
20|FH_F114683_0_0|SrvcGrp|88340|2022|PDM|2298.00|99|0.00|SPINAL FUSION
20|FH_F114853_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F114853_0_0|CSTM-ALL|CSTM-00|2020|PDM|2133.00|99|0.00|AEG 4 (NO REV)
20|FH_F114853_0_0|CSTM-ALL|CSTM-00|2020|PDM|2346.00|99|0.00|AEG 6 (NO REV)
20|FH_F114853_0_0|CSTM-ALL|CSTM-00|2020|PDM|2409.00|99|0.00|AEG 7 (NO REV)
20|FH_F114853_0_0|SrvcGrp|103965|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F114853_0_0|SrvcGrp|11669|2022|PDM|2887.00|99|0.00|OP SURG
20|FH_F114853_0_0|SrvcGrp|41334|2022|PDM|7215.00|99|0.00|TOTAL KNEE
20|FH_F114853_0_0|SrvcGrp|88491|2022|PDM|7215.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR
20|FH_F114853_0_0|SrvcGrp|89404|2022|PDM|7215.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F114853_0_0|SrvcGrp|98495|2022|PDM|7699.00|99|0.00|ARTHRODESIS POSTERIOR TECH
20|FH_F114912_0_0|CSTM-ALL|CSTM-00|2020|PDM|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F114914_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F114914_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F114927_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F114931_0_0|CSTM-ALL|CSTM-00|2020|PDM|1260.00|99|0.00|AEG 5  (NO REV)
20|FH_F114931_0_0|CSTM-ALL|CSTM-00|2020|PDM|1690.00|99|0.00|AEG 8 (NO REV)
20|FH_F114931_0_0|CSTM-ALL|CSTM-00|2020|PDM|1840.00|99|0.00|AEG 9 (NO REV)
20|FH_F114931_0_0|SrvcGrp|104614|2022|PDM|1850.00|99|0.00|BIOPSY OF RECTUM
20|FH_F114931_0_0|SrvcGrp|105752|2022|PDM|5200.00|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F114931_0_0|SrvcGrp|105757|2022|PDM|1850.00|99|0.00|INCISION OF RECTAL ABSCESS
20|FH_F114931_0_0|SrvcGrp|105761|2022|PDM|1850.00|99|0.00|CHEMODENERVATION OF INTERNAL
20|FH_F114931_0_0|SrvcGrp|27345|2022|PDM|3200.00|99|0.00|OP SURGERY (CPT 49650)
20|FH_F114931_0_0|SrvcGrp|80063|2022|PDM|1850.00|99|0.00|HEMORRHOIDECTOMY
20|FH_F114931_0_0|SrvcGrp|82301|2022|PDM|1850.00|99|0.00|HEMORRHOIDECTOMY
20|FH_F38049_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F38051_0_0|SrvcGrp|109|2022|PDM|350.00|99|0.00|CD - DETOX
20|FH_F38061_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F38061_0_0|CSTM-ALL|CSTM-00|2020|PDM|1087.90|99|0.00|ASPG VIII
20|FH_F38061_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|NE REG SUR CTR ARTHROSCOPY FH
20|FH_F38061_0_0|CSTM-ALL|CSTM-00|2020|PDM|405.90|99|0.00|ASPG I
20|FH_F38061_0_0|CSTM-ALL|CSTM-00|2020|PDM|834.90|99|0.00|ASPG V
20|FH_F38080_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38080_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|IMPLANTS
20|FH_F38080_0_0|CSTM-ALL|CSTM-00|2020|PDM|1675.00|99|0.00|AEG 8 (NO REV)
20|FH_F38080_0_0|CSTM-ALL|CSTM-00|2020|PDM|890.00|99|0.00|AEG 10 (NO REV)
20|FH_F38080_0_0|CSTM-ALL|CSTM-00|2020|PDM|925.00|99|0.00|AEG 2 (NO REV)
20|FH_F38085_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38085_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F38088_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|ACUTE PSYCH
20|FH_F38089_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|OP SVCS
20|FH_F38089_0_0|CSTM-ALL|CSTM-00|2020|PDM|1347.00|99|0.00|ACUTE IP MED SVCS
20|FH_F38089_0_0|CSTM-ALL|CSTM-00|2020|PDM|4252.00|99|0.00|MSDRG 286-287 CARDIAC CATH
20|FH_F38089_0_0|SrvcGrp|177|2022|PDM|1383.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F38089_0_0|SrvcGrp|290|2022|PDM|7797.00|99|0.00|IP LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F38089_0_0|SrvcGrp|3138|2022|PDM|851.00|99|0.00|COMPUTED TOMOGRAPHY (CT)
20|FH_F38089_0_0|SrvcGrp|361|2022|PDM|1985.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F38089_0_0|SrvcGrp|405|2022|PDM|1347.00|99|0.00|ACUTE REHAB - LEVEL II
20|FH_F38089_0_0|SrvcGrp|537|2022|PCT|0.68|99|0.00|OBSERVATION SERVICES
20|FH_F38090_0_0|SrvcGrp|147|2022|PDM|101.00|99|0.00|HOME HEALTH CARE
20|FH_F38090_0_0|SrvcGrp|15|2022|PDM|2055.00|99|0.00|PEDIATRIC INTENSIVE CARE UNIT
20|FH_F38090_0_0|SrvcGrp|24703|2022|PDM|562.00|99|0.00|NEWBORN NURSERY
20|FH_F38090_0_0|SrvcGrp|3066|2022|PCT|0.50|99|0.00|HIGH-COST DRUGS
20|FH_F38120_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38135_0_0|SrvcGrp|65|2022|PDM|1323.00|99|0.00|OBSTETRICAL CARE
20|FH_F38151_0_0|SrvcGrp|28281|2022|PCT|0.85|99|0.00|CV SURGERY
20|FH_F38151_0_0|SrvcGrp|97|2022|PDM|4368.00|99|0.00|C-SECTION
20|FH_F38153_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.40|99|0.00|GENERAL ACUTE CARE
20|FH_F38159_0_0|CSTM-ALL|CSTM-00|2020|PDM|357.41|99|0.00|YORK END CTR HAPA EAST ASPG I
20|FH_F38159_0_0|CSTM-ALL|CSTM-00|2020|PDM|676.51|99|0.00|YORK END CTR HAPA EAST ASPG IV
20|FH_F38159_0_0|CSTM-ALL|CSTM-00|2020|PDM|899.36|99|0.00|YORK END CTR HAPA EAST ASPG VI
20|FH_F38172_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F38172_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|GA STANDARD MRI CODES
20|FH_F38183_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38183_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|OP SVCS
20|FH_F38187_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38198_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.20|99|0.00|GENERAL ACUTE CARE
20|FH_F38198_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.20|99|0.00|OP SVCS
20|FH_F38221_0_0|SrvcGrp|6|2022|PCT|0.83|99|0.00|OP SURGERY
20|FH_F38227_0_0|SrvcGrp|47995|2022|PDM|70.00|99|0.00|OCCUPATIONAL THERAPY SERVICES VISIT
20|FH_F38249_0_0|SrvcGrp|13199|2022|PCT|0.95|99|0.00|TRAUMA CARE
20|FH_F38277_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38288_0_0|CSTM-ALL|CSTM-00|2020|PDM|1070.00|99|0.00|ASPG VIII
20|FH_F38288_0_0|CSTM-ALL|CSTM-00|2020|PDM|1473.00|99|0.00|ASPG IX
20|FH_F38288_0_0|CSTM-ALL|CSTM-00|2020|PDM|491.00|99|0.00|ASPG II
20|FH_F38288_0_0|CSTM-ALL|CSTM-00|2020|PDM|789.00|99|0.00|ASPG V
20|FH_F38288_0_0|SrvcGrp|28818|2022|PCT|0.45|99|0.00|SUPPLIES AND DEVICES
20|FH_F38289_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F38289_0_0|CSTM-ALL|CSTM-00|2020|PDM|210.83|99|0.00|CENTER FOR SPINE CARE RAD
20|FH_F38289_0_0|CSTM-ALL|CSTM-00|2020|PDM|724.75|99|0.00|CENTER FOR SPINE CARE ASCS
20|FH_F38289_0_0|SrvcGrp|28707|2022|PDM|316.24|99|0.00|INJECTION PROC FOR JOINT
20|FH_F38332_0_0|CSTM-ALL|CSTM-00|2020|PDM|12064.00|99|0.00|MS DRG 239
20|FH_F38332_0_0|CSTM-ALL|CSTM-00|2020|PDM|12064.00|99|0.00|MS DRG 240
20|FH_F38332_0_0|CSTM-ALL|CSTM-00|2020|PDM|12064.00|99|0.00|MS DRG 242
20|FH_F38332_0_0|CSTM-ALL|CSTM-00|2020|PDM|15759.00|99|0.00|MS DRG 621
20|FH_F38332_0_0|CSTM-ALL|CSTM-00|2020|PDM|42216.00|99|0.00|MS DRG 221
20|FH_F38332_0_0|CSTM-ALL|CSTM-00|2020|PDM|42216.00|99|0.00|MS DRG 228
20|FH_F38332_0_0|CSTM-ALL|CSTM-00|2020|PDM|42216.00|99|0.00|MS DRG 231
20|FH_F38332_0_0|CSTM-ALL|CSTM-00|2020|PDM|688.00|99|0.00|ACUTE PSYCH
20|FH_F38332_0_0|SrvcGrp|19108|2022|PDM|15759.00|99|0.00|MS DRG 619
20|FH_F38332_0_0|SrvcGrp|43|2022|PCT|0.50|99|0.00|IMPLANTS
20|FH_F38349_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS
20|FH_F38363_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F38371_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F38373_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F38376_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38376_0_0|SrvcGrp|11442|2022|PDM|600.00|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)
20|FH_F38376_0_0|SrvcGrp|3327|2022|PDM|90.00|99|0.00|HOSPICE SERVICE - IP RESPITE
20|FH_F38376_0_0|SrvcGrp|3810|2022|PDM|120.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F38380_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|COMPREHENSIVE DAY TREATMENT
20|FH_F38387_0_0|SrvcGrp|3809|2022|PDM|573.00|99|0.00|HOSPICE CARE
20|FH_F38396_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|IMPLANTS (HEART TRANSPLANT)
20|FH_F38396_0_0|SrvcGrp|12350|2022|PDM|600.00|99|0.00|BOARDER BABY SERVICES
20|FH_F38410_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F38410_0_0|SrvcGrp|10542|2022|PDM|110.00|99|0.00|OCCUPATIONAL THERAPY SVCS
20|FH_F38410_0_0|SrvcGrp|10624|2022|PDM|68.00|99|0.00|CPT CODE 99347
20|FH_F38410_0_0|SrvcGrp|22387|2022|PDM|50.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F38411_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 208
20|FH_F38411_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 581
20|FH_F114952_0_0|SrvcGrp|101279|2022|PDM|7560.00|99|0.00|ADDL NECK SPINE FUSION
20|FH_F114952_0_0|SrvcGrp|44461|2022|PDM|7560.00|99|0.00|INSERTION / REPLACEMENT OF SPINAL NEUROSTIMULATOR GENERATOR
20|FH_F114952_0_0|SrvcGrp|75479|2022|PDM|642.60|99|0.00|AEG 1
20|FH_F114952_0_0|SrvcGrp|75481|2022|PDM|787.50|99|0.00|AEG 2
20|FH_F114952_0_0|SrvcGrp|75487|2022|PDM|2205.00|99|0.00|AEG 5
20|FH_F114952_0_0|SrvcGrp|75497|2022|PDM|858.90|99|0.00|AEG 10
20|FH_F114952_0_0|SrvcGrp|97319|2022|PDM|7560.00|99|0.00|REVISE SPINE ELTRD PLATE
20|FH_F114952_0_0|SrvcGrp|98563|2022|PDM|4725.00|99|0.00|LUMBAR SPINE FUSION
20|FH_F114952_0_0|SrvcGrp|98609|2022|PDM|4725.00|99|0.00|POSTERIOR SEGMENTAL INSTRU
20|FH_F114968_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F114974_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F114974_0_0|CSTM-ALL|CSTM-00|2020|PDM|853.00|99|0.00|AEG 3 (NO REV)
20|FH_F114974_0_0|SrvcGrp|79561|2022|PDM|1650.00|99|0.00|AETNA CARDIAC CATH
20|FH_F115010_20105_0|SrvcGrp|22528|2022|PDM|460.00|99|0.00|DAY HOSPITAL FULL DAY
20|FH_F115010_20105_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE
20|FH_F115045_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F115150_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F115150_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F115150_0_0|SrvcGrp|92189|2022|PDM|563.60|99|0.00|CPT 95808  (HCFA)
20|FH_F115150_0_0|SrvcGrp|92190|2022|PDM|557.63|99|0.00|CPT 95810  (HCFA)
20|FH_F115185_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F115185_0_0|SrvcGrp|87077|2022|PDM|157.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F115204_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F115204_0_0|SrvcGrp|81839|2022|PDM|50.00|99|0.00|AETNA MEDICAL RECORD
20|FH_F115206_80923_0|SrvcGrp|12659|2022|PDM|859.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT
20|FH_F115206_80923_0|SrvcGrp|89417|2022|PDM|463.00|99|0.00|PARTIAL HOSPITALIZATION
20|FH_F115208_0_0|SrvcGrp|106170|2022|PDM|1485.00|99|0.00|NASAL/SINUS ENDOSCOPY
20|FH_F115208_0_0|SrvcGrp|106175|2022|PDM|2546.00|99|0.00|EXCISE PAROTID GLAND/LESION
20|FH_F115208_0_0|SrvcGrp|22914|2022|PDM|955.00|99|0.00|CPT CODE 69436
20|FH_F115208_0_0|SrvcGrp|64718|2022|PDM|716.00|99|0.00|CPT 45384
20|FH_F115208_0_0|SrvcGrp|91382|2022|PDM|1485.00|99|0.00|REMOVAL OF TONSILS
20|FH_F115298_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F115303_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F115347_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F115347_0_0|CSTM-ALL|CSTM-00|2020|PDM|1095.00|99|0.00|AEG 7 (NO REV)
20|FH_F115347_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|AEG 10 (NO REV)
20|FH_F115347_0_0|CSTM-ALL|CSTM-00|2020|PDM|695.00|99|0.00|AEG 4 (NO REV)
20|FH_F115347_0_0|CSTM-ALL|CSTM-00|2020|PDM|790.00|99|0.00|AEG 5  (NO REV)
20|FH_F115347_0_0|CSTM-ALL|CSTM-00|2020|PDM|910.00|99|0.00|AEG 6 (NO REV)
20|FH_F115430_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F115430_0_0|CSTM-ALL|CSTM-00|2020|PDM|1410.00|99|0.00|AEG 8 (NO REV)
20|FH_F115430_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 10 (NO REV)
20|FH_F115464_0_0|CSTM-ALL|CSTM-00|2020|PDM|1756.00|99|0.00|AEG 9 (NO REV)
20|FH_F115464_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F115485_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F115487_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F115487_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F115489_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F115495_0_0|SrvcGrp|82981|2022|PDM|140.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F115543_0_0|CSTM-ALL|CSTM-00|2020|PDM|1197.00|99|0.00|AEG 6 (NO REV)
20|FH_F115543_0_0|CSTM-ALL|CSTM-00|2020|PDM|1442.00|99|0.00|AEG 7 (NO REV)
20|FH_F115543_0_0|CSTM-ALL|CSTM-00|2020|PDM|1942.00|99|0.00|AEG 9 (NO REV)
20|FH_F115543_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 10 (NO REV)
20|FH_F115616_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F115616_0_0|CSTM-ALL|CSTM-00|2020|PDM|1405.00|99|0.00|AEG 1 (NO REV)
20|FH_F115616_0_0|SrvcGrp|106223|2022|PDM|3433.00|99|0.00|NECK SPINE DISK SURGERY
20|FH_F115616_0_0|SrvcGrp|106228|2022|PDM|4474.00|99|0.00|LUMBAR FUSION
20|FH_F115616_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F115616_0_0|SrvcGrp|67065|2022|PDM|3121.00|99|0.00|CERVICAL SURGERY
20|FH_F115616_0_0|SrvcGrp|98494|2022|PDM|4474.00|99|0.00|ARTHRODESIS PRE-SACRAL
20|FH_F115625_63110_0|SrvcGrp|73485|2022|PDM|1008.00|99|0.00|AETNA REHAB
20|FH_F115674_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 10 (NO REV)
20|FH_F115674_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|AEG 3 (NO REV)
20|FH_F115674_0_0|CSTM-ALL|CSTM-00|2020|PDM|973.00|99|0.00|AEG 8 (NO REV)
20|FH_F115705_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F115705_0_0|SrvcGrp|3809|2022|PDM|540.00|99|0.00|HOSPICE CARE
20|FH_F115735_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F115735_0_0|SrvcGrp|472|2022|PDM|315.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F115735_0_0|SrvcGrp|75545|2022|PDM|245.00|99|0.00|SUB-ACUTE - LEVEL I AND II
20|FH_F115808_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F115823_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 1 (NO REV)
20|FH_F115823_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|AEG 7 (NO REV)
20|FH_F115868_0_0|SrvcGrp|89783|2022|PDM|100.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F115868_0_0|SrvcGrp|94780|2022|PDM|18.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)
20|FH_F115875_0_0|CSTM-ALL|CSTM-00|2020|PDM|3348.00|99|0.00|AEG 7 (NO REV)
20|FH_F115875_0_0|CSTM-ALL|CSTM-00|2020|PDM|3348.00|99|0.00|AEG 9 (NO REV)
20|FH_F115875_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F115875_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F115884_0_0|SrvcGrp|94780|2022|PDM|111.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)
20|FH_F115884_0_0|SrvcGrp|94781|2022|PDM|111.00|99|0.00|HOSPICE IN LTCH (HCFA)
20|FH_F115889_0_0|SrvcGrp|72990|2022|PDM|542.00|99|0.00|AEG 1
20|FH_F38411_0_0|CSTM-ALL|CSTM-00|2020|PDM|1799.00|99|0.00|ACUTE MEDICAL SERVICES
20|FH_F38411_0_0|SrvcGrp|19731|2022|PCT|0.80|99|0.00|MS DRG 469-470 ONLY
20|FH_F38411_0_0|SrvcGrp|21051|2022|PCT|0.80|99|0.00|MS DRG HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM
20|FH_F38411_0_0|SrvcGrp|3029|2022|PDM|460.00|99|0.00|NEWBORN NURSERY
20|FH_F38417_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|IMPLANTS
20|FH_F38417_0_0|CSTM-ALL|CSTM-00|2020|PDM|1473.00|99|0.00|ASPG IX
20|FH_F38417_0_0|CSTM-ALL|CSTM-00|2020|PDM|693.00|99|0.00|ASPG IV
20|FH_F38417_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|ASPG VI
20|FH_F38420_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38421_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F38425_0_0|CSTM-ALL|CSTM-00|2020|PDM|41.00|99|0.00|SKILLED NURSING
20|FH_F38425_0_0|CSTM-ALL|CSTM-00|2020|PDM|45.00|99|0.00|LPN HI TECH - HOURLY
20|FH_F38425_0_0|CSTM-ALL|CSTM-00|2020|PDM|73.00|99|0.00|LPN VISIT
20|FH_F38425_0_0|SrvcGrp|10541|2022|PDM|110.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F38425_0_0|SrvcGrp|10542|2022|PDM|110.00|99|0.00|OCCUPATIONAL THERAPY SVCS
20|FH_F38425_0_0|SrvcGrp|10545|2022|PDM|115.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F38425_0_0|SrvcGrp|10615|2022|PDM|120.00|99|0.00|HOME HEALTH AIDE
20|FH_F38425_0_0|SrvcGrp|10624|2022|PDM|68.00|99|0.00|CPT CODE 99347
20|FH_F38425_0_0|SrvcGrp|11798|2022|PDM|112.00|99|0.00|HOME INFUSION NURSING SVCS
20|FH_F38425_0_0|SrvcGrp|22387|2022|PDM|50.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F38433_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|OP SVCS
20|FH_F38450_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38473_0_0|SrvcGrp|10407|2022|PDM|55.00|99|0.00|HOME INFUSION
20|FH_F38473_0_0|SrvcGrp|10542|2022|PDM|110.00|99|0.00|OCCUPATIONAL THERAPY SVCS
20|FH_F38473_0_0|SrvcGrp|10615|2022|PDM|120.00|99|0.00|HOME HEALTH AIDE
20|FH_F38473_0_0|SrvcGrp|10624|2022|PDM|68.00|99|0.00|CPT CODE 99347
20|FH_F38475_0_0|SrvcGrp|15846|2022|PDM|47.00|99|0.00|HOME VISIT
20|FH_F38475_0_0|SrvcGrp|27968|2022|PDM|41.00|99|0.00|SKILLED NURSING LPN
20|FH_F38476_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F38476_0_0|SrvcGrp|10407|2022|PDM|55.00|99|0.00|HOME INFUSION
20|FH_F38476_0_0|SrvcGrp|22387|2022|PDM|50.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F38488_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38496_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.50|99|0.00|OP SVCS
20|FH_F38526_0_0|CSTM-ALL|CSTM-00|2020|PDM|1170.00|99|0.00|ACUTE PSYCH
20|FH_F38526_0_0|SrvcGrp|11971|2022|PCT|0.90|99|0.00|TRAUMA CARE
20|FH_F38526_0_0|SrvcGrp|1259|2022|PDM|2040.00|99|0.00|INTERMEDIATE INTENSIVE CARE UNIT
20|FH_F38526_0_0|SrvcGrp|23929|2022|PCT|0.65|99|0.00|HIGH COST DRUGS
20|FH_F38526_0_0|SrvcGrp|2741|2022|PCT|0.65|99|0.00|DRUGS
20|FH_F38526_0_0|SrvcGrp|290|2022|PDM|5900.00|99|0.00|IP LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F38526_0_0|SrvcGrp|51|2022|PDM|12500.00|99|0.00|KNEE REPLACEMENT
20|FH_F38526_0_0|SrvcGrp|997|2022|PCT|0.65|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F38528_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38560_0_0|CSTM-ALL|CSTM-00|2020|PDM|18000.00|99|0.00|ADULT CV SURGERY (MS DRG)
20|FH_F38560_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|ACUTE PSYCH
20|FH_F38560_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38560_0_0|SrvcGrp|12523|2022|PDM|11000.00|99|0.00|GAMMA KNIFE
20|FH_F38560_0_0|SrvcGrp|1259|2022|PDM|1750.00|99|0.00|INTERMEDIATE INTENSIVE CARE UNIT
20|FH_F38560_0_0|SrvcGrp|29520|2022|PDM|3750.00|99|0.00|ADULT ANGIO W/CARDIAC CATH
20|FH_F38560_0_0|SrvcGrp|29533|2022|PDM|5500.00|99|0.00|ADULT AICD IMPLANTATION
20|FH_F38560_0_0|SrvcGrp|29545|2022|PDM|1200.00|99|0.00|LITHOTRIPSY
20|FH_F38560_0_0|SrvcGrp|29547|2022|PDM|3500.00|99|0.00|OP KIDNEY LITHOTRIPSY W/O STENT
20|FH_F38560_0_0|SrvcGrp|29549|2022|PDM|5500.00|99|0.00|OP KIDNEY LITHOTRIPSY W/STENT
20|FH_F38567_0_0|SrvcGrp|16|2022|PDM|670.00|99|0.00|ACUTE REHABILITATION
20|FH_F38568_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F38584_0_0|SrvcGrp|17067|2022|PDM|719.00|99|0.00|ASPG II
20|FH_F38584_0_0|SrvcGrp|17073|2022|PDM|1156.00|99|0.00|ASPG V
20|FH_F38584_0_0|SrvcGrp|17077|2022|PDM|1599.00|99|0.00|ASPG VII
20|FH_F38584_0_0|SrvcGrp|17081|2022|PDM|2156.00|99|0.00|ASPG IX
20|FH_F38584_0_0|SrvcGrp|28783|2022|PCT|0.50|99|0.00|UNGROUPED SURGERY
20|FH_F38591_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|99|0.00|OP SVCS
20|FH_F38591_0_0|SrvcGrp|16|2022|PDM|1432.00|99|0.00|ACUTE REHABILITATION
20|FH_F38591_0_0|SrvcGrp|180|2022|PDM|2745.00|99|0.00|INTENSIVE CARE SERVICES
20|FH_F38591_0_0|SrvcGrp|23477|2022|PDM|6366.00|99|0.00|MSDRG 286-287 ONLY CARDIAC CATH
20|FH_F38591_0_0|SrvcGrp|33793|2022|PDM|11936.00|99|0.00|MSDRG 246-251 ONLY ANGIOPLASTY
20|FH_F38591_0_0|SrvcGrp|361|2022|PDM|2745.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F38591_0_0|SrvcGrp|705|2022|PCT|0.70|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F38601_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F38607_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38607_0_0|SrvcGrp|25697|2022|PDM|1100.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F38676_0_0|SrvcGrp|17624|2022|PCT|0.75|99|0.00|IMPLANTS
20|FH_F38677_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38677_0_0|SrvcGrp|17379|2022|PDM|135.00|99|0.00|CCPD TRAINING
20|FH_F38691_0_0|CSTM-ALL|CSTM-00|2020|PDM|1750.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 219
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 220
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 222
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 232
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 234
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 244
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 246
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 251
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 418
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 462
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 473
20|FH_F115889_0_0|SrvcGrp|72998|2022|PDM|1148.00|99|0.00|AEG 5
20|FH_F115889_0_0|SrvcGrp|73006|2022|PDM|2240.00|99|0.00|AEG 9
20|FH_F115895_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F115895_0_0|CSTM-ALL|CSTM-00|2020|PDM|3395.00|99|0.00|AEG 4 (NO REV)
20|FH_F115895_0_0|CSTM-ALL|CSTM-00|2020|PDM|5027.00|99|0.00|AEG 8 (NO REV)
20|FH_F115895_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F115895_0_0|SrvcGrp|27261|2022|PDM|9548.00|99|0.00|CPT 27446
20|FH_F115895_0_0|SrvcGrp|67065|2022|PDM|6365.00|99|0.00|CERVICAL SURGERY
20|FH_F115895_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F115895_0_0|SrvcGrp|80617|2022|PDM|9442.00|99|0.00|ARTHOPLASTY
20|FH_F115895_0_0|SrvcGrp|89842|2022|PDM|6365.00|99|0.00|LUMBAR
20|FH_F115905_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|ASPG 10 HEARTLAND HEALTHCARE
20|FH_F115905_0_0|CSTM-ALL|CSTM-00|2020|PDM|1441.00|99|0.00|ASPG 5 HEARTLAND HEALTHCARE
20|FH_F115905_0_0|CSTM-ALL|CSTM-00|2020|PDM|1740.00|99|0.00|ASPG 8 HEARTLAND HEALTHCARE
20|FH_F115905_0_0|CSTM-ALL|CSTM-00|2020|PDM|1840.00|99|0.00|ASPG 7 HEARTLAND HEALTHCARE
20|FH_F115905_0_0|CSTM-ALL|CSTM-00|2020|PDM|680.00|99|0.00|ASPG 2 HEARTLAND HEALTHCARE
20|FH_F115943_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F115943_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F115954_0_0|CSTM-ALL|CSTM-00|2020|PDM|403.00|99|0.00|AEG 1 (NO REV)
20|FH_F115954_0_0|CSTM-ALL|CSTM-00|2020|PDM|618.00|99|0.00|AEG 5  (NO REV)
20|FH_F115954_0_0|CSTM-ALL|CSTM-00|2020|PDM|618.00|99|0.00|AEG 6 (NO REV)
20|FH_F115963_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F115963_0_0|SrvcGrp|46482|2022|PDM|190.00|99|0.00|S9083 PER VISIT
20|FH_F115971_0_0|SrvcGrp|106322|2022|PDM|1494.00|99|0.00|CORNEAL TRANSPLANT
20|FH_F115971_0_0|SrvcGrp|705|2022|PCT|0.33|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F115971_0_0|SrvcGrp|72996|2022|PDM|701.00|99|0.00|AEG 4
20|FH_F115971_0_0|SrvcGrp|73002|2022|PDM|1087.00|99|0.00|AEG 7
20|FH_F115971_0_0|SrvcGrp|73006|2022|PDM|1082.00|99|0.00|AEG 9
20|FH_F115974_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F115974_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|AEG 3 (NO REV)
20|FH_F115974_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|AEG 4 (NO REV)
20|FH_F115974_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F115974_0_0|SrvcGrp|93759|2022|PCT|0.00|99|0.00|CARDIAC CATH
20|FH_F115982_0_0|SrvcGrp|11673|2022|PDM|2000.00|99|0.00|CPT 29888
20|FH_F115982_0_0|SrvcGrp|35668|2022|PDM|1500.00|99|0.00|CPT 29824
20|FH_F115982_0_0|SrvcGrp|35669|2022|PDM|2425.00|99|0.00|CPT 63650
20|FH_F115982_0_0|SrvcGrp|41334|2022|PDM|6625.00|99|0.00|TOTAL KNEE
20|FH_F115982_0_0|SrvcGrp|54943|2022|PDM|1300.00|99|0.00|REPAIR OF SLAP LESION
20|FH_F115982_0_0|SrvcGrp|72996|2022|PDM|791.00|99|0.00|AEG 4
20|FH_F115982_0_0|SrvcGrp|72998|2022|PDM|863.00|99|0.00|AEG 5
20|FH_F115982_0_0|SrvcGrp|83641|2022|PDM|2750.00|99|0.00|CPT 29889
20|FH_F115982_0_0|SrvcGrp|98003|2022|PDM|1750.00|99|0.00|BIMALLEOLAR ANKLE FRACTURE
20|FH_F115982_0_0|SrvcGrp|99171|2022|PDM|1400.00|99|0.00|CPT 28485
20|FH_F115985_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F115985_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F115985_0_0|SrvcGrp|79458|2022|PDM|0.10|99|0.00|MED RECORD COPY
20|FH_F115990_0_0|SrvcGrp|72994|2022|PDM|950.00|99|0.00|AEG 3
20|FH_F115990_0_0|SrvcGrp|73004|2022|PDM|1450.00|99|0.00|AEG 8
20|FH_F115990_0_0|SrvcGrp|73008|2022|PDM|1300.00|99|0.00|AEG 10
20|FH_F116005_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F116005_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F116005_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|AEG 2 (NO REV)
20|FH_F116005_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|AEG 4 (NO REV)
20|FH_F116005_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F116019_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F116043_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F116043_0_0|SrvcGrp|63297|2022|PDM|100.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F116043_0_0|SrvcGrp|80317|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F116043_0_0|SrvcGrp|89822|2022|PDM|100.00|99|0.00|HOSPICE ROUTINE HOME CARE
20|FH_F116043_0_0|SrvcGrp|90478|2022|PDM|100.00|99|0.00|HOSPICE
20|FH_F116043_0_0|SrvcGrp|93098|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F116049_0_0|SrvcGrp|3809|2022|PDM|573.47|99|0.00|HOSPICE CARE
20|FH_F116097_0_0|SrvcGrp|104745|2022|PDM|148.79|99|0.00|HOSPICE
20|FH_F116097_0_0|SrvcGrp|26001|2022|PDM|133.35|99|0.00|HOSPICE RESPITE SVCS
20|FH_F116100_0_0|SrvcGrp|76094|2022|PDM|148.79|99|0.00|HOSPICE ROUTINE HOME CARE
20|FH_F116108_0_0|SrvcGrp|3809|2022|PDM|573.47|99|0.00|HOSPICE CARE
20|FH_F116126_0_0|SrvcGrp|26001|2022|PDM|133.35|99|0.00|HOSPICE RESPITE SVCS
20|FH_F116143_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DEVICE INSERTION
20|FH_F116143_0_0|SrvcGrp|73004|2022|PDM|1425.00|99|0.00|AEG 8
20|FH_F116145_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F116145_0_0|SrvcGrp|76094|2022|PDM|148.79|99|0.00|HOSPICE ROUTINE HOME CARE
20|FH_F116159_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F116159_0_0|CSTM-ALL|CSTM-00|2020|PDM|1093.00|99|0.00|AEG 7 (NO REV)
20|FH_F116159_0_0|CSTM-ALL|CSTM-00|2020|PDM|274.00|99|0.00|AEG 1 (NO REV)
20|FH_F116159_0_0|CSTM-ALL|CSTM-00|2020|PDM|684.00|99|0.00|AEG 3 (NO REV)
20|FH_F116159_0_0|CSTM-ALL|CSTM-00|2020|PDM|765.00|99|0.00|AEG 10 (NO REV)
20|FH_F116159_0_0|CSTM-ALL|CSTM-00|2020|PDM|955.00|99|0.00|AEG 6 (NO REV)
20|FH_F116169_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F116169_0_0|SrvcGrp|29428|2022|PDM|424.00|99|0.00|HOME/CHRONIC HEMODIALYSIS TREATMENT
20|FH_F116169_0_0|SrvcGrp|82498|2022|PDM|164.00|99|0.00|DIALYSIS PROCEDURE OTHER THAN HEMODIALYSIS
20|FH_F116176_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F116176_0_0|SrvcGrp|104745|2022|PDM|148.79|99|0.00|HOSPICE
20|FH_F116176_0_0|SrvcGrp|26001|2022|PDM|133.35|99|0.00|HOSPICE RESPITE SVCS
20|FH_F116176_0_0|SrvcGrp|80285|2022|PDM|148.79|99|0.00|HOSPICE ROUTINE HOME CARE
20|FH_F116207_0_0|SrvcGrp|102419|2022|PCT|0.49|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F116245_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F116275_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F116275_0_0|SrvcGrp|103552|2022|PDM|25.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER
20|FH_F116323_0_0|CSTM-ALL|CSTM-00|2020|PDM|2944.00|99|0.00|AEG 9 (NO REV)
20|FH_F116323_0_0|SrvcGrp|26002|2022|PDM|322.00|99|0.00|C-ARM AND LASER
20|FH_F116323_0_0|SrvcGrp|36591|2022|PDM|26766.00|99|0.00|CPT 63685
20|FH_F116323_0_0|SrvcGrp|88492|2022|PDM|24090.00|99|0.00|AETNA SPINAL BONE AUTOGRAFT
20|FH_F116324_0_0|SrvcGrp|75479|2022|PDM|385.00|99|0.00|AEG 1
20|FH_F116332_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F116332_0_0|CSTM-ALL|CSTM-00|2020|PDM|1525.00|99|0.00|AEG 2 (NO REV)
20|FH_F116332_0_0|CSTM-ALL|CSTM-00|2020|PDM|3143.00|99|0.00|AEG 5  (NO REV) W/O MUSCULOSKELETAL ENDOSCOPY/ARTHROSCOPY
20|FH_F116332_0_0|SrvcGrp|115362|2022|PDM|12220.00|99|0.00|FUSION OF STOMACH AND BOWEL
20|FH_F116332_0_0|SrvcGrp|115363|2022|PDM|16182.00|99|0.00|LAPAROSCOPY
20|FH_F116332_0_0|SrvcGrp|115367|2022|PDM|4123.00|99|0.00|SHOULDER LAPAROSCOPY
20|FH_F116332_0_0|SrvcGrp|13187|2022|PCT|0.80|99|0.00|INTRAOCULAR LENSES
20|FH_F116332_0_0|SrvcGrp|35921|2022|PDM|12422.00|99|0.00|BARIATRIC SURGERY
20|FH_F116332_0_0|SrvcGrp|41334|2022|PDM|17319.00|99|0.00|TOTAL KNEE
20|FH_F116332_0_0|SrvcGrp|84939|2022|PDM|18127.00|99|0.00|SHOULDER JOINT
20|FH_F116332_0_0|SrvcGrp|87844|2022|PDM|5100.00|99|0.00|LAPARASCOPY - GASTRIC
20|FH_F116346_0_0|SrvcGrp|105357|2022|PDM|435.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD
20|FH_F116370_0_0|SrvcGrp|103550|2022|PDM|400.00|99|0.00|HEMODIALYSIS SVCS
20|FH_F116370_0_0|SrvcGrp|103551|2022|PDM|171.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS
20|FH_F116373_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F116392_0_0|CSTM-ALL|CSTM-00|2020|PCT|71.00|99|0.00|OP SVCS
20|FH_F116428_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F116428_0_0|SrvcGrp|82222|2022|PDM|148.79|99|0.00|HOSPICE CARE
20|FH_F116430_0_0|CSTM-ALL|CSTM-00|2020|PDM|1212.00|99|0.00|AEG 5  (NO REV)
20|FH_F116430_0_0|CSTM-ALL|CSTM-00|2020|PDM|1415.00|99|0.00|AEG 6 (NO REV)
20|FH_F116430_0_0|CSTM-ALL|CSTM-00|2020|PDM|615.00|99|0.00|AEG 1 (NO REV)
20|FH_F116430_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F116430_0_0|SrvcGrp|106709|2022|PDM|5305.00|99|0.00|NECK & SPINE SURGERY
20|FH_F116430_0_0|SrvcGrp|106711|2022|PDM|1713.00|99|0.00|PODIATRY SURGERY
20|FH_F116430_0_0|SrvcGrp|106715|2022|PDM|2175.00|99|0.00|AETNA ARTHROSCOPY
20|FH_F116430_0_0|SrvcGrp|34606|2022|PDM|2705.00|99|0.00|CPT 29827
20|FH_F116430_0_0|SrvcGrp|58671|2022|PDM|1151.00|99|0.00|ASC CARVE OUT 64721
20|FH_F116430_0_0|SrvcGrp|89888|2022|PDM|2042.00|99|0.00|AETNA SUSPENSION OF TESTIS
20|FH_F116437_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F116437_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 10 (NO REV)
20|FH_F116437_0_0|CSTM-ALL|CSTM-00|2020|PDM|525.80|99|0.00|AEG 1 (NO REV)
20|FH_F116437_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.50|99|0.00|AEG 4 (NO REV)
20|FH_F116437_0_0|SrvcGrp|106767|2022|PDM|1757.00|99|0.00|REPAIR RETINAL DETACHMENT
20|FH_F116437_0_0|SrvcGrp|38908|2022|PDM|1757.00|99|0.00|CPT 67025 - INJECTION OF VITREOUS SUBSTITUTE
20|FH_F116437_0_0|SrvcGrp|77507|2022|PCT|1.10|99|0.00|AETNA CORNEAL TISSUE HANDLING
20|FH_F116437_0_0|SrvcGrp|84121|2022|PCT|1.10|99|0.00|OCULAR IMPLANTS
20|FH_F116437_0_0|SrvcGrp|87759|2022|PDM|793.00|99|0.00|REINFORCE/GRAFT EYE WALL
20|FH_F116437_0_0|SrvcGrp|88269|2022|PCT|1.10|99|0.00|RETINAL TAMPONADE DEVICE
20|FH_F116440_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F116440_0_0|SrvcGrp|73483|2022|PDM|500.00|99|0.00|AETNA SUBACUTE III
20|FH_F116443_0_0|CSTM-ALL|CSTM-00|2020|PDM|2285.00|99|0.00|AEG 4 (NO REV)
20|FH_F116443_0_0|CSTM-ALL|CSTM-00|2020|PDM|2350.00|99|0.00|AEG 5  (NO REV)
20|FH_F116443_0_0|CSTM-ALL|CSTM-00|2020|PDM|981.00|99|0.00|AEG 1 (NO REV)
20|FH_F116443_0_0|SrvcGrp|106798|2022|PDM|4100.00|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT
20|FH_F116443_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F116473_0_0|CSTM-ALL|CSTM-00|2020|PDM|1230.00|99|0.00|AEG 9 (NO REV)
20|FH_F116473_0_0|CSTM-ALL|CSTM-00|2020|PDM|1430.00|99|0.00|AEG 8 (NO REV)
20|FH_F116473_0_0|SrvcGrp|33986|2022|PDM|900.00|99|0.00|CPT 26055
20|FH_F116473_0_0|SrvcGrp|84309|2022|PDM|1900.00|99|0.00|KNEE SURGERY
20|FH_F116473_0_0|SrvcGrp|88030|2022|PDM|15000.00|99|0.00|REVISION OF KNEE JOINT
20|FH_F116473_0_0|SrvcGrp|90063|2022|PDM|2200.00|99|0.00|REPAIR BICEPS TENDON RUPTURE
20|FH_F116485_17033_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F116485_17033_0|SrvcGrp|110062|2022|PDM|31.83|99|0.00|FAMILY ADAPTIVE BH TREATMENT 15 MINS
20|FH_F116485_17033_0|SrvcGrp|114753|2022|PDM|336.81|99|0.00|EDUCATIONALLY BEHAVIORAL SUPPORTS LEVEL 2
20|FH_F116492_0_0|CSTM-ALL|CSTM-00|2020|PDM|1080.00|99|0.00|AEG 5  (NO REV)
20|FH_F116492_0_0|CSTM-ALL|CSTM-00|2020|PDM|1244.00|99|0.00|AEG 6 (NO REV)
20|FH_F116492_0_0|CSTM-ALL|CSTM-00|2020|PDM|1466.00|99|0.00|AEG 8 (NO REV)
20|FH_F116506_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F116506_0_0|SrvcGrp|103391|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F116506_0_0|SrvcGrp|103503|2022|PDM|1700.00|99|0.00|AETNA CARDIAC CATHERTERIZATION
20|FH_F116506_0_0|SrvcGrp|106880|2022|PDM|733.00|99|0.00|PARAVERTEBRAL FACET JOINT NERVE DESTRUCTION
20|FH_F116506_0_0|SrvcGrp|75479|2022|PDM|375.00|99|0.00|AEG 1
20|FH_F116506_0_0|SrvcGrp|75487|2022|PDM|825.00|99|0.00|AEG 5
20|FH_F116506_0_0|SrvcGrp|75493|2022|PDM|1090.00|99|0.00|AEG 8
20|FH_F116506_0_0|SrvcGrp|75495|2022|PDM|1125.00|99|0.00|AEG 9
20|FH_F116549_0_0|SrvcGrp|105357|2022|PDM|425.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD
20|FH_F116554_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F116554_0_0|CSTM-ALL|CSTM-00|2020|PDM|1166.00|99|0.00|AEG 8 (NO REV)
20|FH_F116563_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F116575_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F116575_0_0|CSTM-ALL|CSTM-00|2020|PDM|1525.00|99|0.00|AEG 5  (NO REV)
20|FH_F116575_0_0|CSTM-ALL|CSTM-00|2020|PDM|2012.00|99|0.00|AEG 8 (NO REV)
20|FH_F116575_0_0|CSTM-ALL|CSTM-00|2020|PDM|2768.00|99|0.00|AEG 9 (NO REV)
20|FH_F116575_0_0|CSTM-ALL|CSTM-00|2020|PDM|775.00|99|0.00|AEG 1 (NO REV)
20|FH_F116575_0_0|SrvcGrp|106266|2022|PDM|2624.13|99|0.00|NSL/SINS NDSC TOT W/ SPHENDT
20|FH_F116575_0_0|SrvcGrp|106267|2022|PDM|3132.05|99|0.00|NSL/SINS NDSC SPHN TISS RMVL
20|FH_F116575_0_0|SrvcGrp|106916|2022|PDM|1900.00|99|0.00|NASAL/SINUS ENDOSCPOY - W/ARTERY LIGAMENT
20|FH_F116575_0_0|SrvcGrp|65403|2022|PDM|2500.00|99|0.00|CPT 42830
20|FH_F116575_0_0|SrvcGrp|78093|2022|PDM|1600.00|99|0.00|AETNA NASAL ENDOSCOPY SURG
20|FH_F116575_0_0|SrvcGrp|79101|2022|PDM|1600.00|99|0.00|AETNA NASAL ENDOSCOPY
20|FH_F116575_0_0|SrvcGrp|88599|2022|PDM|1600.00|99|0.00|ENDOSCOPY MAXILLARY SINUS
20|FH_F116583_0_0|SrvcGrp|103903|2022|PDM|150.00|99|0.00|HOSPICE IN SNF
20|FH_F116583_0_0|SrvcGrp|106925|2022|PDM|650.00|99|0.00|HOSPICE IN INPT PSYCH (HCFA)
20|FH_F116583_0_0|SrvcGrp|106932|2022|PDM|650.00|99|0.00|HOSPICE IN LTCH (HCFA)
20|FH_F116583_0_0|SrvcGrp|106934|2022|PDM|150.00|99|0.00|HOSPICE/HH PLACE NOS (HCFA)
20|FH_F116602_0_0|CSTM-ALL|CSTM-00|2020|PCT|49.00|99|0.00|GENERAL ACUTE CARE
20|FH_F116602_0_0|CSTM-ALL|CSTM-00|2020|PCT|49.00|99|0.00|OP SVCS
20|FH_F116637_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F116644_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F116647_0_0|SrvcGrp|26470|2022|PDM|160.00|99|0.00|SELF DIALYSIS TRAINING CAPD
20|FH_F116647_0_0|SrvcGrp|29428|2022|PDM|445.00|99|0.00|HOME/CHRONIC HEMODIALYSIS TREATMENT
20|FH_F116664_0_0|SrvcGrp|103551|2022|PDM|542.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS
20|FH_F116664_0_0|SrvcGrp|106655|2022|PCT|0.90|99|0.00|PARSABIV
20|FH_F116703_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|GENERAL ACUTE CARE
20|FH_F116727_0_0|CSTM-ALL|CSTM-00|2020|PDM|1040.00|99|0.00|AEG 5  (NO REV)
20|FH_F116727_0_0|CSTM-ALL|CSTM-00|2020|PDM|1442.00|99|0.00|AEG 7 (NO REV)
20|FH_F116727_0_0|SrvcGrp|11663|2022|PCT|1.05|99|0.00|IMPLANTS
20|FH_F116731_0_0|SrvcGrp|80920|2022|PDM|475.00|99|0.00|HOSPICE SERVICES
20|FH_F116731_0_0|SrvcGrp|93098|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F116747_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F116747_0_0|SrvcGrp|27969|2022|PCT|0.00|99|0.00|HOME HEALTH AIDE
20|FH_F116793_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F116806_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F116806_0_0|CSTM-ALL|CSTM-00|2020|PDM|887.26|99|0.00|FIXATION OF TONGUE
20|FH_F116806_0_0|SrvcGrp|107008|2022|PDM|2499.85|99|0.00|REMOVAL OF BONE FOR GRAFT
20|FH_F116806_0_0|SrvcGrp|107009|2022|PDM|2047.31|99|0.00|REREVISE ORBITOFACIAL BONES
20|FH_F116806_0_0|SrvcGrp|107010|2022|PDM|1923.16|99|0.00|REMOVE JAW JOINT CARTILAGE
20|FH_F116806_0_0|SrvcGrp|107012|2022|PDM|1923.16|99|0.00|AUGMENTATION LOWER JAW BONE
20|FH_F116806_0_0|SrvcGrp|107016|2022|PDM|1923.16|99|0.00|RECONSTRUCTION MIDFACE, LEFORT 2
20|FH_F116806_0_0|SrvcGrp|107017|2022|PDM|1923.16|99|0.00|CONTOUR CRANIAL BONE LESION
20|FH_F116806_0_0|SrvcGrp|107019|2022|PDM|1923.16|99|0.00|RECONSTRUCT UPPER JAW BONE
20|FH_F116806_0_0|SrvcGrp|107028|2022|PDM|1923.16|99|0.00|RECONSTRUCTION OF MANDIBLE/MAXILLA-COMPLETE ENDOSTEAL IMPLAN
20|FH_F116806_0_0|SrvcGrp|107030|2022|PDM|1923.16|99|0.00|REVISE EYE SOCKETS
20|FH_F116806_0_0|SrvcGrp|107037|2022|PDM|1923.16|99|0.00|REPAIR CHEEK BONE FRACTURE
20|FH_F116806_0_0|SrvcGrp|107041|2022|PDM|1923.16|99|0.00|OPEN TREATMENT OF MANDIBULAR FRACTURE W/ EXTERNAL FIXATION
20|FH_F116806_0_0|SrvcGrp|107067|2022|PDM|1923.16|99|0.00|REPAIR PALATE
20|FH_F116806_0_0|SrvcGrp|107068|2022|PDM|1923.16|99|0.00|REPAIR NOSE TO LIP FISTULA
20|FH_F116806_0_0|SrvcGrp|107069|2022|PDM|1923.16|99|0.00|REPAIR SALIVARY DUCT
20|FH_F116806_0_0|SrvcGrp|107071|2022|PDM|1923.16|99|0.00|DRAINAGE OF THROAT ABSCESS
20|FH_F116806_0_0|SrvcGrp|107073|2022|PDM|1923.16|99|0.00|REPAIR CLEFT LIP
20|FH_F116806_0_0|SrvcGrp|107075|2022|PDM|1923.16|99|0.00|REMOVAL OF JAW BONE LESION
20|FH_F116806_0_0|SrvcGrp|107078|2022|PDM|1923.16|99|0.00|EXCISION LESION ROOF OF MOUTH
20|FH_F116806_0_0|SrvcGrp|107082|2022|PDM|1923.16|99|0.00|ARTHROPLASTY W/ OR W/O AUTOGRAFT
20|FH_F116806_0_0|SrvcGrp|107091|2022|PDM|973.15|99|0.00|BONE BIOPSY OPEN SUPERFICIAL
20|FH_F116806_0_0|SrvcGrp|107092|2022|PDM|973.15|99|0.00|RESECT FACE TUM < 2 CM
20|FH_F116806_0_0|SrvcGrp|107097|2022|PDM|887.26|99|0.00|DRAINAGE OF MOUTH LESION
20|FH_F116806_0_0|SrvcGrp|107102|2022|PDM|887.26|99|0.00|EXCISION OF MOUTH LESION
20|FH_F116806_0_0|SrvcGrp|107103|2022|PDM|887.26|99|0.00|GINGIVECTOMY EACH QUADRANT
20|FH_F116806_0_0|SrvcGrp|107104|2022|PDM|887.26|99|0.00|ARTHROTOMY TEMPOROMANDIBULAR JOINT
20|FH_F116806_0_0|SrvcGrp|107114|2022|PDM|887.26|99|0.00|PARTIAL EXCISION OF LIP
20|FH_F116806_0_0|SrvcGrp|107121|2022|PDM|887.26|99|0.00|RECONSTRUCTION TONGUE FOLD
20|FH_F116806_0_0|SrvcGrp|107128|2022|PDM|887.26|99|0.00|EXCISE PHARYNX LESION
20|FH_F116806_0_0|SrvcGrp|107131|2022|PDM|887.26|99|0.00|REMOVAL OF JAW BONE LESION
20|FH_F116806_0_0|SrvcGrp|107138|2022|PDM|788.84|99|0.00|PREPARE FACE/ORAL PROSTHESIS
20|FH_F116806_0_0|SrvcGrp|107139|2022|PDM|776.99|99|0.00|PREPARE FACE/ORAL PROSTHESIS
20|FH_F116806_0_0|SrvcGrp|83842|2022|PDM|1923.16|99|0.00|REPAIR EYE SOCKET FRACTURE
20|FH_F116806_0_0|SrvcGrp|83844|2022|PDM|1923.16|99|0.00|OPEN TREATMENT OF MANDIBULAR FRACTURE
20|FH_F116806_0_0|SrvcGrp|89853|2022|PDM|1613.14|99|0.00|NASAL/SINUS ENDOSCOPY-SURG
20|FH_F116806_0_0|SrvcGrp|90366|2022|PDM|1923.16|99|0.00|RHINOPLASTY COMPLETE EXT PRT
20|FH_F116809_0_0|CSTM-ALL|CSTM-00|2020|PDM|461.00|99|0.00|AEG 2 (NO REV)
20|FH_F116809_0_0|CSTM-ALL|CSTM-00|2020|PDM|527.00|99|0.00|AEG 10 (NO REV)
20|FH_F116809_0_0|CSTM-ALL|CSTM-00|2020|PDM|742.00|99|0.00|AEG 5  (NO REV)
20|FH_F116809_0_0|CSTM-ALL|CSTM-00|2020|PDM|854.00|99|0.00|AEG 6 (NO REV)
20|FH_F116809_0_0|SrvcGrp|74585|2022|PCT|0.00|99|0.00|AETNA OP IMPLANTS
20|FH_F116809_0_0|SrvcGrp|79593|2022|PDM|536.00|99|0.00|CPT 45378
20|FH_F116809_0_0|SrvcGrp|79594|2022|PDM|461.00|99|0.00|CPT 45380
20|FH_F116809_0_0|SrvcGrp|91465|2022|PDM|438.00|99|0.00|COLORECTAL CANCER SCREENING (HCFA)
20|FH_F116825_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE
20|FH_F116825_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F116825_0_0|SrvcGrp|1259|2022|PDM|1537.00|99|0.00|INTERMEDIATE INTENSIVE CARE UNIT
20|FH_F116825_0_0|SrvcGrp|74381|2022|PDM|33.13|99|0.00|PHYSICAL THERAPY
20|FH_F116828_0_0|SrvcGrp|92501|2022|PDM|133.35|99|0.00|HOSPICE IP RESPITE CARE
20|FH_F116849_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE
20|FH_F116849_0_0|SrvcGrp|13927|2022|PDM|106.00|99|0.00|DAY HOSPITAL FULL DAY
20|FH_F116956_0_0|SrvcGrp|3932|2022|PDM|3000.00|99|0.00|LITHOTRIPSY
20|FH_F116959_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 4 (NO REV)
20|FH_F116959_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 2 (NO REV)
20|FH_F116988_0_0|SrvcGrp|75485|2022|PDM|840.00|99|0.00|AEG 4
20|FH_F116988_0_0|SrvcGrp|75487|2022|PDM|971.00|99|0.00|AEG 5
20|FH_F116988_0_0|SrvcGrp|75493|2022|PDM|1297.00|99|0.00|AEG 8
20|FH_F116988_0_0|SrvcGrp|75497|2022|PDM|446.00|99|0.00|AEG 10
20|FH_F117001_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F117001_0_0|SrvcGrp|106595|2022|PDM|800.00|99|0.00|HEARING AID, PROG, MON, CIC
20|FH_F117001_0_0|SrvcGrp|106600|2022|PDM|650.00|99|0.00|HEARING AID, DIGIT, MON, ITC
20|FH_F117001_0_0|SrvcGrp|80658|2022|PCT|0.25|99|0.00|UPGRADED HEARING AID
20|FH_F117009_0_0|CSTM-ALL|CSTM-00|2020|PDM|2098.00|99|0.00|AEG 9 (NO REV)
20|FH_F117009_0_0|CSTM-ALL|CSTM-00|2020|PDM|742.00|99|0.00|AEG 2 (NO REV)
20|FH_F117009_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F117009_0_0|SrvcGrp|107270|2022|PDM|1337.00|99|0.00|INSERT AQUEOUS DRAIN DEVICE
20|FH_F117009_0_0|SrvcGrp|107273|2022|PDM|1221.00|99|0.00|REVISION OF LOWER EYELID
20|FH_F117009_0_0|SrvcGrp|107274|2022|PDM|2113.00|99|0.00|CORNEAL TRANSPLANT
20|FH_F117009_0_0|SrvcGrp|38909|2022|PDM|2243.00|99|0.00|CPT 67036 - VITRECTOMY, MECHANICAL
20|FH_F117009_0_0|SrvcGrp|95100|2022|PDM|1163.00|99|0.00|INCISE TEAR DUCT OPENING
20|FH_F117023_0_0|SrvcGrp|102261|2022|PDM|3500.00|99|0.00|AETNA ARTHROSCOPY
20|FH_F117023_0_0|SrvcGrp|27261|2022|PDM|5000.00|99|0.00|CPT 27446
20|FH_F117023_0_0|SrvcGrp|72992|2022|PDM|735.00|99|0.00|AEG 2
20|FH_F117023_0_0|SrvcGrp|72994|2022|PDM|840.00|99|0.00|AEG 3
20|FH_F117023_0_0|SrvcGrp|84939|2022|PDM|5000.00|99|0.00|SHOULDER JOINT
20|FH_F117027_0_0|CSTM-ALL|CSTM-00|2020|PDM|581.00|99|0.00|AEG 4 (NO REV)
20|FH_F117027_0_0|CSTM-ALL|CSTM-00|2020|PDM|774.00|99|0.00|AEG 6 (NO REV)
20|FH_F117027_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F117072_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.53|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE
20|FH_F117072_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.53|99|0.00|OP SVCS
20|FH_F117087_0_0|CSTM-ALL|CSTM-00|2020|PDM|5941.00|99|0.00|OSSEOINTEGRATED IMPLANT
20|FH_F117087_0_0|SrvcGrp|106063|2022|PDM|2494.00|99|0.00|REVISE MIDDLE EAR & MASTOID
20|FH_F117087_0_0|SrvcGrp|106265|2022|PDM|4185.00|99|0.00|NSL/SINS NDSC TOTAL
20|FH_F117087_0_0|SrvcGrp|106267|2022|PDM|4185.00|99|0.00|NSL/SINS NDSC SPHN TISS RMVL
20|FH_F117087_0_0|SrvcGrp|107042|2022|PDM|2494.00|99|0.00|REPAIR MOUTH/NOSE FISTULA
20|FH_F117087_0_0|SrvcGrp|107165|2022|PDM|2494.00|99|0.00|EAR CARTILAGE GRAFT
20|FH_F117087_0_0|SrvcGrp|107166|2022|PDM|2494.00|99|0.00|RHINOPLASTY
20|FH_F117087_0_0|SrvcGrp|107168|2022|PDM|2494.00|99|0.00|REMOVAL OF POLYPS
20|FH_F117087_0_0|SrvcGrp|107171|2022|PDM|2494.00|99|0.00|EXCISION OF LINGUAL TONSIL
20|FH_F117087_0_0|SrvcGrp|107177|2022|PDM|2494.00|99|0.00|REMOVE EAR LESION
20|FH_F117087_0_0|SrvcGrp|107179|2022|PDM|2494.00|99|0.00|REPAIR EARDRUM STRUCTURES
20|FH_F117087_0_0|SrvcGrp|107182|2022|PDM|2494.00|99|0.00|REVISE MIDDLE EAR & MASTOID
20|FH_F117087_0_0|SrvcGrp|107186|2022|PDM|2494.00|99|0.00|EXPLORE INNER EAR
20|FH_F117087_0_0|SrvcGrp|107187|2022|PDM|1596.00|99|0.00|REVISE TWO EYE MUSCLES
20|FH_F117087_0_0|SrvcGrp|107188|2022|PDM|1153.00|99|0.00|REMOVE NASAL FOREIGN BODY
20|FH_F117087_0_0|SrvcGrp|36864|2022|PDM|5941.00|99|0.00|COCHLEAR IMPLANTS
20|FH_F117087_0_0|SrvcGrp|44144|2022|PDM|2494.00|99|0.00|CPT 42440
20|FH_F117087_0_0|SrvcGrp|65402|2022|PDM|2494.00|99|0.00|CPT 42145
20|FH_F117087_0_0|SrvcGrp|83646|2022|PDM|2093.00|99|0.00|CPT 31276
20|FH_F117087_0_0|SrvcGrp|84910|2022|PDM|2093.00|99|0.00|ENDOSCOPY
20|FH_F117087_0_0|SrvcGrp|88824|2022|PDM|2494.00|99|0.00|CPT 69631
20|FH_F117087_0_0|SrvcGrp|97471|2022|PDM|2494.00|99|0.00|REMOVAL OF THYROID DUCT LESION
20|FH_F117113_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F117113_0_0|SrvcGrp|471|2022|PDM|367.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F117132_0_0|CSTM-ALL|CSTM-00|2020|PDM|1005.00|99|0.00|AEG 3 (NO REV)
20|FH_F117132_0_0|CSTM-ALL|CSTM-00|2020|PDM|1791.00|99|0.00|AEG 8 (NO REV)
20|FH_F117132_0_0|CSTM-ALL|CSTM-00|2020|PDM|2408.00|99|0.00|AEG 9 (NO REV)
20|FH_F117132_0_0|CSTM-ALL|CSTM-00|2020|PDM|599.00|99|0.00|AEG 1 (NO REV)
20|FH_F117132_0_0|SrvcGrp|84932|2022|PDM|2070.00|99|0.00|VITRECTOMY
20|FH_F117132_0_0|SrvcGrp|87387|2022|PDM|2000.00|99|0.00|REMOVE EYE IMPLANT MATERIAL
20|FH_F117195_0_0|SrvcGrp|74403|2022|PCT|0.59|99|0.00|AETNA OBSERVATION SERVICES
20|FH_F117199_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F117199_0_0|SrvcGrp|92597|2022|PDM|1813.93|99|0.00|GI PEGFILGRASTIM
20|FH_F117206_0_0|SrvcGrp|104450|2022|PDM|1500.00|99|0.00|CYSTOURETHRO W/ ADDL IMPLANT
20|FH_F117206_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F117206_0_0|SrvcGrp|16289|2022|PDM|650.00|99|0.00|CARPAL TUNNEL RELEASE
20|FH_F117206_0_0|SrvcGrp|38364|2022|PDM|1500.00|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F117206_0_0|SrvcGrp|42551|2022|PDM|740.00|99|0.00|OP SURGERY
20|FH_F117206_0_0|SrvcGrp|63472|2022|PDM|1500.00|99|0.00|CPT 64581
20|FH_F117206_0_0|SrvcGrp|72992|2022|PDM|560.00|99|0.00|AEG 2
20|FH_F117206_0_0|SrvcGrp|72994|2022|PDM|710.00|99|0.00|AEG 3
20|FH_F117206_0_0|SrvcGrp|74039|2022|PDM|3605.00|99|0.00|LAMINECTOMY
20|FH_F117206_0_0|SrvcGrp|79589|2022|PDM|600.00|99|0.00|UPPER GI
20|FH_F117206_0_0|SrvcGrp|79590|2022|PDM|721.00|99|0.00|CPT 43248
20|FH_F117206_0_0|SrvcGrp|79594|2022|PDM|721.00|99|0.00|CPT 45380
20|FH_F117206_0_0|SrvcGrp|85966|2022|PDM|1485.00|99|0.00|EXTRACAPSULAR CATARACT
20|FH_F117206_0_0|SrvcGrp|88740|2022|PDM|2884.00|99|0.00|SP BONE ALGRFT
20|FH_F117206_0_0|SrvcGrp|90563|2022|PDM|1485.00|99|0.00|REMOVAL OF LENS MATERIAL
20|FH_F117206_0_0|SrvcGrp|90603|2022|PDM|1485.00|99|0.00|EXTRACTION OF LENS
20|FH_F117206_0_0|SrvcGrp|90609|2022|PDM|619.00|99|0.00|ESOPHAGUS ENDOSCOPY
20|FH_F117208_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F117208_0_0|CSTM-ALL|CSTM-00|2020|PDM|3025.00|99|0.00|AEG 6 (NO REV)
20|FH_F117208_0_0|CSTM-ALL|CSTM-00|2020|PDM|4675.00|99|0.00|AEG 8 (NO REV)
20|FH_F117208_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F117208_0_0|SrvcGrp|106264|2022|PDM|4015.00|99|0.00|NSL/SINS NDSC W/ SINS DILATION
20|FH_F117208_0_0|SrvcGrp|106266|2022|PDM|4015.00|99|0.00|NSL/SINS NDSC TOT W/ SPHENDT
20|FH_F117208_0_0|SrvcGrp|107058|2022|PDM|4015.00|99|0.00|PARTIAL REMOVAL OF TONGUE
20|FH_F117208_0_0|SrvcGrp|77582|2022|PDM|3410.00|99|0.00|CPT 31255
20|FH_F117208_0_0|SrvcGrp|78093|2022|PDM|3410.00|99|0.00|AETNA NASAL ENDOSCOPY SURG
20|FH_F117208_0_0|SrvcGrp|83646|2022|PDM|4015.00|99|0.00|CPT 31276
20|FH_F117210_0_0|CSTM-ALL|CSTM-00|2020|PDM|637.00|99|0.00|AEG 2 (NO REV)
20|FH_F117225_0_0|CSTM-ALL|CSTM-00|2020|PDM|1417.00|99|0.00|AEG 3 (NO REV)
20|FH_F117225_0_0|CSTM-ALL|CSTM-00|2020|PDM|2195.00|99|0.00|AEG 10 (NO REV)
20|FH_F117225_0_0|CSTM-ALL|CSTM-00|2020|PDM|2771.00|99|0.00|AEG 6 (NO REV)
20|FH_F117225_0_0|CSTM-ALL|CSTM-00|2020|PDM|959.00|99|0.00|AEG 8 (NO REV)
20|FH_F117230_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|AEG 2 (NO REV)
20|FH_F117230_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|AEG 3 (NO REV)
20|FH_F117245_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F117245_0_0|SrvcGrp|73002|2022|PDM|1642.00|99|0.00|AEG 7
20|FH_F117245_0_0|SrvcGrp|73008|2022|PDM|1275.00|99|0.00|AEG 10
20|FH_F117245_0_0|SrvcGrp|74585|2022|PCT|0.60|99|0.00|AETNA OP IMPLANTS
20|FH_F117266_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F117299_0_0|CSTM-ALL|CSTM-00|2020|PDM|1266.00|99|0.00|AEG 10 (NO REV)
20|FH_F117299_0_0|CSTM-ALL|CSTM-00|2020|PDM|1485.00|99|0.00|AEG 4 (NO REV)
20|FH_F117299_0_0|CSTM-ALL|CSTM-00|2020|PDM|2034.00|99|0.00|AEG 7 (NO REV)
20|FH_F117299_0_0|CSTM-ALL|CSTM-00|2020|PDM|2224.00|99|0.00|AEG 8 (NO REV)
20|FH_F117299_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F117299_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F117300_0_0|CSTM-ALL|CSTM-00|2020|PDM|2138.00|99|0.00|AEG 3 (NO REV)
20|FH_F117300_0_0|CSTM-ALL|CSTM-00|2020|PDM|2383.00|99|0.00|AEG 5  (NO REV)
20|FH_F117300_0_0|SrvcGrp|11673|2022|PDM|4909.00|99|0.00|CPT 29888
20|FH_F117300_0_0|SrvcGrp|36591|2022|PDM|7853.00|99|0.00|CPT 63685
20|FH_F117300_0_0|SrvcGrp|41334|2022|PDM|7360.00|99|0.00|TOTAL KNEE
20|FH_F117300_0_0|SrvcGrp|67068|2022|PDM|7853.00|99|0.00|LUMBAR SPINE FUSION COMBINED
20|FH_F117300_0_0|SrvcGrp|71666|2022|PDM|6872.00|99|0.00|CPT 63655
20|FH_F117300_0_0|SrvcGrp|88157|2022|PDM|7360.00|99|0.00|TOTAL HIP ARTHROPLASTY
20|FH_F117300_0_0|SrvcGrp|88159|2022|PDM|7360.00|99|0.00|LOW BACK DISK SURGERY
20|FH_F117300_0_0|SrvcGrp|90343|2022|PDM|7360.00|99|0.00|CERVICE CORPECTOMY 1 LEVEL
20|FH_F117300_0_0|SrvcGrp|95559|2022|PDM|7360.00|99|0.00|HIP JOINT
20|FH_F117300_0_0|SrvcGrp|98494|2022|PDM|7853.00|99|0.00|ARTHRODESIS PRE-SACRAL
20|FH_F117300_0_0|SrvcGrp|98498|2022|PDM|7360.00|99|0.00|TRANSPEDICULAR 1 SEG THORACIC
20|FH_F117335_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F117335_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F117335_0_0|SrvcGrp|114518|2022|PDM|1326.00|99|0.00|INSERTION DRAINAGE DEVICE
20|FH_F117335_0_0|SrvcGrp|73002|2022|PDM|1135.00|99|0.00|AEG 7
20|FH_F117392_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F117392_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F117426_0_0|SrvcGrp|472|2022|PDM|315.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F117426_0_0|SrvcGrp|75545|2022|PDM|245.00|99|0.00|SUB-ACUTE - LEVEL I AND II
20|FH_F117426_0_0|SrvcGrp|96201|2022|PDM|45.00|99|0.00|PT/OT/ST
20|FH_F117437_0_0|SrvcGrp|82223|2022|PDM|180.00|99|0.00|HOSPICE CARE
20|FH_F117440_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F117442_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F117465_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F117465_0_0|SrvcGrp|107387|2022|PDM|3000.00|99|0.00|AETNA UNLISTED PROC SPINE
20|FH_F117465_0_0|SrvcGrp|107494|2022|PDM|3000.00|99|0.00|AETNA SHOULDER ARTHROSCOPY/SURGERY
20|FH_F117465_0_0|SrvcGrp|107495|2022|PDM|3000.00|99|0.00|AETNA - ARTHROSCOPY OF JOINT
20|FH_F117465_0_0|SrvcGrp|75483|2022|PDM|1200.00|99|0.00|AEG 3
20|FH_F117465_0_0|SrvcGrp|75491|2022|PDM|1300.00|99|0.00|AEG 7
20|FH_F117465_0_0|SrvcGrp|75497|2022|PDM|550.00|99|0.00|AEG 10
20|FH_F117485_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F117485_0_0|CSTM-ALL|CSTM-00|2020|PDM|1189.00|99|0.00|AEG 4 (NO REV)
20|FH_F117485_0_0|CSTM-ALL|CSTM-00|2020|PDM|1907.00|99|0.00|AEG 8 (NO REV)
20|FH_F117485_0_0|CSTM-ALL|CSTM-00|2020|PDM|2278.00|99|0.00|AEG 5  (NO REV)
20|FH_F117485_0_0|CSTM-ALL|CSTM-00|2020|PDM|781.00|99|0.00|AEG 2 (NO REV)
20|FH_F117485_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F117485_0_0|SrvcGrp|35921|2022|PDM|7519.00|99|0.00|BARIATRIC SURGERY
20|FH_F117486_0_0|SrvcGrp|103550|2022|PDM|400.00|99|0.00|HEMODIALYSIS SVCS
20|FH_F117509_0_0|SrvcGrp|104226|2022|PDM|148.79|99|0.00|HOSPICE CARE (HCFA)
20|FH_F117509_0_0|SrvcGrp|82222|2022|PDM|148.79|99|0.00|HOSPICE CARE
20|FH_F117512_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F117512_0_0|CSTM-ALL|CSTM-00|2020|PDM|1543.00|99|0.00|AEG 5  (NO REV)
20|FH_F117512_0_0|CSTM-ALL|CSTM-00|2020|PDM|1929.00|99|0.00|AEG 6 (NO REV)
20|FH_F117512_0_0|CSTM-ALL|CSTM-00|2020|PDM|912.00|99|0.00|AEG 2 (NO REV)
20|FH_F117525_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F117525_0_0|SrvcGrp|72996|2022|PDM|1035.00|99|0.00|AEG 4
20|FH_F117525_0_0|SrvcGrp|73000|2022|PDM|1200.00|99|0.00|AEG 6
20|FH_F117525_0_0|SrvcGrp|73002|2022|PDM|2000.00|99|0.00|AEG 7
20|FH_F117525_0_0|SrvcGrp|73008|2022|PDM|1300.00|99|0.00|AEG 10
20|FH_F117531_0_0|SrvcGrp|103551|2022|PDM|304.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS
20|FH_F117550_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F117550_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|OP SVCS
20|FH_F117550_0_0|CSTM-ALL|CSTM-00|2020|PDM|192.00|99|0.00|DEVELOPMENTAL TEST EXTEND
20|FH_F117550_0_0|SrvcGrp|104815|2022|PDM|192.00|99|0.00|NEUROBEHAVIORAL STATUS EXAM
20|FH_F117550_0_0|SrvcGrp|106522|2022|PDM|38.00|99|0.00|OCCUPATIONAL THERAPY SVCS RE-EVAL
20|FH_F117550_0_0|SrvcGrp|73606|2022|PDM|800.00|99|0.00|AETNA SKILLED NURSING CARE
20|FH_F117550_0_0|SrvcGrp|88857|2022|PDM|28.00|99|0.00|THERAPEUTIC ACTIVITIES
20|FH_F117550_0_0|SrvcGrp|89502|2022|PDM|28.00|99|0.00|NEUROMUSCULAR REEDUCATION
20|FH_F117552_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F117552_0_0|SrvcGrp|103642|2022|PDM|6500.00|99|0.00|AETNA FEM/POPL REVASE W/ATHER
20|FH_F117552_0_0|SrvcGrp|103646|2022|PDM|9500.00|99|0.00|AETNA TIB/ PER REVASE STENT & ATHER
20|FH_F117552_0_0|SrvcGrp|107544|2022|PDM|6000.00|99|0.00|ILIAC REVASC W/ STENT
20|FH_F117552_0_0|SrvcGrp|108518|2022|PDM|6000.00|99|0.00|IMPLANT PAT ACTIVE HT RECORD
20|FH_F117552_0_0|SrvcGrp|36591|2022|PDM|21500.00|99|0.00|CPT 63685
20|FH_F117552_0_0|SrvcGrp|58636|2022|PDM|13000.00|99|0.00|CPT 62362
20|FH_F117552_0_0|SrvcGrp|88030|2022|PDM|8500.00|99|0.00|REVISION OF KNEE JOINT
20|FH_F117552_0_0|SrvcGrp|91577|2022|PDM|10000.00|99|0.00|FEM/POPL REVASC STNT & ATHER
20|FH_F117559_08619_0|SrvcGrp|100269|2022|PDM|15.00|99|0.00|HEPA VACCINE ADULT IM
20|FH_F117559_08619_0|SrvcGrp|104055|2022|PDM|20.00|99|0.00|INFLUENZA VACCINE
20|FH_F117559_08619_0|SrvcGrp|105357|2022|PDM|648.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD
20|FH_F117559_08619_0|SrvcGrp|107748|2022|PDM|632.00|99|0.00|HEMODIALYSIS IN CENTER
20|FH_F117559_08619_0|SrvcGrp|111061|2022|PDM|45.00|99|0.00|TOXOIDS VACCINES
20|FH_F117559_08619_0|SrvcGrp|113298|2022|PDM|40.00|99|0.00|COVID-19 IMMUN ADMIN 2ND DOSE - PFIZER
20|FH_F117559_08619_0|SrvcGrp|115657|2022|PDM|20.00|99|0.00|INFLUENZA VACCINE QUADRIVALENT IIV4
20|FH_F117559_08619_0|SrvcGrp|15423|2022|PDM|115.00|99|0.00|ENGERIX-B HEPATITIS B
20|FH_F117559_08619_0|SrvcGrp|73362|2022|PDM|15.00|99|0.00|VACCINE SERVICES
20|FH_F117559_08619_0|SrvcGrp|90489|2022|PDM|115.00|99|0.00|PNEUMOCOCCAL VACCINE
20|FH_F117559_08619_0|SrvcGrp|90497|2022|PDM|11.00|99|0.00|FLUZONE VACC 3 YRS & > IM
20|FH_F117575_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F117575_0_0|CSTM-ALL|CSTM-00|2020|PDM|1125.00|99|0.00|AEG 5  (NO REV)
20|FH_F117575_0_0|CSTM-ALL|CSTM-00|2020|PDM|691.00|99|0.00|AEG 2 (NO REV)
20|FH_F117575_0_0|SrvcGrp|76243|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F117626_0_0|CSTM-ALL|CSTM-00|2020|PDM|1282.00|99|0.00|AEG 8 (NO REV)
20|FH_F117626_0_0|SrvcGrp|11663|2022|PCT|1.05|99|0.00|IMPLANTS
20|FH_F117627_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F117627_0_0|CSTM-ALL|CSTM-00|2020|PDM|1080.00|99|0.00|AEG 10 (NO REV)
20|FH_F117627_0_0|CSTM-ALL|CSTM-00|2020|PDM|1080.00|99|0.00|AEG 5  (NO REV)
20|FH_F117627_0_0|CSTM-ALL|CSTM-00|2020|PDM|2020.00|99|0.00|AEG 9 (NO REV)
20|FH_F117627_0_0|CSTM-ALL|CSTM-00|2020|PDM|502.00|99|0.00|AEG 1 (NO REV)
20|FH_F117627_0_0|CSTM-ALL|CSTM-00|2020|PDM|770.00|99|0.00|AEG 3 (NO REV)
20|FH_F117644_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OBSERVATION SERVICES
20|FH_F117644_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|VASCULAR DIAGNOSTIC STUDIES
20|FH_F117647_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F117647_0_0|CSTM-ALL|CSTM-00|2020|PDM|645.00|99|0.00|AEG 2 (NO REV)
20|FH_F117647_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 3 (NO REV)
20|FH_F117647_0_0|CSTM-ALL|CSTM-00|2020|PDM|840.00|99|0.00|AEG 10 (NO REV)
20|FH_F117715_0_0|SrvcGrp|107640|2022|PDM|4748.88|99|0.00|REMOVAL OF KIDNEY STONE
20|FH_F117715_0_0|SrvcGrp|28512|2022|PDM|2107.98|99|0.00|REPAIR BLADDER DEFECT
20|FH_F117715_0_0|SrvcGrp|47545|2022|PDM|18767.27|99|0.00|INSERTION/REPLACEMENT OF PERIPHERAL/GASTRIC NEUROSTIMULATOR
20|FH_F117715_0_0|SrvcGrp|75483|2022|PDM|747.00|99|0.00|AEG 3
20|FH_F117715_0_0|SrvcGrp|75485|2022|PDM|921.00|99|0.00|AEG 4
20|FH_F117715_0_0|SrvcGrp|75491|2022|PDM|1048.00|99|0.00|AEG 7
20|FH_F117728_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F117762_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F117762_0_0|CSTM-ALL|CSTM-00|2020|PDM|1502.00|99|0.00|AEG 7 (NO REV)
20|FH_F117762_0_0|CSTM-ALL|CSTM-00|2020|PDM|516.00|99|0.00|AEG 1 (NO REV)
20|FH_F117762_0_0|CSTM-ALL|CSTM-00|2020|PDM|945.00|99|0.00|AEG 4 (NO REV)
20|FH_F117762_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F117762_0_0|SrvcGrp|36591|2022|PDM|5408.00|99|0.00|CPT 63685
20|FH_F117762_0_0|SrvcGrp|41327|2022|PDM|1976.00|99|0.00|OP SURGERY CPT 28308
20|FH_F117762_0_0|SrvcGrp|41334|2022|PDM|14560.00|99|0.00|TOTAL KNEE
20|FH_F117762_0_0|SrvcGrp|58775|2022|PDM|5720.00|99|0.00|CORPECTOMY
20|FH_F117762_0_0|SrvcGrp|67065|2022|PDM|13520.00|99|0.00|CERVICAL SURGERY
20|FH_F117762_0_0|SrvcGrp|67119|2022|PDM|7800.00|99|0.00|ARTHODESIS
20|FH_F117762_0_0|SrvcGrp|83646|2022|PDM|3120.00|99|0.00|CPT 31276
20|FH_F117762_0_0|SrvcGrp|87062|2022|PDM|1144.00|99|0.00|REVISE ULNAR NERVE AT ELBOW
20|FH_F117762_0_0|SrvcGrp|88023|2022|PDM|7280.00|99|0.00|REMOVAL OF ANTERIOR INSTRUMENTATION
20|FH_F117762_0_0|SrvcGrp|88159|2022|PDM|4992.00|99|0.00|LOW BACK DISK SURGERY
20|FH_F117762_0_0|SrvcGrp|88164|2022|PDM|9360.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR
20|FH_F117762_0_0|SrvcGrp|88340|2022|PDM|7280.00|99|0.00|SPINAL FUSION
20|FH_F117762_0_0|SrvcGrp|88599|2022|PDM|3120.00|99|0.00|ENDOSCOPY MAXILLARY SINUS
20|FH_F117762_0_0|SrvcGrp|88740|2022|PDM|4836.00|99|0.00|SP BONE ALGRFT
20|FH_F117762_0_0|SrvcGrp|89404|2022|PDM|14560.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F117762_0_0|SrvcGrp|89848|2022|PDM|7280.00|99|0.00|SPINE FUSION EXTRA SEGMENT
20|FH_F117762_0_0|SrvcGrp|89856|2022|PDM|5720.00|99|0.00|LAMIN EXCIS EXTRADURAL LUMB
20|FH_F117762_0_0|SrvcGrp|90822|2022|PDM|3120.00|99|0.00|NASAL/SINUS ENDOSCOPY SURGERY
20|FH_F117762_0_0|SrvcGrp|92366|2022|PDM|1976.00|99|0.00|REPAIR ACHILLES TENDON
20|FH_F117762_0_0|SrvcGrp|97741|2022|PDM|14560.00|99|0.00|REVISE KNEE
20|FH_F117762_0_0|SrvcGrp|98498|2022|PDM|4992.00|99|0.00|TRANSPEDICULAR 1 SEG THORACIC
20|FH_F117762_0_0|SrvcGrp|99170|2022|PDM|1950.00|99|0.00|REPAIR HALLUX RIGIDUS
20|FH_F117762_0_0|SrvcGrp|99171|2022|PDM|1976.00|99|0.00|CPT 28485
20|FH_F117762_0_0|SrvcGrp|99175|2022|PDM|3120.00|99|0.00|CPT 31200
20|FH_F117763_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F117763_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE
20|FH_F117783_0_0|CSTM-ALL|CSTM-00|2020|PDM|1133.00|99|0.00|AEG 5  (NO REV)
20|FH_F117783_0_0|CSTM-ALL|CSTM-00|2020|PDM|824.00|99|0.00|AEG 2 (NO REV)
20|FH_F117783_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F117783_0_0|SrvcGrp|106235|2022|PCT|1.00|99|0.00|CYPASS
20|FH_F117783_0_0|SrvcGrp|107610|2022|PCT|1.00|99|0.00|REMOVE EYE/ATTACH IMPLANT
20|FH_F117783_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F117783_0_0|SrvcGrp|58659|2022|PCT|1.00|99|0.00|PROSTHETIC IMPLANTS
20|FH_F117783_0_0|SrvcGrp|78045|2022|PCT|1.00|99|0.00|AETNA AMNIOTIC MEMBRANE
20|FH_F117784_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F117784_0_0|SrvcGrp|106314|2022|PDM|370.45|99|0.00|ADVANCED LIFE SUPPORT LEVEL 2 (ALS2) (HCFA)
20|FH_F117784_0_0|SrvcGrp|106317|2022|PDM|488.38|99|0.00|SPECIALTY CARE TRANSPORT (HCFA)
20|FH_F117799_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F117799_0_0|CSTM-ALL|CSTM-00|2020|PDM|1477.00|99|0.00|AEG 6 (NO REV)
20|FH_F117799_0_0|SrvcGrp|103965|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F117799_0_0|SrvcGrp|104851|2022|PDM|1710.00|99|0.00|REVISION / REMOVAL SINUS
20|FH_F117799_0_0|SrvcGrp|104853|2022|PDM|3713.00|99|0.00|KNEE ARTHROSCOPY
20|FH_F117799_0_0|SrvcGrp|77021|2022|PDM|4244.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY
20|FH_F117802_0_0|SrvcGrp|107624|2022|PDM|441.00|99|0.00|HEMODIALYSIS SVCS
20|FH_F117802_0_0|SrvcGrp|107625|2022|PDM|217.00|99|0.00|CAPD/CCPD TRAINING W/ TREATMENT
20|FH_F117802_0_0|SrvcGrp|29434|2022|PDM|469.00|99|0.00|HOME HEMODIALYSIS TRAINING & TREATMENT
20|FH_F117820_0_0|SrvcGrp|24739|2022|PDM|82.34|99|0.00|RESPITE CARE
20|FH_F117820_0_0|SrvcGrp|90478|2022|PDM|82.34|99|0.00|HOSPICE
20|FH_F117820_0_0|SrvcGrp|90707|2022|PDM|105.00|99|0.00|AETNA HOSPICE CARE
20|FH_F117820_0_0|SrvcGrp|93098|2022|PDM|105.00|99|0.00|HOSPICE CARE
20|FH_F117831_0_0|CSTM-ALL|CSTM-00|2020|PDM|1961.00|99|0.00|AEG 9 (NO REV)
20|FH_F117831_0_0|SrvcGrp|84912|2022|PDM|4200.00|99|0.00|PERQ VERTEBRAL AUGMENTATION
20|FH_F117887_0_0|SrvcGrp|93736|2022|PDM|100.00|99|0.00|URGENT CARE
20|FH_F117896_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F117902_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F117902_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F117902_0_0|CSTM-ALL|CSTM-00|2020|PDM|1050.00|99|0.00|AEG 4 (NO REV)
20|FH_F117902_0_0|CSTM-ALL|CSTM-00|2020|PDM|1175.00|99|0.00|AEG 5  (NO REV)
20|FH_F117902_0_0|CSTM-ALL|CSTM-00|2020|PDM|1305.00|99|0.00|AEG 6 (NO REV)
20|FH_F117902_0_0|CSTM-ALL|CSTM-00|2020|PDM|1625.00|99|0.00|AEG 8 (NO REV)
20|FH_F117902_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F117905_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F117905_0_0|SrvcGrp|103552|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER
20|FH_F118028_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.50|99|0.00|GENERAL ACUTE CARE
20|FH_F118165_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS
20|FH_F118165_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F118165_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OBSERVATION SERVICES
20|FH_F118165_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|VASCULAR DIAGNOSTIC STUDIES
20|FH_F118168_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA CARDIAC CATH INCIDENTAL CODES
20|FH_F118168_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|AETNA CARDIAC CATHERTERIZATION
20|FH_F118168_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP DIALYSIS
20|FH_F118173_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 10 (NO REV)
20|FH_F118173_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|AEG 5  (NO REV)
20|FH_F118173_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|AEG 7 (NO REV)
20|FH_F118180_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F118180_0_0|CSTM-ALL|CSTM-00|2020|PCT|50.00|99|0.00|OP SVCS
20|FH_F118184_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.98|99|0.00|OP SVCS
20|FH_F118184_0_0|SrvcGrp|111932|2022|PDM|51.31|99|0.00|COVID-19 NON-CDC TESTING LAB
20|FH_F118196_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F118196_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS
20|FH_F118196_0_0|SrvcGrp|82138|2022|PDM|504.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F118249_0_0|CSTM-ALL|CSTM-00|2020|PDM|327.00|99|0.00|AEG 1 (NO REV)
20|FH_F118249_0_0|CSTM-ALL|CSTM-00|2020|PDM|438.00|99|0.00|AEG 10 (NO REV)
20|FH_F118249_0_0|CSTM-ALL|CSTM-00|2020|PDM|703.00|99|0.00|AEG 5  (NO REV)
20|FH_F118249_0_0|CSTM-ALL|CSTM-00|2020|PDM|957.00|99|0.00|AEG 8 (NO REV)
20|FH_F118249_0_0|SrvcGrp|108066|2022|PDM|21000.00|99|0.00|IMPLANT NEUROELECTRODES 23
20|FH_F118249_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F118300_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F118300_0_0|SrvcGrp|104745|2022|PDM|148.79|99|0.00|HOSPICE
20|FH_F118303_0_0|CSTM-ALL|CSTM-00|2020|PDM|446.00|99|0.00|AEG 2 (NO REV)
20|FH_F118303_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|AEG 4 (NO REV)
20|FH_F118303_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|AEG 7 (NO REV)
20|FH_F118303_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F118309_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F118309_0_0|CSTM-ALL|CSTM-00|2020|PDM|1479.50|99|0.00|AEG 9 (NO REV)
20|FH_F118309_0_0|CSTM-ALL|CSTM-00|2020|PDM|367.94|99|0.00|AEG 1 (NO REV)
20|FH_F118309_0_0|CSTM-ALL|CSTM-00|2020|PDM|563.51|99|0.00|AEG 3 (NO REV)
20|FH_F118309_0_0|CSTM-ALL|CSTM-00|2020|PDM|696.10|99|0.00|AEG 4 (NO REV)
20|FH_F118309_0_0|CSTM-ALL|CSTM-00|2020|PDM|792.23|99|0.00|AEG 5  (NO REV)
20|FH_F118309_0_0|SrvcGrp|103974|2022|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES
20|FH_F118386_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F118446_0_0|SrvcGrp|80918|2022|PDM|150.00|99|0.00|RESPITE CARE
20|FH_F118459_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F118459_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS
20|FH_F118469_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F118469_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F118469_0_0|CSTM-ALL|CSTM-00|2020|PDM|1307.00|99|0.00|AEG 2 (NO REV)
20|FH_F118469_0_0|CSTM-ALL|CSTM-00|2020|PDM|1451.00|99|0.00|AEG 10 (NO REV)
20|FH_F118469_0_0|CSTM-ALL|CSTM-00|2020|PDM|2585.00|99|0.00|AEG 7 (NO REV)
20|FH_F118469_0_0|CSTM-ALL|CSTM-00|2020|PDM|970.00|99|0.00|AEG 1 (NO REV)
20|FH_F118469_0_0|SrvcGrp|107794|2022|PDM|4100.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE
20|FH_F118482_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F118482_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F118482_0_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F118488_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|AETNA CARDIAC CATHERTERIZATION
20|FH_F118488_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS
20|FH_F118488_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F118488_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|VASCULAR DIAGNOSTIC STUDIES
20|FH_F118555_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F118555_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 9 (NO REV)
20|FH_F118555_0_0|CSTM-ALL|CSTM-00|2020|PDM|315.00|99|0.00|AEG 1 (NO REV)
20|FH_F118555_0_0|CSTM-ALL|CSTM-00|2020|PDM|485.00|99|0.00|AEG 3 (NO REV)
20|FH_F118555_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 4 (NO REV)
20|FH_F118555_0_0|CSTM-ALL|CSTM-00|2020|PDM|685.00|99|0.00|AEG 5  (NO REV)
20|FH_F118555_0_0|CSTM-ALL|CSTM-00|2020|PDM|934.00|99|0.00|AEG 8 (NO REV)
20|FH_F118651_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F118651_0_0|CSTM-ALL|CSTM-00|2020|PDM|1060.90|99|0.00|AEG 4 (NO REV)
20|FH_F118651_0_0|CSTM-ALL|CSTM-00|2020|PDM|1060.90|99|0.00|AEG 8 (NO REV)
20|FH_F118651_0_0|CSTM-ALL|CSTM-00|2020|PDM|1060.90|99|0.00|AEG 9 (NO REV)
20|FH_F118651_0_0|CSTM-ALL|CSTM-00|2020|PDM|1591.35|99|0.00|AEG 3 (NO REV)
20|FH_F118651_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F118651_0_0|SrvcGrp|107868|2022|PDM|4959.71|99|0.00|AETNA LAPAROSCOPY SURGICAL
20|FH_F118651_0_0|SrvcGrp|73495|2022|PDM|4402.74|99|0.00|AETNA MYOMECTOMY
20|FH_F118651_0_0|SrvcGrp|88147|2022|PDM|2652.25|99|0.00|LAPAROSCOPY REMOVE ADNEXA
20|FH_F118661_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F118661_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F118661_0_0|SrvcGrp|107808|2022|PDM|1058.00|99|0.00|AETNA AEG 2 W/O DIGESTIVE/PROF SVCS
20|FH_F118693_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS
20|FH_F118693_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F118693_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP DIALYSIS
20|FH_F118699_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F118699_0_0|CSTM-ALL|CSTM-00|2020|PDM|612.00|99|0.00|AEG 4 (NO REV)
20|FH_F118699_0_0|CSTM-ALL|CSTM-00|2020|PDM|806.00|99|0.00|AEG 6 (NO REV)
20|FH_F118699_0_0|CSTM-ALL|CSTM-00|2020|PDM|949.00|99|0.00|AEG 8 (NO REV)
20|FH_F118703_0_0|SrvcGrp|72996|2022|PDM|719.00|99|0.00|AEG 4
20|FH_F118703_0_0|SrvcGrp|73000|2022|PDM|967.00|99|0.00|AEG 6
20|FH_F118703_0_0|SrvcGrp|93759|2022|PCT|0.00|99|0.00|CARDIAC CATH
20|FH_F118720_0_0|CSTM-ALL|CSTM-00|2020|PDM|713.00|99|0.00|AEG 2 (NO REV)
20|FH_F118742_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING
20|FH_F118783_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|CARDIAC STUDIES
20|FH_F118783_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OBSERVATION SERVICES
20|FH_F118783_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F118786_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F118786_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.33|99|0.00|OP SVCS
20|FH_F118786_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F118786_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.30|99|0.00|HSS ASC
20|FH_F118803_0_0|CSTM-ALL|CSTM-00|2020|PDM|1393.10|99|0.00|AEG 9 (NO REV)
20|FH_F118803_0_0|SrvcGrp|107793|2022|PDM|7547.69|99|0.00|DIALYSIS CIRCUIT PROCEDURE
20|FH_F118803_0_0|SrvcGrp|107878|2022|PDM|2601.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT
20|FH_F118803_0_0|SrvcGrp|107879|2022|PDM|2601.00|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT
20|FH_F118803_0_0|SrvcGrp|107880|2022|PDM|1560.60|99|0.00|BALO ANGIOP CTR DIALYSIS SEG
20|FH_F118803_0_0|SrvcGrp|107881|2022|PDM|2162.15|99|0.00|STENT PLMT CTR DIALYSIS SEG
20|FH_F118803_0_0|SrvcGrp|107884|2022|PDM|2717.44|99|0.00|TRLUML BALO ANGIOP 1ST ART
20|FH_F118803_0_0|SrvcGrp|107885|2022|PDM|2151.79|99|0.00|TRLUML BALO ANGIOP 1ST VEIN
20|FH_F118803_0_0|SrvcGrp|68546|2022|PDM|1156.98|99|0.00|CPT 36558
20|FH_F118848_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|AEG 10 (NO REV)
20|FH_F118848_0_0|SrvcGrp|102120|2022|PDM|4800.00|99|0.00|REVISE EYE MUSCLE
20|FH_F118848_0_0|SrvcGrp|28551|2022|PDM|4100.00|99|0.00|REPAIR OF COMPLEX RETINAL DETACHMENT
20|FH_F118848_0_0|SrvcGrp|33967|2022|PDM|4800.00|99|0.00|CPT 47562
20|FH_F118848_0_0|SrvcGrp|42550|2022|PDM|3000.00|99|0.00|OP SURGERY CPT 66984
20|FH_F118848_0_0|SrvcGrp|47142|2022|PDM|4800.00|99|0.00|CPT 49650
20|FH_F118884_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS
20|FH_F118907_0_0|SrvcGrp|74794|2022|PDM|172.21|99|0.00|SLEEP STUDY
20|FH_F118907_0_0|SrvcGrp|92837|2022|PDM|81.97|99|0.00|SLEEP STUDY
20|FH_F118910_0_0|SrvcGrp|63297|2022|PDM|126.18|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F118910_0_0|SrvcGrp|65720|2022|PDM|113.30|99|0.00|RESPITE CARE
20|FH_F118910_0_0|SrvcGrp|95660|2022|PDM|540.75|99|0.00|HOSPICE SERVICES (HCFA)
20|FH_F118910_0_0|SrvcGrp|97702|2022|PDM|126.18|99|0.00|HOSPICE OR HH IN HOME (HCFA)
20|FH_F118957_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F118957_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|AEG 10 (NO REV)
20|FH_F118957_0_0|CSTM-ALL|CSTM-00|2020|PDM|1045.00|99|0.00|AEG 1 (NO REV)
20|FH_F118957_0_0|CSTM-ALL|CSTM-00|2020|PDM|5500.00|99|0.00|AEG 6 (NO REV)
20|FH_F118957_0_0|SrvcGrp|99073|2022|PDM|1.38|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F118962_0_0|CSTM-ALL|CSTM-00|2020|PDM|1152.35|99|0.00|AEG 6 (NO REV)
20|FH_F118962_0_0|CSTM-ALL|CSTM-00|2020|PDM|712.07|99|0.00|AEG 3 (NO REV)
20|FH_F118962_0_0|CSTM-ALL|CSTM-00|2020|PDM|879.62|99|0.00|AEG 10 (NO REV)
20|FH_F118986_0_0|SrvcGrp|75479|2022|PDM|477.29|99|0.00|AEG 1
20|FH_F118986_0_0|SrvcGrp|75487|2022|PDM|1028.89|99|0.00|AEG 5
20|FH_F118986_0_0|SrvcGrp|75489|2022|PDM|1206.66|99|0.00|AEG 6
20|FH_F119007_0_0|CSTM-ALL|CSTM-00|2020|PDM|1991.00|99|0.00|AEG 9 (NO REV)
20|FH_F119007_0_0|SrvcGrp|103974|2022|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES
20|FH_F119007_0_0|SrvcGrp|98326|2022|PDM|2721.00|99|0.00|PERQ LAMOT/LAM LUMBAR
20|FH_F119008_0_0|SrvcGrp|29155|2022|PDM|100.00|99|0.00|HOSPICE SVCS
20|FH_F119008_0_0|SrvcGrp|84185|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F119029_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F119029_0_0|CSTM-ALL|CSTM-00|2020|PDM|414.00|99|0.00|AEG 1 (NO REV)
20|FH_F119029_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|AEG 2 (NO REV)
20|FH_F119029_0_0|CSTM-ALL|CSTM-00|2020|PDM|761.00|99|0.00|AEG 5  (NO REV)
20|FH_F119029_0_0|CSTM-ALL|CSTM-00|2020|PDM|905.00|99|0.00|AEG 6 (NO REV)
20|FH_F119064_01581_0|SrvcGrp|46903|2022|PDM|482.00|99|0.00|RESIDENTIAL TREATMENT
20|FH_F119070_0_0|CSTM-ALL|CSTM-00|2020|PDM|1025.00|99|0.00|AEG 1 (NO REV)
20|FH_F119070_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 10 (NO REV)
20|FH_F119070_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 2 (NO REV)
20|FH_F119070_0_0|CSTM-ALL|CSTM-00|2020|PDM|2211.00|99|0.00|AEG 5  (NO REV)
20|FH_F119070_0_0|CSTM-ALL|CSTM-00|2020|PDM|2285.00|99|0.00|AEG 4 (NO REV)
20|FH_F119070_0_0|CSTM-ALL|CSTM-00|2020|PDM|2800.00|99|0.00|AEG 8 (NO REV)
20|FH_F119070_0_0|CSTM-ALL|CSTM-00|2020|PDM|2885.00|99|0.00|AEG 7 (NO REV)
20|FH_F119070_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F119070_0_0|SrvcGrp|106798|2022|PDM|4100.00|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT
20|FH_F119074_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F119096_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F119125_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F119125_0_0|SrvcGrp|9541|2022|PDM|200.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F119130_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F119130_0_0|SrvcGrp|108042|2022|PDM|400.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD
20|FH_F119130_0_0|SrvcGrp|108043|2022|PDM|171.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD
20|FH_F119203_0_0|SrvcGrp|103551|2022|PDM|186.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS
20|FH_F119203_0_0|SrvcGrp|108020|2022|PDM|186.00|99|0.00|PERITONEAL DIALYSIS - CCPD/CAPD
20|FH_F119214_0_0|SrvcGrp|75485|2022|PDM|1200.00|99|0.00|AEG 4
20|FH_F119214_0_0|SrvcGrp|75487|2022|PDM|1300.00|99|0.00|AEG 5
20|FH_F119214_0_0|SrvcGrp|75495|2022|PDM|2216.00|99|0.00|AEG 9
20|FH_F119214_0_0|SrvcGrp|75497|2022|PDM|1600.00|99|0.00|AEG 10
20|FH_F119214_0_0|SrvcGrp|83677|2022|PDM|1500.00|99|0.00|AETNA CARDIAC CATH
20|FH_F119266_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F119266_0_0|SrvcGrp|108041|2022|PDM|500.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME
20|FH_F119272_0_0|SrvcGrp|87077|2022|PDM|156.06|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F119285_0_0|CSTM-ALL|CSTM-00|2020|PDM|1137.00|99|0.00|AEG 6 (NO REV)
20|FH_F119285_0_0|CSTM-ALL|CSTM-00|2020|PDM|3216.00|99|0.00|DEVICE INSERTION
20|FH_F119285_0_0|SrvcGrp|104003|2022|PDM|3050.00|99|0.00|INSERT AQUEOUS DRAIN DEVICES
20|FH_F119291_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F119355_0_0|CSTM-ALL|CSTM-00|2020|PDM|120.00|99|0.00|AETNA FAMILY ADAPTIVE BH TREATMENT W/O PATIENT
20|FH_F119355_0_0|CSTM-ALL|CSTM-00|2020|PDM|120.00|99|0.00|SOCIAL SKILLS TRAINING GROUP (HCFA)
20|FH_F119355_0_0|CSTM-ALL|CSTM-00|2020|PDM|50.00|99|0.00|BEHAVIOR TREATMENT (HCFA)
20|FH_F119355_0_0|SrvcGrp|105427|2022|PDM|50.00|99|0.00|AETNA OBSERVATIONS BEHAVIORAL 30 MINS
20|FH_F119355_0_0|SrvcGrp|107561|2022|PDM|90.00|99|0.00|EXPOSURE ADAPTIVE BH TREATMENT 60 MINS (HCFA)
20|FH_F119376_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F119376_0_0|SrvcGrp|103503|2022|PDM|1700.00|99|0.00|AETNA CARDIAC CATHERTERIZATION
20|FH_F119376_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F119376_0_0|SrvcGrp|106798|2022|PDM|4300.00|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT
20|FH_F119376_0_0|SrvcGrp|108118|2022|PDM|1698.78|99|0.00|ARTERIOVENOUS ANASTOMOSIS
20|FH_F119376_0_0|SrvcGrp|108120|2022|PDM|1115.00|99|0.00|REPL TUNNLD CNTRL CVC W/O PORT/PUMP
20|FH_F119376_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F119376_0_0|SrvcGrp|72992|2022|PDM|535.00|99|0.00|AEG 2
20|FH_F119376_0_0|SrvcGrp|72996|2022|PDM|756.00|99|0.00|AEG 4
20|FH_F119376_0_0|SrvcGrp|72998|2022|PDM|860.00|99|0.00|AEG 5
20|FH_F119376_0_0|SrvcGrp|73002|2022|PDM|1194.00|99|0.00|AEG 7
20|FH_F119376_0_0|SrvcGrp|73006|2022|PDM|1607.00|99|0.00|AEG 9
20|FH_F119376_0_0|SrvcGrp|73008|2022|PDM|612.00|99|0.00|AEG 10
20|FH_F119379_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F119379_0_0|CSTM-ALL|CSTM-00|2020|PDM|1042.00|99|0.00|AEG 8 (NO REV)
20|FH_F119379_0_0|CSTM-ALL|CSTM-00|2020|PDM|543.00|99|0.00|AEG 10 (NO REV)
20|FH_F119379_0_0|CSTM-ALL|CSTM-00|2020|PDM|543.00|99|0.00|AEG 3 (NO REV)
20|FH_F119379_0_0|CSTM-ALL|CSTM-00|2020|PDM|885.00|99|0.00|AEG 6 (NO REV)
20|FH_F119379_0_0|SrvcGrp|107825|2022|PDM|1800.00|99|0.00|REPAIR DEFECT OF ARM ARTERY
20|FH_F119379_0_0|SrvcGrp|107828|2022|PDM|1428.00|99|0.00|REMOVE WRIST JOINT CARTILAGE
20|FH_F119379_0_0|SrvcGrp|107834|2022|PDM|1428.00|99|0.00|REPAIR OF HAND OR FOOT NERVE
20|FH_F119379_0_0|SrvcGrp|107836|2022|PDM|1100.00|99|0.00|REPAIR FOREARM TENDON/MUSCLE
20|FH_F119379_0_0|SrvcGrp|107838|2022|PDM|1060.00|99|0.00|REPAIR HAND JOINT WITH GRAFT
20|FH_F119379_0_0|SrvcGrp|107842|2022|PDM|885.00|99|0.00|SKIN GRAFT PROCEDURE
20|FH_F119379_0_0|SrvcGrp|107849|2022|PDM|672.00|99|0.00|SKIN FULL GRAFT PROCEDURE
20|FH_F119379_0_0|SrvcGrp|33971|2022|PDM|1060.00|99|0.00|CPT 25652
20|FH_F119379_0_0|SrvcGrp|35667|2022|PDM|885.00|99|0.00|CPT 20680
20|FH_F119379_0_0|SrvcGrp|76604|2022|PDM|1453.00|99|0.00|CPT 25447
20|FH_F119383_0_0|SrvcGrp|82981|2022|PDM|90.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F119384_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F119384_0_0|SrvcGrp|107746|2022|PCT|0.90|99|0.00|PARSABIV
20|FH_F119384_0_0|SrvcGrp|107748|2022|PDM|424.00|99|0.00|HEMODIALYSIS IN CENTER
20|FH_F119435_0_0|SrvcGrp|107792|2022|PDM|7630.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE
20|FH_F119435_0_0|SrvcGrp|107878|2022|PDM|4300.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT
20|FH_F119435_0_0|SrvcGrp|107885|2022|PDM|4300.00|99|0.00|TRLUML BALO ANGIOP 1ST VEIN
20|FH_F119437_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F119437_0_0|SrvcGrp|58993|2022|PDM|4750.00|99|0.00|DISKECTOMY
20|FH_F119437_0_0|SrvcGrp|67064|2022|PDM|4750.00|99|0.00|MUSCULOSKELETAL SYSTEM
20|FH_F119437_0_0|SrvcGrp|67065|2022|PDM|4750.00|99|0.00|CERVICAL SURGERY
20|FH_F119437_0_0|SrvcGrp|67068|2022|PDM|4750.00|99|0.00|LUMBAR SPINE FUSION COMBINED
20|FH_F119437_0_0|SrvcGrp|67069|2022|PDM|4750.00|99|0.00|CPT 22634
20|FH_F119437_0_0|SrvcGrp|74039|2022|PDM|4750.00|99|0.00|LAMINECTOMY
20|FH_F119437_0_0|SrvcGrp|75481|2022|PDM|1200.00|99|0.00|AEG 2
20|FH_F119437_0_0|SrvcGrp|88160|2022|PDM|4750.00|99|0.00|LAMINECTOMY W/FACETECTOMY
20|FH_F119437_0_0|SrvcGrp|98497|2022|PDM|4750.00|99|0.00|ARTHRODESIS POSTERIOR TECH
20|FH_F119493_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F119511_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F119511_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F119535_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.44|99|0.00|OP SVCS
20|FH_F119535_0_0|SrvcGrp|28221|2022|PDM|350.00|99|0.00|COMPUTED TOMOGRAPHY (CT)
20|FH_F119535_0_0|SrvcGrp|29930|2022|PDM|450.00|99|0.00|DIALYSIS
20|FH_F119544_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F119544_0_0|SrvcGrp|108041|2022|PDM|500.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME
20|FH_F119555_0_0|SrvcGrp|40864|2022|PDM|2710.00|99|0.00|SUBACUTE CARE
20|FH_F119559_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F119575_0_0|SrvcGrp|108180|2022|PDM|435.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD
20|FH_F119578_0_0|SrvcGrp|108081|2022|PDM|186.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS
20|FH_F119578_0_0|SrvcGrp|108180|2022|PDM|435.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD
20|FH_F119581_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F119581_0_0|CSTM-ALL|CSTM-00|2020|PDM|1273.00|99|0.00|AEG 6 (NO REV)
20|FH_F119581_0_0|CSTM-ALL|CSTM-00|2020|PDM|1432.00|99|0.00|AEG 9 (NO REV)
20|FH_F119581_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F119581_0_0|SrvcGrp|107794|2022|PDM|4668.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE
20|FH_F119581_0_0|SrvcGrp|108195|2022|PDM|1910.00|99|0.00|LAP INSERT TUNNEL IP CATH
20|FH_F119581_0_0|SrvcGrp|77272|2022|PDM|1361.00|99|0.00|AETNA INSRT TUNL CVAD 2 CATH-SITE
20|FH_F119581_0_0|SrvcGrp|77278|2022|PDM|1361.00|99|0.00|AETNA REPL TUNNLD CNTRL CVC W/O PORT/PUMP
20|FH_F119581_0_0|SrvcGrp|91577|2022|PDM|9866.00|99|0.00|FEM/POPL REVASC STNT & ATHER
20|FH_F119588_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F119588_0_0|CSTM-ALL|CSTM-00|2020|PDM|373.00|99|0.00|AEG 1 (NO REV)
20|FH_F119588_0_0|CSTM-ALL|CSTM-00|2020|PDM|506.00|99|0.00|AEG 2 (NO REV)
20|FH_F119594_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.44|99|0.00|OP SVCS
20|FH_F119595_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.80|99|0.00|GENERAL ACUTE CARE
20|FH_F119601_0_0|CSTM-ALL|CSTM-00|2020|PDM|2072.00|99|0.00|GENERAL ACUTE CARE
20|FH_F119602_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 1 (NO REV)
20|FH_F119602_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|AEG 2 (NO REV)
20|FH_F119602_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F119602_0_0|SrvcGrp|58638|2022|PDM|3000.00|99|0.00|CPT 63688
20|FH_F119602_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F119603_0_0|SrvcGrp|87077|2022|PDM|185.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F119627_27288_0|SrvcGrp|3378|2022|PCT|0.75|99|0.00|OBSERVATION SVCS
20|FH_F119650_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F119660_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F119660_0_0|SrvcGrp|29155|2022|PDM|90.00|99|0.00|HOSPICE SVCS
20|FH_F119660_0_0|SrvcGrp|82222|2022|PDM|90.00|99|0.00|HOSPICE CARE
20|FH_F119660_0_0|SrvcGrp|82223|2022|PDM|90.00|99|0.00|HOSPICE CARE
20|FH_F119660_0_0|SrvcGrp|83857|2022|PDM|450.00|99|0.00|IP HOSPICE SVCS
20|FH_F119725_0_0|SrvcGrp|106317|2022|PDM|705.97|99|0.00|SPECIALTY CARE TRANSPORT (HCFA)
20|FH_F119725_0_0|SrvcGrp|107353|2022|PDM|258.01|99|0.00|AMB SRVC NEONAT TRNSPRT BS RATE EMERG 1 WAY (HCFA)
20|FH_F119725_0_0|SrvcGrp|13262|2022|PDM|7.45|99|0.00|GROUND MILEAGE, PER STATUTE MILE
20|FH_F119760_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F119760_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F119760_0_0|SrvcGrp|93098|2022|PDM|105.00|99|0.00|HOSPICE CARE
20|FH_F119760_0_0|SrvcGrp|94781|2022|PDM|105.00|99|0.00|HOSPICE IN LTCH (HCFA)
20|FH_F119775_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F119784_0_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|AEG 7 (NO REV)
20|FH_F119784_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 6 (NO REV)
20|FH_F119784_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F119784_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F119795_0_0|CSTM-ALL|CSTM-00|2020|PDM|1197.00|99|0.00|AEG 2 (NO REV)
20|FH_F119795_0_0|SrvcGrp|107002|2022|PDM|20453.00|99|0.00|REVISE/RECONSTRUCT SHOULDER JOINT
20|FH_F119795_0_0|SrvcGrp|16289|2022|PDM|1685.00|99|0.00|CARPAL TUNNEL RELEASE
20|FH_F119795_0_0|SrvcGrp|26278|2022|PDM|5202.00|99|0.00|CPT 29881
20|FH_F119795_0_0|SrvcGrp|27310|2022|PDM|3106.00|99|0.00|ENDOSCOPIC PLANTAR FASCIOTOMY
20|FH_F119795_0_0|SrvcGrp|35672|2022|PDM|4474.00|99|0.00|CPT 23412
20|FH_F119795_0_0|SrvcGrp|54962|2022|PDM|4474.00|99|0.00|RECONSTRUCTION OF SHOULDER CUFF (ROTATOR)
20|FH_F119795_0_0|SrvcGrp|75182|2022|PCT|1.00|99|0.00|AETNA IMPLANTS
20|FH_F119795_0_0|SrvcGrp|78096|2022|PDM|5202.00|99|0.00|AETNA ARTHROSCOPY BICEPS
20|FH_F119795_0_0|SrvcGrp|82107|2022|PDM|5202.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F119795_0_0|SrvcGrp|82108|2022|PDM|5202.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F119795_0_0|SrvcGrp|98347|2022|PDM|3106.00|99|0.00|HIP ARTHROSCOPY / SURGERY
20|FH_F119824_0_0|SrvcGrp|108153|2022|PCT|0.90|99|0.00|PARSABIV
20|FH_F119825_0_0|SrvcGrp|104230|2022|PDM|100.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F119838_0_0|CSTM-ALL|CSTM-00|2020|PDM|2010.00|99|0.00|AEG 3 (NO REV)
20|FH_F119838_0_0|CSTM-ALL|CSTM-00|2020|PDM|2821.00|99|0.00|AEG 5  (NO REV)
20|FH_F119838_0_0|CSTM-ALL|CSTM-00|2020|PDM|3446.00|99|0.00|AEG 7 (NO REV)
20|FH_F119838_0_0|CSTM-ALL|CSTM-00|2020|PDM|3786.00|99|0.00|AETNA AEG 8 WITHOUT 66982-66984
20|FH_F119838_0_0|CSTM-ALL|CSTM-00|2020|PDM|805.00|99|0.00|AEG 1 (NO REV)
20|FH_F119838_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F119838_0_0|SrvcGrp|103974|2022|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES
20|FH_F119934_0_0|SrvcGrp|82981|2022|PDM|185.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F119937_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F119999_0_0|CSTM-ALL|CSTM-00|2020|PDM|3745.00|99|0.00|AEG 6 (NO REV)
20|FH_F119999_0_0|CSTM-ALL|CSTM-00|2020|PDM|5885.00|99|0.00|AEG 8 (NO REV)
20|FH_F119999_0_0|SrvcGrp|74587|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F120057_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F120057_0_0|SrvcGrp|103391|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F120057_0_0|SrvcGrp|103503|2022|PDM|1700.00|99|0.00|AETNA CARDIAC CATHERTERIZATION
20|FH_F120057_0_0|SrvcGrp|107792|2022|PDM|4370.06|99|0.00|DIALYSIS CIRCUIT PROCEDURE
20|FH_F120057_0_0|SrvcGrp|107878|2022|PDM|2500.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT
20|FH_F120057_0_0|SrvcGrp|72996|2022|PDM|756.00|99|0.00|AEG 4
20|FH_F120057_0_0|SrvcGrp|72998|2022|PDM|860.00|99|0.00|AEG 5
20|FH_F120057_0_0|SrvcGrp|73004|2022|PDM|1168.00|99|0.00|AEG 8
20|FH_F120057_0_0|SrvcGrp|73006|2022|PDM|1607.00|99|0.00|AEG 9
20|FH_F120058_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F120059_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 10 (NO REV)
20|FH_F120059_0_0|CSTM-ALL|CSTM-00|2020|PDM|1900.00|99|0.00|AEG 7 (NO REV)
20|FH_F120059_0_0|CSTM-ALL|CSTM-00|2020|PDM|1950.00|99|0.00|AEG 8 (NO REV)
20|FH_F120059_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|AEG 1 (NO REV)
20|FH_F120059_0_0|SrvcGrp|106799|2022|PDM|6500.00|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT
20|FH_F120059_0_0|SrvcGrp|108117|2022|PDM|1650.00|99|0.00|AV FUSION / FOREARM VEIN
20|FH_F120059_0_0|SrvcGrp|108119|2022|PDM|1550.00|99|0.00|ARTERY-VEIN FUSION
20|FH_F120089_0_0|SrvcGrp|75479|2022|PDM|330.00|99|0.00|AEG 1
20|FH_F120089_0_0|SrvcGrp|75487|2022|PDM|718.00|99|0.00|AEG 5
20|FH_F120089_0_0|SrvcGrp|75489|2022|PDM|840.00|99|0.00|AEG 6
20|FH_F120112_0_0|SrvcGrp|63297|2022|PDM|94.50|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F120112_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F120112_0_0|SrvcGrp|95660|2022|PDM|446.25|99|0.00|HOSPICE SERVICES (HCFA)
20|FH_F120119_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 7 (NO REV)
20|FH_F120119_0_0|CSTM-ALL|CSTM-00|2020|PDM|564.00|99|0.00|AEG 10 (NO REV)
20|FH_F120119_0_0|CSTM-ALL|CSTM-00|2020|PDM|696.00|99|0.00|AEG 4 (NO REV)
20|FH_F120119_0_0|CSTM-ALL|CSTM-00|2020|PDM|911.00|99|0.00|AEG 6 (NO REV)
20|FH_F120119_0_0|SrvcGrp|103974|2022|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES
20|FH_F120119_0_0|SrvcGrp|103982|2022|PDM|1074.00|99|0.00|AEG 8 W/O 66982, 66984
20|FH_F120119_0_0|SrvcGrp|106235|2022|PDM|2971.00|99|0.00|CYPASS
20|FH_F120123_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F120123_0_0|SrvcGrp|79720|2022|PDM|1275.00|99|0.00|ACUTE REHAB II
20|FH_F120152_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F120152_0_0|CSTM-ALL|CSTM-00|2020|PDM|2475.00|99|0.00|AEG 7 (NO REV)
20|FH_F120152_0_0|CSTM-ALL|CSTM-00|2020|PDM|2860.00|99|0.00|AEG 8 (NO REV)
20|FH_F120152_0_0|CSTM-ALL|CSTM-00|2020|PDM|3135.00|99|0.00|AEG 9 (NO REV)
20|FH_F120152_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F120152_0_0|SrvcGrp|104112|2022|PDM|3850.00|99|0.00|REPAIR OF ANKLE FRACTURE
20|FH_F120152_0_0|SrvcGrp|108347|2022|PDM|5500.00|99|0.00|REPAIR OF KNEE FRACTURE
20|FH_F120152_0_0|SrvcGrp|110955|2022|PDM|1.22|99|0.00|INJ BUPIVACAINE LIPOSOME (HCFA)
20|FH_F120152_0_0|SrvcGrp|27261|2022|PDM|24750.00|99|0.00|CPT 27446
20|FH_F120152_0_0|SrvcGrp|27315|2022|PDM|3300.00|99|0.00|TENDON REPAIR
20|FH_F120152_0_0|SrvcGrp|36591|2022|PDM|22000.00|99|0.00|CPT 63685
20|FH_F120152_0_0|SrvcGrp|67065|2022|PDM|16500.00|99|0.00|CERVICAL SURGERY
20|FH_F120152_0_0|SrvcGrp|67068|2022|PDM|22000.00|99|0.00|LUMBAR SPINE FUSION COMBINED
20|FH_F120152_0_0|SrvcGrp|76604|2022|PDM|2750.00|99|0.00|CPT 25447
20|FH_F120152_0_0|SrvcGrp|85792|2022|PDM|5500.00|99|0.00|OPEN TREATMENT OF DISTAL
20|FH_F120152_0_0|SrvcGrp|88162|2022|PDM|11000.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON
20|FH_F120152_0_0|SrvcGrp|88163|2022|PDM|19800.00|99|0.00|LUMBAR SPINE FUSION
20|FH_F120152_0_0|SrvcGrp|89848|2022|PDM|19800.00|99|0.00|SPINE FUSION EXTRA SEGMENT
20|FH_F120152_0_0|SrvcGrp|93069|2022|PDM|8800.00|99|0.00|POSTERIOR NON-SEGMENTAL INST
20|FH_F120207_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F120207_0_0|CSTM-ALL|CSTM-00|2020|PDM|1449.00|99|0.00|AEG 6 (NO REV)
20|FH_F120207_0_0|SrvcGrp|105287|2022|PDM|3979.00|99|0.00|LAP INC HERN RECUR COMP
20|FH_F120207_0_0|SrvcGrp|115762|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F120207_0_0|SrvcGrp|33967|2022|PDM|2921.36|99|0.00|CPT 47562
20|FH_F120207_0_0|SrvcGrp|64517|2022|PDM|3399.00|99|0.00|REDUCE MANMMAPLASTY
20|FH_F120207_0_0|SrvcGrp|78283|2022|PDM|2870.00|99|0.00|CPT 49505
20|FH_F120207_0_0|SrvcGrp|84180|2022|PDM|4031.00|99|0.00|AETNA DELAYED BREAST PROSTHESIS
20|FH_F120207_0_0|SrvcGrp|84181|2022|PDM|3000.00|99|0.00|AETNA IMMEDIATE BREAST PROSTHESIS
20|FH_F120210_0_0|CSTM-ALL|CSTM-00|2020|PDM|496.00|99|0.00|AEG 2 (NO REV)
20|FH_F120291_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F120291_0_0|SrvcGrp|108431|2022|PDM|1053.00|99|0.00|HOSPICE SERVICES
20|FH_F120291_0_0|SrvcGrp|83857|2022|PDM|1053.00|99|0.00|IP HOSPICE SVCS
20|FH_F120299_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F120299_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F120300_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F120305_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE
20|FH_F120332_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F120332_0_0|SrvcGrp|29346|2022|PCT|0.00|99|0.00|SKILLED NURSING- LPN
20|FH_F120384_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F120384_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F120384_0_0|SrvcGrp|108082|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER
20|FH_F120408_0_0|SrvcGrp|100859|2022|PDM|287.38|99|0.00|INTENSIVE OUTPATIENT PSYCH
20|FH_F120408_0_0|SrvcGrp|105819|2022|PDM|1326.11|99|0.00|AETNA RESIDENTIAL TREATMNT-EATING DISORDERS
20|FH_F120531_0_0|CSTM-ALL|CSTM-00|2020|PDM|1133.00|99|0.00|AEG 5  (NO REV)
20|FH_F120531_0_0|CSTM-ALL|CSTM-00|2020|PDM|997.00|99|0.00|AEG 4 (NO REV)
20|FH_F120605_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F120605_0_0|SrvcGrp|108494|2022|PDM|1785.00|99|0.00|RPR I/HERN INIT REDUC >5 YR
20|FH_F120605_0_0|SrvcGrp|73008|2022|PDM|815.00|99|0.00|AEG 10
20|FH_F120617_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|OP SVCS
20|FH_F120647_0_0|SrvcGrp|108082|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER
20|FH_F120647_0_0|SrvcGrp|108180|2022|PDM|400.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD
20|FH_F120658_0_0|CSTM-ALL|CSTM-00|2020|PDM|2072.00|99|0.00|GENERAL ACUTE CARE
20|FH_F120665_0_0|CSTM-ALL|CSTM-00|2020|PDM|2072.00|99|0.00|GENERAL ACUTE CARE
20|FH_F120670_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F120670_0_0|CSTM-ALL|CSTM-00|2020|PDM|1595.00|99|0.00|AEG 2 (NO REV)
20|FH_F120670_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|AEG 4 (NO REV)
20|FH_F120670_0_0|SrvcGrp|103538|2022|PDM|4200.00|99|0.00|ARTHROSCOPY HIP W/ FEMOROPLASTY
20|FH_F120670_0_0|SrvcGrp|108910|2022|PDM|16000.00|99|0.00|REVISE HIP ARTHROP
20|FH_F120670_0_0|SrvcGrp|11663|2022|PCT|0.69|99|0.00|IMPLANTS
20|FH_F120670_0_0|SrvcGrp|58776|2022|PDM|9000.00|99|0.00|DISKECTOMY
20|FH_F120671_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F120672_0_0|SrvcGrp|75506|2022|PCT|0.87|99|0.00|VASCULAR DIAGNOSTIC STUDIES
20|FH_F120693_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING
20|FH_F120693_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.00|99|0.00|OP SVCS
20|FH_F120695_15017_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F120695_15017_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F120695_15017_0|SrvcGrp|73605|2022|PDM|1141.00|99|0.00|AETNA ACUTE PSYCH
20|FH_F120707_0_0|SrvcGrp|102419|2022|PCT|0.89|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F120707_0_0|SrvcGrp|75506|2022|PCT|0.89|99|0.00|VASCULAR DIAGNOSTIC STUDIES
20|FH_F120718_0_0|CSTM-ALL|CSTM-00|2020|PCT|76.30|99|0.00|OP SVCS
20|FH_F120721_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.71|99|0.00|OP SVCS
20|FH_F120725_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.61|99|0.00|OP SVCS
20|FH_F120734_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.62|99|0.00|OP SVCS
20|FH_F120745_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.89|99|0.00|GENERAL ACUTE CARE
20|FH_F120901_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F120901_0_0|CSTM-ALL|CSTM-00|2020|PDM|2991.00|99|0.00|AEG 4 (NO REV)
20|FH_F120901_0_0|CSTM-ALL|CSTM-00|2020|PDM|3709.00|99|0.00|AEG 6 (NO REV)
20|FH_F120901_0_0|CSTM-ALL|CSTM-00|2020|PDM|3769.00|99|0.00|AEG 10 (NO REV)
20|FH_F120901_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F120901_0_0|SrvcGrp|11663|2022|PCT|0.40|99|0.00|IMPLANTS
20|FH_F120901_0_0|SrvcGrp|35669|2022|PDM|4682.00|99|0.00|CPT 63650
20|FH_F120901_0_0|SrvcGrp|58638|2022|PDM|4682.00|99|0.00|CPT 63688
20|FH_F120901_0_0|SrvcGrp|89980|2022|PDM|4682.00|99|0.00|OPEN TREATMENT OF DISTAL
20|FH_F120924_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.75|99|0.00|HSS ASC
20|FH_F120930_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F120930_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 10 (NO REV)
20|FH_F120930_0_0|CSTM-ALL|CSTM-00|2020|PDM|2600.00|99|0.00|AEG 9 (NO REV)
20|FH_F120930_0_0|SrvcGrp|103974|2022|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES
20|FH_F120930_0_0|SrvcGrp|104008|2022|PDM|2500.00|99|0.00|CORRECTION HALUX RIDGUS W IMPLANTS
20|FH_F120930_0_0|SrvcGrp|27316|2022|PDM|2000.00|99|0.00|TONSILS & ADENOIDS (42820)
20|FH_F120930_0_0|SrvcGrp|27347|2022|PDM|3000.00|99|0.00|CPT 58558
20|FH_F120930_0_0|SrvcGrp|33965|2022|PDM|3000.00|99|0.00|CPT 58552
20|FH_F120930_0_0|SrvcGrp|35672|2022|PDM|3000.00|99|0.00|CPT 23412
20|FH_F120930_0_0|SrvcGrp|41336|2022|PDM|3000.00|99|0.00|VAGINAL HYSTERECTOMY
20|FH_F120930_0_0|SrvcGrp|65403|2022|PDM|2000.00|99|0.00|CPT 42830
20|FH_F120930_0_0|SrvcGrp|78093|2022|PDM|2200.00|99|0.00|AETNA NASAL ENDOSCOPY SURG
20|FH_F120930_0_0|SrvcGrp|78096|2022|PDM|2000.00|99|0.00|AETNA ARTHROSCOPY BICEPS
20|FH_F120930_0_0|SrvcGrp|80617|2022|PDM|5000.00|99|0.00|ARTHOPLASTY
20|FH_F120930_0_0|SrvcGrp|84307|2022|PDM|2500.00|99|0.00|TENDON REPAIR
20|FH_F120930_0_0|SrvcGrp|88147|2022|PDM|3000.00|99|0.00|LAPAROSCOPY REMOVE ADNEXA
20|FH_F120930_0_0|SrvcGrp|92368|2022|PDM|2500.00|99|0.00|REPAIR OF LEG TENDON
20|FH_F120930_0_0|SrvcGrp|92821|2022|PDM|4500.00|99|0.00|HIP ARTHROSCOPY W/ LABRAL REPAIR
20|FH_F120930_0_0|SrvcGrp|93432|2022|PDM|4000.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT
20|FH_F120930_0_0|SrvcGrp|94989|2022|PDM|2200.00|99|0.00|SINUS ENDO W/ BALLOON DILATION
20|FH_F120945_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F120954_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F120954_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|SKILLED NURSING
20|FH_F120954_0_0|SrvcGrp|108540|2022|PCT|0.00|99|0.00|AIDE HOME HEALTH
20|FH_F120954_0_0|SrvcGrp|108541|2022|PCT|0.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F120954_0_0|SrvcGrp|108544|2022|PDM|201.60|99|0.00|SKILLED NURSING
20|FH_F121078_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F121078_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F121168_0_0|SrvcGrp|83522|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F121168_0_0|SrvcGrp|90707|2022|PDM|100.00|99|0.00|AETNA HOSPICE CARE
20|FH_F121168_0_0|SrvcGrp|94781|2022|PDM|100.00|99|0.00|HOSPICE IN LTCH (HCFA)
20|FH_F121168_0_0|SrvcGrp|97705|2022|PDM|100.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F121219_0_0|CSTM-ALL|CSTM-00|2020|PDM|2611.00|99|0.00|AEG 1 (NO REV)
20|FH_F121219_0_0|CSTM-ALL|CSTM-00|2020|PDM|5699.00|99|0.00|AEG 8 (NO REV)
20|FH_F121219_0_0|CSTM-ALL|CSTM-00|2020|PDM|6645.00|99|0.00|AEG 9 (NO REV)
20|FH_F121223_0_0|SrvcGrp|108041|2022|PDM|435.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME
20|FH_F121335_0_0|CSTM-ALL|CSTM-00|2020|PDM|5699.00|99|0.00|AEG 8 (NO REV)
20|FH_F121335_0_0|SrvcGrp|114930|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F121425_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F121426_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|ASPG X
20|FH_F121426_0_0|CSTM-ALL|CSTM-00|2020|PDM|1780.00|99|0.00|ASPG VIII
20|FH_F121426_0_0|SrvcGrp|3448|2022|PDM|1177.00|99|0.00|MRI
20|FH_F121427_0_0|SrvcGrp|108041|2022|PDM|400.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME
20|FH_F121427_0_0|SrvcGrp|108081|2022|PDM|171.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS
20|FH_F121427_0_0|SrvcGrp|108082|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER
20|FH_F121472_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F121472_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F121472_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|AEG 2 (NO REV)
20|FH_F121476_0_0|CSTM-ALL|CSTM-00|2020|PDM|2120.00|99|0.00|REPAIR OF NASAL VESTIBULAR LATERAL WALL STENOSIS
20|FH_F121476_0_0|SrvcGrp|104924|2022|PDM|150.00|99|0.00|GUIDE WIRE
20|FH_F121476_0_0|SrvcGrp|105319|2022|PDM|30331.00|99|0.00|IMPLT NROSTM PLS GEN DUA REC
20|FH_F121476_0_0|SrvcGrp|107348|2022|PDM|3237.00|99|0.00|EXTERNAL RECHARG SYS INTERN
20|FH_F121476_0_0|SrvcGrp|108823|2022|PDM|2302.00|99|0.00|CATHETER BALLOON DILATATION
20|FH_F121476_0_0|SrvcGrp|108828|2022|PDM|1153.00|99|0.00|NEURAGEN NERVE GUIDE
20|FH_F121476_0_0|SrvcGrp|108830|2022|PDM|35248.00|99|0.00|IMPLT NROSTM PLS GEN DUA NON
20|FH_F121476_0_0|SrvcGrp|108836|2022|PDM|44567.00|99|0.00|COCHLEAR DEVICE/SYSTEM
20|FH_F121476_0_0|SrvcGrp|108843|2022|PDM|4086.00|99|0.00|LEAD CORONARY VENOUS
20|FH_F121476_0_0|SrvcGrp|108846|2022|PDM|1595.00|99|0.00|URINARY INCON REPAIR DEVICE
20|FH_F121476_0_0|SrvcGrp|108851|2022|PDM|169.00|99|0.00|ALLODERM
20|FH_F121476_0_0|SrvcGrp|108853|2022|PDM|695.00|99|0.00|INDWELLING PORT
20|FH_F121476_0_0|SrvcGrp|108854|2022|PDM|525.00|99|0.00|OSSICULA IMPLANT
20|FH_F121476_0_0|SrvcGrp|108855|2022|PDM|4225.00|99|0.00|HALLUX IMPLANT
20|FH_F121476_0_0|SrvcGrp|108864|2022|PDM|889.00|99|0.00|MATERIAL FOR VOCAL CORD MED
20|FH_F121476_0_0|SrvcGrp|108865|2022|PDM|7249.00|99|0.00|PACEMAKER DUAL CHAMBER
20|FH_F121476_0_0|SrvcGrp|111250|2022|PDM|1067.00|99|0.00|LEVONORGESTREL
20|FH_F121476_0_0|SrvcGrp|111251|2022|PDM|1050.00|99|0.00|LEVONORGESTREL
20|FH_F121476_0_0|SrvcGrp|111252|2022|PDM|645.00|99|0.00|CATHETER
20|FH_F121476_0_0|SrvcGrp|40826|2022|PDM|476.00|99|0.00|DISPOSABLE DRUG DELIVERY SYSTEM
20|FH_F121476_0_0|SrvcGrp|88267|2022|PDM|5679.00|99|0.00|CONNECTIVE TISSUE
20|FH_F121476_0_0|SrvcGrp|91759|2022|PDM|2342.00|99|0.00|OCULAR IMPLANT
20|FH_F121476_0_0|SrvcGrp|96104|2022|PDM|793.00|99|0.00|IMPLANTABLE NEUROSTIMULATOR
20|FH_F121799_0_0|SrvcGrp|83857|2022|PDM|525.00|99|0.00|IP HOSPICE SVCS
20|FH_F121800_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F121816_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS
20|FH_F121925_0_0|CSTM-ALL|CSTM-00|2020|PDM|521.00|99|0.00|AEG 10 (NO REV)
20|FH_F121925_0_0|CSTM-ALL|CSTM-00|2020|PDM|573.00|99|0.00|AEG 3 (NO REV)
20|FH_F121925_0_0|CSTM-ALL|CSTM-00|2020|PDM|851.00|99|0.00|AEG 6 (NO REV)
20|FH_F121925_0_0|SrvcGrp|84974|2022|PDM|797.69|99|0.00|CPT 43255
20|FH_F121925_0_0|SrvcGrp|95115|2022|PDM|743.05|99|0.00|BIOPSY OF LIVER
20|FH_F122009_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F122009_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F122009_0_0|SrvcGrp|108082|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER
20|FH_F122067_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F122067_0_0|CSTM-ALL|CSTM-00|2020|PDM|1430.00|99|0.00|AEG 9 (NO REV)
20|FH_F122067_0_0|CSTM-ALL|CSTM-00|2020|PDM|935.00|99|0.00|AEG 4 (NO REV)
20|FH_F122067_0_0|SrvcGrp|103974|2022|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES
20|FH_F122067_0_0|SrvcGrp|108980|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F122067_0_0|SrvcGrp|42550|2022|PDM|1540.00|99|0.00|OP SURGERY CPT 66984
20|FH_F122067_0_0|SrvcGrp|85966|2022|PDM|1540.00|99|0.00|EXTRACAPSULAR CATARACT
20|FH_F122130_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|HSS ASC
20|FH_F122200_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F122200_0_0|SrvcGrp|108151|2022|PDM|314.00|99|0.00|CAPD/CCPD INCLUDES TRAINING
20|FH_F122240_0_0|SrvcGrp|108042|2022|PDM|424.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD
20|FH_F122245_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F122245_0_0|SrvcGrp|3932|2022|PDM|3180.00|99|0.00|LITHOTRIPSY
20|FH_F122245_0_0|SrvcGrp|63459|2022|PDM|2000.00|99|0.00|CPT 52601
20|FH_F122245_0_0|SrvcGrp|85966|2022|PDM|2240.50|99|0.00|EXTRACAPSULAR CATARACT
20|FH_F122262_0_0|CSTM-ALL|CSTM-00|2020|PDM|4815.00|99|0.00|AEG 7 (NO REV)
20|FH_F122262_0_0|CSTM-ALL|CSTM-00|2020|PDM|5885.00|99|0.00|AEG 9 (NO REV)
20|FH_F122262_0_0|CSTM-ALL|CSTM-00|2020|PDM|855.00|99|0.00|AEG 1 (NO REV)
20|FH_F122262_0_0|SrvcGrp|11663|2022|PCT|0.50|99|0.00|IMPLANTS
20|FH_F122338_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F122338_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F122338_0_0|SrvcGrp|72990|2022|PDM|1485.00|99|0.00|AEG 1
20|FH_F122381_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F122381_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F122388_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F122388_0_0|SrvcGrp|106906|2022|PDM|385.00|99|0.00|AETNA SURGERY DEFAULT W/O GROUPER 1 & 2
20|FH_F122433_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F122433_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F122433_0_0|SrvcGrp|109087|2022|PDM|1379.00|99|0.00|AEG 9 W/O PERCUTANEOUS VERTEBROPLASTY
20|FH_F122433_0_0|SrvcGrp|72990|2022|PDM|350.00|99|0.00|AEG 1
20|FH_F122433_0_0|SrvcGrp|72992|2022|PDM|625.00|99|0.00|AEG 2
20|FH_F122433_0_0|SrvcGrp|72994|2022|PDM|580.00|99|0.00|AEG 3
20|FH_F122433_0_0|SrvcGrp|73004|2022|PDM|973.00|99|0.00|AEG 8
20|FH_F122433_0_0|SrvcGrp|88760|2022|PDM|1000.00|99|0.00|CERVICAL ARTHRODESIS
20|FH_F122433_0_0|SrvcGrp|93724|2022|PDM|800.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY
20|FH_F122433_0_0|SrvcGrp|99073|2022|PDM|1.28|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F122574_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F122574_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES
20|FH_F122574_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING
20|FH_F122574_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP DIALYSIS
20|FH_F122574_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|VASCULAR DIAGNOSTIC STUDIES
20|FH_F122623_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|GENERAL ACUTE CARE
20|FH_F122623_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|OP SVCS
20|FH_F122648_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F122648_0_0|CSTM-ALL|CSTM-00|2020|PDM|1004.00|99|0.00|AEG 7 (NO REV)
20|FH_F122648_0_0|CSTM-ALL|CSTM-00|2020|PDM|2573.00|99|0.00|DEVICE INSERTION
20|FH_F122648_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 1 (NO REV)
20|FH_F122648_0_0|CSTM-ALL|CSTM-00|2020|PDM|448.00|99|0.00|AEG 2 (NO REV)
20|FH_F122648_0_0|CSTM-ALL|CSTM-00|2020|PDM|618.00|99|0.00|AEG 3 (NO REV)
20|FH_F122648_0_0|CSTM-ALL|CSTM-00|2020|PDM|631.00|99|0.00|AEG 4 (NO REV)
20|FH_F122648_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F122648_0_0|SrvcGrp|109175|2022|PDM|921.00|99|0.00|EYE SERVICES
20|FH_F122648_0_0|SrvcGrp|78046|2022|PCT|1.00|99|0.00|AETNA AQUEOUS SHUNT
20|FH_F122648_0_0|SrvcGrp|82570|2022|PDM|817.00|99|0.00|REVISION EYELID/EXCESS SKIN
20|FH_F122649_0_0|SrvcGrp|30609|2022|PDM|29.00|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F122649_0_0|SrvcGrp|47411|2022|PDM|112.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F122649_0_0|SrvcGrp|94781|2022|PDM|112.00|99|0.00|HOSPICE IN LTCH (HCFA)
20|FH_F122649_0_0|SrvcGrp|95660|2022|PDM|112.00|99|0.00|HOSPICE SERVICES (HCFA)
20|FH_F122687_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|AEG 10 (NO REV)
20|FH_F122687_0_0|CSTM-ALL|CSTM-00|2020|PDM|1858.00|99|0.00|AEG 8 (NO REV)
20|FH_F122687_0_0|CSTM-ALL|CSTM-00|2020|PDM|2251.00|99|0.00|AEG 9 (NO REV)
20|FH_F122687_0_0|SrvcGrp|100065|2022|PDM|3825.00|99|0.00|DEEP ANT OR POSTER TIBIAL
20|FH_F122687_0_0|SrvcGrp|100072|2022|PDM|3825.00|99|0.00|SHORTEN RADIUS/ULNA
20|FH_F122687_0_0|SrvcGrp|104008|2022|PDM|3278.00|99|0.00|CORRECTION HALUX RIDGUS W IMPLANTS
20|FH_F122687_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F122687_0_0|SrvcGrp|105401|2022|PDM|12381.00|99|0.00|TOTAL HIP ARTHROPLASTY
20|FH_F122687_0_0|SrvcGrp|109186|2022|PDM|12020.00|99|0.00|NECK/SPINE SURGERY
20|FH_F122687_0_0|SrvcGrp|109189|2022|PDM|3825.00|99|0.00|TARSAL BONE DISLOCATION TREATMENT
20|FH_F122687_0_0|SrvcGrp|33984|2022|PDM|2185.00|99|0.00|HAMMERTOE CORRECTION
20|FH_F122687_0_0|SrvcGrp|38364|2022|PDM|8742.00|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F122687_0_0|SrvcGrp|41334|2022|PDM|11474.00|99|0.00|TOTAL KNEE
20|FH_F122687_0_0|SrvcGrp|54943|2022|PDM|3825.00|99|0.00|REPAIR OF SLAP LESION
20|FH_F122687_0_0|SrvcGrp|67279|2022|PDM|11200.00|99|0.00|CERVICAL SURGERY
20|FH_F122687_0_0|SrvcGrp|71666|2022|PDM|6753.00|99|0.00|CPT 63655
20|FH_F122687_0_0|SrvcGrp|77021|2022|PDM|8742.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY
20|FH_F122687_0_0|SrvcGrp|88596|2022|PDM|2732.00|99|0.00|EXC OF TRIANG FIBROCARTILAGE
20|FH_F122687_0_0|SrvcGrp|90063|2022|PDM|3825.00|99|0.00|REPAIR BICEPS TENDON RUPTURE
20|FH_F122687_0_0|SrvcGrp|92366|2022|PDM|2404.00|99|0.00|REPAIR ACHILLES TENDON
20|FH_F122687_0_0|SrvcGrp|96543|2022|PDM|2404.00|99|0.00|REVISION OF CALF TENDON
20|FH_F122687_0_0|SrvcGrp|97741|2022|PDM|14205.00|99|0.00|REVISE KNEE
20|FH_F122687_0_0|SrvcGrp|98003|2022|PDM|3825.00|99|0.00|BIMALLEOLAR ANKLE FRACTURE
20|FH_F122841_0_0|CSTM-ALL|CSTM-00|2020|PDM|2266.00|99|0.00|AEG 8 W/O EYE SERVICES (NO REV)
20|FH_F122841_0_0|CSTM-ALL|CSTM-00|2020|PDM|927.00|99|0.00|AEG 2 W/O  EYE AND OCULAR SERVICES
20|FH_F122841_0_0|SrvcGrp|112137|2022|PDM|2232.00|99|0.00|XCAPSL CTRC RMVL W/ECP
20|FH_F122841_0_0|SrvcGrp|28551|2022|PDM|2497.00|99|0.00|REPAIR OF COMPLEX RETINAL DETACHMENT
20|FH_F122841_0_0|SrvcGrp|85966|2022|PDM|1772.00|99|0.00|EXTRACAPSULAR CATARACT
20|FH_F122841_0_0|SrvcGrp|95108|2022|PDM|302.00|99|0.00|RETINAL DETACHMENT
20|FH_F122926_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F122926_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 9 (NO REV)
20|FH_F122926_0_0|CSTM-ALL|CSTM-00|2020|PDM|485.00|99|0.00|AEG 3 (NO REV)
20|FH_F122926_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 4 (NO REV)
20|FH_F122926_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 10 (NO REV)
20|FH_F122926_0_0|CSTM-ALL|CSTM-00|2020|PDM|934.00|99|0.00|AEG 8 (NO REV)
20|FH_F122926_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 7 (NO REV)
20|FH_F122930_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F122930_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|PHENYLEPHRINE KETOROLAC
20|FH_F122930_0_0|SrvcGrp|72996|2022|PDM|1778.00|99|0.00|AEG 4
20|FH_F122930_0_0|SrvcGrp|72998|2022|PDM|1797.00|99|0.00|AEG 5
20|FH_F122930_0_0|SrvcGrp|73002|2022|PDM|3898.00|99|0.00|AEG 7
20|FH_F122933_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F122953_0_0|SrvcGrp|83857|2022|PDM|475.00|99|0.00|IP HOSPICE SVCS
20|FH_F122968_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F122968_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS
20|FH_F123036_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F123036_0_0|SrvcGrp|103865|2022|PDM|1206.00|99|0.00|PT PRGRM FOR IMPLT NEUROSTIM
20|FH_F123036_0_0|SrvcGrp|107348|2022|PDM|2723.00|99|0.00|EXTERNAL RECHARG SYS INTERN
20|FH_F123064_0_0|CSTM-ALL|CSTM-00|2020|PDM|934.00|99|0.00|AEG 8 (NO REV)
20|FH_F123064_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F123083_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F123083_0_0|CSTM-ALL|CSTM-00|2020|PDM|1122.00|99|0.00|AEG 4 (NO REV)
20|FH_F123083_0_0|CSTM-ALL|CSTM-00|2020|PDM|1430.00|99|0.00|AEG 8 (NO REV)
20|FH_F123083_0_0|CSTM-ALL|CSTM-00|2020|PDM|2019.00|99|0.00|AEG 7 (NO REV)
20|FH_F123083_0_0|CSTM-ALL|CSTM-00|2020|PDM|621.00|99|0.00|AEG 2 (NO REV)
20|FH_F123083_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F123083_0_0|SrvcGrp|28549|2022|PDM|1233.94|99|0.00|VITRECTOMY
20|FH_F123083_0_0|SrvcGrp|77507|2022|PCT|1.00|99|0.00|AETNA CORNEAL TISSUE HANDLING
20|FH_F123144_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F123144_0_0|SrvcGrp|72992|2022|PDM|463.00|99|0.00|AEG 2
20|FH_F123144_0_0|SrvcGrp|73002|2022|PDM|1017.00|99|0.00|AEG 7
20|FH_F123144_0_0|SrvcGrp|73008|2022|PDM|762.00|99|0.00|AEG 10
20|FH_F123157_0_0|SrvcGrp|75479|2022|PDM|317.00|99|0.00|AEG 1
20|FH_F123157_0_0|SrvcGrp|75483|2022|PDM|486.00|99|0.00|AEG 3
20|FH_F123157_0_0|SrvcGrp|75485|2022|PDM|600.00|99|0.00|AEG 4
20|FH_F123157_0_0|SrvcGrp|75487|2022|PDM|650.00|99|0.00|AEG 5
20|FH_F123157_0_0|SrvcGrp|75491|2022|PDM|949.00|99|0.00|AEG 7
20|FH_F123157_0_0|SrvcGrp|75493|2022|PDM|900.00|99|0.00|AEG 8
20|FH_F123158_0_0|CSTM-ALL|CSTM-00|2020|PDM|315.00|99|0.00|AEG 1 (NO REV)
20|FH_F123158_0_0|CSTM-ALL|CSTM-00|2020|PDM|425.00|99|0.00|AEG 2 (NO REV)
20|FH_F123158_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 4 (NO REV)
20|FH_F123158_0_0|CSTM-ALL|CSTM-00|2020|PDM|685.00|99|0.00|AEG 5  (NO REV)
20|FH_F123158_0_0|SrvcGrp|77444|2022|PDM|970.00|99|0.00|VASECTOMY
20|FH_F123162_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 9 (NO REV)
20|FH_F123162_0_0|CSTM-ALL|CSTM-00|2020|PDM|425.00|99|0.00|AEG 2 (NO REV)
20|FH_F123162_0_0|CSTM-ALL|CSTM-00|2020|PDM|685.00|99|0.00|AEG 5  (NO REV)
20|FH_F123162_0_0|CSTM-ALL|CSTM-00|2020|PDM|934.00|99|0.00|AEG 8 (NO REV)
20|FH_F123162_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F123170_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F123170_0_0|CSTM-ALL|CSTM-00|2020|PDM|1115.00|99|0.00|AEG 6 (NO REV)
20|FH_F123170_0_0|CSTM-ALL|CSTM-00|2020|PDM|1808.00|99|0.00|AEG 9 (NO REV)
20|FH_F123170_0_0|CSTM-ALL|CSTM-00|2020|PDM|968.00|99|0.00|AEG 5  (NO REV)
20|FH_F123170_0_0|SrvcGrp|103974|2022|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES
20|FH_F123185_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F123185_0_0|SrvcGrp|73004|2022|PDM|1209.00|99|0.00|AEG 8
20|FH_F123185_0_0|SrvcGrp|73006|2022|PDM|1169.00|99|0.00|AEG 9
20|FH_F123324_0_0|SrvcGrp|11259|2022|PCT|0.52|99|0.00|DRUGS
20|FH_F123324_0_0|SrvcGrp|12918|2022|PDM|2367.00|99|0.00|GYNECOLOGICAL MED/SURG
20|FH_F123325_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F123371_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F123371_0_0|SrvcGrp|104226|2022|PDM|168.00|99|0.00|HOSPICE CARE (HCFA)
20|FH_F123371_0_0|SrvcGrp|89781|2022|PDM|168.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F123371_0_0|SrvcGrp|95660|2022|PDM|600.00|99|0.00|HOSPICE SERVICES (HCFA)
20|FH_F123372_0_0|SrvcGrp|11259|2022|PCT|0.52|99|0.00|DRUGS
20|FH_F123372_0_0|SrvcGrp|63|2022|PDM|1711.00|99|0.00|SUBACUTE CARE
20|FH_F123372_0_0|SrvcGrp|9537|2022|PDM|3249.00|99|0.00|CARDIAC CARE UNIT
20|FH_F123373_0_0|CSTM-ALL|CSTM-00|2020|PDM|1711.00|99|0.00|GENERAL ACUTE CARE
20|FH_F123373_0_0|SrvcGrp|29817|2022|PDM|4548.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F123373_0_0|SrvcGrp|63|2022|PDM|1711.00|99|0.00|SUBACUTE CARE
20|FH_F123373_0_0|SrvcGrp|9537|2022|PDM|3249.00|99|0.00|CARDIAC CARE UNIT
20|FH_F123386_0_0|SrvcGrp|22899|2022|PDM|2800.00|99|0.00|ICU
20|FH_F123386_0_0|SrvcGrp|9518|2022|PCT|0.50|99|0.00|EMERGENCY ROOM
20|FH_F123445_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F123445_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F123445_0_0|SrvcGrp|95661|2022|PDM|706.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F123489_0_0|CSTM-ALL|CSTM-00|2020|PDM|1125.00|99|0.00|AEG 3 (NO REV)
20|FH_F123489_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 5  (NO REV)
20|FH_F123489_0_0|CSTM-ALL|CSTM-00|2020|PDM|2050.00|99|0.00|AEG 8 (NO REV)
20|FH_F123570_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F123570_0_0|SrvcGrp|41333|2022|PDM|4326.00|99|0.00|LITHO MOD 51
20|FH_F123570_0_0|SrvcGrp|41337|2022|PDM|3090.00|99|0.00|LAPAROSCOPIC PROCEDURES
20|FH_F123570_0_0|SrvcGrp|61096|2022|PCT|1.18|99|0.00|IMPLANTS
20|FH_F123570_0_0|SrvcGrp|72992|2022|PDM|630.85|99|0.00|AEG 2
20|FH_F123570_0_0|SrvcGrp|72996|2022|PDM|891.11|99|0.00|AEG 4
20|FH_F123620_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F123620_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F123620_0_0|SrvcGrp|106291|2022|PDM|271.00|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT LEVEL 1 (HCFA)
20|FH_F123620_0_0|SrvcGrp|13597|2022|PDM|238.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT
20|FH_F123620_0_0|SrvcGrp|13681|2022|PDM|247.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT
20|FH_F123620_0_0|SrvcGrp|13683|2022|PDM|624.00|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 491
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PDM|2063.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38700_0_0|SrvcGrp|11336|2022|PCT|0.65|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F38700_0_0|SrvcGrp|360|2022|PDM|1387.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F38700_0_0|SrvcGrp|941|2022|PDM|3195.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F38709_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F38709_0_0|CSTM-ALL|CSTM-00|2020|PDM|2837.00|99|0.00|MS DRG 216-227, 231-236 CV SURGERY
20|FH_F38709_0_0|SrvcGrp|3418|2022|PDM|1751.00|99|0.00|NEONATAL INTENSIVE CARE UNIT
20|FH_F38718_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F38732_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F38738_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38738_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F38790_0_0|CSTM-ALL|CSTM-00|2020|PDM|1177.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F38790_0_0|CSTM-ALL|CSTM-00|2020|PDM|722.00|99|0.00|ACUTE PSYCH
20|FH_F38790_0_0|SrvcGrp|109|2022|PDM|695.00|99|0.00|CD - DETOX
20|FH_F38790_0_0|SrvcGrp|110|2022|PDM|430.00|99|0.00|CD - REHABILITATION
20|FH_F38790_0_0|SrvcGrp|65|2022|PDM|750.00|99|0.00|OBSTETRICAL CARE
20|FH_F38804_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|PROFESSIONAL FEES ON UB04
20|FH_F38807_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38807_0_0|SrvcGrp|17083|2022|PDM|510.00|99|0.00|ASPG X
20|FH_F38808_0_0|SrvcGrp|17067|2022|PDM|491.00|99|0.00|ASPG II
20|FH_F38808_0_0|SrvcGrp|17069|2022|PDM|561.00|99|0.00|ASPG III
20|FH_F38808_0_0|SrvcGrp|17079|2022|PDM|1070.00|99|0.00|ASPG VIII
20|FH_F38826_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|MS DRG 216-227, 231-236 CV SURGERY
20|FH_F38826_0_0|SrvcGrp|359|2022|PCT|0.73|99|0.00|NEONATAL INTENSIVE CARE LEVEL I
20|FH_F38842_0_0|CSTM-ALL|CSTM-00|2020|PDM|1950.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38842_0_0|SrvcGrp|3069|2022|PCT|0.37|99|0.00|IMPLANTS
20|FH_F38843_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|NEWBORN NURSERY
20|FH_F38843_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SURGERY
20|FH_F38845_0_0|CSTM-ALL|CSTM-00|2020|PDM|1950.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38845_0_0|SrvcGrp|3069|2022|PCT|0.37|99|0.00|IMPLANTS
20|FH_F38846_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|ACUTE PSYCH
20|FH_F38846_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F38847_0_0|SrvcGrp|439|2022|PDM|1450.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F38847_0_0|SrvcGrp|97|2022|PDM|3200.00|99|0.00|C-SECTION
20|FH_F38848_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|CHEMICAL DEPENDENCY
20|FH_F38848_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F38848_0_0|SrvcGrp|177|2022|PDM|1800.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F38848_0_0|SrvcGrp|439|2022|PDM|1900.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F38855_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F38865_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|DRUGS
20|FH_F38865_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38865_0_0|CSTM-ALL|CSTM-00|2020|PDM|25000.00|99|0.00|MS DRG 216-227, 231-236 CV SURGERY
20|FH_F38865_0_0|CSTM-ALL|CSTM-00|2020|PDM|320.00|99|0.00|CD DAY TREATMENT
20|FH_F38865_0_0|SrvcGrp|1306|2022|PDM|340.00|99|0.00|OP PSYCH PARTIAL HOSP
20|FH_F38865_0_0|SrvcGrp|131|2022|PCT|0.75|99|0.00|PACEMAKER DEVICE
20|FH_F38865_0_0|SrvcGrp|13811|2022|PDM|340.00|99|0.00|PSYCH PARTIAL HOSP
20|FH_F38865_0_0|SrvcGrp|24703|2022|PDM|500.00|99|0.00|NEWBORN NURSERY
20|FH_F38865_0_0|SrvcGrp|360|2022|PDM|1860.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F38865_0_0|SrvcGrp|361|2022|PDM|1860.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F38865_0_0|SrvcGrp|39|2022|PCT|0.75|99|0.00|TISSUE PLASMINOGEN ACTIVATOR
20|FH_F38865_0_0|SrvcGrp|6|2022|PCT|0.80|99|0.00|OP SURGERY
20|FH_F38867_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|OP SVCS
20|FH_F38889_0_0|CSTM-ALL|CSTM-00|2020|PDM|1104.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38900_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|OP SVCS
20|FH_F38900_0_0|CSTM-ALL|CSTM-00|2020|PDM|1240.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38910_0_0|CSTM-ALL|CSTM-00|2020|PDM|1170.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38914_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F38914_0_0|SrvcGrp|115|2022|PDM|420.00|99|0.00|SKILLED NURSING CARE
20|FH_F38914_0_0|SrvcGrp|12184|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F38933_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F38939_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38948_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|OP SVCS
20|FH_F38948_0_0|SrvcGrp|115|2022|PCT|0.80|99|0.00|SKILLED NURSING CARE
20|FH_F38948_0_0|SrvcGrp|19594|2022|PCT|0.74|99|0.00|IMPLANTS
20|FH_F38948_0_0|SrvcGrp|38|2022|PDM|2743.00|99|0.00|NORMAL DELIVERY
20|FH_F38948_0_0|SrvcGrp|97|2022|PDM|2954.00|99|0.00|C-SECTION
20|FH_F38949_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F38949_0_0|SrvcGrp|3029|2022|PDM|372.00|99|0.00|NEWBORN NURSERY
20|FH_F38949_0_0|SrvcGrp|360|2022|PDM|850.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F38949_0_0|SrvcGrp|411|2022|PDM|3614.00|99|0.00|OP CARDIAC CATH
20|FH_F38949_0_0|SrvcGrp|705|2022|PCT|0.60|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F38952_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.89|99|0.00|OP SVCS
20|FH_F38952_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|MORRISON COMM HOSP PROFESSIONAL SVCS
20|FH_F38953_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F38955_0_0|CSTM-ALL|CSTM-00|2020|PDM|1221.85|99|0.00|ACUTE PSYCH
20|FH_F38961_0_0|SrvcGrp|472|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F38961_0_0|SrvcGrp|474|2022|PDM|250.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F38966_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38966_0_0|SrvcGrp|29971|2022|PDM|529.00|99|0.00|DIALYSIS
20|FH_F38977_0_0|CSTM-ALL|CSTM-00|2020|PDM|1043.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38977_0_0|SrvcGrp|65|2022|PDM|1667.00|99|0.00|OBSTETRICAL CARE
20|FH_F38982_0_0|CSTM-ALL|CSTM-00|2020|PDM|692.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F38982_0_0|SrvcGrp|701|2022|PDM|2391.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F38983_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F38983_0_0|SrvcGrp|115|2022|PDM|525.00|99|0.00|SKILLED NURSING CARE
20|FH_F38983_0_0|SrvcGrp|3029|2022|PDM|425.00|99|0.00|NEWBORN NURSERY
20|FH_F38983_0_0|SrvcGrp|701|2022|PDM|2300.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F38983_0_0|SrvcGrp|97|2022|PDM|4500.00|99|0.00|C-SECTION
20|FH_F38984_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F38986_0_0|SrvcGrp|177|2022|PDM|1321.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F38986_0_0|SrvcGrp|24|2022|PCT|0.65|99|0.00|CARDIAC CATH
20|FH_F39015_0_0|CSTM-ALL|CSTM-00|2020|PDM|748.00|99|0.00|ACUTE PSYCH
20|FH_F39015_0_0|SrvcGrp|65|2022|PDM|2475.00|99|0.00|OBSTETRICAL CARE
20|FH_F39022_0_0|CSTM-ALL|CSTM-00|2020|PDM|1422.00|99|0.00|NICU INTENSIVE CARE LEVEL II
20|FH_F39022_0_0|SrvcGrp|10400|2022|PDM|2610.00|99|0.00|IP SURGERY
20|FH_F39022_0_0|SrvcGrp|13849|2022|PCT|0.80|99|0.00|LITHOTRIPSY
20|FH_F39022_0_0|SrvcGrp|23|2022|PCT|0.87|99|0.00|BONE MARROW TRANSPLANT
20|FH_F39022_0_0|SrvcGrp|38|2022|PDM|4200.00|99|0.00|NORMAL DELIVERY
20|FH_F39041_0_0|CSTM-ALL|CSTM-00|2020|PDM|4439.00|99|0.00|MS DRG 774-775 NORMAL DELIVERY
20|FH_F39041_0_0|SrvcGrp|941|2022|PDM|2054.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F39053_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F39057_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F39066_0_0|SrvcGrp|115|2022|PDM|500.00|99|0.00|SKILLED NURSING CARE
20|FH_F39066_0_0|SrvcGrp|1306|2022|PDM|200.00|99|0.00|OP PSYCH PARTIAL HOSP
20|FH_F39079_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39079_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F39080_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|GENERAL ACUTE CARE
20|FH_F39082_0_0|CSTM-ALL|CSTM-00|2020|PDM|18981.00|99|0.00|MS DRG 243-244
20|FH_F39082_0_0|CSTM-ALL|CSTM-00|2020|PDM|35043.00|99|0.00|MS DRG 219-221
20|FH_F39082_0_0|CSTM-ALL|CSTM-00|2020|PDM|35043.00|99|0.00|MS DRG 231-232
20|FH_F39082_0_0|CSTM-ALL|CSTM-00|2020|PDM|40883.00|99|0.00|MS DRG 228-230
20|FH_F39082_0_0|CSTM-ALL|CSTM-00|2020|PDM|832.00|99|0.00|ACUTE PSYCH
20|FH_F39082_0_0|SrvcGrp|12969|2022|PDM|460.00|99|0.00|NEWBORN NURSERY
20|FH_F39082_0_0|SrvcGrp|8950|2022|PDM|1606.00|99|0.00|INTERMEDIATE ICU/CCU
20|FH_F39085_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39085_0_0|SrvcGrp|63|2022|PDM|525.00|99|0.00|SUBACUTE CARE
20|FH_F39090_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.61|99|0.00|OP SVCS
20|FH_F39098_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F39098_0_0|SrvcGrp|360|2022|PDM|578.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F39098_0_0|SrvcGrp|38|2022|PDM|2627.00|99|0.00|NORMAL DELIVERY
20|FH_F39098_0_0|SrvcGrp|411|2022|PCT|0.75|99|0.00|OP CARDIAC CATH
20|FH_F39098_0_0|SrvcGrp|97|2022|PDM|3678.00|99|0.00|C-SECTION
20|FH_F39101_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|GENERAL ACUTE CARE
20|FH_F39101_0_0|CSTM-ALL|CSTM-00|2020|PDM|38800.00|99|0.00|MSDRG 233-234 CORONARY BYPASS
20|FH_F39121_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|IMPLANTS (HEART TRANSPLANT)
20|FH_F39138_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|MSDRG 219-221 CARDIAC VLV PX+OTR MJR CARDIOTHORAIC W/CC OLR
20|FH_F39138_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F39138_0_0|CSTM-ALL|CSTM-00|2020|PDM|12601.00|99|0.00|MS DRG 243-244
20|FH_F39138_0_0|CSTM-ALL|CSTM-00|2020|PDM|13078.00|99|0.00|MS DRG 247
20|FH_F39138_0_0|CSTM-ALL|CSTM-00|2020|PDM|28507.00|99|0.00|MSDRG 226-227 CV SURG CARDIAC DEFIBRILLATOR
20|FH_F39138_0_0|CSTM-ALL|CSTM-00|2020|PDM|28660.00|99|0.00|MSDRG 228-230
20|FH_F39138_0_0|CSTM-ALL|CSTM-00|2020|PDM|28711.00|99|0.00|MS DRG 234
20|FH_F39138_0_0|SrvcGrp|16|2022|PDM|1038.00|99|0.00|ACUTE REHABILITATION
20|FH_F39138_0_0|SrvcGrp|30096|2022|PDM|98.00|99|0.00|SPEECH THERAPY
20|FH_F39138_0_0|SrvcGrp|313|2022|PCT|0.60|99|0.00|DRUGS
20|FH_F39151_0_0|CSTM-ALL|CSTM-00|2020|PDM|200.00|99|0.00|NEWBORN NURSERY
20|FH_F39151_0_0|SrvcGrp|12350|2022|PDM|600.00|99|0.00|BOARDER BABY SERVICES
20|FH_F39162_0_0|SrvcGrp|25688|2022|PDM|300.00|99|0.00|HOME HEMODIALYSIS
20|FH_F39176_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39178_0_0|CSTM-ALL|CSTM-00|2020|PDM|1685.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39178_0_0|SrvcGrp|65|2022|PDM|1685.00|99|0.00|OBSTETRICAL CARE
20|FH_F39180_0_0|SrvcGrp|16|2022|PDM|900.00|99|0.00|ACUTE REHABILITATION
20|FH_F39180_0_0|SrvcGrp|361|2022|PDM|1783.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F39180_0_0|SrvcGrp|97|2022|PDM|1896.00|99|0.00|C-SECTION
20|FH_F39202_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39209_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|MRI/CT/PET SCAN
20|FH_F39209_0_0|SrvcGrp|13168|2022|PCT|1.10|99|0.00|IMPLANTS
20|FH_F39209_0_0|SrvcGrp|473|2022|PDM|1000.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F39209_0_0|SrvcGrp|474|2022|PDM|900.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F39238_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39274_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F39274_0_0|SrvcGrp|22954|2022|PDM|300.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F39274_0_0|SrvcGrp|3809|2022|PDM|1058.00|99|0.00|HOSPICE CARE
20|FH_F39278_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39278_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F39278_0_0|SrvcGrp|9828|2022|PDM|105.00|99|0.00|HOME HEALTH AIDE
20|FH_F39279_0_0|CSTM-ALL|CSTM-00|2020|PDM|1495.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F39286_0_0|SrvcGrp|15123|2022|PCT|0.82|99|0.00|CARDIAC CATH LAB OP SVCS
20|FH_F39287_0_0|CSTM-ALL|CSTM-00|2020|PDM|130.00|99|0.00|HCPCS A4634 - REPLACE BULB/LAMP ULTRAVIOLET THERAPY SYSTEMS
20|FH_F39287_0_0|SrvcGrp|30266|2022|PDM|2124.00|99|0.00|HCPCS E0693 - MODEL 2400 4 HO LAMP LIGHT SOURCE
20|FH_F39303_0_0|SrvcGrp|13551|2022|PDM|516.00|99|0.00|NEWBORN NURSERY
20|FH_F39339_0_0|CSTM-ALL|CSTM-00|2020|PDM|1460.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39339_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|ACUTE PSYCH
20|FH_F39339_0_0|SrvcGrp|360|2022|PDM|1795.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F39339_0_0|SrvcGrp|361|2022|PDM|2025.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F39339_0_0|SrvcGrp|36589|2022|PCT|0.55|99|0.00|HIGH COST DRUGS
20|FH_F39339_0_0|SrvcGrp|81620|2022|PDM|1605.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F39346_0_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F39346_0_0|CSTM-ALL|CSTM-00|2020|PDM|18282.00|99|0.00|MS DRG 288-290 ONLY
20|FH_F39346_0_0|CSTM-ALL|CSTM-00|2020|PDM|23418.00|99|0.00|MS DRG 237 ONLY
20|FH_F39346_0_0|CSTM-ALL|CSTM-00|2020|PDM|585.00|99|0.00|ACUTE PSYCH
20|FH_F39346_0_0|CSTM-ALL|CSTM-00|2020|PDM|585.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F39346_0_0|SrvcGrp|13551|2022|PDM|295.00|99|0.00|NEWBORN NURSERY
20|FH_F39346_0_0|SrvcGrp|19961|2022|PDM|43813.00|99|0.00|MS DRG 231-232 ONLY CORONARY BYPASS W/ PTCA
20|FH_F39346_0_0|SrvcGrp|20096|2022|PDM|53000.00|99|0.00|MS DRG 222-223 ONLY
20|FH_F39346_0_0|SrvcGrp|20908|2022|PDM|17625.00|99|0.00|MS DRG 247 ONLY
20|FH_F39349_0_0|CSTM-ALL|CSTM-00|2020|PDM|285.00|99|0.00|CD PARTIAL HOSPITALIZATION
20|FH_F39349_0_0|SrvcGrp|109|2022|PDM|568.00|99|0.00|CD - DETOX
20|FH_F39349_0_0|SrvcGrp|110|2022|PDM|505.00|99|0.00|CD - REHABILITATION
20|FH_F39352_0_0|SrvcGrp|43|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F39352_0_0|SrvcGrp|9488|2022|PDM|5000.00|99|0.00|OP LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F39355_0_0|CSTM-ALL|CSTM-00|2020|PDM|1175.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39355_0_0|CSTM-ALL|CSTM-00|2020|PDM|215.00|99|0.00|CD DAY TREATMENT
20|FH_F39355_0_0|SrvcGrp|290|2022|PDM|3800.00|99|0.00|IP LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F39366_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|OP SVCS
20|FH_F39410_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|OP SVCS
20|FH_F39418_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|OP SVCS
20|FH_F39426_0_0|SrvcGrp|473|2022|PDM|380.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F39428_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F39466_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F39476_0_0|SrvcGrp|3066|2022|PCT|0.45|99|0.00|HIGH-COST DRUGS
20|FH_F39476_0_0|SrvcGrp|41408|2022|PDM|2700.00|99|0.00|ANGIO + CARDIAC CATH W/ICD9
20|FH_F39477_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F39493_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39517_0_0|CSTM-ALL|CSTM-00|2020|PDM|2275.00|99|0.00|OBSTETRICAL CARE (MS DRG 765-766, 774-775)
20|FH_F39531_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.89|99|0.00|OP SVCS
20|FH_F39531_0_0|SrvcGrp|43|2022|PCT|0.60|99|0.00|IMPLANTS
20|FH_F39531_0_0|SrvcGrp|72|2022|PDM|400.00|99|0.00|NEWBORN NURSERY
20|FH_F39535_0_0|CSTM-ALL|CSTM-00|2020|PDM|2530.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39538_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F39541_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39546_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F39548_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39558_0_0|SrvcGrp|17071|2022|PDM|736.00|99|0.00|ASPG IV
20|FH_F39558_0_0|SrvcGrp|17083|2022|PDM|389.00|99|0.00|ASPG X
20|FH_F39561_0_0|SrvcGrp|11442|2022|PDM|550.12|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)
20|FH_F39567_0_0|SrvcGrp|43|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F39581_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F39586_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE
20|FH_F39586_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F39586_0_0|SrvcGrp|3327|2022|PDM|140.99|99|0.00|HOSPICE SERVICE - IP RESPITE
20|FH_F39617_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F39617_0_0|CSTM-ALL|CSTM-00|2020|PDM|1379.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39617_0_0|CSTM-ALL|CSTM-00|2020|PDM|637.00|99|0.00|ACUTE PSYCH
20|FH_F39617_0_0|SrvcGrp|3277|2022|PDM|637.00|99|0.00|SKILLED NURSING CARE
20|FH_F39617_0_0|SrvcGrp|38|2022|PDM|2758.00|99|0.00|NORMAL DELIVERY
20|FH_F39619_0_0|SrvcGrp|3029|2022|PDM|371.00|99|0.00|NEWBORN NURSERY
20|FH_F39621_0_0|SrvcGrp|9263|2022|PDM|235.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F39622_0_0|SrvcGrp|1306|2022|PDM|520.00|99|0.00|OP PSYCH PARTIAL HOSP
20|FH_F39622_0_0|SrvcGrp|13811|2022|PDM|520.00|99|0.00|PSYCH PARTIAL HOSP
20|FH_F39622_0_0|SrvcGrp|3069|2022|PCT|0.65|99|0.00|IMPLANTS
20|FH_F39622_0_0|SrvcGrp|6|2022|PCT|0.79|99|0.00|OP SURGERY
20|FH_F39622_0_0|SrvcGrp|675|2022|PDM|1770.00|99|0.00|PEDIATRIC INPATIENT SVCS
20|FH_F39622_0_0|SrvcGrp|97|2022|PDM|2100.00|99|0.00|C-SECTION
20|FH_F39627_0_0|SrvcGrp|12214|2022|PCT|0.70|99|0.00|DRUGS
20|FH_F39627_0_0|SrvcGrp|27906|2022|PDM|21000.00|99|0.00|GAMMA KNIFE
20|FH_F39627_0_0|SrvcGrp|30711|2022|PDM|12500.00|99|0.00|BRACHYTHERAPY SVCS
20|FH_F39633_0_0|SrvcGrp|11000|2022|PCT|0.50|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F39633_0_0|SrvcGrp|15472|2022|PDM|619.00|99|0.00|CPT CODE 62284
20|FH_F39633_0_0|SrvcGrp|17073|2022|PDM|1330.00|99|0.00|ASPG V
20|FH_F39633_0_0|SrvcGrp|17081|2022|PDM|2484.00|99|0.00|ASPG IX
20|FH_F39662_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS
20|FH_F39673_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|OP SVCS
20|FH_F39689_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OCCUPATIONAL / ENVIRONMENTAL SVCS
20|FH_F39695_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39701_0_0|CSTM-ALL|CSTM-00|2020|PDM|1540.00|99|0.00|AEG 9 (NO REV)
20|FH_F39701_0_0|CSTM-ALL|CSTM-00|2020|PDM|587.00|99|0.00|AEG 3 (NO REV)
20|FH_F39701_0_0|CSTM-ALL|CSTM-00|2020|PDM|952.00|99|0.00|AEG 6 (NO REV)
20|FH_F39701_0_0|SrvcGrp|13297|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F39706_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39714_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|OP SVCS
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|115.72|99|0.00|ASPG 226
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|122.22|99|0.00|ASPG 225
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|122.22|99|0.00|ASPG 311
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|1330.10|99|0.00|ASPG 701
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|1347.35|99|0.00|ASPG 8
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|143.01|99|0.00|ASPG 120
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|186.20|99|0.00|ASPG 116
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|194.21|99|0.00|ASPG 115
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|201.90|99|0.00|ASPG 309
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|280.61|99|0.00|ASPG 111
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|321.49|99|0.00|ASPG 108
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|323.86|99|0.00|ASPG 215
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|336.92|99|0.00|ASPG 214
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|336.92|99|0.00|ASPG 307
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|418.03|99|0.00|ASPG 103
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|418.61|99|0.00|ASPG 212
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|433.05|99|0.00|ASPG 211
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|471.41|99|0.00|ASPG 208
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|530.15|99|0.00|ASPG 206
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|566.76|99|0.00|ASPG 202
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|621.75|99|0.00|ASPG 302
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|843.91|99|0.00|ASPG 401
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|876.37|99|0.00|ASPG 4
20|FH_F39721_0_0|SrvcGrp|17379|2022|PDM|210.00|99|0.00|CCPD TRAINING
20|FH_F39721_0_0|SrvcGrp|21814|2022|PDM|210.00|99|0.00|CAPD/CCPD SUPPLEMENT
20|FH_F39721_0_0|SrvcGrp|21815|2022|PDM|210.00|99|0.00|CAPD/CCPD SUPPLEMENT
20|FH_F39721_0_0|SrvcGrp|24651|2022|PDM|210.00|99|0.00|HEMODIALYSIS - HOME TRAINING
20|FH_F39731_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|OP SVCS
20|FH_F39740_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F39740_0_0|CSTM-ALL|CSTM-00|2020|PDM|27587.00|99|0.00|MS DRG 453-455 ONLY COMB ANTI/POST SPINAL FUSION
20|FH_F39740_0_0|SrvcGrp|19961|2022|PDM|37449.00|99|0.00|MS DRG 231-232 ONLY CORONARY BYPASS W/ PTCA
20|FH_F39740_0_0|SrvcGrp|20077|2022|PDM|25442.00|99|0.00|MS DRG 226-227 ONLY CARDIAC DEFIBRILLATOR
20|FH_F39740_0_0|SrvcGrp|20744|2022|PDM|17343.00|99|0.00|MS DRG 242 ONLY
20|FH_F39740_0_0|SrvcGrp|20898|2022|PDM|15687.00|99|0.00|MS DRG 246 ONLY
20|FH_F39740_0_0|SrvcGrp|20906|2022|PDM|11612.00|99|0.00|MS DRG 243-244 ONLY CARDIAC PACEMAKER
20|FH_F39740_0_0|SrvcGrp|28015|2022|PDM|9887.00|99|0.00|MSDRG 466-470 ONLY MAJOR JOINT/LIMB PROC
20|FH_F39753_0_0|SrvcGrp|13551|2022|PDM|731.00|99|0.00|NEWBORN NURSERY
20|FH_F39753_0_0|SrvcGrp|97|2022|PDM|5472.00|99|0.00|C-SECTION
20|FH_F39753_0_0|SrvcGrp|997|2022|PCT|0.85|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F39756_0_0|CSTM-ALL|CSTM-00|2020|PDM|192.50|99|0.00|AMALGAM-ONE SURFACE, PRIMARY OR PERMANENT
20|FH_F39756_0_0|CSTM-ALL|CSTM-00|2020|PDM|247.50|99|0.00|DENTAL PROCEDURES - CHILD
20|FH_F39756_0_0|CSTM-ALL|CSTM-00|2020|PDM|396.00|99|0.00|CUMBERLAND SURGERY CTR-ASPG I
20|FH_F39756_0_0|CSTM-ALL|CSTM-00|2020|PDM|770.00|99|0.00|DENTAL PROCEDURES - CHILD
20|FH_F39756_0_0|CSTM-ALL|CSTM-00|2020|PDM|853.60|99|0.00|CUMBERLAND SURGERY CTR - ASPG V
20|FH_F39756_0_0|CSTM-ALL|CSTM-00|2020|PDM|994.40|99|0.00|CUMBERLAND SURGERY CTR - ASPG VI
20|FH_F39783_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS
20|FH_F39786_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39786_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F39819_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE
20|FH_F39819_0_0|CSTM-ALL|CSTM-00|2020|PDM|14469.00|99|0.00|NY DRG 541 ONLY
20|FH_F39819_0_0|CSTM-ALL|CSTM-00|2020|PDM|20941.00|99|0.00|NY DRG 544 ONLY
20|FH_F39819_0_0|CSTM-ALL|CSTM-00|2020|PDM|34666.00|99|0.00|NY DRG 585 ONLY
20|FH_F39819_0_0|CSTM-ALL|CSTM-00|2020|PDM|5774.00|99|0.00|NY DRG 294 ONLY
20|FH_F39819_0_0|CSTM-ALL|CSTM-00|2020|PDM|6445.00|99|0.00|NY DRG 372 ONLY
20|FH_F39819_0_0|CSTM-ALL|CSTM-00|2020|PDM|6566.00|99|0.00|NY DRG 296 ONLY
20|FH_F39819_0_0|CSTM-ALL|CSTM-00|2020|PDM|6887.00|99|0.00|NY DRG 359 ONLY
20|FH_F39819_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|ACUTE PSYCH
20|FH_F39819_0_0|CSTM-ALL|CSTM-00|2020|PDM|9794.00|99|0.00|NY DRG 122 ONLY
20|FH_F39821_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39821_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|NEWBORN NURSERY
20|FH_F39821_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F39825_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F39825_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F39825_0_0|SrvcGrp|43|2022|PCT|0.75|99|0.00|IMPLANTS
20|FH_F39839_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F39839_0_0|CSTM-ALL|CSTM-00|2020|PDM|1112.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39844_0_0|CSTM-ALL|CSTM-00|2020|PDM|690.00|99|0.00|ACUTE PSYCH
20|FH_F39844_0_0|CSTM-ALL|CSTM-00|2020|PDM|981.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F39844_0_0|SrvcGrp|115|2022|PDM|557.00|99|0.00|SKILLED NURSING CARE
20|FH_F39844_0_0|SrvcGrp|24|2022|PDM|3183.00|99|0.00|CARDIAC CATH
20|FH_F39844_0_0|SrvcGrp|24703|2022|PDM|318.00|99|0.00|NEWBORN NURSERY
20|FH_F39844_0_0|SrvcGrp|38|2022|PDM|1910.00|99|0.00|NORMAL DELIVERY
20|FH_F39844_0_0|SrvcGrp|701|2022|PDM|1432.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F39855_0_0|CSTM-ALL|CSTM-00|2020|PDM|1091.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39855_0_0|SrvcGrp|6|2022|PCT|0.77|99|0.00|OP SURGERY
20|FH_F39855_0_0|SrvcGrp|701|2022|PDM|1803.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F39857_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F39857_0_0|SrvcGrp|1021|2022|PCT|0.75|99|0.00|VENTILATOR EQUIPMENT
20|FH_F39857_0_0|SrvcGrp|11258|2022|PCT|0.75|99|0.00|DRUGS
20|FH_F39857_0_0|SrvcGrp|31474|2022|PCT|0.75|99|0.00|DURABLE MEDICAL EQUIPMENT
20|FH_F39857_0_0|SrvcGrp|701|2022|PDM|2080.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F39863_0_0|CSTM-ALL|CSTM-00|2020|PDM|2278.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39866_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F39866_0_0|CSTM-ALL|CSTM-00|2020|PDM|1600.00|99|0.00|MRI
20|FH_F39866_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|CT SCANS
20|FH_F39866_0_0|SrvcGrp|13293|2022|PCT|0.70|99|0.00|HIGH-COST DRUGS
20|FH_F39866_0_0|SrvcGrp|3081|2022|PCT|0.75|99|0.00|OBSERVATION SVCS
20|FH_F39869_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39886_0_0|CSTM-ALL|CSTM-00|2020|PDM|1272.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39886_0_0|CSTM-ALL|CSTM-00|2020|PDM|795.00|99|0.00|ACUTE PSYCH
20|FH_F39887_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F39893_0_0|CSTM-ALL|CSTM-00|2020|PDM|625.00|99|0.00|ACUTE PSYCH
20|FH_F39893_0_0|SrvcGrp|24703|2022|PDM|320.00|99|0.00|NEWBORN NURSERY
20|FH_F39893_0_0|SrvcGrp|526|2022|PDM|1500.00|99|0.00|CARDIAC CARE UNIT
20|FH_F39893_0_0|SrvcGrp|97|2022|PDM|3200.00|99|0.00|C-SECTION
20|FH_F39894_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39895_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F39895_0_0|CSTM-ALL|CSTM-00|2020|PDM|615.00|99|0.00|ACUTE PSYCH
20|FH_F39895_0_0|SrvcGrp|13811|2022|PDM|270.00|99|0.00|PSYCH PARTIAL HOSP
20|FH_F39895_0_0|SrvcGrp|177|2022|PDM|1298.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F39907_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F39910_0_0|CSTM-ALL|CSTM-00|2020|PDM|1034.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39917_0_0|SrvcGrp|12043|2022|PDM|230.00|99|0.00|CPT 99205
20|FH_F39917_0_0|SrvcGrp|13631|2022|PDM|120.00|99|0.00|CPT 99213
20|FH_F39919_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|OP ARTHROSCOPY
20|FH_F39919_0_0|CSTM-ALL|CSTM-00|2020|PDM|837.16|99|0.00|ASPG VI
20|FH_F39919_0_0|SrvcGrp|28243|2022|PCT|1.10|99|0.00|SUPPLIES AND DEVICES
20|FH_F39920_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.72|99|0.00|OP SVCS
20|FH_F39920_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|ACUTE PSYCH
20|FH_F39925_0_0|SrvcGrp|3029|2022|PDM|250.00|99|0.00|NEWBORN NURSERY
20|FH_F39925_0_0|SrvcGrp|439|2022|PDM|1200.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F39939_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F39939_0_0|CSTM-ALL|CSTM-00|2020|PDM|2510.00|99|0.00|MS DRG 765-768, 774-775 C-SECTION & NORMAL DELIVERY
20|FH_F39939_0_0|SrvcGrp|10425|2022|PDM|700.00|99|0.00|NEWBORN NURSERY
20|FH_F39939_0_0|SrvcGrp|45469|2022|PDM|4000.00|99|0.00|ROBOTIC PROCEDURES
20|FH_F39940_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39941_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39944_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|TRAUMA CARE
20|FH_F39945_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39955_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39956_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F39956_0_0|SrvcGrp|10107|2022|PCT|0.60|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F39956_0_0|SrvcGrp|16|2022|PDM|670.00|99|0.00|ACUTE REHABILITATION
20|FH_F39956_0_0|SrvcGrp|705|2022|PCT|0.60|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F39967_0_0|SrvcGrp|10111|2022|PCT|0.65|99|0.00|IMPLANTS
20|FH_F39969_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39976_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39977_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|BLOOD AND BLOOD PRODUCTS
20|FH_F39977_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39988_0_0|CSTM-ALL|CSTM-00|2020|PDM|1330.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39988_0_0|CSTM-ALL|CSTM-00|2020|PDM|274.00|99|0.00|PSYCHIATRIC FULL DAY TREATMENT
20|FH_F39988_0_0|SrvcGrp|65|2022|PDM|1756.00|99|0.00|OBSTETRICAL CARE
20|FH_F39992_0_0|SrvcGrp|12263|2022|PDM|17.50|99|0.00|HOME HEALTH AIDE- HOURLY
20|FH_F39992_0_0|SrvcGrp|12264|2022|PDM|60.75|99|0.00|DIETICIAN OR LPN SERVICES
20|FH_F39992_0_0|SrvcGrp|9830|2022|PDM|85.50|99|0.00|OT SVCS
20|FH_F39992_0_0|SrvcGrp|9832|2022|PDM|84.50|99|0.00|ST SVCS
20|FH_F39995_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F39995_0_0|SrvcGrp|97|2022|PDM|3100.00|99|0.00|C-SECTION
20|FH_F39996_0_0|SrvcGrp|13292|2022|PCT|1.10|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F40008_0_0|SrvcGrp|22954|2022|PDM|105.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F40022_0_0|CSTM-ALL|CSTM-00|2020|PCT|57.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40026_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|BLOOD AND BLOOD PRODUCTS
20|FH_F40026_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|DURABLE MEDICAL EQUIPMENT
20|FH_F40026_0_0|CSTM-ALL|CSTM-00|2020|PDM|919.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40026_0_0|SrvcGrp|3066|2022|PCT|0.73|99|0.00|HIGH-COST DRUGS
20|FH_F40026_0_0|SrvcGrp|3448|2022|PCT|0.73|99|0.00|MRI
20|FH_F40032_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F40032_0_0|CSTM-ALL|CSTM-00|2020|PDM|200.00|99|0.00|CD PARTIAL HOSPITALIZATION
20|FH_F40032_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|ACUTE PSYCH
20|FH_F40033_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40033_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS
20|FH_F40043_0_0|CSTM-ALL|CSTM-00|2020|PDM|3955.00|99|0.00|MS DRG 767-768, 774-775 NORMAL DELIVERY
20|FH_F40043_0_0|CSTM-ALL|CSTM-00|2020|PDM|5990.00|99|0.00|MS DRG 284
20|FH_F40043_0_0|SrvcGrp|13692|2022|PDM|4061.00|99|0.00|OP CARDIAC CATH
20|FH_F40043_0_0|SrvcGrp|14834|2022|PCT|0.76|99|0.00|TRANS VEGUS NERVE
20|FH_F40043_0_0|SrvcGrp|3029|2022|PDM|611.00|99|0.00|NEWBORN NURSERY
20|FH_F40043_0_0|SrvcGrp|3069|2022|PCT|0.76|99|0.00|IMPLANTS
20|FH_F40043_0_0|SrvcGrp|33261|2022|PDM|755.00|99|0.00|GA ASPG I
20|FH_F40043_0_0|SrvcGrp|33262|2022|PDM|897.00|99|0.00|GA ASPG II
20|FH_F40043_0_0|SrvcGrp|33264|2022|PDM|1221.00|99|0.00|GA ASPG IV
20|FH_F40043_0_0|SrvcGrp|33265|2022|PDM|1586.00|99|0.00|GA ASPG V
20|FH_F40043_0_0|SrvcGrp|33268|2022|PCT|0.76|99|0.00|GA ASPG VIII
20|FH_F40043_0_0|SrvcGrp|33269|2022|PCT|0.76|99|0.00|GA ASPG IX
20|FH_F40043_0_0|SrvcGrp|941|2022|PDM|2792.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F40046_0_0|SrvcGrp|10543|2022|PDM|125.00|99|0.00|SPEECH THERAPY SVCS
20|FH_F40046_0_0|SrvcGrp|30089|2022|PCT|0.60|99|0.00|HEMODIALYSIS SERVICES
20|FH_F40055_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F40056_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|GENERAL ACUTE CARE
20|FH_F40056_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|OP SVCS
20|FH_F40056_0_0|SrvcGrp|30060|2022|PDM|5400.00|99|0.00|NORMAL DELIVERY
20|FH_F40056_0_0|SrvcGrp|30062|2022|PDM|4320.00|99|0.00|MULTIPLE BIRTH NORMAL DELIVERY
20|FH_F40060_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|OP SVCS
20|FH_F40066_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40066_0_0|SrvcGrp|360|2022|PDM|1950.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F40066_0_0|SrvcGrp|411|2022|PDM|4500.00|99|0.00|OP CARDIAC CATH
20|FH_F40066_0_0|SrvcGrp|6|2022|PCT|0.67|99|0.00|OP SURGERY
20|FH_F40066_0_0|SrvcGrp|65|2022|PDM|2016.00|99|0.00|OBSTETRICAL CARE
20|FH_F40066_0_0|SrvcGrp|701|2022|PDM|2070.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F40073_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40073_0_0|SrvcGrp|17065|2022|PDM|1053.00|99|0.00|ASPG I
20|FH_F40073_0_0|SrvcGrp|17069|2022|PCT|0.70|99|0.00|ASPG III
20|FH_F40073_0_0|SrvcGrp|17077|2022|PCT|0.70|99|0.00|ASPG VII
20|FH_F40081_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F40081_0_0|CSTM-ALL|CSTM-00|2020|PDM|300.00|99|0.00|ADULT PSYCH PARTIAL DAY TREATMNT
20|FH_F40081_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|ADOLESCENT PSYCH RESIDENTIAL TREATMENT
20|FH_F40081_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|ADULT PSYCH RESIDENTIAL TREATMENT
20|FH_F40081_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|RESIDENTIAL TREATMENT SERVICES
20|FH_F40081_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|PSYCHIATRIC EATING DISORDERS
20|FH_F40081_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|PSYCHIATRIC EATING DISORDERS
20|FH_F40081_0_0|CSTM-ALL|CSTM-00|2020|PDM|735.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40082_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40088_0_0|SrvcGrp|177|2022|PDM|1060.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F40088_0_0|SrvcGrp|474|2022|PDM|690.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F40089_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40091_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F40104_0_0|SrvcGrp|8962|2022|PDM|107.71|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F40104_0_0|SrvcGrp|9828|2022|PDM|61.01|99|0.00|HOME HEALTH AIDE
20|FH_F40104_0_0|SrvcGrp|9832|2022|PDM|107.71|99|0.00|ST SVCS
20|FH_F40127_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|OP SVCS
20|FH_F40134_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40144_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|BLOOD AND BLOOD PRODUCTS
20|FH_F40144_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F40149_0_0|SrvcGrp|3277|2022|PDM|506.00|99|0.00|SKILLED NURSING CARE
20|FH_F40154_0_0|CSTM-ALL|CSTM-00|2020|PDM|1385.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40154_0_0|CSTM-ALL|CSTM-00|2020|PDM|698.00|99|0.00|ACUTE PSYCH
20|FH_F40154_0_0|SrvcGrp|12840|2022|PCT|0.80|99|0.00|PACEMAKER
20|FH_F40174_0_0|CSTM-ALL|CSTM-00|2020|PDM|60.00|99|0.00|SPEECH THERAPY SVCS
20|FH_F40174_0_0|SrvcGrp|28068|2022|PDM|70.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F40176_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40176_0_0|CSTM-ALL|CSTM-00|2020|PDM|190.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F40182_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40182_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F40186_0_0|CSTM-ALL|CSTM-00|2020|PDM|470.00|99|0.00|CAROLINA DIGESTIVE COLONOSCOPY FH RATES
20|FH_F40191_0_0|CSTM-ALL|CSTM-00|2020|PDM|1616.00|99|0.00|ACUTE IP MED SVCS
20|FH_F40191_0_0|SrvcGrp|24|2022|PDM|3647.00|99|0.00|CARDIAC CATH
20|FH_F40191_0_0|SrvcGrp|8950|2022|PDM|2386.00|99|0.00|INTERMEDIATE ICU/CCU
20|FH_F40193_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.30|99|0.00|GENERAL ACUTE CARE
20|FH_F40198_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F40198_0_0|CSTM-ALL|CSTM-00|2020|PDM|1325.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40198_0_0|CSTM-ALL|CSTM-00|2020|PDM|636.00|99|0.00|ACUTE PSYCH
20|FH_F40198_0_0|SrvcGrp|65|2022|PDM|1717.00|99|0.00|OBSTETRICAL CARE
20|FH_F40203_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F40205_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40207_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP ARTHROSCOPIC KNEE SURGERY
20|FH_F40236_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40252_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40255_0_0|SrvcGrp|17100|2022|PDM|946.00|99|0.00|SKILLED NURSING
20|FH_F40255_0_0|SrvcGrp|473|2022|PDM|838.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F40256_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F40266_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F40270_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE
20|FH_F40286_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F40289_0_0|SrvcGrp|6|2022|PCT|0.75|99|0.00|OP SURGERY
20|FH_F40295_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40296_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40297_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|ACUTE REHABILITATION
20|FH_F40297_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40297_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F40302_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F40302_0_0|CSTM-ALL|CSTM-00|2020|PDM|1409.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40302_0_0|CSTM-ALL|CSTM-00|2020|PDM|577.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F40302_0_0|SrvcGrp|38|2022|PDM|3000.00|99|0.00|NORMAL DELIVERY
20|FH_F40304_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F40304_0_0|SrvcGrp|11312|2022|PCT|0.50|99|0.00|IMPLANTS/PROSHETICS/ORTHOTICS/DRUGS
20|FH_F40318_0_0|CSTM-ALL|CSTM-00|2020|PDM|45.00|99|0.00|ANESTHESIA SERVICES
20|FH_F40321_0_0|SrvcGrp|38|2022|PDM|3570.00|99|0.00|NORMAL DELIVERY
20|FH_F40331_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F40331_0_0|CSTM-ALL|CSTM-00|2020|PDM|1573.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40332_0_0|CSTM-ALL|CSTM-00|2020|PDM|1600.00|99|0.00|MS DRG 767-768, 774-775  NORMAL DELIVERY
20|FH_F40332_0_0|CSTM-ALL|CSTM-00|2020|PDM|2600.00|99|0.00|MS DRG 765-766 C-SECTION
20|FH_F40332_0_0|SrvcGrp|12299|2022|PCT|0.65|99|0.00|PROSTHETICS/IMPLANTS/DEVICES
20|FH_F40332_0_0|SrvcGrp|9774|2022|PDM|1600.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F40334_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F40340_0_0|CSTM-ALL|CSTM-00|2020|PDM|720.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40345_0_0|CSTM-ALL|CSTM-00|2020|PDM|1133.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40346_0_0|CSTM-ALL|CSTM-00|2020|PDM|1203.00|99|0.00|ASPG IV
20|FH_F40346_0_0|CSTM-ALL|CSTM-00|2020|PDM|1450.00|99|0.00|ACUTE MEDICAL/SURGICAL SVCS
20|FH_F40346_0_0|CSTM-ALL|CSTM-00|2020|PDM|1545.00|99|0.00|ASPG VI
20|FH_F40346_0_0|CSTM-ALL|CSTM-00|2020|PDM|2443.00|99|0.00|ASPG IX
20|FH_F40346_0_0|CSTM-ALL|CSTM-00|2020|PDM|2443.00|99|0.00|ASPG VIII
20|FH_F40346_0_0|CSTM-ALL|CSTM-00|2020|PDM|2800.00|99|0.00|MS DRG 767-768, 774-775  NORMAL DELIVERY
20|FH_F40346_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|MS DRG 765-766 C-SECTION
20|FH_F40346_0_0|SrvcGrp|16|2022|PDM|850.00|99|0.00|ACUTE REHABILITATION
20|FH_F40346_0_0|SrvcGrp|21805|2022|PCT|0.75|99|0.00|PT/OT/ST
20|FH_F40346_0_0|SrvcGrp|9774|2022|PDM|2000.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F40346_0_0|SrvcGrp|9911|2022|PCT|0.75|99|0.00|EMERGENCY ROOM SVCS
20|FH_F40347_0_0|CSTM-ALL|CSTM-00|2020|PDM|1450.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F40347_0_0|CSTM-ALL|CSTM-00|2020|PDM|2800.00|99|0.00|MS DRG 767-768, 774-775  NORMAL DELIVERY
20|FH_F40347_0_0|SrvcGrp|16|2022|PDM|850.00|99|0.00|ACUTE REHABILITATION
20|FH_F40347_0_0|SrvcGrp|9774|2022|PDM|2000.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F40350_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40350_0_0|CSTM-ALL|CSTM-00|2020|PDM|1450.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F40350_0_0|CSTM-ALL|CSTM-00|2020|PDM|2800.00|99|0.00|MS DRG 767-768, 774-775  NORMAL DELIVERY
20|FH_F40350_0_0|SrvcGrp|19973|2022|PDM|650.00|99|0.00|CAT SCAN
20|FH_F40350_0_0|SrvcGrp|3029|2022|PDM|350.00|99|0.00|NEWBORN NURSERY
20|FH_F40358_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40358_0_0|SrvcGrp|9774|2022|PDM|2000.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F40370_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F40370_0_0|SrvcGrp|1306|2022|PDM|406.00|99|0.00|OP PSYCH PARTIAL HOSP
20|FH_F40388_0_0|SrvcGrp|7|2022|PDM|335.00|99|0.00|NEONATAL INTENSIVE
20|FH_F40391_0_0|CSTM-ALL|CSTM-00|2020|PCT|57.00|99|0.00|OP SVCS
20|FH_F40393_0_0|SrvcGrp|97|2022|PDM|1950.00|99|0.00|C-SECTION
20|FH_F40399_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS
20|FH_F40402_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F40402_0_0|SrvcGrp|30941|2022|PDM|266.00|99|0.00|NEWBORN NURSERY
20|FH_F40410_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS
20|FH_F40415_0_0|CSTM-ALL|CSTM-00|2020|PDM|743.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40415_0_0|SrvcGrp|405|2022|PDM|1034.00|99|0.00|ACUTE REHAB - LEVEL II
20|FH_F40416_0_0|SrvcGrp|13551|2022|PDM|403.00|99|0.00|NEWBORN NURSERY
20|FH_F40417_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F40418_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F40421_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|ACUTE IP MED SVCS
20|FH_F40421_0_0|SrvcGrp|3458|2022|PDM|1400.00|99|0.00|NEONATAL INTENSIVE CARE UNIT
20|FH_F40421_0_0|SrvcGrp|43|2022|PCT|0.80|99|0.00|IMPLANTS
20|FH_F40427_0_0|SrvcGrp|3499|2022|PCT|0.60|99|0.00|IMPLANTS
20|FH_F40427_0_0|SrvcGrp|38|2022|PDM|2127.00|99|0.00|NORMAL DELIVERY
20|FH_F40431_0_0|CSTM-ALL|CSTM-00|2020|PDM|1010.00|99|0.00|BRAIN INJURY REHAB
20|FH_F40431_0_0|CSTM-ALL|CSTM-00|2020|PDM|925.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40446_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F40446_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40448_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F40448_0_0|CSTM-ALL|CSTM-00|2020|PDM|811.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40448_0_0|SrvcGrp|16|2022|PDM|811.00|99|0.00|ACUTE REHABILITATION
20|FH_F40454_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F40465_0_0|CSTM-ALL|CSTM-00|2020|PDM|12000.00|99|0.00|DRG 517 ONLY
20|FH_F40465_0_0|CSTM-ALL|CSTM-00|2020|PDM|12500.00|99|0.00|DRG 111 ONLY - MAJOR CV PROCEDURE W/O CC
20|FH_F40465_0_0|CSTM-ALL|CSTM-00|2020|PDM|35000.00|99|0.00|DRG 106 ONLY CORONARY BYPASS W/ PTCA
20|FH_F40465_0_0|CSTM-ALL|CSTM-00|2020|PDM|7000.00|99|0.00|DRG 117 CARDIAC PACE REVISION
20|FH_F40465_0_0|CSTM-ALL|CSTM-00|2020|PDM|730.00|99|0.00|ACUTE PSYCH
20|FH_F40465_0_0|SrvcGrp|24703|2022|PDM|491.00|99|0.00|NEWBORN NURSERY
20|FH_F40465_0_0|SrvcGrp|360|2022|PCT|0.75|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F40471_0_0|CSTM-ALL|CSTM-00|2020|PDM|414.00|99|0.00|ASC I ENDOSCOPY CTR CENTRAL PA
20|FH_F40471_0_0|CSTM-ALL|CSTM-00|2020|PDM|470.00|99|0.00|ASC III ENDOSCOPY CTR CENTRAL PA
20|FH_F40472_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40472_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F40472_0_0|CSTM-ALL|CSTM-00|2020|PDM|60.00|99|0.00|PT & OT
20|FH_F40472_0_0|SrvcGrp|28068|2022|PDM|70.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F40497_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS
20|FH_F40498_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40498_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F40501_0_0|CSTM-ALL|CSTM-00|2020|PDM|131.00|99|0.00|OP PSYCHIATRIC TREATMENT (4-7 HRS)
20|FH_F40501_0_0|CSTM-ALL|CSTM-00|2020|PDM|572.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40517_0_0|SrvcGrp|3327|2022|PDM|167.24|99|0.00|HOSPICE SERVICE - IP RESPITE
20|FH_F40526_0_0|SrvcGrp|27210|2022|PDM|325.00|99|0.00|SKILLED NURSING LEVEL I
20|FH_F40527_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40527_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|HEAD INJURY REHABILITATION
20|FH_F40530_0_0|SrvcGrp|13551|2022|PDM|440.00|99|0.00|NEWBORN NURSERY
20|FH_F40530_0_0|SrvcGrp|38|2022|PDM|2500.00|99|0.00|NORMAL DELIVERY
20|FH_F40530_0_0|SrvcGrp|701|2022|PDM|2156.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F40530_0_0|SrvcGrp|97|2022|PDM|3500.00|99|0.00|C-SECTION
20|FH_F40535_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|100.27|99|0.00|DELAWARE VALLEY- ASC 310
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|113.15|99|0.00|DELAWARE VALLEY- ASC 220
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|117.45|99|0.00|DELAWARE VALLEY- ASC 120
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|121.01|99|0.00|DELAWARE VALLEY- ASC 119
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|274.04|99|0.00|DELAWARE VALLEY- ASC 212
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|353.72|99|0.00|DELAWARE VALLEY- ASC 102
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|353.72|99|0.00|DELAWARE VALLEY- ASC 211
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|366.43|99|0.00|DELAWARE VALLEY- ASC 209
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|391.98|99|0.00|DELAWARE VALLEY- ASC 207
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|474.34|99|0.00|DELAWARE VALLEY- ASC 402
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|505.52|99|0.00|DELAWARE VALLEY- ASC 2
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|526.10|99|0.00|DELAWARE VALLEY- ASC 301
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|1087.00|99|0.00|HAPA EPA ASC 7
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|113.00|99|0.00|HAPA EPA ASC 19
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|117.00|99|0.00|HAPA EPA ASC 20
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|139.00|99|0.00|HAPA EPA ASC 21
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|1462.00|99|0.00|HAPA EPA ASC 9
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|179.00|99|0.00|HAPA EPA ASC 28
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|259.00|99|0.00|HAPA EPA ASC 33
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|353.00|99|0.00|HAPA EPA ASC 42
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|366.00|99|0.00|HAPA EPA ASC 43
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|432.00|99|0.00|HAPA EPA ASC 48
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|436.00|99|0.00|HAPA EPA ASC 49
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|457.00|99|0.00|HAPA EPA ASC 51
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|911.00|99|0.00|HAPA EPA ASC 6
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|97.00|99|0.00|HAPA EPA ASC 16
20|FH_F40550_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40554_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F40564_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40564_0_0|SrvcGrp|30941|2022|PDM|400.00|99|0.00|NEWBORN NURSERY
20|FH_F40566_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS
20|FH_F40568_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40568_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS
20|FH_F40571_0_0|SrvcGrp|16|2022|PDM|950.00|99|0.00|ACUTE REHABILITATION
20|FH_F40581_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40581_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F40590_0_0|CSTM-ALL|CSTM-00|2020|PDM|811.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40591_0_0|CSTM-ALL|CSTM-00|2020|PDM|5175.00|99|0.00|MS DRG 417-419
20|FH_F40591_0_0|SrvcGrp|1168|2022|PCT|0.75|99|0.00|CONTINUOUS HOMECARE
20|FH_F40591_0_0|SrvcGrp|9774|2022|PDM|4025.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F40593_0_0|SrvcGrp|473|2022|PDM|325.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F40598_0_0|SrvcGrp|115|2022|PDM|450.00|99|0.00|SKILLED NURSING CARE
20|FH_F40599_0_0|CSTM-ALL|CSTM-00|2020|PDM|1185.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40599_0_0|SrvcGrp|10|2022|PDM|12360.00|99|0.00|ANGIOPLASTY
20|FH_F40599_0_0|SrvcGrp|16374|2022|PCT|0.60|99|0.00|IMPLANTS
20|FH_F40600_0_0|SrvcGrp|63|2022|PDM|1402.00|99|0.00|SUBACUTE CARE
20|FH_F40600_0_0|SrvcGrp|701|2022|PDM|2061.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F40600_0_0|SrvcGrp|705|2022|PCT|0.70|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F40603_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40603_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F40603_0_0|SrvcGrp|13631|2022|PDM|140.00|99|0.00|CPT 99213
20|FH_F40603_0_0|SrvcGrp|3404|2022|PDM|65.00|99|0.00|CPT 99211
20|FH_F40605_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F40607_0_0|CSTM-ALL|CSTM-00|2020|PDM|45.00|99|0.00|SPEECH THERAPY SVCS
20|FH_F40615_0_0|CSTM-ALL|CSTM-00|2020|PDM|1248.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40615_0_0|SrvcGrp|16|2022|PDM|909.00|99|0.00|ACUTE REHABILITATION
20|FH_F40615_0_0|SrvcGrp|72|2022|PDM|416.00|99|0.00|NEWBORN NURSERY
20|FH_F40622_0_0|CSTM-ALL|CSTM-00|2020|PDM|742.00|99|0.00|ACUTE PSYCH
20|FH_F40624_0_0|SrvcGrp|19846|2022|PDM|18909.00|99|0.00|MS DRG 249 ONLY
20|FH_F40624_0_0|SrvcGrp|19961|2022|PDM|46977.00|99|0.00|MS DRG 231-232 ONLY CORONARY BYPASS W/ PTCA
20|FH_F40624_0_0|SrvcGrp|3409|2022|PDM|400.00|99|0.00|NEWBORN NURSERY
20|FH_F40627_0_0|CSTM-ALL|CSTM-00|2020|PDM|17250.00|99|0.00|SPINAL SURGERY MS DRGS 028-030, 453-460, 471-473, 490-491
20|FH_F40627_0_0|CSTM-ALL|CSTM-00|2020|PDM|3420.00|99|0.00|MS DRG 765-766 C-SECTION
20|FH_F40627_0_0|CSTM-ALL|CSTM-00|2020|PDM|5520.00|99|0.00|MSDRG 246-251 ANGIOPLASTY
20|FH_F40627_0_0|CSTM-ALL|CSTM-00|2020|PDM|5520.00|99|0.00|MSDRG 286-287 CARDIAC CATH
20|FH_F40627_0_0|SrvcGrp|11920|2022|PCT|0.70|99|0.00|PHARMACY SVCS
20|FH_F40627_0_0|SrvcGrp|12359|2022|PDM|3048.00|99|0.00|TELEMETRY SVCS
20|FH_F40627_0_0|SrvcGrp|12670|2022|PCT|0.60|99|0.00|IMPLANTS/PROSTHETICS/DEVICES
20|FH_F40627_0_0|SrvcGrp|29|2022|PCT|0.85|99|0.00|ELECTROPHYSIOLOGY
20|FH_F40627_0_0|SrvcGrp|360|2022|PDM|2760.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F40634_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F40635_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F40635_0_0|SrvcGrp|97|2022|PDM|3715.00|99|0.00|C-SECTION
20|FH_F40643_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F40643_0_0|CSTM-ALL|CSTM-00|2020|PDM|1004.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40643_0_0|SrvcGrp|12280|2022|PCT|0.60|99|0.00|IMPLANTS
20|FH_F40644_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F40644_0_0|SrvcGrp|705|2022|PCT|0.80|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F40647_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|DRUGS
20|FH_F40649_0_0|SrvcGrp|13551|2022|PDM|535.00|99|0.00|NEWBORN NURSERY
20|FH_F40649_0_0|SrvcGrp|65|2022|PDM|1621.00|99|0.00|OBSTETRICAL CARE
20|FH_F40653_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F40653_0_0|SrvcGrp|3029|2022|PDM|410.00|99|0.00|NEWBORN NURSERY
20|FH_F40653_0_0|SrvcGrp|3066|2022|PCT|0.85|99|0.00|HIGH-COST DRUGS
20|FH_F40653_0_0|SrvcGrp|3499|2022|PCT|0.85|99|0.00|IMPLANTS
20|FH_F40653_0_0|SrvcGrp|361|2022|PDM|1270.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F40653_0_0|SrvcGrp|8942|2022|PCT|0.90|99|0.00|BRACHYTHERAPY SVCS
20|FH_F40659_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40659_0_0|SrvcGrp|33164|2022|PDM|275.00|99|0.00|SKILLED NURSING - LEVEL I
20|FH_F40659_0_0|SrvcGrp|33166|2022|PDM|500.00|99|0.00|SKILLED NURSING - LEVEL III
20|FH_F40661_0_0|CSTM-ALL|CSTM-00|2020|PDM|245.00|99|0.00|CD PARTIAL HOSPITALIZATION
20|FH_F40661_0_0|SrvcGrp|110|2022|PDM|432.00|99|0.00|CD - REHABILITATION
20|FH_F40667_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|GENERAL ACUTE CARE
20|FH_F40684_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F40689_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40690_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|ACTIVASE/ALTEPLASE
20|FH_F40690_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|PSYCHIATRIC OP SVCS
20|FH_F40690_0_0|SrvcGrp|701|2022|PDM|1536.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F40719_0_0|CSTM-ALL|CSTM-00|2020|PDM|552.00|99|0.00|SKILLED NURSING
20|FH_F40736_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40738_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|HEAD INJURY REHAB
20|FH_F40739_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F40739_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40780_0_0|CSTM-ALL|CSTM-00|2020|PDM|145.00|99|0.00|INTENSIVE PSYCH SVCS
20|FH_F40780_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40780_0_0|SrvcGrp|166|2022|PDM|580.00|99|0.00|CD (ADULT) - DETOXIFICATION
20|FH_F40780_0_0|SrvcGrp|167|2022|PDM|500.00|99|0.00|CD (ADULT) - REHABILITATION
20|FH_F40783_0_0|CSTM-ALL|CSTM-00|2020|PDM|806.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40783_0_0|CSTM-ALL|CSTM-00|2020|PDM|988.00|99|0.00|BRAIN INJURY REHAB
20|FH_F40784_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40785_0_0|CSTM-ALL|CSTM-00|2020|PCT|57.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40786_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F40786_0_0|CSTM-ALL|CSTM-00|2020|PDM|541.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F40797_0_0|SrvcGrp|439|2022|PDM|725.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F40800_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F40800_0_0|SrvcGrp|177|2022|PDM|950.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F40800_0_0|SrvcGrp|97|2022|PDM|2600.00|99|0.00|C-SECTION
20|FH_F40812_0_0|CSTM-ALL|CSTM-00|2020|PDM|613.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F40812_0_0|CSTM-ALL|CSTM-00|2020|PDM|613.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40834_0_0|SrvcGrp|118|2022|PCT|0.80|99|0.00|LONG-TERM CARE
20|FH_F40834_0_0|SrvcGrp|16|2022|PCT|0.80|99|0.00|ACUTE REHABILITATION
20|FH_F40834_0_0|SrvcGrp|177|2022|PDM|1629.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F40834_0_0|SrvcGrp|3277|2022|PCT|0.80|99|0.00|SKILLED NURSING CARE
20|FH_F40834_0_0|SrvcGrp|359|2022|PDM|787.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL I
20|FH_F40834_0_0|SrvcGrp|413|2022|PCT|0.85|99|0.00|TRANSPLANT SVCS
20|FH_F40834_0_0|SrvcGrp|6|2022|PCT|0.80|99|0.00|OP SURGERY
20|FH_F40834_0_0|SrvcGrp|63|2022|PCT|0.80|99|0.00|SUBACUTE CARE
20|FH_F40834_0_0|SrvcGrp|701|2022|PDM|2146.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F40838_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F40850_0_0|SrvcGrp|32550|2022|PDM|104.00|99|0.00|NEWBORN NURSERY
20|FH_F40853_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|OP SVCS
20|FH_F40853_0_0|SrvcGrp|97|2022|PDM|4000.00|99|0.00|C-SECTION
20|FH_F40855_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F40855_0_0|CSTM-ALL|CSTM-00|2020|PDM|390.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F40855_0_0|SrvcGrp|439|2022|PDM|1600.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F40855_0_0|SrvcGrp|526|2022|PDM|1600.00|99|0.00|CARDIAC CARE UNIT
20|FH_F40885_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40890_0_0|CSTM-ALL|CSTM-00|2020|PDM|440.00|99|0.00|SUB-ACUTE SKILLED NURSING CARE
20|FH_F40903_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40903_0_0|SrvcGrp|13681|2022|PDM|278.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT
20|FH_F40903_0_0|SrvcGrp|14557|2022|PDM|47.25|99|0.00|AMBULANCE SVCS - WHEELCHAIR VAN
20|FH_F40903_0_0|SrvcGrp|18071|2022|PDM|55.00|99|0.00|AMBULANCE RESPONSE/TREATMENT - NO TRANSPORT
20|FH_F40903_0_0|SrvcGrp|18539|2022|PDM|1.05|99|0.00|ADDITIONAL MILEAGE - WHEELCHAIR VAN
20|FH_F40904_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|AMBULATORY SURGERY
20|FH_F40904_0_0|CSTM-ALL|CSTM-00|2020|PDM|425.00|99|0.00|SUB-ACUTE SKILLED NURSING CARE
20|FH_F40906_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40906_0_0|SrvcGrp|13683|2022|PDM|455.00|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2
20|FH_F40912_0_0|CSTM-ALL|CSTM-00|2020|PCT|91.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40912_0_0|CSTM-ALL|CSTM-00|2020|PCT|91.00|99|0.00|OP SVCS
20|FH_F40917_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F40917_0_0|SrvcGrp|110|2022|PDM|483.00|99|0.00|CD - REHABILITATION
20|FH_F40943_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F40943_0_0|SrvcGrp|471|2022|PDM|608.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F40972_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F40979_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|PT SVCS
20|FH_F40979_0_0|SrvcGrp|10362|2022|PDM|150.00|99|0.00|CPT CODE 99282
20|FH_F40980_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|MED/SURG SUPPLIES AND DEVICES - OTHER
20|FH_F40980_0_0|CSTM-ALL|CSTM-00|2020|PDM|10313.00|99|0.00|MS DRG 287
20|FH_F40980_0_0|CSTM-ALL|CSTM-00|2020|PDM|15469.00|99|0.00|MS DRG 242-244 PACEMAKER IMPLANT
20|FH_F40980_0_0|CSTM-ALL|CSTM-00|2020|PDM|15469.00|99|0.00|MSDRG 280-281 CIRCULATORY DISORDERS
20|FH_F40980_0_0|CSTM-ALL|CSTM-00|2020|PDM|20625.00|99|0.00|MS DRG 247
20|FH_F40980_0_0|CSTM-ALL|CSTM-00|2020|PDM|22249.00|99|0.00|ROBOTIC PROCEDURES
20|FH_F40980_0_0|CSTM-ALL|CSTM-00|2020|PDM|4820.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40980_0_0|CSTM-ALL|CSTM-00|2020|PDM|5826.00|99|0.00|INTENSIVE CARE/CORONARY CARE UNIT
20|FH_F40980_0_0|CSTM-ALL|CSTM-00|2020|PDM|59298.00|99|0.00|MS DRG 234
20|FH_F40980_0_0|CSTM-ALL|CSTM-00|2020|PDM|64454.00|99|0.00|MSDRG 231-232 CORONARY BYPASS
20|FH_F40980_0_0|CSTM-ALL|CSTM-00|2020|PDM|77346.00|99|0.00|MSDRG 222-223 CARDIAC DEFIB W/ AMI/HF SHOCK
20|FH_F40980_0_0|CSTM-ALL|CSTM-00|2020|PDM|91312.00|99|0.00|SPINAL FUSION (MS DRG 456-458)
20|FH_F40980_0_0|SrvcGrp|12184|2022|PCT|1.05|99|0.00|IMPLANTS
20|FH_F40980_0_0|SrvcGrp|13292|2022|PCT|1.05|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F40980_0_0|SrvcGrp|3066|2022|PCT|0.50|99|0.00|HIGH-COST DRUGS
20|FH_F40980_0_0|SrvcGrp|411|2022|PDM|9230.00|99|0.00|OP CARDIAC CATH
20|FH_F40983_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F40983_0_0|CSTM-ALL|CSTM-00|2020|PDM|1011.42|99|0.00|ASPG VII
20|FH_F40983_0_0|CSTM-ALL|CSTM-00|2020|PDM|453.36|99|0.00|ASPG II
20|FH_F40983_0_0|CSTM-ALL|CSTM-00|2020|PDM|986.58|99|0.00|ASPG VIII
20|FH_F40991_0_0|CSTM-ALL|CSTM-00|2020|PDM|75.00|99|0.00|OP SVCS
20|FH_F40993_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.76|99|0.00|OP SVCS
20|FH_F40994_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F40994_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|ACUTE PSYCH
20|FH_F40994_0_0|SrvcGrp|350|2022|PDM|950.00|99|0.00|SURGICAL CARE
20|FH_F40994_0_0|SrvcGrp|97|2022|PDM|2600.00|99|0.00|C-SECTION
20|FH_F41021_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41021_0_0|SrvcGrp|17083|2022|PCT|0.74|99|0.00|ASPG X
20|FH_F41033_0_0|SrvcGrp|17073|2022|PDM|789.00|99|0.00|ASPG V
20|FH_F41033_0_0|SrvcGrp|17079|2022|PDM|1070.00|99|0.00|ASPG VIII
20|FH_F41035_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F41035_0_0|SrvcGrp|107784|2022|PDM|919.00|99|0.00|AETNA AEG 6 W/O EYE/OCULAR SURGERY
20|FH_F41035_0_0|SrvcGrp|107785|2022|PDM|1076.00|99|0.00|AETNA AEG 8 W/O EYE/OCULAR SURGERY
20|FH_F41035_0_0|SrvcGrp|54962|2022|PDM|1200.00|99|0.00|RECONSTRUCTION OF SHOULDER CUFF (ROTATOR)
20|FH_F41035_0_0|SrvcGrp|73006|2022|PDM|1129.00|99|0.00|AEG 9
20|FH_F41035_0_0|SrvcGrp|73008|2022|PDM|1260.00|99|0.00|AEG 10
20|FH_F41035_0_0|SrvcGrp|77582|2022|PDM|850.00|99|0.00|CPT 31255
20|FH_F41053_0_0|CSTM-ALL|CSTM-00|2020|PDM|562.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F41053_0_0|SrvcGrp|453|2022|PDM|281.00|99|0.00|PSYCH PARTIAL HOSP
20|FH_F41059_0_0|CSTM-ALL|CSTM-00|2020|PDM|230.00|99|0.00|ADOLESCENT PARTIAL HOSPITALIZATION
20|FH_F41059_0_0|CSTM-ALL|CSTM-00|2020|PDM|332.00|99|0.00|ADULT RESIDENTIAL TREATMENT
20|FH_F41059_0_0|SrvcGrp|109|2022|PDM|485.00|99|0.00|CD - DETOX
20|FH_F41112_0_0|CSTM-ALL|CSTM-00|2020|PDM|1950.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41112_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|SUB-ACUTE PHYSICAL REHAB
20|FH_F41135_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F41135_0_0|SrvcGrp|17065|2022|PDM|321.40|99|0.00|ASPG I
20|FH_F41135_0_0|SrvcGrp|17069|2022|PDM|492.54|99|0.00|ASPG III
20|FH_F41135_0_0|SrvcGrp|17075|2022|PDM|802.00|99|0.00|ASPG VI
20|FH_F41135_0_0|SrvcGrp|17077|2022|PDM|966.14|99|0.00|ASPG VII
20|FH_F41135_0_0|SrvcGrp|17081|2022|PDM|492.54|99|0.00|ASPG IX
20|FH_F41142_0_0|CSTM-ALL|CSTM-00|2020|PDM|168.00|99|0.00|CD - ADOLESCENT HALF DAY
20|FH_F41142_0_0|CSTM-ALL|CSTM-00|2020|PDM|255.00|99|0.00|ADULT PSYCH FULL DAY (8-12 HRS)
20|FH_F41142_0_0|CSTM-ALL|CSTM-00|2020|PDM|281.00|99|0.00|ADOLESCENT PSYCH FULL DAY (8-12 HRS)
20|FH_F41158_0_0|SrvcGrp|110|2022|PDM|428.00|99|0.00|CD - REHABILITATION
20|FH_F41160_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F41160_0_0|CSTM-ALL|CSTM-00|2020|PDM|1167.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41167_0_0|SrvcGrp|3029|2022|PDM|350.00|99|0.00|NEWBORN NURSERY
20|FH_F41173_0_0|CSTM-ALL|CSTM-00|2020|PDM|364.00|99|0.00|CD ADOLESCENT RESIDENTIAL TREATMENT
20|FH_F41173_0_0|CSTM-ALL|CSTM-00|2020|PDM|364.00|99|0.00|CHILD RESIDENTIAL TREATMENT
20|FH_F41178_0_0|CSTM-ALL|CSTM-00|2020|PDM|886.00|99|0.00|EATING DISORDER
20|FH_F41178_0_0|SrvcGrp|1306|2022|PDM|324.00|99|0.00|OP PSYCH PARTIAL HOSP
20|FH_F41178_0_0|SrvcGrp|13811|2022|PDM|324.00|99|0.00|PSYCH PARTIAL HOSP
20|FH_F41181_0_0|CSTM-ALL|CSTM-00|2020|PDM|1144.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41181_0_0|SrvcGrp|11663|2022|PCT|0.65|99|0.00|IMPLANTS
20|FH_F41181_0_0|SrvcGrp|12280|2022|PCT|0.65|99|0.00|IMPLANTS
20|FH_F41196_0_0|CSTM-ALL|CSTM-00|2020|PCT|67.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41201_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|ACUTE PSYCH
20|FH_F41201_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|CHEMICAL DEPENDENCY
20|FH_F41201_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F41201_0_0|SrvcGrp|65|2022|PCT|0.73|99|0.00|OBSTETRICAL CARE
20|FH_F41229_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|HEAD INJURY REHABILITATION
20|FH_F41236_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F41261_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41273_0_0|SrvcGrp|13052|2022|PCT|0.75|99|0.00|OP SURGERY
20|FH_F41275_0_0|CSTM-ALL|CSTM-00|2020|PDM|130.00|99|0.00|IP ADULT PARTIAL HOSPITALIZATION FULL DAY (8-12 HOURS)
20|FH_F41275_0_0|CSTM-ALL|CSTM-00|2020|PDM|85.00|99|0.00|IP ADULT PARTIAL HOSPITALIZATION HALF DAY (4-7 HOURS)
20|FH_F41276_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41317_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|SKILLED NURSING
20|FH_F41317_0_0|CSTM-ALL|CSTM-00|2020|PDM|935.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41320_0_0|SrvcGrp|439|2022|PDM|1050.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F41342_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F41342_0_0|SrvcGrp|16173|2022|PDM|275.00|99|0.00|PARTIAL HOSPITALIZATION
20|FH_F41348_0_0|CSTM-ALL|CSTM-00|2020|PDM|250.00|99|0.00|IP ADOLESCENT PSYCHIATRIC PARTIAL HOSP
20|FH_F41355_0_0|CSTM-ALL|CSTM-00|2020|PDM|60.00|99|0.00|OP SVCS
20|FH_F41374_0_0|CSTM-ALL|CSTM-00|2020|PDM|536.00|99|0.00|ADOLESCENT PSYCHIATRIC
20|FH_F41377_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F41429_0_0|CSTM-ALL|CSTM-00|2020|PDM|587.00|99|0.00|ACUTE PSYCH
20|FH_F41429_0_0|CSTM-ALL|CSTM-00|2020|PDM|587.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41429_0_0|SrvcGrp|1306|2022|PDM|263.00|99|0.00|OP PSYCH PARTIAL HOSP
20|FH_F41433_0_0|CSTM-ALL|CSTM-00|2020|PDM|25.00|99|0.00|HOSPICE PAIN MGMT COMFORT KIT
20|FH_F41438_0_0|SrvcGrp|11442|2022|PDM|623.00|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)
20|FH_F41441_0_0|SrvcGrp|115|2022|PDM|530.00|99|0.00|SKILLED NURSING CARE
20|FH_F41442_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41442_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS
20|FH_F41452_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41452_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F41452_0_0|CSTM-ALL|CSTM-00|2020|PDM|1071.40|99|0.00|ASPG 8- PROGRESSIVE SURG
20|FH_F41452_0_0|CSTM-ALL|CSTM-00|2020|PDM|1085.70|99|0.00|ASPG 7- PROGRESSIVE SURG
20|FH_F41452_0_0|CSTM-ALL|CSTM-00|2020|PDM|1540.00|99|0.00|ASPG 10- PROGRESSIVE SURG- LAP & ARTHRO CODES
20|FH_F41452_0_0|CSTM-ALL|CSTM-00|2020|PDM|687.50|99|0.00|ASPG 4- PROGRESSIVE SURG
20|FH_F41452_0_0|CSTM-ALL|CSTM-00|2020|PDM|910.80|99|0.00|ASPG 6- PROGRESSIVE SURG
20|FH_F41457_0_0|CSTM-ALL|CSTM-00|2020|PDM|345.00|99|0.00|ADVANCED LIFE SUPPORT (ALS) PARAMEDIC INTERCEPT
20|FH_F41457_0_0|CSTM-ALL|CSTM-00|2020|PDM|383.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC
20|FH_F41457_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|EMERGENCY ROOM SVCS
20|FH_F41457_0_0|CSTM-ALL|CSTM-00|2020|PDM|545.00|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2
20|FH_F41457_0_0|CSTM-ALL|CSTM-00|2020|PDM|8.65|99|0.00|GROUND MILEAGE, PER STATUTE MILE
20|FH_F41457_0_0|SrvcGrp|177|2022|PDM|1150.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F41457_0_0|SrvcGrp|29121|2022|PCT|0.62|99|0.00|LABORATORY
20|FH_F41458_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41461_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41474_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F41481_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41481_0_0|SrvcGrp|17067|2022|PDM|490.00|99|0.00|ASPG II
20|FH_F41484_0_0|CSTM-ALL|CSTM-00|2020|PDM|430.85|99|0.00|ASPG II
20|FH_F41489_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F41489_0_0|SrvcGrp|3029|2022|PDM|450.00|99|0.00|NEWBORN NURSERY
20|FH_F41489_0_0|SrvcGrp|38|2022|PDM|1500.00|99|0.00|NORMAL DELIVERY
20|FH_F41489_0_0|SrvcGrp|701|2022|PDM|1500.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F41491_0_0|SrvcGrp|38|2022|PDM|2016.00|99|0.00|NORMAL DELIVERY
20|FH_F41491_0_0|SrvcGrp|97|2022|PDM|2864.00|99|0.00|C-SECTION
20|FH_F41494_0_0|SrvcGrp|72|2022|PDM|490.00|99|0.00|NEWBORN NURSERY
20|FH_F41516_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F41516_0_0|SrvcGrp|34550|2022|PCT|0.95|99|0.00|CAT SCAN
20|FH_F41519_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F41519_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F41519_0_0|SrvcGrp|3029|2022|PDM|300.00|99|0.00|NEWBORN NURSERY
20|FH_F41535_0_0|SrvcGrp|3029|2022|PDM|220.00|99|0.00|NEWBORN NURSERY
20|FH_F41535_0_0|SrvcGrp|38|2022|PDM|1600.00|99|0.00|NORMAL DELIVERY
20|FH_F41535_0_0|SrvcGrp|701|2022|PDM|1600.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F41539_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41539_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F41539_0_0|SrvcGrp|33826|2022|PDM|595.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG 4
20|FH_F41539_0_0|SrvcGrp|33831|2022|PDM|1265.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG 9
20|FH_F41540_0_0|SrvcGrp|33830|2022|PDM|1710.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG 8
20|FH_F41600_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|BLOOD AND BLOOD PRODUCTS
20|FH_F41600_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41600_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|OP SVCS
20|FH_F41602_0_0|CSTM-ALL|CSTM-00|2020|PDM|668.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41605_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|OP SVCS
20|FH_F41617_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F41633_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41633_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS
20|FH_F41663_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F41663_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|ACUTE MEDICAL/SURGICAL SVCS
20|FH_F41663_0_0|CSTM-ALL|CSTM-00|2020|PDM|2250.00|99|0.00|MS DRG 774-775, 767-768 NORMAL DELIVERY (MS DRG ONLY)
20|FH_F41663_0_0|SrvcGrp|3029|2022|PDM|325.00|99|0.00|NEWBORN NURSERY
20|FH_F41663_0_0|SrvcGrp|9774|2022|PDM|2300.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F41666_0_0|CSTM-ALL|CSTM-00|2020|PDM|457.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41672_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F41675_0_0|SrvcGrp|34668|2022|PDM|650.00|99|0.00|UNCOMPLICATED VENTILATOR SERVICES
20|FH_F41679_0_0|SrvcGrp|16420|2022|PDM|380.00|99|0.00|PSYCH RESIDENTIAL TREATMENT
20|FH_F41695_0_0|SrvcGrp|34766|2022|PDM|46.00|99|0.00|GHP THERAPY SERVICES
20|FH_F41695_0_0|SrvcGrp|472|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F41696_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F41738_0_0|CSTM-ALL|CSTM-00|2020|PDM|1164.00|99|0.00|COVENTRY ENHANCED GROUPER 7
20|FH_F41738_0_0|CSTM-ALL|CSTM-00|2020|PDM|545.00|99|0.00|COVENTRY ENHANCED GROUPER 2
20|FH_F41739_0_0|CSTM-ALL|CSTM-00|2020|PDM|23540.00|99|0.00|DRG 127 ONLY
20|FH_F41739_0_0|CSTM-ALL|CSTM-00|2020|PDM|29532.00|99|0.00|DRG 109 ONLY
20|FH_F41739_0_0|SrvcGrp|10061|2022|PDM|11770.00|99|0.00|DRG 125 ONLY CIRC DISORD W/CA CATH W/O
20|FH_F41739_0_0|SrvcGrp|11336|2022|PCT|0.70|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F41739_0_0|SrvcGrp|14752|2022|PDM|22256.00|99|0.00|DRG 122 ONLY
20|FH_F41749_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F41749_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|EATING DISORDER PARTIAL DAY - ADULT
20|FH_F41796_0_0|CSTM-ALL|CSTM-00|2020|PDM|685.00|99|0.00|ACUTE PSYCH
20|FH_F41796_0_0|CSTM-ALL|CSTM-00|2020|PDM|685.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41796_0_0|SrvcGrp|109|2022|PDM|475.00|99|0.00|CD - DETOX
20|FH_F41796_0_0|SrvcGrp|71244|2022|PDM|240.00|99|0.00|PSYCH PARTIAL HOSPITALIZATION
20|FH_F41798_0_0|CSTM-ALL|CSTM-00|2020|PDM|380.00|99|0.00|ACUTE PSYCH
20|FH_F41798_0_0|CSTM-ALL|CSTM-00|2020|PDM|380.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41798_0_0|SrvcGrp|110|2022|PDM|333.00|99|0.00|CD - REHABILITATION
20|FH_F41799_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41801_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F41801_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|ADULT PSYCHIATRIC
20|FH_F41801_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|CHILD PSYCHIATRIC
20|FH_F41803_0_0|SrvcGrp|34873|2022|PCT|0.80|99|0.00|INTRAOCULAR LENS
20|FH_F41804_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F41808_0_0|SrvcGrp|3809|2022|PDM|601.02|99|0.00|HOSPICE CARE
20|FH_F41809_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F41809_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F41814_0_0|SrvcGrp|6|2022|PDM|2392.00|99|0.00|OP SURGERY
20|FH_F41814_0_0|SrvcGrp|9510|2022|PDM|580.00|99|0.00|SKILLED NURSING CARE
20|FH_F41818_0_0|CSTM-ALL|CSTM-00|2020|PDM|1479.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41874_0_0|SrvcGrp|110|2022|PDM|483.00|99|0.00|CD - REHABILITATION
20|FH_F41885_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F41885_0_0|SrvcGrp|38|2022|PDM|1600.00|99|0.00|NORMAL DELIVERY
20|FH_F41887_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F41934_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE
20|FH_F41976_0_0|CSTM-ALL|CSTM-00|2020|PDM|265.00|99|0.00|MARLBORO GASTRO GI PROCEDURES 265
20|FH_F41979_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41988_0_0|CSTM-ALL|CSTM-00|2020|PDM|198.00|99|0.00|PSYCHIATRIC PARTIAL HOSPITALIZATION
20|FH_F41988_0_0|CSTM-ALL|CSTM-00|2020|PDM|442.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41989_0_0|CSTM-ALL|CSTM-00|2020|PDM|179.00|99|0.00|CD SVCS (ADULT)
20|FH_F41989_0_0|SrvcGrp|110|2022|PDM|525.00|99|0.00|CD - REHABILITATION
20|FH_F41989_0_0|SrvcGrp|3934|2022|PDM|179.00|99|0.00|INTENSIVE ADULT DUAL DIAGNOSIS
20|FH_F42001_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42018_0_0|CSTM-ALL|CSTM-00|2020|PCT|62.79|99|0.00|GENERAL ACUTE CARE
20|FH_F42019_0_0|SrvcGrp|3029|2022|PDM|220.00|99|0.00|NEWBORN NURSERY
20|FH_F42024_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|ACUTE PSYCH
20|FH_F42024_0_0|CSTM-ALL|CSTM-00|2020|PDM|17000.00|99|0.00|MS DRG 003-004, 163-165
20|FH_F42024_0_0|SrvcGrp|35557|2022|PCT|1.00|99|0.00|BLOOD AND BLOOD PRODUCTS - OP
20|FH_F42024_0_0|SrvcGrp|9511|2022|PDM|140.00|99|0.00|OBSERVATION SVCS
20|FH_F42024_0_0|SrvcGrp|9774|2022|PDM|4170.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F42024_0_0|SrvcGrp|9795|2022|PDM|960.00|99|0.00|SUBACUTE REHAB
20|FH_F42024_0_0|SrvcGrp|9984|2022|PDM|135.00|99|0.00|URGENT CARE
20|FH_F42026_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F42042_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|OP SVCS
20|FH_F42098_0_0|CSTM-ALL|CSTM-00|2020|PDM|26.00|99|0.00|NURSING CARE MOD TE
20|FH_F42098_0_0|SrvcGrp|10544|2022|PDM|53.00|99|0.00|ENTEROSTOMAL THERAPY SERVICES
20|FH_F42098_0_0|SrvcGrp|11068|2022|PDM|50.00|99|0.00|PT SVCS
20|FH_F42098_0_0|SrvcGrp|11089|2022|PDM|40.00|99|0.00|NURSING CARE
20|FH_F42105_0_0|SrvcGrp|701|2022|PDM|1450.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F42117_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F42117_0_0|CSTM-ALL|CSTM-00|2020|PDM|160.00|99|0.00|SONOGRAM
20|FH_F42130_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|OP SVCS
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|109.00|99|0.00|HAPA EPA ASC 18
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|139.00|99|0.00|HAPA EPA ASC 22
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|143.00|99|0.00|HAPA EPA ASC 23
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|144.00|99|0.00|HAPA EPA ASC 24
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|1460.00|99|0.00|HAPA EPA ASC 9
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|179.00|99|0.00|HAPA EPA ASC 28
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|229.00|99|0.00|HAPA EPA ASC 31
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|243.00|99|0.00|HAPA EPA ASC 32
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|327.00|99|0.00|HAPA EPA ASC 38
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|366.00|99|0.00|HAPA EPA ASC 43
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|506.00|99|0.00|HAPA EPA ASC 53
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|557.00|99|0.00|HAPA EPA ASC 3
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|782.00|99|0.00|HAPA EPA ASC 5
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|97.00|99|0.00|HAPA EPA ASC 16
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|99.00|99|0.00|HAPA EPA ASC 17
20|FH_F42153_0_0|SrvcGrp|115|2022|PDM|809.00|99|0.00|SKILLED NURSING CARE
20|FH_F42153_0_0|SrvcGrp|941|2022|PDM|3195.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F42156_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F42159_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|PEDIATRIC IP SVCS
20|FH_F42159_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|ACUTE IP MED SVCS
20|FH_F42159_0_0|SrvcGrp|12118|2022|PCT|0.95|99|0.00|COMPUTED TOMOGRAPHY (CT)
20|FH_F42159_0_0|SrvcGrp|12146|2022|PDM|1400.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F42159_0_0|SrvcGrp|20801|2022|PCT|0.95|99|0.00|HOME HEALTH
20|FH_F42160_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42161_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|ACUTE IP MED SVCS
20|FH_F42161_0_0|SrvcGrp|177|2022|PDM|1100.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F42161_0_0|SrvcGrp|20534|2022|PCT|0.88|99|0.00|SKILLED NURSING
20|FH_F42161_0_0|SrvcGrp|22461|2022|PCT|0.88|99|0.00|INPATIENT HOSPICE SVCS
20|FH_F42161_0_0|SrvcGrp|29817|2022|PDM|2000.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F42165_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|PEDIATRIC IP SVCS
20|FH_F42165_0_0|SrvcGrp|31007|2022|PDM|210.00|99|0.00|MS DRG 795 ONLY & REV CODES 170-171 NORMAL NEWBORN
20|FH_F42165_0_0|SrvcGrp|3138|2022|PCT|0.85|99|0.00|COMPUTED TOMOGRAPHY (CT)
20|FH_F42165_0_0|SrvcGrp|31853|2022|PCT|0.85|99|0.00|OP LITHOTRIPSY
20|FH_F42168_0_0|SrvcGrp|20534|2022|PDM|500.00|99|0.00|SKILLED NURSING
20|FH_F42169_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|MS DRG 765-766 ONLY C-SECTION
20|FH_F42176_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|ACUTE IP MED SVCS
20|FH_F42176_0_0|SrvcGrp|12118|2022|PCT|0.88|99|0.00|COMPUTED TOMOGRAPHY (CT)
20|FH_F42176_0_0|SrvcGrp|31007|2022|PDM|210.00|99|0.00|MS DRG 795 ONLY & REV CODES 170-171 NORMAL NEWBORN
20|FH_F42177_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE
20|FH_F42177_0_0|SrvcGrp|20534|2022|PCT|0.85|99|0.00|SKILLED NURSING
20|FH_F42195_0_0|CSTM-ALL|CSTM-00|2020|PCT|68.80|99|0.00|OP SVCS
20|FH_F42244_0_0|SrvcGrp|290|2022|PCT|0.70|99|0.00|IP LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F42244_0_0|SrvcGrp|38|2022|PDM|1951.00|99|0.00|NORMAL DELIVERY
20|FH_F42244_0_0|SrvcGrp|97|2022|PDM|3381.00|99|0.00|C-SECTION
20|FH_F42248_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F42250_0_0|CSTM-ALL|CSTM-00|2020|PCT|74.00|99|0.00|OP SVCS
20|FH_F42255_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F42255_0_0|CSTM-ALL|CSTM-00|2020|PDM|430.85|99|0.00|ASPG II
20|FH_F42255_0_0|CSTM-ALL|CSTM-00|2020|PDM|692.55|99|0.00|ASPG V
20|FH_F42260_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F42260_0_0|CSTM-ALL|CSTM-00|2020|PDM|1875.00|99|0.00|COVENTRY ENHANCED GROUPER 9 MOD 50
20|FH_F42260_0_0|CSTM-ALL|CSTM-00|2020|PDM|466.00|99|0.00|COVENTRY ENHANCED GROUPER 1
20|FH_F42260_0_0|SrvcGrp|26058|2022|PCT|1.00|99|0.00|IMPLANTS, PROSTHETICS, OR SUPPLIES
20|FH_F42272_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42272_0_0|CSTM-ALL|CSTM-00|2020|PDM|300.00|99|0.00|ASPG I
20|FH_F42279_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42282_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F42282_0_0|CSTM-ALL|CSTM-00|2020|PDM|598.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42333_0_0|CSTM-ALL|CSTM-00|2020|PDM|330.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F42342_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F42342_0_0|SrvcGrp|12157|2022|PDM|131.25|99|0.00|RN VISIT
20|FH_F42342_0_0|SrvcGrp|12263|2022|PDM|26.25|99|0.00|HOME HEALTH AIDE- HOURLY
20|FH_F42342_0_0|SrvcGrp|12702|2022|PDM|68.25|99|0.00|RN, INTERMITTENT VISIT
20|FH_F42342_0_0|SrvcGrp|26798|2022|PDM|78.75|99|0.00|LICENSED PRACTICAL NURSE
20|FH_F42342_0_0|SrvcGrp|9830|2022|PDM|131.25|99|0.00|OT SVCS
20|FH_F42343_0_0|CSTM-ALL|CSTM-00|2020|PDM|255.00|99|0.00|CD PARTIAL HOSPITALIZATION
20|FH_F42343_0_0|CSTM-ALL|CSTM-00|2020|PDM|517.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42343_0_0|SrvcGrp|110|2022|PDM|485.00|99|0.00|CD - REHABILITATION
20|FH_F42352_0_0|CSTM-ALL|CSTM-00|2020|PDM|2912.00|99|0.00|MS DRG 216-221, 231-234 CV SURGERY
20|FH_F42352_0_0|SrvcGrp|1121|2022|PCT|0.65|99|0.00|OP PTCA ANGIOPLASTY
20|FH_F42352_0_0|SrvcGrp|290|2022|PDM|3270.00|99|0.00|IP LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F42352_0_0|SrvcGrp|72|2022|PDM|460.00|99|0.00|NEWBORN NURSERY
20|FH_F42355_0_0|CSTM-ALL|CSTM-00|2020|PDM|420.00|99|0.00|ACUTE PSYCH
20|FH_F42355_0_0|CSTM-ALL|CSTM-00|2020|PDM|420.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42355_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|OP SVCS
20|FH_F42364_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|OP SVCS
20|FH_F42366_0_0|CSTM-ALL|CSTM-00|2020|PCT|58.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42379_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42379_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|OP SVCS
20|FH_F42397_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F42402_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|MS DRG 795 ONLY & REV CODES 170-171 NRML NEWBORN OTLR
20|FH_F42402_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F42402_0_0|SrvcGrp|12118|2022|PCT|0.90|99|0.00|COMPUTED TOMOGRAPHY (CT)
20|FH_F42402_0_0|SrvcGrp|20801|2022|PCT|0.85|99|0.00|HOME HEALTH
20|FH_F42402_0_0|SrvcGrp|29817|2022|PDM|1708.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F42402_0_0|SrvcGrp|31661|2022|PCT|0.90|99|0.00|DURABLE MEDICAL EQUIPMENT
20|FH_F42402_0_0|SrvcGrp|36005|2022|PCT|0.90|99|0.00|ENDOSCOPY
20|FH_F42420_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F42423_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|COVENTRY ENHANCED GROUPER 5
20|FH_F42427_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42431_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42431_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F42438_0_0|CSTM-ALL|CSTM-00|2020|PDM|1111.00|99|0.00|COVENTRY ENHANCED GROUPER 5
20|FH_F42438_0_0|CSTM-ALL|CSTM-00|2020|PDM|1280.00|99|0.00|COVENTRY ENHANCED GROUPER 6
20|FH_F42438_0_0|CSTM-ALL|CSTM-00|2020|PDM|977.00|99|0.00|COVENTRY ENHANCED GROUPER 4
20|FH_F42438_0_0|SrvcGrp|29985|2022|PCT|1.05|99|0.00|SUPPLIES
20|FH_F42444_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F42446_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F42449_0_0|CSTM-ALL|CSTM-00|2020|PDM|775.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42453_0_0|SrvcGrp|167|2022|PDM|367.00|99|0.00|CD (ADULT) - REHABILITATION
20|FH_F42464_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|MS DRG 901-905, 927-929, 933-935 BURN SERVICES
20|FH_F42466_0_0|SrvcGrp|3029|2022|PDM|244.00|99|0.00|NEWBORN NURSERY
20|FH_F42511_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|GENERAL ACUTE CARE
20|FH_F42511_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|OP SVCS
20|FH_F42521_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42538_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42538_0_0|SrvcGrp|22954|2022|PDM|148.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F42551_0_0|CSTM-ALL|CSTM-00|2020|PDM|3465.00|99|0.00|CD SVCS (ADULT)
20|FH_F42556_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42556_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F42557_0_0|CSTM-ALL|CSTM-00|2020|PDM|360.00|99|0.00|CD - ADOLESCENT PARTIAL HOSPITAL
20|FH_F42557_0_0|CSTM-ALL|CSTM-00|2020|PDM|430.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42557_0_0|CSTM-ALL|CSTM-00|2020|PDM|458.00|99|0.00|ACUTE REHABILITATION - ADOLESCENT
20|FH_F42573_0_0|CSTM-ALL|CSTM-00|2020|PDM|75.00|99|0.00|OP SVCS
20|FH_F42577_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F42626_0_0|SrvcGrp|115|2022|PDM|477.00|99|0.00|SKILLED NURSING CARE
20|FH_F42640_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F42640_0_0|SrvcGrp|28147|2022|PDM|440.00|99|0.00|SKILLED NURSING
20|FH_F42646_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|ACUTE PSYCH
20|FH_F42655_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS
20|FH_F42688_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F42688_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|TRAUMA CARE
20|FH_F42690_0_0|SrvcGrp|115|2022|PDM|120.00|99|0.00|SKILLED NURSING CARE
20|FH_F42706_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42706_0_0|CSTM-ALL|CSTM-00|2020|PDM|506.59|99|0.00|ASPG III
20|FH_F42706_0_0|CSTM-ALL|CSTM-00|2020|PDM|821.48|99|0.00|ASPG VI
20|FH_F42706_0_0|SrvcGrp|17861|2022|PDM|100.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F42708_0_0|CSTM-ALL|CSTM-00|2020|PDM|684.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42708_0_0|SrvcGrp|1306|2022|PDM|311.00|99|0.00|OP PSYCH PARTIAL HOSP
20|FH_F42715_0_0|SrvcGrp|474|2022|PDM|302.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F42715_0_0|SrvcGrp|592|2022|PDM|717.00|99|0.00|SUB-ACUTE CARE
20|FH_F42746_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F42746_0_0|SrvcGrp|28068|2022|PDM|55.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F42748_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F42754_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F42754_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|ACUTE PSYCH
20|FH_F42754_0_0|SrvcGrp|110|2022|PDM|350.00|99|0.00|CD - REHABILITATION
20|FH_F42755_0_0|CSTM-ALL|CSTM-00|2020|PDM|250.00|99|0.00|PARTIAL HOSPITAL
20|FH_F42755_0_0|CSTM-ALL|CSTM-00|2020|PDM|585.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42797_0_0|CSTM-ALL|CSTM-00|2020|PDM|55.00|99|0.00|OP SVCS
20|FH_F42803_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F42807_0_0|CSTM-ALL|CSTM-00|2020|PDM|1664.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42807_0_0|SrvcGrp|10107|2022|PCT|0.75|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F42807_0_0|SrvcGrp|11259|2022|PCT|0.75|99|0.00|DRUGS
20|FH_F42807_0_0|SrvcGrp|360|2022|PDM|2080.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F42807_0_0|SrvcGrp|701|2022|PDM|2080.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F42814_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42822_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F42822_0_0|CSTM-ALL|CSTM-00|2020|PDM|225.00|99|0.00|ADULT PSYCH PARTIAL HOSPITALIZATION
20|FH_F42822_0_0|CSTM-ALL|CSTM-00|2020|PDM|250.00|99|0.00|CHILD PARTIAL HOSPITALIZATION
20|FH_F42822_0_0|CSTM-ALL|CSTM-00|2020|PDM|48.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42822_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|ADULT PSYCHIATRIC
20|FH_F42822_0_0|SrvcGrp|166|2022|PDM|567.00|99|0.00|CD (ADULT) - DETOXIFICATION
20|FH_F42822_0_0|SrvcGrp|170|2022|PDM|350.00|99|0.00|CD (ADOLESCENT) - REHAB
20|FH_F42896_0_0|CSTM-ALL|CSTM-00|2020|PCT|58.40|99|0.00|GENERAL ACUTE CARE
20|FH_F42917_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE
20|FH_F42917_0_0|SrvcGrp|4109|2022|PDM|825.00|99|0.00|ACUTE PSYCH
20|FH_F42923_0_0|CSTM-ALL|CSTM-00|2020|PCT|58.30|99|0.00|OP SVCS
20|FH_F42932_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|OP SVCS
20|FH_F42933_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42937_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42941_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42943_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42945_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42946_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F42947_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42964_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F42979_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F42979_0_0|CSTM-ALL|CSTM-00|2020|PDM|79.00|99|0.00|CPT 90862
20|FH_F42979_0_0|CSTM-ALL|CSTM-00|2020|PDM|96.00|99|0.00|CPT 90808
20|FH_F42979_0_0|SrvcGrp|26350|2022|PDM|212.00|99|0.00|CPT 90802
20|FH_F42979_0_0|SrvcGrp|3403|2022|PDM|96.00|99|0.00|CPT 99203
20|FH_F42980_0_0|SrvcGrp|50203|2022|PDM|125.00|99|0.00|CPT 99214
20|FH_F42984_0_0|CSTM-ALL|CSTM-00|2020|PDM|584.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42984_0_0|SrvcGrp|110|2022|PDM|557.00|99|0.00|CD - REHABILITATION
20|FH_F42985_0_0|SrvcGrp|109|2022|PDM|400.00|99|0.00|CD - DETOX
20|FH_F42992_0_0|SrvcGrp|13643|2022|PDM|1950.00|99|0.00|DRG 372 NORMAL DELIVERY (MOTHER ONLY)
20|FH_F43000_0_0|CSTM-ALL|CSTM-00|2020|PDM|75.00|99|0.00|PT SVCS
20|FH_F43000_0_0|CSTM-ALL|CSTM-00|2020|PDM|75.00|99|0.00|RN VISIT
20|FH_F43004_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.40|99|0.00|OP SVCS
20|FH_F43007_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F43008_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.66|99|0.00|OP SVCS
20|FH_F43008_0_0|SrvcGrp|37018|2022|PDM|250.00|99|0.00|BOARDER BABY
20|FH_F43008_0_0|SrvcGrp|9539|2022|PDM|3275.00|99|0.00|SUBACUTE CARE
20|FH_F43018_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F43018_0_0|SrvcGrp|11201|2022|PDM|4515.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F43018_0_0|SrvcGrp|29817|2022|PDM|4980.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F43027_0_0|SrvcGrp|33166|2022|PDM|450.00|99|0.00|SKILLED NURSING - LEVEL III
20|FH_F43076_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F43076_0_0|CSTM-ALL|CSTM-00|2020|PDM|3763.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43078_0_0|SrvcGrp|26001|2022|PDM|525.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F43081_0_0|CSTM-ALL|CSTM-00|2020|PDM|144.00|99|0.00|OP SVCS
20|FH_F43081_0_0|SrvcGrp|1306|2022|PDM|186.00|99|0.00|OP PSYCH PARTIAL HOSP
20|FH_F43113_0_0|SrvcGrp|9828|2022|PDM|38.50|99|0.00|HOME HEALTH AIDE
20|FH_F43135_0_0|SrvcGrp|16|2022|PDM|710.00|99|0.00|ACUTE REHABILITATION
20|FH_F43139_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS
20|FH_F43147_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F43147_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|RESIDENTIAL PSYCH / CD (ADOLESCENT)
20|FH_F43147_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|ACUTE PSYCH
20|FH_F43147_0_0|SrvcGrp|109|2022|PDM|600.00|99|0.00|CD - DETOX
20|FH_F43156_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F43156_0_0|CSTM-ALL|CSTM-00|2020|PDM|225.00|99|0.00|SUB-ACUTE PHYSICAL REHAB
20|FH_F43164_0_0|CSTM-ALL|CSTM-00|2020|PDM|876.00|99|0.00|SPINAL CORD REHAB
20|FH_F43167_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F43167_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|CD ADULT REHAB
20|FH_F43171_0_0|CSTM-ALL|CSTM-00|2020|PDM|325.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43171_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|ADULT PSYCH RESIDENT TREATMENT- IP
20|FH_F43172_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43192_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43199_0_0|SrvcGrp|13703|2022|PDM|36.75|99|0.00|LICENSED PRACTICAL NURSE- HOURLY
20|FH_F43199_0_0|SrvcGrp|26798|2022|PDM|78.75|99|0.00|LICENSED PRACTICAL NURSE
20|FH_F43199_0_0|SrvcGrp|9828|2022|PDM|47.25|99|0.00|HOME HEALTH AIDE
20|FH_F43199_0_0|SrvcGrp|9832|2022|PDM|131.25|99|0.00|ST SVCS
20|FH_F43210_0_0|CSTM-ALL|CSTM-00|2020|PDM|194.00|99|0.00|SKILLED NURSING CARE
20|FH_F43237_0_0|SrvcGrp|3165|2022|PCT|0.80|99|0.00|EMERGENCY ROOM
20|FH_F43243_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43244_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS
20|FH_F43244_0_0|CSTM-ALL|CSTM-00|2020|PDM|2141.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43245_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F43249_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.54|99|0.00|MSDRG 453-517, 533-566   MUSCULOSKELETAL & CONNECTIVE TISSUE
20|FH_F43249_0_0|CSTM-ALL|CSTM-00|2020|PDM|5544.00|99|0.00|MS DRG 765-766 C-SECTION
20|FH_F43249_0_0|SrvcGrp|15150|2022|PCT|0.54|99|0.00|DRUGS
20|FH_F43249_0_0|SrvcGrp|18932|2022|PDM|4043.00|99|0.00|MS DRG 774 REPLACEMENT MS DRG 805-806
20|FH_F43249_0_0|SrvcGrp|299|2022|PCT|0.54|99|0.00|GAMMA KNIFE
20|FH_F43249_0_0|SrvcGrp|3165|2022|PCT|0.54|99|0.00|EMERGENCY ROOM
20|FH_F43260_0_0|CSTM-ALL|CSTM-00|2020|PDM|110.00|99|0.00|OP SVCS
20|FH_F43260_0_0|CSTM-ALL|CSTM-00|2020|PDM|525.00|99|0.00|ACUTE PSYCH
20|FH_F43260_0_0|CSTM-ALL|CSTM-00|2020|PDM|525.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43293_0_0|SrvcGrp|360|2022|PDM|1150.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F43293_0_0|SrvcGrp|37018|2022|PDM|200.00|99|0.00|BOARDER BABY
20|FH_F43294_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|MS DRG 765-766 C-SECTION
20|FH_F43294_0_0|SrvcGrp|31134|2022|PDM|1400.00|99|0.00|SURGICAL - ADULT/PEDIATRIC
20|FH_F43295_0_0|SrvcGrp|24|2022|PCT|0.75|99|0.00|CARDIAC CATH
20|FH_F43296_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|CD INTENSIVE OUTPATIENT SVCS
20|FH_F43296_0_0|SrvcGrp|9539|2022|PDM|940.00|99|0.00|SUBACUTE CARE
20|FH_F43352_0_0|CSTM-ALL|CSTM-00|2020|PDM|1570.00|99|0.00|WELLPATH PROPIETARY ASC VIII
20|FH_F43352_0_0|CSTM-ALL|CSTM-00|2020|PDM|90.00|99|0.00|WELLPATH PROPIETARY ASC X (MINOR PROCEDURE) 731315
20|FH_F43411_0_0|SrvcGrp|18932|2022|PDM|3865.00|99|0.00|MS DRG 774 REPLACEMENT MS DRG 805-806
20|FH_F43411_0_0|SrvcGrp|24|2022|PCT|0.75|99|0.00|CARDIAC CATH
20|FH_F43411_0_0|SrvcGrp|31134|2022|PDM|1980.00|99|0.00|SURGICAL - ADULT/PEDIATRIC
20|FH_F43417_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43417_0_0|SrvcGrp|31134|2022|PDM|1040.00|99|0.00|SURGICAL - ADULT/PEDIATRIC
20|FH_F43418_0_0|SrvcGrp|40820|2022|PDM|1280.00|99|0.00|ICU/CCU
20|FH_F43421_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F43446_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F43450_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F43503_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|OP SVCS
20|FH_F43536_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F43536_0_0|CSTM-ALL|CSTM-00|2020|PDM|2613.00|99|0.00|ACUTE IP MED SVCS
20|FH_F43612_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F43612_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F43612_0_0|SrvcGrp|13811|2022|PDM|250.00|99|0.00|PSYCH PARTIAL HOSP
20|FH_F43613_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE
20|FH_F43653_0_0|CSTM-ALL|CSTM-00|2020|PDM|425.00|99|0.00|ACUTE PSYCH
20|FH_F43653_0_0|CSTM-ALL|CSTM-00|2020|PDM|735.00|99|0.00|SPINAL CORD REHABILITATION
20|FH_F43653_0_0|CSTM-ALL|CSTM-00|2020|PDM|735.00|99|0.00|TRAUMATIC BRAIN INJURY
20|FH_F43653_0_0|CSTM-ALL|CSTM-00|2020|PDM|845.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43653_0_0|SrvcGrp|3409|2022|PDM|175.00|99|0.00|NEWBORN NURSERY
20|FH_F43653_0_0|SrvcGrp|7|2022|PDM|735.00|99|0.00|NEONATAL INTENSIVE
20|FH_F43663_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F43663_0_0|SrvcGrp|16173|2022|PDM|221.00|99|0.00|PARTIAL HOSPITALIZATION
20|FH_F43665_0_0|CSTM-ALL|CSTM-00|2020|PDM|761.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43665_0_0|SrvcGrp|26901|2022|PDM|892.00|99|0.00|VENTILATOR REHAB SERVICES
20|FH_F43679_0_0|SrvcGrp|166|2022|PDM|625.00|99|0.00|CD (ADULT) - DETOXIFICATION
20|FH_F43693_0_0|CSTM-ALL|CSTM-00|2020|PDM|490.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F43693_0_0|SrvcGrp|16420|2022|PDM|340.00|99|0.00|PSYCH RESIDENTIAL TREATMENT
20|FH_F43694_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|ACUTE PSYCH
20|FH_F43698_0_0|CSTM-ALL|CSTM-00|2020|PDM|175.00|99|0.00|CD PARTIAL HOSPITALIZATION
20|FH_F43698_0_0|CSTM-ALL|CSTM-00|2020|PDM|225.00|99|0.00|CD RESIDENTIAL TREATMENT
20|FH_F43717_0_0|SrvcGrp|38|2022|PDM|1785.00|99|0.00|NORMAL DELIVERY
20|FH_F43717_0_0|SrvcGrp|701|2022|PDM|1020.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F43719_0_0|CSTM-ALL|CSTM-00|2020|PDM|240.00|99|0.00|CD PARTIAL HOSPITALIZATION
20|FH_F43719_0_0|CSTM-ALL|CSTM-00|2020|PDM|240.00|99|0.00|PSYCH PARTIAL HOSPITALIZATION
20|FH_F43774_0_0|SrvcGrp|9829|2022|PDM|115.00|99|0.00|PT SVCS
20|FH_F43774_0_0|SrvcGrp|9830|2022|PDM|115.00|99|0.00|OT SVCS
20|FH_F43779_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|FACTOR IX
20|FH_F43779_0_0|SrvcGrp|12969|2022|PDM|677.00|99|0.00|NEWBORN NURSERY
20|FH_F43786_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F43801_0_0|CSTM-ALL|CSTM-00|2020|PDM|961.00|99|0.00|SPINAL CORD REHABILITATION
20|FH_F43832_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|MEDICAL SUPPLIES
20|FH_F43832_0_0|SrvcGrp|12263|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE- HOURLY
20|FH_F43832_0_0|SrvcGrp|13703|2022|PDM|67.00|99|0.00|LICENSED PRACTICAL NURSE- HOURLY
20|FH_F43832_0_0|SrvcGrp|47622|2022|PDM|152.00|99|0.00|ENTEROSTOMAL THERAPY
20|FH_F43837_0_0|CSTM-ALL|CSTM-00|2020|PDM|250.00|99|0.00|INITIAL VESTIBULAR EVAL & TESTING
20|FH_F43858_0_0|SrvcGrp|27725|2022|PDM|40.00|99|0.00|SKILLED RN HOURLY
20|FH_F43858_0_0|SrvcGrp|30955|2022|PDM|115.00|99|0.00|SKILLED RN VISIT
20|FH_F43858_0_0|SrvcGrp|37404|2022|PDM|90.00|99|0.00|PT SVCS
20|FH_F43858_0_0|SrvcGrp|37405|2022|PDM|90.00|99|0.00|OT SVCS
20|FH_F43859_0_0|SrvcGrp|27725|2022|PDM|40.00|99|0.00|SKILLED RN HOURLY
20|FH_F43859_0_0|SrvcGrp|35468|2022|PDM|75.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F43860_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE
20|FH_F43860_0_0|CSTM-ALL|CSTM-00|2020|PDM|25.00|99|0.00|SKILLED LPN HOURLY
20|FH_F43860_0_0|SrvcGrp|27725|2022|PDM|40.00|99|0.00|SKILLED RN HOURLY
20|FH_F43860_0_0|SrvcGrp|30958|2022|PDM|65.00|99|0.00|SKILLED LPN VISIT
20|FH_F43860_0_0|SrvcGrp|37404|2022|PDM|90.00|99|0.00|PT SVCS
20|FH_F43861_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE
20|FH_F43861_0_0|SrvcGrp|37405|2022|PDM|90.00|99|0.00|OT SVCS
20|FH_F43862_0_0|SrvcGrp|30955|2022|PDM|115.00|99|0.00|SKILLED RN VISIT
20|FH_F43862_0_0|SrvcGrp|35468|2022|PDM|75.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F43862_0_0|SrvcGrp|37404|2022|PDM|90.00|99|0.00|PT SVCS
20|FH_F43862_0_0|SrvcGrp|37406|2022|PDM|90.00|99|0.00|SPEECH THERAPY SVCS
20|FH_F43863_0_0|SrvcGrp|30961|2022|PDM|12.50|99|0.00|HOME HEALTH AIDE
20|FH_F43863_0_0|SrvcGrp|37404|2022|PDM|90.00|99|0.00|PT SVCS
20|FH_F43865_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F43865_0_0|SrvcGrp|27725|2022|PDM|40.00|99|0.00|SKILLED RN HOURLY
20|FH_F43865_0_0|SrvcGrp|30961|2022|PDM|12.50|99|0.00|HOME HEALTH AIDE
20|FH_F43867_0_0|SrvcGrp|37403|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE
20|FH_F43867_0_0|SrvcGrp|37406|2022|PDM|90.00|99|0.00|SPEECH THERAPY SVCS
20|FH_F43872_0_0|SrvcGrp|472|2022|PDM|359.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F43872_0_0|SrvcGrp|473|2022|PDM|303.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F43895_0_0|SrvcGrp|45883|2022|PDM|125.00|99|0.00|OT
20|FH_F43913_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|OP SVCS
20|FH_F43913_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43913_0_0|SrvcGrp|13990|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F43953_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.66|99|0.00|OP SVCS
20|FH_F43953_0_0|SrvcGrp|13488|2022|PCT|0.70|99|0.00|ELECTROSHOCK THERAPY TREATMENT
20|FH_F43953_0_0|SrvcGrp|27569|2022|PCT|0.70|99|0.00|MEDICAL/SURGICAL SUPPLIES
20|FH_F43953_0_0|SrvcGrp|38444|2022|PCT|0.70|99|0.00|MEDICAL/SURGICAL SUPPLIES
20|FH_F44020_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44023_0_0|SrvcGrp|10675|2022|PDM|3152.00|99|0.00|ICU/CCU
20|FH_F44023_0_0|SrvcGrp|38421|2022|PCT|0.69|99|0.00|INTERLUKEN II & DRUGS (IP)
20|FH_F44042_0_0|SrvcGrp|10425|2022|PDM|225.00|99|0.00|NEWBORN NURSERY
20|FH_F44048_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|CHILD PSYCH RESIDENTIAL TREATMENT
20|FH_F44048_0_0|CSTM-ALL|CSTM-00|2020|PDM|609.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44075_0_0|CSTM-ALL|CSTM-00|2020|PDM|1144.00|99|0.00|ASPG VIII
20|FH_F44075_0_0|CSTM-ALL|CSTM-00|2020|PDM|730.40|99|0.00|ASPG IV
20|FH_F44075_0_0|SrvcGrp|13297|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F44093_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F44095_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F44095_0_0|CSTM-ALL|CSTM-00|2020|PDM|1255.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44097_0_0|CSTM-ALL|CSTM-00|2020|PDM|312.00|99|0.00|PSYCH PARTIAL HOSPITALIZATION
20|FH_F44113_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE
20|FH_F44113_0_0|SrvcGrp|177|2022|PDM|1400.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F44113_0_0|SrvcGrp|22461|2022|PCT|0.80|99|0.00|INPATIENT HOSPICE SVCS
20|FH_F44113_0_0|SrvcGrp|58433|2022|PDM|600.00|99|0.00|COMPUTED TOMOGRAPHY (CT SCAN)
20|FH_F44132_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44132_0_0|SrvcGrp|33166|2022|PDM|480.00|99|0.00|SKILLED NURSING - LEVEL III
20|FH_F44132_0_0|SrvcGrp|33224|2022|PCT|1.00|99|0.00|HIGH COST DRUGS
20|FH_F44132_0_0|SrvcGrp|471|2022|PDM|550.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F44134_0_0|CSTM-ALL|CSTM-00|2020|PDM|612.48|99|0.00|COVENTRY ENHANCED GROUPER 2
20|FH_F44134_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.37|99|0.00|COVENTRY ENHANCED GROUPER 10
20|FH_F44134_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.37|99|0.00|COVENTRY ENHANCED GROUPER 3
20|FH_F44134_0_0|CSTM-ALL|CSTM-00|2020|PDM|865.16|99|0.00|COVENTRY ENHANCED GROUPER 4
20|FH_F44134_0_0|CSTM-ALL|CSTM-00|2020|PDM|984.64|99|0.00|COVENTRY ENHANCED GROUPER 5
20|FH_F44172_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44177_0_0|CSTM-ALL|CSTM-00|2020|PDM|1633.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F44177_0_0|SrvcGrp|21826|2022|PDM|3149.00|99|0.00|PTCA (MS DRG ONLY)
20|FH_F44177_0_0|SrvcGrp|8968|2022|PDM|2030.00|99|0.00|NICU LEVEL III & IV
20|FH_F44195_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F44195_0_0|CSTM-ALL|CSTM-00|2020|PDM|156.00|99|0.00|CD RESIDENTIAL TREATMENT
20|FH_F44198_0_0|SrvcGrp|2067|2022|PDM|566.00|99|0.00|SPECIALTY CARE TRANSPORT
20|FH_F44218_0_0|SrvcGrp|3577|2022|PDM|300.00|99|0.00|PARTIAL HOSPITALIZATION
20|FH_F44225_0_0|SrvcGrp|229|2022|PDM|700.00|99|0.00|COMPUTED TOMOGRAPHY (CT SCAN)
20|FH_F44241_0_0|CSTM-ALL|CSTM-00|2020|PDM|1594.00|99|0.00|ASPG III
20|FH_F44241_0_0|CSTM-ALL|CSTM-00|2020|PDM|2880.00|99|0.00|ASPG VII
20|FH_F44241_0_0|CSTM-ALL|CSTM-00|2020|PDM|4641.00|99|0.00|LAPAROSCOPY
20|FH_F44255_0_0|CSTM-ALL|CSTM-00|2020|PDM|212.00|99|0.00|CD PARTIAL HOSPITALIZATION
20|FH_F44255_0_0|CSTM-ALL|CSTM-00|2020|PDM|583.00|99|0.00|ACUTE PSYCH
20|FH_F44255_0_0|SrvcGrp|1306|2022|PDM|265.00|99|0.00|OP PSYCH PARTIAL HOSP
20|FH_F44257_0_0|CSTM-ALL|CSTM-00|2020|PDM|1044.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44257_0_0|CSTM-ALL|CSTM-00|2020|PDM|451.00|99|0.00|SKILLED NURSING
20|FH_F44257_0_0|CSTM-ALL|CSTM-00|2020|PDM|579.00|99|0.00|ACUTE PSYCH
20|FH_F44257_0_0|SrvcGrp|16|2022|PDM|974.00|99|0.00|ACUTE REHABILITATION
20|FH_F44257_0_0|SrvcGrp|350|2022|PDM|1739.00|99|0.00|SURGICAL CARE
20|FH_F44278_0_0|SrvcGrp|177|2022|PDM|2100.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F44278_0_0|SrvcGrp|22092|2022|PDM|850.00|99|0.00|MAGNETIC RESONANCE IMAGING (MRI)
20|FH_F44278_0_0|SrvcGrp|31007|2022|PDM|300.00|99|0.00|MS DRG 795 ONLY & REV CODES 170-171 NORMAL NEWBORN
20|FH_F44278_0_0|SrvcGrp|3224|2022|PCT|0.85|99|0.00|EMERGENCY ROOM SVCS
20|FH_F44279_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F44293_0_0|CSTM-ALL|CSTM-00|2020|PCT|71.20|99|0.00|GENERAL ACUTE CARE
20|FH_F44299_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F44312_0_0|CSTM-ALL|CSTM-00|2020|PDM|555.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44312_0_0|CSTM-ALL|CSTM-00|2020|PDM|565.00|99|0.00|ADOLESCENT PSYCHIATRIC
20|FH_F44314_0_0|SrvcGrp|26205|2022|PDM|46.00|99|0.00|ST
20|FH_F44314_0_0|SrvcGrp|33165|2022|PDM|325.00|99|0.00|SKILLED NURSING - LEVEL II
20|FH_F44314_0_0|SrvcGrp|33166|2022|PDM|450.00|99|0.00|SKILLED NURSING - LEVEL III
20|FH_F44336_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F44336_0_0|SrvcGrp|170|2022|PDM|354.00|99|0.00|CD (ADOLESCENT) - REHAB
20|FH_F44342_0_0|CSTM-ALL|CSTM-00|2020|PDM|680.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44354_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F44356_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS
20|FH_F44358_0_0|CSTM-ALL|CSTM-00|2020|PDM|495.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F44358_0_0|CSTM-ALL|CSTM-00|2020|PDM|597.00|99|0.00|ACUTE PSYCH
20|FH_F44394_0_0|CSTM-ALL|CSTM-00|2020|PDM|222.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44396_0_0|CSTM-ALL|CSTM-00|2020|PDM|359.00|99|0.00|ACUTE PSYCH
20|FH_F44435_0_0|CSTM-ALL|CSTM-00|2020|PDM|1462.00|99|0.00|AEG 10 (NO REV)
20|FH_F44435_0_0|CSTM-ALL|CSTM-00|2020|PDM|2251.00|99|0.00|AEG 6 (NO REV)
20|FH_F44435_0_0|CSTM-ALL|CSTM-00|2020|PDM|2510.00|99|0.00|AEG 8 (NO REV)
20|FH_F44435_0_0|CSTM-ALL|CSTM-00|2020|PDM|2686.00|99|0.00|AEG 7 (NO REV)
20|FH_F44435_0_0|CSTM-ALL|CSTM-00|2020|PDM|4100.00|99|0.00|OP SURGERY (CPT 58541-58542, 58552)
20|FH_F44435_0_0|CSTM-ALL|CSTM-00|2020|PDM|693.00|99|0.00|AEG 1 (NO REV)
20|FH_F44435_0_0|SrvcGrp|16732|2022|PDM|3900.00|99|0.00|HYSTEROSCOPY ABLATION
20|FH_F44435_0_0|SrvcGrp|38585|2022|PDM|2600.00|99|0.00|OP SURGERY (CPT 49505, 49565)
20|FH_F44438_0_0|CSTM-ALL|CSTM-00|2020|PDM|1406.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F44438_0_0|SrvcGrp|2741|2022|PCT|0.70|99|0.00|DRUGS
20|FH_F44438_0_0|SrvcGrp|3077|2022|PCT|0.70|99|0.00|IMPLANTS
20|FH_F44438_0_0|SrvcGrp|997|2022|PCT|0.70|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F44449_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F44476_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS
20|FH_F44495_0_0|SrvcGrp|12401|2022|PDM|108.00|99|0.00|RN VISIT
20|FH_F44495_0_0|SrvcGrp|38695|2022|PDM|140.00|99|0.00|DIETICIAN VISIT
20|FH_F44557_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44582_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|ASPG IX
20|FH_F44582_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|ASPG VII
20|FH_F44582_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|ASPG X
20|FH_F44582_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|PACEMAKER / AICD WITHOUT ACUTE INFARCTION
20|FH_F44582_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|MS DRG 767-768, 774-775 NORMAL DELIVERY
20|FH_F44582_0_0|SrvcGrp|13292|2022|PCT|0.65|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F44582_0_0|SrvcGrp|23477|2022|PDM|7000.00|99|0.00|MSDRG 286-287 ONLY CARDIAC CATH
20|FH_F44582_0_0|SrvcGrp|3029|2022|PDM|600.00|99|0.00|NEWBORN NURSERY
20|FH_F44582_0_0|SrvcGrp|30456|2022|PCT|0.65|99|0.00|DRUGS
20|FH_F44582_0_0|SrvcGrp|360|2022|PDM|2800.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F44582_0_0|SrvcGrp|8968|2022|PDM|3300.00|99|0.00|NICU LEVEL III & IV
20|FH_F44582_0_0|SrvcGrp|9511|2022|PCT|0.70|99|0.00|OBSERVATION SVCS
20|FH_F44584_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|OP SVCS
20|FH_F44606_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44606_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F44606_0_0|SrvcGrp|38823|2022|PDM|375.00|99|0.00|HOME SLEEP TEST (TYPE III)
20|FH_F44612_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F44638_0_0|CSTM-ALL|CSTM-00|2020|PDM|190.00|99|0.00|ADOLESCENT CD PARTIAL HOSP
20|FH_F44638_0_0|CSTM-ALL|CSTM-00|2020|PDM|190.00|99|0.00|CD PARTIAL HOSPITALIZATION (OP) - ADULT
20|FH_F44638_0_0|CSTM-ALL|CSTM-00|2020|PDM|200.00|99|0.00|OP ADULT PSYCHIATRIC PARTIAL HOSP
20|FH_F44638_0_0|CSTM-ALL|CSTM-00|2020|PDM|200.00|99|0.00|PSYCHIATRIC PARTIAL HOSPITALIZATION (IP) - ADOLESCENT
20|FH_F44638_0_0|SrvcGrp|167|2022|PDM|425.00|99|0.00|CD (ADULT) - REHABILITATION
20|FH_F44638_0_0|SrvcGrp|196|2022|PDM|590.00|99|0.00|CD (ADOLESCENT) - DETOX
20|FH_F44644_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44644_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|OP SVCS
20|FH_F44660_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44660_0_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|MS DRG 765-766 C-SECTION
20|FH_F44660_0_0|SrvcGrp|9774|2022|PDM|2300.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F44701_0_0|CSTM-ALL|CSTM-00|2020|PDM|1443.00|99|0.00|ASPG VII
20|FH_F44701_0_0|SrvcGrp|38907|2022|PDM|950.00|99|0.00|CPT 66170 - FISTULIZATION OF SCLERA FOR GLAUCOMA
20|FH_F44724_0_0|SrvcGrp|33164|2022|PDM|260.00|99|0.00|SKILLED NURSING - LEVEL I
20|FH_F44724_0_0|SrvcGrp|33166|2022|PDM|515.00|99|0.00|SKILLED NURSING - LEVEL III
20|FH_F44754_0_0|SrvcGrp|10541|2022|PDM|80.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F44754_0_0|SrvcGrp|10545|2022|PDM|72.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F44772_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44813_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F44813_0_0|CSTM-ALL|CSTM-00|2020|PDM|240.00|99|0.00|RESIDENTIAL TREATMENT SVCS
20|FH_F44813_0_0|CSTM-ALL|CSTM-00|2020|PDM|430.00|99|0.00|ADOLESCENT PSYCHIATRIC
20|FH_F44952_0_0|SrvcGrp|22954|2022|PDM|135.11|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F44992_0_0|SrvcGrp|13217|2022|PCT|1.10|99|0.00|ORTHOTICS/PROSTHETICS/IMPLANTS
20|FH_F44992_0_0|SrvcGrp|16|2022|PDM|900.00|99|0.00|ACUTE REHABILITATION
20|FH_F45093_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F45120_0_0|CSTM-ALL|CSTM-00|2020|PDM|1347.00|99|0.00|COVENTRY ENHANCED GROUPER 8
20|FH_F45120_0_0|CSTM-ALL|CSTM-00|2020|PDM|1366.00|99|0.00|COVENTRY ENHANCED GROUPER 7
20|FH_F45120_0_0|CSTM-ALL|CSTM-00|2020|PDM|457.00|99|0.00|COVENTRY ENHANCED GROUPER 1
20|FH_F45120_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|COVENTRY ENHANCED GROUPER 3
20|FH_F45120_0_0|CSTM-ALL|CSTM-00|2020|PDM|984.00|99|0.00|COVENTRY ENHANCED GROUPER 5
20|FH_F45120_0_0|SrvcGrp|13292|2022|PCT|0.21|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F45120_0_0|SrvcGrp|40403|2022|PDM|500.00|99|0.00|EMERGENCY ROOM SVCS
20|FH_F45121_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F45174_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.72|99|0.00|OP SVCS
20|FH_F45175_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F45176_0_0|CSTM-ALL|CSTM-00|2020|PDM|1682.00|99|0.00|ASPG VI
20|FH_F45176_0_0|CSTM-ALL|CSTM-00|2020|PDM|2032.00|99|0.00|ASPG VII
20|FH_F45176_0_0|CSTM-ALL|CSTM-00|2020|PDM|2250.00|99|0.00|NASAL/SINUS ENDOSCOPY
20|FH_F45179_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.63|99|0.00|OP SVCS
20|FH_F45212_0_0|CSTM-ALL|CSTM-00|2020|PDM|1727.00|99|0.00|CD RESIDENTIAL TREATMENT
20|FH_F45212_0_0|CSTM-ALL|CSTM-00|2020|PDM|35.00|99|0.00|PHYSICIANS SERVICES
20|FH_F45303_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING
20|FH_F45303_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F45303_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F45312_0_0|SrvcGrp|39742|2022|PCT|0.88|99|0.00|BURN INTENSIVE CARE - OUTPATIENT
20|FH_F45324_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F45324_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING
20|FH_F45324_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP DIALYSIS
20|FH_F45372_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|ACUTE PSYCH
20|FH_F45392_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F45392_0_0|SrvcGrp|10400|2022|PDM|1500.00|99|0.00|IP SURGERY
20|FH_F45435_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE
20|FH_F45435_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F45435_0_0|SrvcGrp|12856|2022|PDM|50.00|99|0.00|NURSING CARE
20|FH_F45435_0_0|SrvcGrp|17766|2022|PDM|90.00|99|0.00|HOME HEALTH - PT/OT/ST
20|FH_F45436_0_0|SrvcGrp|12856|2022|PDM|70.00|99|0.00|NURSING CARE
20|FH_F45436_0_0|SrvcGrp|9828|2022|PDM|55.00|99|0.00|HOME HEALTH AIDE
20|FH_F45513_0_0|CSTM-ALL|CSTM-00|2020|PDM|1145.83|99|0.00|COVENTRY ENHANCED GROUPER 6
20|FH_F45513_0_0|CSTM-ALL|CSTM-00|2020|PDM|1366.41|99|0.00|COVENTRY ENHANCED GROUPER 7
20|FH_F45513_0_0|CSTM-ALL|CSTM-00|2020|PDM|1838.81|99|0.00|COVENTRY ENHANCED GROUPER 9
20|FH_F45513_0_0|CSTM-ALL|CSTM-00|2020|PDM|457.30|99|0.00|COVENTRY ENHANCED GROUPER 1
20|FH_F45513_0_0|CSTM-ALL|CSTM-00|2020|PDM|612.48|99|0.00|COVENTRY ENHANCED GROUPER 2
20|FH_F45513_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.37|99|0.00|COVENTRY ENHANCED GROUPER 3
20|FH_F45513_0_0|CSTM-ALL|CSTM-00|2020|PDM|984.64|99|0.00|COVENTRY ENHANCED GROUPER 5
20|FH_F45513_0_0|SrvcGrp|10986|2022|PDM|2300.00|99|0.00|ARTHROSCOPIC KNEE REPAIR
20|FH_F45513_0_0|SrvcGrp|41333|2022|PDM|4200.00|99|0.00|LITHO MOD 51
20|FH_F45513_0_0|SrvcGrp|60816|2022|PCT|1.10|99|0.00|IMPLANTS/PROSTHETICS/DEVICES
20|FH_F45535_0_0|CSTM-ALL|CSTM-00|2020|PDM|1096.00|99|0.00|ASPG VIII- GNADEN HUETTEN
20|FH_F45535_0_0|CSTM-ALL|CSTM-00|2020|PDM|1568.00|99|0.00|ASPG X- GNADEN HUETTEN (LAP/ARTH)
20|FH_F45535_0_0|CSTM-ALL|CSTM-00|2020|PDM|572.00|99|0.00|ASPG III - GNADEN HUETTEN
20|FH_F45535_0_0|CSTM-ALL|CSTM-00|2020|PDM|931.00|99|0.00|ASPG VI- GNADEN HUETTEN
20|FH_F45573_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F45573_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F45752_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F45752_0_0|CSTM-ALL|CSTM-00|2020|PDM|575.00|99|0.00|ASPG I
20|FH_F45752_0_0|CSTM-ALL|CSTM-00|2020|PDM|870.00|99|0.00|ASPG III
20|FH_F45752_0_0|CSTM-ALL|CSTM-00|2020|PDM|870.00|99|0.00|ASPG X
20|FH_F45798_0_0|CSTM-ALL|CSTM-00|2020|PDM|12300.00|99|0.00|DRG 499 ONLY
20|FH_F45798_0_0|CSTM-ALL|CSTM-00|2020|PDM|15600.00|99|0.00|DRG 520 CERVICAL SPINAL FUSION W/O CC
20|FH_F45798_0_0|CSTM-ALL|CSTM-00|2020|PDM|16900.00|99|0.00|DRG 233 ONLY - OTHR MUSCULOSKEL &  CONN TISS O.R.  PROC W CC
20|FH_F45798_0_0|CSTM-ALL|CSTM-00|2020|PDM|2074.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F45798_0_0|CSTM-ALL|CSTM-00|2020|PDM|33900.00|99|0.00|DRG 497 ONLY
20|FH_F45798_0_0|CSTM-ALL|CSTM-00|2020|PDM|8200.00|99|0.00|DRG 500 BACK & NECK PROCEDURE EXCEPT SPINAL FUSION W/O CC
20|FH_F45798_0_0|SrvcGrp|11188|2022|PDM|18500.00|99|0.00|DRG 552 OTHER PERMANENT CARDIAC PACEMAKER IMP W/O CV DX
20|FH_F45798_0_0|SrvcGrp|16|2022|PDM|1539.00|99|0.00|ACUTE REHABILITATION
20|FH_F45798_0_0|SrvcGrp|329|2022|PDM|17000.00|99|0.00|DRG 288 GASTROPLASTY PROCEDURE OBESITY
20|FH_F45798_0_0|SrvcGrp|63|2022|PDM|1604.00|99|0.00|SUBACUTE CARE
20|FH_F45798_0_0|SrvcGrp|8|2022|PDM|2933.00|99|0.00|BURN INTENSIVE CARE
20|FH_F45798_0_0|SrvcGrp|9529|2022|PDM|911.00|99|0.00|HOSPICE SVCS
20|FH_F45915_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F45915_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F45932_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F45973_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F45974_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F46097_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F46173_0_0|SrvcGrp|29971|2022|PDM|675.00|99|0.00|DIALYSIS
20|FH_F46192_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F46192_0_0|SrvcGrp|10111|2022|PCT|0.70|99|0.00|IMPLANTS
20|FH_F46257_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F46273_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F46276_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F46284_0_0|SrvcGrp|24639|2022|PDM|147.00|99|0.00|SPEECH THERAPY SERVICES
20|FH_F46290_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|OP SVCS
20|FH_F46333_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F46352_0_0|CSTM-ALL|CSTM-00|2020|PDM|158.00|99|0.00|SKILLED NURSING CARE
20|FH_F46352_0_0|CSTM-ALL|CSTM-00|2020|PDM|158.00|99|0.00|SOCIAL WORKER
20|FH_F46352_0_0|SrvcGrp|12403|2022|PDM|72.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F46354_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F46354_0_0|CSTM-ALL|CSTM-00|2020|PDM|531.31|99|0.00|COVENTRY ENHANCED GROUPER 10
20|FH_F46354_0_0|CSTM-ALL|CSTM-00|2020|PDM|656.33|99|0.00|COVENTRY ENHANCED GROUPER 4
20|FH_F46354_0_0|CSTM-ALL|CSTM-00|2020|PDM|869.25|99|0.00|COVENTRY ENHANCED GROUPER 6
20|FH_F46354_0_0|SrvcGrp|3932|2022|PDM|3150.00|99|0.00|LITHOTRIPSY
20|FH_F46357_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F46357_0_0|CSTM-ALL|CSTM-00|2020|PDM|1269.70|99|0.00|COVENTRY ENHANCED GROUPER 6
20|FH_F46357_0_0|CSTM-ALL|CSTM-00|2020|PDM|795.81|99|0.00|COVENTRY ENHANCED GROUPER 10
20|FH_F46357_0_0|CSTM-ALL|CSTM-00|2020|PDM|795.81|99|0.00|COVENTRY ENHANCED GROUPER 3
20|FH_F46357_0_0|SrvcGrp|41335|2022|PDM|3400.00|99|0.00|TOTAL HIP
20|FH_F46357_0_0|SrvcGrp|41336|2022|PDM|3300.00|99|0.00|VAGINAL HYSTERECTOMY
20|FH_F46357_0_0|SrvcGrp|41546|2022|PDM|3000.00|99|0.00|LAPAROSCOPIC APPENDECTOMY
20|FH_F46357_0_0|SrvcGrp|41547|2022|PDM|3000.00|99|0.00|OP LAPAROSCOPIC HYSTERECTOMY
20|FH_F46359_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE
20|FH_F46372_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F46373_0_0|SrvcGrp|977|2022|PCT|0.84|99|0.00|RADIOLOGY SVCS
20|FH_F46473_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|ASPG X
20|FH_F46473_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F46473_0_0|CSTM-ALL|CSTM-00|2020|PDM|1158.00|99|0.00|ASPG IV
20|FH_F46473_0_0|CSTM-ALL|CSTM-00|2020|PDM|1315.00|99|0.00|ASPG V
20|FH_F46473_0_0|CSTM-ALL|CSTM-00|2020|PDM|1828.00|99|0.00|ASPG VII
20|FH_F46473_0_0|SrvcGrp|10391|2022|PDM|2076.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F46473_0_0|SrvcGrp|3388|2022|PDM|969.00|99|0.00|SUBACUTE CARE
20|FH_F46492_0_0|CSTM-ALL|CSTM-00|2020|PDM|1315.00|99|0.00|ASPG V
20|FH_F46492_0_0|CSTM-ALL|CSTM-00|2020|PDM|1512.00|99|0.00|ASPG VI
20|FH_F46492_0_0|CSTM-ALL|CSTM-00|2020|PDM|1828.00|99|0.00|ASPG VII
20|FH_F46492_0_0|CSTM-ALL|CSTM-00|2020|PDM|820.00|99|0.00|ASPG II
20|FH_F46492_0_0|SrvcGrp|3448|2022|PDM|1177.00|99|0.00|MRI
20|FH_F46612_0_0|CSTM-ALL|CSTM-00|2020|PDM|166.00|99|0.00|SKILLED NURSING CARE
20|FH_F46612_0_0|SrvcGrp|10410|2022|PDM|83.00|99|0.00|SKILLED NURSING CARE
20|FH_F46612_0_0|SrvcGrp|11080|2022|PDM|166.00|99|0.00|NURSING CARE
20|FH_F46612_0_0|SrvcGrp|24639|2022|PDM|154.00|99|0.00|SPEECH THERAPY SERVICES
20|FH_F46612_0_0|SrvcGrp|26001|2022|PDM|329.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F46612_0_0|SrvcGrp|9828|2022|PDM|66.00|99|0.00|HOME HEALTH AIDE
20|FH_F46612_0_0|SrvcGrp|9937|2022|PDM|154.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F46672_0_0|SrvcGrp|38695|2022|PDM|70.00|99|0.00|DIETICIAN VISIT
20|FH_F46732_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F46732_0_0|SrvcGrp|14306|2022|PDM|134.00|99|0.00|WELL MOM/WELL BABY VISIT
20|FH_F46732_0_0|SrvcGrp|29402|2022|PDM|144.00|99|0.00|HOME HEALTH THERAPY VISITS OP
20|FH_F46732_0_0|SrvcGrp|9828|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE
20|FH_F46772_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS
20|FH_F46815_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F46856_0_0|CSTM-ALL|CSTM-00|2020|PCT|68.00|99|0.00|OP SVCS
20|FH_F46857_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS
20|FH_F46874_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|ASPG X
20|FH_F46874_0_0|CSTM-ALL|CSTM-00|2020|PDM|1750.00|99|0.00|ASPG VII
20|FH_F46876_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.50|99|0.00|OP SVCS
20|FH_F46903_0_0|CSTM-ALL|CSTM-00|2020|PDM|60.00|99|0.00|OP SVCS
20|FH_F46914_0_0|CSTM-ALL|CSTM-00|2020|PDM|158.00|99|0.00|SKILLED NURSING CARE
20|FH_F46914_0_0|SrvcGrp|10410|2022|PDM|79.00|99|0.00|SKILLED NURSING CARE
20|FH_F46914_0_0|SrvcGrp|26742|2022|PDM|147.00|99|0.00|PT
20|FH_F46918_0_0|SrvcGrp|10540|2022|PDM|22.00|99|0.00|HOME HEALTH AIDE
20|FH_F46918_0_0|SrvcGrp|10541|2022|PDM|110.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F46918_0_0|SrvcGrp|10542|2022|PDM|110.00|99|0.00|OCCUPATIONAL THERAPY SVCS
20|FH_F46918_0_0|SrvcGrp|22387|2022|PDM|50.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F46918_0_0|SrvcGrp|27968|2022|PDM|41.00|99|0.00|SKILLED NURSING LPN
20|FH_F46938_0_0|SrvcGrp|32189|2022|PDM|35.00|99|0.00|RESPITE CARE
20|FH_F46941_0_0|SrvcGrp|32189|2022|PDM|35.00|99|0.00|RESPITE CARE
20|FH_F46972_0_0|SrvcGrp|10528|2022|PDM|45.00|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F47037_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F47037_0_0|SrvcGrp|10540|2022|PDM|37.00|99|0.00|HOME HEALTH AIDE
20|FH_F47037_0_0|SrvcGrp|10543|2022|PDM|92.00|99|0.00|SPEECH THERAPY SVCS
20|FH_F47037_0_0|SrvcGrp|18024|2022|PDM|65.00|99|0.00|NUTRITNAL CNSLNG/DIABETES EDU
20|FH_F47056_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F47056_0_0|SrvcGrp|12403|2022|PDM|30.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F47056_0_0|SrvcGrp|26001|2022|PDM|110.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F47056_0_0|SrvcGrp|3809|2022|PDM|550.00|99|0.00|HOSPICE CARE
20|FH_F47113_0_0|CSTM-ALL|CSTM-00|2020|PDM|1304.00|99|0.00|AEG 7 (NO REV)
20|FH_F47113_0_0|CSTM-ALL|CSTM-00|2020|PDM|1753.00|99|0.00|AEG 9 (NO REV)
20|FH_F47113_0_0|CSTM-ALL|CSTM-00|2020|PDM|884.00|99|0.00|AEG 6 (NO REV)
20|FH_F47128_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F47130_0_0|SrvcGrp|3142|2022|PDM|2270.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F47137_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F47140_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F47140_0_0|CSTM-ALL|CSTM-00|2020|PDM|105.12|99|0.00|SLEEP STUDIES CPT 95806 W/MODIFIER TC
20|FH_F47140_0_0|CSTM-ALL|CSTM-00|2020|PDM|173.53|99|0.00|SLEEP STUDIES CPT 95811 W/MODIFIER 26
20|FH_F47140_0_0|SrvcGrp|13626|2022|PDM|462.88|99|0.00|SLEEP STUDIES
20|FH_F47140_0_0|SrvcGrp|13627|2022|PDM|181.17|99|0.00|SLEEP STUDY
20|FH_F47140_0_0|SrvcGrp|28727|2022|PDM|86.87|99|0.00|SLEEP STUDIES CPT 95805 W/MODIFIER 26
20|FH_F47233_0_0|CSTM-ALL|CSTM-00|2020|PDM|1620.00|99|0.00|WELLPATH PROPIETARY ASC VIII
20|FH_F47233_0_0|CSTM-ALL|CSTM-00|2020|PDM|810.00|99|0.00|WELLPATH PROPIETARY ASC V
20|FH_F47234_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|PROFESSIONAL FEES ON CMS1500
20|FH_F47234_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F47245_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F47245_0_0|SrvcGrp|42434|2022|PDM|45.00|99|0.00|OUTPATIENT THERAPY SVCS
20|FH_F47359_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE
20|FH_F47421_0_0|CSTM-ALL|CSTM-00|2020|PDM|1480.00|99|0.00|ASPG VIII
20|FH_F47421_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|ASPG II
20|FH_F47421_0_0|SrvcGrp|36991|2022|PCT|0.50|99|0.00|IMPLANTS
20|FH_F47424_0_0|SrvcGrp|22954|2022|PDM|164.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F47462_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F47462_0_0|SrvcGrp|10507|2022|PDM|130.00|99|0.00|OCCUPATIONAL THERAPY SVCS RE-EVAL
20|FH_F47462_0_0|SrvcGrp|15477|2022|PDM|130.00|99|0.00|PHYSICAL THERAPY SVCS INITIAL EVAL
20|FH_F47495_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE
20|FH_F47495_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F47495_0_0|SrvcGrp|18076|2022|PCT|0.50|99|0.00|MRI
20|FH_F47495_0_0|SrvcGrp|42783|2022|PCT|0.50|99|0.00|HIGH COST DRUGS
20|FH_F47552_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F47552_0_0|CSTM-ALL|CSTM-00|2020|PDM|1888.00|99|0.00|ASPG VIII
20|FH_F47552_0_0|CSTM-ALL|CSTM-00|2020|PDM|2597.00|99|0.00|ASPG IX
20|FH_F47573_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F47573_0_0|SrvcGrp|42824|2022|PDM|140.00|99|0.00|SKILLED NURSING VISIT
20|FH_F47573_0_0|SrvcGrp|42827|2022|PDM|158.00|99|0.00|OCCUPATIONAL THERAPY VISIT
20|FH_F47605_0_0|SrvcGrp|115049|2022|PDM|500.00|99|0.00|DAY PROGRAM
20|FH_F47636_0_0|SrvcGrp|22954|2022|PDM|132.94|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F47641_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|OP SVCS
20|FH_F47656_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|OP SVCS
20|FH_F47656_0_0|CSTM-ALL|CSTM-00|2020|PDM|6100.00|99|0.00|CV SURGERY (MS DRG)
20|FH_F47656_0_0|SrvcGrp|11336|2022|PCT|0.75|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F47656_0_0|SrvcGrp|24703|2022|PDM|740.00|99|0.00|NEWBORN NURSERY
20|FH_F47656_0_0|SrvcGrp|360|2022|PCT|0.80|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F47659_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|OP SVCS
20|FH_F47659_0_0|SrvcGrp|360|2022|PCT|0.80|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F47679_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F47679_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F47679_0_0|CSTM-ALL|CSTM-00|2020|PDM|560.00|99|0.00|SKILLED NURSING
20|FH_F47679_0_0|SrvcGrp|42784|2022|PDM|40.12|99|0.00|OCCUPATIONAL THERAPY  SRVCS
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|1020.00|99|0.00|GA RETINA SURG CTR ASC 24
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|1168.00|99|0.00|GA RETINA SURG CTR ASC 27
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|1408.00|99|0.00|GA RETINA SURG CTR ASC 29
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|1502.00|99|0.00|GA RETINA SURG CTR ASC 32
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|177.00|99|0.00|GA RETINA SURG CTR ASC 3
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|199.00|99|0.00|GA RETINA SURG CTR ASC 5
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|257.00|99|0.00|GA RETINA SURG CTR ASC 8
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|320.00|99|0.00|GA RETINA SURG CTR ASC 11
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|328.00|99|0.00|GA RETINA SURG CTR ASC 12
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|924.00|99|0.00|GA RETINA SURG CTR ASC 20
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|972.00|99|0.00|GA RETINA SURG CTR ASC 22
20|FH_F47717_0_0|SrvcGrp|33484|2022|PDM|62.00|99|0.00|THERAPY SERVICES
20|FH_F47724_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F47724_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F47736_0_0|SrvcGrp|12403|2022|PDM|30.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F47736_0_0|SrvcGrp|22954|2022|PDM|120.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F47736_0_0|SrvcGrp|26001|2022|PDM|125.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F47812_0_0|SrvcGrp|42871|2022|PDM|40.12|99|0.00|SPEECH THERAPY VISIT
20|FH_F47836_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|ENT SURG CTR -CVTY ENHANCED GROUP 3
20|FH_F47836_0_0|SrvcGrp|44142|2022|PDM|1750.00|99|0.00|CPT  31541, 42825, 42830, 60280
20|FH_F47836_0_0|SrvcGrp|44143|2022|PDM|1675.00|99|0.00|CPT  30520, 42820, 69421, 69436
20|FH_F47836_0_0|SrvcGrp|44325|2022|PDM|1300.00|99|0.00|CPT  40819,41115,69205, 69424
20|FH_F47836_0_0|SrvcGrp|68059|2022|PDM|1300.00|99|0.00|CPT 61782
20|FH_F47857_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F47857_0_0|CSTM-ALL|CSTM-00|2020|PDM|175.00|99|0.00|CD DAY TREATMENT
20|FH_F47884_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F47884_0_0|SrvcGrp|11258|2022|PCT|0.50|99|0.00|DRUGS
20|FH_F47884_0_0|SrvcGrp|11336|2022|PCT|0.50|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F47952_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F47952_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F47952_0_0|SrvcGrp|32189|2022|PDM|35.00|99|0.00|RESPITE CARE
20|FH_F47952_0_0|SrvcGrp|42973|2022|PDM|95.00|99|0.00|SPEECH  THERAPIST
20|FH_F47952_0_0|SrvcGrp|43955|2022|PDM|90.00|99|0.00|NURSING CARE
20|FH_F47969_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE
20|FH_F47969_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F47996_0_0|CSTM-ALL|CSTM-00|2020|PCT|69.50|99|0.00|OP SVCS
20|FH_F47999_0_0|CSTM-ALL|CSTM-00|2020|PDM|121.00|99|0.00|RN VISIT
20|FH_F47999_0_0|SrvcGrp|26001|2022|PDM|159.50|99|0.00|HOSPICE RESPITE SVCS
20|FH_F47999_0_0|SrvcGrp|3809|2022|PDM|550.00|99|0.00|HOSPICE CARE
20|FH_F47999_0_0|SrvcGrp|42830|2022|PDM|104.50|99|0.00|MEDICAL SOCIAL WORKER VISIT
20|FH_F48034_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F48052_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F48052_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F48092_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F48092_0_0|SrvcGrp|15488|2022|PDM|325.00|99|0.00|COMPUTED TOMOGRAPHY (CT SCAN)
20|FH_F48092_0_0|SrvcGrp|30096|2022|PDM|28.75|99|0.00|SPEECH THERAPY
20|FH_F48133_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F48133_0_0|SrvcGrp|42869|2022|PDM|40.12|99|0.00|PHYSICAL THERAPY VISIT
20|FH_F48174_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F48174_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F48192_0_0|SrvcGrp|473|2022|PDM|375.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F48215_0_0|SrvcGrp|12263|2022|PDM|17.50|99|0.00|HOME HEALTH AIDE- HOURLY
20|FH_F48215_0_0|SrvcGrp|12403|2022|PDM|26.25|99|0.00|CONTINUOUS HOMECARE
20|FH_F48215_0_0|SrvcGrp|22954|2022|PDM|94.50|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F48215_0_0|SrvcGrp|3809|2022|PDM|483.00|99|0.00|HOSPICE CARE
20|FH_F48215_0_0|SrvcGrp|9828|2022|PDM|36.00|99|0.00|HOME HEALTH AIDE
20|FH_F48230_0_0|CSTM-ALL|CSTM-00|2020|PCT|66.00|99|0.00|OP SVCS
20|FH_F48292_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F112665_0_0|CSTM-ALL|CSTM-00|2020|PDM|2096.00|99|0.00|AEG 3 (NO REV)
20|FH_F112665_0_0|CSTM-ALL|CSTM-00|2020|PDM|2409.00|99|0.00|AEG 7 (NO REV)
20|FH_F112665_0_0|SrvcGrp|11669|2022|PDM|2887.00|99|0.00|OP SURG
20|FH_F112665_0_0|SrvcGrp|11673|2022|PDM|4812.00|99|0.00|CPT 29888
20|FH_F112665_0_0|SrvcGrp|35669|2022|PDM|4812.00|99|0.00|CPT 63650
20|FH_F112665_0_0|SrvcGrp|88491|2022|PDM|7215.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR
20|FH_F112665_0_0|SrvcGrp|90343|2022|PDM|7215.00|99|0.00|CERVICE CORPECTOMY 1 LEVEL
20|FH_F112665_0_0|SrvcGrp|95559|2022|PDM|7215.00|99|0.00|HIP JOINT
20|FH_F112665_0_0|SrvcGrp|98500|2022|PDM|7215.00|99|0.00|INCISE SPINAL COLUMN NERVES
20|FH_F112668_0_0|SrvcGrp|73000|2022|PDM|945.00|99|0.00|AEG 6
20|FH_F112668_0_0|SrvcGrp|73004|2022|PDM|1102.00|99|0.00|AEG 8
20|FH_F112704_0_0|CSTM-ALL|CSTM-00|2020|PDM|1133.00|99|0.00|AEG 5  (NO REV)
20|FH_F112704_0_0|CSTM-ALL|CSTM-00|2020|PDM|1535.00|99|0.00|AEG 8 (NO REV)
20|FH_F112704_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.50|99|0.00|AEG 4 (NO REV)
20|FH_F112704_0_0|SrvcGrp|101320|2022|PDM|1030.00|99|0.00|PARAVERTEBRAL FACET JOINT NERVE
20|FH_F112708_0_0|CSTM-ALL|CSTM-00|2020|PDM|1173.00|99|0.00|AEG 5  (NO REV)
20|FH_F112708_0_0|CSTM-ALL|CSTM-00|2020|PDM|1333.00|99|0.00|AEG 6 (NO REV)
20|FH_F112708_0_0|CSTM-ALL|CSTM-00|2020|PDM|695.00|99|0.00|AEG 2 (NO REV)
20|FH_F112717_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|OP SVCS
20|FH_F112722_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.00|99|0.00|GENERAL ACUTE CARE
20|FH_F112727_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|GENERAL ACUTE CARE
20|FH_F112727_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|OP SVCS
20|FH_F112791_0_0|SrvcGrp|72990|2022|PDM|349.00|99|0.00|AEG 1
20|FH_F112791_0_0|SrvcGrp|73002|2022|PDM|1044.00|99|0.00|AEG 7
20|FH_F112791_0_0|SrvcGrp|73006|2022|PDM|1405.00|99|0.00|AEG 9
20|FH_F112791_0_0|SrvcGrp|81859|2022|PDM|535.00|99|0.00|AETNA CARDIAC CATH
20|FH_F112823_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F112823_0_0|CSTM-ALL|CSTM-00|2020|PDM|424.00|99|0.00|AEG 1 (NO REV)
20|FH_F112823_0_0|CSTM-ALL|CSTM-00|2020|PDM|646.00|99|0.00|AEG 3 (NO REV)
20|FH_F112823_0_0|CSTM-ALL|CSTM-00|2020|PDM|911.00|99|0.00|AEG 10 (NO REV)
20|FH_F112823_0_0|SrvcGrp|103974|2022|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES
20|FH_F112844_0_0|SrvcGrp|90707|2022|PDM|115.00|99|0.00|AETNA HOSPICE CARE
20|FH_F112863_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F112863_0_0|CSTM-ALL|CSTM-00|2020|PDM|1074.00|99|0.00|AEG 6 (NO REV)
20|FH_F112863_0_0|CSTM-ALL|CSTM-00|2020|PDM|1265.00|99|0.00|AEG 8 (NO REV)
20|FH_F112863_0_0|CSTM-ALL|CSTM-00|2020|PDM|755.00|99|0.00|AEG 2 (NO REV)
20|FH_F112863_0_0|CSTM-ALL|CSTM-00|2020|PDM|820.00|99|0.00|AEG 10 (NO REV)
20|FH_F112863_0_0|SrvcGrp|103974|2022|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES
20|FH_F112863_0_0|SrvcGrp|104249|2022|PDM|2002.00|99|0.00|FULL GRAFT PROCEDURE
20|FH_F112863_0_0|SrvcGrp|104253|2022|PDM|1141.00|99|0.00|SKIN TISSUE REARRANGEMENT
20|FH_F112863_0_0|SrvcGrp|104257|2022|PDM|1141.00|99|0.00|SKIN TISSUE REARRANGEMENT
20|FH_F112863_0_0|SrvcGrp|104259|2022|PDM|1141.00|99|0.00|SKIN FULL GRAFT PROCEDURE
20|FH_F112863_0_0|SrvcGrp|74587|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F112908_0_0|SrvcGrp|48385|2022|PDM|85.00|99|0.00|SPEECH THERAPY
20|FH_F112908_0_0|SrvcGrp|48394|2022|PDM|26.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F112943_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F112943_0_0|CSTM-ALL|CSTM-00|2020|PDM|1025.20|99|0.00|AEG 5  (NO REV)
20|FH_F112943_0_0|CSTM-ALL|CSTM-00|2020|PDM|729.30|99|0.00|AEG 3 (NO REV)
20|FH_F112943_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.90|99|0.00|AEG 4 (NO REV)
20|FH_F112943_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F112946_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F112946_0_0|CSTM-ALL|CSTM-00|2020|PDM|375.00|99|0.00|COVENTRY ENHANCED GROUPER 1
20|FH_F112946_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|COVENTRY ENHANCED GROUPER 6
20|FH_F112946_0_0|SrvcGrp|87684|2022|PCT|0.65|99|0.00|OP SURGERY-ALL OTHER
20|FH_F112956_0_0|SrvcGrp|105030|2022|PDM|735.00|99|0.00|AETNA SURGICAL CARVEOUT
20|FH_F112956_0_0|SrvcGrp|105031|2022|PDM|630.00|99|0.00|AETNA SURGICAL CARVEOUT
20|FH_F112956_0_0|SrvcGrp|75485|2022|PDM|688.00|99|0.00|AEG 4
20|FH_F112956_0_0|SrvcGrp|75495|2022|PDM|1493.00|99|0.00|AEG 9
20|FH_F112962_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F112962_0_0|CSTM-ALL|CSTM-00|2020|PDM|714.00|99|0.00|AEG 4 (NO REV)
20|FH_F112962_0_0|CSTM-ALL|CSTM-00|2020|PDM|936.00|99|0.00|AEG 6 (NO REV)
20|FH_F112967_0_0|SrvcGrp|29353|2022|PDM|115.00|99|0.00|HOSPICE SVCS
20|FH_F112967_0_0|SrvcGrp|89822|2022|PDM|115.00|99|0.00|HOSPICE ROUTINE HOME CARE
20|FH_F112967_0_0|SrvcGrp|90477|2022|PDM|115.00|99|0.00|HOSPICE
20|FH_F112967_0_0|SrvcGrp|90707|2022|PDM|115.00|99|0.00|AETNA HOSPICE CARE
20|FH_F112995_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F112995_0_0|CSTM-ALL|CSTM-00|2020|PDM|1613.92|99|0.00|AEG 9 (NO REV)
20|FH_F112995_0_0|CSTM-ALL|CSTM-00|2020|PDM|614.72|99|0.00|AEG 3 (NO REV)
20|FH_F113025_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F113025_0_0|SrvcGrp|104719|2022|PDM|815.00|99|0.00|RELIEVE INNER EYE PRESSURE
20|FH_F113025_0_0|SrvcGrp|104722|2022|PDM|458.00|99|0.00|REPAIR EYELID DEFECT
20|FH_F113025_0_0|SrvcGrp|104961|2022|PDM|535.00|99|0.00|AEG 3 W/O CPT 15822
20|FH_F113025_0_0|SrvcGrp|104963|2022|PDM|752.00|99|0.00|AEG 5 W/O CPT 15823
20|FH_F113025_0_0|SrvcGrp|104998|2022|PDM|1022.00|99|0.00|AEG 8 W/O CPT 66982-66984
20|FH_F113025_0_0|SrvcGrp|16427|2022|PDM|951.00|99|0.00|OP SURGERY
20|FH_F113033_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE
20|FH_F113074_0_0|CSTM-ALL|CSTM-00|2020|PDM|1175.00|99|0.00|AEG 8 (NO REV)
20|FH_F113074_0_0|CSTM-ALL|CSTM-00|2020|PDM|487.00|99|0.00|AEG 2 (NO REV)
20|FH_F113074_0_0|CSTM-ALL|CSTM-00|2020|PDM|686.00|99|0.00|AEG 10 (NO REV)
20|FH_F113115_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F113115_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS
20|FH_F113115_0_0|CSTM-ALL|CSTM-00|2020|PDM|1179.00|99|0.00|COVENTRY ENHANCED GROUPER 7
20|FH_F113115_0_0|CSTM-ALL|CSTM-00|2020|PDM|395.00|99|0.00|COVENTRY ENHANCED GROUPER 1
20|FH_F113115_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|COVENTRY ENHANCED GROUPER 5
20|FH_F113115_0_0|CSTM-ALL|CSTM-00|2020|PDM|978.00|99|0.00|COVENTRY ENHANCED GROUPER 6
20|FH_F113130_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F113139_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F113139_0_0|SrvcGrp|102420|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATHETERIZATION INCIDENTAL CODES
20|FH_F113139_0_0|SrvcGrp|103503|2022|PDM|2750.00|99|0.00|AETNA CARDIAC CATHERTERIZATION
20|FH_F113139_0_0|SrvcGrp|104922|2022|PDM|400.00|99|0.00|ENDOLUMINL IVUS OCT C 1ST-CONCUR
20|FH_F113139_0_0|SrvcGrp|104923|2022|PCT|1.00|99|0.00|CATHETER INTRAVASCULAR ULTRS
20|FH_F113139_0_0|SrvcGrp|104925|2022|PDM|5300.00|99|0.00|PRQ CARDIAC ANGIOPLAST 1 ART-CONCUR
20|FH_F113143_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F113143_0_0|SrvcGrp|102419|2022|PDM|4410.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F113143_0_0|SrvcGrp|103965|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F113143_0_0|SrvcGrp|72992|2022|PDM|468.00|99|0.00|AEG 2
20|FH_F113143_0_0|SrvcGrp|72998|2022|PDM|753.00|99|0.00|AEG 5
20|FH_F113143_0_0|SrvcGrp|73000|2022|PDM|945.00|99|0.00|AEG 6
20|FH_F113143_0_0|SrvcGrp|73006|2022|PDM|1406.00|99|0.00|AEG 9
20|FH_F113255_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F113255_0_0|CSTM-ALL|CSTM-00|2020|PDM|663.00|99|0.00|AETNA AMBULATORY SURGERY W/O AEG 1 & 2
20|FH_F113386_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F113390_0_0|CSTM-ALL|CSTM-00|2020|PDM|3135.00|99|0.00|AEG 8 (NO REV)
20|FH_F113390_0_0|SrvcGrp|105234|2022|PDM|2200.00|99|0.00|EXPLORE DEEP NODE NECK
20|FH_F113390_0_0|SrvcGrp|105235|2022|PDM|2200.00|99|0.00|PARTIAL REMOVAL OF THYROID
20|FH_F113390_0_0|SrvcGrp|105239|2022|PDM|1320.00|99|0.00|EXCISION OF TONGUE LESION
20|FH_F113390_0_0|SrvcGrp|105241|2022|PDM|1320.00|99|0.00|REMOVAL OF SALIVARY STONE
20|FH_F113390_0_0|SrvcGrp|105243|2022|PDM|1320.00|99|0.00|PARTIAL REMOVAL EXTERNAL EAR
20|FH_F113390_0_0|SrvcGrp|105245|2022|PDM|880.00|99|0.00|CREATE EARDRUM OPENING
20|FH_F113390_0_0|SrvcGrp|89882|2022|PDM|2200.00|99|0.00|AETNA REMOVAL OF TONSILS
20|FH_F113392_0_0|CSTM-ALL|CSTM-00|2020|PDM|1074.36|99|0.00|AEG 8 (NO REV)
20|FH_F113392_0_0|CSTM-ALL|CSTM-00|2020|PDM|1099.41|99|0.00|AEG 7 (NO REV)
20|FH_F113392_0_0|CSTM-ALL|CSTM-00|2020|PDM|2750.00|99|0.00|BREAST RECONSTRUCTION
20|FH_F113392_0_0|CSTM-ALL|CSTM-00|2020|PDM|958.32|99|0.00|AEG 5  (NO REV)
20|FH_F113392_0_0|SrvcGrp|11663|2022|PCT|1.10|99|0.00|IMPLANTS
20|FH_F113392_0_0|SrvcGrp|83839|2022|PDM|3346.20|99|0.00|BREAST RECONSTRUCTION
20|FH_F113410_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F113410_0_0|CSTM-ALL|CSTM-00|2020|PDM|2049.00|99|0.00|AEG 9 (NO REV)
20|FH_F113410_0_0|CSTM-ALL|CSTM-00|2020|PDM|578.00|99|0.00|AEG 1 (NO REV)
20|FH_F113410_0_0|SrvcGrp|100065|2022|PDM|2942.00|99|0.00|DEEP ANT OR POSTER TIBIAL
20|FH_F113410_0_0|SrvcGrp|104006|2022|PDM|7549.00|99|0.00|LAPS ABLATION UTERINE FIBROIDS
20|FH_F113410_0_0|SrvcGrp|104760|2022|PDM|3887.00|99|0.00|VAGINAL HYSTERECTOMY
20|FH_F113410_0_0|SrvcGrp|105253|2022|PDM|1996.00|99|0.00|REMOVAL/TRANSPLANT TENDON
20|FH_F113410_0_0|SrvcGrp|26281|2022|PDM|3992.00|99|0.00|CPT 58353
20|FH_F113410_0_0|SrvcGrp|27316|2022|PDM|1681.00|99|0.00|TONSILS & ADENOIDS (42820)
20|FH_F113410_0_0|SrvcGrp|54943|2022|PDM|2837.00|99|0.00|REPAIR OF SLAP LESION
20|FH_F113410_0_0|SrvcGrp|84182|2022|PDM|1786.00|99|0.00|AETNA REMOVAL OF BREAST CAPSULE
20|FH_F113410_0_0|SrvcGrp|90418|2022|PDM|3257.00|99|0.00|ENLARGE BREAST WITH IMPLANT
20|FH_F113410_0_0|SrvcGrp|97922|2022|PDM|3362.00|99|0.00|PARTIAL HYSTERECTOMY
20|FH_F113410_0_0|SrvcGrp|99174|2022|PDM|1996.00|99|0.00|CPT 30140
20|FH_F113426_0_0|CSTM-ALL|CSTM-00|2020|PDM|1420.00|99|0.00|AEG 10 (NO REV)
20|FH_F113426_0_0|CSTM-ALL|CSTM-00|2020|PDM|1673.00|99|0.00|AEG 8 (NO REV)
20|FH_F113426_0_0|CSTM-ALL|CSTM-00|2020|PDM|572.00|99|0.00|AEG 1 (NO REV)
20|FH_F113426_0_0|CSTM-ALL|CSTM-00|2020|PDM|767.00|99|0.00|AEG 2 (NO REV)
20|FH_F113487_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F113503_0_0|SrvcGrp|73806|2022|PCT|0.70|99|0.00|AETNA ER
20|FH_F113524_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F113524_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F113537_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F113537_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F113541_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F113541_0_0|CSTM-ALL|CSTM-00|2020|PDM|1018.00|99|0.00|AEG 3 (NO REV)
20|FH_F113541_0_0|CSTM-ALL|CSTM-00|2020|PDM|1259.00|99|0.00|AEG 4 (NO REV)
20|FH_F113541_0_0|CSTM-ALL|CSTM-00|2020|PDM|2670.00|99|0.00|AEG 9 (NO REV)
20|FH_F113541_0_0|CSTM-ALL|CSTM-00|2020|PDM|665.00|99|0.00|AEG 1 (NO REV)
20|FH_F113541_0_0|CSTM-ALL|CSTM-00|2020|PDM|889.00|99|0.00|AEG 2 (NO REV)
20|FH_F113541_0_0|SrvcGrp|104950|2022|PDM|2580.00|99|0.00|REMOVAL OF IMPLANT MATERIAL
20|FH_F113541_0_0|SrvcGrp|83835|2022|PDM|2579.00|99|0.00|REPLACE TISSUE EXPANDER
20|FH_F113541_0_0|SrvcGrp|84180|2022|PDM|6662.00|99|0.00|AETNA DELAYED BREAST PROSTHESIS
20|FH_F113546_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F113546_0_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN
20|FH_F113586_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F113586_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F113586_0_0|SrvcGrp|75491|2022|PDM|1173.00|99|0.00|AEG 7
20|FH_F113586_0_0|SrvcGrp|75495|2022|PDM|1479.00|99|0.00|AEG 9
20|FH_F113588_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F113588_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F113588_0_0|SrvcGrp|22954|2022|PDM|89.93|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F113588_0_0|SrvcGrp|26001|2022|PDM|93.03|99|0.00|HOSPICE RESPITE SVCS
20|FH_F113588_0_0|SrvcGrp|3809|2022|PDM|400.05|99|0.00|HOSPICE CARE
20|FH_F113677_0_0|SrvcGrp|87077|2022|PDM|165.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F113682_0_0|SrvcGrp|17421|2022|PDM|497.81|99|0.00|INPATIENT MEDICAL
20|FH_F113682_0_0|SrvcGrp|29915|2022|PDM|641.70|99|0.00|SUBACUTE CARE
20|FH_F113705_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F113705_0_0|CSTM-ALL|CSTM-00|2020|PCT|57.00|99|0.00|OP SVCS
20|FH_F113715_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|GENERAL ACUTE CARE
20|FH_F113765_0_0|SrvcGrp|22954|2022|PDM|105.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F113765_0_0|SrvcGrp|48385|2022|PDM|85.00|99|0.00|SPEECH THERAPY
20|FH_F113765_0_0|SrvcGrp|48398|2022|PDM|90.00|99|0.00|PT SERVICES
20|FH_F113765_0_0|SrvcGrp|88620|2022|PDM|85.00|99|0.00|SKILLED NURSING RN
20|FH_F113765_0_0|SrvcGrp|88621|2022|PDM|60.00|99|0.00|SKILLED NURSING LPN
20|FH_F113784_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F113784_0_0|SrvcGrp|42971|2022|PDM|80.00|99|0.00|SKN RN
20|FH_F113792_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F113792_0_0|SrvcGrp|46605|2022|PDM|85.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES
20|FH_F113794_0_0|SrvcGrp|44042|2022|PDM|80.00|99|0.00|SKILLED NURSING - LPN
20|FH_F113794_0_0|SrvcGrp|45924|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE
20|FH_F113794_0_0|SrvcGrp|48396|2022|PDM|80.00|99|0.00|OT SERVICES
20|FH_F113815_0_0|SrvcGrp|72996|2022|PDM|233.00|99|0.00|AEG 4
20|FH_F113815_0_0|SrvcGrp|72998|2022|PDM|233.00|99|0.00|AEG 5
20|FH_F113815_0_0|SrvcGrp|73004|2022|PDM|233.00|99|0.00|AEG 8
20|FH_F113815_0_0|SrvcGrp|73008|2022|PDM|233.00|99|0.00|AEG 10
20|FH_F113866_0_0|SrvcGrp|74546|2022|PDM|475.00|99|0.00|HOSPICE SERVICES
20|FH_F113866_0_0|SrvcGrp|90707|2022|PDM|100.00|99|0.00|AETNA HOSPICE CARE
20|FH_F113866_0_0|SrvcGrp|93099|2022|PDM|475.00|99|0.00|HOSPICE CARE PROVIDED IN INPATIENT HOSPICE FACILITY
20|FH_F113885_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F113885_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F113885_0_0|SrvcGrp|76094|2022|PDM|159.50|99|0.00|HOSPICE ROUTINE HOME CARE
20|FH_F113903_0_0|SrvcGrp|87077|2022|PDM|200.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F113906_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F113906_0_0|SrvcGrp|72990|2022|PDM|545.00|99|0.00|AEG 1
20|FH_F113906_0_0|SrvcGrp|72996|2022|PDM|665.00|99|0.00|AEG 4
20|FH_F113906_0_0|SrvcGrp|73004|2022|PDM|665.00|99|0.00|AEG 8
20|FH_F113926_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F113926_0_0|SrvcGrp|82981|2022|PDM|100.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F113985_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F114002_0_0|SrvcGrp|42972|2022|PDM|65.00|99|0.00|HOME HEALTH AIDE
20|FH_F114002_0_0|SrvcGrp|42974|2022|PDM|65.00|99|0.00|OCCUPATIONAL THERAPIST
20|FH_F114002_0_0|SrvcGrp|42976|2022|PDM|70.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F114024_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F114024_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F114024_0_0|SrvcGrp|75487|2022|PDM|735.00|99|0.00|AEG 5
20|FH_F114024_0_0|SrvcGrp|75491|2022|PDM|1017.00|99|0.00|AEG 7
20|FH_F114064_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F114064_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F114145_0_0|CSTM-ALL|CSTM-00|2020|PDM|1097.00|99|0.00|AEG 7 (NO REV)
20|FH_F114145_0_0|CSTM-ALL|CSTM-00|2020|PDM|398.00|99|0.00|AEG 1 (NO REV)
20|FH_F114145_0_0|CSTM-ALL|CSTM-00|2020|PDM|791.00|99|0.00|AEG 10 (NO REV)
20|FH_F114145_0_0|CSTM-ALL|CSTM-00|2020|PDM|817.00|99|0.00|AEG 5  (NO REV)
20|FH_F114145_0_0|CSTM-ALL|CSTM-00|2020|PDM|928.00|99|0.00|AEG 6 (NO REV)
20|FH_F114145_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F114145_0_0|SrvcGrp|77507|2022|PCT|1.00|99|0.00|AETNA CORNEAL TISSUE HANDLING
20|FH_F114151_0_0|SrvcGrp|95441|2022|PDM|90.00|99|0.00|HOSPICE OR HOME CARE
20|FH_F114166_0_0|SrvcGrp|109732|2022|PDM|187.46|99|0.00|COFINITY  GLOBAL FEE URGENT CARE CENTERS
20|FH_F114166_0_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC
20|FH_F114166_0_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA
20|FH_F114171_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|AEG 4 (NO REV)
20|FH_F114171_0_0|CSTM-ALL|CSTM-00|2020|PDM|741.00|99|0.00|AEG 5  (NO REV)
20|FH_F114171_0_0|CSTM-ALL|CSTM-00|2020|PDM|902.00|99|0.00|AEG 10 (NO REV)
20|FH_F114171_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F114267_0_0|CSTM-ALL|CSTM-00|2020|PDM|1114.00|99|0.00|AEG 8 (NO REV)
20|FH_F114267_0_0|CSTM-ALL|CSTM-00|2020|PDM|586.00|99|0.00|AEG 3 (NO REV)
20|FH_F114267_0_0|CSTM-ALL|CSTM-00|2020|PDM|836.00|99|0.00|AEG 10 (NO REV)
20|FH_F114267_0_0|SrvcGrp|102260|2022|PDM|10000.00|99|0.00|AETNA TOTAL JOINT REPLACEMENT
20|FH_F114267_0_0|SrvcGrp|105551|2022|PDM|1800.00|99|0.00|AETNA LAPAROSCOPY
20|FH_F114267_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F114267_0_0|SrvcGrp|76847|2022|PDM|1800.00|99|0.00|AETNA ARTHROSCOPY
20|FH_F114310_0_0|CSTM-ALL|CSTM-00|2020|PDM|531.00|99|0.00|AEG 1 (NO REV)
20|FH_F114310_0_0|SrvcGrp|105488|2022|PDM|2050.00|99|0.00|SHOULDER ANDOSCOPY PROCEDURES
20|FH_F114310_0_0|SrvcGrp|105491|2022|PDM|2050.00|99|0.00|KNEE ARTHROCOPY PROCEDURES
20|FH_F114310_0_0|SrvcGrp|16289|2022|PDM|1085.00|99|0.00|CARPAL TUNNEL RELEASE
20|FH_F114310_0_0|SrvcGrp|54943|2022|PDM|3200.00|99|0.00|REPAIR OF SLAP LESION
20|FH_F114310_0_0|SrvcGrp|55071|2022|PDM|2050.00|99|0.00|ARTHROSCOPY SHOULDER
20|FH_F114310_0_0|SrvcGrp|94883|2022|PDM|1275.00|99|0.00|NASAL/SINUS ENDOSCOPY
20|FH_F114326_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F114416_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F114511_0_0|SrvcGrp|87317|2022|PDM|770.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)
20|FH_F114511_0_0|SrvcGrp|93919|2022|PDM|624.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY
20|FH_F114519_0_0|SrvcGrp|72992|2022|PDM|862.00|99|0.00|AEG 2
20|FH_F114519_0_0|SrvcGrp|72994|2022|PDM|1241.00|99|0.00|AEG 3
20|FH_F114519_0_0|SrvcGrp|72998|2022|PDM|1372.00|99|0.00|AEG 5
20|FH_F114519_0_0|SrvcGrp|73004|2022|PDM|1560.00|99|0.00|AEG 8
20|FH_F114572_0_0|CSTM-ALL|CSTM-00|2020|PDM|1040.00|99|0.00|AEG 5  (NO REV)
20|FH_F114572_0_0|CSTM-ALL|CSTM-00|2020|PDM|739.00|99|0.00|AEG 3 (NO REV)
20|FH_F114572_0_0|SrvcGrp|11663|2022|PCT|1.05|99|0.00|IMPLANTS
20|FH_F114572_0_0|SrvcGrp|35669|2022|PDM|5000.00|99|0.00|CPT 63650
20|FH_F114572_0_0|SrvcGrp|36591|2022|PDM|6500.00|99|0.00|CPT 63685
20|FH_F114606_0_0|SrvcGrp|74546|2022|PDM|608.17|99|0.00|HOSPICE SERVICES
20|FH_F114606_0_0|SrvcGrp|80317|2022|PDM|131.76|99|0.00|RESPITE CARE
20|FH_F114606_0_0|SrvcGrp|82223|2022|PDM|27.54|99|0.00|HOSPICE CARE
20|FH_F114683_0_0|SrvcGrp|104007|2022|PDM|4500.00|99|0.00|ENDOSCOPIC DCMPR 1
20|FH_F114683_0_0|SrvcGrp|105732|2022|PDM|1910.00|99|0.00|SPINE SURGERY
20|FH_F114683_0_0|SrvcGrp|11306|2022|PCT|1.10|99|0.00|IMPLANTS
20|FH_F114683_0_0|SrvcGrp|27261|2022|PDM|5595.00|99|0.00|CPT 27446
20|FH_F114683_0_0|SrvcGrp|41334|2022|PDM|6750.00|99|0.00|TOTAL KNEE
20|FH_F114683_0_0|SrvcGrp|72996|2022|PDM|1655.00|99|0.00|AEG 4
20|FH_F114683_0_0|SrvcGrp|72998|2022|PDM|1746.00|99|0.00|AEG 5
20|FH_F114683_0_0|SrvcGrp|73006|2022|PDM|2688.00|99|0.00|AEG 9
20|FH_F114683_0_0|SrvcGrp|84912|2022|PDM|4500.00|99|0.00|PERQ VERTEBRAL AUGMENTATION
20|FH_F114683_0_0|SrvcGrp|86233|2022|PDM|5075.00|99|0.00|AETNA RECONSTRUCT ANKLE JOINT
20|FH_F114683_0_0|SrvcGrp|88343|2022|PDM|7800.00|99|0.00|REVISION OF KNEE JOINT
20|FH_F114707_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F114707_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F114707_0_0|SrvcGrp|82981|2022|PDM|90.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F114853_0_0|CSTM-ALL|CSTM-00|2020|PDM|2096.00|99|0.00|AEG 3 (NO REV)
20|FH_F114853_0_0|SrvcGrp|35670|2022|PDM|7699.00|99|0.00|SPINAL NEUROSTIMULATORS PROCEDURE
20|FH_F114853_0_0|SrvcGrp|54943|2022|PDM|2887.00|99|0.00|REPAIR OF SLAP LESION
20|FH_F114853_0_0|SrvcGrp|58993|2022|PDM|7215.00|99|0.00|DISKECTOMY
20|FH_F114853_0_0|SrvcGrp|67065|2022|PDM|7699.00|99|0.00|CERVICAL SURGERY
20|FH_F114853_0_0|SrvcGrp|67068|2022|PDM|7699.00|99|0.00|LUMBAR SPINE FUSION COMBINED
20|FH_F114853_0_0|SrvcGrp|67279|2022|PDM|7699.00|99|0.00|CERVICAL SURGERY
20|FH_F114853_0_0|SrvcGrp|71666|2022|PDM|6737.00|99|0.00|CPT 63655
20|FH_F114853_0_0|SrvcGrp|72121|2022|PDM|2887.00|99|0.00|ARTHOSCOPY
20|FH_F114853_0_0|SrvcGrp|90343|2022|PDM|7215.00|99|0.00|CERVICE CORPECTOMY 1 LEVEL
20|FH_F114912_0_0|CSTM-ALL|CSTM-00|2020|PDM|90.00|99|0.00|OP SVCS
20|FH_F114931_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 10 (NO REV)
20|FH_F114931_0_0|CSTM-ALL|CSTM-00|2020|PDM|1633.00|99|0.00|AEG 7 (NO REV)
20|FH_F114931_0_0|SrvcGrp|104113|2022|PDM|3200.00|99|0.00|REMOVE ANAL FIST COMPLEX
20|FH_F114931_0_0|SrvcGrp|104618|2022|PDM|1850.00|99|0.00|EXCISION OF ANAL LESION(S)
20|FH_F114931_0_0|SrvcGrp|105753|2022|PDM|3200.00|99|0.00|GASTRIC RESTRICTIVE PROCEDURE
20|FH_F114931_0_0|SrvcGrp|105756|2022|PDM|1850.00|99|0.00|SURGICAL ANORECTAL EXAM
20|FH_F114931_0_0|SrvcGrp|105758|2022|PDM|1850.00|99|0.00|I & D PERIANAL ABSCESS
20|FH_F114931_0_0|SrvcGrp|105760|2022|PDM|1850.00|99|0.00|REMOVE HEMORRHOIDS & FISSURE
20|FH_F114931_0_0|SrvcGrp|33967|2022|PDM|4494.00|99|0.00|CPT 47562
20|FH_F114931_0_0|SrvcGrp|38364|2022|PDM|3200.00|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F114931_0_0|SrvcGrp|58779|2022|PDM|3200.00|99|0.00|HERNIA REPAIR W/ MESH
20|FH_F114931_0_0|SrvcGrp|63467|2022|PDM|1850.00|99|0.00|CPT 64585
20|FH_F114931_0_0|SrvcGrp|63471|2022|PDM|5200.00|99|0.00|CPT 64590
20|FH_F114931_0_0|SrvcGrp|74587|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F114931_0_0|SrvcGrp|78284|2022|PDM|1850.00|99|0.00|CPT 46200
20|FH_F114931_0_0|SrvcGrp|84908|2022|PDM|3200.00|99|0.00|LAPAROSCOPY
20|FH_F114931_0_0|SrvcGrp|87844|2022|PDM|6039.00|99|0.00|LAPARASCOPY - GASTRIC
20|FH_F114931_0_0|SrvcGrp|87845|2022|PDM|3200.00|99|0.00|GASTRIC RESTRICTIVE PROCEDURE
20|FH_F114931_0_0|SrvcGrp|90801|2022|PDM|3200.00|99|0.00|REPAIR EPIGASTRIC HERNIA REDUCED
20|FH_F114931_0_0|SrvcGrp|91939|2022|PDM|1850.00|99|0.00|SURGICAL TREATMENT OF ANAL FISTULA
20|FH_F114931_0_0|SrvcGrp|92418|2022|PDM|3200.00|99|0.00|LAPAROSCOPY
20|FH_F114941_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F114941_0_0|SrvcGrp|87077|2022|PDM|124.84|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F114952_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F114952_0_0|SrvcGrp|101300|2022|PDM|3675.00|99|0.00|PARTIAL REMOVAL SHOULDER BONE
20|FH_F114952_0_0|SrvcGrp|103965|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F114952_0_0|SrvcGrp|16692|2022|PDM|2625.00|99|0.00|KNEE SCOPE
20|FH_F114952_0_0|SrvcGrp|75483|2022|PDM|1299.38|99|0.00|AEG 3
20|FH_F114952_0_0|SrvcGrp|75491|2022|PDM|1785.00|99|0.00|AEG 7
20|FH_F114952_0_0|SrvcGrp|84442|2022|PDM|7560.00|99|0.00|REVISION KNEE
20|FH_F114952_0_0|SrvcGrp|85198|2022|PDM|3360.00|99|0.00|AETNA KNEE ARTHROSCOPY
20|FH_F114968_0_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS
20|FH_F114968_0_0|SrvcGrp|471|2022|PDM|856.98|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F114968_0_0|SrvcGrp|472|2022|PDM|696.30|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F114968_0_0|SrvcGrp|79458|2022|PDM|0.25|99|0.00|MED RECORD COPY
20|FH_F114968_0_0|SrvcGrp|81839|2022|PDM|50.00|99|0.00|AETNA MEDICAL RECORD
20|FH_F114974_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F114974_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F115010_20105_0|SrvcGrp|22529|2022|PDM|329.00|99|0.00|DAY HOSPITAL HALF DAY
20|FH_F115045_0_0|SrvcGrp|92324|2022|PCT|0.00|99|0.00|VBAC DELIVERY
20|FH_F115045_0_0|SrvcGrp|98331|2022|PDM|1500.00|99|0.00|INTERIM LABOR FACILITY GLOBAL
20|FH_F115127_0_0|SrvcGrp|103552|2022|PDM|75.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER
20|FH_F115150_0_0|SrvcGrp|103928|2022|PDM|73.77|99|0.00|SLEEP STUDY UNATTENDED ANALYSIS(HCFA)
20|FH_F115150_0_0|SrvcGrp|103929|2022|PDM|155.55|99|0.00|SLEEP STUDY UNATTENDED RESPIRATORY EFFORT(HCFA)
20|FH_F115150_0_0|SrvcGrp|92188|2022|PDM|350.17|99|0.00|CPT 95805  (HCFA)
20|FH_F115204_0_0|SrvcGrp|79458|2022|PDM|0.25|99|0.00|MED RECORD COPY
20|FH_F115206_80923_0|SrvcGrp|73841|2022|PDM|463.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP
20|FH_F115206_80923_0|SrvcGrp|86722|2022|PDM|258.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)
20|FH_F115206_80923_0|SrvcGrp|88819|2022|PDM|859.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY
20|FH_F48295_0_0|SrvcGrp|10527|2022|PDM|100.00|99|0.00|HOSPICE SVCS
20|FH_F48295_0_0|SrvcGrp|32189|2022|PDM|35.00|99|0.00|RESPITE CARE
20|FH_F48295_0_0|SrvcGrp|33722|2022|PDM|45.00|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F48295_0_0|SrvcGrp|44428|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY SVCS (VISIT LVL)
20|FH_F48302_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F48346_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE
20|FH_F48357_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F48374_0_0|CSTM-ALL|CSTM-00|2020|PCT|68.00|99|0.00|GENERAL ACUTE CARE
20|FH_F48374_0_0|CSTM-ALL|CSTM-00|2020|PCT|68.00|99|0.00|OP SVCS
20|FH_F48396_0_0|CSTM-ALL|CSTM-00|2020|PDM|129.00|99|0.00|OP SVCS
20|FH_F48459_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F48459_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F48459_0_0|SrvcGrp|44302|2022|PDM|60.00|99|0.00|PT & OT (VISIT LVL) PT MOD GP
20|FH_F48473_0_0|SrvcGrp|9828|2022|PDM|44.00|99|0.00|HOME HEALTH AIDE
20|FH_F48473_0_0|SrvcGrp|9832|2022|PDM|88.00|99|0.00|ST SVCS
20|FH_F48475_0_0|SrvcGrp|103388|2022|PDM|19.80|99|0.00|PT/OT/ST
20|FH_F48476_0_0|SrvcGrp|10527|2022|PDM|100.00|99|0.00|HOSPICE SVCS
20|FH_F48476_0_0|SrvcGrp|27969|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE
20|FH_F48476_0_0|SrvcGrp|43956|2022|PDM|52.00|99|0.00|NURSING CARE
20|FH_F48552_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F48581_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE
20|FH_F48581_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F48581_0_0|SrvcGrp|23024|2022|PDM|300.00|99|0.00|NEWBORN NURSERY
20|FH_F48581_0_0|SrvcGrp|360|2022|PDM|710.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F48695_0_0|SrvcGrp|471|2022|PDM|1825.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F48752_0_0|SrvcGrp|33166|2022|PDM|450.00|99|0.00|SKILLED NURSING - LEVEL III
20|FH_F48787_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.00|99|0.00|GENERAL ACUTE CARE
20|FH_F48787_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.00|99|0.00|OP SVCS
20|FH_F48855_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F48855_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F48857_0_0|CSTM-ALL|CSTM-00|2020|PDM|110.00|99|0.00|OP SVCS
20|FH_F48927_0_0|CSTM-ALL|CSTM-00|2020|PDM|2400.00|99|0.00|GENERAL ACUTE CARE
20|FH_F48927_0_0|SrvcGrp|10391|2022|PDM|2400.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F48929_0_0|SrvcGrp|26001|2022|PDM|165.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F48929_0_0|SrvcGrp|3809|2022|PDM|713.00|99|0.00|HOSPICE CARE
20|FH_F48935_0_0|SrvcGrp|473|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F48937_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F48937_0_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN
20|FH_F48937_0_0|SrvcGrp|29406|2022|PDM|65.00|99|0.00|PHYSICAL THERAPY
20|FH_F48994_0_0|CSTM-ALL|CSTM-00|2020|PDM|1289.00|99|0.00|ASPG VI
20|FH_F48994_0_0|CSTM-ALL|CSTM-00|2020|PDM|696.00|99|0.00|ASPG II- MOD 50
20|FH_F48994_0_0|SrvcGrp|30076|2022|PCT|1.00|99|0.00|IMPLANTS, PROSTHETICS, OR SUPPLIES
20|FH_F48998_0_0|SrvcGrp|44131|2022|PDM|18.00|99|0.00|SPEECH THERAPY VISIT
20|FH_F49005_0_0|CSTM-ALL|CSTM-00|2020|PDM|150.00|99|0.00|IP SKILLED NURSING VISIT
20|FH_F49005_0_0|CSTM-ALL|CSTM-00|2020|PDM|25.00|99|0.00|HOME HEALTH AIDE (ADDITIONAL HOURS)
20|FH_F49005_0_0|CSTM-ALL|CSTM-00|2020|PDM|50.00|99|0.00|HOME HEALTH AIDE
20|FH_F49005_0_0|SrvcGrp|44703|2022|PDM|150.00|99|0.00|NURSING CARE
20|FH_F49016_0_0|SrvcGrp|10903|2022|PDM|350.00|99|0.00|EMERGENCY ROOM LEVEL I
20|FH_F49016_0_0|SrvcGrp|10906|2022|PCT|0.60|99|0.00|EMERGENCY ROOM LEVEL IV
20|FH_F49016_0_0|SrvcGrp|16|2022|PDM|850.00|99|0.00|ACUTE REHABILITATION
20|FH_F49016_0_0|SrvcGrp|31377|2022|PCT|0.60|99|0.00|EMERGENCY ROOM LEVEL V
20|FH_F49016_0_0|SrvcGrp|42825|2022|PDM|28.00|99|0.00|HOME HEALTH AIDE VISIT
20|FH_F49016_0_0|SrvcGrp|45145|2022|PDM|85.00|99|0.00|PT/OT/ST
20|FH_F49029_0_0|SrvcGrp|43785|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY SERVICES
20|FH_F49029_0_0|SrvcGrp|44860|2022|PDM|600.00|99|0.00|SKILLED NURSING, BARIATRIC
20|FH_F49029_0_0|SrvcGrp|45150|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY
20|FH_F49035_0_0|SrvcGrp|21594|2022|PDM|335.00|99|0.00|SKILLED NURSING
20|FH_F49037_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F49037_0_0|SrvcGrp|45150|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY
20|FH_F49039_0_0|SrvcGrp|21594|2022|PDM|335.00|99|0.00|SKILLED NURSING
20|FH_F49039_0_0|SrvcGrp|45148|2022|PDM|90.00|99|0.00|SPEECH THERAPY
20|FH_F49039_0_0|SrvcGrp|45150|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY
20|FH_F49044_0_0|SrvcGrp|44860|2022|PDM|600.00|99|0.00|SKILLED NURSING, BARIATRIC
20|FH_F49044_0_0|SrvcGrp|45150|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY
20|FH_F49049_0_0|SrvcGrp|43785|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY SERVICES
20|FH_F49051_0_0|SrvcGrp|44860|2022|PDM|600.00|99|0.00|SKILLED NURSING, BARIATRIC
20|FH_F49051_0_0|SrvcGrp|45150|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY
20|FH_F49054_0_0|SrvcGrp|44860|2022|PDM|600.00|99|0.00|SKILLED NURSING, BARIATRIC
20|FH_F49093_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F49197_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F49279_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F49279_0_0|CSTM-ALL|CSTM-00|2020|PDM|959.00|99|0.00|ASPG IV
20|FH_F49279_0_0|SrvcGrp|45333|2022|PDM|200.00|99|0.00|FLUOROSCOPIC GUIDANCE
20|FH_F49280_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F49287_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F49287_0_0|SrvcGrp|58931|2022|PCT|0.80|99|0.00|LAB GLOBAL
20|FH_F49287_0_0|SrvcGrp|58932|2022|PCT|0.80|99|0.00|RAD GLOBAL
20|FH_F49300_0_0|SrvcGrp|10527|2022|PDM|100.00|99|0.00|HOSPICE SVCS
20|FH_F49300_0_0|SrvcGrp|42046|2022|PDM|595.00|99|0.00|HOSPICE CARE
20|FH_F49300_0_0|SrvcGrp|42973|2022|PDM|100.00|99|0.00|SPEECH  THERAPIST
20|FH_F49300_0_0|SrvcGrp|42974|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPIST
20|FH_F49300_0_0|SrvcGrp|43956|2022|PDM|52.00|99|0.00|NURSING CARE
20|FH_F49300_0_0|SrvcGrp|43957|2022|PDM|35.00|99|0.00|HOME HEALTH AIDE
20|FH_F49300_0_0|SrvcGrp|43958|2022|PDM|90.00|99|0.00|ENTEROSTOMAL THERAPY SERVICES
20|FH_F115206_80923_0|SrvcGrp|90388|2022|PDM|859.00|99|0.00|ELECTROCONVULSIVE THERAPY (HCFA)
20|FH_F115208_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F115208_0_0|CSTM-ALL|CSTM-00|2020|PDM|1061.00|99|0.00|AEG 10 (NO REV)
20|FH_F115208_0_0|CSTM-ALL|CSTM-00|2020|PDM|1061.00|99|0.00|AEG 5  (NO REV)
20|FH_F115208_0_0|CSTM-ALL|CSTM-00|2020|PDM|1432.00|99|0.00|AEG 8 (NO REV)
20|FH_F115208_0_0|CSTM-ALL|CSTM-00|2020|PDM|690.00|99|0.00|AEG 2 (NO REV)
20|FH_F115208_0_0|CSTM-ALL|CSTM-00|2020|PDM|769.00|99|0.00|AEG 3 (NO REV)
20|FH_F115208_0_0|CSTM-ALL|CSTM-00|2020|PDM|955.00|99|0.00|AEG 4 (NO REV)
20|FH_F115208_0_0|SrvcGrp|106172|2022|PDM|2016.00|99|0.00|SINUS SURGICAL ENDOSCOPY
20|FH_F115208_0_0|SrvcGrp|106173|2022|PDM|2016.00|99|0.00|NASAL/SINUS ENDOSCOPY
20|FH_F115208_0_0|SrvcGrp|106177|2022|PDM|2546.00|99|0.00|EXCISE PAROTID GLAND/LESION
20|FH_F115208_0_0|SrvcGrp|106178|2022|PDM|1379.00|99|0.00|REMOVAL TONSILS AND ADENOIDS
20|FH_F115208_0_0|SrvcGrp|106179|2022|PDM|716.00|99|0.00|EGD CAUTERY TUMORE POLYP
20|FH_F115208_0_0|SrvcGrp|106184|2022|PDM|2546.00|99|0.00|REVISE MIDDLE EAR & MASTOID
20|FH_F115208_0_0|SrvcGrp|106185|2022|PDM|2546.00|99|0.00|REVISE MIDDLE EAR & MASTOID
20|FH_F115208_0_0|SrvcGrp|57863|2022|PDM|2016.00|99|0.00|NASAL/SINUS ENDOSCOPY
20|FH_F115208_0_0|SrvcGrp|64720|2022|PDM|716.00|99|0.00|CPT 45385
20|FH_F115303_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F115347_0_0|CSTM-ALL|CSTM-00|2020|PDM|675.00|99|0.00|AEG 3 (NO REV)
20|FH_F115347_0_0|SrvcGrp|93750|2022|PDM|1550.00|99|0.00|ERCP REMOVE FOREIGN BODY DUCT
20|FH_F115430_0_0|CSTM-ALL|CSTM-00|2020|PDM|1942.00|99|0.00|AEG 9 (NO REV)
20|FH_F115430_0_0|CSTM-ALL|CSTM-00|2020|PDM|647.00|99|0.00|AEG 2 (NO REV)
20|FH_F115430_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 4 (NO REV)
20|FH_F115430_0_0|SrvcGrp|11663|2022|PCT|1.05|99|0.00|IMPLANTS
20|FH_F115430_0_0|SrvcGrp|44461|2022|PDM|7150.00|99|0.00|INSERTION / REPLACEMENT OF SPINAL NEUROSTIMULATOR GENERATOR
20|FH_F115430_0_0|SrvcGrp|58755|2022|PDM|5720.00|99|0.00|INJECTION PROC FOR JOINT
20|FH_F115443_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|AEG 1 (NO REV)
20|FH_F115443_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 2 (NO REV)
20|FH_F115464_0_0|CSTM-ALL|CSTM-00|2020|PDM|1083.00|99|0.00|AEG 6 (NO REV)
20|FH_F115464_0_0|CSTM-ALL|CSTM-00|2020|PDM|1305.00|99|0.00|AEG 7 (NO REV)
20|FH_F115464_0_0|CSTM-ALL|CSTM-00|2020|PDM|585.00|99|0.00|AEG 2 (NO REV)
20|FH_F115464_0_0|CSTM-ALL|CSTM-00|2020|PDM|669.00|99|0.00|AEG 3 (NO REV)
20|FH_F115464_0_0|CSTM-ALL|CSTM-00|2020|PDM|827.00|99|0.00|AEG 10 (NO REV)
20|FH_F115464_0_0|CSTM-ALL|CSTM-00|2020|PDM|827.00|99|0.00|AEG 4 (NO REV)
20|FH_F115464_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F115488_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F115491_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F115495_0_0|SrvcGrp|87077|2022|PDM|140.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F115543_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F115543_0_0|CSTM-ALL|CSTM-00|2020|PDM|1040.00|99|0.00|AEG 5  (NO REV)
20|FH_F115616_0_0|CSTM-ALL|CSTM-00|2020|PDM|1405.00|99|0.00|AEG 10 (NO REV)
20|FH_F115616_0_0|CSTM-ALL|CSTM-00|2020|PDM|2393.00|99|0.00|AEG 4 (NO REV)
20|FH_F115616_0_0|CSTM-ALL|CSTM-00|2020|PDM|3069.00|99|0.00|AEG 7 (NO REV)
20|FH_F115616_0_0|SrvcGrp|103671|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F115616_0_0|SrvcGrp|106227|2022|PDM|3121.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F115616_0_0|SrvcGrp|65350|2022|PDM|4474.00|99|0.00|KNEE ARTHRO/ANTER
20|FH_F115616_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F115616_0_0|SrvcGrp|88030|2022|PDM|5930.00|99|0.00|REVISION OF KNEE JOINT
20|FH_F115616_0_0|SrvcGrp|90063|2022|PDM|3121.00|99|0.00|REPAIR BICEPS TENDON RUPTURE
20|FH_F115616_0_0|SrvcGrp|93641|2022|PDM|3121.00|99|0.00|KNEE ARTHROSCOPIC SURGERY
20|FH_F115625_63110_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F115625_63110_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F115674_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 1 (NO REV)
20|FH_F115674_0_0|CSTM-ALL|CSTM-00|2020|PDM|446.00|99|0.00|AEG 2 (NO REV)
20|FH_F115674_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|AEG 4 (NO REV)
20|FH_F115735_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F115735_0_0|SrvcGrp|96201|2022|PDM|45.00|99|0.00|PT/OT/ST
20|FH_F115771_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F115771_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F115771_0_0|SrvcGrp|87077|2022|PDM|155.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F115808_0_0|SrvcGrp|82981|2022|PDM|100.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F115823_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F115823_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 10 (NO REV)
20|FH_F115823_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|AEG 3 (NO REV)
20|FH_F115823_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|AEG 4 (NO REV)
20|FH_F115868_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F115868_0_0|SrvcGrp|74546|2022|PDM|500.00|99|0.00|HOSPICE SERVICES
20|FH_F115868_0_0|SrvcGrp|90477|2022|PDM|100.00|99|0.00|HOSPICE
20|FH_F115875_0_0|CSTM-ALL|CSTM-00|2020|PDM|1391.00|99|0.00|AEG 2 (NO REV)
20|FH_F115875_0_0|CSTM-ALL|CSTM-00|2020|PDM|2318.00|99|0.00|AEG 3 (NO REV)
20|FH_F115875_0_0|CSTM-ALL|CSTM-00|2020|PDM|3348.00|99|0.00|AEG 5  (NO REV)
20|FH_F115875_0_0|SrvcGrp|106326|2022|PDM|412.00|99|0.00|SCAN PROC CRANIAL EXTRA (HCFA)
20|FH_F115884_0_0|SrvcGrp|63297|2022|PDM|111.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F115884_0_0|SrvcGrp|89783|2022|PDM|111.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F115884_0_0|SrvcGrp|90477|2022|PDM|111.00|99|0.00|HOSPICE
20|FH_F115884_0_0|SrvcGrp|9529|2022|PDM|515.00|99|0.00|HOSPICE SVCS
20|FH_F115889_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F115889_0_0|SrvcGrp|11663|2022|PCT|1.05|99|0.00|IMPLANTS
20|FH_F115889_0_0|SrvcGrp|72996|2022|PDM|1066.00|99|0.00|AEG 4
20|FH_F115889_0_0|SrvcGrp|73004|2022|PDM|1640.00|99|0.00|AEG 8
20|FH_F115895_0_0|CSTM-ALL|CSTM-00|2020|PDM|1694.00|99|0.00|AEG 1 (NO REV)
20|FH_F49329_0_0|CSTM-ALL|CSTM-00|2020|PDM|108.00|99|0.00|IP SKILLED NURSING VISIT
20|FH_F49329_0_0|CSTM-ALL|CSTM-00|2020|PDM|20.00|99|0.00|HOME HEALTH AIDE (ADDITIONAL HOURS)
20|FH_F49434_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS
20|FH_F49444_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F49444_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F49452_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE
20|FH_F49458_0_0|SrvcGrp|45569|2022|PDM|61.97|99|0.00|SOFTEE POST MASTECTOMY
20|FH_F49458_0_0|SrvcGrp|45570|2022|PDM|170.96|99|0.00|NON SILICONE BREAST FORM
20|FH_F49459_0_0|SrvcGrp|31702|2022|PDM|180.00|99|0.00|INTENSIVE OUTPATIENT
20|FH_F49478_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F49478_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F49478_0_0|CSTM-ALL|CSTM-00|2020|PDM|368.00|99|0.00|COVENTRY ENHANCED GROUPER 1
20|FH_F49478_0_0|CSTM-ALL|CSTM-00|2020|PDM|792.00|99|0.00|COVENTRY ENHANCED GROUPER 5
20|FH_F49489_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F49489_0_0|CSTM-ALL|CSTM-00|2020|PDM|2087.82|99|0.00|ASPG VI
20|FH_F49489_0_0|CSTM-ALL|CSTM-00|2020|PDM|2756.36|99|0.00|ASPG IX
20|FH_F49554_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F49572_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F49575_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F49598_0_0|CSTM-ALL|CSTM-00|2020|PDM|5092.00|99|0.00|CARDIAC CATH (WITH PTCA / ROTO / STENT)
20|FH_F49598_0_0|SrvcGrp|33793|2022|PDM|3183.00|99|0.00|MSDRG 246-251 ONLY ANGIOPLASTY
20|FH_F49598_0_0|SrvcGrp|9939|2022|PDM|1157.00|99|0.00|ACUTE MEDICAL SVCS
20|FH_F49601_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F49601_0_0|CSTM-ALL|CSTM-00|2020|PDM|425.00|99|0.00|OP SURGERY MOD SG
20|FH_F49735_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F49739_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F49776_0_0|SrvcGrp|12856|2022|PDM|53.00|99|0.00|NURSING CARE
20|FH_F49776_0_0|SrvcGrp|42828|2022|PDM|102.00|99|0.00|SPEECH THERAPY VISIT
20|FH_F49832_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F49852_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F49853_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE
20|FH_F49913_0_0|SrvcGrp|21594|2022|PDM|335.00|99|0.00|SKILLED NURSING
20|FH_F49914_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F49914_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F49914_0_0|SrvcGrp|44860|2022|PDM|600.00|99|0.00|SKILLED NURSING, BARIATRIC
20|FH_F49937_0_0|SrvcGrp|21594|2022|PDM|335.00|99|0.00|SKILLED NURSING
20|FH_F49937_0_0|SrvcGrp|43785|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY SERVICES
20|FH_F49943_0_0|SrvcGrp|42975|2022|PDM|140.00|99|0.00|PHYSICAL THERAPIST
20|FH_F49943_0_0|SrvcGrp|45950|2022|PDM|140.00|99|0.00|SPEECH THERAPY
20|FH_F49954_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F49954_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F49954_0_0|SrvcGrp|44860|2022|PDM|600.00|99|0.00|SKILLED NURSING, BARIATRIC
20|FH_F49954_0_0|SrvcGrp|45148|2022|PDM|90.00|99|0.00|SPEECH THERAPY
20|FH_F49954_0_0|SrvcGrp|45150|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY
20|FH_F49979_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F49979_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F49996_0_0|CSTM-ALL|CSTM-00|2020|PDM|1119.00|99|0.00|ASPG V
20|FH_F49996_0_0|CSTM-ALL|CSTM-00|2020|PDM|1119.00|99|0.00|ASPG V- MOD 50
20|FH_F49996_0_0|CSTM-ALL|CSTM-00|2020|PDM|696.00|99|0.00|ASPG II
20|FH_F50013_0_0|CSTM-ALL|CSTM-00|2020|PDM|776.00|99|0.00|ACUTE PSYCH
20|FH_F50074_0_0|CSTM-ALL|CSTM-00|2020|PCT|74.00|99|0.00|OP SVCS
20|FH_F50100_0_0|SrvcGrp|46112|2022|PDM|55.32|99|0.00|MATERNAL/CHILD HEALTH (ADDITIONAL HOUR)
20|FH_F50100_0_0|SrvcGrp|46113|2022|PDM|110.64|99|0.00|PT VISIT
20|FH_F50137_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS
20|FH_F50137_0_0|CSTM-ALL|CSTM-00|2020|PDM|120.00|99|0.00|HOME VISIT CATHETER CARE
20|FH_F50137_0_0|CSTM-ALL|CSTM-00|2020|PDM|120.00|99|0.00|HOME VISIT NEWBORN CARE
20|FH_F50137_0_0|CSTM-ALL|CSTM-00|2020|PDM|120.00|99|0.00|HOME VISIT POSTNATAL CARE
20|FH_F50137_0_0|SrvcGrp|10541|2022|PDM|115.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F50137_0_0|SrvcGrp|14081|2022|PDM|120.00|99|0.00|HOME VISIT - POSTNATAL
20|FH_F50137_0_0|SrvcGrp|28992|2022|PDM|120.00|99|0.00|RN HI-TECH VISIT
20|FH_F50137_0_0|SrvcGrp|42972|2022|PDM|26.00|99|0.00|HOME HEALTH AIDE
20|FH_F50163_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE
20|FH_F50163_0_0|CSTM-ALL|CSTM-00|2020|PDM|180.00|99|0.00|CD - HALF DAY (4-7 HR)
20|FH_F50163_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|ADULT PSYCHIATRIC
20|FH_F50163_0_0|CSTM-ALL|CSTM-00|2020|PDM|680.00|99|0.00|ADOLESCENT PSYCHIATRIC
20|FH_F50163_0_0|SrvcGrp|109|2022|PDM|600.00|99|0.00|CD - DETOX
20|FH_F50163_0_0|SrvcGrp|15634|2022|PDM|180.00|99|0.00|OP PARTIAL PSYCH
20|FH_F50214_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F50218_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS
20|FH_F50218_0_0|CSTM-ALL|CSTM-00|2020|PDM|120.00|99|0.00|HOME VISIT POSTNATAL CARE
20|FH_F50218_0_0|CSTM-ALL|CSTM-00|2020|PDM|120.00|99|0.00|HOME VISIT RESPIRATORY THERAPY CARE
20|FH_F50218_0_0|CSTM-ALL|CSTM-00|2020|PDM|120.00|99|0.00|OCCUPATIONAL THERAPY SERVICES
20|FH_F50218_0_0|CSTM-ALL|CSTM-00|2020|PDM|120.00|99|0.00|PHYSICAL THERAPY SERVICES
20|FH_F50218_0_0|CSTM-ALL|CSTM-00|2020|PDM|120.00|99|0.00|SPEECH THERAPY SERVICES
20|FH_F50218_0_0|CSTM-ALL|CSTM-00|2020|PDM|125.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES
20|FH_F50218_0_0|SrvcGrp|10519|2022|PDM|125.00|99|0.00|MEDICAL SOCIAL WORKER VISIT
20|FH_F50218_0_0|SrvcGrp|10541|2022|PDM|120.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F50218_0_0|SrvcGrp|10542|2022|PDM|120.00|99|0.00|OCCUPATIONAL THERAPY SVCS
20|FH_F50218_0_0|SrvcGrp|10543|2022|PDM|120.00|99|0.00|SPEECH THERAPY SVCS
20|FH_F50218_0_0|SrvcGrp|42972|2022|PDM|32.00|99|0.00|HOME HEALTH AIDE
20|FH_F50218_0_0|SrvcGrp|46249|2022|PDM|120.00|99|0.00|HOME VISIT STOMA/COLOSTOMY/CYSTOSTOMY CARE
20|FH_F50218_0_0|SrvcGrp|46250|2022|PDM|120.00|99|0.00|HOME VISIT CATHETER CARE
20|FH_F115895_0_0|CSTM-ALL|CSTM-00|2020|PDM|3169.00|99|0.00|AEG 10 (NO REV)
20|FH_F115895_0_0|CSTM-ALL|CSTM-00|2020|PDM|3713.00|99|0.00|AEG 5  (NO REV)
20|FH_F115895_0_0|CSTM-ALL|CSTM-00|2020|PDM|5027.00|99|0.00|AEG 7 (NO REV)
20|FH_F115895_0_0|SrvcGrp|58775|2022|PDM|4774.00|99|0.00|CORPECTOMY
20|FH_F115895_0_0|SrvcGrp|88492|2022|PDM|4774.00|99|0.00|AETNA SPINAL BONE AUTOGRAFT
20|FH_F115905_0_0|CSTM-ALL|CSTM-00|2020|PDM|1080.00|99|0.00|ASPG 3 HEARTLAND HEALTHCARE
20|FH_F115905_0_0|CSTM-ALL|CSTM-00|2020|PDM|1265.00|99|0.00|ASPG 4 HEARTLAND HEALTHCARE
20|FH_F115954_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F115954_0_0|CSTM-ALL|CSTM-00|2020|PDM|618.00|99|0.00|AEG 8 (NO REV)
20|FH_F115963_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F115971_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F115971_0_0|SrvcGrp|103965|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F115971_0_0|SrvcGrp|72990|2022|PDM|363.00|99|0.00|AEG 1
20|FH_F115971_0_0|SrvcGrp|72998|2022|PDM|799.00|99|0.00|AEG 5
20|FH_F115971_0_0|SrvcGrp|73000|2022|PDM|927.00|99|0.00|AEG 6
20|FH_F115971_0_0|SrvcGrp|73008|2022|PDM|585.00|99|0.00|AEG 10
20|FH_F115974_0_0|CSTM-ALL|CSTM-00|2020|PDM|973.00|99|0.00|AEG 8 (NO REV)
20|FH_F115982_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F115982_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F115982_0_0|SrvcGrp|26273|2022|PDM|1350.00|99|0.00|CPT 29880
20|FH_F115982_0_0|SrvcGrp|26275|2022|PDM|1800.00|99|0.00|CPT 29826
20|FH_F115982_0_0|SrvcGrp|27261|2022|PDM|5250.00|99|0.00|CPT 27446
20|FH_F115982_0_0|SrvcGrp|27315|2022|PDM|2100.00|99|0.00|TENDON REPAIR
20|FH_F115982_0_0|SrvcGrp|35670|2022|PDM|12750.00|99|0.00|SPINAL NEUROSTIMULATORS PROCEDURE
20|FH_F115982_0_0|SrvcGrp|70749|2022|PDM|1200.00|99|0.00|CPT 29823
20|FH_F115982_0_0|SrvcGrp|73000|2022|PDM|992.00|99|0.00|AEG 6
20|FH_F115982_0_0|SrvcGrp|73008|2022|PDM|396.00|99|0.00|AEG 10
20|FH_F115982_0_0|SrvcGrp|82114|2022|PDM|1600.00|99|0.00|MENISCUS REPAIR MED OR LAT
20|FH_F115982_0_0|SrvcGrp|84939|2022|PDM|6875.00|99|0.00|SHOULDER JOINT
20|FH_F115982_0_0|SrvcGrp|85778|2022|PDM|1750.00|99|0.00|REPAIR OF ANKLE FRACTURE
20|FH_F115982_0_0|SrvcGrp|89989|2022|PDM|2250.00|99|0.00|FUSION OF BIG TOE JOINT
20|FH_F115985_0_0|SrvcGrp|15557|2022|PDM|444.00|99|0.00|VENTILATOR
20|FH_F115985_0_0|SrvcGrp|17100|2022|PDM|1585.00|99|0.00|SKILLED NURSING
20|FH_F115985_0_0|SrvcGrp|29930|2022|PDM|444.00|99|0.00|DIALYSIS
20|FH_F115985_0_0|SrvcGrp|82037|2022|PDM|1585.00|99|0.00|AETNA ICU
20|FH_F115990_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F115990_0_0|SrvcGrp|72992|2022|PDM|750.00|99|0.00|AEG 2
20|FH_F115990_0_0|SrvcGrp|72996|2022|PDM|1055.00|99|0.00|AEG 4
20|FH_F116005_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|AEG 10 (NO REV)
20|FH_F116005_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|AEG 3 (NO REV)
20|FH_F116005_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|AEG 6 (NO REV)
20|FH_F116005_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|AEG 8 (NO REV)
20|FH_F116019_0_0|SrvcGrp|87077|2022|PDM|100.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F116043_0_0|SrvcGrp|65720|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F116043_0_0|SrvcGrp|73656|2022|PDM|475.00|99|0.00|AETNA HOSPICE SVCS
20|FH_F116043_0_0|SrvcGrp|90477|2022|PDM|100.00|99|0.00|HOSPICE
20|FH_F116097_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F116100_0_0|SrvcGrp|3809|2022|PDM|573.47|99|0.00|HOSPICE CARE
20|FH_F116108_0_0|SrvcGrp|22954|2022|PDM|148.79|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F116126_0_0|SrvcGrp|76094|2022|PDM|148.79|99|0.00|HOSPICE ROUTINE HOME CARE
20|FH_F116143_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F116143_0_0|SrvcGrp|106235|2022|PCT|1.00|99|0.00|CYPASS
20|FH_F116143_0_0|SrvcGrp|82138|2022|PDM|1050.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F116145_0_0|SrvcGrp|26001|2022|PDM|133.35|99|0.00|HOSPICE RESPITE SVCS
20|FH_F116145_0_0|SrvcGrp|3809|2022|PDM|573.47|99|0.00|HOSPICE CARE
20|FH_F116159_0_0|CSTM-ALL|CSTM-00|2020|PDM|792.00|99|0.00|AEG 4 (NO REV)
20|FH_F116159_0_0|SrvcGrp|114930|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F116176_0_0|SrvcGrp|3809|2022|PDM|573.47|99|0.00|HOSPICE CARE
20|FH_F116176_0_0|SrvcGrp|57968|2022|PDM|31.35|99|0.00|CONTINUOUS HOMECARE
20|FH_F116207_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F116207_0_0|SrvcGrp|104911|2022|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES
20|FH_F116245_0_0|SrvcGrp|76094|2022|PDM|148.79|99|0.00|HOSPICE ROUTINE HOME CARE
20|FH_F116275_0_0|SrvcGrp|103550|2022|PDM|420.00|99|0.00|HEMODIALYSIS SVCS
20|FH_F116275_0_0|SrvcGrp|103551|2022|PDM|180.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS
20|FH_F116279_0_0|CSTM-ALL|CSTM-00|2020|PCT|71.00|99|0.00|GENERAL ACUTE CARE
20|FH_F116323_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F116323_0_0|CSTM-ALL|CSTM-00|2020|PDM|1874.00|99|0.00|AEG 3 (NO REV)
20|FH_F116323_0_0|CSTM-ALL|CSTM-00|2020|PDM|1874.00|99|0.00|AEG 7 (NO REV)
20|FH_F116323_0_0|CSTM-ALL|CSTM-00|2020|PDM|2275.00|99|0.00|AEG 8 (NO REV)
20|FH_F116323_0_0|CSTM-ALL|CSTM-00|2020|PDM|2316.00|99|0.00|AEG 6 (NO REV)
20|FH_F116323_0_0|SrvcGrp|105657|2022|PDM|322.00|99|0.00|C-ARM AND LASER FLUOROSCOPY (HCFA)
20|FH_F116323_0_0|SrvcGrp|106666|2022|PDM|28954.00|99|0.00|RECONSTRUCT SHOULDER JOINT
20|FH_F116323_0_0|SrvcGrp|106669|2022|PDM|24089.00|99|0.00|AETNA POSTERIOR CERVICAL FUSION
20|FH_F116323_0_0|SrvcGrp|106670|2022|PDM|20075.00|99|0.00|AETNA ANTERIOR CERVICAL FUSION
20|FH_F116323_0_0|SrvcGrp|71666|2022|PDM|26766.00|99|0.00|CPT 63655
20|FH_F116324_0_0|SrvcGrp|106742|2022|PDM|600.00|99|0.00|ENDOSCOPY
20|FH_F116324_0_0|SrvcGrp|75487|2022|PDM|550.00|99|0.00|AEG 5
20|FH_F116324_0_0|SrvcGrp|75489|2022|PDM|550.00|99|0.00|AEG 6
20|FH_F116324_0_0|SrvcGrp|75491|2022|PDM|550.00|99|0.00|AEG 7
20|FH_F116332_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F116332_0_0|SrvcGrp|106680|2022|PDM|8689.00|99|0.00|REVISION OF ANKLE JOINT
20|FH_F116332_0_0|SrvcGrp|115366|2022|PDM|2832.00|99|0.00|KNEE ARTHROSCOPY
20|FH_F116332_0_0|SrvcGrp|11663|2022|PCT|0.80|99|0.00|IMPLANTS
20|FH_F50237_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F50237_0_0|SrvcGrp|13711|2022|PDM|1400.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F50297_0_0|SrvcGrp|42972|2022|PDM|26.00|99|0.00|HOME HEALTH AIDE
20|FH_F50297_0_0|SrvcGrp|42973|2022|PDM|82.00|99|0.00|SPEECH  THERAPIST
20|FH_F50297_0_0|SrvcGrp|42975|2022|PDM|82.00|99|0.00|PHYSICAL THERAPIST
20|FH_F50334_0_0|SrvcGrp|3809|2022|PDM|540.00|99|0.00|HOSPICE CARE
20|FH_F50334_0_0|SrvcGrp|44131|2022|PDM|123.00|99|0.00|SPEECH THERAPY VISIT
20|FH_F50334_0_0|SrvcGrp|46549|2022|PDM|50.00|99|0.00|HOME HEALTH AIDE
20|FH_F50372_0_0|SrvcGrp|46592|2022|PDM|190.00|99|0.00|CPT 99214
20|FH_F50372_0_0|SrvcGrp|46593|2022|PDM|225.00|99|0.00|CPT 99215
20|FH_F50432_0_0|CSTM-ALL|CSTM-00|2020|PDM|1017.00|99|0.00|COVENTRY ENHANCED GROUPER 4
20|FH_F50432_0_0|CSTM-ALL|CSTM-00|2020|PDM|1334.00|99|0.00|COVENTRY ENHANCED GROUPER 6
20|FH_F50432_0_0|CSTM-ALL|CSTM-00|2020|PDM|1571.00|99|0.00|COVENTRY ENHANCED GROUPER 8
20|FH_F50432_0_0|CSTM-ALL|CSTM-00|2020|PDM|1571.00|99|0.00|COVENTRY ENHANCED GROUPER 8 MOD 50
20|FH_F50459_0_0|SrvcGrp|33164|2022|PDM|305.00|99|0.00|SKILLED NURSING - LEVEL I
20|FH_F50459_0_0|SrvcGrp|43892|2022|PDM|90.00|99|0.00|PHYSICAL THERAPY VISIT
20|FH_F50459_0_0|SrvcGrp|43893|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY VISIT
20|FH_F50459_0_0|SrvcGrp|44131|2022|PDM|110.00|99|0.00|SPEECH THERAPY VISIT
20|FH_F50459_0_0|SrvcGrp|471|2022|PDM|650.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F50462_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F50462_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F50462_0_0|SrvcGrp|45948|2022|PDM|140.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F50474_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F50475_0_0|CSTM-ALL|CSTM-00|2020|PDM|1020.00|99|0.00|ASPG IV - FH SW CUSTOM GROUPERS
20|FH_F50475_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|ASPG VI - FH SW CUSTOM GROUPERS
20|FH_F50475_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|ASPG IX - FH SW CUSTOM GROUPERS
20|FH_F50477_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F50484_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE
20|FH_F50493_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.00|99|0.00|OP SVCS
20|FH_F50496_0_0|CSTM-ALL|CSTM-00|2020|PCT|74.00|99|0.00|GENERAL ACUTE CARE
20|FH_F50497_0_0|CSTM-ALL|CSTM-00|2020|PCT|74.00|99|0.00|OP SVCS
20|FH_F50519_0_0|SrvcGrp|46769|2022|PDM|40.00|99|0.00|CPT CODE 90853 PER VISIT
20|FH_F50535_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F50535_0_0|CSTM-ALL|CSTM-00|2020|PDM|1614.00|99|0.00|COVENTRY ENHANCED GROUPER 9
20|FH_F50535_0_0|CSTM-ALL|CSTM-00|2020|PDM|538.00|99|0.00|COVENTRY ENHANCED GROUPER 2
20|FH_F50577_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F50578_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F50583_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F50583_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F50612_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F50621_0_0|CSTM-ALL|CSTM-00|2020|PCT|91.00|99|0.00|OP SVCS
20|FH_F50622_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS
20|FH_F50635_0_0|SrvcGrp|9811|2022|PDM|395.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F50654_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|ASPG I
20|FH_F50654_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|ASPG VII
20|FH_F50654_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|ASPG VIII
20|FH_F50654_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|ASPG X
20|FH_F50654_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REVISION OF UPPER/LOWER EYELID
20|FH_F50654_0_0|SrvcGrp|46889|2022|PCT|1.00|99|0.00|LASER TREATMENT OF RETINA
20|FH_F50655_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|GENERAL ACUTE CARE
20|FH_F50715_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F50715_0_0|SrvcGrp|12403|2022|PDM|32.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F50715_0_0|SrvcGrp|22954|2022|PDM|132.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F50832_0_0|CSTM-ALL|CSTM-00|2020|PCT|66.30|99|0.00|GENERAL ACUTE CARE
20|FH_F50873_0_0|SrvcGrp|42824|2022|PDM|75.00|99|0.00|SKILLED NURSING VISIT
20|FH_F50873_0_0|SrvcGrp|42826|2022|PDM|75.00|99|0.00|PHYSICAL THERAPY VISIT
20|FH_F50873_0_0|SrvcGrp|42830|2022|PDM|75.00|99|0.00|MEDICAL SOCIAL WORKER VISIT
20|FH_F50952_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F50952_0_0|SrvcGrp|15122|2022|PCT|0.80|99|0.00|CARDIAC CATH LAB SVCS
20|FH_F50994_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F50994_0_0|SrvcGrp|3809|2022|PDM|350.00|99|0.00|HOSPICE CARE
20|FH_F51015_0_0|CSTM-ALL|CSTM-00|2020|PCT|67.00|99|0.00|OP SVCS
20|FH_F51016_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F51016_0_0|SrvcGrp|33164|2022|PDM|305.00|99|0.00|SKILLED NURSING - LEVEL I
20|FH_F51016_0_0|SrvcGrp|471|2022|PDM|650.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F51074_0_0|CSTM-ALL|CSTM-00|2020|PDM|1257.00|99|0.00|GENERAL ACUTE CARE
20|FH_F51074_0_0|CSTM-ALL|CSTM-00|2020|PDM|3704.00|99|0.00|MS DRG 765-766 C-SECTION
20|FH_F51074_0_0|SrvcGrp|36991|2022|PCT|0.55|99|0.00|IMPLANTS
20|FH_F51115_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F51115_0_0|SrvcGrp|26001|2022|PDM|137.82|99|0.00|HOSPICE RESPITE SVCS
20|FH_F51115_0_0|SrvcGrp|42825|2022|PDM|57.30|99|0.00|HOME HEALTH AIDE VISIT
20|FH_F51120_0_0|SrvcGrp|26001|2022|PDM|160.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F51121_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F51123_0_0|SrvcGrp|10618|2022|PDM|122.50|99|0.00|CPT CODE 99344
20|FH_F51123_0_0|SrvcGrp|15385|2022|PDM|141.75|99|0.00|SKILLED NURSING NON IV RELATED
20|FH_F51123_0_0|SrvcGrp|29303|2022|PDM|120.75|99|0.00|OCCUPATIONAL THERAPY
20|FH_F51124_0_0|SrvcGrp|11796|2022|PDM|115.00|99|0.00|DIETICIAN
20|FH_F51124_0_0|SrvcGrp|29303|2022|PDM|120.75|99|0.00|OCCUPATIONAL THERAPY
20|FH_F51124_0_0|SrvcGrp|3809|2022|PDM|675.00|99|0.00|HOSPICE CARE
20|FH_F51129_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|PTE SURGERY
20|FH_F51129_0_0|SrvcGrp|11336|2022|PCT|0.55|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F51129_0_0|SrvcGrp|30064|2022|PDM|850.00|99|0.00|ELECTROCONVULSIVE THERAPY (ECT)
20|FH_F51129_0_0|SrvcGrp|3409|2022|PDM|800.00|99|0.00|NEWBORN NURSERY
20|FH_F116332_0_0|SrvcGrp|26275|2022|PDM|5313.00|99|0.00|CPT 29826
20|FH_F116332_0_0|SrvcGrp|83677|2022|PDM|6090.00|99|0.00|AETNA CARDIAC CATH
20|FH_F116332_0_0|SrvcGrp|83824|2022|PCT|0.00|99|0.00|AETNA CADIAC CATH INCIDENTAL CODES
20|FH_F116332_0_0|SrvcGrp|87843|2022|PDM|13568.00|99|0.00|REVISE STOMACH - BOWEL FUSION
20|FH_F116332_0_0|SrvcGrp|93433|2022|PDM|16726.00|99|0.00|PARTIAL HIP REPLACEMENT
20|FH_F116346_0_0|SrvcGrp|103552|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER
20|FH_F116373_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|HSS ASC
20|FH_F116392_0_0|CSTM-ALL|CSTM-00|2020|PCT|71.00|99|0.00|GENERAL ACUTE CARE
20|FH_F116428_0_0|SrvcGrp|57967|2022|PDM|148.79|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F116428_0_0|SrvcGrp|57968|2022|PDM|31.35|99|0.00|CONTINUOUS HOMECARE
20|FH_F116428_0_0|SrvcGrp|92502|2022|PDM|573.47|99|0.00|HOSPICE GENERAL IP CARE
20|FH_F116430_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F116430_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F116430_0_0|CSTM-ALL|CSTM-00|2020|PDM|1062.00|99|0.00|AEG 4 (NO REV)
20|FH_F116430_0_0|CSTM-ALL|CSTM-00|2020|PDM|801.00|99|0.00|AEG 2 (NO REV)
20|FH_F116430_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F116430_0_0|SrvcGrp|106708|2022|PDM|2403.00|99|0.00|OTHER ENT SURGERY
20|FH_F116430_0_0|SrvcGrp|106710|2022|PDM|3183.00|99|0.00|PAIN STIM SURGERY
20|FH_F116430_0_0|SrvcGrp|11673|2022|PDM|2705.00|99|0.00|CPT 29888
20|FH_F116430_0_0|SrvcGrp|27315|2022|PDM|3395.00|99|0.00|TENDON REPAIR
20|FH_F116430_0_0|SrvcGrp|27316|2022|PDM|2864.00|99|0.00|TONSILS & ADENOIDS (42820)
20|FH_F116437_0_0|CSTM-ALL|CSTM-00|2020|PDM|1870.00|99|0.00|AEG 5 W/O OCULAR SERVICES (NO REV)
20|FH_F116437_0_0|SrvcGrp|46888|2022|PDM|1757.00|99|0.00|VITRECTOMY
20|FH_F116437_0_0|SrvcGrp|46889|2022|PDM|1757.00|99|0.00|LASER TREATMENT OF RETINA
20|FH_F116437_0_0|SrvcGrp|84123|2022|PDM|870.00|99|0.00|INSERT ANT SEGMENT DRAIN EXT
20|FH_F116440_0_0|SrvcGrp|24027|2022|PDM|65.00|99|0.00|PHYSICAL/OCCUPATIONAL/SPEECH THERAPY
20|FH_F116440_0_0|SrvcGrp|73485|2022|PDM|880.00|99|0.00|AETNA REHAB
20|FH_F116443_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|AEG 3 (NO REV)
20|FH_F116443_0_0|CSTM-ALL|CSTM-00|2020|PDM|3455.00|99|0.00|AEG 9 (NO REV)
20|FH_F116443_0_0|SrvcGrp|104098|2022|PDM|4100.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT
20|FH_F116473_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F116473_0_0|CSTM-ALL|CSTM-00|2020|PDM|1050.00|99|0.00|AEG 5  (NO REV)
20|FH_F116473_0_0|CSTM-ALL|CSTM-00|2020|PDM|1227.00|99|0.00|AEG 6 (NO REV)
20|FH_F116473_0_0|CSTM-ALL|CSTM-00|2020|PDM|560.00|99|0.00|AEG 1 (NO REV)
20|FH_F116473_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|AEG 10 (NO REV)
20|FH_F116473_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F116473_0_0|SrvcGrp|89404|2022|PDM|15000.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F116485_17033_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F116485_17033_0|SrvcGrp|105425|2022|PDM|30.55|99|0.00|AETNA EXPOSURE ADAPTIVE BH TREATMENT 60 MINS
20|FH_F116485_17033_0|SrvcGrp|110061|2022|PDM|31.83|99|0.00|ADAPTIVE BH TREATMENT 15 MINS
20|FH_F116485_17033_0|SrvcGrp|114754|2022|PDM|303.85|99|0.00|EDUCATIONALLY BEHAVIORAL SUPPORTS LEVEL 3
20|FH_F116492_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 4 (NO REV)
20|FH_F116506_0_0|SrvcGrp|75485|2022|PDM|725.00|99|0.00|AEG 4
20|FH_F116506_0_0|SrvcGrp|75497|2022|PDM|375.00|99|0.00|AEG 10
20|FH_F116549_0_0|SrvcGrp|103551|2022|PDM|182.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS
20|FH_F116554_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F116554_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 6 (NO REV)
20|FH_F116563_0_0|CSTM-ALL|CSTM-00|2020|PDM|1421.81|99|0.00|AETNA SURGERY DEFAULT WITHOUT GROUPER 1 & 2
20|FH_F116572_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|OP SVCS
20|FH_F116575_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F116575_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 2 (NO REV)
20|FH_F116575_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|AEG 3 (NO REV)
20|FH_F116575_0_0|CSTM-ALL|CSTM-00|2020|PDM|2046.00|99|0.00|AEG 7 (NO REV)
20|FH_F116575_0_0|SrvcGrp|106264|2022|PDM|2537.92|99|0.00|NSL/SINS NDSC W/ SINS DILATION
20|FH_F116575_0_0|SrvcGrp|106265|2022|PDM|2650.00|99|0.00|NSL/SINS NDSC TOTAL
20|FH_F116575_0_0|SrvcGrp|15473|2022|PDM|1600.00|99|0.00|CPT CODE 42820
20|FH_F116575_0_0|SrvcGrp|59841|2022|PDM|1250.00|99|0.00|SUBMUCOUS RESECTION
20|FH_F116575_0_0|SrvcGrp|83646|2022|PDM|1800.00|99|0.00|CPT 31276
20|FH_F116575_0_0|SrvcGrp|84910|2022|PDM|1800.00|99|0.00|ENDOSCOPY
20|FH_F116575_0_0|SrvcGrp|89882|2022|PDM|2500.00|99|0.00|AETNA REMOVAL OF TONSILS
20|FH_F116575_0_0|SrvcGrp|94479|2022|PDM|1250.00|99|0.00|AETNA SCAN PROC CRANIAL EXTRA
20|FH_F116583_0_0|SrvcGrp|104229|2022|PDM|150.00|99|0.00|HOSPICE IN HOME (HCFA)
20|FH_F116583_0_0|SrvcGrp|104841|2022|PDM|650.00|99|0.00|HOSPICE CARE PROVIDED IP HOSPICE FAC
20|FH_F116583_0_0|SrvcGrp|106927|2022|PDM|150.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)
20|FH_F116583_0_0|SrvcGrp|29155|2022|PDM|150.00|99|0.00|HOSPICE SVCS
20|FH_F116583_0_0|SrvcGrp|33722|2022|PDM|40.00|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F116583_0_0|SrvcGrp|80918|2022|PDM|150.00|99|0.00|RESPITE CARE
20|FH_F116583_0_0|SrvcGrp|80920|2022|PDM|650.00|99|0.00|HOSPICE SERVICES
20|FH_F116583_0_0|SrvcGrp|84185|2022|PDM|150.00|99|0.00|RESPITE CARE
20|FH_F116583_0_0|SrvcGrp|95660|2022|PDM|650.00|99|0.00|HOSPICE SERVICES (HCFA)
20|FH_F116600_0_0|CSTM-ALL|CSTM-00|2020|PCT|69.00|99|0.00|OP SVCS
20|FH_F116647_0_0|SrvcGrp|82498|2022|PDM|191.00|99|0.00|DIALYSIS PROCEDURE OTHER THAN HEMODIALYSIS
20|FH_F116657_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F116657_0_0|SrvcGrp|473|2022|PDM|375.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F116657_0_0|SrvcGrp|474|2022|PDM|295.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F116664_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F116727_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F116727_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F116727_0_0|SrvcGrp|35669|2022|PDM|5200.00|99|0.00|CPT 63650
20|FH_F116731_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F116747_0_0|SrvcGrp|23683|2022|PCT|0.00|99|0.00|SKILLED NURSING RN
20|FH_F116747_0_0|SrvcGrp|26160|2022|PDM|26.80|99|0.00|HOME HEALTH AIDE VISIT
20|FH_F116747_0_0|SrvcGrp|48385|2022|PDM|91.00|99|0.00|SPEECH THERAPY
20|FH_F116747_0_0|SrvcGrp|48396|2022|PDM|91.00|99|0.00|OT SERVICES
20|FH_F116747_0_0|SrvcGrp|88620|2022|PDM|91.00|99|0.00|SKILLED NURSING RN
20|FH_F116793_0_0|SrvcGrp|471|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F116793_0_0|SrvcGrp|87691|2022|PDM|45.00|99|0.00|AETNA THERAPIES
20|FH_F116806_0_0|CSTM-ALL|CSTM-00|2020|PDM|1050.00|99|0.00|AEG 4 (NO REV)
20|FH_F116806_0_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|AEG 6 (NO REV)
20|FH_F116806_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|AEG 7 (NO REV)
20|FH_F116806_0_0|CSTM-ALL|CSTM-00|2020|PDM|1750.00|99|0.00|AEG 8 (NO REV)
20|FH_F116806_0_0|CSTM-ALL|CSTM-00|2020|PDM|1900.00|99|0.00|AEG 9 (NO REV)
20|FH_F116806_0_0|SrvcGrp|104908|2022|PDM|1923.16|99|0.00|EXCISE PAROTID GLAND/LESION
20|FH_F116806_0_0|SrvcGrp|104909|2022|PDM|1923.16|99|0.00|EXCISE PAROTID GLAND/LESION
20|FH_F116806_0_0|SrvcGrp|107006|2022|PDM|10683.28|99|0.00|ARTHROPLASTY W/ PROSTHETIC JOINT REPLACEMENT
20|FH_F116806_0_0|SrvcGrp|107024|2022|PDM|1923.16|99|0.00|ARTHROPLASTY W/ ALLOGRAFT
20|FH_F116806_0_0|SrvcGrp|107031|2022|PDM|1923.16|99|0.00|RECONSTRUCT FACIAL CONTOUR
20|FH_F116806_0_0|SrvcGrp|107032|2022|PDM|1923.16|99|0.00|TREATMENT OF NOSE FRACTURE
20|FH_F116806_0_0|SrvcGrp|107033|2022|PDM|1923.16|99|0.00|REPAIR NASOETHMOID FRACTURE
20|FH_F116806_0_0|SrvcGrp|107035|2022|PDM|1923.16|99|0.00|TREATMENT OF FRACTURE
20|FH_F116806_0_0|SrvcGrp|107036|2022|PDM|1923.16|99|0.00|REPAIR CHEEK BONE FRACTURE
20|FH_F116806_0_0|SrvcGrp|107043|2022|PDM|1923.16|99|0.00|SURGERY ON UPPER JAW
20|FH_F116806_0_0|SrvcGrp|107046|2022|PDM|1923.16|99|0.00|DRAINAGE OF MOUTH LESION
20|FH_F116806_0_0|SrvcGrp|107048|2022|PDM|1923.16|99|0.00|EXCISION OF BONE-FACIAL
20|FH_F116806_0_0|SrvcGrp|107052|2022|PDM|1923.16|99|0.00|REPAIR CLEFT LIP
20|FH_F116806_0_0|SrvcGrp|107055|2022|PDM|1923.16|99|0.00|RECONSTRUCTION OF MOUTH
20|FH_F116806_0_0|SrvcGrp|107058|2022|PDM|1923.16|99|0.00|PARTIAL REMOVAL OF TONGUE
20|FH_F116806_0_0|SrvcGrp|107065|2022|PDM|1923.16|99|0.00|LENGTHENING OF PALATE
20|FH_F116806_0_0|SrvcGrp|107070|2022|PDM|1923.16|99|0.00|REPAIR SALIVARY DUCT
20|FH_F116806_0_0|SrvcGrp|107076|2022|PDM|1923.16|99|0.00|EXCISION BENIGN TUMOR/CYST
20|FH_F116806_0_0|SrvcGrp|107085|2022|PDM|1923.16|99|0.00|REPAIR UPPER JAW FISTULA
20|FH_F116806_0_0|SrvcGrp|107086|2022|PDM|1780.06|99|0.00|REPAIR OF FACIAL NERVE
20|FH_F116806_0_0|SrvcGrp|107093|2022|PDM|973.15|99|0.00|REMOVAL OF SKIN LESION
20|FH_F116806_0_0|SrvcGrp|107095|2022|PDM|973.15|99|0.00|COMPLEX  WOUND DRAINAGE
20|FH_F116806_0_0|SrvcGrp|107099|2022|PDM|887.26|99|0.00|TREATMENT OF NOSE FRACTURE
20|FH_F116806_0_0|SrvcGrp|107112|2022|PCT|0.50|99|0.00|DENTAL SERVICES UNDER ANESTHESIA
20|FH_F116806_0_0|SrvcGrp|107115|2022|PDM|887.26|99|0.00|PARTIAL EXCISION OF LIP
20|FH_F116806_0_0|SrvcGrp|107116|2022|PDM|887.26|99|0.00|RECONSTRUCT LIP WITH FLAP
20|FH_F116806_0_0|SrvcGrp|107117|2022|PDM|887.26|99|0.00|EXCISE/REPAIR MOUTH LESION
20|FH_F116806_0_0|SrvcGrp|107118|2022|PDM|887.26|99|0.00|EXCIS TONGUE LESION W/LOCAL FLP
20|FH_F116806_0_0|SrvcGrp|107120|2022|PDM|887.26|99|0.00|TONGUE TO LIP SURGERY
20|FH_F116806_0_0|SrvcGrp|107123|2022|PDM|887.26|99|0.00|DRAINAGE OF SALIVARY GLAND
20|FH_F116806_0_0|SrvcGrp|107124|2022|PDM|887.26|99|0.00|REMOVAL OF SALIVARY STONE
20|FH_F116806_0_0|SrvcGrp|107136|2022|PDM|828.77|99|0.00|PREPARE FACE/ORAL PROSTHESIS
20|FH_F116806_0_0|SrvcGrp|107163|2022|PDM|1923.16|99|0.00|SINUSOTOMY RADICAL CALDWELL-LUC
20|FH_F116806_0_0|SrvcGrp|35667|2022|PDM|973.15|99|0.00|CPT 20680
20|FH_F116806_0_0|SrvcGrp|59338|2022|PDM|2655.05|99|0.00|GENIOPLASTY ARGUMENTATION
20|FH_F116806_0_0|SrvcGrp|83843|2022|PDM|1923.16|99|0.00|CLOSED TREATMENT OF MANDIBULAR FRACTURE
20|FH_F116806_0_0|SrvcGrp|90822|2022|PDM|1613.14|99|0.00|NASAL/SINUS ENDOSCOPY SURGERY
20|FH_F116809_0_0|CSTM-ALL|CSTM-00|2020|PDM|1029.00|99|0.00|AEG 7 (NO REV)
20|FH_F116809_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F116809_0_0|SrvcGrp|79595|2022|PDM|536.00|99|0.00|CPT 45385
20|FH_F116809_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F116825_0_0|SrvcGrp|44264|2022|PDM|1325.00|99|0.00|ACUTE MEDICAL SERVICES
20|FH_F116825_0_0|SrvcGrp|74383|2022|PDM|33.13|99|0.00|SPEECH THERAPY
20|FH_F116828_0_0|SrvcGrp|57967|2022|PDM|148.79|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F116849_0_0|SrvcGrp|12514|2022|PDM|550.00|99|0.00|TRANSITIONAL LIVING CENTER
20|FH_F116849_0_0|SrvcGrp|13928|2022|PDM|300.00|99|0.00|DAY HOSPITAL HALF DAY
20|FH_F116956_0_0|CSTM-ALL|CSTM-00|2020|PDM|1527.85|99|0.00|2005 ASPG GROUPER IX
20|FH_F116956_0_0|CSTM-ALL|CSTM-00|2020|PDM|379.97|99|0.00|2005 ASPG GROUPER I
20|FH_F116956_0_0|CSTM-ALL|CSTM-00|2020|PDM|508.90|99|0.00|2005 ASPG GROUPER II
20|FH_F116956_0_0|CSTM-ALL|CSTM-00|2020|PDM|581.93|99|0.00|2005 ASPG GROUPER III
20|FH_F116956_0_0|CSTM-ALL|CSTM-00|2020|PDM|718.86|99|0.00|2005 ASPG GROUPER X
20|FH_F116956_0_0|CSTM-ALL|CSTM-00|2020|PDM|942.50|99|0.00|2005 ASPG GROUPER VI
20|FH_F116959_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F116959_0_0|CSTM-ALL|CSTM-00|2020|PDM|1550.00|99|0.00|AEG 7 (NO REV)
20|FH_F116959_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|AEG 9 (NO REV)
20|FH_F116959_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 10 (NO REV)
20|FH_F116959_0_0|SrvcGrp|97019|2022|PDM|4000.00|99|0.00|ARTHROSCOPY BICEPS TENODESIS
20|FH_F116988_0_0|SrvcGrp|103965|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F116988_0_0|SrvcGrp|75483|2022|PDM|682.00|99|0.00|AEG 3
20|FH_F117001_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|HEARING AID, BICROS, IN THE
20|FH_F117001_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|HEARING AID, CROS, IN THE EA
20|FH_F117001_0_0|SrvcGrp|106594|2022|PDM|400.00|99|0.00|HEARING AID, BINAURAL, CIC
20|FH_F117001_0_0|SrvcGrp|106598|2022|PDM|1300.00|99|0.00|HEARING AID, PROG, BIN, ITC
20|FH_F117001_0_0|SrvcGrp|106599|2022|PDM|800.00|99|0.00|HEARING ID, DIGIT, MON, CIC
20|FH_F117001_0_0|SrvcGrp|106601|2022|PDM|1600.00|99|0.00|HEARING AID, DIGIT, BIN, CIC
20|FH_F117001_0_0|SrvcGrp|24405|2022|PDM|500.00|99|0.00|HEARING AIDE
20|FH_F117006_0_0|SrvcGrp|104226|2022|PDM|148.79|99|0.00|HOSPICE CARE (HCFA)
20|FH_F117006_0_0|SrvcGrp|57968|2022|PDM|31.35|99|0.00|CONTINUOUS HOMECARE
20|FH_F117006_0_0|SrvcGrp|92501|2022|PDM|133.35|99|0.00|HOSPICE IP RESPITE CARE
20|FH_F117009_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F117009_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F117009_0_0|CSTM-ALL|CSTM-00|2020|PDM|1184.00|99|0.00|AEG 5  (NO REV)
20|FH_F117009_0_0|CSTM-ALL|CSTM-00|2020|PDM|1664.00|99|0.00|AEG 7 (NO REV)
20|FH_F117009_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F117009_0_0|SrvcGrp|107271|2022|PDM|1097.00|99|0.00|REVISE EYELID DEFECT
20|FH_F117009_0_0|SrvcGrp|114581|2022|PDM|2368.00|99|0.00|INSERT ANT SEGMENT DRAIN IN
20|FH_F117009_0_0|SrvcGrp|28551|2022|PDM|2348.00|99|0.00|REPAIR OF COMPLEX RETINAL DETACHMENT
20|FH_F117009_0_0|SrvcGrp|46885|2022|PDM|1393.00|99|0.00|REPAIR BROW DEFECT
20|FH_F117009_0_0|SrvcGrp|84934|2022|PDM|1279.00|99|0.00|REMOVAL OF EYE LESION
20|FH_F117023_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F117023_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F117023_0_0|SrvcGrp|12491|2022|PCT|1.10|99|0.00|PACEMAKER
20|FH_F117023_0_0|SrvcGrp|36591|2022|PDM|3575.00|99|0.00|CPT 63685
20|FH_F117023_0_0|SrvcGrp|41334|2022|PDM|5000.00|99|0.00|TOTAL KNEE
20|FH_F117023_0_0|SrvcGrp|73002|2022|PDM|1639.00|99|0.00|AEG 7
20|FH_F117023_0_0|SrvcGrp|73004|2022|PDM|1603.00|99|0.00|AEG 8
20|FH_F117023_0_0|SrvcGrp|75497|2022|PDM|1038.00|99|0.00|AEG 10
20|FH_F117027_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F117027_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F117072_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.50|99|0.00|HSS ASC
20|FH_F117087_0_0|CSTM-ALL|CSTM-00|2020|PDM|1189.00|99|0.00|AEG 2 (NO REV)
20|FH_F117087_0_0|CSTM-ALL|CSTM-00|2020|PDM|1367.00|99|0.00|AEG 3 (NO REV)
20|FH_F117087_0_0|CSTM-ALL|CSTM-00|2020|PDM|1382.00|99|0.00|AEG 4 (NO REV)
20|FH_F117087_0_0|CSTM-ALL|CSTM-00|2020|PDM|2434.00|99|0.00|AEG 7 (NO REV)
20|FH_F117087_0_0|SrvcGrp|106064|2022|PDM|2494.00|99|0.00|REVISE MIDDLE EAR & MASTOID
20|FH_F117087_0_0|SrvcGrp|107170|2022|PDM|2494.00|99|0.00|EXCISION OF NECK CYST
20|FH_F117087_0_0|SrvcGrp|107172|2022|PDM|2494.00|99|0.00|EXPLORE PARATHYROID GLANDS
20|FH_F117087_0_0|SrvcGrp|107175|2022|PDM|2494.00|99|0.00|MASTOIDECTOMY
20|FH_F117087_0_0|SrvcGrp|107178|2022|PDM|2494.00|99|0.00|TYMPANOPLASTY W/O MASTOIDECT
20|FH_F117087_0_0|SrvcGrp|107183|2022|PDM|2494.00|99|0.00|REVISE MIDDLE EAR BONE
20|FH_F117087_0_0|SrvcGrp|107184|2022|PDM|2494.00|99|0.00|REVISE MIDDLE EAR BONE
20|FH_F117087_0_0|SrvcGrp|107185|2022|PDM|2494.00|99|0.00|REVISION OF STAPEDECTOMY
20|FH_F117087_0_0|SrvcGrp|27316|2022|PDM|2494.00|99|0.00|TONSILS & ADENOIDS (42820)
20|FH_F117087_0_0|SrvcGrp|77582|2022|PDM|2093.00|99|0.00|CPT 31255
20|FH_F117087_0_0|SrvcGrp|78093|2022|PDM|2093.00|99|0.00|AETNA NASAL ENDOSCOPY SURG
20|FH_F117087_0_0|SrvcGrp|79101|2022|PDM|1368.00|99|0.00|AETNA NASAL ENDOSCOPY
20|FH_F117087_0_0|SrvcGrp|89853|2022|PDM|2093.00|99|0.00|NASAL/SINUS ENDOSCOPY-SURG
20|FH_F117087_0_0|SrvcGrp|89882|2022|PDM|2494.00|99|0.00|AETNA REMOVAL OF TONSILS
20|FH_F117087_0_0|SrvcGrp|91880|2022|PDM|5941.00|99|0.00|OSSEOINTEGRATED IMPLANT
20|FH_F117087_0_0|SrvcGrp|91941|2022|PDM|2093.00|99|0.00|NASAL/SINUS ENDOSCOPY WITH DILATION
20|FH_F117087_0_0|SrvcGrp|94989|2022|PDM|2093.00|99|0.00|SINUS ENDO W/ BALLOON DILATION
20|FH_F117113_0_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS
20|FH_F117113_0_0|SrvcGrp|75545|2022|PDM|367.00|99|0.00|SUB-ACUTE - LEVEL I AND II
20|FH_F117132_0_0|CSTM-ALL|CSTM-00|2020|PDM|1134.00|99|0.00|AEG 4 (NO REV)
20|FH_F117132_0_0|SrvcGrp|104357|2022|PDM|1400.00|99|0.00|DACRYOCYSTORHINOSTOMY
20|FH_F117132_0_0|SrvcGrp|12491|2022|PCT|1.10|99|0.00|PACEMAKER
20|FH_F117132_0_0|SrvcGrp|77507|2022|PCT|1.00|99|0.00|AETNA CORNEAL TISSUE HANDLING
20|FH_F117132_0_0|SrvcGrp|80784|2022|PDM|2189.00|99|0.00|IMPLANT EYE SHUNT
20|FH_F117132_0_0|SrvcGrp|81859|2022|PDM|1250.00|99|0.00|AETNA CARDIAC CATH
20|FH_F117132_0_0|SrvcGrp|84931|2022|PDM|2030.00|99|0.00|KERATOPLASTY
20|FH_F117147_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F117147_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F117195_0_0|SrvcGrp|13715|2022|PCT|0.90|99|0.00|DME/ORTHOTICS/PROSTHETICS/IMPLANTS
20|FH_F117195_0_0|SrvcGrp|14067|2022|PCT|0.75|99|0.00|PROFESSIONAL FEES ON UB04
20|FH_F117195_0_0|SrvcGrp|36144|2022|PCT|0.59|99|0.00|OP SURGERY
20|FH_F117195_0_0|SrvcGrp|89985|2022|PCT|0.75|99|0.00|PROFESSIONAL SERVICES (CMS-1500)
20|FH_F117199_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F117202_0_0|SrvcGrp|87077|2022|PDM|100.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F117206_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F117206_0_0|SrvcGrp|107289|2022|PDM|1970.00|99|0.00|KNEE ARTHRO/POSTER C LIG REP
20|FH_F117206_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS
20|FH_F117206_0_0|SrvcGrp|27347|2022|PDM|810.00|99|0.00|CPT 58558
20|FH_F117206_0_0|SrvcGrp|33986|2022|PDM|700.00|99|0.00|CPT 26055
20|FH_F117206_0_0|SrvcGrp|42550|2022|PDM|1442.00|99|0.00|OP SURGERY CPT 66984
20|FH_F117206_0_0|SrvcGrp|62740|2022|PDM|1485.00|99|0.00|SURGERY CARVE OUTS
20|FH_F117206_0_0|SrvcGrp|67064|2022|PDM|2884.00|99|0.00|MUSCULOSKELETAL SYSTEM
20|FH_F117206_0_0|SrvcGrp|67072|2022|PDM|2781.00|99|0.00|CPT 22845
20|FH_F117206_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F117206_0_0|SrvcGrp|73000|2022|PDM|1255.00|99|0.00|AEG 6
20|FH_F117206_0_0|SrvcGrp|73002|2022|PDM|1417.00|99|0.00|AEG 7
20|FH_F117206_0_0|SrvcGrp|73004|2022|PDM|1364.00|99|0.00|AEG 8
20|FH_F117206_0_0|SrvcGrp|79593|2022|PDM|721.00|99|0.00|CPT 45378
20|FH_F117206_0_0|SrvcGrp|79595|2022|PDM|700.00|99|0.00|CPT 45385
20|FH_F117206_0_0|SrvcGrp|82307|2022|PDM|618.00|99|0.00|COLORECTAL CANCER SCREENING
20|FH_F117206_0_0|SrvcGrp|90599|2022|PDM|1485.00|99|0.00|REMOVAL OF LENS LESION
20|FH_F117206_0_0|SrvcGrp|90600|2022|PDM|1485.00|99|0.00|REMOVAL OF LENS LESION
20|FH_F117206_0_0|SrvcGrp|90606|2022|PDM|1485.00|99|0.00|INSERT LENS PROSTHESIS
20|FH_F117206_0_0|SrvcGrp|90608|2022|PDM|698.00|99|0.00|PROCTOSIGMOIDOSCOPY DIAGNOSTICS
20|FH_F117206_0_0|SrvcGrp|99067|2022|PDM|2781.00|99|0.00|SPINE PROSTH DEVICE
20|FH_F117208_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F117208_0_0|CSTM-ALL|CSTM-00|2020|PDM|1320.00|99|0.00|AEG 2 (NO REV)
20|FH_F117208_0_0|CSTM-ALL|CSTM-00|2020|PDM|2090.00|99|0.00|AEG 4 (NO REV)
20|FH_F117208_0_0|SrvcGrp|106265|2022|PDM|4015.00|99|0.00|NSL/SINS NDSC TOTAL
20|FH_F117208_0_0|SrvcGrp|15473|2022|PDM|3410.00|99|0.00|CPT CODE 42820
20|FH_F117208_0_0|SrvcGrp|59841|2022|PDM|1980.00|99|0.00|SUBMUCOUS RESECTION
20|FH_F117208_0_0|SrvcGrp|79101|2022|PDM|3410.00|99|0.00|AETNA NASAL ENDOSCOPY
20|FH_F117208_0_0|SrvcGrp|83644|2022|PDM|4015.00|99|0.00|CPT 30465
20|FH_F117208_0_0|SrvcGrp|89853|2022|PDM|3410.00|99|0.00|NASAL/SINUS ENDOSCOPY-SURG
20|FH_F117210_0_0|CSTM-ALL|CSTM-00|2020|PDM|494.00|99|0.00|AEG 1 (NO REV)
20|FH_F117210_0_0|CSTM-ALL|CSTM-00|2020|PDM|725.00|99|0.00|AETNA SURGERY DEFAULT WITHOUT GROUPER 1 & 2
20|FH_F117216_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE
20|FH_F117216_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F117224_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F117225_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F117225_0_0|CSTM-ALL|CSTM-00|2020|PDM|2010.00|99|0.00|AEG 5  (NO REV)
20|FH_F117225_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F117230_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F117230_0_0|CSTM-ALL|CSTM-00|2020|PDM|2160.00|99|0.00|AEG 9 (NO REV)
20|FH_F117245_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F117245_0_0|SrvcGrp|73004|2022|PDM|1606.00|99|0.00|AEG 8
20|FH_F117266_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F117287_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F117299_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F117299_0_0|CSTM-ALL|CSTM-00|2020|PDM|1289.00|99|0.00|AEG 3 (NO REV)
20|FH_F117299_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F117299_0_0|SrvcGrp|107497|2022|PDM|976.00|99|0.00|AETNA - CYSTOSCOPY AND TREATMENT
20|FH_F117299_0_0|SrvcGrp|107499|2022|PDM|996.00|99|0.00|AETNA - DESTRUCTION, PENIS LESION
20|FH_F117299_0_0|SrvcGrp|47544|2022|PDM|4994.00|99|0.00|PERCUTANEOUS IMPLANT OF NEUROSTIMULATOR ELECTRODES
20|FH_F117300_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F117300_0_0|CSTM-ALL|CSTM-00|2020|PDM|1178.00|99|0.00|AEG 1 (NO REV)
20|FH_F117300_0_0|SrvcGrp|13187|2022|PCT|1.00|99|0.00|INTRAOCULAR LENSES
20|FH_F117300_0_0|SrvcGrp|35669|2022|PDM|4909.00|99|0.00|CPT 63650
20|FH_F117300_0_0|SrvcGrp|58993|2022|PDM|7360.00|99|0.00|DISKECTOMY
20|FH_F117300_0_0|SrvcGrp|67279|2022|PDM|7853.00|99|0.00|CERVICAL SURGERY
20|FH_F117300_0_0|SrvcGrp|88160|2022|PDM|7360.00|99|0.00|LAMINECTOMY W/FACETECTOMY
20|FH_F117300_0_0|SrvcGrp|88163|2022|PDM|5402.00|99|0.00|LUMBAR SPINE FUSION
20|FH_F117300_0_0|SrvcGrp|98493|2022|PDM|7853.00|99|0.00|THORACIC
20|FH_F117300_0_0|SrvcGrp|98499|2022|PDM|7360.00|99|0.00|INCISE SPINAL COLUMN NERVES
20|FH_F117300_0_0|SrvcGrp|98500|2022|PDM|7360.00|99|0.00|INCISE SPINAL COLUMN NERVES
20|FH_F117335_0_0|SrvcGrp|72992|2022|PDM|557.00|99|0.00|AEG 2
20|FH_F117335_0_0|SrvcGrp|72994|2022|PDM|668.00|99|0.00|AEG 3
20|FH_F117335_0_0|SrvcGrp|72996|2022|PDM|759.00|99|0.00|AEG 4
20|FH_F117335_0_0|SrvcGrp|73004|2022|PDM|1135.00|99|0.00|AEG 8
20|FH_F117335_0_0|SrvcGrp|73006|2022|PDM|1284.00|99|0.00|AEG 9
20|FH_F117382_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F117387_0_0|CSTM-ALL|CSTM-00|2020|PCT|74.00|99|0.00|OP SVCS
20|FH_F117392_0_0|SrvcGrp|75481|2022|PDM|550.00|99|0.00|AEG 2
20|FH_F117399_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F117399_0_0|SrvcGrp|103550|2022|PDM|400.00|99|0.00|HEMODIALYSIS SVCS
20|FH_F117399_0_0|SrvcGrp|103551|2022|PDM|171.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS
20|FH_F117399_0_0|SrvcGrp|103552|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER
20|FH_F117399_0_0|SrvcGrp|105357|2022|PDM|400.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD
20|FH_F117437_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F117437_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F117437_0_0|SrvcGrp|104228|2022|PDM|180.00|99|0.00|HOSPICE CARE (HCFA)
20|FH_F117437_0_0|SrvcGrp|104229|2022|PDM|180.00|99|0.00|HOSPICE IN HOME (HCFA)
20|FH_F117437_0_0|SrvcGrp|104230|2022|PDM|180.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F117437_0_0|SrvcGrp|29155|2022|PDM|180.00|99|0.00|HOSPICE SVCS
20|FH_F117437_0_0|SrvcGrp|80918|2022|PDM|180.00|99|0.00|RESPITE CARE
20|FH_F117437_0_0|SrvcGrp|82222|2022|PDM|180.00|99|0.00|HOSPICE CARE
20|FH_F117442_0_0|SrvcGrp|57968|2022|PDM|31.35|99|0.00|CONTINUOUS HOMECARE
20|FH_F117465_0_0|SrvcGrp|101114|2022|PDM|10000.00|99|0.00|ARTHOPLASTY
20|FH_F117465_0_0|SrvcGrp|40003|2022|PDM|9000.00|99|0.00|TOTAL KNEE
20|FH_F117465_0_0|SrvcGrp|75481|2022|PDM|800.00|99|0.00|AEG 2
20|FH_F117465_0_0|SrvcGrp|75487|2022|PDM|1600.00|99|0.00|AEG 5
20|FH_F117465_0_0|SrvcGrp|75489|2022|PDM|1400.00|99|0.00|AEG 6
20|FH_F117465_0_0|SrvcGrp|84442|2022|PDM|9000.00|99|0.00|REVISION KNEE
20|FH_F117465_0_0|SrvcGrp|96353|2022|PDM|9000.00|99|0.00|RECONSTRUCT ANKLE JOINT
20|FH_F117485_0_0|CSTM-ALL|CSTM-00|2020|PDM|1733.00|99|0.00|AEG 7 (NO REV)
20|FH_F117485_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F117485_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F117485_0_0|SrvcGrp|29369|2022|PDM|5515.00|99|0.00|CPT 28890
20|FH_F117486_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F117486_0_0|SrvcGrp|103551|2022|PDM|171.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS
20|FH_F117486_0_0|SrvcGrp|103552|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER
20|FH_F117509_0_0|SrvcGrp|92501|2022|PDM|133.35|99|0.00|HOSPICE IP RESPITE CARE
20|FH_F117512_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F117512_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F117512_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F117512_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F117525_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F117525_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F117525_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F117525_0_0|SrvcGrp|72992|2022|PDM|800.00|99|0.00|AEG 2
20|FH_F117525_0_0|SrvcGrp|72998|2022|PDM|1185.00|99|0.00|AEG 5
20|FH_F117531_0_0|SrvcGrp|29428|2022|PDM|525.00|99|0.00|HOME/CHRONIC HEMODIALYSIS TREATMENT
20|FH_F117550_0_0|SrvcGrp|29993|2022|PDM|36.00|99|0.00|POOL THERAPY
20|FH_F117550_0_0|SrvcGrp|38582|2022|PDM|28.00|99|0.00|THERAPY
20|FH_F117550_0_0|SrvcGrp|87536|2022|PDM|200.00|99|0.00|MED REHAB DAY PROGRAM (HALF)
20|FH_F117550_0_0|SrvcGrp|99460|2022|PDM|46.78|99|0.00|OCCUPATIONAL THERAPY EVALUATION
20|FH_F117552_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F117552_0_0|SrvcGrp|103643|2022|PDM|6000.00|99|0.00|AETNA FEM/POPL REVASE W/ STENT
20|FH_F117552_0_0|SrvcGrp|103644|2022|PDM|9500.00|99|0.00|AETNA TIB/ PER REVASE W/ ATHER
20|FH_F117552_0_0|SrvcGrp|107545|2022|PDM|8500.00|99|0.00|PARTIAL OR TOTAL HIP REPLACEMENT
20|FH_F117552_0_0|SrvcGrp|35669|2022|PDM|4400.00|99|0.00|CPT 63650
20|FH_F117552_0_0|SrvcGrp|72990|2022|PDM|400.00|99|0.00|AEG 1
20|FH_F117552_0_0|SrvcGrp|72994|2022|PDM|614.00|99|0.00|AEG 3
20|FH_F117552_0_0|SrvcGrp|72998|2022|PDM|863.00|99|0.00|AEG 5
20|FH_F117559_08619_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F117559_08619_0|SrvcGrp|103552|2022|PDM|150.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER
20|FH_F117559_08619_0|SrvcGrp|107482|2022|PDM|115.00|99|0.00|HEPATITIS B VACCINE (3 DOSE IMMUNSUP IM)
20|FH_F117559_08619_0|SrvcGrp|109210|2022|PDM|20.00|99|0.00|CCIIV4 VACC ABX FREE IM
20|FH_F117559_08619_0|SrvcGrp|113299|2022|PDM|40.00|99|0.00|COVID-19 IMMUN ADMIN 1ST DOSE - MODERNA
20|FH_F117559_08619_0|SrvcGrp|113300|2022|PDM|40.00|99|0.00|COVID-19 IMMUN ADMIN 2ND DOSE - MODERNA
20|FH_F117559_08619_0|SrvcGrp|113701|2022|PDM|40.00|99|0.00|COVID-19 IMMUN ADMIN - JANSSEN
20|FH_F117559_08619_0|SrvcGrp|114533|2022|PDM|40.00|99|0.00|ADM SARS COV2 100MCG/0.5 ML (3RD)
20|FH_F117559_08619_0|SrvcGrp|114538|2022|PDM|40.00|99|0.00|ADM SARS COV2 50MCG / 0.25ML BST
20|FH_F117575_0_0|CSTM-ALL|CSTM-00|2020|PDM|1044.00|99|0.00|AEG 4 (NO REV)
20|FH_F117575_0_0|CSTM-ALL|CSTM-00|2020|PDM|1221.00|99|0.00|AEG 6 (NO REV)
20|FH_F117575_0_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|AEG 10 (NO REV)
20|FH_F117575_0_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|AEG 7 (NO REV)
20|FH_F117575_0_0|CSTM-ALL|CSTM-00|2020|PDM|1447.00|99|0.00|AEG 8 (NO REV)
20|FH_F117575_0_0|CSTM-ALL|CSTM-00|2020|PDM|483.00|99|0.00|AEG 1 (NO REV)
20|FH_F117626_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F117626_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 1 (NO REV)
20|FH_F117626_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|AEG 2 (NO REV)
20|FH_F117626_0_0|CSTM-ALL|CSTM-00|2020|PDM|831.00|99|0.00|AEG 10 (NO REV)
20|FH_F117626_0_0|CSTM-ALL|CSTM-00|2020|PDM|945.00|99|0.00|AEG 5  (NO REV)
20|FH_F117626_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F117627_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 7 (NO REV)
20|FH_F117627_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F117644_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS
20|FH_F117644_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP DIALYSIS
20|FH_F117644_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F117647_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F117647_0_0|CSTM-ALL|CSTM-00|2020|PDM|1075.00|99|0.00|AEG 6 (NO REV)
20|FH_F117647_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|AEG 7 (NO REV)
20|FH_F117647_0_0|CSTM-ALL|CSTM-00|2020|PDM|1725.00|99|0.00|AEG 9 (NO REV)
20|FH_F117647_0_0|CSTM-ALL|CSTM-00|2020|PDM|840.00|99|0.00|AEG 4 (NO REV)
20|FH_F117715_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F117715_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F117715_0_0|SrvcGrp|104450|2022|PDM|2041.91|99|0.00|CYSTOURETHRO W/ ADDL IMPLANT
20|FH_F117715_0_0|SrvcGrp|68048|2022|PDM|5234.92|99|0.00|CPT 64581
20|FH_F117715_0_0|SrvcGrp|75487|2022|PDM|1048.00|99|0.00|AEG 5
20|FH_F117715_0_0|SrvcGrp|75497|2022|PDM|1048.00|99|0.00|AEG 10
20|FH_F117728_0_0|SrvcGrp|107639|2022|PDM|400.00|99|0.00|HEMODIALYSIS
20|FH_F117762_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F117762_0_0|CSTM-ALL|CSTM-00|2020|PDM|1239.00|99|0.00|AEG 6 (NO REV)
20|FH_F117762_0_0|CSTM-ALL|CSTM-00|2020|PDM|1461.00|99|0.00|AEG 8 (NO REV)
20|FH_F117762_0_0|SrvcGrp|26279|2022|PDM|2577.00|99|0.00|CPT 29884
20|FH_F117762_0_0|SrvcGrp|35669|2022|PDM|3328.00|99|0.00|CPT 63650
20|FH_F117762_0_0|SrvcGrp|67066|2022|PDM|8840.00|99|0.00|CERVICAL SURGERY
20|FH_F117762_0_0|SrvcGrp|78093|2022|PDM|3120.00|99|0.00|AETNA NASAL ENDOSCOPY SURG
20|FH_F117762_0_0|SrvcGrp|78282|2022|PDM|3120.00|99|0.00|CPT 47563
20|FH_F117762_0_0|SrvcGrp|79101|2022|PDM|2288.00|99|0.00|AETNA NASAL ENDOSCOPY
20|FH_F117762_0_0|SrvcGrp|80617|2022|PDM|14560.00|99|0.00|ARTHOPLASTY
20|FH_F117762_0_0|SrvcGrp|83642|2022|PDM|1872.00|99|0.00|CPT 29883
20|FH_F117762_0_0|SrvcGrp|88024|2022|PDM|7280.00|99|0.00|REMOVAL OF POSTERIOR SEGMENTAL INSTRUMENTATION
20|FH_F117762_0_0|SrvcGrp|88065|2022|PDM|9360.00|99|0.00|TOTAL DISC ARTHROPLASTY
20|FH_F117762_0_0|SrvcGrp|88157|2022|PDM|14560.00|99|0.00|TOTAL HIP ARTHROPLASTY
20|FH_F117762_0_0|SrvcGrp|88161|2022|PDM|4992.00|99|0.00|LAMINECTOMY W/FACE-THORACIC
20|FH_F117762_0_0|SrvcGrp|89853|2022|PDM|3120.00|99|0.00|NASAL/SINUS ENDOSCOPY-SURG
20|FH_F117762_0_0|SrvcGrp|89861|2022|PDM|4992.00|99|0.00|LUMBAR LAMINOTOMY
20|FH_F117762_0_0|SrvcGrp|89981|2022|PDM|3620.00|99|0.00|SHOULDER ARTHROSCOPY / SURGERY
20|FH_F117762_0_0|SrvcGrp|89989|2022|PDM|3640.00|99|0.00|FUSION OF BIG TOE JOINT
20|FH_F117762_0_0|SrvcGrp|93069|2022|PDM|7280.00|99|0.00|POSTERIOR NON-SEGMENTAL INST
20|FH_F117762_0_0|SrvcGrp|97895|2022|PDM|14560.00|99|0.00|REVISE KNEE 2
20|FH_F117762_0_0|SrvcGrp|99067|2022|PDM|2201.00|99|0.00|SPINE PROSTH DEVICE
20|FH_F117762_0_0|SrvcGrp|99160|2022|PDM|1872.00|99|0.00|DRILL FOR OSTEOCH/BONE GRAFT
20|FH_F117762_0_0|SrvcGrp|99162|2022|PDM|12480.00|99|0.00|CPT 24366
20|FH_F117762_0_0|SrvcGrp|99163|2022|PDM|1430.00|99|0.00|CPT 27703
20|FH_F117762_0_0|SrvcGrp|99164|2022|PDM|7280.00|99|0.00|CPT 22846
20|FH_F117762_0_0|SrvcGrp|99165|2022|PDM|7280.00|99|0.00|CPT 22848
20|FH_F117762_0_0|SrvcGrp|99167|2022|PDM|4992.00|99|0.00|CPT 63057
20|FH_F117762_0_0|SrvcGrp|99168|2022|PDM|2201.00|99|0.00|CPT 22899
20|FH_F117762_0_0|SrvcGrp|99169|2022|PDM|1976.00|99|0.00|CPT 28200
20|FH_F117762_0_0|SrvcGrp|99174|2022|PDM|1352.00|99|0.00|CPT 30140
20|FH_F117783_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F117783_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DEVICE INSERTION
20|FH_F117783_0_0|CSTM-ALL|CSTM-00|2020|PDM|1545.00|99|0.00|AEG 9 (NO REV)
20|FH_F117783_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F117784_0_0|SrvcGrp|107353|2022|PDM|194.92|99|0.00|AMB SRVC NEONAT TRNSPRT BS RATE EMERG 1 WAY (HCFA)
20|FH_F117784_0_0|SrvcGrp|13422|2022|PDM|147.90|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC
20|FH_F117784_0_0|SrvcGrp|13595|2022|PDM|155.47|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC
20|FH_F117784_0_0|SrvcGrp|13681|2022|PDM|134.93|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT
20|FH_F117784_0_0|SrvcGrp|2067|2022|PDM|488.38|99|0.00|SPECIALTY CARE TRANSPORT
20|FH_F117799_0_0|CSTM-ALL|CSTM-00|2020|PDM|1034.00|99|0.00|AEG 3 (NO REV)
20|FH_F117799_0_0|CSTM-ALL|CSTM-00|2020|PDM|1252.00|99|0.00|AEG 4 (NO REV)
20|FH_F117799_0_0|CSTM-ALL|CSTM-00|2020|PDM|1963.00|99|0.00|AEG 7 (NO REV) W/O VITRECTOMY
20|FH_F117799_0_0|CSTM-ALL|CSTM-00|2020|PDM|610.00|99|0.00|AEG 1 (NO REV)
20|FH_F117799_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F117799_0_0|SrvcGrp|104852|2022|PDM|5305.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F117799_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F117799_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F117799_0_0|SrvcGrp|16301|2022|PDM|3395.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F117799_0_0|SrvcGrp|27261|2022|PDM|11935.00|99|0.00|CPT 27446
20|FH_F117799_0_0|SrvcGrp|41334|2022|PDM|11935.00|99|0.00|TOTAL KNEE
20|FH_F117799_0_0|SrvcGrp|74039|2022|PDM|4244.00|99|0.00|LAMINECTOMY
20|FH_F117816_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F117816_0_0|SrvcGrp|57967|2022|PDM|148.79|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F117816_0_0|SrvcGrp|92501|2022|PDM|133.35|99|0.00|HOSPICE IP RESPITE CARE
20|FH_F117820_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F117820_0_0|SrvcGrp|29353|2022|PDM|62.60|99|0.00|HOSPICE SVCS
20|FH_F117820_0_0|SrvcGrp|74546|2022|PDM|499.00|99|0.00|HOSPICE SERVICES
20|FH_F117820_0_0|SrvcGrp|89783|2022|PDM|62.60|99|0.00|RESPITE CARE (HCFA)
20|FH_F117820_0_0|SrvcGrp|89822|2022|PDM|105.00|99|0.00|HOSPICE ROUTINE HOME CARE
20|FH_F117820_0_0|SrvcGrp|90477|2022|PDM|105.00|99|0.00|HOSPICE
20|FH_F117831_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F117831_0_0|CSTM-ALL|CSTM-00|2020|PDM|1069.00|99|0.00|AEG 6 (NO REV)
20|FH_F117831_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 1 (NO REV)
20|FH_F117858_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F117896_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F117896_0_0|SrvcGrp|82222|2022|PDM|140.00|99|0.00|HOSPICE CARE
20|FH_F117896_0_0|SrvcGrp|92501|2022|PDM|125.00|99|0.00|HOSPICE IP RESPITE CARE
20|FH_F117902_0_0|CSTM-ALL|CSTM-00|2020|PDM|1495.00|99|0.00|AEG 7 (NO REV)
20|FH_F117902_0_0|CSTM-ALL|CSTM-00|2020|PDM|675.00|99|0.00|AEG 2 (NO REV)
20|FH_F117902_0_0|SrvcGrp|103671|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F117902_0_0|SrvcGrp|107657|2022|PDM|1625.00|99|0.00|AETNA CARVE OUT CODES SERIES B
20|FH_F117902_0_0|SrvcGrp|107658|2022|PDM|725.00|99|0.00|AETNA CARVE OUT CODES SERIES C
20|FH_F117902_0_0|SrvcGrp|35967|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F117905_0_0|SrvcGrp|103550|2022|PDM|420.00|99|0.00|HEMODIALYSIS SVCS
20|FH_F117905_0_0|SrvcGrp|105356|2022|PCT|0.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD - INCL CODES
20|FH_F118165_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA CARDIAC CATH INCIDENTAL CODES
20|FH_F118165_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING
20|FH_F118168_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS
20|FH_F118168_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F118173_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F118173_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|AEG 4 (NO REV)
20|FH_F118173_0_0|CSTM-ALL|CSTM-00|2020|PDM|973.00|99|0.00|AEG 8 (NO REV)
20|FH_F118173_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F118184_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.98|99|0.00|GENERAL ACUTE CARE
20|FH_F118243_0_0|SrvcGrp|103551|2022|PDM|193.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS
20|FH_F118249_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 3 (NO REV)
20|FH_F118249_0_0|CSTM-ALL|CSTM-00|2020|PDM|618.00|99|0.00|AEG 4 (NO REV)
20|FH_F118249_0_0|CSTM-ALL|CSTM-00|2020|PDM|976.00|99|0.00|AEG 7 (NO REV)
20|FH_F118249_0_0|SrvcGrp|12664|2022|PCT|0.50|99|0.00|IMPLANTS
20|FH_F118300_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F118300_0_0|SrvcGrp|92502|2022|PDM|573.47|99|0.00|HOSPICE GENERAL IP CARE
20|FH_F118303_0_0|CSTM-ALL|CSTM-00|2020|PDM|1339.00|99|0.00|AEG 9 (NO REV)
20|FH_F118309_0_0|CSTM-ALL|CSTM-00|2020|PDM|1074.36|99|0.00|AEG 8 (NO REV)
20|FH_F118309_0_0|CSTM-ALL|CSTM-00|2020|PDM|1099.41|99|0.00|AEG 7 (NO REV)
20|FH_F118309_0_0|CSTM-ALL|CSTM-00|2020|PDM|492.80|99|0.00|AEG 2 (NO REV)
20|FH_F118446_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F118446_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F118446_0_0|SrvcGrp|83857|2022|PDM|610.00|99|0.00|IP HOSPICE SVCS
20|FH_F118469_0_0|CSTM-ALL|CSTM-00|2020|PDM|1819.00|99|0.00|AEG 4 (NO REV)
20|FH_F118469_0_0|CSTM-ALL|CSTM-00|2020|PDM|2800.00|99|0.00|AEG 8 (NO REV)
20|FH_F118469_0_0|SrvcGrp|107792|2022|PDM|4100.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE
20|FH_F118473_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING
20|FH_F118488_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA CARDIAC CATH INCIDENTAL CODES
20|FH_F118488_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F118488_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING
20|FH_F118488_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F118555_0_0|CSTM-ALL|CSTM-00|2020|PDM|425.00|99|0.00|AEG 2 (NO REV)
20|FH_F118555_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F118651_0_0|CSTM-ALL|CSTM-00|2020|PDM|1060.90|99|0.00|AEG 1 (NO REV)
20|FH_F118651_0_0|CSTM-ALL|CSTM-00|2020|PDM|1697.44|99|0.00|AEG 5  (NO REV)
20|FH_F118651_0_0|SrvcGrp|101525|2022|PDM|4959.71|99|0.00|MYOMECTOMY
20|FH_F118651_0_0|SrvcGrp|27348|2022|PDM|2652.25|99|0.00|OP SURGERY (CPT 58662)
20|FH_F118651_0_0|SrvcGrp|83348|2022|PDM|4959.71|99|0.00|AETNA LAPAR-ASST HYSTERECTOMY
20|FH_F118661_0_0|SrvcGrp|107852|2022|PDM|1079.00|99|0.00|AETNA AMBULATORY SURGERY W/O AEG 1 & 2 AND DIGESTIVE/PROF SV
20|FH_F118661_0_0|SrvcGrp|72990|2022|PDM|1018.00|99|0.00|AEG 1
20|FH_F118661_0_0|SrvcGrp|82310|2022|PDM|894.00|99|0.00|COLORECTAL CANCER SCREENING
20|FH_F118693_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING
20|FH_F118693_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|AETNA CARDIAC CATHERTERIZATION
20|FH_F118693_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|CARDIAC STUDIES
20|FH_F118699_0_0|CSTM-ALL|CSTM-00|2020|PDM|323.00|99|0.00|AEG 1 (NO REV)
20|FH_F118699_0_0|SrvcGrp|103391|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F118699_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F118703_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F118720_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F118741_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F118742_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F118783_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA CARDIAC CATH INCIDENTAL CODES
20|FH_F118783_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F118783_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F118803_0_0|CSTM-ALL|CSTM-00|2020|PDM|1012.31|99|0.00|AEG 8 (NO REV)
20|FH_F118803_0_0|CSTM-ALL|CSTM-00|2020|PDM|346.45|99|0.00|AEG 1 (NO REV)
20|FH_F118803_0_0|CSTM-ALL|CSTM-00|2020|PDM|530.60|99|0.00|AEG 3 (NO REV)
20|FH_F118803_0_0|CSTM-ALL|CSTM-00|2020|PDM|859.37|99|0.00|AEG 6 (NO REV)
20|FH_F118803_0_0|SrvcGrp|107792|2022|PDM|5632.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE
20|FH_F118803_0_0|SrvcGrp|107872|2022|PDM|349.70|99|0.00|INJECTION EXT VENOGRAPHY
20|FH_F118803_0_0|SrvcGrp|107877|2022|PDM|349.70|99|0.00|INTRO CATH DIALYSIS CIRCUIT
20|FH_F118803_0_0|SrvcGrp|77276|2022|PDM|349.70|99|0.00|AETNA REP CV ACSS CATH W/O PORT/PUMP
20|FH_F118803_0_0|SrvcGrp|77290|2022|PDM|349.70|99|0.00|AETNA REMV TUNNLD CVC W/O SUBQ PORT
20|FH_F118848_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 1 (NO REV)
20|FH_F118848_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|AEG 6 (NO REV)
20|FH_F118848_0_0|CSTM-ALL|CSTM-00|2020|PDM|3700.00|99|0.00|AEG 5  (NO REV)
20|FH_F118848_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F118848_0_0|SrvcGrp|46887|2022|PDM|4800.00|99|0.00|REPAIR DETACHED RETINA
20|FH_F118907_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F118907_0_0|SrvcGrp|103928|2022|PDM|81.97|99|0.00|SLEEP STUDY UNATTENDED ANALYSIS(HCFA)
20|FH_F118907_0_0|SrvcGrp|103929|2022|PDM|171.01|99|0.00|SLEEP STUDY UNATTENDED RESPIRATORY EFFORT(HCFA)
20|FH_F118907_0_0|SrvcGrp|107897|2022|PDM|508.10|99|0.00|SLEEP STUDIES (HCFA)
20|FH_F118909_0_0|SrvcGrp|65720|2022|PDM|123.60|99|0.00|RESPITE CARE
20|FH_F118909_0_0|SrvcGrp|80918|2022|PDM|123.60|99|0.00|RESPITE CARE
20|FH_F118909_0_0|SrvcGrp|94780|2022|PDM|133.90|99|0.00|HOSPICE OR HH IN HOME (HCFA)
20|FH_F118909_0_0|SrvcGrp|95661|2022|PDM|123.60|99|0.00|RESPITE CARE (HCFA)
20|FH_F118909_0_0|SrvcGrp|97702|2022|PDM|133.90|99|0.00|HOSPICE OR HH IN HOME (HCFA)
20|FH_F118910_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F118910_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F118910_0_0|SrvcGrp|80918|2022|PDM|113.30|99|0.00|RESPITE CARE
20|FH_F118910_0_0|SrvcGrp|94780|2022|PDM|126.18|99|0.00|HOSPICE OR HH IN HOME (HCFA)
20|FH_F118910_0_0|SrvcGrp|94781|2022|PDM|113.30|99|0.00|HOSPICE IN LTCH (HCFA)
20|FH_F118910_0_0|SrvcGrp|95661|2022|PDM|113.30|99|0.00|RESPITE CARE (HCFA)
20|FH_F118910_0_0|SrvcGrp|97703|2022|PDM|113.30|99|0.00|HOSPICE IN LTCH (HCFA)
20|FH_F118957_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F118957_0_0|CSTM-ALL|CSTM-00|2020|PDM|4400.00|99|0.00|AEG 5  (NO REV)
20|FH_F118957_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F118962_0_0|CSTM-ALL|CSTM-00|2020|PDM|622.72|99|0.00|AEG 2 (NO REV)
20|FH_F118962_0_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS
20|FH_F118964_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F118964_0_0|CSTM-ALL|CSTM-00|2020|PDM|734.00|99|0.00|AEG 1 (NO REV)
20|FH_F118986_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F118986_0_0|SrvcGrp|75483|2022|PDM|731.46|99|0.00|AEG 3
20|FH_F118986_0_0|SrvcGrp|75495|2022|PDM|1848.43|99|0.00|AEG 9
20|FH_F118986_0_0|SrvcGrp|75497|2022|PDM|796.43|99|0.00|AEG 10
20|FH_F119007_0_0|CSTM-ALL|CSTM-00|2020|PDM|1356.00|99|0.00|AEG 7 (NO REV)
20|FH_F119007_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|AEG 1 (NO REV) W/O NERVOUS SYST SERVICES
20|FH_F119007_0_0|SrvcGrp|103236|2022|PDM|11876.00|99|0.00|AETNA INSJ STABLJ DEV
20|FH_F119007_0_0|SrvcGrp|88739|2022|PDM|2033.00|99|0.00|IMPLANT SPINAL CANAL
20|FH_F119007_0_0|SrvcGrp|96819|2022|PDM|393.00|99|0.00|DESTROY L/S FACET JNT ADDL
20|FH_F119008_0_0|SrvcGrp|82222|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F119029_0_0|CSTM-ALL|CSTM-00|2020|PDM|1057.00|99|0.00|AEG 7 (NO REV)
20|FH_F119029_0_0|CSTM-ALL|CSTM-00|2020|PDM|669.00|99|0.00|AEG 4 (NO REV)
20|FH_F119029_0_0|SrvcGrp|74587|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F119070_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F119072_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE
20|FH_F119072_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F119074_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.75|99|0.00|HSS ASC
20|FH_F119096_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 2 (NO REV)
20|FH_F119096_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 1 (NO REV)
20|FH_F119125_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F119130_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F119130_0_0|SrvcGrp|108081|2022|PDM|171.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS
20|FH_F119203_0_0|SrvcGrp|108022|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER
20|FH_F119214_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F119214_0_0|SrvcGrp|75493|2022|PDM|1646.00|99|0.00|AEG 8
20|FH_F119214_0_0|SrvcGrp|83824|2022|PCT|0.00|99|0.00|AETNA CADIAC CATH INCIDENTAL CODES
20|FH_F119272_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F119272_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F119285_0_0|CSTM-ALL|CSTM-00|2020|PDM|1431.00|99|0.00|AEG 8 (NO REV)
20|FH_F119285_0_0|CSTM-ALL|CSTM-00|2020|PDM|604.00|99|0.00|AEG 2 (NO REV)
20|FH_F119285_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS
20|FH_F119285_0_0|SrvcGrp|87391|2022|PDM|1751.00|99|0.00|REAPIR RETINAL DETACHMENT
20|FH_F119291_0_0|SrvcGrp|105357|2022|PDM|435.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD
20|FH_F119352_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F119355_0_0|CSTM-ALL|CSTM-00|2020|PDM|120.00|99|0.00|FAMILY ADAPTIVE BH TREATMENT W/O PATIENT (HCFA)
20|FH_F119355_0_0|CSTM-ALL|CSTM-00|2020|PDM|180.00|99|0.00|AETNA BEHAVIORAL ID ASSESSMENT
20|FH_F119355_0_0|CSTM-ALL|CSTM-00|2020|PDM|180.00|99|0.00|BEHAVIORAL ID ASSESSMENT (HCFA)
20|FH_F119355_0_0|CSTM-ALL|CSTM-00|2020|PDM|50.00|99|0.00|AETNA OBSERVATIONS BEHAVIORAL 30 MINS
20|FH_F119355_0_0|CSTM-ALL|CSTM-00|2020|PDM|60.00|99|0.00|ADAPTIVE BEHAVIOR TREATMNT MODIFIED 30 MINS (HCFA)
20|FH_F119355_0_0|CSTM-ALL|CSTM-00|2020|PDM|60.00|99|0.00|AETNA ADAPTIVE BEHAVIOR TREATMNT MODIFIED 30 MINS
20|FH_F119355_0_0|SrvcGrp|105425|2022|PDM|90.00|99|0.00|AETNA EXPOSURE ADAPTIVE BH TREATMENT 60 MINS
20|FH_F119376_0_0|SrvcGrp|108115|2022|PDM|1969.74|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT
20|FH_F119376_0_0|SrvcGrp|108117|2022|PDM|1698.78|99|0.00|AV FUSION / FOREARM VEIN
20|FH_F119376_0_0|SrvcGrp|108119|2022|PDM|1257.61|99|0.00|ARTERY-VEIN FUSION
20|FH_F119376_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F119376_0_0|SrvcGrp|72990|2022|PDM|400.00|99|0.00|AEG 1
20|FH_F119376_0_0|SrvcGrp|73004|2022|PDM|1168.00|99|0.00|AEG 8
20|FH_F119379_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F119379_0_0|CSTM-ALL|CSTM-00|2020|PDM|762.00|99|0.00|AEG 5  (NO REV)
20|FH_F119379_0_0|SrvcGrp|100075|2022|PDM|1428.00|99|0.00|REVISION OF RADIUS
20|FH_F119379_0_0|SrvcGrp|100079|2022|PDM|1428.00|99|0.00|RECONSTRUCT ULNA/RADIOLULNAR
20|FH_F119379_0_0|SrvcGrp|107824|2022|PDM|885.00|99|0.00|REMOVE WRIST/FOREARM LESION
20|FH_F119379_0_0|SrvcGrp|107826|2022|PDM|1700.00|99|0.00|REMOVAL OF WRIST BONE
20|FH_F119379_0_0|SrvcGrp|107831|2022|PDM|1428.00|99|0.00|REPAIR WRIST FRACTURE
20|FH_F119379_0_0|SrvcGrp|107832|2022|PDM|1428.00|99|0.00|REPAIR FINGER FRACTURE
20|FH_F119379_0_0|SrvcGrp|107844|2022|PDM|885.00|99|0.00|RELEASE WRIST/FOREARM TENDON
20|FH_F119379_0_0|SrvcGrp|107846|2022|PDM|672.00|99|0.00|REPAIR FINGER TENDON
20|FH_F119379_0_0|SrvcGrp|107848|2022|PDM|764.00|99|0.00|REVISE MEDIAN NERVE AT WRIST
20|FH_F119379_0_0|SrvcGrp|11663|2022|PCT|1.05|99|0.00|IMPLANTS
20|FH_F119379_0_0|SrvcGrp|27343|2022|PDM|1428.00|99|0.00|OP SURGERY (CPT 25607 - 25609)
20|FH_F119379_0_0|SrvcGrp|33986|2022|PDM|672.00|99|0.00|CPT 26055
20|FH_F119379_0_0|SrvcGrp|69981|2022|PDM|1428.00|99|0.00|CPT 24358
20|FH_F119379_0_0|SrvcGrp|76603|2022|PDM|885.00|99|0.00|CPT 25111
20|FH_F119379_0_0|SrvcGrp|94904|2022|PDM|1428.00|99|0.00|REPAIR/REVISE WRIST JOINT
20|FH_F119383_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F119384_0_0|SrvcGrp|108042|2022|PDM|424.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD
20|FH_F119400_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F119435_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F119435_0_0|CSTM-ALL|CSTM-00|2020|PDM|1475.00|99|0.00|AEG 5  (NO REV)
20|FH_F119435_0_0|CSTM-ALL|CSTM-00|2020|PDM|2050.00|99|0.00|AEG 8 (NO REV)
20|FH_F119435_0_0|CSTM-ALL|CSTM-00|2020|PDM|2080.00|99|0.00|AEG 7 (NO REV)
20|FH_F119435_0_0|CSTM-ALL|CSTM-00|2020|PDM|685.00|99|0.00|AEG 1 (NO REV) W/O CARDIOVASCULAR SVCS
20|FH_F119435_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 2 (NO REV) W/O CARDIAC SERVICES
20|FH_F119435_0_0|SrvcGrp|103974|2022|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES
20|FH_F119435_0_0|SrvcGrp|107793|2022|PDM|11795.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE
20|FH_F119435_0_0|SrvcGrp|68546|2022|PDM|2212.00|99|0.00|CPT 36558
20|FH_F119437_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F119437_0_0|SrvcGrp|71666|2022|PDM|5000.00|99|0.00|CPT 63655
20|FH_F119437_0_0|SrvcGrp|75491|2022|PDM|2225.00|99|0.00|AEG 7
20|FH_F119437_0_0|SrvcGrp|75495|2022|PDM|2700.00|99|0.00|AEG 9
20|FH_F119437_0_0|SrvcGrp|75497|2022|PDM|700.00|99|0.00|AEG 10
20|FH_F119437_0_0|SrvcGrp|88065|2022|PDM|4750.00|99|0.00|TOTAL DISC ARTHROPLASTY
20|FH_F119437_0_0|SrvcGrp|88492|2022|PDM|4750.00|99|0.00|AETNA SPINAL BONE AUTOGRAFT
20|FH_F119437_0_0|SrvcGrp|88740|2022|PDM|4750.00|99|0.00|SP BONE ALGRFT
20|FH_F119437_0_0|SrvcGrp|92412|2022|PDM|4750.00|99|0.00|SPINAL CRD DECOMP->2 CERVIC
20|FH_F119437_0_0|SrvcGrp|93059|2022|PDM|4750.00|99|0.00|SPINAL BONE AUTOGRAFT
20|FH_F119493_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F119493_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F119493_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|HEMODIALYSIS SERVICES
20|FH_F119493_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|INTERMEDIATE ICU/CCU
20|FH_F119530_0_0|SrvcGrp|75479|2022|PDM|450.00|99|0.00|AEG 1
20|FH_F119530_0_0|SrvcGrp|82137|2022|PDM|450.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F119535_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.44|99|0.00|GENERAL ACUTE CARE
20|FH_F119535_0_0|SrvcGrp|11606|2022|PDM|1275.00|99|0.00|ACUTE CARE (MEDICAL & SURGICAL)
20|FH_F119535_0_0|SrvcGrp|45882|2022|PDM|90.00|99|0.00|PT
20|FH_F119555_0_0|SrvcGrp|474|2022|PDM|2710.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F119559_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F119581_0_0|CSTM-ALL|CSTM-00|2020|PDM|637.00|99|0.00|AEG 3 (NO REV)
20|FH_F119581_0_0|SrvcGrp|107544|2022|PDM|6525.00|99|0.00|ILIAC REVASC W/ STENT
20|FH_F119581_0_0|SrvcGrp|107878|2022|PDM|2646.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT
20|FH_F119581_0_0|SrvcGrp|107885|2022|PDM|2546.00|99|0.00|TRLUML BALO ANGIOP 1ST VEIN
20|FH_F119581_0_0|SrvcGrp|108077|2022|PDM|2329.00|99|0.00|ARTERIOVENOUS ANASTOMOSIS
20|FH_F119588_0_0|CSTM-ALL|CSTM-00|2020|PDM|708.00|99|0.00|AEG 3 W/O CARDIAC SERVICES (NO REV)
20|FH_F119588_0_0|CSTM-ALL|CSTM-00|2020|PDM|810.00|99|0.00|AEG 4 W/O ATRIAL/VENTRICULAR ELECTRODE (NO REV)
20|FH_F119593_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F119599_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F119599_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F119602_0_0|CSTM-ALL|CSTM-00|2020|PDM|1765.00|99|0.00|AEG 9 (NO REV)
20|FH_F119603_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F119604_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.48|99|0.00|OP SVCS
20|FH_F119627_27288_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F119635_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F119635_0_0|CSTM-ALL|CSTM-00|2020|PDM|315.00|99|0.00|AEG 1 (NO REV)
20|FH_F119635_0_0|CSTM-ALL|CSTM-00|2020|PDM|485.00|99|0.00|AEG 3 (NO REV)
20|FH_F119635_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 10 (NO REV)
20|FH_F119650_0_0|SrvcGrp|40003|2022|PDM|25151.00|99|0.00|TOTAL KNEE
20|FH_F119652_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F119652_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F119652_0_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS
20|FH_F119652_0_0|SrvcGrp|93924|2022|PDM|1350.00|99|0.00|AETNA MEDICAL SERVICES
20|FH_F119660_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F119660_0_0|SrvcGrp|80918|2022|PDM|90.00|99|0.00|RESPITE CARE
20|FH_F119660_0_0|SrvcGrp|84185|2022|PDM|90.00|99|0.00|RESPITE CARE
20|FH_F119725_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F119725_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F119725_0_0|SrvcGrp|100961|2022|PDM|258.01|99|0.00|AMB SRVC NEONAT TRNSPRT BS RATE EMERG 1 WAY
20|FH_F119725_0_0|SrvcGrp|106300|2022|PDM|347.56|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT (HCFA)
20|FH_F119725_0_0|SrvcGrp|13595|2022|PDM|412.72|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC
20|FH_F119725_0_0|SrvcGrp|13597|2022|PDM|217.22|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT
20|FH_F119725_0_0|SrvcGrp|13681|2022|PDM|347.56|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT
20|FH_F119725_0_0|SrvcGrp|2067|2022|PDM|705.97|99|0.00|SPECIALTY CARE TRANSPORT
20|FH_F119729_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F119760_0_0|SrvcGrp|65720|2022|PDM|107.00|99|0.00|RESPITE CARE
20|FH_F119760_0_0|SrvcGrp|80918|2022|PDM|107.00|99|0.00|RESPITE CARE
20|FH_F119760_0_0|SrvcGrp|89781|2022|PDM|107.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F119760_0_0|SrvcGrp|95661|2022|PDM|107.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F119760_0_0|SrvcGrp|97507|2022|PDM|105.00|99|0.00|AETNA HOSPICE
20|FH_F119760_0_0|SrvcGrp|97702|2022|PDM|105.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)
20|FH_F119775_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F119775_0_0|SrvcGrp|72996|2022|PDM|667.00|99|0.00|AEG 4
20|FH_F119775_0_0|SrvcGrp|73004|2022|PDM|931.00|99|0.00|AEG 8
20|FH_F119775_0_0|SrvcGrp|73008|2022|PDM|353.00|99|0.00|AEG 10
20|FH_F119784_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 9 (NO REV)
20|FH_F119784_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 5  (NO REV)
20|FH_F119784_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 8 (NO REV)
20|FH_F119784_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|AEG 3 (NO REV)
20|FH_F119784_0_0|SrvcGrp|102419|2022|PDM|2450.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F119784_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F119795_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F119795_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F119795_0_0|CSTM-ALL|CSTM-00|2020|PDM|1640.00|99|0.00|AEG 4 (NO REV)
20|FH_F119795_0_0|CSTM-ALL|CSTM-00|2020|PDM|2518.00|99|0.00|AEG 7 (NO REV)
20|FH_F119795_0_0|CSTM-ALL|CSTM-00|2020|PDM|897.00|99|0.00|AEG 1 (NO REV)
20|FH_F119795_0_0|SrvcGrp|35668|2022|PDM|5202.00|99|0.00|CPT 29824
20|FH_F119795_0_0|SrvcGrp|77021|2022|PDM|5202.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY
20|FH_F119795_0_0|SrvcGrp|82720|2022|PDM|3106.00|99|0.00|WRIST ENDOSCOPY/SURGERY
20|FH_F119795_0_0|SrvcGrp|91564|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F119795_0_0|SrvcGrp|92823|2022|PDM|4474.00|99|0.00|REVISE KNUCKLE WITH IMPLANT
20|FH_F119824_0_0|SrvcGrp|108151|2022|PDM|164.00|99|0.00|CAPD/CCPD INCLUDES TRAINING
20|FH_F119825_0_0|SrvcGrp|104229|2022|PDM|100.00|99|0.00|HOSPICE IN HOME (HCFA)
20|FH_F119825_0_0|SrvcGrp|29155|2022|PDM|100.00|99|0.00|HOSPICE SVCS
20|FH_F119825_0_0|SrvcGrp|82222|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F119825_0_0|SrvcGrp|84185|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F119838_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F119838_0_0|CSTM-ALL|CSTM-00|2020|PDM|1484.00|99|0.00|AEG 10 (NO REV)
20|FH_F119838_0_0|CSTM-ALL|CSTM-00|2020|PDM|2595.00|99|0.00|AEG 4 (NO REV)
20|FH_F51129_0_0|SrvcGrp|360|2022|PDM|2760.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F51135_0_0|SrvcGrp|12403|2022|PDM|36.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F51136_0_0|CSTM-ALL|CSTM-00|2020|PDM|1475.00|99|0.00|GENERAL ACUTE CARE
20|FH_F51138_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F51138_0_0|SrvcGrp|3809|2022|PDM|694.00|99|0.00|HOSPICE CARE
20|FH_F51192_0_0|SrvcGrp|33164|2022|PDM|350.00|99|0.00|SKILLED NURSING - LEVEL I
20|FH_F51192_0_0|SrvcGrp|44107|2022|PDM|55.00|99|0.00|SPEECH THERAPY
20|FH_F51197_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.77|99|0.00|GENERAL ACUTE CARE
20|FH_F51254_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F51258_0_0|SrvcGrp|43283|2022|PDM|81.00|99|0.00|PHYSICAL THERAPY
20|FH_F51258_0_0|SrvcGrp|473|2022|PDM|318.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F51272_0_0|SrvcGrp|15774|2022|PCT|0.75|99|0.00|TREATMENT ROOM
20|FH_F51272_0_0|SrvcGrp|27718|2022|PDM|28000.00|99|0.00|CYBER KNIFE
20|FH_F51272_0_0|SrvcGrp|47583|2022|PCT|0.75|99|0.00|HOSPICE SVCS
20|FH_F51272_0_0|SrvcGrp|47593|2022|PDM|9000.00|99|0.00|OBSTETRICAL CARE CESAREAN DELIVERY
20|FH_F51318_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|IMPLANTS 274-276, 278  LINE LEVEL
20|FH_F51318_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F51356_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F51358_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F51358_0_0|SrvcGrp|45924|2022|PDM|50.00|99|0.00|HOME HEALTH AIDE
20|FH_F51358_0_0|SrvcGrp|45948|2022|PDM|125.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F51358_0_0|SrvcGrp|45950|2022|PDM|125.00|99|0.00|SPEECH THERAPY
20|FH_F51359_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|GENERAL ACUTE CARE
20|FH_F51364_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.00|99|0.00|OP SVCS
20|FH_F51476_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F51476_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F51478_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F51482_0_0|CSTM-ALL|CSTM-00|2020|PCT|68.00|99|0.00|OP SVCS
20|FH_F51492_0_0|CSTM-ALL|CSTM-00|2020|PDM|75.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F51492_0_0|SrvcGrp|45783|2022|PDM|75.00|99|0.00|SKILLED NURSING VISIT
20|FH_F51519_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F51545_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F51545_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F51545_0_0|SrvcGrp|42826|2022|PDM|150.00|99|0.00|PHYSICAL THERAPY VISIT
20|FH_F51548_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F51548_0_0|SrvcGrp|10541|2022|PDM|125.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F51548_0_0|SrvcGrp|10544|2022|PDM|73.00|99|0.00|ENTEROSTOMAL THERAPY SERVICES
20|FH_F51548_0_0|SrvcGrp|22387|2022|PDM|55.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F51554_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F51558_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F51558_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F51564_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|GENERAL ACUTE CARE
20|FH_F51564_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|OP SVCS
20|FH_F51658_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F51658_0_0|SrvcGrp|45948|2022|PDM|105.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F51658_0_0|SrvcGrp|46248|2022|PDM|90.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F51733_0_0|SrvcGrp|44430|2022|PDM|105.00|99|0.00|SPEECH THERAPY SVCS (VISIT LVL)
20|FH_F51733_0_0|SrvcGrp|45944|2022|PDM|46.00|99|0.00|HOME HEALTH AIDE SVCS
20|FH_F51733_0_0|SrvcGrp|46248|2022|PDM|90.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F51814_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE
20|FH_F51934_0_0|SrvcGrp|46605|2022|PDM|120.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES
20|FH_F51934_0_0|SrvcGrp|48395|2022|PDM|110.00|99|0.00|OT SERVICES
20|FH_F51934_0_0|SrvcGrp|48396|2022|PDM|110.00|99|0.00|OT SERVICES
20|FH_F51972_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F51972_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F52112_0_0|SrvcGrp|3932|2022|PDM|5700.00|99|0.00|LITHOTRIPSY
20|FH_F52152_0_0|CSTM-ALL|CSTM-00|2020|PDM|2392.00|99|0.00|GENERAL ACUTE CARE
20|FH_F52152_0_0|CSTM-ALL|CSTM-00|2020|PDM|3120.00|99|0.00|ACUTE IP SVCS ONE DAY STAY
20|FH_F52278_0_0|SrvcGrp|30401|2022|PCT|1.10|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F52393_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F52393_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|HEARING AID
20|FH_F52393_0_0|CSTM-ALL|CSTM-00|2020|PDM|3200.00|99|0.00|HEARING AID
20|FH_F52393_0_0|SrvcGrp|24405|2022|PDM|950.00|99|0.00|HEARING AIDE
20|FH_F52452_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F52516_0_0|SrvcGrp|11442|2022|PDM|601.02|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)
20|FH_F52614_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F52713_0_0|CSTM-ALL|CSTM-00|2020|PDM|10331.00|99|0.00|OP CARDIAC CATH
20|FH_F52713_0_0|SrvcGrp|20096|2022|PDM|91221.00|99|0.00|MS DRG 222-223 ONLY
20|FH_F52713_0_0|SrvcGrp|21354|2022|PDM|26051.00|99|0.00|MS DRG 250-251 ONLY
20|FH_F52713_0_0|SrvcGrp|26690|2022|PDM|134802.00|99|0.00|MS DRG 215 ONLY
20|FH_F52713_0_0|SrvcGrp|31038|2022|PDM|58494.00|99|0.00|MS DRG 233-234 ONLY
20|FH_F52713_0_0|SrvcGrp|3499|2022|PCT|0.42|99|0.00|IMPLANTS
20|FH_F52713_0_0|SrvcGrp|3950|2022|PDM|13958.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F52713_0_0|SrvcGrp|39522|2022|PDM|93894.00|99|0.00|MS DRG 216-218 ONLY
20|FH_F52713_0_0|SrvcGrp|70439|2022|PDM|5000.00|99|0.00|EMERGENCY ROOM WITH SURGERY
20|FH_F52713_0_0|SrvcGrp|8968|2022|PDM|5000.00|99|0.00|NICU LEVEL III & IV
20|FH_F52713_0_0|SrvcGrp|9511|2022|PCT|0.60|99|0.00|OBSERVATION SVCS
20|FH_F52713_0_0|SrvcGrp|9529|2022|PDM|790.00|99|0.00|HOSPICE SVCS
20|FH_F52713_0_0|SrvcGrp|9911|2022|PDM|5000.00|99|0.00|EMERGENCY ROOM SVCS
20|FH_F52716_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F52733_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F52753_0_0|CSTM-ALL|CSTM-00|2020|PDM|1145.00|99|0.00|ASPG IV
20|FH_F52753_0_0|CSTM-ALL|CSTM-00|2020|PDM|1495.00|99|0.00|ASPG VII
20|FH_F52753_0_0|CSTM-ALL|CSTM-00|2020|PDM|675.00|99|0.00|ASPG I
20|FH_F52753_0_0|CSTM-ALL|CSTM-00|2020|PDM|945.00|99|0.00|ASPG X
20|FH_F52753_0_0|SrvcGrp|13557|2022|PCT|1.10|99|0.00|CORNEAL TISSUE SVCS
20|FH_F52753_0_0|SrvcGrp|46890|2022|PDM|1700.00|99|0.00|IMPLANT EYE SHUNT
20|FH_F52753_0_0|SrvcGrp|49205|2022|PDM|1700.00|99|0.00|REPAIR DETACHED RETINA
20|FH_F52754_0_0|SrvcGrp|9861|2022|PDM|1120.00|99|0.00|ACUTE REHABILITATION
20|FH_F52805_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F52872_0_0|CSTM-ALL|CSTM-00|2020|PDM|1900.00|99|0.00|WILLS COMM SURG SVC ASC 8
20|FH_F52872_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|WILLS COMM SURG SVC ASC 3
20|FH_F52956_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|ZERO ALLOWABLE - INPATIENT SERVICES
20|FH_F53032_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS
20|FH_F53094_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F53373_0_0|CSTM-ALL|CSTM-00|2020|PDM|1082.00|99|0.00|ASPG VI
20|FH_F53373_0_0|CSTM-ALL|CSTM-00|2020|PDM|1294.00|99|0.00|ASPG VII
20|FH_F53373_0_0|CSTM-ALL|CSTM-00|2020|PDM|930.00|99|0.00|ASPG V
20|FH_F53572_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F53572_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F53592_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS
20|FH_F53872_0_0|SrvcGrp|10528|2022|PDM|45.00|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F53872_0_0|SrvcGrp|32189|2022|PDM|35.00|99|0.00|RESPITE CARE
20|FH_F54052_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F54056_0_0|SrvcGrp|26001|2022|PDM|139.76|99|0.00|HOSPICE RESPITE SVCS
20|FH_F54172_0_0|SrvcGrp|15850|2022|PDM|150.00|99|0.00|HOSPICE SVCS
20|FH_F54212_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE
20|FH_F54272_0_0|CSTM-ALL|CSTM-00|2020|PDM|1135.00|99|0.00|PAIN MANAGEMENT
20|FH_F54272_0_0|CSTM-ALL|CSTM-00|2020|PDM|1917.00|99|0.00|ASPG VI
20|FH_F54272_0_0|CSTM-ALL|CSTM-00|2020|PDM|408.00|99|0.00|CHEMOTHERAPY
20|FH_F54272_0_0|SrvcGrp|109|2022|PDM|1116.00|99|0.00|CD - DETOX
20|FH_F54272_0_0|SrvcGrp|110|2022|PDM|789.00|99|0.00|CD - REHABILITATION
20|FH_F54272_0_0|SrvcGrp|11000|2022|PCT|0.45|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F54272_0_0|SrvcGrp|11336|2022|PCT|0.45|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F54272_0_0|SrvcGrp|12079|2022|PCT|0.45|99|0.00|MED SURG SUPPLIES
20|FH_F54272_0_0|SrvcGrp|51322|2022|PDM|125.00|99|0.00|OT SERVICES
20|FH_F54272_0_0|SrvcGrp|701|2022|PDM|2069.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F54293_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F54432_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE
20|FH_F54513_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F54513_0_0|SrvcGrp|10528|2022|PDM|45.00|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F54513_0_0|SrvcGrp|10540|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE
20|FH_F54513_0_0|SrvcGrp|10542|2022|PDM|110.00|99|0.00|OCCUPATIONAL THERAPY SVCS
20|FH_F54513_0_0|SrvcGrp|32189|2022|PDM|35.00|99|0.00|RESPITE CARE
20|FH_F54513_0_0|SrvcGrp|3327|2022|PDM|140.00|99|0.00|HOSPICE SERVICE - IP RESPITE
20|FH_F54572_0_0|SrvcGrp|16|2022|PDM|1000.00|99|0.00|ACUTE REHABILITATION
20|FH_F54572_0_0|SrvcGrp|21975|2022|PDM|1575.00|99|0.00|INPATIENT SERVICES
20|FH_F54614_0_0|SrvcGrp|50904|2022|PDM|35.00|99|0.00|HOME HEALTH AIDE
20|FH_F54652_0_0|CSTM-ALL|CSTM-00|2020|PDM|754.23|99|0.00|ASPG V
20|FH_F54652_0_0|CSTM-ALL|CSTM-00|2020|PDM|868.00|99|0.00|ASPG VI
20|FH_F54652_0_0|SrvcGrp|50922|2022|PDM|349.79|99|0.00|SPINE CARE DELAWARE CARVE OUT
20|FH_F54752_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|ASPG VII
20|FH_F54952_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F55054_0_0|SrvcGrp|13854|2022|PDM|1035.00|99|0.00|HYPERBARIC CHAMBER
20|FH_F55054_0_0|SrvcGrp|31074|2022|PDM|455.00|99|0.00|MS DRG 795 ONLY
20|FH_F55054_0_0|SrvcGrp|361|2022|PDM|3115.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F55054_0_0|SrvcGrp|51266|2022|PCT|0.57|99|0.00|CD UNIT REHAB OUTIER
20|FH_F55113_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|GENERAL ACUTE CARE
20|FH_F55113_0_0|SrvcGrp|3388|2022|PDM|680.00|99|0.00|SUBACUTE CARE
20|FH_F55113_0_0|SrvcGrp|51263|2022|PDM|4770.00|99|0.00|ANGIOPLASTY
20|FH_F55113_0_0|SrvcGrp|51276|2022|PCT|0.70|99|0.00|TRANSPLANT
20|FH_F55113_0_0|SrvcGrp|9774|2022|PDM|2250.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F55212_0_0|SrvcGrp|26354|2022|PDM|108.00|99|0.00|CPT 90846
20|FH_F55212_0_0|SrvcGrp|3397|2022|PDM|43.00|99|0.00|CPT 90849
20|FH_F55212_0_0|SrvcGrp|51063|2022|PDM|121.00|99|0.00|SUBSEQUENT HOSPITAL CARE
20|FH_F55212_0_0|SrvcGrp|51066|2022|PDM|215.00|99|0.00|HOSP DISCHARGE DAY MGMT MORE THAN 30 MINS
20|FH_F55212_0_0|SrvcGrp|52006|2022|PDM|457.00|99|0.00|INITIAL HOSPITAL II
20|FH_F55212_0_0|SrvcGrp|9493|2022|PDM|69.00|99|0.00|CPT 90804
20|FH_F55255_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS
20|FH_F55493_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F55493_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F55532_0_0|SrvcGrp|9861|2022|PDM|825.00|99|0.00|ACUTE REHABILITATION
20|FH_F55552_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F55552_0_0|CSTM-ALL|CSTM-00|2020|PCT|9000.00|99|0.00|TIMELY FILING
20|FH_F55613_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE
20|FH_F55613_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS
20|FH_F55653_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F55673_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F55693_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F55694_0_0|SrvcGrp|16|2022|PDM|1064.00|99|0.00|ACUTE REHABILITATION
20|FH_F55694_0_0|SrvcGrp|20272|2022|PDM|40140.00|99|0.00|MS DRG 219-221 ONLY CARDIAC VLV PROC W/O CA CAT
20|FH_F55694_0_0|SrvcGrp|23477|2022|PDM|9712.00|99|0.00|MSDRG 286-287 ONLY CARDIAC CATH
20|FH_F55694_0_0|SrvcGrp|25934|2022|PDM|715.00|99|0.00|SKILLED NURSING
20|FH_F55694_0_0|SrvcGrp|27726|2022|PCT|0.54|99|0.00|OP SURGERY
20|FH_F55694_0_0|SrvcGrp|29817|2022|PDM|4922.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F55812_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F55812_0_0|SrvcGrp|10538|2022|PDM|26.00|99|0.00|NURSING CARE
20|FH_F55812_0_0|SrvcGrp|10540|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE
20|FH_F55812_0_0|SrvcGrp|15850|2022|PDM|110.00|99|0.00|HOSPICE SVCS
20|FH_F55812_0_0|SrvcGrp|22387|2022|PDM|35.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F55812_0_0|SrvcGrp|44423|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE (VISIT LVL)
20|FH_F55854_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F55857_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F55857_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F55876_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F55895_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F56054_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP CLINIC
20|FH_F56092_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.74|99|0.00|OP SVCS
20|FH_F56092_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.74|99|0.00|PROFESSIONAL FEES ON CMS1500
20|FH_F56136_0_0|SrvcGrp|12290|2022|PDM|1004.00|99|0.00|DETOXIFICATION
20|FH_F56136_0_0|SrvcGrp|12393|2022|PCT|0.92|99|0.00|AMBULANCE SVCS
20|FH_F56136_0_0|SrvcGrp|13472|2022|PDM|3345.00|99|0.00|ICU/CCU
20|FH_F56136_0_0|SrvcGrp|17378|2022|PCT|0.92|99|0.00|CAPD TRAINING
20|FH_F56136_0_0|SrvcGrp|21818|2022|PCT|0.92|99|0.00|DIAGNOSTIC CARDIAC CATH
20|FH_F56136_0_0|SrvcGrp|24600|2022|PCT|0.92|99|0.00|CAPD TRAINING
20|FH_F56136_0_0|SrvcGrp|33484|2022|PCT|0.92|99|0.00|THERAPY SERVICES
20|FH_F56136_0_0|SrvcGrp|37260|2022|PCT|0.92|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F56136_0_0|SrvcGrp|52742|2022|PCT|0.92|99|0.00|LAMINECTOMY
20|FH_F56136_0_0|SrvcGrp|919|2022|PCT|0.92|99|0.00|OP URGENT CARE
20|FH_F56137_0_0|CSTM-ALL|CSTM-00|2020|PDM|1125.00|99|0.00|GENERAL ACUTE CARE
20|FH_F56137_0_0|SrvcGrp|48085|2022|PDM|95.00|99|0.00|SPEECH PATHOLOGY VISIT
20|FH_F56276_0_0|SrvcGrp|26776|2022|PDM|58.00|99|0.00|CPT 90804
20|FH_F56276_0_0|SrvcGrp|52244|2022|PDM|200.00|99|0.00|BUPRENORPHINE MAINTENANCE
20|FH_F56276_0_0|SrvcGrp|52946|2022|PDM|118.00|99|0.00|PSYCHIATRIC CPT 90807
20|FH_F56276_0_0|SrvcGrp|52952|2022|PDM|88.00|99|0.00|PSYCHIATRIC CPT 90847
20|FH_F56276_0_0|SrvcGrp|52954|2022|PDM|60.00|99|0.00|MEDICATION MANAGEMENT
20|FH_F56293_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F56293_0_0|SrvcGrp|52843|2022|PDM|500.00|99|0.00|GI PROCEDURE GROUP B
20|FH_F56332_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F56472_0_0|SrvcGrp|10623|2022|PDM|85.00|99|0.00|SPEECH THERAPY SERVICES
20|FH_F56472_0_0|SrvcGrp|36066|2022|PDM|40.00|99|0.00|NURSING CARE
20|FH_F56472_0_0|SrvcGrp|46424|2022|PDM|85.00|99|0.00|HI TECH SKILLED NURSING SERVICES
20|FH_F56512_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F56512_0_0|CSTM-ALL|CSTM-00|2020|PDM|560.00|99|0.00|SKILLED NURSING
20|FH_F56573_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F56652_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE
20|FH_F56652_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS
20|FH_F56672_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F56676_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F56683_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS
20|FH_F56693_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F56813_0_0|SrvcGrp|18007|2022|PDM|171.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F56832_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|HIGH COST DRUGS
20|FH_F56832_0_0|SrvcGrp|16|2022|PDM|900.00|99|0.00|ACUTE REHABILITATION
20|FH_F56832_0_0|SrvcGrp|439|2022|PDM|3500.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F56832_0_0|SrvcGrp|9793|2022|PDM|300.00|99|0.00|NEWBORN NURSERY
20|FH_F56833_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F56972_0_0|SrvcGrp|471|2022|PDM|660.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F56972_0_0|SrvcGrp|472|2022|PDM|460.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F56972_0_0|SrvcGrp|474|2022|PDM|360.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F57032_0_0|SrvcGrp|53485|2022|PDM|16.00|99|0.00|LANCING DEVICE
20|FH_F57073_0_0|SrvcGrp|63|2022|PDM|603.00|99|0.00|SUBACUTE CARE
20|FH_F57093_0_0|SrvcGrp|1137|2022|PDM|550.00|99|0.00|ELECTRO CONVULSIVE THERAPY
20|FH_F57372_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE
20|FH_F57372_0_0|SrvcGrp|45884|2022|PDM|110.00|99|0.00|ST
20|FH_F57396_0_0|SrvcGrp|46587|2022|PDM|80.00|99|0.00|CPT 99211
20|FH_F57396_0_0|SrvcGrp|53745|2022|PDM|15.00|99|0.00|IMMUNIZATIONS CPT 90657-90658
20|FH_F57592_0_0|CSTM-ALL|CSTM-00|2020|PDM|2400.00|99|0.00|PET SCAN
20|FH_F57592_0_0|SrvcGrp|11336|2022|PCT|0.50|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F57592_0_0|SrvcGrp|12197|2022|PDM|1500.00|99|0.00|EMERGENCY ROOM SVCS
20|FH_F57592_0_0|SrvcGrp|20926|2022|PDM|65000.00|99|0.00|MS DRG 235 ONLY
20|FH_F57592_0_0|SrvcGrp|21104|2022|PDM|57500.00|99|0.00|MS DRG 220 ONLY
20|FH_F57592_0_0|SrvcGrp|28623|2022|PCT|0.50|99|0.00|HIGH COST DRUGS
20|FH_F57592_0_0|SrvcGrp|28624|2022|PCT|0.50|99|0.00|HIGH COST DRUGS
20|FH_F57592_0_0|SrvcGrp|39870|2022|PDM|23500.00|99|0.00|MS DRG 619-621 ONLY
20|FH_F57592_0_0|SrvcGrp|50942|2022|PDM|1350.00|99|0.00|MRI
20|FH_F57592_0_0|SrvcGrp|53582|2022|PCT|0.68|99|0.00|AMBULATORY SURGICAL PROCEDURES
20|FH_F57592_0_0|SrvcGrp|53603|2022|PDM|25000.00|99|0.00|MS DRG 494 ONLY
20|FH_F57592_0_0|SrvcGrp|8950|2022|PDM|5000.00|99|0.00|INTERMEDIATE ICU/CCU
20|FH_F57592_0_0|SrvcGrp|8968|2022|PDM|4000.00|99|0.00|NICU LEVEL III & IV
20|FH_F57834_0_0|SrvcGrp|10679|2022|PDM|1418.00|99|0.00|ACUTE MEDICAL & SURGICAL SVCS
20|FH_F57834_0_0|SrvcGrp|11577|2022|PDM|420.00|99|0.00|DIALYSIS
20|FH_F57853_0_0|CSTM-ALL|CSTM-00|2020|PCT|68.80|99|0.00|OP SVCS
20|FH_F57956_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F58012_0_0|CSTM-ALL|CSTM-00|2020|PCT|36500.00|99|0.00|TIMELY FILING
20|FH_F58012_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F58013_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F58014_0_0|CSTM-ALL|CSTM-00|2020|PDM|130.00|99|0.00|OP SVCS
20|FH_F58096_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS
20|FH_F58173_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS
20|FH_F58215_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F58252_0_0|SrvcGrp|46604|2022|PDM|35.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES
20|FH_F58252_0_0|SrvcGrp|48396|2022|PDM|31.25|99|0.00|OT SERVICES
20|FH_F58272_0_0|SrvcGrp|44302|2022|PDM|60.00|99|0.00|PT & OT (VISIT LVL) PT MOD GP
20|FH_F58292_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F58574_0_0|SrvcGrp|44302|2022|PDM|60.00|99|0.00|PT & OT (VISIT LVL) PT MOD GP
20|FH_F58574_0_0|SrvcGrp|44326|2022|PDM|60.00|99|0.00|PT & OT (VISIT LVL) OT MOD GO
20|FH_F58592_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F58713_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|ASPG X
20|FH_F58713_0_0|CSTM-ALL|CSTM-00|2020|PDM|1348.00|99|0.00|ASPG VI
20|FH_F58713_0_0|CSTM-ALL|CSTM-00|2020|PDM|1588.00|99|0.00|ASPG VIII
20|FH_F58713_0_0|SrvcGrp|15473|2022|PDM|1171.00|99|0.00|CPT CODE 42820
20|FH_F58714_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F58856_0_0|CSTM-ALL|CSTM-00|2020|PDM|30625.00|99|0.00|MS DRG 238 ONLY
20|FH_F58856_0_0|SrvcGrp|10400|2022|PDM|1900.00|99|0.00|IP SURGERY
20|FH_F58856_0_0|SrvcGrp|19633|2022|PDM|33750.00|99|0.00|MS DRG 226 ONLY
20|FH_F58856_0_0|SrvcGrp|20075|2022|PDM|9200.00|99|0.00|MS DRG 286 ONLY
20|FH_F58856_0_0|SrvcGrp|20902|2022|PDM|20625.00|99|0.00|MS DRG 249 ONLY
20|FH_F58856_0_0|SrvcGrp|21104|2022|PDM|35800.00|99|0.00|MS DRG 220 ONLY
20|FH_F58856_0_0|SrvcGrp|21106|2022|PDM|19500.00|99|0.00|MS DRG 250 ONLY
20|FH_F58856_0_0|SrvcGrp|22402|2022|PDM|1280.00|99|0.00|ASPG II (REV CODE + CPT/HCPCS)
20|FH_F58856_0_0|SrvcGrp|22407|2022|PDM|3450.00|99|0.00|ASPG VII (REV CODE + CPT)
20|FH_F58856_0_0|SrvcGrp|22410|2022|PCT|0.55|99|0.00|ASPG X (REV CODE + CPT/HCPCS)
20|FH_F58856_0_0|SrvcGrp|28162|2022|PDM|38520.00|99|0.00|MS DRG 217 ONLY
20|FH_F58856_0_0|SrvcGrp|28166|2022|PDM|30950.00|99|0.00|MS DRG 229 ONLY
20|FH_F58856_0_0|SrvcGrp|29609|2022|PDM|37500.00|99|0.00|MS DRG 232 ONLY
20|FH_F58856_0_0|SrvcGrp|360|2022|PDM|1800.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F58972_0_0|CSTM-ALL|CSTM-00|2020|PDM|2328.00|99|0.00|GENERAL ACUTE CARE
20|FH_F58973_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F58973_0_0|CSTM-ALL|CSTM-00|2020|PDM|1108.00|99|0.00|COVENTRY ENHANCED GROUPER 4
20|FH_F58974_0_0|CSTM-ALL|CSTM-00|2020|PCT|50.00|99|0.00|DME/ORTHOTICS/PROSTHETICS
20|FH_F59052_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE
20|FH_F59052_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS
20|FH_F59052_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|ER/URGENT CARE SERVICES
20|FH_F59093_0_0|SrvcGrp|42972|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE
20|FH_F59274_0_0|SrvcGrp|1168|2022|PDM|32.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F59274_0_0|SrvcGrp|46350|2022|PDM|32.00|99|0.00|HI TECH SKILLED NURSING SERVICES
20|FH_F59274_0_0|SrvcGrp|46605|2022|PDM|35.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES
20|FH_F59274_0_0|SrvcGrp|48385|2022|PDM|34.00|99|0.00|SPEECH THERAPY
20|FH_F59274_0_0|SrvcGrp|48394|2022|PDM|18.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F59312_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F59312_0_0|SrvcGrp|473|2022|PDM|303.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F59312_0_0|SrvcGrp|474|2022|PDM|248.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F59333_0_0|SrvcGrp|12403|2022|PDM|788.55|99|0.00|CONTINUOUS HOMECARE
20|FH_F59652_0_0|SrvcGrp|55794|2022|PDM|420.00|99|0.00|RESIDENTIAL TREATMENT - YOUTH AND ADULT
20|FH_F59992_0_0|SrvcGrp|54670|2022|PDM|4200.00|99|0.00|NORMAL DELIVERY
20|FH_F59992_0_0|SrvcGrp|56104|2022|PDM|200.00|99|0.00|DELIVERY PLACENTA ONLY
20|FH_F60019_0_0|SrvcGrp|29146|2022|PCT|0.75|99|0.00|HIGH COST DRUGS
20|FH_F60072_0_0|CSTM-ALL|CSTM-00|2020|PDM|2375.00|99|0.00|GENERAL ACUTE CARE
20|FH_F60072_0_0|SrvcGrp|16|2022|PDM|1150.00|99|0.00|ACUTE REHABILITATION
20|FH_F60072_0_0|SrvcGrp|4109|2022|PDM|1100.00|99|0.00|ACUTE PSYCH
20|FH_F60072_0_0|SrvcGrp|68245|2022|PCT|0.70|99|0.00|MS DRG 927-929, 933-935 & REV 207 BURN SVCS
20|FH_F60095_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|GENERAL ACUTE CARE
20|FH_F60273_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F60273_0_0|CSTM-ALL|CSTM-00|2020|PDM|916.24|99|0.00|ASPG V
20|FH_F60273_0_0|SrvcGrp|44066|2022|PDM|3197.25|99|0.00|CPT 57288
20|FH_F60276_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F60276_0_0|CSTM-ALL|CSTM-00|2020|PDM|928.00|99|0.00|ASPG VIII
20|FH_F60292_0_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F60292_0_0|SrvcGrp|473|2022|PDM|375.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F60296_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|MSDRG 789-793 NICU
20|FH_F60296_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|TRAUMA CARE
20|FH_F60365_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|BONE MARROW TRANSPLANT
20|FH_F60812_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F60836_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F60836_0_0|CSTM-ALL|CSTM-00|2020|PDM|1152.10|99|0.00|ASPG VI
20|FH_F60836_0_0|CSTM-ALL|CSTM-00|2020|PDM|711.34|99|0.00|ASPG III
20|FH_F60836_0_0|SrvcGrp|13368|2022|PDM|711.34|99|0.00|OP SURGERY
20|FH_F61034_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|GENERAL ACUTE CARE
20|FH_F61034_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|OP SVCS
20|FH_F61072_0_0|SrvcGrp|42826|2022|PDM|100.00|99|0.00|PHYSICAL THERAPY VISIT
20|FH_F61072_0_0|SrvcGrp|42828|2022|PDM|100.00|99|0.00|SPEECH THERAPY VISIT
20|FH_F61292_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.44|99|0.00|OP SVCS
20|FH_F61292_0_0|CSTM-ALL|CSTM-00|2020|PDM|1493.00|99|0.00|ASPG II - FH SW CUSTOM GROUPERS
20|FH_F61292_0_0|CSTM-ALL|CSTM-00|2020|PDM|3334.00|99|0.00|ASPG VII - FH SW CUSTOM GROUPERS
20|FH_F61292_0_0|CSTM-ALL|CSTM-00|2020|PDM|4489.00|99|0.00|ASPG IX - FH SW CUSTOM GROUPERS
20|FH_F61292_0_0|CSTM-ALL|CSTM-00|2020|PDM|901.00|99|0.00|ACUTE PSYCH
20|FH_F61292_0_0|CSTM-ALL|CSTM-00|2020|PDM|901.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F61292_0_0|SrvcGrp|12683|2022|PDM|308.00|99|0.00|OP PSYCH PARTIAL HOSP - HALF DAY
20|FH_F61292_0_0|SrvcGrp|13724|2022|PCT|0.49|99|0.00|PHARMACY SVCS
20|FH_F61292_0_0|SrvcGrp|19973|2022|PDM|756.00|99|0.00|CAT SCAN
20|FH_F61292_0_0|SrvcGrp|20252|2022|PDM|37486.00|99|0.00|MS DRG 224-225 ONLY
20|FH_F61292_0_0|SrvcGrp|20898|2022|PDM|14535.00|99|0.00|MS DRG 246 ONLY
20|FH_F61292_0_0|SrvcGrp|20900|2022|PDM|14535.00|99|0.00|MS DRG 248 ONLY
20|FH_F61292_0_0|SrvcGrp|20908|2022|PDM|14535.00|99|0.00|MS DRG 247 ONLY
20|FH_F61292_0_0|SrvcGrp|21354|2022|PDM|14535.00|99|0.00|MS DRG 250-251 ONLY
20|FH_F61292_0_0|SrvcGrp|30623|2022|PDM|7326.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788
20|FH_F61292_0_0|SrvcGrp|360|2022|PDM|1540.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F61292_0_0|SrvcGrp|39870|2022|PDM|2168.00|99|0.00|MS DRG 619-621 ONLY
20|FH_F61292_0_0|SrvcGrp|45883|2022|PDM|105.00|99|0.00|OT
20|FH_F61292_0_0|SrvcGrp|57322|2022|PDM|5233.00|99|0.00|OP DIAGNOSTIC CARDIAC CATH
20|FH_F61292_0_0|SrvcGrp|57402|2022|PCT|0.49|99|0.00|LABORATORY
20|FH_F61292_0_0|SrvcGrp|79377|2022|PCT|0.49|99|0.00|UNGROUPABLE ASPG + REV CODES
20|FH_F61292_0_0|SrvcGrp|92622|2022|PDM|23775.00|99|0.00|AORTIC & HEART ASSIST PRECEDURE
20|FH_F61312_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F61332_0_0|SrvcGrp|16|2022|PDM|1150.00|99|0.00|ACUTE REHABILITATION
20|FH_F61332_0_0|SrvcGrp|23132|2022|PDM|495.00|99|0.00|DIALYSIS/CHEMOTHERAPY/RADIATION
20|FH_F61773_0_0|CSTM-ALL|CSTM-00|2020|PCT|86.00|99|0.00|OP SVCS
20|FH_F62252_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F62252_0_0|SrvcGrp|473|2022|PDM|380.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F62292_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F62292_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F62333_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE
20|FH_F62333_0_0|SrvcGrp|3810|2022|PDM|160.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F62352_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F62373_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F62513_0_0|CSTM-ALL|CSTM-00|2020|PDM|2261.85|99|0.00|ASPG VI
20|FH_F62513_0_0|CSTM-ALL|CSTM-00|2020|PDM|2660.49|99|0.00|ASPG VIII
20|FH_F62532_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.00|99|0.00|OP SVCS
20|FH_F62577_0_0|SrvcGrp|58456|2022|PDM|1015.00|99|0.00|ASPG III
20|FH_F62577_0_0|SrvcGrp|58457|2022|PDM|1262.00|99|0.00|ASPG IV
20|FH_F62600_0_0|CSTM-ALL|CSTM-00|2020|PDM|1008.00|99|0.00|ASPG IV
20|FH_F62600_0_0|CSTM-ALL|CSTM-00|2020|PDM|1147.00|99|0.00|ASPG V
20|FH_F62600_0_0|CSTM-ALL|CSTM-00|2020|PDM|125.00|99|0.00|MINOR PROCEDURES
20|FH_F62601_0_0|SrvcGrp|46350|2022|PDM|30.00|99|0.00|HI TECH SKILLED NURSING SERVICES
20|FH_F62601_0_0|SrvcGrp|48393|2022|PDM|7.00|99|0.00|SKILLED NURSING SERVICES (PER HOUR)
20|FH_F62601_0_0|SrvcGrp|48395|2022|PDM|30.00|99|0.00|OT SERVICES
20|FH_F62601_0_0|SrvcGrp|48396|2022|PDM|30.00|99|0.00|OT SERVICES
20|FH_F62601_0_0|SrvcGrp|48397|2022|PDM|30.00|99|0.00|PT SERVICES
20|FH_F62614_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE
20|FH_F62614_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F62614_0_0|SrvcGrp|46350|2022|PDM|30.00|99|0.00|HI TECH SKILLED NURSING SERVICES
20|FH_F62614_0_0|SrvcGrp|46605|2022|PDM|30.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES
20|FH_F62614_0_0|SrvcGrp|48393|2022|PDM|6.00|99|0.00|SKILLED NURSING SERVICES (PER HOUR)
20|FH_F62614_0_0|SrvcGrp|48399|2022|PDM|30.00|99|0.00|SPEECH THERAPY
20|FH_F62624_0_0|SrvcGrp|21784|2022|PDM|7800.00|99|0.00|PACEMAKER
20|FH_F62624_0_0|SrvcGrp|29702|2022|PDM|8800.00|99|0.00|CV SURGERY MS DRG 260-262 ONLY
20|FH_F62624_0_0|SrvcGrp|33751|2022|PCT|0.75|99|0.00|OP SURGERY
20|FH_F62624_0_0|SrvcGrp|3932|2022|PDM|6500.00|99|0.00|LITHOTRIPSY
20|FH_F62624_0_0|SrvcGrp|58517|2022|PDM|600.00|99|0.00|OP DIALYSIS
20|FH_F62627_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F62627_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OBSERVATION SVCS
20|FH_F62695_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE
20|FH_F62703_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F62719_0_0|SrvcGrp|12264|2022|PDM|91.80|99|0.00|DIETICIAN OR LPN SERVICES
20|FH_F62719_0_0|SrvcGrp|44711|2022|PDM|108.00|99|0.00|PT SVCS
20|FH_F62761_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F62765_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F62773_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|ER SVCS
20|FH_F62799_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F62802_0_0|CSTM-ALL|CSTM-00|2020|PDM|1150.00|99|0.00|ASPG V
20|FH_F62802_0_0|CSTM-ALL|CSTM-00|2020|PDM|945.00|99|0.00|ASPG IV
20|FH_F62853_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F62876_0_0|CSTM-ALL|CSTM-00|2020|PCT|50.00|99|0.00|OP SVCS
20|FH_F62892_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F62892_0_0|SrvcGrp|10534|2022|PDM|90.00|99|0.00|NURSING CARE
20|FH_F62892_0_0|SrvcGrp|10543|2022|PDM|95.00|99|0.00|SPEECH THERAPY SVCS
20|FH_F62892_0_0|SrvcGrp|10544|2022|PDM|73.00|99|0.00|ENTEROSTOMAL THERAPY SERVICES
20|FH_F62892_0_0|SrvcGrp|15850|2022|PDM|120.00|99|0.00|HOSPICE SVCS
20|FH_F62892_0_0|SrvcGrp|58847|2022|PDM|125.00|99|0.00|HOSPICE RESPITE CARE
20|FH_F62917_0_0|CSTM-ALL|CSTM-00|2020|PCT|40.00|99|0.00|OP SVCS
20|FH_F62922_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F62922_0_0|SrvcGrp|3259|2022|PDM|650.00|99|0.00|ACUTE REHABILITATION
20|FH_F62974_0_0|SrvcGrp|17139|2022|PDM|498.00|99|0.00|HOSPICE CARE
20|FH_F62977_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|ASPG I
20|FH_F62977_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|ASPG X
20|FH_F62977_0_0|CSTM-ALL|CSTM-00|2020|PDM|525.00|99|0.00|ASPG II
20|FH_F62977_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|ASPG VI
20|FH_F62977_0_0|CSTM-ALL|CSTM-00|2020|PDM|973.00|99|0.00|ASPG VIII
20|FH_F62977_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|ASPG VII
20|FH_F62978_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F62978_0_0|CSTM-ALL|CSTM-00|2020|PDM|1168.00|99|0.00|ASPG VIII
20|FH_F62978_0_0|CSTM-ALL|CSTM-00|2020|PDM|1597.00|99|0.00|ASPG IX
20|FH_F62978_0_0|CSTM-ALL|CSTM-00|2020|PDM|860.00|99|0.00|ASPG V
20|FH_F62978_0_0|CSTM-ALL|CSTM-00|2020|PDM|991.00|99|0.00|ASPG VI
20|FH_F63018_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F63049_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63083_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63095_0_0|SrvcGrp|12889|2022|PCT|0.65|99|0.00|RADIOLOGY
20|FH_F63095_0_0|SrvcGrp|13168|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F63095_0_0|SrvcGrp|13368|2022|PCT|0.65|99|0.00|OP SURGERY
20|FH_F63095_0_0|SrvcGrp|29815|2022|PDM|3734.00|99|0.00|MS DRG 003-004, 207-208 ONLY
20|FH_F63095_0_0|SrvcGrp|59291|2022|PDM|1580.00|99|0.00|DAY HOSPITAL FULL DAY
20|FH_F63114_0_0|SrvcGrp|48396|2022|PDM|30.00|99|0.00|OT SERVICES
20|FH_F63124_0_0|SrvcGrp|42972|2022|PDM|36.00|99|0.00|HOME HEALTH AIDE
20|FH_F63124_0_0|SrvcGrp|46248|2022|PDM|135.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F63129_0_0|SrvcGrp|46424|2022|PDM|25.00|99|0.00|HI TECH SKILLED NURSING SERVICES
20|FH_F63129_0_0|SrvcGrp|46604|2022|PDM|25.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES
20|FH_F63129_0_0|SrvcGrp|48394|2022|PDM|8.50|99|0.00|SKILLED NURSING SERVICES
20|FH_F63129_0_0|SrvcGrp|48399|2022|PDM|30.00|99|0.00|SPEECH THERAPY
20|FH_F63153_0_0|CSTM-ALL|CSTM-00|2020|PCT|42.00|99|0.00|OP SVCS
20|FH_F63178_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63178_0_0|CSTM-ALL|CSTM-00|2020|PDM|615.00|99|0.00|COVENTRY ENHANCED GROUPER 3
20|FH_F63178_0_0|CSTM-ALL|CSTM-00|2020|PDM|864.00|99|0.00|COVENTRY ENHANCED GROUPER 5
20|FH_F63182_0_0|CSTM-ALL|CSTM-00|2020|PDM|156.00|99|0.00|OP SVCS
20|FH_F63186_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63190_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS
20|FH_F63196_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63197_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63229_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63229_0_0|SrvcGrp|44250|2022|PDM|385.00|99|0.00|CCPD TRAINING
20|FH_F63229_0_0|SrvcGrp|59396|2022|PDM|290.00|99|0.00|CAPD
20|FH_F63232_0_0|CSTM-ALL|CSTM-00|2020|PDM|110.00|99|0.00|OP SVCS
20|FH_F63235_0_0|SrvcGrp|27726|2022|PDM|2499.00|99|0.00|OP SURGERY
20|FH_F63235_0_0|SrvcGrp|72992|2022|PDM|1246.00|99|0.00|AEG 2
20|FH_F63235_0_0|SrvcGrp|73002|2022|PDM|2784.00|99|0.00|AEG 7
20|FH_F63235_0_0|SrvcGrp|73006|2022|PDM|3746.00|99|0.00|AEG 9
20|FH_F63244_0_0|SrvcGrp|33165|2022|PDM|370.00|99|0.00|SKILLED NURSING - LEVEL II
20|FH_F63249_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63249_0_0|SrvcGrp|42976|2022|PDM|95.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F63249_0_0|SrvcGrp|43567|2022|PDM|95.00|99|0.00|SKILLED NURSING - POSTNATAL
20|FH_F63249_0_0|SrvcGrp|46104|2022|PDM|90.00|99|0.00|HOME VISIT - PRENATAL
20|FH_F63249_0_0|SrvcGrp|46424|2022|PDM|95.00|99|0.00|HI TECH SKILLED NURSING SERVICES
20|FH_F63249_0_0|SrvcGrp|57649|2022|PDM|70.00|99|0.00|PHYSICAL THERAPY SVCS MOD GP
20|FH_F63250_0_0|SrvcGrp|42976|2022|PDM|105.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F63250_0_0|SrvcGrp|52782|2022|PDM|46.00|99|0.00|VENIPUNCTURE PER VISIT
20|FH_F63250_0_0|SrvcGrp|57649|2022|PDM|77.00|99|0.00|PHYSICAL THERAPY SVCS MOD GP
20|FH_F63250_0_0|SrvcGrp|57650|2022|PDM|77.00|99|0.00|OCCUPATIONAL THERAPY SVCS MOD GO
20|FH_F63256_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63258_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.10|99|0.00|OP SVCS
20|FH_F63275_0_0|SrvcGrp|3809|2022|PDM|585.88|99|0.00|HOSPICE CARE
20|FH_F63276_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63276_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F63276_0_0|SrvcGrp|42824|2022|PDM|140.00|99|0.00|SKILLED NURSING VISIT
20|FH_F63276_0_0|SrvcGrp|42825|2022|PDM|50.00|99|0.00|HOME HEALTH AIDE VISIT
20|FH_F63297_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63297_0_0|SrvcGrp|59423|2022|PDM|75.00|99|0.00|RN VISIT
20|FH_F63312_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63312_0_0|SrvcGrp|10538|2022|PDM|25.00|99|0.00|NURSING CARE
20|FH_F63312_0_0|SrvcGrp|10540|2022|PDM|37.00|99|0.00|HOME HEALTH AIDE
20|FH_F63312_0_0|SrvcGrp|10545|2022|PDM|90.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F63312_0_0|SrvcGrp|14081|2022|PDM|85.00|99|0.00|HOME VISIT - POSTNATAL
20|FH_F63317_0_0|SrvcGrp|26179|2022|PDM|60.00|99|0.00|OT
20|FH_F63317_0_0|SrvcGrp|29893|2022|PDM|60.00|99|0.00|ST
20|FH_F63385_0_0|CSTM-ALL|CSTM-00|2020|PDM|1060.00|99|0.00|ASPG IV
20|FH_F63385_0_0|CSTM-ALL|CSTM-00|2020|PDM|1254.00|99|0.00|ASPG V
20|FH_F63385_0_0|CSTM-ALL|CSTM-00|2020|PDM|1742.00|99|0.00|ASPG VIII
20|FH_F63385_0_0|CSTM-ALL|CSTM-00|2020|PDM|676.00|99|0.00|ASPG I
20|FH_F63385_0_0|CSTM-ALL|CSTM-00|2020|PDM|931.00|99|0.00|ASPG III
20|FH_F63385_0_0|SrvcGrp|36991|2022|PCT|0.45|99|0.00|IMPLANTS
20|FH_F63391_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F63396_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F63398_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE
20|FH_F63403_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63417_0_0|SrvcGrp|472|2022|PDM|460.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F63419_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F63419_0_0|SrvcGrp|3087|2022|PDM|712.00|99|0.00|CD - DETOX
20|FH_F63419_0_0|SrvcGrp|80|2022|PDM|712.00|99|0.00|ACUTE PSYCH
20|FH_F63422_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE
20|FH_F63422_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F63432_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.76|99|0.00|OP SVCS
20|FH_F63432_0_0|SrvcGrp|47482|2022|PCT|0.76|99|0.00|OP MENTAL HEALTH
20|FH_F63436_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS
20|FH_F63438_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F63444_0_0|SrvcGrp|1306|2022|PDM|350.00|99|0.00|OP PSYCH PARTIAL HOSP
20|FH_F63444_0_0|SrvcGrp|3259|2022|PDM|645.00|99|0.00|ACUTE REHABILITATION
20|FH_F63457_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F63458_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63459_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F63462_0_0|CSTM-ALL|CSTM-00|2020|PDM|1168.00|99|0.00|ASPG IV
20|FH_F63462_0_0|CSTM-ALL|CSTM-00|2020|PDM|1903.00|99|0.00|ASPG VIII
20|FH_F63462_0_0|CSTM-ALL|CSTM-00|2020|PDM|1903.00|99|0.00|ASPG X
20|FH_F63514_0_0|SrvcGrp|3810|2022|PDM|135.89|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F63516_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63556_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F63556_0_0|SrvcGrp|49062|2022|PDM|4000.00|99|0.00|CV SURGERY 216 - 234 MS DRG ONLY
20|FH_F63580_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F63618_0_0|SrvcGrp|29817|2022|PDM|4500.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F63618_0_0|SrvcGrp|361|2022|PDM|3000.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F63618_0_0|SrvcGrp|43871|2022|PDM|800.00|99|0.00|NEWBORN NURSERY
20|FH_F63625_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP CLINIC
20|FH_F63625_0_0|SrvcGrp|16|2022|PDM|1742.00|99|0.00|ACUTE REHABILITATION
20|FH_F63625_0_0|SrvcGrp|23477|2022|PDM|11576.00|99|0.00|MSDRG 286-287 ONLY CARDIAC CATH
20|FH_F63625_0_0|SrvcGrp|33793|2022|PDM|16464.00|99|0.00|MSDRG 246-251 ONLY ANGIOPLASTY
20|FH_F63625_0_0|SrvcGrp|9774|2022|PDM|5789.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F63627_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63627_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F63701_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63759_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63881_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63881_0_0|SrvcGrp|21815|2022|PDM|120.00|99|0.00|CAPD/CCPD SUPPLEMENT
20|FH_F64160_0_0|SrvcGrp|12403|2022|PDM|43.02|99|0.00|CONTINUOUS HOMECARE
20|FH_F64440_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.69|99|0.00|OP SVCS
20|FH_F64440_0_0|SrvcGrp|108687|2022|PDM|465.00|99|0.00|CT W/O CONTRAST
20|FH_F64440_0_0|SrvcGrp|108688|2022|PDM|729.00|99|0.00|CT W/ CONTRAST
20|FH_F64440_0_0|SrvcGrp|108690|2022|PDM|795.00|99|0.00|MRI/MRA W/O CONTRAST
20|FH_F64440_0_0|SrvcGrp|108692|2022|PDM|1144.00|99|0.00|MRI/MRA W/ & W/O CONTRAST
20|FH_F64440_0_0|SrvcGrp|108694|2022|PDM|1058.00|99|0.00|OP SLEEP STUDIES (MOD TC) (HCFA)
20|FH_F64441_0_0|SrvcGrp|1168|2022|PDM|640.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F64441_0_0|SrvcGrp|42785|2022|PDM|68.00|99|0.00|SPEECH THERAPY  SRVCS
20|FH_F64559_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F64639_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F64639_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F64739_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F64779_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F64779_0_0|SrvcGrp|42825|2022|PDM|82.00|99|0.00|HOME HEALTH AIDE VISIT
20|FH_F64779_0_0|SrvcGrp|42826|2022|PDM|163.00|99|0.00|PHYSICAL THERAPY VISIT
20|FH_F64799_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F64900_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F64940_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F64940_0_0|SrvcGrp|3810|2022|PDM|137.50|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F64943_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F64943_0_0|CSTM-ALL|CSTM-00|2020|PDM|691.00|99|0.00|OCD RESIDENTIAL
20|FH_F64943_0_0|CSTM-ALL|CSTM-00|2020|PDM|783.00|99|0.00|EATING DISORDER RESIDENTIAL
20|FH_F64943_0_0|SrvcGrp|17275|2022|PDM|783.00|99|0.00|CHEMICAL DEPENDENCY - YOUTH
20|FH_F64943_0_0|SrvcGrp|61040|2022|PDM|783.00|99|0.00|ADOLESCENT ACUTE RESIDENTIAL
20|FH_F64943_0_0|SrvcGrp|80|2022|PDM|1900.00|99|0.00|ACUTE PSYCH
20|FH_F65100_0_0|SrvcGrp|44326|2022|PDM|60.00|99|0.00|PT & OT (VISIT LVL) OT MOD GO
20|FH_F65139_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F65182_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F65182_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F65182_0_0|SrvcGrp|33165|2022|PDM|400.00|99|0.00|SKILLED NURSING - LEVEL II
20|FH_F65182_0_0|SrvcGrp|33166|2022|PDM|500.00|99|0.00|SKILLED NURSING - LEVEL III
20|FH_F65200_0_0|SrvcGrp|76207|2022|PDM|60.00|99|0.00|SPEECH THERAPY (VISIT LVL) MOD GN
20|FH_F65239_0_0|CSTM-ALL|CSTM-00|2020|PDM|1385.00|99|0.00|AEG 8 (NO REV)
20|FH_F65359_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F65359_0_0|CSTM-ALL|CSTM-00|2020|PCT|36500.00|99|0.00|TIMELY FILING
20|FH_F65359_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|DRUGS
20|FH_F65440_0_0|CSTM-ALL|CSTM-00|2020|PDM|1012.00|99|0.00|COVENTRY ENHANCED GROUPER 4
20|FH_F65440_0_0|CSTM-ALL|CSTM-00|2020|PDM|1267.00|99|0.00|COVENTRY ENHANCED GROUPER 10
20|FH_F65440_0_0|SrvcGrp|11663|2022|PCT|0.75|99|0.00|IMPLANTS
20|FH_F65440_0_0|SrvcGrp|27402|2022|PDM|3214.00|99|0.00|LASER PROCEDURES
20|FH_F65440_0_0|SrvcGrp|38364|2022|PDM|4821.00|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F65444_0_0|SrvcGrp|44302|2022|PDM|75.00|99|0.00|PT & OT (VISIT LVL) PT MOD GP
20|FH_F65444_0_0|SrvcGrp|44326|2022|PDM|75.00|99|0.00|PT & OT (VISIT LVL) OT MOD GO
20|FH_F65559_0_0|CSTM-ALL|CSTM-00|2020|PDM|1919.00|99|0.00|ACUTE IP REHAB LEVEL B
20|FH_F65559_0_0|SrvcGrp|59290|2022|PDM|647.00|99|0.00|DAY HOSPITAL HALF DAY
20|FH_F65619_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F65619_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F65680_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS
20|FH_F65681_0_0|SrvcGrp|474|2022|PDM|285.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F65719_0_0|CSTM-ALL|CSTM-00|2020|PDM|1281.00|99|0.00|AEG 8 (NO REV)
20|FH_F65719_0_0|CSTM-ALL|CSTM-00|2020|PDM|436.00|99|0.00|AEG 1 (NO REV)
20|FH_F65719_0_0|CSTM-ALL|CSTM-00|2020|PDM|884.00|99|0.00|AEG 6 (NO REV)
20|FH_F65719_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F65719_0_0|SrvcGrp|35669|2022|PDM|3988.20|99|0.00|CPT 63650
20|FH_F65979_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|COVENTRY ENHANCED GROUPER 4
20|FH_F65979_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|COVENTRY ENHANCED GROUPER 6
20|FH_F65979_0_0|CSTM-ALL|CSTM-00|2020|PDM|2640.00|99|0.00|COVENTRY ENHANCED GROUPER 7
20|FH_F65979_0_0|SrvcGrp|61559|2022|PDM|1200.00|99|0.00|MUSCULOSKELETAL SURGERY
20|FH_F66059_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F66101_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F66220_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F66220_0_0|SrvcGrp|33164|2022|PDM|350.00|99|0.00|SKILLED NURSING - LEVEL I
20|FH_F66259_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F66403_0_0|SrvcGrp|33165|2022|PDM|425.00|99|0.00|SKILLED NURSING - LEVEL II
20|FH_F66403_0_0|SrvcGrp|471|2022|PDM|625.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F66404_0_0|SrvcGrp|33164|2022|PDM|350.00|99|0.00|SKILLED NURSING - LEVEL I
20|FH_F66404_0_0|SrvcGrp|33165|2022|PDM|425.00|99|0.00|SKILLED NURSING - LEVEL II
20|FH_F66405_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F66406_0_0|SrvcGrp|33165|2022|PDM|425.00|99|0.00|SKILLED NURSING - LEVEL II
20|FH_F66406_0_0|SrvcGrp|33166|2022|PDM|500.00|99|0.00|SKILLED NURSING - LEVEL III
20|FH_F66406_0_0|SrvcGrp|471|2022|PDM|625.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F66408_0_0|SrvcGrp|33165|2022|PDM|425.00|99|0.00|SKILLED NURSING - LEVEL II
20|FH_F66409_0_0|SrvcGrp|471|2022|PDM|625.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F66411_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F66411_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F66412_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F66412_0_0|SrvcGrp|33164|2022|PDM|350.00|99|0.00|SKILLED NURSING - LEVEL I
20|FH_F66412_0_0|SrvcGrp|471|2022|PDM|625.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F66420_0_0|SrvcGrp|33164|2022|PDM|350.00|99|0.00|SKILLED NURSING - LEVEL I
20|FH_F66422_0_0|SrvcGrp|44106|2022|PDM|48.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F66439_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F66439_0_0|CSTM-ALL|CSTM-00|2020|PCT|56.00|99|0.00|OP SURGERY
20|FH_F66439_0_0|CSTM-ALL|CSTM-00|2020|PCT|62.00|99|0.00|IMPLANTS
20|FH_F66465_0_0|SrvcGrp|44326|2022|PDM|60.00|99|0.00|PT & OT (VISIT LVL) OT MOD GO
20|FH_F66480_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F66481_0_0|SrvcGrp|42973|2022|PDM|100.00|99|0.00|SPEECH  THERAPIST
20|FH_F66481_0_0|SrvcGrp|42974|2022|PDM|100.00|99|0.00|OCCUPATIONAL THERAPIST
20|FH_F66481_0_0|SrvcGrp|42976|2022|PDM|115.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F66481_0_0|SrvcGrp|45924|2022|PDM|40.00|99|0.00|HOME HEALTH AIDE
20|FH_F66541_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F66541_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F66545_0_0|SrvcGrp|62098|2022|PDM|110.00|99|0.00|RN VISIT
20|FH_F66569_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F66569_0_0|SrvcGrp|62258|2022|PDM|85.00|99|0.00|PHYSICAL THERAY EVAL/RE-EVAL
20|FH_F66630_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|PARTIAL EATING DISORDERS
20|FH_F66630_0_0|SrvcGrp|46903|2022|PDM|625.00|99|0.00|RESIDENTIAL TREATMENT
20|FH_F66642_0_0|CSTM-ALL|CSTM-00|2020|PCT|50.30|99|0.00|OP SVCS
20|FH_F66648_0_0|CSTM-ALL|CSTM-00|2020|PCT|50.90|99|0.00|GENERAL ACUTE CARE
20|FH_F66649_0_0|CSTM-ALL|CSTM-00|2020|PCT|50.90|99|0.00|GENERAL ACUTE CARE
20|FH_F66687_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.87|99|0.00|GENERAL ACUTE CARE
20|FH_F66687_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.87|99|0.00|OP SVCS
20|FH_F66687_0_0|SrvcGrp|19671|2022|PDM|18496.00|99|0.00|MS DRG 286 ONLY CIRCULATORY DISORDERS W/CARD CATH COMPLEX DX
20|FH_F66687_0_0|SrvcGrp|19846|2022|PDM|41677.00|99|0.00|MS DRG 249 ONLY
20|FH_F66687_0_0|SrvcGrp|20908|2022|PDM|51270.00|99|0.00|MS DRG 247 ONLY
20|FH_F66687_0_0|SrvcGrp|21102|2022|PDM|111984.00|99|0.00|MS DRG 219 ONLY
20|FH_F66687_0_0|SrvcGrp|21104|2022|PDM|92780.00|99|0.00|MS DRG 220 ONLY
20|FH_F66687_0_0|SrvcGrp|21350|2022|PDM|14185.00|99|0.00|MS DRG 287 ONLY
20|FH_F66687_0_0|SrvcGrp|29127|2022|PCT|0.85|99|0.00|MSDRG 265 ONLY
20|FH_F66687_0_0|SrvcGrp|29755|2022|PCT|0.85|99|0.00|MS DRG 245 ONLY
20|FH_F66687_0_0|SrvcGrp|54975|2022|PCT|0.85|99|0.00|MS DRG 223 ONLY
20|FH_F66687_0_0|SrvcGrp|62296|2022|PDM|10381.00|99|0.00|HEART CATHETERIZATION - COMBINED RIGHT AND LEFT
20|FH_F66687_0_0|SrvcGrp|69925|2022|PDM|22871.00|99|0.00|PTCA W/ CARDIAC ABLATION
20|FH_F66688_0_0|SrvcGrp|46482|2022|PDM|128.00|99|0.00|S9083 PER VISIT
20|FH_F66705_0_0|SrvcGrp|43428|2022|PDM|25.00|99|0.00|RN HOURLY
20|FH_F66705_0_0|SrvcGrp|43432|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE HOURLY
20|FH_F66705_0_0|SrvcGrp|44392|2022|PDM|40.00|99|0.00|HOME HEALTH AIDE
20|FH_F66705_0_0|SrvcGrp|60057|2022|PDM|90.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F66711_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F66711_0_0|SrvcGrp|62537|2022|PDM|85.00|99|0.00|SPEECH THERAPY
20|FH_F66711_0_0|SrvcGrp|62538|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY
20|FH_F66711_0_0|SrvcGrp|62539|2022|PDM|85.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F66760_0_0|SrvcGrp|63458|2022|PDM|800.00|99|0.00|ANTEPARTUM VISITS 7 OR MORE
20|FH_F66765_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE
20|FH_F66765_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F66765_0_0|SrvcGrp|12263|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE- HOURLY
20|FH_F66765_0_0|SrvcGrp|17139|2022|PDM|657.00|99|0.00|HOSPICE CARE
20|FH_F66765_0_0|SrvcGrp|17140|2022|PDM|152.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F66765_0_0|SrvcGrp|62537|2022|PDM|100.00|99|0.00|SPEECH THERAPY
20|FH_F66835_0_0|SrvcGrp|14165|2022|PDM|245.00|99|0.00|PARTIAL HOSP PSYCH/CD
20|FH_F66835_0_0|SrvcGrp|26596|2022|PDM|290.00|99|0.00|PARTIAL HOSP PSYCH/CD (HALF DAY)
20|FH_F66879_0_0|SrvcGrp|11258|2022|PCT|0.99|99|0.00|DRUGS
20|FH_F66906_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F66906_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F66961_0_0|SrvcGrp|44302|2022|PDM|60.00|99|0.00|PT & OT (VISIT LVL) PT MOD GP
20|FH_F66970_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|ASPG I
20|FH_F66970_0_0|CSTM-ALL|CSTM-00|2020|PDM|735.00|99|0.00|ASPG II
20|FH_F66970_0_0|CSTM-ALL|CSTM-00|2020|PDM|825.00|99|0.00|ASPG III
20|FH_F66970_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|ASPG IV
20|FH_F66991_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.20|99|0.00|OP SVCS
20|FH_F67025_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F67025_0_0|CSTM-ALL|CSTM-00|2020|PDM|1150.00|99|0.00|ASPG VI
20|FH_F67025_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|ASPG IX
20|FH_F67063_0_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|WELLPATH ASC VII
20|FH_F67063_0_0|CSTM-ALL|CSTM-00|2020|PDM|2220.00|99|0.00|WELLPATH ASC IX
20|FH_F67063_0_0|CSTM-ALL|CSTM-00|2020|PDM|310.00|99|0.00|WELLPATH ASC X
20|FH_F67063_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|WELLPATH ASC I
20|FH_F67063_0_0|CSTM-ALL|CSTM-00|2020|PDM|810.00|99|0.00|WELLPATH ASC II
20|FH_F67063_0_0|CSTM-ALL|CSTM-00|2020|PDM|920.00|99|0.00|WELLPATH ASC III
20|FH_F67086_0_0|SrvcGrp|17139|2022|PDM|601.02|99|0.00|HOSPICE CARE
20|FH_F67136_0_0|SrvcGrp|16274|2022|PCT|1.00|99|0.00|ORGAN ACQUISITION
20|FH_F67136_0_0|SrvcGrp|36137|2022|PCT|0.70|99|0.00|TRANSPLANT SVCS
20|FH_F67136_0_0|SrvcGrp|39870|2022|PDM|10112.00|99|0.00|MS DRG 619-621 ONLY
20|FH_F67136_0_0|SrvcGrp|44564|2022|PDM|3371.00|99|0.00|NEWBORN NURSERY
20|FH_F67136_0_0|SrvcGrp|62717|2022|PCT|0.70|99|0.00|IMPLANTS
20|FH_F67136_0_0|SrvcGrp|62718|2022|PCT|0.95|99|0.00|TRAUMA
20|FH_F67147_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|OP SVCS
20|FH_F67148_0_0|CSTM-ALL|CSTM-00|2020|PCT|69.00|99|0.00|GENERAL ACUTE CARE
20|FH_F67150_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F67169_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.00|99|0.00|GENERAL ACUTE CARE
20|FH_F67173_0_0|CSTM-ALL|CSTM-00|2020|PDM|545.00|99|0.00|ASPG I - FH SW CUSTOM GROUPERS
20|FH_F67182_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F67195_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F67195_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|COVENTRY ENHANCED GROUPER 10
20|FH_F67195_0_0|CSTM-ALL|CSTM-00|2020|PDM|1156.00|99|0.00|COVENTRY ENHANCED GROUPER 6
20|FH_F67195_0_0|CSTM-ALL|CSTM-00|2020|PDM|1362.00|99|0.00|COVENTRY ENHANCED GROUPER 8
20|FH_F67195_0_0|CSTM-ALL|CSTM-00|2020|PDM|1393.00|99|0.00|COVENTRY ENHANCED GROUPER 7
20|FH_F67200_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F67200_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F67207_0_0|SrvcGrp|44107|2022|PDM|48.00|99|0.00|SPEECH THERAPY
20|FH_F67265_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE
20|FH_F67265_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F67265_0_0|CSTM-ALL|CSTM-00|2020|PDM|267.00|99|0.00|INTENSIVE OP SUBSTANCE ABUSE PROGRAM
20|FH_F67265_0_0|CSTM-ALL|CSTM-00|2020|PDM|830.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F67280_0_0|SrvcGrp|44105|2022|PDM|54.00|99|0.00|PHYSICAL THERAPY
20|FH_F67281_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F67285_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F67285_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F67288_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F67305_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE
20|FH_F67319_0_0|SrvcGrp|27968|2022|PDM|32.00|99|0.00|SKILLED NURSING LPN
20|FH_F67319_0_0|SrvcGrp|42975|2022|PDM|95.00|99|0.00|PHYSICAL THERAPIST
20|FH_F67319_0_0|SrvcGrp|42976|2022|PDM|100.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F67319_0_0|SrvcGrp|43955|2022|PDM|90.00|99|0.00|NURSING CARE
20|FH_F67319_0_0|SrvcGrp|43957|2022|PDM|40.00|99|0.00|HOME HEALTH AIDE
20|FH_F67319_0_0|SrvcGrp|43958|2022|PDM|115.00|99|0.00|ENTEROSTOMAL THERAPY SERVICES
20|FH_F67319_0_0|SrvcGrp|63118|2022|PDM|35.00|99|0.00|HOSPICE CARE
20|FH_F67319_0_0|SrvcGrp|63119|2022|PDM|45.00|99|0.00|BASIC HOME HOSPICE CARE
20|FH_F67339_0_0|SrvcGrp|473|2022|PDM|1300.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F67359_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F67379_0_0|SrvcGrp|20898|2022|PDM|11300.00|99|0.00|MS DRG 246 ONLY
20|FH_F67379_0_0|SrvcGrp|21350|2022|PDM|6357.00|99|0.00|MS DRG 287 ONLY
20|FH_F67379_0_0|SrvcGrp|30033|2022|PDM|35315.00|99|0.00|MSDRG 216-238  ONLY CV SURGERY
20|FH_F67379_0_0|SrvcGrp|30623|2022|PDM|4237.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788
20|FH_F67379_0_0|SrvcGrp|43986|2022|PDM|14126.00|99|0.00|CARDIAC PACEMAKER (MS DRG 242-244, 258-262 ONLY)
20|FH_F67379_0_0|SrvcGrp|8950|2022|PDM|1696.00|99|0.00|INTERMEDIATE ICU/CCU
20|FH_F67383_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F67423_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.00|99|0.00|OP SVCS
20|FH_F67424_0_0|SrvcGrp|471|2022|PDM|480.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F67425_0_0|SrvcGrp|12359|2022|PDM|2329.00|99|0.00|TELEMETRY SVCS
20|FH_F67425_0_0|SrvcGrp|20752|2022|PDM|16200.00|99|0.00|MSDRG 619-621 ONLY BARIATRIC SURGERY
20|FH_F67425_0_0|SrvcGrp|30160|2022|PDM|5226.00|99|0.00|MS DRG 216-238, 242-244  ONLY CV SURGERY
20|FH_F67500_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|GENERAL ACUTE CARE
20|FH_F67500_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|OP SVCS
20|FH_F67502_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|OP SVCS
20|FH_F67504_0_0|SrvcGrp|3259|2022|PDM|926.00|99|0.00|ACUTE REHABILITATION
20|FH_F67504_0_0|SrvcGrp|43892|2022|PDM|93.00|99|0.00|PHYSICAL THERAPY VISIT
20|FH_F67504_0_0|SrvcGrp|49862|2022|PDM|93.00|99|0.00|SPEECH THERAPY
20|FH_F67560_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.83|99|0.00|GENERAL ACUTE CARE
20|FH_F67560_0_0|SrvcGrp|17079|2022|PCT|0.83|99|0.00|ASPG VIII
20|FH_F67560_0_0|SrvcGrp|17083|2022|PCT|0.83|99|0.00|ASPG X
20|FH_F67581_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F67639_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F67639_0_0|CSTM-ALL|CSTM-00|2020|PDM|692.55|99|0.00|ASPG V
20|FH_F67639_0_0|CSTM-ALL|CSTM-00|2020|PDM|944.29|99|0.00|ASPG VIII
20|FH_F67639_0_0|CSTM-ALL|CSTM-00|2020|PDM|966.14|99|0.00|ASPG VII
20|FH_F67639_0_0|SrvcGrp|27402|2022|PDM|1800.00|99|0.00|LASER PROCEDURES
20|FH_F67639_0_0|SrvcGrp|44067|2022|PDM|1025.00|99|0.00|CPT 52240
20|FH_F67639_0_0|SrvcGrp|44068|2022|PDM|850.00|99|0.00|CPT 52332
20|FH_F67639_0_0|SrvcGrp|56463|2022|PDM|1735.00|99|0.00|CPT 53852
20|FH_F67639_0_0|SrvcGrp|63459|2022|PDM|1500.00|99|0.00|CPT 52601
20|FH_F67639_0_0|SrvcGrp|63467|2022|PDM|775.00|99|0.00|CPT 64585
20|FH_F67639_0_0|SrvcGrp|63469|2022|PDM|520.00|99|0.00|CPT 55700
20|FH_F67683_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F67683_0_0|SrvcGrp|43525|2022|PDM|250.00|99|0.00|INTENSIVE OUTPATIENT PROGRAM - PSYCHIATRIC
20|FH_F67683_0_0|SrvcGrp|63488|2022|PDM|150.00|99|0.00|PSYCH/CHEM REHAB
20|FH_F67739_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F67763_0_0|SrvcGrp|43534|2022|PDM|350.00|99|0.00|HOME HEMODIALYSIS
20|FH_F67763_0_0|SrvcGrp|44247|2022|PDM|375.00|99|0.00|CAPD TRAINING
20|FH_F67763_0_0|SrvcGrp|44248|2022|PDM|150.00|99|0.00|CAPD/CCPD SUPPLEMENT
20|FH_F67763_0_0|SrvcGrp|64298|2022|PDM|280.00|99|0.00|CCPE
20|FH_F67803_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F67803_0_0|SrvcGrp|24029|2022|PDM|55.00|99|0.00|RN HOURLY
20|FH_F67803_0_0|SrvcGrp|42826|2022|PDM|120.00|99|0.00|PHYSICAL THERAPY VISIT
20|FH_F67861_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F67861_0_0|SrvcGrp|29817|2022|PDM|3630.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F67861_0_0|SrvcGrp|3029|2022|PDM|880.00|99|0.00|NEWBORN NURSERY
20|FH_F67861_0_0|SrvcGrp|3066|2022|PCT|0.60|99|0.00|HIGH-COST DRUGS
20|FH_F67861_0_0|SrvcGrp|46029|2022|PDM|13200.00|99|0.00|GASTRIC REDUCTION - LAP BANDING
20|FH_F67861_0_0|SrvcGrp|46032|2022|PDM|13200.00|99|0.00|GASTRIC REDUCTION - LAP BANDING
20|FH_F67861_0_0|SrvcGrp|73979|2022|PDM|13200.00|99|0.00|IP SLEEVE GASTRECTOMY
20|FH_F67887_0_0|SrvcGrp|42828|2022|PDM|100.00|99|0.00|SPEECH THERAPY VISIT
20|FH_F67887_0_0|SrvcGrp|72779|2022|PDM|100.00|99|0.00|RN - VISIT LEVEL
20|FH_F67888_0_0|SrvcGrp|3809|2022|PDM|615.30|99|0.00|HOSPICE CARE
20|FH_F67924_0_0|SrvcGrp|42827|2022|PDM|125.00|99|0.00|OCCUPATIONAL THERAPY VISIT
20|FH_F67924_0_0|SrvcGrp|43891|2022|PDM|60.00|99|0.00|RN HOURLY PEDS
20|FH_F67984_0_0|SrvcGrp|59423|2022|PDM|130.00|99|0.00|RN VISIT
20|FH_F67999_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F68040_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F68043_0_0|CSTM-ALL|CSTM-00|2020|PCT|9000.00|99|0.00|TIMELY FILING
20|FH_F68121_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE
20|FH_F68121_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F68121_0_0|SrvcGrp|3259|2022|PDM|1100.00|99|0.00|ACUTE REHABILITATION
20|FH_F68121_0_0|SrvcGrp|64319|2022|PDM|100.00|99|0.00|PHYSICAL THERAPY
20|FH_F68121_0_0|SrvcGrp|64323|2022|PDM|700.00|99|0.00|FUNCTIONAL CAPACITY EVAL
20|FH_F68124_0_0|CSTM-ALL|CSTM-00|2020|PDM|920.00|99|0.00|GENERAL ACUTE CARE
20|FH_F68161_0_0|CSTM-ALL|CSTM-00|2020|PDM|1662.00|99|0.00|COVENTRY ENHANCED GROUPER 3
20|FH_F68161_0_0|CSTM-ALL|CSTM-00|2020|PDM|1987.00|99|0.00|COVENTRY ENHANCED GROUPER 10
20|FH_F68251_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F68309_0_0|CSTM-ALL|CSTM-00|2020|PDM|1194.00|99|0.00|AEG 7 (NO REV)
20|FH_F68309_0_0|CSTM-ALL|CSTM-00|2020|PDM|1607.00|99|0.00|AEG 9 (NO REV)
20|FH_F68309_0_0|CSTM-ALL|CSTM-00|2020|PDM|416.00|99|0.00|AEG 1 (NO REV)
20|FH_F68309_0_0|CSTM-ALL|CSTM-00|2020|PDM|860.00|99|0.00|AEG 5  (NO REV)
20|FH_F68322_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F68322_0_0|SrvcGrp|17069|2022|PDM|900.00|99|0.00|ASPG III
20|FH_F68322_0_0|SrvcGrp|17071|2022|PDM|1100.00|99|0.00|ASPG IV
20|FH_F68363_0_0|CSTM-ALL|CSTM-00|2020|PDM|55.00|99|0.00|CPT 99201
20|FH_F68363_0_0|SrvcGrp|13631|2022|PDM|137.00|99|0.00|CPT 99213
20|FH_F68365_0_0|CSTM-ALL|CSTM-00|2020|PDM|1753.00|99|0.00|COVENTRY ENHANCED GROUPER 9
20|FH_F68365_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|COVENTRY ENHANCED GROUPER 4
20|FH_F68442_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F68442_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F68442_0_0|SrvcGrp|33164|2022|PDM|305.00|99|0.00|SKILLED NURSING - LEVEL I
20|FH_F68442_0_0|SrvcGrp|43893|2022|PDM|80.00|99|0.00|OCCUPATIONAL THERAPY VISIT
20|FH_F68460_0_0|SrvcGrp|74614|2022|PDM|419.00|99|0.00|OP PARTIAL HOSPITALIZATION
20|FH_F68460_0_0|SrvcGrp|87317|2022|PDM|813.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)
20|FH_F68481_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F68481_0_0|CSTM-ALL|CSTM-00|2020|PDM|1740.00|99|0.00|ASPG VIII
20|FH_F68481_0_0|CSTM-ALL|CSTM-00|2020|PDM|585.00|99|0.00|ASPG I
20|FH_F68544_0_0|CSTM-ALL|CSTM-00|2020|PDM|140.00|99|0.00|OP SVCS
20|FH_F68622_0_0|SrvcGrp|12512|2022|PDM|1394.00|99|0.00|ACUTE REHABILITATION
20|FH_F68622_0_0|SrvcGrp|13927|2022|PCT|0.80|99|0.00|DAY HOSPITAL FULL DAY
20|FH_F68622_0_0|SrvcGrp|13928|2022|PCT|0.80|99|0.00|DAY HOSPITAL HALF DAY
20|FH_F68622_0_0|SrvcGrp|58642|2022|PDM|415.00|99|0.00|DIALYSIS
20|FH_F68626_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS
20|FH_F68626_0_0|SrvcGrp|11606|2022|PDM|1450.00|99|0.00|ACUTE CARE (MEDICAL & SURGICAL)
20|FH_F68626_0_0|SrvcGrp|3142|2022|PDM|1695.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F68660_0_0|SrvcGrp|15132|2022|PDM|1500.00|99|0.00|ACUTE IP MEDICAL SVCS
20|FH_F68823_0_0|SrvcGrp|44326|2022|PDM|60.00|99|0.00|PT & OT (VISIT LVL) OT MOD GO
20|FH_F68831_0_0|SrvcGrp|26001|2022|PDM|154.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F68831_0_0|SrvcGrp|8962|2022|PDM|99.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F68831_0_0|SrvcGrp|9827|2022|PDM|104.50|99|0.00|RN INTERMITTENT VISIT
20|FH_F68841_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F68843_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F68844_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS
20|FH_F68844_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|BOARDER BABY SVCS
20|FH_F68845_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F68846_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F68847_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F68848_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F68849_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F68850_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F68865_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F68866_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS
20|FH_F68868_0_0|SrvcGrp|16|2022|PDM|1185.00|99|0.00|ACUTE REHABILITATION
20|FH_F68868_0_0|SrvcGrp|29817|2022|PDM|2836.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F68887_0_0|SrvcGrp|44107|2022|PDM|48.00|99|0.00|SPEECH THERAPY
20|FH_F68888_0_0|SrvcGrp|472|2022|PDM|460.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F68888_0_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F68909_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|GENERAL ACUTE CARE
20|FH_F68943_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|OP SVCS
20|FH_F68944_0_0|SrvcGrp|12258|2022|PCT|0.70|99|0.00|CARDIAC CATHETERIZATION
20|FH_F68944_0_0|SrvcGrp|15559|2022|PDM|2870.00|99|0.00|ACUTE MED & SURG SVCS
20|FH_F68944_0_0|SrvcGrp|29817|2022|PDM|6046.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F68944_0_0|SrvcGrp|30623|2022|PDM|6361.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788
20|FH_F68944_0_0|SrvcGrp|33625|2022|PDM|1175.00|99|0.00|ACUTE PSYCH
20|FH_F68944_0_0|SrvcGrp|3499|2022|PCT|0.50|99|0.00|IMPLANTS
20|FH_F68944_0_0|SrvcGrp|44011|2022|PDM|630.00|99|0.00|DIALYSIS
20|FH_F68944_0_0|SrvcGrp|9947|2022|PCT|0.50|99|0.00|DRUGS
20|FH_F68947_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|COVENTRY ENHANCED GROUPER 10
20|FH_F68947_0_0|CSTM-ALL|CSTM-00|2020|PDM|1750.00|99|0.00|COVENTRY ENHANCED GROUPER 3
20|FH_F68947_0_0|CSTM-ALL|CSTM-00|2020|PDM|2100.00|99|0.00|COVENTRY ENHANCED GROUPER 6
20|FH_F68947_0_0|SrvcGrp|59840|2022|PDM|2991.00|99|0.00|TYMPANOSTOMY
20|FH_F68947_0_0|SrvcGrp|65401|2022|PDM|5367.60|99|0.00|CPT 21335
20|FH_F68947_0_0|SrvcGrp|65402|2022|PDM|4865.08|99|0.00|CPT 42145
20|FH_F68950_0_0|CSTM-ALL|CSTM-00|2020|PDM|1426.19|99|0.00|ASPG X
20|FH_F68950_0_0|CSTM-ALL|CSTM-00|2020|PDM|2211.07|99|0.00|ASPG VIII
20|FH_F68950_0_0|CSTM-ALL|CSTM-00|2020|PDM|753.62|99|0.00|ASPG I
20|FH_F68950_0_0|SrvcGrp|40945|2022|PDM|4051.69|99|0.00|LITHOTRIPSY
20|FH_F68964_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|GENERAL ACUTE CARE
20|FH_F68970_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|GENERAL ACUTE CARE
20|FH_F68976_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|OP SVCS
20|FH_F69063_0_0|SrvcGrp|42974|2022|PDM|95.00|99|0.00|OCCUPATIONAL THERAPIST
20|FH_F69063_0_0|SrvcGrp|42975|2022|PDM|95.00|99|0.00|PHYSICAL THERAPIST
20|FH_F69063_0_0|SrvcGrp|43958|2022|PDM|73.00|99|0.00|ENTEROSTOMAL THERAPY SERVICES
20|FH_F69071_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F69071_0_0|SrvcGrp|13422|2022|PDM|396.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC
20|FH_F69071_0_0|SrvcGrp|13597|2022|PDM|314.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT
20|FH_F69071_0_0|SrvcGrp|13682|2022|PDM|549.00|99|0.00|ADVANCED LIFE SUPPORT (ALS) PARAMEDIC INTERCEPT
20|FH_F69084_0_0|CSTM-ALL|CSTM-00|2020|PDM|576.00|99|0.00|AEG 3 (NO REV)
20|FH_F69202_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.90|99|0.00|ASPG III
20|FH_F69202_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.90|99|0.00|ASPG IV
20|FH_F69202_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.90|99|0.00|ASPG VII
20|FH_F69202_0_0|CSTM-ALL|CSTM-00|2020|PDM|2400.00|99|0.00|GENERAL ACUTE CARE
20|FH_F69202_0_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|ASPG X
20|FH_F69202_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F69202_0_0|SrvcGrp|20077|2022|PDM|30000.00|99|0.00|MS DRG 226-227 ONLY CARDIAC DEFIBRILLATOR
20|FH_F69202_0_0|SrvcGrp|20240|2022|PDM|14600.00|99|0.00|PTCA W/O STENT (MS DRG ONLY)
20|FH_F69202_0_0|SrvcGrp|20252|2022|PDM|40000.00|99|0.00|MS DRG 224-225 ONLY
20|FH_F69202_0_0|SrvcGrp|23477|2022|PDM|8100.00|99|0.00|MSDRG 286-287 ONLY CARDIAC CATH
20|FH_F69202_0_0|SrvcGrp|29817|2022|PDM|3300.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F69202_0_0|SrvcGrp|3982|2022|PDM|3100.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F69202_0_0|SrvcGrp|9774|2022|PDM|3100.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F69202_0_0|SrvcGrp|9938|2022|PDM|125.00|99|0.00|SPEECH THERAPY
20|FH_F69205_0_0|SrvcGrp|10519|2022|PDM|172.80|99|0.00|MEDICAL SOCIAL WORKER VISIT
20|FH_F69205_0_0|SrvcGrp|115426|2022|PDM|172.81|99|0.00|MATERNAL / CHILD HEALTH VISIT
20|FH_F69205_0_0|SrvcGrp|15385|2022|PDM|172.80|99|0.00|SKILLED NURSING NON IV RELATED
20|FH_F69205_0_0|SrvcGrp|15850|2022|PDM|241.90|99|0.00|HOSPICE SVCS
20|FH_F69242_0_0|SrvcGrp|36068|2022|PDM|55.00|99|0.00|SKILLED NURSING NON IV RELATED
20|FH_F69242_0_0|SrvcGrp|42973|2022|PDM|95.00|99|0.00|SPEECH  THERAPIST
20|FH_F69242_0_0|SrvcGrp|42975|2022|PDM|95.00|99|0.00|PHYSICAL THERAPIST
20|FH_F69242_0_0|SrvcGrp|42976|2022|PDM|95.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F69242_0_0|SrvcGrp|47764|2022|PDM|120.00|99|0.00|HOSPICE CARE/ IN HOME S9126 VISIT LEVEL
20|FH_F69249_0_0|SrvcGrp|12787|2022|PCT|0.50|99|0.00|IMPLANTS
20|FH_F69284_0_0|CSTM-ALL|CSTM-00|2020|PCT|71.70|99|0.00|OP SVCS
20|FH_F69322_0_0|CSTM-ALL|CSTM-00|2020|PDM|402.00|99|0.00|CD PARTIAL HOSPITALIZATION - CHILD
20|FH_F69322_0_0|CSTM-ALL|CSTM-00|2020|PDM|402.00|99|0.00|CHILD PSYCH PARTIAL HOSP
20|FH_F69322_0_0|CSTM-ALL|CSTM-00|2020|PDM|962.00|99|0.00|ADOLESCENT PSYCHIATRIC
20|FH_F69322_0_0|SrvcGrp|170|2022|PDM|881.00|99|0.00|CD (ADOLESCENT) - REHAB
20|FH_F69423_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 5  (NO REV)
20|FH_F69423_0_0|CSTM-ALL|CSTM-00|2020|PDM|1527.00|99|0.00|AEG 7 (NO REV)
20|FH_F69423_0_0|CSTM-ALL|CSTM-00|2020|PDM|2185.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F69423_0_0|SrvcGrp|65624|2022|PDM|1000.00|99|0.00|CPT 31254 AND 31267
20|FH_F69504_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE
20|FH_F69504_0_0|SrvcGrp|48394|2022|PDM|7.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F69504_0_0|SrvcGrp|66005|2022|PDM|27.00|99|0.00|SKILLED NURSING HCPC
20|FH_F69610_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F69610_0_0|CSTM-ALL|CSTM-00|2020|PDM|1150.00|99|0.00|GENERAL ACUTE CARE
20|FH_F69647_0_0|SrvcGrp|17071|2022|PDM|1100.00|99|0.00|ASPG IV
20|FH_F69648_0_0|CSTM-ALL|CSTM-00|2020|PDM|11.25|99|0.00|SKILLED NURSING HCPC
20|FH_F69648_0_0|SrvcGrp|44042|2022|PDM|45.00|99|0.00|SKILLED NURSING - LPN
20|FH_F69648_0_0|SrvcGrp|46424|2022|PDM|11.25|99|0.00|HI TECH SKILLED NURSING SERVICES
20|FH_F69648_0_0|SrvcGrp|46605|2022|PDM|11.25|99|0.00|CLINICAL SOCIAL WORKER SERVICES
20|FH_F69648_0_0|SrvcGrp|48398|2022|PDM|11.25|99|0.00|PT SERVICES
20|FH_F69651_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE
20|FH_F69651_0_0|SrvcGrp|10537|2022|PDM|55.00|99|0.00|NURSING CARE
20|FH_F69651_0_0|SrvcGrp|10538|2022|PDM|27.50|99|0.00|NURSING CARE
20|FH_F69651_0_0|SrvcGrp|10540|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE
20|FH_F69651_0_0|SrvcGrp|10542|2022|PDM|95.00|99|0.00|OCCUPATIONAL THERAPY SVCS
20|FH_F69651_0_0|SrvcGrp|15850|2022|PDM|120.00|99|0.00|HOSPICE SVCS
20|FH_F69651_0_0|SrvcGrp|58847|2022|PDM|125.00|99|0.00|HOSPICE RESPITE CARE
20|FH_F69651_0_0|SrvcGrp|58848|2022|PDM|525.00|99|0.00|HOSPICE GENERAL CARE
20|FH_F69683_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|GENERAL ACUTE CARE
20|FH_F69694_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|OP SVCS
20|FH_F69703_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F69703_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F69703_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|COVENTRY ENHANCED GROUPER 7
20|FH_F69703_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|COVENTRY ENHANCED GROUPER 8
20|FH_F69751_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F69787_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F69804_0_0|CSTM-ALL|CSTM-00|2020|PCT|52.10|99|0.00|OP SVCS
20|FH_F69806_0_0|CSTM-ALL|CSTM-00|2020|PCT|81.18|99|0.00|GENERAL ACUTE CARE
20|FH_F69811_0_0|CSTM-ALL|CSTM-00|2020|PCT|51.00|99|0.00|GENERAL ACUTE CARE
20|FH_F69811_0_0|CSTM-ALL|CSTM-00|2020|PCT|51.00|99|0.00|OP SVCS
20|FH_F69845_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS
20|FH_F69846_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F69942_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS
20|FH_F69965_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F69965_0_0|SrvcGrp|66480|2022|PDM|110.00|99|0.00|RN VISIT
20|FH_F69965_0_0|SrvcGrp|66481|2022|PDM|140.00|99|0.00|SOCIAL WORKER
20|FH_F69971_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AEG 5 DUBUQUE ENDOSCOPY CENTER (NO REV)
20|FH_F69971_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AEG 8 DUBUQUE ENDOSCOPY CENTER (NO REV)
20|FH_F69971_0_0|SrvcGrp|24952|2022|PDM|371.00|99|0.00|GASTROESOPHOGEAL STUDY
20|FH_F69982_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F70005_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 10 (NO REV)
20|FH_F70005_0_0|SrvcGrp|24714|2022|PCT|0.55|99|0.00|INTRAOCULAR LENS
20|FH_F70026_0_0|SrvcGrp|1168|2022|PDM|40.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F70026_0_0|SrvcGrp|17140|2022|PDM|160.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F70026_0_0|SrvcGrp|3810|2022|PDM|160.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F70043_0_0|CSTM-ALL|CSTM-00|2020|PCT|40.00|99|0.00|OP SVCS
20|FH_F70090_0_0|CSTM-ALL|CSTM-00|2020|PCT|66.00|99|0.00|GENERAL ACUTE CARE
20|FH_F70090_0_0|CSTM-ALL|CSTM-00|2020|PCT|66.00|99|0.00|OP SVCS
20|FH_F70104_0_0|SrvcGrp|48396|2022|PDM|12.00|99|0.00|OT SERVICES
20|FH_F70104_0_0|SrvcGrp|66265|2022|PDM|4.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F70162_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F70165_0_0|CSTM-ALL|CSTM-00|2020|PCT|56.00|99|0.00|OP SVCS
20|FH_F70182_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F70182_0_0|SrvcGrp|43892|2022|PDM|125.00|99|0.00|PHYSICAL THERAPY VISIT
20|FH_F70182_0_0|SrvcGrp|57642|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE
20|FH_F70205_0_0|SrvcGrp|472|2022|PDM|460.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F70205_0_0|SrvcGrp|474|2022|PDM|360.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F70303_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F70303_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F70303_0_0|SrvcGrp|11442|2022|PDM|948.00|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)
20|FH_F70303_0_0|SrvcGrp|15873|2022|PDM|53.00|99|0.00|HOSPICE SERVICE - CONTINUOUS HOME CARE
20|FH_F70343_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE
20|FH_F70444_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F70484_0_0|CSTM-ALL|CSTM-00|2020|PCT|53.80|99|0.00|OP SVCS
20|FH_F70510_0_0|SrvcGrp|17139|2022|PDM|605.00|99|0.00|HOSPICE CARE
20|FH_F70510_0_0|SrvcGrp|3810|2022|PDM|135.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F70531_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F70645_0_0|SrvcGrp|10708|2022|PDM|90.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F70645_0_0|SrvcGrp|12512|2022|PDM|1000.00|99|0.00|ACUTE REHABILITATION
20|FH_F70645_0_0|SrvcGrp|3259|2022|PDM|900.00|99|0.00|ACUTE REHABILITATION
20|FH_F70805_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F70964_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F71005_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F71042_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F71042_0_0|SrvcGrp|14609|2022|PCT|0.70|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F71047_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F71049_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.69|99|0.00|OP SVCS
20|FH_F71049_0_0|SrvcGrp|12403|2022|PDM|65.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F71049_0_0|SrvcGrp|22954|2022|PDM|295.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F71049_0_0|SrvcGrp|26001|2022|PDM|270.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F71065_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.00|99|0.00|GENERAL ACUTE CARE
20|FH_F71066_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F71066_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F71068_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F71069_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F71070_0_0|CSTM-ALL|CSTM-00|2020|PDM|1600.00|99|0.00|COVENTRY ENHANCED GROUPER 5
20|FH_F71070_0_0|CSTM-ALL|CSTM-00|2020|PDM|2100.00|99|0.00|COVENTRY ENHANCED GROUPER 8
20|FH_F71070_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|COVENTRY ENHANCED GROUPER 1
20|FH_F71070_0_0|SrvcGrp|16468|2022|PDM|3000.00|99|0.00|LASER PROCEDURES
20|FH_F71070_0_0|SrvcGrp|47545|2022|PDM|3000.00|99|0.00|INSERTION/REPLACEMENT OF PERIPHERAL/GASTRIC NEUROSTIMULATOR
20|FH_F71070_0_0|SrvcGrp|68052|2022|PDM|1200.00|99|0.00|CPT 52204
20|FH_F71070_0_0|SrvcGrp|68053|2022|PDM|1500.00|99|0.00|CPT 52234
20|FH_F71070_0_0|SrvcGrp|68054|2022|PDM|1800.00|99|0.00|CPT 52332
20|FH_F71103_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F71103_0_0|SrvcGrp|42784|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY  SRVCS
20|FH_F71103_0_0|SrvcGrp|68140|2022|PDM|35.00|99|0.00|HOME HEALTH AID
20|FH_F71105_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE
20|FH_F71105_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F71144_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F71144_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F71145_0_0|SrvcGrp|44243|2022|PDM|395.00|99|0.00|HOME HEMO TRAINING
20|FH_F71145_0_0|SrvcGrp|44245|2022|PDM|145.00|99|0.00|CAPD/CCPD SUPPLEMENT
20|FH_F71145_0_0|SrvcGrp|44249|2022|PDM|165.00|99|0.00|CAPD TRAINING
20|FH_F71268_0_0|SrvcGrp|14366|2022|PDM|4100.00|99|0.00|ICU/PICU/CCU
20|FH_F71268_0_0|SrvcGrp|3178|2022|PDM|1773.00|99|0.00|ACUTE PSYCH
20|FH_F71268_0_0|SrvcGrp|3212|2022|PDM|600.00|99|0.00|HEMODIALYSIS SERVICES
20|FH_F71268_0_0|SrvcGrp|9826|2022|PCT|0.80|99|0.00|OP SURGERY
20|FH_F71271_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F71271_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F71271_0_0|SrvcGrp|46605|2022|PDM|12.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES
20|FH_F71271_0_0|SrvcGrp|66265|2022|PDM|8.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F71271_0_0|SrvcGrp|68260|2022|PDM|12.00|99|0.00|PHYSICAL THERAPY
20|FH_F71271_0_0|SrvcGrp|68263|2022|PDM|12.00|99|0.00|RESPIRATORY THERAPY
20|FH_F71342_0_0|CSTM-ALL|CSTM-00|2020|PDM|1223.00|99|0.00|AEG 1 (NO REV)
20|FH_F71342_0_0|CSTM-ALL|CSTM-00|2020|PDM|2503.00|99|0.00|AEG 7 (NO REV)
20|FH_F71342_0_0|SrvcGrp|46857|2022|PDM|1223.00|99|0.00|CPT CODE 62284
20|FH_F71345_0_0|SrvcGrp|12403|2022|PDM|37.35|99|0.00|CONTINUOUS HOMECARE
20|FH_F71345_0_0|SrvcGrp|3809|2022|PDM|641.85|99|0.00|HOSPICE CARE
20|FH_F71346_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F71346_0_0|SrvcGrp|1168|2022|PDM|31.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F71346_0_0|SrvcGrp|3810|2022|PDM|127.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F71362_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F71364_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|HOSPICE SERVICES
20|FH_F71364_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F71364_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|AMBULANCE SVCS
20|FH_F71365_0_0|SrvcGrp|59426|2022|PDM|90.00|99|0.00|PT
20|FH_F71365_0_0|SrvcGrp|66482|2022|PDM|35.00|99|0.00|HOME HEALTH AID
20|FH_F71443_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F71484_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F71523_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS
20|FH_F71546_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE
20|FH_F71546_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS
20|FH_F71625_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F71628_0_0|SrvcGrp|46424|2022|PDM|15.00|99|0.00|HI TECH SKILLED NURSING SERVICES
20|FH_F71647_0_0|SrvcGrp|471|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F71647_0_0|SrvcGrp|473|2022|PDM|335.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F71665_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F71686_0_0|SrvcGrp|30623|2022|PDM|4300.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788
20|FH_F71686_0_0|SrvcGrp|36991|2022|PCT|0.50|99|0.00|IMPLANTS
20|FH_F71686_0_0|SrvcGrp|68662|2022|PCT|0.50|99|0.00|HIGH COST DRUGS
20|FH_F71702_0_0|CSTM-ALL|CSTM-00|2020|PDM|430.85|99|0.00|ASPG II
20|FH_F71702_0_0|CSTM-ALL|CSTM-00|2020|PDM|966.14|99|0.00|ASPG VII
20|FH_F71704_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|OP SVCS
20|FH_F71748_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F71748_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F71748_0_0|SrvcGrp|17140|2022|PDM|172.08|99|0.00|HOSPICE RESPITE SVCS
20|FH_F71748_0_0|SrvcGrp|3810|2022|PDM|168.44|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F71829_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F71829_0_0|SrvcGrp|3809|2022|PDM|704.00|99|0.00|HOSPICE CARE
20|FH_F71848_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|GENERAL ACUTE CARE
20|FH_F71848_0_0|SrvcGrp|56522|2022|PDM|191.35|99|0.00|SURGICAL PATHOLOGY LEVEL IV
20|FH_F71863_0_0|SrvcGrp|11109|2022|PDM|104.50|99|0.00|SKILLED NURSING CARE
20|FH_F71863_0_0|SrvcGrp|17139|2022|PDM|687.50|99|0.00|HOSPICE CARE
20|FH_F71863_0_0|SrvcGrp|3810|2022|PDM|165.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F71863_0_0|SrvcGrp|8962|2022|PDM|104.50|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F71905_0_0|SrvcGrp|59426|2022|PDM|75.00|99|0.00|PT
20|FH_F71905_0_0|SrvcGrp|66480|2022|PDM|75.00|99|0.00|RN VISIT
20|FH_F71984_0_0|CSTM-ALL|CSTM-00|2020|PCT|71.81|99|0.00|OP SVCS
20|FH_F72024_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72024_0_0|SrvcGrp|1168|2022|PDM|640.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F72024_0_0|SrvcGrp|42784|2022|PDM|68.00|99|0.00|OCCUPATIONAL THERAPY  SRVCS
20|FH_F72047_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72047_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|IMPLANTS
20|FH_F72049_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F72049_0_0|SrvcGrp|17139|2022|PDM|704.00|99|0.00|HOSPICE CARE
20|FH_F72051_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72051_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F72065_0_0|SrvcGrp|3810|2022|PDM|193.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F72085_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72085_0_0|SrvcGrp|43534|2022|PDM|392.00|99|0.00|HOME HEMODIALYSIS
20|FH_F72085_0_0|SrvcGrp|44247|2022|PDM|420.00|99|0.00|CAPD TRAINING
20|FH_F72085_0_0|SrvcGrp|44248|2022|PDM|168.00|99|0.00|CAPD/CCPD SUPPLEMENT
20|FH_F72085_0_0|SrvcGrp|64298|2022|PDM|314.00|99|0.00|CCPE
20|FH_F72090_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72090_0_0|SrvcGrp|1168|2022|PDM|39.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F72090_0_0|SrvcGrp|3810|2022|PDM|160.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F72262_0_0|SrvcGrp|10393|2022|PDM|2000.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F72262_0_0|SrvcGrp|16|2022|PDM|1300.00|99|0.00|ACUTE REHABILITATION
20|FH_F72262_0_0|SrvcGrp|8950|2022|PDM|1750.00|99|0.00|INTERMEDIATE ICU/CCU
20|FH_F72302_0_0|CSTM-ALL|CSTM-00|2020|PDM|1081.00|99|0.00|AEG 8 (NO REV)
20|FH_F72302_0_0|CSTM-ALL|CSTM-00|2020|PDM|372.00|99|0.00|AEG 1 (NO REV)
20|FH_F72302_0_0|SrvcGrp|27346|2022|PDM|898.00|99|0.00|REPAIR BLADDER DEFECT
20|FH_F72302_0_0|SrvcGrp|38013|2022|PDM|1706.00|99|0.00|HYSTEROSCOPY
20|FH_F72306_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72306_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|COVENTRY ENHANCED GROUPER 3
20|FH_F72306_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|COVENTRY ENHANCED GROUPER 4
20|FH_F72306_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|COVENTRY ENHANCED GROUPER 5
20|FH_F72306_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|COVENTRY ENHANCED GROUPER 1
20|FH_F72387_0_0|SrvcGrp|3087|2022|PDM|600.00|99|0.00|CD - DETOX
20|FH_F72390_0_0|CSTM-ALL|CSTM-00|2020|PDM|1982.00|99|0.00|ASPG II
20|FH_F72390_0_0|CSTM-ALL|CSTM-00|2020|PDM|2797.00|99|0.00|ASPG IV
20|FH_F72390_0_0|CSTM-ALL|CSTM-00|2020|PDM|4325.00|99|0.00|ASPG VIII
20|FH_F72390_0_0|CSTM-ALL|CSTM-00|2020|PDM|4420.00|99|0.00|ASPG VII
20|FH_F72390_0_0|SrvcGrp|15472|2022|PDM|1292.00|99|0.00|CPT CODE 62284
20|FH_F72404_0_0|SrvcGrp|3932|2022|PDM|4087.00|99|0.00|LITHOTRIPSY
20|FH_F72404_0_0|SrvcGrp|98362|2022|PDM|1851.00|99|0.00|AETNA LASER COAGULATION OF PROSTATE
20|FH_F72416_0_0|SrvcGrp|34551|2022|PDM|825.00|99|0.00|SUB ACUTE / REHAB - LEVEL I
20|FH_F72427_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72427_0_0|SrvcGrp|10639|2022|PDM|360.00|99|0.00|CT SCAN
20|FH_F72542_0_0|SrvcGrp|9537|2022|PDM|1400.00|99|0.00|CARDIAC CARE UNIT
20|FH_F72543_0_0|SrvcGrp|12403|2022|PDM|40.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F72543_0_0|SrvcGrp|26001|2022|PDM|150.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F72543_0_0|SrvcGrp|3809|2022|PDM|675.00|99|0.00|HOSPICE CARE
20|FH_F72543_0_0|SrvcGrp|46183|2022|PCT|0.75|99|0.00|WOUND CARE / MEDICAL SUPPLIES
20|FH_F72543_0_0|SrvcGrp|68987|2022|PDM|108.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F72543_0_0|SrvcGrp|69020|2022|PDM|91.80|99|0.00|LPN
20|FH_F72584_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72584_0_0|SrvcGrp|42827|2022|PDM|130.00|99|0.00|OCCUPATIONAL THERAPY VISIT
20|FH_F72606_0_0|CSTM-ALL|CSTM-00|2020|PDM|4300.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72606_0_0|SrvcGrp|14210|2022|PDM|450.00|99|0.00|PSYCH INTENSIVE OUTPATIENT
20|FH_F72606_0_0|SrvcGrp|23477|2022|PDM|9525.00|99|0.00|MSDRG 286-287 ONLY CARDIAC CATH
20|FH_F72606_0_0|SrvcGrp|3029|2022|PDM|950.00|99|0.00|NEWBORN NURSERY
20|FH_F72606_0_0|SrvcGrp|30477|2022|PDM|4300.00|99|0.00|IMCU / DOU
20|FH_F72606_0_0|SrvcGrp|3069|2022|PCT|0.70|99|0.00|IMPLANTS
20|FH_F72606_0_0|SrvcGrp|3646|2022|PDM|9525.00|99|0.00|ELECTROPHYSIOLOGY
20|FH_F72606_0_0|SrvcGrp|46731|2022|PCT|0.85|99|0.00|NITRIC OXIDE THERAPY
20|FH_F72606_0_0|SrvcGrp|69679|2022|PDM|9525.00|99|0.00|AICD MS DRG ONLY
20|FH_F72648_0_0|SrvcGrp|44247|2022|PDM|280.00|99|0.00|CAPD TRAINING
20|FH_F72648_0_0|SrvcGrp|64580|2022|PDM|240.00|99|0.00|CAPD/CCPD SUPPLEMENT
20|FH_F72662_0_0|SrvcGrp|17754|2022|PDM|63.00|99|0.00|DRESSING SET FOR  NEG PRESSURE WOUND THERAPY ELEC PUMP
20|FH_F72662_0_0|SrvcGrp|33414|2022|PDM|200.00|99|0.00|SNF VENTILATOR SUPPORT
20|FH_F72664_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72664_0_0|SrvcGrp|68384|2022|PDM|75.00|99|0.00|PHYSICAL THERAPY
20|FH_F72666_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F72666_0_0|CSTM-ALL|CSTM-00|2020|PDM|1425.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72666_0_0|SrvcGrp|12523|2022|PDM|22976.00|99|0.00|GAMMA KNIFE
20|FH_F72666_0_0|SrvcGrp|26994|2022|PDM|591.00|99|0.00|SKILLED NURSING
20|FH_F72666_0_0|SrvcGrp|29817|2022|PDM|2400.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F72666_0_0|SrvcGrp|30623|2022|PDM|4360.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788
20|FH_F72666_0_0|SrvcGrp|33793|2022|PDM|8010.00|99|0.00|MSDRG 246-251 ONLY ANGIOPLASTY
20|FH_F72666_0_0|SrvcGrp|360|2022|PDM|866.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F72666_0_0|SrvcGrp|69683|2022|PDM|21762.00|99|0.00|CARDIOVASCULAR SURGERY MS DRG ONLY
20|FH_F72666_0_0|SrvcGrp|69686|2022|PCT|0.75|99|0.00|OP CARDIAC CATHETERIZATION
20|FH_F72666_0_0|SrvcGrp|69688|2022|PCT|0.75|99|0.00|OP ELECTROPHYSIOLOGY SERVICES
20|FH_F72666_0_0|SrvcGrp|69747|2022|PCT|0.65|99|0.00|HOME HEALTH SERVICES
20|FH_F72666_0_0|SrvcGrp|828|2022|PDM|7187.00|99|0.00|CARDIAC CATH ABLATIONS
20|FH_F72666_0_0|SrvcGrp|8968|2022|PDM|1941.00|99|0.00|NICU LEVEL III & IV
20|FH_F72702_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72702_0_0|CSTM-ALL|CSTM-00|2020|PDM|485.00|99|0.00|AEG 10 (NO REV)
20|FH_F72702_0_0|CSTM-ALL|CSTM-00|2020|PDM|485.00|99|0.00|AEG 7 (NO REV)
20|FH_F72702_0_0|CSTM-ALL|CSTM-00|2020|PDM|485.00|99|0.00|AEG 9 (NO REV)
20|FH_F72704_0_0|SrvcGrp|33164|2022|PDM|305.00|99|0.00|SKILLED NURSING - LEVEL I
20|FH_F72704_0_0|SrvcGrp|33166|2022|PDM|475.00|99|0.00|SKILLED NURSING - LEVEL III
20|FH_F72743_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F72746_0_0|SrvcGrp|22954|2022|PDM|158.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F72764_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.66|99|0.00|OP SVCS
20|FH_F72764_0_0|SrvcGrp|29930|2022|PDM|400.00|99|0.00|DIALYSIS
20|FH_F72766_0_0|SrvcGrp|12118|2022|PDM|350.00|99|0.00|COMPUTED TOMOGRAPHY (CT)
20|FH_F72766_0_0|SrvcGrp|21975|2022|PDM|1575.00|99|0.00|INPATIENT SERVICES
20|FH_F72766_0_0|SrvcGrp|32703|2022|PDM|1900.00|99|0.00|ICU
20|FH_F72784_0_0|SrvcGrp|44564|2022|PDM|590.55|99|0.00|NEWBORN NURSERY
20|FH_F72785_0_0|CSTM-ALL|CSTM-00|2020|PDM|3411.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72785_0_0|SrvcGrp|3029|2022|PDM|756.00|99|0.00|NEWBORN NURSERY
20|FH_F72788_0_0|CSTM-ALL|CSTM-00|2020|PDM|1475.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F72788_0_0|CSTM-ALL|CSTM-00|2020|PDM|3411.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72788_0_0|SrvcGrp|29817|2022|PDM|5157.10|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F72823_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F72823_0_0|SrvcGrp|33166|2022|PDM|500.00|99|0.00|SKILLED NURSING - LEVEL III
20|FH_F72830_0_0|SrvcGrp|3434|2022|PDM|1600.00|99|0.00|OBSERVATION SERVICES
20|FH_F72830_0_0|SrvcGrp|70043|2022|PDM|2000.00|99|0.00|CVTY ENHANCED + REV CODE ASPG 3
20|FH_F72830_0_0|SrvcGrp|70044|2022|PDM|2500.00|99|0.00|CVTY ENHANCED + REV CODE ASPG 4
20|FH_F72830_0_0|SrvcGrp|70045|2022|PDM|2900.00|99|0.00|CVTY ENHANCED + REV CODE ASPG 5
20|FH_F72830_0_0|SrvcGrp|70081|2022|PCT|0.40|99|0.00|LAB WITH REV CODE 300-319
20|FH_F72842_0_0|CSTM-ALL|CSTM-00|2020|PDM|1475.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F72842_0_0|SrvcGrp|30623|2022|PDM|11282.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788
20|FH_F72845_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F72845_0_0|SrvcGrp|29817|2022|PDM|4968.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F72845_0_0|SrvcGrp|3029|2022|PDM|796.00|99|0.00|NEWBORN NURSERY
20|FH_F72850_0_0|CSTM-ALL|CSTM-00|2020|PDM|1475.00|99|0.00|ACUTE PSYCH
20|FH_F72850_0_0|CSTM-ALL|CSTM-00|2020|PDM|1475.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F72859_0_0|CSTM-ALL|CSTM-00|2020|PDM|102.58|99|0.00|HOME INFUSION NURSING SVCS
20|FH_F72859_0_0|CSTM-ALL|CSTM-00|2020|PDM|150.57|99|0.00|TOTAL PARENTERAL NUTRITION
20|FH_F72859_0_0|CSTM-ALL|CSTM-00|2020|PDM|20.64|99|0.00|TOTAL PARENTERAL NUTRITION
20|FH_F72859_0_0|CSTM-ALL|CSTM-00|2020|PDM|50.00|99|0.00|HOME INFUSION THERAPY
20|FH_F72859_0_0|SrvcGrp|10410|2022|PDM|25.00|99|0.00|SKILLED NURSING CARE
20|FH_F72859_0_0|SrvcGrp|10541|2022|PDM|108.22|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F72859_0_0|SrvcGrp|10545|2022|PDM|101.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F72859_0_0|SrvcGrp|10649|2022|PDM|15.00|99|0.00|HOME INFUSION
20|FH_F72859_0_0|SrvcGrp|1168|2022|PDM|665.79|99|0.00|CONTINUOUS HOMECARE
20|FH_F72859_0_0|SrvcGrp|11791|2022|PDM|130.00|99|0.00|HOME INFUSION THERAPY
20|FH_F72859_0_0|SrvcGrp|11794|2022|PDM|17.00|99|0.00|HOME INFUSION THERAPY
20|FH_F72859_0_0|SrvcGrp|11796|2022|PDM|75.00|99|0.00|DIETICIAN
20|FH_F72859_0_0|SrvcGrp|11800|2022|PDM|46.00|99|0.00|HOME INFUSION THERAPY
20|FH_F72859_0_0|SrvcGrp|15477|2022|PDM|123.22|99|0.00|PHYSICAL THERAPY SVCS INITIAL EVAL
20|FH_F72859_0_0|SrvcGrp|15515|2022|PDM|50.00|99|0.00|HYDRATION THERAPY
20|FH_F72859_0_0|SrvcGrp|473|2022|PDM|300.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F72863_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72890_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F72928_0_0|CSTM-ALL|CSTM-00|2020|PCT|67.00|99|0.00|OP SVCS
20|FH_F72930_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F72940_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE
20|FH_F72943_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F72980_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72980_0_0|SrvcGrp|13595|2022|PDM|431.35|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC
20|FH_F73011_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F73025_0_0|SrvcGrp|48398|2022|PDM|30.00|99|0.00|PT SERVICES
20|FH_F73084_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.74|99|0.00|OP SVCS
20|FH_F73084_0_0|SrvcGrp|68987|2022|PDM|72.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F73125_0_0|CSTM-ALL|CSTM-00|2020|PDM|12.00|99|0.00|SKILLED NURSING HCPC
20|FH_F73125_0_0|SrvcGrp|46424|2022|PDM|12.00|99|0.00|HI TECH SKILLED NURSING SERVICES
20|FH_F73125_0_0|SrvcGrp|48385|2022|PDM|12.00|99|0.00|SPEECH THERAPY
20|FH_F73126_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F73128_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F73142_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F73163_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.19|99|0.00|OP SVCS
20|FH_F73204_0_0|SrvcGrp|12403|2022|PDM|35.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F73228_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F73342_0_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|ASPG 2 PIEDMONT OUTPATIENT SURGERY CENTER
20|FH_F73342_0_0|CSTM-ALL|CSTM-00|2020|PDM|2100.00|99|0.00|ASPG 5 PIEDMONT OUTPATIENT SURGERY CENTER
20|FH_F73342_0_0|CSTM-ALL|CSTM-00|2020|PDM|2490.00|99|0.00|ASPG 7 PIEDMONT OUTPATIENT SURGERY CENTER
20|FH_F73403_0_0|SrvcGrp|62538|2022|PDM|130.00|99|0.00|PHYSICAL THERAPY
20|FH_F73442_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F73442_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F73442_0_0|SrvcGrp|44107|2022|PDM|50.00|99|0.00|SPEECH THERAPY
20|FH_F73505_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F73505_0_0|CSTM-ALL|CSTM-00|2020|PDM|103.00|99|0.00|ASPG 10 SURGICAL EYE CENTER
20|FH_F73505_0_0|CSTM-ALL|CSTM-00|2020|PDM|948.00|99|0.00|ASPG 6 SURGICAL EYE CENTER
20|FH_F73626_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F73705_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|ASPG IV
20|FH_F73705_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|ASPG VI
20|FH_F73705_0_0|SrvcGrp|42870|2022|PDM|75.00|99|0.00|OCCUPATIONAL THERAPY VISIT
20|FH_F73729_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F73731_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE
20|FH_F73743_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F73764_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F73787_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE
20|FH_F73787_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS
20|FH_F73842_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|GENERAL ACUTE CARE
20|FH_F73847_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F73847_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F73864_0_0|SrvcGrp|46424|2022|PDM|12.00|99|0.00|HI TECH SKILLED NURSING SERVICES
20|FH_F73864_0_0|SrvcGrp|46605|2022|PDM|12.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES
20|FH_F73864_0_0|SrvcGrp|48398|2022|PDM|12.00|99|0.00|PT SERVICES
20|FH_F73923_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F73923_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F73923_0_0|CSTM-ALL|CSTM-00|2020|PDM|1144.00|99|0.00|AEG 7 (NO REV)
20|FH_F73923_0_0|CSTM-ALL|CSTM-00|2020|PDM|587.00|99|0.00|AEG 3 (NO REV)
20|FH_F73923_0_0|CSTM-ALL|CSTM-00|2020|PDM|610.00|99|0.00|AEG 2 (NO REV)
20|FH_F73923_0_0|SrvcGrp|71220|2022|PDM|647.00|99|0.00|SIGMOIDOSCOPY  CPT 45334
20|FH_F74102_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F74102_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F74102_0_0|SrvcGrp|11069|2022|PDM|105.00|99|0.00|OT SVCS
20|FH_F74102_0_0|SrvcGrp|11072|2022|PDM|105.00|99|0.00|SPEECH THERAPY SVCS
20|FH_F74102_0_0|SrvcGrp|12403|2022|PDM|39.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F74143_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F74143_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F74163_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE
20|FH_F74163_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F74163_0_0|SrvcGrp|14110|2022|PDM|18.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F74163_0_0|SrvcGrp|14114|2022|PDM|18.00|99|0.00|SPEECH THERAPY SVCS
20|FH_F74163_0_0|SrvcGrp|473|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F74227_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS
20|FH_F74227_0_0|SrvcGrp|3165|2022|PDM|450.00|99|0.00|EMERGENCY ROOM
20|FH_F74263_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F74263_0_0|CSTM-ALL|CSTM-00|2020|PDM|1114.00|99|0.00|SURGICAL SPECIALTY CENTER  ASC GROUPER 5
20|FH_F74263_0_0|CSTM-ALL|CSTM-00|2020|PDM|1305.00|99|0.00|SURGICAL SPECIALTY CENTER  ASC GROUPER 6
20|FH_F74283_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F74283_0_0|CSTM-ALL|CSTM-00|2020|PDM|11.00|99|0.00|VACCINE ADMINISTRATION
20|FH_F74283_0_0|SrvcGrp|1168|2022|PDM|30.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F74283_0_0|SrvcGrp|44391|2022|PDM|75.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F74305_0_0|CSTM-ALL|CSTM-00|2020|PDM|366.00|99|0.00|ASPG I
20|FH_F74305_0_0|CSTM-ALL|CSTM-00|2020|PDM|693.00|99|0.00|ASPG IV
20|FH_F74305_0_0|SrvcGrp|15472|2022|PDM|366.00|99|0.00|CPT CODE 62284
20|FH_F74307_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE
20|FH_F74424_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F74424_0_0|SrvcGrp|42869|2022|PDM|252.00|99|0.00|PHYSICAL THERAPY VISIT
20|FH_F74424_0_0|SrvcGrp|42870|2022|PDM|255.00|99|0.00|OCCUPATIONAL THERAPY VISIT
20|FH_F74424_0_0|SrvcGrp|42871|2022|PDM|275.00|99|0.00|SPEECH THERAPY VISIT
20|FH_F74424_0_0|SrvcGrp|48004|2022|PDM|105.00|99|0.00|HOME HEALTH AIDE
20|FH_F74463_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F74463_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|COVENTRY ENHANCED GROUPER 10
20|FH_F74463_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|COVENTRY ENHANCED GROUPER 4
20|FH_F74463_0_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|COVENTRY ENHANCED GROUPER 8
20|FH_F74463_0_0|SrvcGrp|21342|2022|PCT|1.05|99|0.00|IMPLANTS
20|FH_F74463_0_0|SrvcGrp|67073|2022|PDM|1450.00|99|0.00|CPT 22851
20|FH_F74507_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F74507_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F74562_0_0|SrvcGrp|110|2022|PDM|352.00|99|0.00|CD - REHABILITATION
20|FH_F74562_0_0|SrvcGrp|290|2022|PCT|0.80|99|0.00|IP LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F74562_0_0|SrvcGrp|3458|2022|PCT|0.80|99|0.00|NEONATAL INTENSIVE CARE UNIT
20|FH_F74562_0_0|SrvcGrp|38|2022|PDM|2725.00|99|0.00|NORMAL DELIVERY
20|FH_F74562_0_0|SrvcGrp|97|2022|PDM|4200.00|99|0.00|C-SECTION
20|FH_F74583_0_0|SrvcGrp|46248|2022|PDM|56.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F74583_0_0|SrvcGrp|46605|2022|PDM|14.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES
20|FH_F74583_0_0|SrvcGrp|48385|2022|PDM|14.00|99|0.00|SPEECH THERAPY
20|FH_F74622_0_0|CSTM-ALL|CSTM-00|2020|PDM|1681.00|99|0.00|COVENTRY ENHANCED GROUPER 9
20|FH_F74622_0_0|CSTM-ALL|CSTM-00|2020|PDM|418.00|99|0.00|COVENTRY ENHANCED GROUPER 1
20|FH_F74622_0_0|CSTM-ALL|CSTM-00|2020|PDM|560.00|99|0.00|COVENTRY ENHANCED GROUPER 2
20|FH_F74622_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|COVENTRY ENHANCED GROUPER 5
20|FH_F74647_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F74653_0_0|CSTM-ALL|CSTM-00|2020|PCT|66.00|99|0.00|OP SVCS
20|FH_F74670_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F74670_0_0|SrvcGrp|15403|2022|PDM|120.00|99|0.00|SPEECH THERAPY SVCS INITIAL EVAL
20|FH_F74670_0_0|SrvcGrp|3044|2022|PDM|1150.00|99|0.00|TRANSITIONAL CARE UNIT
20|FH_F74670_0_0|SrvcGrp|72380|2022|PDM|86.00|99|0.00|PHYSICAL AND OCCUPATIONAL THERAPY
20|FH_F74765_0_0|CSTM-ALL|CSTM-00|2020|PDM|401.00|99|0.00|COVENTRY ENHANCED GROUPER 1
20|FH_F74765_0_0|CSTM-ALL|CSTM-00|2020|PDM|571.00|99|0.00|COVENTRY ENHANCED GROUPER 2
20|FH_F74765_0_0|CSTM-ALL|CSTM-00|2020|PDM|653.00|99|0.00|COVENTRY ENHANCED GROUPER 3
20|FH_F74802_0_0|CSTM-ALL|CSTM-00|2020|PCT|57.30|99|0.00|GENERAL ACUTE CARE
20|FH_F74825_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE
20|FH_F74825_0_0|SrvcGrp|44883|2022|PDM|18.00|99|0.00|RT/PT/ST/OT
20|FH_F74844_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F74845_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F74845_0_0|CSTM-ALL|CSTM-00|2020|PDM|1840.00|99|0.00|ACUTE IP MED SVCS
20|FH_F74845_0_0|SrvcGrp|115|2022|PCT|0.85|99|0.00|SKILLED NURSING CARE
20|FH_F74845_0_0|SrvcGrp|13292|2022|PCT|1.15|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F74845_0_0|SrvcGrp|13294|2022|PDM|473.00|99|0.00|MRI
20|FH_F74845_0_0|SrvcGrp|13295|2022|PDM|1890.00|99|0.00|PET SCAN
20|FH_F74845_0_0|SrvcGrp|177|2022|PDM|3680.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F74845_0_0|SrvcGrp|361|2022|PCT|0.85|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F74845_0_0|SrvcGrp|59838|2022|PCT|1.15|99|0.00|ALBUMIN
20|FH_F74845_0_0|SrvcGrp|61198|2022|PCT|1.15|99|0.00|AZT
20|FH_F74845_0_0|SrvcGrp|941|2022|PCT|0.85|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F74947_0_0|SrvcGrp|33164|2022|PDM|400.00|99|0.00|SKILLED NURSING - LEVEL I
20|FH_F75084_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F75087_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|COVENTRY ENHANCED GROUPER 3
20|FH_F75087_0_0|CSTM-ALL|CSTM-00|2020|PDM|2100.00|99|0.00|COVENTRY ENHANCED GROUPER 7
20|FH_F75087_0_0|SrvcGrp|56464|2022|PDM|8700.00|99|0.00|CPT 55873
20|FH_F75087_0_0|SrvcGrp|72287|2022|PDM|1400.00|99|0.00|URETHRAL PROCEDURES
20|FH_F75184_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F75202_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE
20|FH_F75202_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F75202_0_0|SrvcGrp|63|2022|PDM|530.00|99|0.00|SUBACUTE CARE
20|FH_F75202_0_0|SrvcGrp|9939|2022|PDM|1061.00|99|0.00|ACUTE MEDICAL SVCS
20|FH_F75205_0_0|SrvcGrp|43431|2022|PDM|45.00|99|0.00|LPN
20|FH_F75205_0_0|SrvcGrp|45966|2022|PDM|140.00|99|0.00|SOCIAL WORKER
20|FH_F75251_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F75307_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F75307_0_0|SrvcGrp|22954|2022|PDM|154.10|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F75307_0_0|SrvcGrp|23683|2022|PDM|33.00|99|0.00|SKILLED NURSING RN
20|FH_F75307_0_0|SrvcGrp|27969|2022|PDM|44.00|99|0.00|HOME HEALTH AIDE
20|FH_F75307_0_0|SrvcGrp|42973|2022|PDM|105.00|99|0.00|SPEECH  THERAPIST
20|FH_F75307_0_0|SrvcGrp|57650|2022|PDM|77.00|99|0.00|OCCUPATIONAL THERAPY SVCS MOD GO
20|FH_F75425_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F75425_0_0|SrvcGrp|33166|2022|PDM|650.00|99|0.00|SKILLED NURSING - LEVEL III
20|FH_F75483_0_0|CSTM-ALL|CSTM-00|2020|PCT|36500.00|99|0.00|TIMELY FILING
20|FH_F75483_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F75483_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|HOME HEALTH
20|FH_F75542_0_0|SrvcGrp|17139|2022|PDM|644.00|99|0.00|HOSPICE CARE
20|FH_F75606_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|99|0.00|OP SVCS
20|FH_F75606_0_0|SrvcGrp|12791|2022|PCT|0.64|99|0.00|PROSTHETICS/IMPLANTS/DEVICES
20|FH_F75606_0_0|SrvcGrp|27761|2022|PDM|2836.00|99|0.00|ICU/CCU
20|FH_F75788_0_0|CSTM-ALL|CSTM-00|2020|PCT|64.90|99|0.00|GENERAL ACUTE CARE
20|FH_F75803_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F75806_0_0|SrvcGrp|100947|2022|PDM|216.00|99|0.00|HOME HEALTH RN SERVICE
20|FH_F75806_0_0|SrvcGrp|10543|2022|PDM|249.00|99|0.00|SPEECH THERAPY SVCS
20|FH_F75862_0_0|SrvcGrp|12403|2022|PDM|38.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F75944_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F75944_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS
20|FH_F75963_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F75963_0_0|SrvcGrp|48394|2022|PDM|8.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F75963_0_0|SrvcGrp|48396|2022|PDM|18.00|99|0.00|OT SERVICES
20|FH_F75963_0_0|SrvcGrp|66264|2022|PDM|8.00|99|0.00|PHYSICAL THERAPY SERVICES
20|FH_F76022_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F76022_0_0|SrvcGrp|11000|2022|PCT|0.85|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F76022_0_0|SrvcGrp|11259|2022|PCT|0.85|99|0.00|DRUGS
20|FH_F76022_0_0|SrvcGrp|4109|2022|PDM|1040.00|99|0.00|ACUTE PSYCH
20|FH_F76022_0_0|SrvcGrp|73381|2022|PCT|0.85|99|0.00|GAMMA KNIFE
20|FH_F76028_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F76028_0_0|SrvcGrp|62537|2022|PDM|130.00|99|0.00|SPEECH THERAPY
20|FH_F76074_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F76124_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F76124_0_0|SrvcGrp|471|2022|PDM|683.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F76124_0_0|SrvcGrp|9934|2022|PDM|800.00|99|0.00|GENERAL ACUTE CARE W/VENTILATOR SVCS
20|FH_F76146_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F76146_0_0|SrvcGrp|34342|2022|PCT|0.50|99|0.00|IMPLANTS
20|FH_F76146_0_0|SrvcGrp|68187|2022|PDM|893.00|99|0.00|CVTY ENHANCED + REV CODES ASPG 3
20|FH_F76146_0_0|SrvcGrp|68189|2022|PDM|1255.00|99|0.00|CVTY ENHANCED + REV CODES ASPG 5
20|FH_F76146_0_0|SrvcGrp|68192|2022|PDM|1703.00|99|0.00|CVTY ENHANCED + REV CODES ASPG 8
20|FH_F76171_0_0|CSTM-ALL|CSTM-00|2020|PDM|14.00|99|0.00|RN HOURLY
20|FH_F76171_0_0|SrvcGrp|44884|2022|PDM|172.00|99|0.00|PT SVCS INITIAL EVAL 97001 VISIT LEVEL
20|FH_F76171_0_0|SrvcGrp|44885|2022|PDM|154.00|99|0.00|PHYSICAL THERAPY SVCS RE-EVAL PER VISIT
20|FH_F76171_0_0|SrvcGrp|48382|2022|PDM|172.00|99|0.00|CPT 92507
20|FH_F76171_0_0|SrvcGrp|73300|2022|PDM|172.00|99|0.00|PHYSICAL THERAPY TREATMENT
20|FH_F76171_0_0|SrvcGrp|73521|2022|PDM|48.00|99|0.00|RESPIRATORY THERAPY HOURLY
20|FH_F76222_0_0|SrvcGrp|115|2022|PDM|1513.00|99|0.00|SKILLED NURSING CARE
20|FH_F76262_0_0|CSTM-ALL|CSTM-00|2020|PDM|525.00|99|0.00|ENDOSCOPY
20|FH_F76284_0_0|SrvcGrp|12403|2022|PDM|41.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F76285_0_0|CSTM-ALL|CSTM-00|2020|PDM|14.00|99|0.00|RN HOURLY
20|FH_F76285_0_0|CSTM-ALL|CSTM-00|2020|PDM|16.00|99|0.00|RN HIGH TECH HOURLY
20|FH_F76285_0_0|SrvcGrp|73302|2022|PDM|225.00|99|0.00|SPEECH THERAPY RE-EVALUATION
20|FH_F76303_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F76303_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F76303_0_0|SrvcGrp|42975|2022|PDM|150.00|99|0.00|PHYSICAL THERAPIST
20|FH_F76303_0_0|SrvcGrp|48428|2022|PDM|125.00|99|0.00|RESPIRATORY THERAPY INITIAL
20|FH_F76303_0_0|SrvcGrp|53144|2022|PDM|18.00|99|0.00|SPEECH THERAPY
20|FH_F76382_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE
20|FH_F76382_0_0|SrvcGrp|474|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F76402_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F76402_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F76402_0_0|CSTM-ALL|CSTM-00|2020|PCT|26780.00|99|0.00|CAPD/CCPD SUPPLEMENT
20|FH_F76402_0_0|CSTM-ALL|CSTM-00|2020|PCT|56650.00|99|0.00|CAPD TRAINING
20|FH_F76502_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE
20|FH_F76522_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|COVENTRY ENHANCED DEFAULT 10021-69990
20|FH_F76522_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F76522_0_0|CSTM-ALL|CSTM-00|2020|PDM|2298.00|99|0.00|COVENTRY ENHANCED GROUPER 4
20|FH_F76522_0_0|CSTM-ALL|CSTM-00|2020|PDM|3013.00|99|0.00|COVENTRY ENHANCED GROUPER 6
20|FH_F76522_0_0|CSTM-ALL|CSTM-00|2020|PDM|3628.00|99|0.00|COVENTRY ENHANCED GROUPER 7
20|FH_F76522_0_0|CSTM-ALL|CSTM-00|2020|PDM|4883.00|99|0.00|COVENTRY ENHANCED GROUPER 9
20|FH_F76544_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F76544_0_0|CSTM-ALL|CSTM-00|2020|PDM|1529.00|99|0.00|IP LEVEL B
20|FH_F76588_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F76624_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F76624_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.66|99|0.00|OP SVCS
20|FH_F76624_0_0|CSTM-ALL|CSTM-00|2020|PDM|1942.00|99|0.00|ASPG VI - IOWA
20|FH_F76624_0_0|CSTM-ALL|CSTM-00|2020|PDM|2241.00|99|0.00|ASPG VIII - IOWA
20|FH_F76624_0_0|CSTM-ALL|CSTM-00|2020|PDM|917.00|99|0.00|ASPG II - IOWA
20|FH_F76662_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F76662_0_0|SrvcGrp|66480|2022|PDM|85.00|99|0.00|RN VISIT
20|FH_F76662_0_0|SrvcGrp|66482|2022|PDM|35.00|99|0.00|HOME HEALTH AID
20|FH_F76782_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F76824_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F76824_0_0|SrvcGrp|24028|2022|PDM|40.00|99|0.00|LICENSED PRACTICAL NURSE
20|FH_F76824_0_0|SrvcGrp|29137|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE
20|FH_F76824_0_0|SrvcGrp|29898|2022|PDM|90.00|99|0.00|RN VISIT
20|FH_F77025_0_0|CSTM-ALL|CSTM-00|2020|PDM|1575.00|99|0.00|COVENTRY ENHANCED GROUPER 10
20|FH_F77025_0_0|CSTM-ALL|CSTM-00|2020|PDM|1575.00|99|0.00|COVENTRY ENHANCED GROUPER 4
20|FH_F77025_0_0|CSTM-ALL|CSTM-00|2020|PDM|2065.00|99|0.00|COVENTRY ENHANCED GROUPER 6
20|FH_F77025_0_0|SrvcGrp|14614|2022|PDM|3500.00|99|0.00|LITHOTRIPSY
20|FH_F77025_0_0|SrvcGrp|73944|2022|PDM|1383.00|99|0.00|CYSTOSCOPY
20|FH_F77042_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE
20|FH_F77082_0_0|CSTM-ALL|CSTM-00|2020|PDM|13641.00|99|0.00|2007 MEDICARE ASPG IX
20|FH_F77082_0_0|CSTM-ALL|CSTM-00|2020|PDM|4438.00|99|0.00|2007 MEDICARE ASPG I
20|FH_F77082_0_0|CSTM-ALL|CSTM-00|2020|PDM|5377.00|99|0.00|2007 MEDICARE ASPG II
20|FH_F77082_0_0|SrvcGrp|13476|2022|PCT|0.95|99|0.00|TRAUMA CARE
20|FH_F77082_0_0|SrvcGrp|19613|2022|PDM|6610.00|99|0.00|MS DRG CONTRACT
20|FH_F77082_0_0|SrvcGrp|21040|2022|PCT|0.80|99|0.00|MS DRG 652 ONLY - KIDNEY TRANSPLANT
20|FH_F77082_0_0|SrvcGrp|3029|2022|PDM|1242.00|99|0.00|NEWBORN NURSERY
20|FH_F77082_0_0|SrvcGrp|3165|2022|PCT|0.75|99|0.00|EMERGENCY ROOM
20|FH_F77082_0_0|SrvcGrp|360|2022|PDM|2060.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F77082_0_0|SrvcGrp|941|2022|PDM|5624.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F77184_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F77232_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|GENERAL ACUTE CARE
20|FH_F77234_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F77462_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F77462_0_0|SrvcGrp|15385|2022|PDM|55.00|99|0.00|SKILLED NURSING NON IV RELATED
20|FH_F77462_0_0|SrvcGrp|43958|2022|PDM|110.00|99|0.00|ENTEROSTOMAL THERAPY SERVICES
20|FH_F77462_0_0|SrvcGrp|46729|2022|PDM|35.00|99|0.00|RESPITE CARE
20|FH_F77463_0_0|SrvcGrp|471|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F77504_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F77504_0_0|SrvcGrp|10013|2022|PDM|350.00|99|0.00|NEWBORN NURSERY
20|FH_F77504_0_0|SrvcGrp|13854|2022|PDM|450.00|99|0.00|HYPERBARIC CHAMBER
20|FH_F77504_0_0|SrvcGrp|33231|2022|PCT|1.00|99|0.00|TAKE HOME DRUGS
20|FH_F77504_0_0|SrvcGrp|8|2022|PDM|1600.00|99|0.00|BURN INTENSIVE CARE
20|FH_F77504_0_0|SrvcGrp|97|2022|PDM|3900.00|99|0.00|C-SECTION
20|FH_F77585_0_0|SrvcGrp|38439|2022|PDM|1200.00|99|0.00|DIAGNOSTIC TESTING
20|FH_F77585_0_0|SrvcGrp|43322|2022|PDM|100.00|99|0.00|INDIVIDUAL THERAPY
20|FH_F77597_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|AETNA OBSERVATION
20|FH_F77625_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F77625_0_0|SrvcGrp|42826|2022|PDM|90.00|99|0.00|PHYSICAL THERAPY VISIT
20|FH_F77625_0_0|SrvcGrp|42828|2022|PDM|90.00|99|0.00|SPEECH THERAPY VISIT
20|FH_F77662_0_0|SrvcGrp|42869|2022|PDM|65.00|99|0.00|PHYSICAL THERAPY VISIT
20|FH_F77663_0_0|SrvcGrp|9811|2022|PDM|300.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F77665_0_0|SrvcGrp|10518|2022|PDM|15.00|99|0.00|ENTEROSTOMAL VISIT F/U VISIT
20|FH_F77665_0_0|SrvcGrp|10542|2022|PDM|60.00|99|0.00|OCCUPATIONAL THERAPY SVCS
20|FH_F77665_0_0|SrvcGrp|10615|2022|PDM|55.00|99|0.00|HOME HEALTH AIDE
20|FH_F77665_0_0|SrvcGrp|10624|2022|PDM|50.00|99|0.00|CPT CODE 99347
20|FH_F77665_0_0|SrvcGrp|15477|2022|PDM|65.00|99|0.00|PHYSICAL THERAPY SVCS INITIAL EVAL
20|FH_F77665_0_0|SrvcGrp|15478|2022|PDM|65.00|99|0.00|OCCUPATIONAL THERAPY SVCS INITIAL EVAL
20|FH_F77665_0_0|SrvcGrp|27579|2022|PDM|65.00|99|0.00|RESPIRATORY THERAPY INITIAL VISIT
20|FH_F77665_0_0|SrvcGrp|29406|2022|PDM|15.00|99|0.00|PHYSICAL THERAPY
20|FH_F77665_0_0|SrvcGrp|74860|2022|PDM|6.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F77722_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F77762_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F77762_0_0|SrvcGrp|23683|2022|PDM|55.00|99|0.00|SKILLED NURSING RN
20|FH_F77762_0_0|SrvcGrp|27968|2022|PDM|55.00|99|0.00|SKILLED NURSING LPN
20|FH_F77763_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F77763_0_0|SrvcGrp|10542|2022|PDM|85.00|99|0.00|OCCUPATIONAL THERAPY SVCS
20|FH_F77763_0_0|SrvcGrp|3810|2022|PDM|105.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F77822_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F77822_0_0|SrvcGrp|473|2022|PDM|468.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F77862_0_0|SrvcGrp|45541|2022|PDM|99.17|99|0.00|SPEECH THERAPY
20|FH_F77883_0_0|SrvcGrp|74927|2022|PDM|206.66|99|0.00|SPEECH THERAPY
20|FH_F77883_0_0|SrvcGrp|74928|2022|PDM|217.42|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F77883_0_0|SrvcGrp|74931|2022|PDM|911.67|99|0.00|HOSPICE LEVEL 3
20|FH_F77883_0_0|SrvcGrp|74932|2022|PDM|818.03|99|0.00|HOSPICE
20|FH_F77903_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|COVENTRY ENHANCED GROUPER 5
20|FH_F77903_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|COVENTRY ENHANCED GROUPER 7
20|FH_F77903_0_0|SrvcGrp|14187|2022|PDM|2500.00|99|0.00|MRI
20|FH_F77903_0_0|SrvcGrp|220|2022|PCT|0.60|99|0.00|INTRAOCULAR LENSES
20|FH_F77903_0_0|SrvcGrp|3066|2022|PCT|0.60|99|0.00|HIGH-COST DRUGS
20|FH_F77923_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F77923_0_0|SrvcGrp|46633|2022|PDM|45.00|99|0.00|SPEECH THERAPY
20|FH_F77923_0_0|SrvcGrp|471|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F77923_0_0|SrvcGrp|472|2022|PDM|360.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F77925_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F77925_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.74|99|0.00|OP SVCS
20|FH_F77925_0_0|SrvcGrp|16|2022|PDM|4968.00|99|0.00|ACUTE REHABILITATION
20|FH_F77925_0_0|SrvcGrp|360|2022|PDM|5400.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F77943_0_0|SrvcGrp|11000|2022|PCT|0.55|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F77943_0_0|SrvcGrp|11336|2022|PCT|0.49|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F77943_0_0|SrvcGrp|28002|2022|PDM|28613.02|99|0.00|MS DRG 253-254 ONLY
20|FH_F77943_0_0|SrvcGrp|29817|2022|PDM|12392.15|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F77943_0_0|SrvcGrp|31038|2022|PDM|77263.16|99|0.00|MS DRG 233-234 ONLY
20|FH_F77943_0_0|SrvcGrp|33793|2022|PDM|30071.78|99|0.00|MSDRG 246-251 ONLY ANGIOPLASTY
20|FH_F77943_0_0|SrvcGrp|9522|2022|PDM|13846.75|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F77943_0_0|SrvcGrp|9984|2022|PCT|0.70|99|0.00|URGENT CARE
20|FH_F78003_0_0|SrvcGrp|473|2022|PDM|245.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F78009_0_0|SrvcGrp|30095|2022|PDM|45.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F78009_0_0|SrvcGrp|35964|2022|PDM|45.00|99|0.00|SPEECH THERAPY
20|FH_F78009_0_0|SrvcGrp|474|2022|PDM|245.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F78023_0_0|SrvcGrp|30094|2022|PDM|45.00|99|0.00|PHYSICAL THERAPY
20|FH_F78023_0_0|SrvcGrp|30095|2022|PDM|45.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F78048_0_0|SrvcGrp|472|2022|PDM|360.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F78048_0_0|SrvcGrp|473|2022|PDM|245.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F78048_0_0|SrvcGrp|474|2022|PDM|245.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F78167_0_0|SrvcGrp|30095|2022|PDM|45.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F78167_0_0|SrvcGrp|472|2022|PDM|360.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F78167_0_0|SrvcGrp|473|2022|PDM|245.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F78204_0_0|CSTM-ALL|CSTM-00|2020|PDM|492.54|99|0.00|ASPG III
20|FH_F78204_0_0|CSTM-ALL|CSTM-00|2020|PDM|608.96|99|0.00|ASPG IV
20|FH_F78204_0_0|CSTM-ALL|CSTM-00|2020|PDM|944.29|99|0.00|ASPG VIII
20|FH_F78243_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F78343_0_0|SrvcGrp|30095|2022|PDM|45.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F78343_0_0|SrvcGrp|474|2022|PDM|245.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F78363_0_0|SrvcGrp|68820|2022|PDM|700.00|99|0.00|SKILLED NURSING
20|FH_F78385_0_0|SrvcGrp|474|2022|PDM|245.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F78446_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE
20|FH_F78446_0_0|SrvcGrp|471|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F78446_0_0|SrvcGrp|473|2022|PDM|245.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F78447_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE
20|FH_F78447_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F78542_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F78603_0_0|SrvcGrp|20075|2022|PDM|19698.59|99|0.00|MS DRG 286 ONLY
20|FH_F78603_0_0|SrvcGrp|20898|2022|PDM|31355.80|99|0.00|MS DRG 246 ONLY
20|FH_F78603_0_0|SrvcGrp|21350|2022|PDM|10214.81|99|0.00|MS DRG 287 ONLY
20|FH_F78603_0_0|SrvcGrp|28167|2022|PDM|76163.07|99|0.00|MS DRG 231 ONLY
20|FH_F78603_0_0|SrvcGrp|29609|2022|PDM|55094.20|99|0.00|MS DRG 232 ONLY
20|FH_F78603_0_0|SrvcGrp|29757|2022|PDM|15978.95|99|0.00|MS DRG 251 ONLY
20|FH_F78603_0_0|SrvcGrp|3029|2022|PDM|738.69|99|0.00|NEWBORN NURSERY
20|FH_F78603_0_0|SrvcGrp|54973|2022|PDM|58795.27|99|0.00|MS DRG 225 ONLY
20|FH_F78603_0_0|SrvcGrp|54975|2022|PDM|62640.58|99|0.00|MS DRG 223 ONLY
20|FH_F78762_0_0|SrvcGrp|79678|2022|PCT|0.57|99|0.00|BURN SERVICES
20|FH_F78889_0_0|CSTM-ALL|CSTM-00|2020|PCT|81.00|99|0.00|OP SVCS
20|FH_F78893_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F78922_0_0|SrvcGrp|42870|2022|PDM|95.00|99|0.00|OCCUPATIONAL THERAPY VISIT
20|FH_F78922_0_0|SrvcGrp|42871|2022|PDM|95.00|99|0.00|SPEECH THERAPY VISIT
20|FH_F78922_0_0|SrvcGrp|76041|2022|PDM|400.00|99|0.00|DIALYSIS
20|FH_F78945_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F79003_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F79003_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F79025_0_0|SrvcGrp|33166|2022|PDM|750.00|99|0.00|SKILLED NURSING - LEVEL III
20|FH_F79102_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE
20|FH_F79212_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F79212_0_0|SrvcGrp|12403|2022|PDM|35.57|99|0.00|CONTINUOUS HOMECARE
20|FH_F79212_0_0|SrvcGrp|26001|2022|PDM|160.99|99|0.00|HOSPICE RESPITE SVCS
20|FH_F79245_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F79245_0_0|SrvcGrp|59427|2022|PDM|75.00|99|0.00|OT
20|FH_F79245_0_0|SrvcGrp|59428|2022|PDM|75.00|99|0.00|ST
20|FH_F79245_0_0|SrvcGrp|66480|2022|PDM|75.00|99|0.00|RN VISIT
20|FH_F79245_0_0|SrvcGrp|66482|2022|PDM|35.00|99|0.00|HOME HEALTH AID
20|FH_F79305_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS
20|FH_F79426_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F79427_0_0|CSTM-ALL|CSTM-00|2020|PDM|1055.00|99|0.00|ASPG X
20|FH_F79427_0_0|CSTM-ALL|CSTM-00|2020|PDM|1291.00|99|0.00|ASPG V
20|FH_F79427_0_0|CSTM-ALL|CSTM-00|2020|PDM|1526.00|99|0.00|ASPG VI
20|FH_F79427_0_0|CSTM-ALL|CSTM-00|2020|PDM|791.00|99|0.00|ASPG II
20|FH_F79427_0_0|CSTM-ALL|CSTM-00|2020|PDM|938.00|99|0.00|ASPG III
20|FH_F79429_0_0|CSTM-ALL|CSTM-00|2020|PDM|11.00|99|0.00|VACCINE ADMINISTRATION
20|FH_F79429_0_0|SrvcGrp|3809|2022|PDM|540.00|99|0.00|HOSPICE CARE
20|FH_F79429_0_0|SrvcGrp|59428|2022|PDM|75.00|99|0.00|ST
20|FH_F79429_0_0|SrvcGrp|66481|2022|PDM|75.00|99|0.00|SOCIAL WORKER
20|FH_F79485_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS
20|FH_F79525_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.20|99|0.00|OP SVCS
20|FH_F79551_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F79551_0_0|CSTM-ALL|CSTM-00|2020|PDM|415.00|99|0.00|AEG 1 (NO REV)
20|FH_F79551_0_0|CSTM-ALL|CSTM-00|2020|PDM|557.00|99|0.00|AEG 2 (NO REV)
20|FH_F79570_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|GENERAL ACUTE CARE
20|FH_F79584_0_0|CSTM-ALL|CSTM-00|2020|PDM|1172.00|99|0.00|COVENTRY ENHANCED GROUPER 8
20|FH_F79584_0_0|CSTM-ALL|CSTM-00|2020|PDM|1199.00|99|0.00|COVENTRY ENHANCED GROUPER 7
20|FH_F79584_0_0|CSTM-ALL|CSTM-00|2020|PDM|401.00|99|0.00|COVENTRY ENHANCED GROUPER 1
20|FH_F79584_0_0|CSTM-ALL|CSTM-00|2020|PDM|615.00|99|0.00|COVENTRY ENHANCED GROUPER 3
20|FH_F79623_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F79624_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F79625_0_0|SrvcGrp|471|2022|PDM|815.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F79625_0_0|SrvcGrp|473|2022|PDM|489.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F79625_0_0|SrvcGrp|76501|2022|PDM|435.00|99|0.00|SUB-ACUTE - LEVEL I
20|FH_F79704_0_0|SrvcGrp|76528|2022|PDM|32.61|99|0.00|HOSPICE LTCH
20|FH_F79763_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F79763_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F79763_0_0|SrvcGrp|59426|2022|PDM|90.00|99|0.00|PT
20|FH_F79763_0_0|SrvcGrp|59428|2022|PDM|90.00|99|0.00|ST
20|FH_F79927_0_0|SrvcGrp|46482|2022|PDM|147.00|99|0.00|S9083 PER VISIT
20|FH_F80024_0_0|CSTM-ALL|CSTM-00|2020|PCT|99.00|99|0.00|OP SVCS
20|FH_F80064_0_0|SrvcGrp|8950|2022|PDM|1730.00|99|0.00|INTERMEDIATE ICU/CCU
20|FH_F80084_0_0|SrvcGrp|12403|2022|PDM|33.01|99|0.00|CONTINUOUS HOMECARE
20|FH_F80102_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F80185_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F80185_0_0|SrvcGrp|44106|2022|PDM|48.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F80185_0_0|SrvcGrp|474|2022|PDM|210.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F80186_0_0|CSTM-ALL|CSTM-00|2020|PDM|407.00|99|0.00|AEG 1 (NO REV)
20|FH_F80186_0_0|CSTM-ALL|CSTM-00|2020|PDM|629.20|99|0.00|AEG 2 (NO REV)
20|FH_F80224_0_0|CSTM-ALL|CSTM-00|2020|PDM|1403.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F80224_0_0|CSTM-ALL|CSTM-00|2020|PDM|2623.00|99|0.00|ACUTE IP MED SVCS
20|FH_F80224_0_0|SrvcGrp|177|2022|PDM|3343.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F80224_0_0|SrvcGrp|29817|2022|PDM|4538.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F80224_0_0|SrvcGrp|30623|2022|PDM|4965.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788
20|FH_F80224_0_0|SrvcGrp|3443|2022|PCT|0.76|99|0.00|BARIATRIC SURGERY SERVICES
20|FH_F80224_0_0|SrvcGrp|4116|2022|PCT|1.00|99|0.00|AMBULANCE SERVICES
20|FH_F80224_0_0|SrvcGrp|64916|2022|PCT|0.76|99|0.00|MS DRG 927-929, 933-935 ONLY BURN SVCS
20|FH_F80224_0_0|SrvcGrp|762|2022|PCT|1.00|99|0.00|AIR AMBULANCE SVCS
20|FH_F80224_0_0|SrvcGrp|997|2022|PCT|0.76|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F80283_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F80283_0_0|SrvcGrp|22954|2022|PDM|209.81|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F80283_0_0|SrvcGrp|26001|2022|PDM|220.13|99|0.00|HOSPICE RESPITE SVCS
20|FH_F80283_0_0|SrvcGrp|3809|2022|PDM|938.18|99|0.00|HOSPICE CARE
20|FH_F80362_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE
20|FH_F80362_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS
20|FH_F80363_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F80455_0_0|CSTM-ALL|CSTM-00|2020|PDM|492.80|99|0.00|AEG 2 (NO REV)
20|FH_F80455_0_0|CSTM-ALL|CSTM-00|2020|PDM|563.20|99|0.00|AEG 3 (NO REV)
20|FH_F80455_0_0|SrvcGrp|78047|2022|PDM|291.50|99|0.00|AETNA VISION SERVICES
20|FH_F80511_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F80511_0_0|SrvcGrp|16429|2022|PCT|0.60|99|0.00|OBSERVATION SVCS
20|FH_F80511_0_0|SrvcGrp|3224|2022|PCT|0.60|99|0.00|EMERGENCY ROOM SVCS
20|FH_F80511_0_0|SrvcGrp|75639|2022|PDM|781.00|99|0.00|AETNA IP DETOX SERVICES
20|FH_F80511_0_0|SrvcGrp|78182|2022|PDM|1215.00|99|0.00|AETNA OP CAT SCAN
20|FH_F80511_0_0|SrvcGrp|78183|2022|PDM|1643.00|99|0.00|AETNA MRI
20|FH_F80513_0_0|SrvcGrp|20900|2022|PDM|22875.00|99|0.00|MS DRG 248 ONLY
20|FH_F80513_0_0|SrvcGrp|22106|2022|PDM|710.00|99|0.00|CAT SCAN
20|FH_F80513_0_0|SrvcGrp|27813|2022|PDM|11575.00|99|0.00|MS DRG 280 ONLY
20|FH_F80513_0_0|SrvcGrp|27817|2022|PDM|7346.00|99|0.00|MSDRG 282 ONLY CIRCULATORY DISORDERS W/O CC
20|FH_F80513_0_0|SrvcGrp|28120|2022|PDM|23066.00|99|0.00|MS DRG 467 ONLY
20|FH_F80513_0_0|SrvcGrp|30623|2022|PDM|6572.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788
20|FH_F80513_0_0|SrvcGrp|31017|2022|PDM|18603.00|99|0.00|MS DRG 468 ONLY
20|FH_F80513_0_0|SrvcGrp|360|2022|PDM|2003.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F80513_0_0|SrvcGrp|53150|2022|PDM|9127.00|99|0.00|MS DRG 065-066 ONLY
20|FH_F80513_0_0|SrvcGrp|9838|2022|PDM|1670.00|99|0.00|TRANSITIONAL CARE UNIT
20|FH_F80532_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F80535_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F80535_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F80537_0_0|SrvcGrp|61916|2022|PCT|0.74|99|0.00|OP SURGERY
20|FH_F80694_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F80731_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F80771_0_0|CSTM-ALL|CSTM-00|2020|PDM|1199.00|99|0.00|COVENTRY ENHANCED GROUPER 7
20|FH_F80771_0_0|CSTM-ALL|CSTM-00|2020|PDM|401.00|99|0.00|COVENTRY ENHANCED GROUPER 1
20|FH_F80771_0_0|CSTM-ALL|CSTM-00|2020|PDM|864.00|99|0.00|COVENTRY ENHANCED GROUPER 10
20|FH_F80771_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|COVENTRY ENHANCED GROUPER 6
20|FH_F80776_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F80814_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.77|99|0.00|GENERAL ACUTE CARE
20|FH_F80814_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.77|99|0.00|OP SVCS
20|FH_F80831_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|99|0.00|GENERAL ACUTE CARE
20|FH_F80855_0_0|SrvcGrp|26275|2022|PDM|2200.00|99|0.00|CPT 29826
20|FH_F80855_0_0|SrvcGrp|33986|2022|PDM|1100.00|99|0.00|CPT 26055
20|FH_F80855_0_0|SrvcGrp|65625|2022|PDM|1100.00|99|0.00|CPT 30520
20|FH_F80855_0_0|SrvcGrp|72990|2022|PDM|525.00|99|0.00|AEG 1
20|FH_F80855_0_0|SrvcGrp|72992|2022|PDM|700.00|99|0.00|AEG 2
20|FH_F80855_0_0|SrvcGrp|72994|2022|PDM|850.00|99|0.00|AEG 3
20|FH_F80855_0_0|SrvcGrp|76096|2022|PCT|0.00|99|0.00|AETNA CONTRAST AGENT
20|FH_F80855_0_0|SrvcGrp|78093|2022|PDM|1100.00|99|0.00|AETNA NASAL ENDOSCOPY SURG
20|FH_F81033_0_0|SrvcGrp|78665|2022|PDM|892.50|99|0.00|AETNA HYSTEROSCPY, SURGICAL
20|FH_F81033_0_0|SrvcGrp|78666|2022|PDM|892.50|99|0.00|AETNA MISSED ABORTION, ANY TRIMEST
20|FH_F81115_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F81152_0_0|SrvcGrp|33166|2022|PDM|472.50|99|0.00|SKILLED NURSING - LEVEL III
20|FH_F81152_0_0|SrvcGrp|471|2022|PDM|577.50|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F81172_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F81312_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F81312_0_0|SrvcGrp|12889|2022|PCT|0.65|99|0.00|RADIOLOGY
20|FH_F81312_0_0|SrvcGrp|29092|2022|PCT|1.00|99|0.00|AMBULANCE SVCS
20|FH_F81312_0_0|SrvcGrp|537|2022|PCT|0.65|99|0.00|OBSERVATION SERVICES
20|FH_F81312_0_0|SrvcGrp|59290|2022|PCT|1.00|99|0.00|DAY HOSPITAL HALF DAY
20|FH_F81313_0_0|SrvcGrp|33164|2022|PDM|250.00|99|0.00|SKILLED NURSING - LEVEL I
20|FH_F81377_0_0|CSTM-ALL|CSTM-00|2020|PDM|822.00|99|0.00|AEG 5  (NO REV)
20|FH_F81377_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 6 (NO REV)
20|FH_F81377_0_0|SrvcGrp|11663|2022|PCT|1.13|99|0.00|IMPLANTS
20|FH_F81377_0_0|SrvcGrp|70074|2022|PDM|2604.00|99|0.00|LAPAROSCOPY CPT 49651
20|FH_F81393_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F81393_0_0|CSTM-ALL|CSTM-00|2020|PDM|1021.65|99|0.00|AEG 8 (NO REV)
20|FH_F81393_0_0|CSTM-ALL|CSTM-00|2020|PDM|535.50|99|0.00|AEG 3 (NO REV)
20|FH_F81393_0_0|CSTM-ALL|CSTM-00|2020|PDM|752.85|99|0.00|AEG 5  (NO REV)
20|FH_F81456_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F81481_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F81494_0_0|CSTM-ALL|CSTM-00|2020|PDM|1229.00|99|0.00|HAPA-SEPA GRAND VIEW HOSPITAL 2013 MRI
20|FH_F81494_0_0|CSTM-ALL|CSTM-00|2020|PDM|2371.00|99|0.00|GENERAL ACUTE CARE
20|FH_F81494_0_0|SrvcGrp|16618|2022|PDM|136.00|99|0.00|ST SVCS
20|FH_F81494_0_0|SrvcGrp|26001|2022|PDM|186.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F81563_0_0|CSTM-ALL|CSTM-00|2020|PDM|731.26|99|0.00|AEG 2 (NO REV)
20|FH_F81656_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.50|99|0.00|GENERAL ACUTE CARE
20|FH_F81737_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.00|99|0.00|OP SVCS
20|FH_F81763_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.50|99|0.00|GENERAL ACUTE CARE
20|FH_F81771_0_0|SrvcGrp|22954|2022|PDM|120.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F81771_0_0|SrvcGrp|26001|2022|PDM|125.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F81823_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F81823_0_0|SrvcGrp|3066|2022|PDM|20.59|99|0.00|HIGH-COST DRUGS
20|FH_F81823_0_0|SrvcGrp|3809|2022|PDM|540.00|99|0.00|HOSPICE CARE
20|FH_F81823_0_0|SrvcGrp|59427|2022|PDM|75.00|99|0.00|OT
20|FH_F81835_0_0|SrvcGrp|74664|2022|PDM|658.54|99|0.00|AETNA SLEEP STUDIES
20|FH_F81835_0_0|SrvcGrp|75327|2022|PDM|163.33|99|0.00|SLEEP STUDY CPT 95806
20|FH_F81853_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F82033_0_0|CSTM-ALL|CSTM-00|2020|PDM|2625.00|99|0.00|AEG 8 (NO REV)
20|FH_F82033_0_0|CSTM-ALL|CSTM-00|2020|PDM|5250.00|99|0.00|AEG 9 (NO REV)
20|FH_F82033_0_0|CSTM-ALL|CSTM-00|2020|PDM|840.00|99|0.00|AEG 1 (NO REV)
20|FH_F82114_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F82114_0_0|SrvcGrp|74662|2022|PDM|533.50|99|0.00|AETNA SLEEP STUDIES
20|FH_F82114_0_0|SrvcGrp|74664|2022|PDM|696.94|99|0.00|AETNA SLEEP STUDIES
20|FH_F82136_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|OP SVCS
20|FH_F82197_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F82215_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE
20|FH_F82234_0_0|SrvcGrp|9263|2022|PDM|152.03|99|0.00|HOSPICE RESPITE SVCS
20|FH_F82235_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F82235_0_0|SrvcGrp|72996|2022|PDM|693.00|99|0.00|AEG 4
20|FH_F82235_0_0|SrvcGrp|73004|2022|PDM|1070.30|99|0.00|AEG 8
20|FH_F82235_0_0|SrvcGrp|73006|2022|PDM|1472.90|99|0.00|AEG 9
20|FH_F82235_0_0|SrvcGrp|79937|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F82379_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F82380_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F82432_0_0|SrvcGrp|30609|2022|PDM|24.15|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F82452_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F82571_0_0|CSTM-ALL|CSTM-00|2020|PDM|546.00|99|0.00|OP SVCS
20|FH_F82571_0_0|CSTM-ALL|CSTM-00|2020|PDM|767.00|99|0.00|COVENTRY ENHANCED GROUPER 5
20|FH_F82591_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F82591_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F82591_0_0|SrvcGrp|75479|2022|PDM|1102.50|99|0.00|AEG 1
20|FH_F82671_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F82671_0_0|CSTM-ALL|CSTM-00|2020|PDM|456.00|99|0.00|COVENTRY ENHANCED GROUPER 1
20|FH_F82671_0_0|SrvcGrp|66563|2022|PDM|1362.00|99|0.00|COVENTRY ENHANCED DEFAULT 10021-69990 WITH REV CODE
20|FH_F82771_0_0|CSTM-ALL|CSTM-00|2020|PDM|1680.00|99|0.00|AEG 3 (NO REV)
20|FH_F82771_0_0|CSTM-ALL|CSTM-00|2020|PDM|2205.00|99|0.00|AEG 7 (NO REV)
20|FH_F82771_0_0|CSTM-ALL|CSTM-00|2020|PDM|2310.00|99|0.00|AEG 8 (NO REV)
20|FH_F82771_0_0|SrvcGrp|11306|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F82771_0_0|SrvcGrp|36591|2022|PDM|1575.00|99|0.00|CPT 63685
20|FH_F82779_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F82779_0_0|CSTM-ALL|CSTM-00|2020|PDM|1424.00|99|0.00|COVENTRY ENHANCED GROUPER 9
20|FH_F82779_0_0|CSTM-ALL|CSTM-00|2020|PDM|375.00|99|0.00|COVENTRY ENHANCED GROUPER 1
20|FH_F82779_0_0|CSTM-ALL|CSTM-00|2020|PDM|542.00|99|0.00|COVENTRY ENHANCED GROUPER 3
20|FH_F82779_0_0|CSTM-ALL|CSTM-00|2020|PDM|762.00|99|0.00|COVENTRY ENHANCED GROUPER 5
20|FH_F82813_0_0|SrvcGrp|72996|2022|PDM|989.00|99|0.00|AEG 4
20|FH_F82813_0_0|SrvcGrp|73002|2022|PDM|1403.00|99|0.00|AEG 7
20|FH_F82813_0_0|SrvcGrp|73004|2022|PDM|1548.00|99|0.00|AEG 8
20|FH_F82813_0_0|SrvcGrp|73006|2022|PDM|2026.00|99|0.00|AEG 9
20|FH_F82813_0_0|SrvcGrp|73008|2022|PDM|694.00|99|0.00|AEG 10
20|FH_F82813_0_0|SrvcGrp|79937|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F82894_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F82973_0_0|CSTM-ALL|CSTM-00|2020|PDM|523.00|99|0.00|AEG 10 (NO REV)
20|FH_F82973_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F83035_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F83053_0_0|SrvcGrp|73000|2022|PDM|5566.00|99|0.00|AEG 6
20|FH_F83074_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F83074_0_0|SrvcGrp|81023|2022|PDM|225.00|99|0.00|AETNA CAPD CCPD IPD DIALYSIS PROC
20|FH_F83152_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F83294_0_0|SrvcGrp|42973|2022|PDM|85.00|99|0.00|SPEECH  THERAPIST
20|FH_F83294_0_0|SrvcGrp|42975|2022|PDM|85.00|99|0.00|PHYSICAL THERAPIST
20|FH_F83451_0_0|SrvcGrp|10986|2022|PDM|2000.00|99|0.00|ARTHROSCOPIC KNEE REPAIR
20|FH_F83451_0_0|SrvcGrp|78096|2022|PDM|1300.00|99|0.00|AETNA ARTHROSCOPY BICEPS
20|FH_F83451_0_0|SrvcGrp|81560|2022|PDM|1575.00|99|0.00|STAPECTOMY AND/OR REVISION
20|FH_F83451_0_0|SrvcGrp|81564|2022|PDM|1625.00|99|0.00|ARTHROSCOPY HIP
20|FH_F83451_0_0|SrvcGrp|81566|2022|PDM|1575.00|99|0.00|ALLOGRAFT FOR SPINE SURGERY
20|FH_F83451_0_0|SrvcGrp|81569|2022|PDM|2415.00|99|0.00|SURGICAL SPINE PROCEDURES
20|FH_F83451_0_0|SrvcGrp|81598|2022|PDM|1575.00|99|0.00|ARTHOSCOPY KNEE
20|FH_F83472_0_0|CSTM-ALL|CSTM-00|2020|PDM|1049.43|99|0.00|AEG 7 (NO REV)
20|FH_F83472_0_0|CSTM-ALL|CSTM-00|2020|PDM|351.21|99|0.00|AEG 1 (NO REV)
20|FH_F83472_0_0|CSTM-ALL|CSTM-00|2020|PDM|537.89|99|0.00|AEG 3 (NO REV)
20|FH_F83534_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F83621_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F83621_0_0|CSTM-ALL|CSTM-00|2020|PDM|2578.00|99|0.00|AEG 6 (NO REV)
20|FH_F83621_0_0|SrvcGrp|77260|2022|PDM|3200.00|99|0.00|AETNA CARDIAC CATHERTERIZATION
20|FH_F83672_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F83754_0_0|SrvcGrp|113016|2022|PDM|1226.00|99|0.00|NORMAL NEWBORN VIA NORMAL DELIVERY
20|FH_F83754_0_0|SrvcGrp|113017|2022|PDM|1318.00|99|0.00|NORMAL NEWBORN VIA C-SECTION
20|FH_F83754_0_0|SrvcGrp|13131|2022|PDM|4006.00|99|0.00|OBSERVATION SVCS
20|FH_F83754_0_0|SrvcGrp|20272|2022|PCT|0.81|99|0.00|MS DRG 219-221 ONLY CARDIAC VLV PROC W/O CA CAT
20|FH_F83754_0_0|SrvcGrp|22812|2022|PDM|12920.00|99|0.00|ENDOSCOPY
20|FH_F83754_0_0|SrvcGrp|22819|2022|PCT|0.86|99|0.00|PTCA
20|FH_F83754_0_0|SrvcGrp|29817|2022|PDM|3678.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F83754_0_0|SrvcGrp|30504|2022|PCT|0.86|99|0.00|CCPD TRAINING
20|FH_F83754_0_0|SrvcGrp|31038|2022|PCT|0.81|99|0.00|MS DRG 233-234 ONLY
20|FH_F83754_0_0|SrvcGrp|3418|2022|PDM|6138.00|99|0.00|NEONATAL INTENSIVE CARE UNIT
20|FH_F83754_0_0|SrvcGrp|37260|2022|PDM|15503.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F83754_0_0|SrvcGrp|919|2022|PDM|12920.00|99|0.00|OP URGENT CARE
20|FH_F83772_0_0|CSTM-ALL|CSTM-00|2020|PCT|59.28|99|0.00|OP SVCS
20|FH_F83792_0_0|SrvcGrp|73461|2022|PDM|1575.00|99|0.00|AETNA NICU IV
20|FH_F83792_0_0|SrvcGrp|73483|2022|PDM|683.00|99|0.00|AETNA SUBACUTE III
20|FH_F83792_0_0|SrvcGrp|73559|2022|PDM|1837.00|99|0.00|AETNA INTENSIVE CARE
20|FH_F83792_0_0|SrvcGrp|73606|2022|PDM|683.00|99|0.00|AETNA SKILLED NURSING CARE
20|FH_F83871_0_0|CSTM-ALL|CSTM-00|2020|PDM|606.00|99|0.00|AEG 2 (NO REV)
20|FH_F83920_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F83920_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F83937_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS
20|FH_F84032_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F84057_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F84058_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F84058_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F84058_0_0|SrvcGrp|82447|2022|PDM|276.23|99|0.00|AMBULANCE SVC ADV LIFE SUPPORT NON-EMER
20|FH_F84058_0_0|SrvcGrp|82449|2022|PDM|368.31|99|0.00|AMBULANCE SVC BASIC LIFE SUPPT EMER
20|FH_F84058_0_0|SrvcGrp|82451|2022|PDM|748.14|99|0.00|SPECIALTY CARE TRANSPORT
20|FH_F84058_0_0|SrvcGrp|82452|2022|PDM|210.05|99|0.00|AMBULANCE SVC NEONATAL EMERG TRANSPORT
20|FH_F84091_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.20|99|0.00|GENERAL ACUTE CARE
20|FH_F84135_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F84175_0_0|SrvcGrp|471|2022|PDM|703.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F84175_0_0|SrvcGrp|472|2022|PDM|703.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F84175_0_0|SrvcGrp|75545|2022|PDM|703.00|99|0.00|SUB-ACUTE - LEVEL I AND II
20|FH_F84193_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F84215_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F84215_0_0|SrvcGrp|26275|2022|PDM|1623.00|99|0.00|CPT 29826
20|FH_F84215_0_0|SrvcGrp|26278|2022|PDM|1181.00|99|0.00|CPT 29881
20|FH_F84215_0_0|SrvcGrp|72996|2022|PDM|767.00|99|0.00|AEG 4
20|FH_F84215_0_0|SrvcGrp|73004|2022|PDM|1181.00|99|0.00|AEG 8
20|FH_F84215_0_0|SrvcGrp|77452|2022|PDM|2750.00|99|0.00|CPT 54405
20|FH_F84413_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F84433_0_0|SrvcGrp|44885|2022|PDM|93.36|99|0.00|PHYSICAL THERAPY SVCS RE-EVAL PER VISIT
20|FH_F84446_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCES
20|FH_F84450_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCES
20|FH_F84450_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F84454_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCES
20|FH_F84454_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F84532_0_0|CSTM-ALL|CSTM-00|2020|PDM|5374.00|99|0.00|FRAGMENTING KIDNEY STONE PARTIAL TREATMENT
20|FH_F84532_0_0|SrvcGrp|12491|2022|PCT|0.31|99|0.00|PACEMAKER
20|FH_F84532_0_0|SrvcGrp|13187|2022|PCT|0.31|99|0.00|INTRAOCULAR LENSES
20|FH_F84532_0_0|SrvcGrp|42550|2022|PDM|3694.00|99|0.00|OP SURGERY CPT 66984
20|FH_F84532_0_0|SrvcGrp|73000|2022|PDM|2017.00|99|0.00|AEG 6
20|FH_F84532_0_0|SrvcGrp|73002|2022|PDM|2758.00|99|0.00|AEG 7
20|FH_F84532_0_0|SrvcGrp|82810|2022|PDM|2687.00|99|0.00|SURGICAL CARVEOUTS
20|FH_F84556_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE
20|FH_F84655_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F84672_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F84676_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F84676_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F84712_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F84712_0_0|SrvcGrp|14614|2022|PDM|6938.00|99|0.00|LITHOTRIPSY
20|FH_F84712_0_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS
20|FH_F84712_0_0|SrvcGrp|72994|2022|PDM|2523.00|99|0.00|AEG 3
20|FH_F84712_0_0|SrvcGrp|73002|2022|PDM|4920.00|99|0.00|AEG 7
20|FH_F84712_0_0|SrvcGrp|73463|2022|PDM|2208.00|99|0.00|AETNA NICU II
20|FH_F84712_0_0|SrvcGrp|73501|2022|PDM|1980.00|99|0.00|AETNA OBSERVATION
20|FH_F84712_0_0|SrvcGrp|73605|2022|PDM|695.00|99|0.00|AETNA ACUTE PSYCH
20|FH_F84712_0_0|SrvcGrp|73610|2022|PCT|0.63|99|0.00|AETNA IMPLANTS
20|FH_F84712_0_0|SrvcGrp|73659|2022|PDM|2082.00|99|0.00|AETNA MED & SURG SVCS
20|FH_F84712_0_0|SrvcGrp|74581|2022|PCT|0.33|99|0.00|AETNA IP HIGH COST DRUGS
20|FH_F84712_0_0|SrvcGrp|78180|2022|PDM|473.00|99|0.00|AETNA RESIDENTIAL TREATMENT
20|FH_F84712_0_0|SrvcGrp|79298|2022|PDM|59.00|99|0.00|AETNA X-RAY (CPT 77055)
20|FH_F84712_0_0|SrvcGrp|81341|2022|PCT|0.63|99|0.00|AETNA CHEMOTHERAPY DRUGS
20|FH_F84712_0_0|SrvcGrp|81405|2022|PDM|15.00|99|0.00|URINALYSIS W/ MICROSCPY
20|FH_F84712_0_0|SrvcGrp|82737|2022|PDM|34.00|99|0.00|URINALYSIS
20|FH_F84712_0_0|SrvcGrp|82739|2022|PDM|33.00|99|0.00|LIPID PROFILE
20|FH_F84712_0_0|SrvcGrp|82740|2022|PDM|203.00|99|0.00|US EXAM PG UTERUS COMPL
20|FH_F84712_0_0|SrvcGrp|82749|2022|PDM|50.00|99|0.00|AUTOMAT HEMOGRAM COMPLET DIF
20|FH_F84712_0_0|SrvcGrp|82756|2022|PDM|65.00|99|0.00|ASSAY BLOOD LIPASE
20|FH_F84712_0_0|SrvcGrp|82760|2022|PDM|64.00|99|0.00|ASSAY OF SERUM AMYLASE
20|FH_F84712_0_0|SrvcGrp|82765|2022|PDM|54.00|99|0.00|ELECTROLYTE PANEL
20|FH_F84712_0_0|SrvcGrp|82884|2022|PDM|695.00|99|0.00|AETNA IP/OP BH OBSERVATION (BHOBSALL)
20|FH_F84712_0_0|SrvcGrp|84439|2022|PDM|3154.00|99|0.00|AETNA MATERNITY CARE (NORMAL DELIVERY)
20|FH_F84755_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F84755_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F84755_0_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS
20|FH_F84778_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F84778_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F84778_0_0|SrvcGrp|72994|2022|PDM|1733.00|99|0.00|AEG 3
20|FH_F84778_0_0|SrvcGrp|73008|2022|PDM|1050.00|99|0.00|AEG 10
20|FH_F84778_0_0|SrvcGrp|78448|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F84816_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.70|99|0.00|OP SVCS
20|FH_F84855_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F84855_0_0|CSTM-ALL|CSTM-00|2020|PDM|2197.00|99|0.00|COVENTRY ENHANCED GROUPER 7
20|FH_F84855_0_0|SrvcGrp|30401|2022|PCT|1.10|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F84893_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F84894_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.00|99|0.00|OP SVCS
20|FH_F84912_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F84912_0_0|SrvcGrp|83179|2022|PDM|21.28|99|0.00|CEPHALOGRAM ORTHODONTIC
20|FH_F84932_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.20|99|0.00|GENERAL ACUTE CARE
20|FH_F84932_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.20|99|0.00|OP SVCS
20|FH_F85014_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F85039_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F85039_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F85039_0_0|SrvcGrp|75479|2022|PDM|366.00|99|0.00|AEG 1
20|FH_F85039_0_0|SrvcGrp|75493|2022|PDM|1070.00|99|0.00|AEG 8
20|FH_F85039_0_0|SrvcGrp|79937|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F85055_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F85055_0_0|SrvcGrp|11663|2022|PCT|0.55|99|0.00|IMPLANTS
20|FH_F85055_0_0|SrvcGrp|73006|2022|PDM|1050.00|99|0.00|AEG 9
20|FH_F85055_0_0|SrvcGrp|76579|2022|PCT|1.00|99|0.00|IMPLANTS W/ HCPC
20|FH_F85115_0_0|SrvcGrp|16526|2022|PDM|169.05|99|0.00|DIALYSIS
20|FH_F85132_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F85135_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F85211_0_0|CSTM-ALL|CSTM-00|2020|PDM|1320.00|99|0.00|REMOVAL OF TISSUE FOR GRAFT
20|FH_F85211_0_0|SrvcGrp|11663|2022|PCT|1.03|99|0.00|IMPLANTS
20|FH_F85211_0_0|SrvcGrp|72990|2022|PDM|456.50|99|0.00|AEG 1
20|FH_F85211_0_0|SrvcGrp|72994|2022|PDM|699.60|99|0.00|AEG 3
20|FH_F85211_0_0|SrvcGrp|73002|2022|PDM|1366.20|99|0.00|AEG 7
20|FH_F85211_0_0|SrvcGrp|73008|2022|PDM|808.50|99|0.00|AEG 10
20|FH_F85211_0_0|SrvcGrp|78448|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F85211_0_0|SrvcGrp|83624|2022|PDM|3300.00|99|0.00|REPAIR BICEPS TENDON RUPTURE
20|FH_F85211_0_0|SrvcGrp|83626|2022|PDM|2310.00|99|0.00|ORTHO SHOULDER PROCEDURES
20|FH_F85295_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|AEG 7 (NO REV)
20|FH_F85295_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F85314_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F85314_0_0|CSTM-ALL|CSTM-00|2020|PDM|640.00|99|0.00|AEG 2 (NO REV)
20|FH_F85314_0_0|SrvcGrp|83901|2022|PDM|640.00|99|0.00|AETNA COLONSCOPY
20|FH_F85393_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F85393_0_0|SrvcGrp|42973|2022|PDM|75.00|99|0.00|SPEECH  THERAPIST
20|FH_F85393_0_0|SrvcGrp|88620|2022|PDM|75.00|99|0.00|SKILLED NURSING RN
20|FH_F85475_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F85475_0_0|SrvcGrp|46482|2022|PDM|143.00|99|0.00|S9083 PER VISIT
20|FH_F85655_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.79|99|0.00|GENERAL ACUTE CARE
20|FH_F85674_0_0|CSTM-ALL|CSTM-00|2020|PDM|128.65|99|0.00|AETNA SLEEP STUDIES
20|FH_F85674_0_0|CSTM-ALL|CSTM-00|2020|PDM|156.60|99|0.00|AETNA POLYSOMNOGRAPHY (MOD 26)
20|FH_F85674_0_0|CSTM-ALL|CSTM-00|2020|PDM|422.87|99|0.00|AETNA POLYSOMNOGRAPHY
20|FH_F85674_0_0|CSTM-ALL|CSTM-00|2020|PDM|69.55|99|0.00|AETNA SLEEP STUDY (MOD 26)
20|FH_F85674_0_0|CSTM-ALL|CSTM-00|2020|PDM|696.94|99|0.00|AETNA SLEEP STUDY CPT 95811
20|FH_F85713_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F85753_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F85753_0_0|SrvcGrp|14412|2022|PDM|585.23|99|0.00|HOSPICE CARE
20|FH_F85753_0_0|SrvcGrp|57968|2022|PDM|31.90|99|0.00|CONTINUOUS HOMECARE
20|FH_F85753_0_0|SrvcGrp|80285|2022|PDM|131.17|99|0.00|HOSPICE ROUTINE HOME CARE
20|FH_F85753_0_0|SrvcGrp|9263|2022|PDM|136.94|99|0.00|HOSPICE RESPITE SVCS
20|FH_F85757_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F85772_0_0|CSTM-ALL|CSTM-00|2020|PDM|586.00|99|0.00|AEG 1 (NO REV)
20|FH_F85772_0_0|CSTM-ALL|CSTM-00|2020|PDM|783.00|99|0.00|AEG 2 (NO REV)
20|FH_F85911_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.50|99|0.00|OP SVCS
20|FH_F86011_0_0|CSTM-ALL|CSTM-00|2020|PCT|86.50|99|0.00|OP SVCS
20|FH_F86137_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SURGERY
20|FH_F86293_0_0|CSTM-ALL|CSTM-00|2020|PDM|1470.00|99|0.00|AEG 4 (NO REV)
20|FH_F86293_0_0|CSTM-ALL|CSTM-00|2020|PDM|1656.00|99|0.00|AEG 6 (NO REV)
20|FH_F86293_0_0|CSTM-ALL|CSTM-00|2020|PDM|2208.00|99|0.00|AEG 7 (NO REV)
20|FH_F86293_0_0|CSTM-ALL|CSTM-00|2020|PDM|929.00|99|0.00|AEG 2 (NO REV)
20|FH_F86293_0_0|CSTM-ALL|CSTM-00|2020|PDM|943.00|99|0.00|AEG 10 (NO REV)
20|FH_F86293_0_0|SrvcGrp|82112|2022|PDM|2714.00|99|0.00|KNEE ARTHROSCOPY SURGERY
20|FH_F86294_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F86294_0_0|CSTM-ALL|CSTM-00|2020|PDM|1040.00|99|0.00|2006 MEDICARE ASPG V
20|FH_F86294_0_0|CSTM-ALL|CSTM-00|2020|PDM|942.00|99|0.00|2006 MEDICARE ASPG IV
20|FH_F86315_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F86315_0_0|CSTM-ALL|CSTM-00|2020|PDM|446.00|99|0.00|COVENTRY ENHANCED GROUPER 2
20|FH_F86315_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|COVENTRY ENHANCED GROUPER 3
20|FH_F86375_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F86375_0_0|SrvcGrp|80920|2022|PDM|504.00|99|0.00|HOSPICE SERVICES
20|FH_F86377_0_0|SrvcGrp|26001|2022|PDM|126.33|99|0.00|HOSPICE RESPITE SVCS
20|FH_F86434_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|AEG 10 (NO REV)
20|FH_F86434_0_0|CSTM-ALL|CSTM-00|2020|PDM|2400.00|99|0.00|AEG 8 (NO REV)
20|FH_F86434_0_0|CSTM-ALL|CSTM-00|2020|PDM|2600.00|99|0.00|AEG 9 (NO REV)
20|FH_F86434_0_0|SrvcGrp|35669|2022|PDM|6000.00|99|0.00|CPT 63650
20|FH_F86434_0_0|SrvcGrp|35670|2022|PDM|7500.00|99|0.00|SPINAL NEUROSTIMULATORS PROCEDURE
20|FH_F86435_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F86452_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.66|99|0.00|OP SVCS
20|FH_F86452_0_0|CSTM-ALL|CSTM-00|2020|PDM|1101.00|99|0.00|2007 MEDICARE ASPG X
20|FH_F86452_0_0|CSTM-ALL|CSTM-00|2020|PDM|583.00|99|0.00|2007 MEDICARE ASPG I
20|FH_F86452_0_0|CSTM-ALL|CSTM-00|2020|PDM|781.00|99|0.00|2007 MEDICARE ASPG II
20|FH_F86552_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|AEG 4 (NO REV)
20|FH_F86552_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 5  (NO REV)
20|FH_F86552_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 1 (NO REV)
20|FH_F86655_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F86655_0_0|CSTM-ALL|CSTM-00|2020|PDM|666.51|99|0.00|AEG 3 (NO REV)
20|FH_F86655_0_0|CSTM-ALL|CSTM-00|2020|PDM|740.56|99|0.00|AEG 10 (NO REV)
20|FH_F86658_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F86660_0_0|CSTM-ALL|CSTM-00|2020|PDM|1155.00|99|0.00|COVENTRY ENHANCED GROUPER 1
20|FH_F86660_0_0|CSTM-ALL|CSTM-00|2020|PDM|1519.00|99|0.00|COVENTRY ENHANCED GROUPER 2
20|FH_F86660_0_0|CSTM-ALL|CSTM-00|2020|PDM|2147.00|99|0.00|COVENTRY ENHANCED GROUPER 4
20|FH_F86660_0_0|CSTM-ALL|CSTM-00|2020|PDM|3014.00|99|0.00|COVENTRY ENHANCED GROUPER 8
20|FH_F86660_0_0|SrvcGrp|705|2022|PCT|0.55|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F86717_0_0|CSTM-ALL|CSTM-00|2020|PDM|589.94|99|0.00|AEG 1 (NO REV)
20|FH_F86752_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F86752_0_0|SrvcGrp|75485|2022|PDM|821.00|99|0.00|AEG 4
20|FH_F86752_0_0|SrvcGrp|75487|2022|PDM|932.00|99|0.00|AEG 5
20|FH_F86752_0_0|SrvcGrp|75491|2022|PDM|1283.00|99|0.00|AEG 7
20|FH_F86815_0_0|CSTM-ALL|CSTM-00|2020|PDM|1340.00|99|0.00|AEG 8 (NO REV)
20|FH_F86815_0_0|CSTM-ALL|CSTM-00|2020|PDM|1375.00|99|0.00|AEG 7 (NO REV)
20|FH_F86815_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|AEG 9 (NO REV)
20|FH_F86815_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 3 (NO REV)
20|FH_F86815_0_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS
20|FH_F86815_0_0|SrvcGrp|79937|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F86836_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F86836_0_0|SrvcGrp|3259|2022|PDM|3200.00|99|0.00|ACUTE REHABILITATION
20|FH_F86914_19605_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F86953_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F87012_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F87012_0_0|SrvcGrp|73002|2022|PDM|1696.72|99|0.00|AEG 7
20|FH_F87012_0_0|SrvcGrp|73006|2022|PDM|2283.46|99|0.00|AEG 9
20|FH_F87012_0_0|SrvcGrp|85637|2022|PDM|1362.31|99|0.00|ESOPHAGOGASTRODUODENOSCOPY
20|FH_F87031_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F87031_0_0|SrvcGrp|72994|2022|PDM|795.00|99|0.00|AEG 3
20|FH_F87031_0_0|SrvcGrp|73002|2022|PDM|1551.00|99|0.00|AEG 7
20|FH_F87053_0_0|SrvcGrp|24714|2022|PCT|1.00|99|0.00|INTRAOCULAR LENS
20|FH_F87053_0_0|SrvcGrp|72992|2022|PDM|727.00|99|0.00|AEG 2
20|FH_F87053_0_0|SrvcGrp|73000|2022|PDM|1320.00|99|0.00|AEG 6
20|FH_F87053_0_0|SrvcGrp|73006|2022|PDM|2152.00|99|0.00|AEG 9
20|FH_F87053_0_0|SrvcGrp|75182|2022|PCT|1.00|99|0.00|AETNA IMPLANTS
20|FH_F87054_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F87054_0_0|CSTM-ALL|CSTM-00|2020|PDM|2100.00|99|0.00|DEVICE INSERTION
20|FH_F87054_0_0|SrvcGrp|46890|2022|PDM|2205.00|99|0.00|IMPLANT EYE SHUNT
20|FH_F87054_0_0|SrvcGrp|72990|2022|PDM|604.00|99|0.00|AEG 1
20|FH_F87054_0_0|SrvcGrp|73000|2022|PDM|1301.00|99|0.00|AEG 6
20|FH_F87054_0_0|SrvcGrp|73004|2022|PDM|1568.00|99|0.00|AEG 8
20|FH_F87054_0_0|SrvcGrp|83960|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F87054_0_0|SrvcGrp|84934|2022|PDM|1260.00|99|0.00|REMOVAL OF EYE LESION
20|FH_F87114_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.30|99|0.00|GENERAL ACUTE CARE
20|FH_F87117_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F87152_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F87219_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F87219_0_0|CSTM-ALL|CSTM-00|2020|PDM|147.82|99|0.00|AETNA SLEEP STUDIES
20|FH_F87219_0_0|CSTM-ALL|CSTM-00|2020|PDM|150.20|99|0.00|AETNA POLYSOMNOGRAPHY (MOD 26)
20|FH_F87219_0_0|CSTM-ALL|CSTM-00|2020|PDM|53.58|99|0.00|AETNA SLEEP STUDIES (MOD TC)
20|FH_F87219_0_0|CSTM-ALL|CSTM-00|2020|PDM|610.62|99|0.00|AETNA POLYSOMNOGRAPHY
20|FH_F87219_0_0|CSTM-ALL|CSTM-00|2020|PDM|642.53|99|0.00|AETNA POLYSOMNOGRAPHY
20|FH_F87219_0_0|SrvcGrp|83884|2022|PDM|107.13|99|0.00|AETNA POLYSOMNOGRAPHY (MOD 26)
20|FH_F87254_0_0|SrvcGrp|104611|2022|PDM|662.00|99|0.00|REMOVAL OF SKIN LESION
20|FH_F87254_0_0|SrvcGrp|104612|2022|PDM|1000.00|99|0.00|EXC FOOT/TOE TUM SC > 1.5 CM
20|FH_F87254_0_0|SrvcGrp|104615|2022|PDM|1000.00|99|0.00|EXC RECT TUM TRANSANAL PART
20|FH_F87254_0_0|SrvcGrp|104616|2022|PDM|1400.00|99|0.00|REPAIR OF RECTOCELE
20|FH_F87254_0_0|SrvcGrp|104619|2022|PDM|1445.00|99|0.00|REPAIR OF VAGINA
20|FH_F87254_0_0|SrvcGrp|27402|2022|PDM|1100.00|99|0.00|LASER PROCEDURES
20|FH_F87254_0_0|SrvcGrp|44068|2022|PDM|1100.00|99|0.00|CPT 52332
20|FH_F87254_0_0|SrvcGrp|63462|2022|PDM|1000.00|99|0.00|CPT 64595
20|FH_F87254_0_0|SrvcGrp|63467|2022|PDM|1000.00|99|0.00|CPT 64585
20|FH_F87254_0_0|SrvcGrp|72994|2022|PDM|819.00|99|0.00|AEG 3
20|FH_F87254_0_0|SrvcGrp|72996|2022|PDM|874.00|99|0.00|AEG 4
20|FH_F87254_0_0|SrvcGrp|73006|2022|PDM|2800.00|99|0.00|AEG 9
20|FH_F87272_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F87333_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F87333_0_0|SrvcGrp|72992|2022|PDM|788.75|99|0.00|AEG 2
20|FH_F87333_0_0|SrvcGrp|72998|2022|PDM|1817.64|99|0.00|AEG 5
20|FH_F87333_0_0|SrvcGrp|73000|2022|PDM|1332.94|99|0.00|AEG 6
20|FH_F87411_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F87411_0_0|CSTM-ALL|CSTM-00|2020|PDM|137.37|99|0.00|AETNA SLEEP STUDY (MOD 26)
20|FH_F87411_0_0|CSTM-ALL|CSTM-00|2020|PDM|374.80|99|0.00|SLEEP STUDY CPT 95807 W/O MOD 26 7 TC
20|FH_F87411_0_0|CSTM-ALL|CSTM-00|2020|PDM|428.49|99|0.00|AETNA POLYSOMNOGRAPHY
20|FH_F87411_0_0|CSTM-ALL|CSTM-00|2020|PDM|597.08|99|0.00|AETNA POLYSOMNOGRAPHY
20|FH_F87411_0_0|CSTM-ALL|CSTM-00|2020|PDM|81.00|99|0.00|AETNA SLEEP STUDY CPT 95801
20|FH_F87411_0_0|CSTM-ALL|CSTM-00|2020|PDM|915.23|99|0.00|POLYSOMNOGRAPHY W/O MOD 26 & TC
20|FH_F87411_0_0|CSTM-ALL|CSTM-00|2020|PDM|94.68|99|0.00|AETNA SLEEP STUDIES
20|FH_F87411_0_0|SrvcGrp|85677|2022|PDM|749.30|99|0.00|POLYSOM (MOD TC)
20|FH_F87411_0_0|SrvcGrp|85681|2022|PDM|309.00|99|0.00|SLEEP STUDY (MOD TC)
20|FH_F87411_0_0|SrvcGrp|85685|2022|PDM|65.80|99|0.00|SLEEP STUDY (MOD 26)
20|FH_F87432_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F87480_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|AEG 10 (NO REV)
20|FH_F87480_0_0|CSTM-ALL|CSTM-00|2020|PDM|789.00|99|0.00|AEG 5  (NO REV)
20|FH_F87480_0_0|SrvcGrp|78713|2022|PDM|2500.00|99|0.00|AETNA SPINAL STIMULATOR
20|FH_F87480_0_0|SrvcGrp|82720|2022|PDM|1500.00|99|0.00|WRIST ENDOSCOPY/SURGERY
20|FH_F87480_0_0|SrvcGrp|86233|2022|PDM|7500.00|99|0.00|AETNA RECONSTRUCT ANKLE JOINT
20|FH_F87480_0_0|SrvcGrp|86235|2022|PDM|1000.00|99|0.00|AETHA HAND SURGERY
20|FH_F87541_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F87541_0_0|SrvcGrp|72990|2022|PDM|401.00|99|0.00|AEG 1
20|FH_F87541_0_0|SrvcGrp|72992|2022|PDM|538.00|99|0.00|AEG 2
20|FH_F87541_0_0|SrvcGrp|73000|2022|PDM|995.00|99|0.00|AEG 6
20|FH_F87541_0_0|SrvcGrp|85538|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F87559_0_0|CSTM-ALL|CSTM-00|2020|PDM|110.47|99|0.00|CPT 95810 (W/MOD 26)
20|FH_F87559_0_0|CSTM-ALL|CSTM-00|2020|PDM|509.13|99|0.00|CPT 95811 (W/MOD TC)
20|FH_F87559_0_0|CSTM-ALL|CSTM-00|2020|PDM|585.51|99|0.00|AETNA SLEEP STUDIES W/O MOD 26 & TC
20|FH_F87559_0_0|SrvcGrp|42723|2022|PDM|107.06|99|0.00|SLEEP STUDIES CPT 95806 W/MODIFIER TC
20|FH_F87559_0_0|SrvcGrp|86474|2022|PDM|43.65|99|0.00|AETNA SLEEP STUDY (MOD 26)
20|FH_F87571_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F87571_0_0|SrvcGrp|10904|2022|PDM|550.00|99|0.00|EMERGENCY ROOM LEVEL II
20|FH_F87571_0_0|SrvcGrp|14174|2022|PDM|650.00|99|0.00|MRI
20|FH_F87571_0_0|SrvcGrp|31074|2022|PDM|240.00|99|0.00|MS DRG 795 ONLY
20|FH_F87571_0_0|SrvcGrp|45883|2022|PDM|85.00|99|0.00|OT
20|FH_F87595_0_0|SrvcGrp|36991|2022|PCT|0.49|99|0.00|IMPLANTS
20|FH_F87618_0_0|CSTM-ALL|CSTM-00|2020|PCT|67.00|99|0.00|OP SVCS
20|FH_F87619_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F87619_0_0|SrvcGrp|11663|2022|PCT|0.50|99|0.00|IMPLANTS
20|FH_F87716_0_0|CSTM-ALL|CSTM-00|2020|PDM|1751.00|99|0.00|GENERAL ACUTE CARE
20|FH_F87716_0_0|SrvcGrp|59116|2022|PDM|2509.00|99|0.00|REUSE!!!  ICU/CCU 200-203, 207-209, 210-213, 219
20|FH_F87822_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F87856_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F87856_0_0|SrvcGrp|111584|2022|PDM|1293.00|99|0.00|REMOVAL OF TISSUE FOR GRAFT
20|FH_F87856_0_0|SrvcGrp|75485|2022|PDM|818.00|99|0.00|AEG 4
20|FH_F87856_0_0|SrvcGrp|83835|2022|PDM|2114.00|99|0.00|REPLACE TISSUE EXPANDER
20|FH_F87856_0_0|SrvcGrp|83838|2022|PDM|1693.00|99|0.00|SUSPENSION OF BREAST
20|FH_F87856_0_0|SrvcGrp|84180|2022|PDM|4000.00|99|0.00|AETNA DELAYED BREAST PROSTHESIS
20|FH_F87856_0_0|SrvcGrp|84183|2022|PDM|1693.00|99|0.00|AETNA SURGERY OF BREAST CAPSULE
20|FH_F87856_0_0|SrvcGrp|84184|2022|PDM|1693.00|99|0.00|AETNA REMOVAL OF BREAST IMPLANT
20|FH_F87856_0_0|SrvcGrp|86460|2022|PDM|2332.00|99|0.00|REVISE BREAST RECONSTRUCTION
20|FH_F87915_0_0|SrvcGrp|3403|2022|PDM|154.00|99|0.00|CPT 99203
20|FH_F87993_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 7 (NO REV)
20|FH_F87993_0_0|CSTM-ALL|CSTM-00|2020|PDM|563.00|99|0.00|AEG 3 (NO REV)
20|FH_F87993_0_0|SrvcGrp|73486|2022|PCT|0.00|99|0.00|AETNA CONTRAST AGENT
20|FH_F88058_0_0|CSTM-ALL|CSTM-00|2020|PCT|66.00|99|0.00|OP SVCS
20|FH_F88096_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F88096_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 5  (NO REV)
20|FH_F88096_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|AEG 10 (NO REV)
20|FH_F88096_0_0|SrvcGrp|83379|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH INCIDENTAL CODES
20|FH_F88274_0_0|SrvcGrp|75481|2022|PDM|700.00|99|0.00|AEG 2
20|FH_F88355_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F88355_0_0|CSTM-ALL|CSTM-00|2020|PDM|1110.00|99|0.00|AEG 8 (NO REV)
20|FH_F88355_0_0|CSTM-ALL|CSTM-00|2020|PDM|964.00|99|0.00|AEG 7 (NO REV)
20|FH_F88357_0_0|CSTM-ALL|CSTM-00|2020|PDM|323.00|99|0.00|AEG 1 (NO REV)
20|FH_F88357_0_0|CSTM-ALL|CSTM-00|2020|PDM|645.00|99|0.00|AEG 10 (NO REV)
20|FH_F88391_0_0|SrvcGrp|22954|2022|PDM|135.31|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F88391_0_0|SrvcGrp|3809|2022|PDM|603.09|99|0.00|HOSPICE CARE
20|FH_F88451_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F88451_0_0|SrvcGrp|56603|2022|PDM|70.00|99|0.00|HOME HEALTH AIDE
20|FH_F88451_0_0|SrvcGrp|60057|2022|PDM|126.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F88456_0_0|CSTM-ALL|CSTM-00|2020|PDM|1064.00|99|0.00|AEG 4 (NO REV)
20|FH_F88456_0_0|CSTM-ALL|CSTM-00|2020|PDM|1232.00|99|0.00|AEG 5  (NO REV)
20|FH_F88456_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 6 (NO REV)
20|FH_F88456_0_0|CSTM-ALL|CSTM-00|2020|PDM|1569.00|99|0.00|AEG 8 (NO REV)
20|FH_F88456_0_0|CSTM-ALL|CSTM-00|2020|PDM|897.00|99|0.00|AEG 3 (NO REV)
20|FH_F88456_0_0|SrvcGrp|104448|2022|PDM|7907.00|99|0.00|CYSTOSCOPY IMPLANT 4 OR MORE
20|FH_F88456_0_0|SrvcGrp|27402|2022|PDM|4313.00|99|0.00|LASER PROCEDURES
20|FH_F88456_0_0|SrvcGrp|37317|2022|PDM|4481.00|99|0.00|LITHOTRIPSY
20|FH_F88483_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F88483_0_0|CSTM-ALL|CSTM-00|2020|PDM|506.00|99|0.00|AEG 3 (NO REV)
20|FH_F88672_0_0|CSTM-ALL|CSTM-00|2020|PDM|471.00|99|0.00|AEG 2 (NO REV)
20|FH_F88672_0_0|SrvcGrp|87677|2022|PDM|819.00|99|0.00|CERVICAL OR THORACIC SURGERY
20|FH_F88704_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.00|99|0.00|GENERAL ACUTE CARE
20|FH_F88704_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F88733_0_0|SrvcGrp|87536|2022|PDM|315.00|99|0.00|MED REHAB DAY PROGRAM (HALF)
20|FH_F88740_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F88740_0_0|CSTM-ALL|CSTM-00|2020|PDM|1108.00|99|0.00|AEG 4 (NO REV)
20|FH_F88740_0_0|CSTM-ALL|CSTM-00|2020|PDM|2355.00|99|0.00|AEG 10 (NO REV)
20|FH_F88740_0_0|CSTM-ALL|CSTM-00|2020|PDM|2355.00|99|0.00|AEG 9 (NO REV)
20|FH_F88797_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F88818_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F88818_0_0|SrvcGrp|75491|2022|PDM|943.00|99|0.00|AEG 7
20|FH_F88818_0_0|SrvcGrp|87819|2022|PDM|475.00|99|0.00|REPAIR OF WOUND/LESION
20|FH_F88885_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F88893_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F88893_0_0|CSTM-ALL|CSTM-00|2020|PDM|397.68|99|0.00|AEG 1 (NO REV)
20|FH_F88893_0_0|CSTM-ALL|CSTM-00|2020|PDM|753.44|99|0.00|AEG 4 (NO REV)
20|FH_F88893_0_0|CSTM-ALL|CSTM-00|2020|PDM|770.00|99|0.00|AEG 3 (NO REV)
20|FH_F88893_0_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS
20|FH_F88893_0_0|SrvcGrp|35921|2022|PDM|8667.00|99|0.00|BARIATRIC SURGERY
20|FH_F88933_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F88933_0_0|CSTM-ALL|CSTM-00|2020|PDM|1633.00|99|0.00|AEG 8 (NO REV)
20|FH_F88933_0_0|CSTM-ALL|CSTM-00|2020|PDM|1639.00|99|0.00|AEG 10 (NO REV)
20|FH_F88933_0_0|SrvcGrp|11043|2022|PDM|1688.00|99|0.00|CARPAL TUNNEL RELEASE
20|FH_F88933_0_0|SrvcGrp|112911|2022|PDM|7725.00|99|0.00|PACEMAKER INSERTION
20|FH_F88933_0_0|SrvcGrp|17324|2022|PDM|3824.00|99|0.00|ARTHROSCOPIC KNEE REPAIR
20|FH_F88933_0_0|SrvcGrp|87523|2022|PDM|3824.00|99|0.00|AETNA KNEE RECONSTRUCTION
20|FH_F88933_0_0|SrvcGrp|87526|2022|PDM|5245.00|99|0.00|AETNA PERMANENT NEUROSTIMULATOR
20|FH_F88935_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F88935_0_0|SrvcGrp|76094|2022|PDM|129.05|99|0.00|HOSPICE ROUTINE HOME CARE
20|FH_F89037_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F89037_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F89037_0_0|SrvcGrp|16719|2022|PCT|1.10|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F89037_0_0|SrvcGrp|23585|2022|PCT|1.10|99|0.00|IMPLANTS
20|FH_F89037_0_0|SrvcGrp|72990|2022|PDM|401.37|99|0.00|AEG 1
20|FH_F89037_0_0|SrvcGrp|72994|2022|PDM|614.72|99|0.00|AEG 3
20|FH_F89037_0_0|SrvcGrp|72996|2022|PDM|759.35|99|0.00|AEG 4
20|FH_F89037_0_0|SrvcGrp|73004|2022|PDM|1172.78|99|0.00|AEG 8
20|FH_F89111_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F89111_0_0|SrvcGrp|33166|2022|PDM|425.00|99|0.00|SKILLED NURSING - LEVEL III
20|FH_F89111_0_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II
20|FH_F89173_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F89173_0_0|CSTM-ALL|CSTM-00|2020|PDM|1026.00|99|0.00|AEG 6 (NO REV)
20|FH_F89173_0_0|CSTM-ALL|CSTM-00|2020|PDM|411.00|99|0.00|AEG 1 (NO REV)
20|FH_F89173_0_0|CSTM-ALL|CSTM-00|2020|PDM|777.00|99|0.00|AEG 4 (NO REV)
20|FH_F89211_0_0|SrvcGrp|88398|2022|PDM|950.00|99|0.00|ACUTE SURGICAL SVCS
20|FH_F89211_0_0|SrvcGrp|9939|2022|PDM|875.00|99|0.00|ACUTE MEDICAL SVCS
20|FH_F89233_0_0|CSTM-ALL|CSTM-00|2020|PDM|1827.00|99|0.00|GENERAL ACUTE CARE
20|FH_F89233_0_0|SrvcGrp|997|2022|PCT|0.76|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F89273_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F89273_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|AEG 3 (NO REV)
20|FH_F89273_0_0|SrvcGrp|13557|2022|PDM|4300.00|99|0.00|CORNEAL TISSUE SVCS
20|FH_F89273_0_0|SrvcGrp|88262|2022|PDM|795.00|99|0.00|AETNA AQUEOUS SHUNT (HCFA)
20|FH_F89273_0_0|SrvcGrp|88269|2022|PDM|400.00|99|0.00|RETINAL TAMPONADE DEVICE
20|FH_F89311_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F89311_0_0|CSTM-ALL|CSTM-00|2020|PDM|1277.00|99|0.00|COVENTRY ENHANCED GROUPER 8
20|FH_F89311_0_0|CSTM-ALL|CSTM-00|2020|PDM|1825.00|99|0.00|COVENTRY ENHANCED GROUPER 9
20|FH_F89311_0_0|CSTM-ALL|CSTM-00|2020|PDM|496.00|99|0.00|COVENTRY ENHANCED GROUPER 2
20|FH_F89311_0_0|CSTM-ALL|CSTM-00|2020|PDM|884.00|99|0.00|COVENTRY ENHANCED GROUPER 5
20|FH_F89340_0_0|CSTM-ALL|CSTM-00|2020|PDM|1377.00|99|0.00|AEG 8 (NO REV)
20|FH_F89340_0_0|CSTM-ALL|CSTM-00|2020|PDM|1422.00|99|0.00|AEG 7 (NO REV)
20|FH_F89340_0_0|CSTM-ALL|CSTM-00|2020|PDM|477.00|99|0.00|AEG 1 (NO REV)
20|FH_F89340_0_0|CSTM-ALL|CSTM-00|2020|PDM|730.00|99|0.00|AEG 3 (NO REV)
20|FH_F89340_0_0|SrvcGrp|44066|2022|PDM|1848.00|99|0.00|CPT 57288
20|FH_F89340_0_0|SrvcGrp|87769|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F89372_0_0|CSTM-ALL|CSTM-00|2020|PDM|5789.00|99|0.00|GENERAL ACUTE CARE
20|FH_F89372_0_0|SrvcGrp|105889|2022|PDM|21630.00|99|0.00|AETNA IO RAD TX DELIVERY BY X-RAY
20|FH_F89372_0_0|SrvcGrp|12659|2022|PDM|751.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT
20|FH_F89372_0_0|SrvcGrp|15386|2022|PCT|0.00|99|0.00|CLINIC VISIT
20|FH_F89372_0_0|SrvcGrp|3078|2022|PCT|0.51|99|0.00|DRUGS
20|FH_F89372_0_0|SrvcGrp|3378|2022|PCT|0.61|99|0.00|OBSERVATION SVCS
20|FH_F89372_0_0|SrvcGrp|43522|2022|PDM|343.00|99|0.00|ELECTRIC CONVULSIVE THERAPY
20|FH_F89372_0_0|SrvcGrp|70381|2022|PDM|629.00|99|0.00|PSYCH PARTIAL HOSP (FULL & PARTIAL DAY) PER VISIT
20|FH_F89372_0_0|SrvcGrp|73559|2022|PDM|10437.00|99|0.00|AETNA INTENSIVE CARE
20|FH_F89372_0_0|SrvcGrp|88667|2022|PCT|1.00|99|0.00|AETNA PATIENT CONVENIENCE ITEMS
20|FH_F89495_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F89495_0_0|SrvcGrp|72996|2022|PDM|653.00|99|0.00|AEG 4
20|FH_F89495_0_0|SrvcGrp|83806|2022|PDM|1530.00|99|0.00|JAW ARTHROSCOPY/TMJ SURGERY
20|FH_F89495_0_0|SrvcGrp|88538|2022|PDM|1875.00|99|0.00|RETINAL PROCEDURES
20|FH_F89538_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F89538_0_0|CSTM-ALL|CSTM-00|2020|PDM|1483.72|99|0.00|AEG 8 (NO REV)
20|FH_F89574_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F89580_0_0|CSTM-ALL|CSTM-00|2020|PDM|28800.00|99|0.00|EXTRA CORPOREAL MEMBRANE
20|FH_F89580_0_0|CSTM-ALL|CSTM-00|2020|PDM|5869.00|99|0.00|GENERAL ACUTE CARE
20|FH_F89580_0_0|SrvcGrp|13990|2022|PCT|0.46|99|0.00|PACEMAKER
20|FH_F89580_0_0|SrvcGrp|24714|2022|PCT|0.50|99|0.00|INTRAOCULAR LENS
20|FH_F89580_0_0|SrvcGrp|88478|2022|PCT|0.47|99|0.00|OP HIGH COST DRUGS
20|FH_F89582_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F89645_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.66|99|0.00|GENERAL ACUTE CARE
20|FH_F89645_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.66|99|0.00|OP SVCS
20|FH_F89732_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.48|99|0.00|OP SVCS
20|FH_F89736_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F89736_0_0|SrvcGrp|111946|2022|PDM|13212.00|99|0.00|SPINE PROCEDURES (HIGH ACUITY)
20|FH_F89736_0_0|SrvcGrp|115056|2022|PDM|7736.00|99|0.00|LAPAROSCOPY SERVICES
20|FH_F89736_0_0|SrvcGrp|12104|2022|PCT|0.50|99|0.00|DRUGS
20|FH_F89778_0_0|SrvcGrp|26273|2022|PDM|1215.74|99|0.00|CPT 29880
20|FH_F89778_0_0|SrvcGrp|27348|2022|PDM|2135.54|99|0.00|OP SURGERY (CPT 58662)
20|FH_F89778_0_0|SrvcGrp|35667|2022|PDM|1030.82|99|0.00|CPT 20680
20|FH_F89778_0_0|SrvcGrp|77444|2022|PDM|1023.96|99|0.00|VASECTOMY
20|FH_F89778_0_0|SrvcGrp|78283|2022|PDM|1511.75|99|0.00|CPT 49505
20|FH_F89778_0_0|SrvcGrp|79101|2022|PDM|1135.88|99|0.00|AETNA NASAL ENDOSCOPY
20|FH_F89778_0_0|SrvcGrp|79561|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F89778_0_0|SrvcGrp|82107|2022|PDM|1215.74|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F89778_0_0|SrvcGrp|88241|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F89778_0_0|SrvcGrp|88822|2022|PDM|1030.82|99|0.00|CPT 69205
20|FH_F89778_0_0|SrvcGrp|88824|2022|PDM|2107.64|99|0.00|CPT 69631
20|FH_F89778_0_0|SrvcGrp|90157|2022|PDM|1099.68|99|0.00|AETNA REMOVAL OF TONSILS
20|FH_F89779_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F89779_0_0|SrvcGrp|27261|2022|PDM|19500.00|99|0.00|CPT 27446
20|FH_F89779_0_0|SrvcGrp|72992|2022|PDM|2100.00|99|0.00|AEG 2
20|FH_F89779_0_0|SrvcGrp|72996|2022|PDM|3000.00|99|0.00|AEG 4
20|FH_F89779_0_0|SrvcGrp|73002|2022|PDM|3500.00|99|0.00|AEG 7
20|FH_F89779_0_0|SrvcGrp|77021|2022|PDM|12500.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY
20|FH_F89779_0_0|SrvcGrp|88065|2022|PDM|12000.00|99|0.00|TOTAL DISC ARTHROPLASTY
20|FH_F89779_0_0|SrvcGrp|88158|2022|PDM|12500.00|99|0.00|NECK SPINE DISK SURGERY
20|FH_F89779_0_0|SrvcGrp|88160|2022|PDM|13000.00|99|0.00|LAMINECTOMY W/FACETECTOMY
20|FH_F89799_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F89912_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.70|99|0.00|GENERAL ACUTE CARE
20|FH_F89952_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F89952_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 10 (NO REV)
20|FH_F89952_0_0|CSTM-ALL|CSTM-00|2020|PDM|973.00|99|0.00|AEG 8 (NO REV)
20|FH_F89952_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|AEG 7 (NO REV)
20|FH_F89952_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F90136_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F90136_0_0|SrvcGrp|82222|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F90157_0_0|SrvcGrp|22528|2022|PCT|0.00|99|0.00|DAY HOSPITAL FULL DAY
20|FH_F90173_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F90184_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|ASPG X
20|FH_F90184_0_0|CSTM-ALL|CSTM-00|2020|PDM|1078.00|99|0.00|ASPG VI
20|FH_F90184_0_0|CSTM-ALL|CSTM-00|2020|PDM|1286.00|99|0.00|ASPG VII
20|FH_F90184_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|ASPG III
20|FH_F90184_0_0|CSTM-ALL|CSTM-00|2020|PDM|814.00|99|0.00|ASPG IV
20|FH_F90184_0_0|CSTM-ALL|CSTM-00|2020|PDM|927.00|99|0.00|ASPG V
20|FH_F90197_0_0|CSTM-ALL|CSTM-00|2020|PCT|66.00|99|0.00|OP SVCS
20|FH_F90354_0_0|SrvcGrp|57967|2022|PDM|160.93|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F90362_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F90362_0_0|CSTM-ALL|CSTM-00|2020|PDM|1061.00|99|0.00|IMPLANT PAT-ACTIVE HT RECORD
20|FH_F90362_0_0|SrvcGrp|41334|2022|PDM|11670.00|99|0.00|TOTAL KNEE
20|FH_F90362_0_0|SrvcGrp|73002|2022|PDM|1139.00|99|0.00|AEG 7
20|FH_F90362_0_0|SrvcGrp|78448|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F90362_0_0|SrvcGrp|89945|2022|PDM|2122.00|99|0.00|REPAIR OF TENDON(S)
20|FH_F90422_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F90422_0_0|SrvcGrp|15873|2022|PDM|76.00|99|0.00|HOSPICE SERVICE - CONTINUOUS HOME CARE
20|FH_F90455_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F90455_0_0|SrvcGrp|43567|2022|PDM|128.00|99|0.00|SKILLED NURSING - POSTNATAL
20|FH_F90455_0_0|SrvcGrp|44042|2022|PDM|110.00|99|0.00|SKILLED NURSING - LPN
20|FH_F90455_0_0|SrvcGrp|45924|2022|PDM|58.00|99|0.00|HOME HEALTH AIDE
20|FH_F90455_0_0|SrvcGrp|48394|2022|PDM|58.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F90455_0_0|SrvcGrp|48398|2022|PDM|140.00|99|0.00|PT SERVICES
20|FH_F90559_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F90564_0_0|CSTM-ALL|CSTM-00|2020|PCT|64.30|99|0.00|OP SVCS
20|FH_F90653_0_0|SrvcGrp|16778|2022|PCT|0.70|99|0.00|DIALYSIS
20|FH_F90653_0_0|SrvcGrp|17990|2022|PCT|0.70|99|0.00|CT / MRI
20|FH_F90653_0_0|SrvcGrp|25696|2022|PDM|950.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F90653_0_0|SrvcGrp|58764|2022|PCT|0.70|99|0.00|PHYSICIANS FEES
20|FH_F90654_0_0|SrvcGrp|25695|2022|PDM|1300.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F90654_0_0|SrvcGrp|58763|2022|PCT|0.70|99|0.00|IMMUNE ENHANCING/SUPPRESSANT PHARMACY
20|FH_F90691_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F90691_0_0|SrvcGrp|73000|2022|PDM|892.00|99|0.00|AEG 6
20|FH_F90691_0_0|SrvcGrp|77507|2022|PCT|1.00|99|0.00|AETNA CORNEAL TISSUE HANDLING
20|FH_F90714_0_0|SrvcGrp|72990|2022|PDM|354.00|99|0.00|AEG 1
20|FH_F90714_0_0|SrvcGrp|72996|2022|PDM|710.00|99|0.00|AEG 4
20|FH_F90714_0_0|SrvcGrp|72998|2022|PDM|820.00|99|0.00|AEG 5
20|FH_F90714_0_0|SrvcGrp|73004|2022|PDM|1079.00|99|0.00|AEG 8
20|FH_F90811_0_0|CSTM-ALL|CSTM-00|2020|PDM|1954.00|99|0.00|AEG 9 (NO REV)
20|FH_F90811_0_0|CSTM-ALL|CSTM-00|2020|PDM|913.50|99|0.00|AEG 10 (NO REV)
20|FH_F90811_0_0|SrvcGrp|27343|2022|PDM|4000.00|99|0.00|OP SURGERY (CPT 25607 - 25609)
20|FH_F90811_0_0|SrvcGrp|64517|2022|PDM|2700.00|99|0.00|REDUCE MANMMAPLASTY
20|FH_F90811_0_0|SrvcGrp|87769|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F90811_0_0|SrvcGrp|89569|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F90811_0_0|SrvcGrp|90365|2022|PDM|2700.00|99|0.00|REPAIR METACARPAL FRACTURE
20|FH_F90811_0_0|SrvcGrp|90417|2022|PDM|2700.00|99|0.00|TREATMENT OF JOINT
20|FH_F90811_0_0|SrvcGrp|90420|2022|PDM|4000.00|99|0.00|REPAIR CLAVICLE FRACTURE
20|FH_F90811_0_0|SrvcGrp|90429|2022|PDM|2700.00|99|0.00|REPAIR WRIST BONE FRACTURE
20|FH_F90811_0_0|SrvcGrp|90430|2022|PDM|2500.00|99|0.00|REPAIR ACHILLES TENDON
20|FH_F90811_0_0|SrvcGrp|90432|2022|PDM|2000.00|99|0.00|REMOVAL OF BREAST IMPLANT
20|FH_F90811_0_0|SrvcGrp|90433|2022|PDM|1500.00|99|0.00|HAND PROCEDURES
20|FH_F90811_0_0|SrvcGrp|90435|2022|PDM|5300.00|99|0.00|NECK SPINE DISK SURGERY
20|FH_F90817_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 10 (NO REV)
20|FH_F90817_0_0|CSTM-ALL|CSTM-00|2020|PDM|658.00|99|0.00|AEG 2 (NO REV)
20|FH_F90817_0_0|SrvcGrp|26275|2022|PDM|1574.00|99|0.00|CPT 29826
20|FH_F90817_0_0|SrvcGrp|54962|2022|PDM|2096.00|99|0.00|RECONSTRUCTION OF SHOULDER CUFF (ROTATOR)
20|FH_F90817_0_0|SrvcGrp|82107|2022|PDM|1574.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F90817_0_0|SrvcGrp|82110|2022|PDM|1574.00|99|0.00|KNEE ARTHROSCOPY DIAGNOSTIC
20|FH_F90817_0_0|SrvcGrp|89569|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F90817_0_0|SrvcGrp|90359|2022|PDM|2096.00|99|0.00|REPAIR SHOULDER CAPSULE
20|FH_F90817_0_0|SrvcGrp|90360|2022|PDM|2162.00|99|0.00|REPAIR FRACTURE OF ULNA
20|FH_F90817_0_0|SrvcGrp|90368|2022|PDM|1151.00|99|0.00|REMOVAL OF TEAR SAC
20|FH_F90817_0_0|SrvcGrp|90385|2022|PDM|1762.00|99|0.00|NASAL ENDOSCOPY SURGICAL
20|FH_F90817_0_0|SrvcGrp|91002|2022|PDM|1433.00|99|0.00|RELEASE FOREARM/HAND TENDON (HCFA)
20|FH_F90817_0_0|SrvcGrp|91004|2022|PDM|1997.00|99|0.00|REPAIR METACARPAL FRACTURE (HCFA)
20|FH_F90817_0_0|SrvcGrp|91007|2022|PDM|6580.00|99|0.00|REVISION OF KNEE JOINTLANT (HCFA)
20|FH_F90817_0_0|SrvcGrp|91008|2022|PDM|2293.00|99|0.00|REPAIR OF ANKLE FRACTURE (HCFA)
20|FH_F90817_0_0|SrvcGrp|91013|2022|PDM|2280.00|99|0.00|KNEE ARTHROSCOPY SURGICAL (HCFA)
20|FH_F90817_0_0|SrvcGrp|91022|2022|PDM|1057.00|99|0.00|REVISE EXTERNAL EAR (HCFA)
20|FH_F90817_0_0|SrvcGrp|91024|2022|PDM|7520.00|99|0.00|REPAIR OF RUPTURED TENDON (HCFA)
20|FH_F90817_0_0|SrvcGrp|91026|2022|PDM|2256.00|99|0.00|REPAIR EARDRUM STRUCTURES (HCFA)
20|FH_F90817_0_0|SrvcGrp|91029|2022|PDM|2350.00|99|0.00|CORNEAL TRANSPLANT (HCFA)
20|FH_F90817_0_0|SrvcGrp|91037|2022|PDM|2068.00|99|0.00|LAP HERNIORRHAPY (HCFA)
20|FH_F90817_0_0|SrvcGrp|91042|2022|PDM|1574.00|99|0.00|KNEE ARTHROSCOPY DIAGNOSTIC (HCFA)
20|FH_F90817_0_0|SrvcGrp|91045|2022|PDM|1574.00|99|0.00|SHOULDER ARTHROSCOPY (HCFA)
20|FH_F90817_0_0|SrvcGrp|91046|2022|PDM|1443.00|99|0.00|RPR I/HERN INIT REDUC>5 YR (HCFA)
20|FH_F90817_0_0|SrvcGrp|91048|2022|PDM|3008.00|99|0.00|LAPAROSCOPY CHOLECYSTECTOMY (HCFA)
20|FH_F90818_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F90818_0_0|CSTM-ALL|CSTM-00|2020|PDM|1785.00|99|0.00|AEG 8 (NO REV)
20|FH_F90818_0_0|SrvcGrp|15473|2022|PDM|3125.00|99|0.00|CPT CODE 42820
20|FH_F90818_0_0|SrvcGrp|26274|2022|PDM|5500.00|99|0.00|CPT 29877
20|FH_F90818_0_0|SrvcGrp|54943|2022|PDM|6500.00|99|0.00|REPAIR OF SLAP LESION
20|FH_F90818_0_0|SrvcGrp|79589|2022|PDM|3600.00|99|0.00|UPPER GI
20|FH_F90818_0_0|SrvcGrp|82107|2022|PDM|6500.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F90818_0_0|SrvcGrp|89883|2022|PDM|3625.00|99|0.00|AETNA TREAT HUMERUS FRACTURE
20|FH_F90818_0_0|SrvcGrp|89884|2022|PDM|3125.00|99|0.00|AETNA ABLATE TURBINATE SUBMUC
20|FH_F90818_0_0|SrvcGrp|90814|2022|PDM|3125.00|99|0.00|REPAIR HERNIA (<5 YRS)
20|FH_F90840_0_0|CSTM-ALL|CSTM-00|2020|PDM|522.00|99|0.00|AEG 1 (NO REV)
20|FH_F90840_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|AEG 3 (NO REV)
20|FH_F90840_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F90840_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F90840_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F90852_0_0|SrvcGrp|30089|2022|PDM|420.00|99|0.00|HEMODIALYSIS SERVICES
20|FH_F90853_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F91034_0_0|SrvcGrp|87077|2022|PDM|128.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F91039_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F91039_0_0|CSTM-ALL|CSTM-00|2020|PDM|1045.00|99|0.00|AEG 7 (NO REV)
20|FH_F91039_0_0|CSTM-ALL|CSTM-00|2020|PDM|1406.00|99|0.00|AEG 9 (NO REV)
20|FH_F91039_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|AEG 1 (NO REV)
20|FH_F91039_0_0|CSTM-ALL|CSTM-00|2020|PDM|662.00|99|0.00|AEG 4 (NO REV)
20|FH_F91039_0_0|CSTM-ALL|CSTM-00|2020|PDM|753.00|99|0.00|AEG 5  (NO REV)
20|FH_F91039_0_0|SrvcGrp|89978|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F91056_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F91067_0_0|SrvcGrp|72990|2022|PDM|410.00|99|0.00|AEG 1
20|FH_F91067_0_0|SrvcGrp|72998|2022|PDM|884.00|99|0.00|AEG 5
20|FH_F91067_0_0|SrvcGrp|73006|2022|PDM|1648.00|99|0.00|AEG 9
20|FH_F91072_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.70|99|0.00|GENERAL ACUTE CARE
20|FH_F91072_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.70|99|0.00|OP SVCS
20|FH_F91171_0_0|CSTM-ALL|CSTM-00|2020|PDM|1038.00|99|0.00|AEG 10 (NO REV)
20|FH_F91171_0_0|CSTM-ALL|CSTM-00|2020|PDM|1038.00|99|0.00|AEG 6 (NO REV)
20|FH_F91171_0_0|CSTM-ALL|CSTM-00|2020|PDM|1186.00|99|0.00|AEG 8 (NO REV)
20|FH_F91171_0_0|CSTM-ALL|CSTM-00|2020|PDM|1212.00|99|0.00|AEG 9 (NO REV)
20|FH_F91171_0_0|CSTM-ALL|CSTM-00|2020|PDM|592.00|99|0.00|AEG 3 (NO REV)
20|FH_F91171_0_0|SrvcGrp|59841|2022|PDM|778.00|99|0.00|SUBMUCOUS RESECTION
20|FH_F91171_0_0|SrvcGrp|78093|2022|PDM|783.00|99|0.00|AETNA NASAL ENDOSCOPY SURG
20|FH_F91171_0_0|SrvcGrp|88599|2022|PDM|783.00|99|0.00|ENDOSCOPY MAXILLARY SINUS
20|FH_F91171_0_0|SrvcGrp|89853|2022|PDM|783.00|99|0.00|NASAL/SINUS ENDOSCOPY-SURG
20|FH_F91216_0_0|CSTM-ALL|CSTM-00|2020|PCT|12000.00|99|0.00|TIMELY FILING
20|FH_F91216_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F91216_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F91259_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F91263_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE
20|FH_F91275_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS
20|FH_F91284_0_0|CSTM-ALL|CSTM-00|2020|PDM|1340.00|99|0.00|AEG 3 (NO REV)
20|FH_F91284_0_0|CSTM-ALL|CSTM-00|2020|PDM|1738.00|99|0.00|AEG 10 (NO REV)
20|FH_F91284_0_0|CSTM-ALL|CSTM-00|2020|PDM|3178.00|99|0.00|AEG 8 (NO REV)
20|FH_F91284_0_0|CSTM-ALL|CSTM-00|2020|PDM|944.00|99|0.00|AEG 1 (NO REV)
20|FH_F91284_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F91284_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F91313_0_0|CSTM-ALL|CSTM-00|2020|PCT|99.00|99|0.00|OP SVCS
20|FH_F91331_0_0|CSTM-ALL|CSTM-00|2020|PDM|1166.16|99|0.00|ASPG VIII
20|FH_F91331_0_0|CSTM-ALL|CSTM-00|2020|PDM|399.11|99|0.00|ASPG I
20|FH_F91331_0_0|CSTM-ALL|CSTM-00|2020|PDM|755.07|99|0.00|ASPG IV
20|FH_F91332_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F91332_0_0|CSTM-ALL|CSTM-00|2020|PDM|1339.00|99|0.00|COVENTRY ENHANCED GROUPER 9
20|FH_F91332_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|COVENTRY ENHANCED GROUPER 4
20|FH_F91412_0_0|CSTM-ALL|CSTM-00|2020|PDM|1313.93|99|0.00|AEG 5  (NO REV)
20|FH_F91412_0_0|CSTM-ALL|CSTM-00|2020|PDM|1525.99|99|0.00|AEG 6 (NO REV)
20|FH_F91412_0_0|CSTM-ALL|CSTM-00|2020|PDM|813.58|99|0.00|AEG 2 (NO REV)
20|FH_F91412_0_0|SrvcGrp|90317|2022|PDM|8908.90|99|0.00|NECK SPINE FUSE
20|FH_F91575_0_0|CSTM-ALL|CSTM-00|2020|PDM|788.00|99|0.00|AEG 5  (NO REV)
20|FH_F91575_0_0|CSTM-ALL|CSTM-00|2020|PDM|909.00|99|0.00|AEG 6 (NO REV)
20|FH_F91575_0_0|SrvcGrp|78448|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F91575_0_0|SrvcGrp|79937|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F91594_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F91594_0_0|SrvcGrp|537|2022|PCT|0.85|99|0.00|OBSERVATION SERVICES
20|FH_F91594_0_0|SrvcGrp|74694|2022|PCT|0.85|99|0.00|AETNA INPATIENT SERVICES
20|FH_F91634_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 5  (NO REV)
20|FH_F91634_0_0|CSTM-ALL|CSTM-00|2020|PDM|860.00|99|0.00|AEG 4 (NO REV)
20|FH_F91641_0_0|CSTM-ALL|CSTM-00|2020|PDM|1051.84|99|0.00|AEG 2 (NO REV)
20|FH_F91641_0_0|CSTM-ALL|CSTM-00|2020|PDM|1264.09|99|0.00|AEG 3 (NO REV)
20|FH_F91641_0_0|CSTM-ALL|CSTM-00|2020|PDM|1560.60|99|0.00|AEG 10 (NO REV)
20|FH_F91641_0_0|CSTM-ALL|CSTM-00|2020|PDM|1692.73|99|0.00|AEG 5  (NO REV)
20|FH_F91641_0_0|CSTM-ALL|CSTM-00|2020|PDM|785.50|99|0.00|AEG 1 (NO REV)
20|FH_F91641_0_0|SrvcGrp|86505|2022|PDM|1560.60|99|0.00|DENTAL SURGERY
20|FH_F91641_0_0|SrvcGrp|91456|2022|PDM|1664.64|99|0.00|LAGOPHTHALMOS CORRECTION
20|FH_F91641_0_0|SrvcGrp|91457|2022|PDM|1768.68|99|0.00|MINOR SURGERY
20|FH_F91641_0_0|SrvcGrp|91460|2022|PDM|2392.92|99|0.00|LAPAROSCOPY
20|FH_F91739_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F91752_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F91787_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AEG 10 (NO REV)
20|FH_F91819_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F91819_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|COVENTRY ENHANCED GROUPER 1
20|FH_F91819_0_0|CSTM-ALL|CSTM-00|2020|PDM|446.00|99|0.00|COVENTRY ENHANCED GROUPER 2
20|FH_F91819_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|COVENTRY ENHANCED GROUPER 3
20|FH_F91819_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|COVENTRY ENHANCED GROUPER 4
20|FH_F91819_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|COVENTRY ENHANCED GROUPER 5
20|FH_F91819_0_0|SrvcGrp|91687|2022|PDM|1100.00|99|0.00|OPHTHALMOLOGY SURGERY PROCEDURE
20|FH_F91876_0_0|SrvcGrp|72992|2022|PDM|1197.00|99|0.00|AEG 2
20|FH_F91876_0_0|SrvcGrp|72994|2022|PDM|1369.00|99|0.00|AEG 3
20|FH_F91876_0_0|SrvcGrp|72998|2022|PDM|1925.00|99|0.00|AEG 5
20|FH_F91876_0_0|SrvcGrp|73004|2022|PDM|2612.00|99|0.00|AEG 8
20|FH_F91876_0_0|SrvcGrp|77582|2022|PDM|2345.00|99|0.00|CPT 31255
20|FH_F91876_0_0|SrvcGrp|78282|2022|PDM|2925.00|99|0.00|CPT 47563
20|FH_F91876_0_0|SrvcGrp|91322|2022|PCT|0.00|99|0.00|IMAGING ENHANCING
20|FH_F91898_0_0|CSTM-ALL|CSTM-00|2020|PDM|16526.00|99|0.00|AEG 9 (NO REV)
20|FH_F91898_0_0|SrvcGrp|116021|2022|PDM|13050.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F91898_0_0|SrvcGrp|116022|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES
20|FH_F91898_0_0|SrvcGrp|32560|2022|PCT|0.95|99|0.00|BURN SERVICES (MS DRG)
20|FH_F91898_0_0|SrvcGrp|91754|2022|PDM|10138.00|99|0.00|AETNA SURGICAL MSDRG AND INTENSIVE CARE
20|FH_F91900_0_0|CSTM-ALL|CSTM-00|2020|PDM|355.00|99|0.00|COVENTRY ENHANCED GROUPER 1
20|FH_F91900_0_0|CSTM-ALL|CSTM-00|2020|PDM|545.00|99|0.00|COVENTRY ENHANCED GROUPER 3
20|FH_F91900_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F91912_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F91912_0_0|SrvcGrp|16069|2022|PDM|414.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT
20|FH_F91912_0_0|SrvcGrp|88819|2022|PDM|431.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY
20|FH_F91913_0_0|SrvcGrp|73000|2022|PDM|826.00|99|0.00|AEG 6
20|FH_F91913_0_0|SrvcGrp|73002|2022|PDM|995.00|99|0.00|AEG 7
20|FH_F91913_0_0|SrvcGrp|73006|2022|PDM|1339.00|99|0.00|AEG 9
20|FH_F91913_0_0|SrvcGrp|73008|2022|PDM|630.00|99|0.00|AEG 10
20|FH_F91933_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F91933_0_0|SrvcGrp|8950|2022|PDM|1400.00|99|0.00|INTERMEDIATE ICU/CCU
20|FH_F91940_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F91940_0_0|CSTM-ALL|CSTM-00|2020|PDM|1569.00|99|0.00|AEG 6 (NO REV)
20|FH_F91940_0_0|CSTM-ALL|CSTM-00|2020|PDM|1890.00|99|0.00|AEG 7 (NO REV)
20|FH_F91940_0_0|CSTM-ALL|CSTM-00|2020|PDM|633.00|99|0.00|AEG 1 (NO REV)
20|FH_F91940_0_0|SrvcGrp|81859|2022|PDM|1890.00|99|0.00|AETNA CARDIAC CATH
20|FH_F91940_0_0|SrvcGrp|91564|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F91973_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F91973_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F91973_0_0|CSTM-ALL|CSTM-00|2020|PDM|2029.00|99|0.00|AEG 8 (NO REV)
20|FH_F91973_0_0|CSTM-ALL|CSTM-00|2020|PDM|2049.00|99|0.00|AEG 4 (NO REV)
20|FH_F91973_0_0|CSTM-ALL|CSTM-00|2020|PDM|2624.00|99|0.00|AEG 6 (NO REV)
20|FH_F91975_0_0|CSTM-ALL|CSTM-00|2020|PDM|335.00|99|0.00|AEG 1 (NO REV)
20|FH_F91975_0_0|CSTM-ALL|CSTM-00|2020|PDM|514.00|99|0.00|AEG 3 (NO REV)
20|FH_F91975_0_0|CSTM-ALL|CSTM-00|2020|PDM|715.00|99|0.00|AEG 5  (NO REV)
20|FH_F91975_0_0|CSTM-ALL|CSTM-00|2020|PDM|780.00|99|0.00|AEG 6 (NO REV)
20|FH_F91975_0_0|SrvcGrp|79757|2022|PDM|926.00|99|0.00|ESOPHAGUS ENDOSCOPY REPAIR
20|FH_F91975_0_0|SrvcGrp|86863|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F91975_0_0|SrvcGrp|91859|2022|PDM|352.00|99|0.00|SIGMOIDOSCOPY W/ ENDOSCOPIC
20|FH_F91994_0_0|SrvcGrp|14614|2022|PDM|4712.00|99|0.00|LITHOTRIPSY
20|FH_F91994_0_0|SrvcGrp|16719|2022|PCT|1.15|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F91994_0_0|SrvcGrp|63459|2022|PDM|1760.00|99|0.00|CPT 52601
20|FH_F91998_0_0|SrvcGrp|73000|2022|PDM|896.00|99|0.00|AEG 6
20|FH_F91998_0_0|SrvcGrp|83641|2022|PDM|1734.00|99|0.00|CPT 29889
20|FH_F91998_0_0|SrvcGrp|90376|2022|PDM|8500.00|99|0.00|REVISION OF KNEE JOINTLANT
20|FH_F91998_0_0|SrvcGrp|90435|2022|PDM|5300.00|99|0.00|NECK SPINE DISK SURGERY
20|FH_F92012_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.20|99|0.00|GENERAL ACUTE CARE
20|FH_F92012_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.20|99|0.00|OP SVCS
20|FH_F92034_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F92034_0_0|SrvcGrp|107348|2022|PDM|2000.00|99|0.00|EXTERNAL RECHARG SYS INTERN
20|FH_F92034_0_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS
20|FH_F92034_0_0|SrvcGrp|72996|2022|PDM|831.00|99|0.00|AEG 4
20|FH_F92034_0_0|SrvcGrp|73002|2022|PDM|1311.00|99|0.00|AEG 7
20|FH_F92034_0_0|SrvcGrp|73006|2022|PDM|1765.00|99|0.00|AEG 9
20|FH_F92034_0_0|SrvcGrp|96104|2022|PDM|1000.00|99|0.00|IMPLANTABLE NEUROSTIMULATOR
20|FH_F92091_0_0|SrvcGrp|77580|2022|PDM|1350.00|99|0.00|CPT 28296 - 28299
20|FH_F92091_0_0|SrvcGrp|88030|2022|PDM|10000.00|99|0.00|REVISION OF KNEE JOINT
20|FH_F92091_0_0|SrvcGrp|88159|2022|PDM|7800.00|99|0.00|LOW BACK DISK SURGERY
20|FH_F92091_0_0|SrvcGrp|89979|2022|PDM|6000.00|99|0.00|RECONSTRUCT SHOULDER JOINT
20|FH_F92091_0_0|SrvcGrp|89982|2022|PDM|3000.00|99|0.00|SHOULDER ARTHROSCOPY / SURGERY
20|FH_F92091_0_0|SrvcGrp|89988|2022|PDM|3000.00|99|0.00|REPAIR HALLUX RIGIDUS
20|FH_F92119_0_0|CSTM-ALL|CSTM-00|2020|PDM|934.00|99|0.00|AEG 7 (NO REV)
20|FH_F92120_0_0|CSTM-ALL|CSTM-00|2020|PDM|1197.00|99|0.00|AEG 4 (NO REV)
20|FH_F92120_0_0|CSTM-ALL|CSTM-00|2020|PDM|1569.00|99|0.00|AEG 6 (NO REV)
20|FH_F92120_0_0|CSTM-ALL|CSTM-00|2020|PDM|1849.00|99|0.00|AEG 8 (NO REV)
20|FH_F92120_0_0|CSTM-ALL|CSTM-00|2020|PDM|1890.00|99|0.00|AEG 7 (NO REV)
20|FH_F92120_0_0|CSTM-ALL|CSTM-00|2020|PDM|847.00|99|0.00|AEG 2 (NO REV)
20|FH_F92120_0_0|CSTM-ALL|CSTM-00|2020|PDM|969.00|99|0.00|AEG 3 (NO REV)
20|FH_F92120_0_0|SrvcGrp|85022|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F92174_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F92212_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F92212_0_0|CSTM-ALL|CSTM-00|2020|PDM|1334.00|99|0.00|AEG 9 (NO REV)
20|FH_F92212_0_0|CSTM-ALL|CSTM-00|2020|PDM|628.00|99|0.00|AEG 10 (NO REV)
20|FH_F92212_0_0|CSTM-ALL|CSTM-00|2020|PDM|628.00|99|0.00|AEG 4 (NO REV)
20|FH_F92212_0_0|SrvcGrp|92086|2022|PDM|945.00|99|0.00|VITRECTOMY
20|FH_F92454_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F92454_0_0|CSTM-ALL|CSTM-00|2020|PDM|1456.00|99|0.00|AEG 6 (NO REV)
20|FH_F92454_0_0|CSTM-ALL|CSTM-00|2020|PDM|1716.00|99|0.00|AEG 10 (NO REV)
20|FH_F92454_0_0|CSTM-ALL|CSTM-00|2020|PDM|2246.40|99|0.00|AEG 9 (NO REV)
20|FH_F92454_0_0|CSTM-ALL|CSTM-00|2020|PDM|572.00|99|0.00|AEG 1 (NO REV)
20|FH_F92454_0_0|CSTM-ALL|CSTM-00|2020|PDM|757.12|99|0.00|AEG 2 (NO REV)
20|FH_F92454_0_0|CSTM-ALL|CSTM-00|2020|PDM|887.12|99|0.00|AEG 3 (NO REV)
20|FH_F92454_0_0|SrvcGrp|58636|2022|PDM|7700.00|99|0.00|CPT 62362
20|FH_F92454_0_0|SrvcGrp|77461|2022|PDM|7800.00|99|0.00|CPT 52356
20|FH_F92454_0_0|SrvcGrp|79561|2022|PDM|1716.00|99|0.00|AETNA CARDIAC CATH
20|FH_F92474_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F92474_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F92474_0_0|CSTM-ALL|CSTM-00|2020|PDM|893.00|99|0.00|AEG 6 (NO REV)
20|FH_F92474_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS
20|FH_F92474_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F92477_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F92477_0_0|SrvcGrp|73601|2022|PDM|1470.00|99|0.00|AETNA INTERMEDIATE ICU/CCU
20|FH_F92493_0_0|CSTM-ALL|CSTM-00|2020|PDM|1640.10|99|0.00|AEG 10 (NO REV)
20|FH_F92493_0_0|CSTM-ALL|CSTM-00|2020|PDM|1893.10|99|0.00|AEG 6 (NO REV)
20|FH_F92493_0_0|CSTM-ALL|CSTM-00|2020|PDM|821.21|99|0.00|AEG 1 (NO REV)
20|FH_F92493_0_0|SrvcGrp|35667|2022|PDM|1689.77|99|0.00|CPT 20680
20|FH_F92493_0_0|SrvcGrp|72121|2022|PDM|2989.14|99|0.00|ARTHOSCOPY
20|FH_F92493_0_0|SrvcGrp|77021|2022|PDM|14674.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY
20|FH_F92493_0_0|SrvcGrp|82114|2022|PDM|2601.06|99|0.00|MENISCUS REPAIR MED OR LAT
20|FH_F92493_0_0|SrvcGrp|86233|2022|PDM|16193.10|99|0.00|AETNA RECONSTRUCT ANKLE JOINT
20|FH_F92493_0_0|SrvcGrp|89404|2022|PDM|20798.09|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F92493_0_0|SrvcGrp|90063|2022|PDM|2601.06|99|0.00|REPAIR BICEPS TENDON RUPTURE
20|FH_F92493_0_0|SrvcGrp|90420|2022|PDM|6500.34|99|0.00|REPAIR CLAVICLE FRACTURE
20|FH_F92493_0_0|SrvcGrp|92359|2022|PDM|12999.53|99|0.00|REMOVAL OF TAIL BONE
20|FH_F92493_0_0|SrvcGrp|92360|2022|PDM|12999.53|99|0.00|REMOVAL OF HIP PROSTHESIS
20|FH_F92493_0_0|SrvcGrp|92362|2022|PDM|12999.53|99|0.00|AUTOLOG CHONDROCYTE IMP KNEE
20|FH_F92493_0_0|SrvcGrp|92368|2022|PDM|2601.06|99|0.00|REPAIR OF LEG TENDON
20|FH_F92493_0_0|SrvcGrp|95559|2022|PDM|16193.10|99|0.00|HIP JOINT
20|FH_F92493_0_0|SrvcGrp|99161|2022|PDM|16193.10|99|0.00|CPT 27138
20|FH_F92516_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F92516_0_0|SrvcGrp|72998|2022|PDM|725.00|99|0.00|AEG 5
20|FH_F92516_0_0|SrvcGrp|73002|2022|PDM|1005.00|99|0.00|AEG 7
20|FH_F92516_0_0|SrvcGrp|73006|2022|PDM|1352.00|99|0.00|AEG 9
20|FH_F92531_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F92531_0_0|CSTM-ALL|CSTM-00|2020|PDM|1602.00|99|0.00|AEG 4 (NO REV)
20|FH_F92531_0_0|CSTM-ALL|CSTM-00|2020|PDM|1810.00|99|0.00|AEG 10 (NO REV)
20|FH_F92531_0_0|CSTM-ALL|CSTM-00|2020|PDM|2770.00|99|0.00|AEG 7 (NO REV)
20|FH_F92531_0_0|CSTM-ALL|CSTM-00|2020|PDM|3270.00|99|0.00|AEG 9 (NO REV)
20|FH_F92531_0_0|SrvcGrp|92195|2022|PDM|11275.00|99|0.00|LUMBAR SPINE FUSION
20|FH_F92531_0_0|SrvcGrp|92196|2022|PDM|11275.00|99|0.00|TOTAL JOINTS - KNEE/HIP SURGERY
20|FH_F92531_0_0|SrvcGrp|92197|2022|PDM|2875.00|99|0.00|CORRECTION OF BUNION
20|FH_F92599_0_0|SrvcGrp|75487|2022|PDM|1031.00|99|0.00|AEG 5
20|FH_F92599_0_0|SrvcGrp|75491|2022|PDM|1432.00|99|0.00|AEG 7
20|FH_F92599_0_0|SrvcGrp|75493|2022|PDM|1424.00|99|0.00|AEG 8
20|FH_F92600_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F92618_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F92618_0_0|SrvcGrp|3809|2022|PDM|609.83|99|0.00|HOSPICE CARE
20|FH_F92618_0_0|SrvcGrp|75399|2022|PDM|0.12|99|0.00|MED RECORD COPY
20|FH_F92655_0_0|CSTM-ALL|CSTM-00|2020|PDM|373.00|99|0.00|AEG 1 (NO REV)
20|FH_F92659_0_0|CSTM-ALL|CSTM-00|2020|PDM|1714.00|99|0.00|AEG 9 (NO REV)
20|FH_F92659_0_0|SrvcGrp|91564|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F92659_0_0|SrvcGrp|92540|2022|PDM|806.00|99|0.00|MUSCLE FLAP
20|FH_F92659_0_0|SrvcGrp|92544|2022|PDM|842.00|99|0.00|FOLLOW-UP SURGERY OF EYE
20|FH_F92659_0_0|SrvcGrp|92546|2022|PDM|652.00|99|0.00|SKIN FULL GRAFT PROCEDURE
20|FH_F92659_0_0|SrvcGrp|92550|2022|PDM|652.00|99|0.00|TREATMENT OF RETINA
20|FH_F92716_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F92716_0_0|SrvcGrp|93118|2022|PDM|744.00|99|0.00|AETNA AMB SURG W/O AEG 1-2 AND CPT 46221
20|FH_F92752_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F92752_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F92792_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OP IMAGING ENHANC. SUBSTANCES (IMAGENHANCE)
20|FH_F92792_0_0|CSTM-ALL|CSTM-00|2020|PDM|746.90|99|0.00|AEG 2 (NO REV)
20|FH_F92792_0_0|SrvcGrp|46906|2022|PDM|2200.00|99|0.00|CORNEAL TISSUE
20|FH_F92792_0_0|SrvcGrp|99073|2022|PDM|1.38|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F92833_0_0|CSTM-ALL|CSTM-00|2020|PDM|1338.00|99|0.00|AEG 10 (NO REV)
20|FH_F92833_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F92833_0_0|SrvcGrp|35668|2022|PDM|2215.00|99|0.00|CPT 29824
20|FH_F92852_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F92852_0_0|CSTM-ALL|CSTM-00|2020|PDM|557.70|99|0.00|AETNA GLENNVILLE 2016 AEG 1
20|FH_F92852_0_0|CSTM-ALL|CSTM-00|2020|PDM|746.90|99|0.00|AETNA GLENNVILLE 2016 AEG 2
20|FH_F92852_0_0|SrvcGrp|38909|2022|PDM|1320.00|99|0.00|CPT 67036 - VITRECTOMY, MECHANICAL
20|FH_F92852_0_0|SrvcGrp|46887|2022|PDM|2200.00|99|0.00|REPAIR DETACHED RETINA
20|FH_F92852_0_0|SrvcGrp|46906|2022|PDM|2200.00|99|0.00|CORNEAL TISSUE
20|FH_F92852_0_0|SrvcGrp|88154|2022|PDM|2200.00|99|0.00|LASER TREATMENT OLD RETINA
20|FH_F92871_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F92871_0_0|CSTM-ALL|CSTM-00|2020|PDM|1211.00|99|0.00|AEG 9 (NO REV)
20|FH_F92871_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 3 (NO REV)
20|FH_F92871_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F92935_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F92935_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F92935_0_0|CSTM-ALL|CSTM-00|2020|PDM|1304.00|99|0.00|AEG 7 (NO REV)
20|FH_F92935_0_0|CSTM-ALL|CSTM-00|2020|PDM|884.88|99|0.00|AEG 6 (NO REV)
20|FH_F92935_0_0|CSTM-ALL|CSTM-00|2020|PDM|939.00|99|0.00|AEG 5  (NO REV)
20|FH_F92959_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F92993_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F92993_0_0|CSTM-ALL|CSTM-00|2020|PDM|137.03|99|0.00|CPT 95810 (W/MOD 26)
20|FH_F92993_0_0|CSTM-ALL|CSTM-00|2020|PDM|142.10|99|0.00|CPT 95811 (W/MOD 26)
20|FH_F92993_0_0|CSTM-ALL|CSTM-00|2020|PDM|413.06|99|0.00|AETNA POLYSOMNOGRAPHY
20|FH_F92993_0_0|CSTM-ALL|CSTM-00|2020|PDM|47.12|99|0.00|CPT 95805 (W/MOD 26)
20|FH_F92993_0_0|CSTM-ALL|CSTM-00|2020|PDM|481.86|99|0.00|AETNA POLYSOMNOGRAPHY (MOD 26 AND TC)
20|FH_F92993_0_0|CSTM-ALL|CSTM-00|2020|PDM|562.97|99|0.00|CPT 95810 (W/MOD TC)
20|FH_F92993_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|POLYSOMNOGRAPHY
20|FH_F92993_0_0|SrvcGrp|42722|2022|PDM|48.50|99|0.00|SLEEP STUDIES CPT 95806 W/MODIFIER 26
20|FH_F93136_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F93136_0_0|SrvcGrp|72992|2022|PDM|446.00|99|0.00|AEG 2
20|FH_F93136_0_0|SrvcGrp|72996|2022|PDM|630.00|99|0.00|AEG 4
20|FH_F93136_0_0|SrvcGrp|73004|2022|PDM|973.00|99|0.00|AEG 8
20|FH_F93136_0_0|SrvcGrp|73008|2022|PDM|630.00|99|0.00|AEG 10
20|FH_F93136_0_0|SrvcGrp|89239|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F93136_0_0|SrvcGrp|89569|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F93171_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F93172_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|AETNA CARDIAC CATHETERIZATION
20|FH_F93172_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|CARDIAC CATHETERIZATION INJECTIONS
20|FH_F93212_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F93212_0_0|SrvcGrp|11663|2022|PCT|0.70|99|0.00|IMPLANTS
20|FH_F93232_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F93232_0_0|SrvcGrp|42784|2022|PDM|45.00|99|0.00|OCCUPATIONAL THERAPY  SRVCS
20|FH_F93232_0_0|SrvcGrp|471|2022|PDM|575.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F93237_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F93252_0_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|AEG 7 (NO REV) 2016 BRANDON ASC
20|FH_F93252_0_0|CSTM-ALL|CSTM-00|2020|PDM|1826.00|99|0.00|AEG 8 (NO REV) 2016 BRANDON ASC
20|FH_F93252_0_0|CSTM-ALL|CSTM-00|2020|PDM|873.00|99|0.00|AEG 3 (NO REV) 2016 BRANDON ASC
20|FH_F93252_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F93252_0_0|SrvcGrp|33967|2022|PDM|2500.00|99|0.00|CPT 47562
20|FH_F93252_0_0|SrvcGrp|33984|2022|PDM|2000.00|99|0.00|HAMMERTOE CORRECTION
20|FH_F93252_0_0|SrvcGrp|87679|2022|PDM|1500.00|99|0.00|LUMBAR OR SACRAL SURGERY
20|FH_F93252_0_0|SrvcGrp|88739|2022|PDM|2500.00|99|0.00|IMPLANT SPINAL CANAL
20|FH_F93252_0_0|SrvcGrp|93013|2022|PDM|1500.00|99|0.00|COLORECTAL CANCER SCREENING
20|FH_F93252_0_0|SrvcGrp|93015|2022|PDM|2500.00|99|0.00|CERVICAL DISC REPLACEMENT SURGERIES
20|FH_F93252_0_0|SrvcGrp|93028|2022|PDM|2000.00|99|0.00|BREAST BIOPSY SURGERIES
20|FH_F93275_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F93275_0_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|AEG 4 (NO REV)
20|FH_F93275_0_0|CSTM-ALL|CSTM-00|2020|PDM|2805.00|99|0.00|AEG 6 (NO REV)
20|FH_F93275_0_0|CSTM-ALL|CSTM-00|2020|PDM|6600.00|99|0.00|AEG 8 (NO REV)
20|FH_F93275_0_0|SrvcGrp|91564|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F93279_0_0|CSTM-ALL|CSTM-00|2020|PDM|777.00|99|0.00|AEG 4 (NO REV)
20|FH_F93281_0_0|CSTM-ALL|CSTM-00|2020|PDM|430.00|99|0.00|AEG 10 (NO REV)
20|FH_F93287_0_0|CSTM-ALL|CSTM-00|2020|PDM|395.00|99|0.00|AEG 10 (NO REV)
20|FH_F93331_0_0|CSTM-ALL|CSTM-00|2020|PDM|1957.00|99|0.00|AEG 5  (NO REV)
20|FH_F93331_0_0|CSTM-ALL|CSTM-00|2020|PDM|2678.00|99|0.00|AEG 8 (NO REV)
20|FH_F93332_0_0|CSTM-ALL|CSTM-00|2020|PDM|1236.00|99|0.00|AEG 6 (NO REV)
20|FH_F93332_0_0|CSTM-ALL|CSTM-00|2020|PDM|1313.00|99|0.00|AEG 8 (NO REV)
20|FH_F93332_0_0|CSTM-ALL|CSTM-00|2020|PDM|1365.00|99|0.00|AEG 7 (NO REV)
20|FH_F93332_0_0|CSTM-ALL|CSTM-00|2020|PDM|536.00|99|0.00|AEG 1 (NO REV)
20|FH_F93332_0_0|CSTM-ALL|CSTM-00|2020|PDM|536.00|99|0.00|AEG 10 (NO REV)
20|FH_F93332_0_0|CSTM-ALL|CSTM-00|2020|PDM|937.00|99|0.00|AEG 4 (NO REV)
20|FH_F93332_0_0|SrvcGrp|82109|2022|PDM|3090.00|99|0.00|REVISE ULNAR NERVE ELBOW
20|FH_F93332_0_0|SrvcGrp|88162|2022|PDM|7025.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON
20|FH_F93332_0_0|SrvcGrp|89857|2022|PDM|6386.00|99|0.00|REMOVAL OF SPINAL LAMINA
20|FH_F93332_0_0|SrvcGrp|93060|2022|PDM|2096.00|99|0.00|SPINAL BONE AUTOGRAFT (HCFA)
20|FH_F93332_0_0|SrvcGrp|93062|2022|PDM|3090.00|99|0.00|PERQ CERVICOTHORACIC INJECTION (HCFA)
20|FH_F93332_0_0|SrvcGrp|93069|2022|PDM|2295.00|99|0.00|POSTERIOR NON-SEGMENTAL INST
20|FH_F93332_0_0|SrvcGrp|93070|2022|PDM|2295.00|99|0.00|POSTERIOR NON-SEGMENTAL INST (HFCA)
20|FH_F93332_0_0|SrvcGrp|93071|2022|PDM|2295.00|99|0.00|POSTERIOR SEGMENTAL INSTRU
20|FH_F93332_0_0|SrvcGrp|93072|2022|PDM|2295.00|99|0.00|POSTERIOR SEGMENTAL INSTRU (HCFA)
20|FH_F93332_0_0|SrvcGrp|93073|2022|PDM|1906.00|99|0.00|ALLOGRAFT SPINE SURG (HCFA)
20|FH_F93332_0_0|SrvcGrp|93081|2022|PDM|7725.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY (HCFA)
20|FH_F93332_0_0|SrvcGrp|93082|2022|PDM|7416.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR (HCFA)
20|FH_F93332_0_0|SrvcGrp|93094|2022|PDM|7025.00|99|0.00|CORPECTOMY (HCFA)
20|FH_F93333_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F93333_0_0|CSTM-ALL|CSTM-00|2020|PDM|1814.00|99|0.00|AEG 8 (NO REV)
20|FH_F93333_0_0|CSTM-ALL|CSTM-00|2020|PDM|947.00|99|0.00|AEG 3 (NO REV)
20|FH_F93333_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F93333_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F93354_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F93375_0_0|SrvcGrp|73004|2022|PDM|1102.00|99|0.00|AEG 8
20|FH_F93375_0_0|SrvcGrp|73008|2022|PDM|535.00|99|0.00|AEG 10
20|FH_F93377_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F93377_0_0|SrvcGrp|74546|2022|PDM|500.00|99|0.00|HOSPICE SERVICES
20|FH_F93377_0_0|SrvcGrp|82223|2022|PDM|27.00|99|0.00|HOSPICE CARE
20|FH_F93381_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F93384_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F93384_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F93384_0_0|SrvcGrp|42785|2022|PDM|45.00|99|0.00|SPEECH THERAPY  SRVCS
20|FH_F93384_0_0|SrvcGrp|471|2022|PDM|580.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F93421_0_0|SrvcGrp|12403|2022|PDM|32.24|99|0.00|CONTINUOUS HOMECARE
20|FH_F93512_0_0|CSTM-ALL|CSTM-00|2020|PDM|1045.00|99|0.00|AEG 7 (NO REV)
20|FH_F93512_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|AEG 1 (NO REV)
20|FH_F93512_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F93517_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F93517_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F93517_0_0|CSTM-ALL|CSTM-00|2020|PDM|746.00|99|0.00|AEG 1 (NO REV)
20|FH_F93592_0_0|CSTM-ALL|CSTM-00|2020|PDM|1070.00|99|0.00|AEG 8 (NO REV)
20|FH_F93592_0_0|CSTM-ALL|CSTM-00|2020|PDM|1095.00|99|0.00|AEG 7 (NO REV)
20|FH_F93592_0_0|CSTM-ALL|CSTM-00|2020|PDM|366.00|99|0.00|AEG 1 (NO REV)
20|FH_F123638_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F123644_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F123644_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F123644_0_0|SrvcGrp|73842|2022|PDM|215.00|99|0.00|AETNA INTENSIVE OUTPATIENT
20|FH_F123644_0_0|SrvcGrp|86722|2022|PDM|215.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)
20|FH_F123726_0_0|CSTM-ALL|CSTM-00|2020|PDM|1196.00|99|0.00|AEG 8 (NO REV)
20|FH_F123726_0_0|CSTM-ALL|CSTM-00|2020|PDM|490.00|99|0.00|AEG 2 (NO REV)
20|FH_F123726_0_0|SrvcGrp|93759|2022|PCT|0.00|99|0.00|CARDIAC CATH
20|FH_F123745_0_0|CSTM-ALL|CSTM-00|2020|PDM|4500.00|99|0.00|AEG 5  (NO REV)
20|FH_F123745_0_0|SrvcGrp|10986|2022|PDM|8500.00|99|0.00|ARTHROSCOPIC KNEE REPAIR
20|FH_F123745_0_0|SrvcGrp|35666|2022|PDM|2500.00|99|0.00|CPT 23700
20|FH_F123745_0_0|SrvcGrp|67066|2022|PDM|4000.00|99|0.00|CERVICAL SURGERY
20|FH_F123745_0_0|SrvcGrp|67068|2022|PDM|13500.00|99|0.00|LUMBAR SPINE FUSION COMBINED
20|FH_F123745_0_0|SrvcGrp|67069|2022|PDM|4000.00|99|0.00|CPT 22634
20|FH_F123745_0_0|SrvcGrp|93071|2022|PDM|3600.00|99|0.00|POSTERIOR SEGMENTAL INSTRU
20|FH_F123745_0_0|SrvcGrp|97895|2022|PDM|16500.00|99|0.00|REVISE KNEE 2
20|FH_F123774_0_0|SrvcGrp|72998|2022|PDM|1008.00|99|0.00|AEG 5
20|FH_F123844_0_0|SrvcGrp|65720|2022|PDM|190.00|99|0.00|RESPITE CARE
20|FH_F123844_0_0|SrvcGrp|80920|2022|PDM|678.00|99|0.00|HOSPICE SERVICES
20|FH_F123850_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F123850_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F123915_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F123915_0_0|SrvcGrp|30609|2022|PDM|44.74|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F123915_0_0|SrvcGrp|63297|2022|PDM|194.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F123915_0_0|SrvcGrp|90707|2022|PDM|190.00|99|0.00|AETNA HOSPICE CARE
20|FH_F123915_0_0|SrvcGrp|94781|2022|PDM|194.00|99|0.00|HOSPICE IN LTCH (HCFA)
20|FH_F123926_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F123926_0_0|CSTM-ALL|CSTM-00|2020|PDM|1339.00|99|0.00|AEG 9 (NO REV)
20|FH_F123926_0_0|SrvcGrp|86505|2022|PDM|1785.00|99|0.00|DENTAL SURGERY
20|FH_F123963_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F123963_0_0|CSTM-ALL|CSTM-00|2020|PDM|2369.52|99|0.00|AEG 8 (NO REV)
20|FH_F123963_0_0|CSTM-ALL|CSTM-00|2020|PDM|824.18|99|0.00|AEG 1 (NO REV)
20|FH_F123963_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F124017_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F124017_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 8 (NO REV)
20|FH_F124017_0_0|SrvcGrp|101303|2022|PDM|3500.00|99|0.00|KNEE ARTHROSCOPY / SURGERY
20|FH_F124017_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F124017_0_0|SrvcGrp|107374|2022|PDM|8500.00|99|0.00|AETNA ARTHRODESIS INTERSPC
20|FH_F124017_0_0|SrvcGrp|108275|2022|PDM|4500.00|99|0.00|SP BONE ALGRFT MORSEL ADD-ON
20|FH_F124017_0_0|SrvcGrp|109667|2022|PDM|7000.00|99|0.00|ARTHRODESIS, ANT INTER TECH
20|FH_F124017_0_0|SrvcGrp|109668|2022|PDM|8500.00|99|0.00|ARTHRODESIS, POSTERIOR, LUMBAR
20|FH_F124017_0_0|SrvcGrp|109669|2022|PDM|4500.00|99|0.00|POSTERIOR NON-SEGMENTAL INST
20|FH_F124017_0_0|SrvcGrp|11043|2022|PDM|1450.00|99|0.00|CARPAL TUNNEL RELEASE
20|FH_F124017_0_0|SrvcGrp|85198|2022|PDM|8000.00|99|0.00|AETNA KNEE ARTHROSCOPY
20|FH_F124017_0_0|SrvcGrp|86199|2022|PDM|3500.00|99|0.00|ARTHROSCOPY HIP
20|FH_F124017_0_0|SrvcGrp|96350|2022|PDM|12800.00|99|0.00|SHOULDER JOINT
20|FH_F124017_0_0|SrvcGrp|97099|2022|PDM|5200.00|99|0.00|SPINAL DISK SURGERY ADD-ON
20|FH_F124017_0_0|SrvcGrp|98563|2022|PDM|5000.00|99|0.00|LUMBAR SPINE FUSION
20|FH_F124017_0_0|SrvcGrp|98601|2022|PDM|5200.00|99|0.00|TRANSPEDICULAR 1 SEG THORACIC
20|FH_F124044_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F124044_0_0|SrvcGrp|82137|2022|PCT|0.82|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F124180_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F124180_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F124180_0_0|CSTM-ALL|CSTM-00|2020|PDM|465.00|99|0.00|PHENYLEPHRINE KETOROLAC
20|FH_F124180_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F124180_0_0|SrvcGrp|108935|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F124180_0_0|SrvcGrp|109738|2022|PDM|3000.00|99|0.00|OCULR RECNSTR; LIMBL CONJNCT
20|FH_F124180_0_0|SrvcGrp|109742|2022|PDM|1900.00|99|0.00|LARYNGOSCOPY
20|FH_F124180_0_0|SrvcGrp|22915|2022|PDM|3184.50|99|0.00|CPT CODE 42820
20|FH_F124180_0_0|SrvcGrp|45863|2022|PDM|3500.00|99|0.00|CPT 65730
20|FH_F124180_0_0|SrvcGrp|68281|2022|PDM|3500.00|99|0.00|CPT 67041
20|FH_F124180_0_0|SrvcGrp|72992|2022|PDM|1125.00|99|0.00|AEG 2
20|FH_F124180_0_0|SrvcGrp|72996|2022|PDM|1519.00|99|0.00|AEG 4
20|FH_F124180_0_0|SrvcGrp|73002|2022|PDM|2700.00|99|0.00|AEG 7
20|FH_F124180_0_0|SrvcGrp|80139|2022|PDM|7314.50|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F124180_0_0|SrvcGrp|86033|2022|PDM|3500.00|99|0.00|CPT 67107
20|FH_F124180_0_0|SrvcGrp|86036|2022|PDM|3500.00|99|0.00|CORNEAL TRANSPLANT
20|FH_F124180_0_0|SrvcGrp|91381|2022|PDM|1800.00|99|0.00|REMOVAL OF ADENOIDS
20|FH_F124219_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F124219_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F124262_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F124369_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F124369_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F124369_0_0|CSTM-ALL|CSTM-00|2020|PDM|2113.00|99|0.00|AEG 3 (NO REV)
20|FH_F124369_0_0|SrvcGrp|100065|2022|PDM|4400.00|99|0.00|DEEP ANT OR POSTER TIBIAL
20|FH_F124369_0_0|SrvcGrp|102480|2022|PDM|11220.00|99|0.00|CPT 29897
20|FH_F124369_0_0|SrvcGrp|102481|2022|PDM|12155.00|99|0.00|CPT 29898
20|FH_F124369_0_0|SrvcGrp|103331|2022|PDM|17765.00|99|0.00|REVISION OF LOWER LEG TENDON
20|FH_F124369_0_0|SrvcGrp|104114|2022|PDM|9350.00|99|0.00|INCISION OF FOOT FASCIA
20|FH_F124369_0_0|SrvcGrp|107986|2022|PDM|6545.00|99|0.00|REMOVAL OF FOOT LESION
20|FH_F124369_0_0|SrvcGrp|109788|2022|PDM|4730.00|99|0.00|REVISION OF HAMMERTOE
20|FH_F124369_0_0|SrvcGrp|109789|2022|PDM|11220.00|99|0.00|REPAIR OF FOOT BONES
20|FH_F124369_0_0|SrvcGrp|109791|2022|PDM|17765.00|99|0.00|FUSION OF FOOT BONES
20|FH_F124369_0_0|SrvcGrp|33973|2022|PDM|9350.00|99|0.00|CPT 28119
20|FH_F124369_0_0|SrvcGrp|34609|2022|PDM|7480.00|99|0.00|PODIATRIC PROCEDURE CPT 28080
20|FH_F124369_0_0|SrvcGrp|35667|2022|PDM|2750.00|99|0.00|CPT 20680
20|FH_F124369_0_0|SrvcGrp|38352|2022|PDM|4400.00|99|0.00|FOOT MUSCLOSKELETAL PROCEDURE
20|FH_F124369_0_0|SrvcGrp|84307|2022|PDM|12155.00|99|0.00|TENDON REPAIR
20|FH_F124369_0_0|SrvcGrp|89989|2022|PDM|11220.00|99|0.00|FUSION OF BIG TOE JOINT
20|FH_F124369_0_0|SrvcGrp|92197|2022|PDM|17765.00|99|0.00|CORRECTION OF BUNION
20|FH_F124369_0_0|SrvcGrp|98465|2022|PDM|11220.00|99|0.00|OPEN TXMT METATARSOPHALANGEAL
20|FH_F124369_0_0|SrvcGrp|98467|2022|PDM|4290.00|99|0.00|REPAIR BIG TOE FRACTURE
20|FH_F124369_0_0|SrvcGrp|98470|2022|PDM|1815.00|99|0.00|AMPUTATION TOE
20|FH_F124369_0_0|SrvcGrp|99172|2022|PDM|17765.00|99|0.00|CPT 28740
20|FH_F124371_0_0|SrvcGrp|100961|2022|PDM|284.05|99|0.00|AMB SRVC NEONAT TRNSPRT BS RATE EMERG 1 WAY
20|FH_F124371_0_0|SrvcGrp|106294|2022|PDM|344.16|99|0.00|AMBULANCE SERVICE EMERGENCY TRANSPORT LEVEL 1 (HFCA)
20|FH_F124371_0_0|SrvcGrp|107353|2022|PDM|284.05|99|0.00|AMB SRVC NEONAT TRNSPRT BS RATE EMERG 1 WAY (HCFA)
20|FH_F124371_0_0|SrvcGrp|13262|2022|PDM|6.47|99|0.00|GROUND MILEAGE, PER STATUTE MILE
20|FH_F124371_0_0|SrvcGrp|13422|2022|PDM|217.36|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC
20|FH_F124371_0_0|SrvcGrp|13595|2022|PDM|344.16|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC
20|FH_F124371_0_0|SrvcGrp|13681|2022|PDM|289.81|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT
20|FH_F124371_0_0|SrvcGrp|13683|2022|PDM|498.38|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2
20|FH_F124372_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F124372_0_0|SrvcGrp|107747|2022|PDM|339.00|99|0.00|HOME HEMODIALYSIS
20|FH_F124372_0_0|SrvcGrp|113580|2022|PDM|150.00|99|0.00|DIALYSIS PATIENT TRAINING
20|FH_F124388_0_0|CSTM-ALL|CSTM-00|2020|PDM|845.90|99|0.00|AEG 3 (NO REV)
20|FH_F124388_0_0|SrvcGrp|11663|2022|PCT|1.05|99|0.00|IMPLANTS
20|FH_F124388_0_0|SrvcGrp|63463|2022|PDM|1254.00|99|0.00|CPT 52204
20|FH_F124388_0_0|SrvcGrp|63466|2022|PDM|1254.00|99|0.00|CPT 52005
20|FH_F124388_0_0|SrvcGrp|77445|2022|PDM|2303.40|99|0.00|REMOVAL OF HYDROCELE
20|FH_F124388_0_0|SrvcGrp|77449|2022|PDM|2755.50|99|0.00|CPT 52352
20|FH_F124388_0_0|SrvcGrp|77452|2022|PDM|19908.90|99|0.00|CPT 54405
20|FH_F124388_0_0|SrvcGrp|77461|2022|PDM|2755.50|99|0.00|CPT 52356
20|FH_F124388_0_0|SrvcGrp|84704|2022|PDM|1254.00|99|0.00|CYSTOURETHROSCOPY W/ REMOVAL OF FOREIGN BODY
20|FH_F124388_0_0|SrvcGrp|98526|2022|PDM|1254.00|99|0.00|CYSTOURETHROSCOPY
20|FH_F124407_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F124407_0_0|CSTM-ALL|CSTM-00|2020|PDM|503.00|99|0.00|AEG 2 (NO REV)
20|FH_F124407_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|AMBULATORY SURGERY W/O AEG 1 & 2
20|FH_F124438_0_0|SrvcGrp|87077|2022|PDM|140.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F124441_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F124441_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F124441_0_0|CSTM-ALL|CSTM-00|2020|PDM|1182.75|99|0.00|AEG 2 (NO REV)
20|FH_F124441_0_0|SrvcGrp|100059|2022|PDM|3040.00|99|0.00|REPAIR ULNA FRACTURE
20|FH_F124441_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F124441_0_0|SrvcGrp|104448|2022|PDM|11244.20|99|0.00|CYSTOSCOPY IMPLANT 4 OR MORE
20|FH_F124441_0_0|SrvcGrp|107035|2022|PDM|2375.00|99|0.00|TREATMENT OF FRACTURE
20|FH_F124441_0_0|SrvcGrp|108094|2022|PDM|12825.00|99|0.00|REVISE KNEE
20|FH_F124441_0_0|SrvcGrp|109830|2022|PDM|11400.00|99|0.00|INSERTION  BIOMECHANICAL DEVICE
20|FH_F124441_0_0|SrvcGrp|109832|2022|PDM|12825.00|99|0.00|SHOULDER / ELBOW ARTHROPLASTY
20|FH_F124441_0_0|SrvcGrp|11673|2022|PDM|3325.00|99|0.00|CPT 29888
20|FH_F124441_0_0|SrvcGrp|15473|2022|PDM|2375.00|99|0.00|CPT CODE 42820
20|FH_F124441_0_0|SrvcGrp|26278|2022|PDM|2375.00|99|0.00|CPT 29881
20|FH_F124441_0_0|SrvcGrp|27261|2022|PDM|12825.00|99|0.00|CPT 27446
20|FH_F124441_0_0|SrvcGrp|36591|2022|PDM|30400.00|99|0.00|CPT 63685
20|FH_F124441_0_0|SrvcGrp|77021|2022|PDM|5700.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY
20|FH_F124441_0_0|SrvcGrp|88162|2022|PDM|5700.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON
20|FH_F124441_0_0|SrvcGrp|88164|2022|PDM|9025.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR
20|FH_F124441_0_0|SrvcGrp|89853|2022|PDM|2375.00|99|0.00|NASAL/SINUS ENDOSCOPY-SURG
20|FH_F124441_0_0|SrvcGrp|89980|2022|PDM|5700.00|99|0.00|OPEN TREATMENT OF DISTAL
20|FH_F124441_0_0|SrvcGrp|92365|2022|PDM|13300.00|99|0.00|FUSION OF SACROILIAC JOINT
20|FH_F124444_0_0|SrvcGrp|82981|2022|PDM|130.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F124486_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F124486_0_0|CSTM-ALL|CSTM-00|2020|PDM|2618.00|99|0.00|INSERT ANT SEGMENT DRAIN IN (HCFA)
20|FH_F124486_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 1 (NO REV)
20|FH_F124486_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|AEG 3 (NO REV)
20|FH_F124486_0_0|CSTM-ALL|CSTM-00|2020|PDM|973.00|99|0.00|AEG 8 (NO REV)
20|FH_F124505_0_0|SrvcGrp|109899|2022|PDM|311.00|99|0.00|MEDICARE OUTPATIENT GROUPER 9 & 10
20|FH_F124505_0_0|SrvcGrp|80537|2022|PDM|323.00|99|0.00|AETNA MEDICARE OUTPATIENT GROUPER 1
20|FH_F124505_0_0|SrvcGrp|80540|2022|PDM|612.00|99|0.00|AETNA MEDICARE OUTPATIENT GROUPER 4
20|FH_F124542_0_0|SrvcGrp|109899|2022|PDM|311.00|99|0.00|MEDICARE OUTPATIENT GROUPER 9 & 10
20|FH_F124542_0_0|SrvcGrp|80541|2022|PDM|698.00|99|0.00|AETNA MEDICARE OUTPATIENT GROUPER 5
20|FH_F124542_0_0|SrvcGrp|99073|2022|PDM|1.32|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F124608_0_0|SrvcGrp|109833|2022|PDM|8160.00|99|0.00|REPLACE ELBOW JOINT
20|FH_F124608_0_0|SrvcGrp|33965|2022|PDM|5396.00|99|0.00|CPT 58552
20|FH_F124608_0_0|SrvcGrp|41334|2022|PDM|7956.00|99|0.00|TOTAL KNEE
20|FH_F124608_0_0|SrvcGrp|74039|2022|PDM|5865.00|99|0.00|LAMINECTOMY
20|FH_F124608_0_0|SrvcGrp|80617|2022|PDM|9149.00|99|0.00|ARTHOPLASTY
20|FH_F124608_0_0|SrvcGrp|93067|2022|PDM|8160.00|99|0.00|SPINE FUSION EXTRA SEGMENT
20|FH_F124608_0_0|SrvcGrp|97730|2022|PDM|7650.00|99|0.00|REVERSE HIP JOINT
20|FH_F124660_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F124660_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F124660_0_0|SrvcGrp|109930|2022|PDM|903.00|99|0.00|DESTROY CERV/THOR FACET JNT
20|FH_F124660_0_0|SrvcGrp|72990|2022|PDM|443.00|99|0.00|AEG 1
20|FH_F124660_0_0|SrvcGrp|72994|2022|PDM|603.00|99|0.00|AEG 3
20|FH_F124660_0_0|SrvcGrp|73004|2022|PDM|1138.00|99|0.00|AEG 8
20|FH_F124660_0_0|SrvcGrp|73008|2022|PDM|847.00|99|0.00|AEG 10
20|FH_F124660_0_0|SrvcGrp|89721|2022|PDM|2500.00|99|0.00|SPINAL NEUROSTIMULATION
20|FH_F124710_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F124710_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F124711_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F124727_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F124738_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F124738_0_0|SrvcGrp|72996|2022|PDM|620.00|99|0.00|AEG 4
20|FH_F124738_0_0|SrvcGrp|73006|2022|PDM|1320.00|99|0.00|AEG 9
20|FH_F124738_0_0|SrvcGrp|73008|2022|PDM|330.00|99|0.00|AEG 10
20|FH_F124743_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F124785_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F124785_0_0|SrvcGrp|87077|2022|PDM|80.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F124788_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F124788_0_0|SrvcGrp|72994|2022|PDM|510.00|99|0.00|AEG 3
20|FH_F124788_0_0|SrvcGrp|73000|2022|PDM|826.00|99|0.00|AEG 6
20|FH_F124788_0_0|SrvcGrp|73004|2022|PDM|973.00|99|0.00|AEG 8
20|FH_F124854_0_0|SrvcGrp|82222|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F124903_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F124903_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F124927_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 9 (NO REV)
20|FH_F124927_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|AEG 1 (NO REV)
20|FH_F124965_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F124965_0_0|SrvcGrp|72996|2022|PDM|1100.00|99|0.00|AEG 4
20|FH_F124965_0_0|SrvcGrp|73000|2022|PDM|1400.00|99|0.00|AEG 6
20|FH_F124976_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F124976_0_0|SrvcGrp|16069|2022|PDM|651.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT
20|FH_F124976_0_0|SrvcGrp|3178|2022|PDM|1213.00|99|0.00|ACUTE PSYCH
20|FH_F124976_0_0|SrvcGrp|87441|2022|PDM|651.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY (HCFA)
20|FH_F125053_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F125053_0_0|SrvcGrp|110066|2022|PDM|768.00|99|0.00|ANOSCOPY CONTROL BLEEDING
20|FH_F125053_0_0|SrvcGrp|67989|2022|PDM|2370.00|99|0.00|CPT 49320
20|FH_F125053_0_0|SrvcGrp|72992|2022|PDM|482.00|99|0.00|AEG 2
20|FH_F125053_0_0|SrvcGrp|73000|2022|PDM|905.00|99|0.00|AEG 6
20|FH_F125053_0_0|SrvcGrp|73002|2022|PDM|1077.00|99|0.00|AEG 7
20|FH_F125053_0_0|SrvcGrp|79579|2022|PDM|3315.00|99|0.00|CPT 43251
20|FH_F125053_0_0|SrvcGrp|79583|2022|PDM|2028.00|99|0.00|CPT 45381
20|FH_F125053_0_0|SrvcGrp|79588|2022|PDM|1783.50|99|0.00|CPT 43235
20|FH_F125053_0_0|SrvcGrp|79593|2022|PDM|1962.00|99|0.00|CPT 45378
20|FH_F125069_0_0|CSTM-ALL|CSTM-00|2020|PDM|912.00|99|0.00|AETNA AMBULATORY SURGERY W/O AEG 1 & 2
20|FH_F125110_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F125113_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F125113_0_0|SrvcGrp|93740|2022|PDM|2000.00|99|0.00|REVISE/REMOVE NEURO RECEIVER
20|FH_F125115_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F125124_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F125124_0_0|SrvcGrp|72992|2022|PDM|482.00|99|0.00|AEG 2
20|FH_F125124_0_0|SrvcGrp|72996|2022|PDM|680.00|99|0.00|AEG 4
20|FH_F125124_0_0|SrvcGrp|73006|2022|PDM|1547.00|99|0.00|AEG 9
20|FH_F125124_0_0|SrvcGrp|73008|2022|PDM|360.00|99|0.00|AEG 10
20|FH_F125124_0_0|SrvcGrp|78286|2022|PDM|8280.00|99|0.00|CPT 49322
20|FH_F125124_0_0|SrvcGrp|79589|2022|PDM|1923.00|99|0.00|UPPER GI
20|FH_F125124_0_0|SrvcGrp|79593|2022|PDM|1962.00|99|0.00|CPT 45378
20|FH_F125124_0_0|SrvcGrp|79595|2022|PDM|2535.00|99|0.00|CPT 45385
20|FH_F125124_0_0|SrvcGrp|82301|2022|PDM|2233.50|99|0.00|HEMORRHOIDECTOMY
20|FH_F125134_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F125134_0_0|SrvcGrp|108042|2022|PDM|400.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD
20|FH_F125134_0_0|SrvcGrp|108043|2022|PDM|171.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD
20|FH_F125146_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F125146_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F125163_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F125163_0_0|SrvcGrp|108042|2022|PDM|1300.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD
20|FH_F125173_0_0|SrvcGrp|108042|2022|PDM|400.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD
20|FH_F125173_0_0|SrvcGrp|108043|2022|PDM|171.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD
20|FH_F125181_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F125181_0_0|SrvcGrp|87077|2022|PDM|150.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F125182_0_0|SrvcGrp|110066|2022|PDM|768.00|99|0.00|ANOSCOPY CONTROL BLEEDING
20|FH_F125182_0_0|SrvcGrp|73002|2022|PDM|1077.00|99|0.00|AEG 7
20|FH_F125182_0_0|SrvcGrp|79583|2022|PDM|2028.00|99|0.00|CPT 45381
20|FH_F125182_0_0|SrvcGrp|79588|2022|PDM|1783.50|99|0.00|CPT 43235
20|FH_F125182_0_0|SrvcGrp|85000|2022|PDM|2410.50|99|0.00|CPT 45384
20|FH_F125206_0_0|CSTM-ALL|CSTM-00|2020|PDM|1519.00|99|0.00|COVENTRY ENHANCED GROUPER 2
20|FH_F125206_0_0|CSTM-ALL|CSTM-00|2020|PDM|3085.00|99|0.00|COVENTRY ENHANCED GROUPER 7
20|FH_F125244_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F125244_0_0|CSTM-ALL|CSTM-00|2020|PDM|1600.00|99|0.00|AEG 8 (NO REV)
20|FH_F125244_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 2 (NO REV)
20|FH_F125244_0_0|SrvcGrp|101522|2022|PDM|5500.00|99|0.00|T1H W/T/O UTERUS (>250G)
20|FH_F125244_0_0|SrvcGrp|104750|2022|PDM|4500.00|99|0.00|REPAIR BLADDER & VAGINA
20|FH_F125244_0_0|SrvcGrp|104751|2022|PDM|3700.00|99|0.00|REPAIR RECTUM & VAGINA
20|FH_F125244_0_0|SrvcGrp|110095|2022|PDM|2500.00|99|0.00|REPAIR PARAVAG DEFECT
20|FH_F125244_0_0|SrvcGrp|110096|2022|PDM|5500.00|99|0.00|LAPAROSCOPY SURGICAL COLPOPE
20|FH_F125244_0_0|SrvcGrp|110097|2022|PDM|4500.00|99|0.00|SUSPENSION OF UTERUS
20|FH_F125244_0_0|SrvcGrp|17327|2022|PDM|3000.00|99|0.00|HYSTEROSCOPY
20|FH_F125244_0_0|SrvcGrp|27347|2022|PDM|4000.00|99|0.00|CPT 58558
20|FH_F125244_0_0|SrvcGrp|33965|2022|PDM|5000.00|99|0.00|CPT 58552
20|FH_F125244_0_0|SrvcGrp|63472|2022|PDM|6900.00|99|0.00|CPT 64581
20|FH_F125244_0_0|SrvcGrp|78285|2022|PDM|4000.00|99|0.00|CPT 58671
20|FH_F125249_0_0|CSTM-ALL|CSTM-00|2020|PDM|2230.00|99|0.00|AEG 9 (NO REV)
20|FH_F125249_0_0|CSTM-ALL|CSTM-00|2020|PDM|608.00|99|0.00|AEG 1 (NO REV)
20|FH_F125249_0_0|CSTM-ALL|CSTM-00|2020|PDM|811.00|99|0.00|AEG 2 (NO REV)
20|FH_F125249_0_0|SrvcGrp|100002|2022|PDM|2600.00|99|0.00|REPAIR SHOULDER CAPSULE
20|FH_F125249_0_0|SrvcGrp|100066|2022|PDM|1400.00|99|0.00|REPAIR RADIUS FRACTURE
20|FH_F125249_0_0|SrvcGrp|104111|2022|PDM|900.00|99|0.00|EXCISE WRIST TENDON SHEATH
20|FH_F125249_0_0|SrvcGrp|108252|2022|PDM|1800.00|99|0.00|AETNA REPAIR DISLOCATION/FRACTURE
20|FH_F125249_0_0|SrvcGrp|108253|2022|PDM|1700.00|99|0.00|AETNA REPAIR ELBOW FRACTURE
20|FH_F125249_0_0|SrvcGrp|108257|2022|PDM|1400.00|99|0.00|AETNA FUSION HAND BONES WITH GRAFT
20|FH_F125249_0_0|SrvcGrp|108261|2022|PDM|1000.00|99|0.00|AETNA EXPLORE TREAT ANKLE JOINT
20|FH_F125249_0_0|SrvcGrp|108263|2022|PDM|700.00|99|0.00|AETNA DRAINAGE OF ARM LESION
20|FH_F125249_0_0|SrvcGrp|34606|2022|PDM|3200.00|99|0.00|CPT 29827
20|FH_F125249_0_0|SrvcGrp|41327|2022|PDM|1200.00|99|0.00|OP SURGERY CPT 28308
20|FH_F125249_0_0|SrvcGrp|58993|2022|PDM|5000.00|99|0.00|DISKECTOMY
20|FH_F125249_0_0|SrvcGrp|85792|2022|PDM|2000.00|99|0.00|OPEN TREATMENT OF DISTAL
20|FH_F125249_0_0|SrvcGrp|88162|2022|PDM|4000.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON
20|FH_F125249_0_0|SrvcGrp|90360|2022|PDM|1200.00|99|0.00|REPAIR FRACTURE OF ULNA
20|FH_F125249_0_0|SrvcGrp|90420|2022|PDM|1700.00|99|0.00|REPAIR CLAVICLE FRACTURE
20|FH_F125249_0_0|SrvcGrp|90422|2022|PDM|2000.00|99|0.00|REPAIR GRAFT RADIUS OR ULNA
20|FH_F125249_0_0|SrvcGrp|94904|2022|PDM|1100.00|99|0.00|REPAIR/REVISE WRIST JOINT
20|FH_F125249_0_0|SrvcGrp|98003|2022|PDM|1200.00|99|0.00|BIMALLEOLAR ANKLE FRACTURE
20|FH_F125259_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F125259_0_0|CSTM-ALL|CSTM-00|2020|PDM|1010.00|99|0.00|AEG 10 (NO REV)
20|FH_F125259_0_0|CSTM-ALL|CSTM-00|2020|PDM|1320.00|99|0.00|AEG 6 (NO REV)
20|FH_F125259_0_0|CSTM-ALL|CSTM-00|2020|PDM|720.00|99|0.00|AEG 2 (NO REV)
20|FH_F125259_0_0|SrvcGrp|106798|2022|PDM|4500.00|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT
20|FH_F125259_0_0|SrvcGrp|108118|2022|PDM|1750.00|99|0.00|ARTERIOVENOUS ANASTOMOSIS
20|FH_F125259_0_0|SrvcGrp|110098|2022|PDM|1750.00|99|0.00|AV FISTULA EXCISION
20|FH_F125260_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F125260_0_0|SrvcGrp|27968|2022|PCT|0.00|99|0.00|SKILLED NURSING LPN
20|FH_F125260_0_0|SrvcGrp|48396|2022|PDM|202.86|99|0.00|OT SERVICES
20|FH_F125260_0_0|SrvcGrp|88621|2022|PDM|185.10|99|0.00|SKILLED NURSING LPN
20|FH_F125328_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F125328_0_0|SrvcGrp|68000|2022|PDM|8718.00|99|0.00|CPT 58561
20|FH_F125328_0_0|SrvcGrp|72990|2022|PDM|360.00|99|0.00|AEG 1
20|FH_F125328_0_0|SrvcGrp|73004|2022|PDM|950.00|99|0.00|AEG 8
20|FH_F125328_0_0|SrvcGrp|73008|2022|PDM|360.00|99|0.00|AEG 10
20|FH_F125328_0_0|SrvcGrp|75282|2022|PDM|2305.50|99|0.00|DIAGNOSTIC HYSTEROSCOPY
20|FH_F125328_0_0|SrvcGrp|79588|2022|PDM|1783.50|99|0.00|CPT 43235
20|FH_F125328_0_0|SrvcGrp|79589|2022|PDM|1923.00|99|0.00|UPPER GI
20|FH_F125328_0_0|SrvcGrp|79590|2022|PDM|1884.00|99|0.00|CPT 43248
20|FH_F125328_0_0|SrvcGrp|79593|2022|PDM|1962.00|99|0.00|CPT 45378
20|FH_F125328_0_0|SrvcGrp|79594|2022|PDM|2259.00|99|0.00|CPT 45380
20|FH_F125473_0_0|CSTM-ALL|CSTM-00|2020|PDM|4157.00|99|0.00|AEG 4 (NO REV)
20|FH_F125473_0_0|CSTM-ALL|CSTM-00|2020|PDM|5300.00|99|0.00|AEG 8 (NO REV)
20|FH_F125515_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F125515_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F125515_0_0|SrvcGrp|82981|2022|PDM|135.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F125657_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F125772_0_0|CSTM-ALL|CSTM-00|2020|PDM|1600.00|99|0.00|AEG 10 (NO REV)
20|FH_F125824_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F125870_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F125870_0_0|SrvcGrp|28548|2022|PDM|2445.00|99|0.00|VITRECTOMY
20|FH_F125870_0_0|SrvcGrp|38909|2022|PDM|2445.00|99|0.00|CPT 67036 - VITRECTOMY, MECHANICAL
20|FH_F125928_0_0|SrvcGrp|106294|2022|PDM|344.16|99|0.00|AMBULANCE SERVICE EMERGENCY TRANSPORT LEVEL 1 (HFCA)
20|FH_F125928_0_0|SrvcGrp|106297|2022|PDM|181.13|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT (HCFA)
20|FH_F125938_0_0|SrvcGrp|13928|2022|PCT|0.75|99|0.00|DAY HOSPITAL HALF DAY
20|FH_F125940_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F125946_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F126070_0_0|SrvcGrp|72992|2022|PDM|543.00|99|0.00|AEG 2
20|FH_F126104_0_0|SrvcGrp|108081|2022|PDM|192.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS
20|FH_F126116_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F126116_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F126116_0_0|CSTM-ALL|CSTM-00|2020|PDM|736.00|99|0.00|AEG 1 (NO REV)
20|FH_F126116_0_0|SrvcGrp|101527|2022|PDM|982.00|99|0.00|HYSTEROSCOPY LYSIS
20|FH_F126116_0_0|SrvcGrp|103644|2022|PDM|11291.00|99|0.00|AETNA TIB/ PER REVASE W/ ATHER
20|FH_F126116_0_0|SrvcGrp|104315|2022|PDM|390.00|99|0.00|EVALUATION CARDIO TILT TABL
20|FH_F126116_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F126116_0_0|SrvcGrp|108192|2022|PDM|3331.00|99|0.00|FEM/POPL REVAS W/TLA
20|FH_F126116_0_0|SrvcGrp|41334|2022|PDM|13500.00|99|0.00|TOTAL KNEE
20|FH_F126116_0_0|SrvcGrp|91577|2022|PDM|11944.00|99|0.00|FEM/POPL REVASC STNT & ATHER
20|FH_F126116_0_0|SrvcGrp|97921|2022|PDM|2191.00|99|0.00|MYOMECTOMY ABDOM METHOD
20|FH_F126305_0_0|SrvcGrp|87077|2022|PDM|133.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F126345_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F126345_0_0|SrvcGrp|17327|2022|PDM|2428.00|99|0.00|HYSTEROSCOPY
20|FH_F126345_0_0|SrvcGrp|38364|2022|PDM|2278.00|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F126345_0_0|SrvcGrp|68000|2022|PDM|2376.00|99|0.00|CPT 58561
20|FH_F126345_0_0|SrvcGrp|75282|2022|PDM|1503.00|99|0.00|DIAGNOSTIC HYSTEROSCOPY
20|FH_F126489_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F126489_0_0|SrvcGrp|108042|2022|PDM|400.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD
20|FH_F126489_0_0|SrvcGrp|108043|2022|PDM|171.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD
20|FH_F126523_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F126525_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F126527_0_0|SrvcGrp|29155|2022|PDM|110.00|99|0.00|HOSPICE SVCS
20|FH_F126554_0_0|CSTM-ALL|CSTM-00|2020|PDM|1210.00|99|0.00|AEG 10 (NO REV)
20|FH_F126554_0_0|CSTM-ALL|CSTM-00|2020|PDM|1210.00|99|0.00|AEG 4 (NO REV)
20|FH_F126554_0_0|CSTM-ALL|CSTM-00|2020|PDM|1331.00|99|0.00|AEG 5  (NO REV)
20|FH_F126554_0_0|CSTM-ALL|CSTM-00|2020|PDM|1997.00|99|0.00|AEG 9 (NO REV)
20|FH_F126554_0_0|CSTM-ALL|CSTM-00|2020|PDM|787.00|99|0.00|AEG 2 (NO REV)
20|FH_F126554_0_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS
20|FH_F126554_0_0|SrvcGrp|35669|2022|PDM|4400.00|99|0.00|CPT 63650
20|FH_F126567_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F126567_0_0|SrvcGrp|107747|2022|PDM|1200.00|99|0.00|HOME HEMODIALYSIS
20|FH_F126567_0_0|SrvcGrp|107748|2022|PDM|1200.00|99|0.00|HEMODIALYSIS IN CENTER
20|FH_F126647_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F126647_0_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F126672_0_0|CSTM-ALL|CSTM-00|2020|PDM|1530.00|99|0.00|AEG 9 (NO REV)
20|FH_F126672_0_0|CSTM-ALL|CSTM-00|2020|PDM|612.00|99|0.00|AEG 2 (NO REV)
20|FH_F126672_0_0|CSTM-ALL|CSTM-00|2020|PDM|867.00|99|0.00|AEG 10 (NO REV)
20|FH_F126672_0_0|CSTM-ALL|CSTM-00|2020|PDM|906.00|99|0.00|AEG 8 (NO REV)
20|FH_F126672_0_0|SrvcGrp|28549|2022|PDM|1752.00|99|0.00|VITRECTOMY
20|FH_F126732_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F126732_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F126817_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F126867_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS APC GROUPED
20|FH_F126867_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS APC HOLD HARMLESS
20|FH_F126904_0_0|SrvcGrp|84185|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F126930_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F126964_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F126964_0_0|SrvcGrp|82981|2022|PDM|158.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F126990_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANESTHESIOLOGIST/CRNA (HAN4) SAME DOS
20|FH_F126990_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HOSPICE (UHSP) SAME DOS
20|FH_F127011_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F127073_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F127138_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F127188_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F127199_0_0|SrvcGrp|80918|2022|PDM|114.00|99|0.00|RESPITE CARE
20|FH_F127207_0_0|SrvcGrp|73656|2022|PDM|450.00|99|0.00|AETNA HOSPICE SVCS
20|FH_F127207_0_0|SrvcGrp|80317|2022|PDM|90.00|99|0.00|RESPITE CARE
20|FH_F127207_0_0|SrvcGrp|82222|2022|PDM|90.00|99|0.00|HOSPICE CARE
20|FH_F127324_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F127324_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 4 (NO REV)
20|FH_F127324_0_0|CSTM-ALL|CSTM-00|2020|PDM|1485.00|99|0.00|AEG 6 (NO REV)
20|FH_F127324_0_0|CSTM-ALL|CSTM-00|2020|PDM|3520.00|99|0.00|AEG 9 (NO REV)
20|FH_F127324_0_0|CSTM-ALL|CSTM-00|2020|PDM|908.00|99|0.00|AEG 3 (NO REV)
20|FH_F127324_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F127324_0_0|SrvcGrp|106666|2022|PDM|14830.00|99|0.00|RECONSTRUCT SHOULDER JOINT
20|FH_F127324_0_0|SrvcGrp|12664|2022|PCT|0.50|99|0.00|IMPLANTS
20|FH_F127325_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F127325_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F127325_0_0|SrvcGrp|73008|2022|PDM|512.00|99|0.00|AEG 10
20|FH_F127343_0_0|CSTM-ALL|CSTM-00|2020|PDM|1320.00|99|0.00|AEG 5  (NO REV)
20|FH_F127343_0_0|CSTM-ALL|CSTM-00|2020|PDM|1485.00|99|0.00|AEG 6 (NO REV)
20|FH_F127343_0_0|CSTM-ALL|CSTM-00|2020|PDM|1660.00|99|0.00|AEG 8 (NO REV)
20|FH_F127343_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AEG 1 (NO REV)
20|FH_F127343_0_0|SrvcGrp|103538|2022|PDM|3105.00|99|0.00|ARTHROSCOPY HIP W/ FEMOROPLASTY
20|FH_F127343_0_0|SrvcGrp|106666|2022|PDM|14830.00|99|0.00|RECONSTRUCT SHOULDER JOINT
20|FH_F127343_0_0|SrvcGrp|110674|2022|PDM|11480.00|99|0.00|MUSCULOSKELETAL SYSTEM
20|FH_F127343_0_0|SrvcGrp|82694|2022|PDM|1725.00|99|0.00|PODIATRY
20|FH_F127343_0_0|SrvcGrp|87060|2022|PDM|3105.00|99|0.00|SHOULDER ARTHROSCOPY/SURGERY
20|FH_F127399_0_0|SrvcGrp|102481|2022|PDM|3225.00|99|0.00|CPT 29898
20|FH_F127399_0_0|SrvcGrp|105000|2022|PDM|2913.00|99|0.00|REPAIR OF KNEECAP FRACTURE
20|FH_F127399_0_0|SrvcGrp|27261|2022|PDM|14045.00|99|0.00|CPT 27446
20|FH_F127399_0_0|SrvcGrp|41325|2022|PDM|2497.00|99|0.00|OP SURGERY CPT 24342
20|FH_F127399_0_0|SrvcGrp|42472|2022|PDM|2913.00|99|0.00|CPT 58670
20|FH_F127399_0_0|SrvcGrp|63472|2022|PDM|4162.00|99|0.00|CPT 64581
20|FH_F127399_0_0|SrvcGrp|72120|2022|PDM|2913.00|99|0.00|TENOTOMY
20|FH_F127399_0_0|SrvcGrp|72996|2022|PDM|2393.00|99|0.00|AEG 4
20|FH_F127399_0_0|SrvcGrp|73006|2022|PDM|3433.00|99|0.00|AEG 9
20|FH_F127399_0_0|SrvcGrp|80617|2022|PDM|14045.00|99|0.00|ARTHOPLASTY
20|FH_F127399_0_0|SrvcGrp|88162|2022|PDM|3849.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON
20|FH_F127399_0_0|SrvcGrp|89404|2022|PDM|14045.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F127399_0_0|SrvcGrp|90063|2022|PDM|3121.00|99|0.00|REPAIR BICEPS TENDON RUPTURE
20|FH_F127399_0_0|SrvcGrp|92821|2022|PDM|6763.00|99|0.00|HIP ARTHROSCOPY W/ LABRAL REPAIR
20|FH_F127399_0_0|SrvcGrp|92822|2022|PDM|3121.00|99|0.00|REPAIR OF RUPTURED TENDON
20|FH_F127399_0_0|SrvcGrp|96539|2022|PDM|2913.00|99|0.00|REVISION OF ANKLE LIGAMENT
20|FH_F127418_0_0|SrvcGrp|110759|2022|PDM|30935.95|99|0.00|THORACIC OPEN TX OF VERTEBRAL FX
20|FH_F127418_0_0|SrvcGrp|110762|2022|PDM|40295.78|99|0.00|LUMBAR VERTEBRAL CORPECTOMY
20|FH_F127418_0_0|SrvcGrp|110764|2022|PDM|18957.29|99|0.00|REPAIR OF DURAL FLUID LEAK W/ LAMI
20|FH_F127418_0_0|SrvcGrp|110765|2022|PDM|5481.88|99|0.00|2ND LEVEL INJ PARAVERT F JNT C/T
20|FH_F127418_0_0|SrvcGrp|110766|2022|PDM|5481.88|99|0.00|3RD LEVEL INJ PARAVERT F JNT C/T
20|FH_F127418_0_0|SrvcGrp|27330|2022|PDM|7877.98|99|0.00|CPT 27096
20|FH_F127418_0_0|SrvcGrp|88024|2022|PDM|14259.26|99|0.00|REMOVAL OF POSTERIOR SEGMENTAL INSTRUMENTATION
20|FH_F127418_0_0|SrvcGrp|88158|2022|PDM|23957.33|99|0.00|NECK SPINE DISK SURGERY
20|FH_F127418_0_0|SrvcGrp|88162|2022|PDM|7980.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON
20|FH_F127418_0_0|SrvcGrp|89861|2022|PDM|5487.89|99|0.00|LUMBAR LAMINOTOMY
20|FH_F127418_0_0|SrvcGrp|90978|2022|PDM|3718.75|99|0.00|INJECTION CERVICAL OR THORACIC TRANSFORAMINAL EPIDURAL
20|FH_F127422_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F127422_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|IMPLANTS
20|FH_F127422_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F127422_0_0|SrvcGrp|72990|2022|PDM|333.00|99|0.00|AEG 1
20|FH_F127422_0_0|SrvcGrp|78046|2022|PCT|1.00|99|0.00|AETNA AQUEOUS SHUNT
20|FH_F127448_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F127448_0_0|SrvcGrp|107878|2022|PDM|2150.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT
20|FH_F127448_0_0|SrvcGrp|107884|2022|PDM|2150.00|99|0.00|TRLUML BALO ANGIOP 1ST ART
20|FH_F127448_0_0|SrvcGrp|107885|2022|PDM|2150.00|99|0.00|TRLUML BALO ANGIOP 1ST VEIN
20|FH_F127558_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F127558_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F127558_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.55|99|0.00|HSS ASC
20|FH_F127571_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F127711_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F127711_0_0|CSTM-ALL|CSTM-00|2020|PDM|1881.00|99|0.00|AEG 5  (NO REV)
20|FH_F127711_0_0|CSTM-ALL|CSTM-00|2020|PDM|2620.00|99|0.00|AEG 7 (NO REV)
20|FH_F127711_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F127711_0_0|SrvcGrp|77461|2022|PDM|4313.00|99|0.00|CPT 52356
20|FH_F128027_0_0|SrvcGrp|12491|2022|PCT|1.10|99|0.00|PACEMAKER
20|FH_F128027_0_0|SrvcGrp|64723|2022|PDM|1260.00|99|0.00|CPT 45380
20|FH_F128027_0_0|SrvcGrp|64725|2022|PDM|1085.00|99|0.00|CPT 45378
20|FH_F128031_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F128031_0_0|SrvcGrp|72990|2022|PDM|460.00|99|0.00|AEG 1
20|FH_F128148_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANESTHESIOLOGIST/CRNA (HAN2)(HSUR)
20|FH_F128148_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|BONE MARROW W/BIOPSY (HBMW) (HBIO)
20|FH_F128148_0_0|SrvcGrp|34865|2022|PDM|55.00|99|0.00|HOME HEALTH AIDE
20|FH_F128148_0_0|SrvcGrp|34866|2022|PDM|130.00|99|0.00|HOME HEALTH - PT/OT/ST
20|FH_F128148_0_0|SrvcGrp|34868|2022|PDM|185.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F128185_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F128185_0_0|CSTM-ALL|CSTM-00|2020|PDM|2187.00|99|0.00|AEG 7 (NO REV)
20|FH_F128185_0_0|CSTM-ALL|CSTM-00|2020|PDM|889.00|99|0.00|AEG 2 (NO REV)
20|FH_F128185_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F128185_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F128185_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F128188_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F128188_0_0|SrvcGrp|471|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F128237_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F128237_0_0|SrvcGrp|84185|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F128246_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F128246_0_0|SrvcGrp|104723|2022|PDM|726.00|99|0.00|REPAIR EYELID DEFECT
20|FH_F128246_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F128246_0_0|SrvcGrp|111042|2022|PDM|841.00|99|0.00|BIOPSY OF EYELID
20|FH_F128246_0_0|SrvcGrp|111043|2022|PDM|841.00|99|0.00|EXCISION OF LESION OF EYELID
20|FH_F128246_0_0|SrvcGrp|16427|2022|PDM|907.00|99|0.00|OP SURGERY
20|FH_F128246_0_0|SrvcGrp|84160|2022|PDM|726.00|99|0.00|OCCULAR RECONST/AMNIOTIC MEMB
20|FH_F128270_0_0|SrvcGrp|42784|2022|PDM|80.00|99|0.00|OCCUPATIONAL THERAPY  SRVCS
20|FH_F128270_0_0|SrvcGrp|472|2022|PDM|499.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F128270_0_0|SrvcGrp|473|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F128270_0_0|SrvcGrp|76501|2022|PDM|380.00|99|0.00|SUB-ACUTE - LEVEL I
20|FH_F128334_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F128360_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F128360_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|AEG 2 (NO REV)
20|FH_F128360_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F128360_0_0|SrvcGrp|11663|2022|PCT|1.05|99|0.00|IMPLANTS
20|FH_F128360_0_0|SrvcGrp|36591|2022|PDM|3500.00|99|0.00|CPT 63685
20|FH_F128360_0_0|SrvcGrp|58638|2022|PDM|3000.00|99|0.00|CPT 63688
20|FH_F128378_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F128378_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F128378_0_0|SrvcGrp|82222|2022|PDM|160.00|99|0.00|HOSPICE CARE
20|FH_F128378_0_0|SrvcGrp|82223|2022|PDM|160.00|99|0.00|HOSPICE CARE
20|FH_F128378_0_0|SrvcGrp|84185|2022|PDM|160.00|99|0.00|RESPITE CARE
20|FH_F128379_0_0|CSTM-ALL|CSTM-00|2020|PDM|1030.00|99|0.00|AEG 2 (NO REV)
20|FH_F128379_0_0|SrvcGrp|100919|2022|PDM|3319.00|99|0.00|SPINE PROSTH DEVICE
20|FH_F128379_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F128379_0_0|SrvcGrp|11663|2022|PCT|1.05|99|0.00|IMPLANTS
20|FH_F128379_0_0|SrvcGrp|67069|2022|PDM|7553.00|99|0.00|CPT 22634
20|FH_F128379_0_0|SrvcGrp|67072|2022|PDM|7553.00|99|0.00|CPT 22845
20|FH_F128379_0_0|SrvcGrp|67119|2022|PDM|7553.00|99|0.00|ARTHODESIS
20|FH_F128379_0_0|SrvcGrp|88163|2022|PDM|14306.00|99|0.00|LUMBAR SPINE FUSION
20|FH_F128379_0_0|SrvcGrp|88164|2022|PDM|14306.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR
20|FH_F128379_0_0|SrvcGrp|93069|2022|PDM|7553.00|99|0.00|POSTERIOR NON-SEGMENTAL INST
20|FH_F128379_0_0|SrvcGrp|93071|2022|PDM|7553.00|99|0.00|POSTERIOR SEGMENTAL INSTRU
20|FH_F128384_0_0|CSTM-ALL|CSTM-00|2020|PCT|45.00|99|0.00|GENERAL ACUTE CARE
20|FH_F128390_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F128390_0_0|SrvcGrp|80918|2022|PDM|125.00|99|0.00|RESPITE CARE
20|FH_F128430_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F128580_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F128580_0_0|CSTM-ALL|CSTM-00|2020|PDM|649.00|99|0.00|AEG 4 (NO REV)
20|FH_F128580_0_0|CSTM-ALL|CSTM-00|2020|PDM|737.00|99|0.00|AEG 10 (NO REV)
20|FH_F128580_0_0|SrvcGrp|108076|2022|PDM|2248.00|99|0.00|AV FUSION / FOREARM VEIN
20|FH_F128580_0_0|SrvcGrp|109137|2022|PDM|2248.00|99|0.00|AV FISTULA REVISION
20|FH_F128580_0_0|SrvcGrp|77278|2022|PDM|1735.00|99|0.00|AETNA REPL TUNNLD CNTRL CVC W/O PORT/PUMP
20|FH_F128699_0_0|SrvcGrp|82223|2022|PDM|90.00|99|0.00|HOSPICE CARE
20|FH_F128699_0_0|SrvcGrp|83857|2022|PDM|450.00|99|0.00|IP HOSPICE SVCS
20|FH_F128804_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F128804_0_0|CSTM-ALL|CSTM-00|2020|PDM|2090.00|99|0.00|AEG 3 (NO REV)
20|FH_F128804_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|AEG 4 (NO REV)
20|FH_F128804_0_0|CSTM-ALL|CSTM-00|2020|PDM|2750.00|99|0.00|AEG 5  (NO REV)
20|FH_F128804_0_0|CSTM-ALL|CSTM-00|2020|PDM|3080.00|99|0.00|AEG 6 (NO REV)
20|FH_F128804_0_0|CSTM-ALL|CSTM-00|2020|PDM|3410.00|99|0.00|AEG 8 (NO REV)
20|FH_F128804_0_0|SrvcGrp|103974|2022|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES
20|FH_F128804_0_0|SrvcGrp|111209|2022|PDM|1210.00|99|0.00|TONGUE BASE VOL REDUCTION
20|FH_F128804_0_0|SrvcGrp|81571|2022|PDM|3960.00|99|0.00|NASAL ENDOSCOPY W/ SINUS OSTIA DILATION
20|FH_F128804_0_0|SrvcGrp|88599|2022|PDM|3520.00|99|0.00|ENDOSCOPY MAXILLARY SINUS
20|FH_F128804_0_0|SrvcGrp|89853|2022|PDM|3520.00|99|0.00|NASAL/SINUS ENDOSCOPY-SURG
20|FH_F128821_0_0|SrvcGrp|108043|2022|PDM|182.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD
20|FH_F128821_0_0|SrvcGrp|111218|2022|PDM|182.00|99|0.00|CAPD/CCPD
20|FH_F128833_0_0|SrvcGrp|108082|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER
20|FH_F128839_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F128893_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F128893_0_0|SrvcGrp|65720|2022|PDM|160.00|99|0.00|RESPITE CARE
20|FH_F128893_0_0|SrvcGrp|93098|2022|PDM|160.00|99|0.00|HOSPICE CARE
20|FH_F128893_0_0|SrvcGrp|94780|2022|PDM|160.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)
20|FH_F128893_0_0|SrvcGrp|95661|2022|PDM|150.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F128924_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F128924_0_0|SrvcGrp|106655|2022|PCT|0.90|99|0.00|PARSABIV
20|FH_F128924_0_0|SrvcGrp|111216|2022|PDM|424.00|99|0.00|ACUTE KIDNEY INJURY HEMODIALYSIS NO ESRD
20|FH_F128924_0_0|SrvcGrp|111217|2022|PDM|182.00|99|0.00|ACUTE KIDNEY INJURY IPD/CAPD/CCPD NO ESRD
20|FH_F128927_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F128977_0_0|SrvcGrp|82981|2022|PDM|265.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F128990_0_0|CSTM-ALL|CSTM-00|2020|PCT|54.00|99|0.00|GENERAL ACUTE CARE
20|FH_F129046_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F129053_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F129053_0_0|CSTM-ALL|CSTM-00|2020|PDM|1311.00|99|0.00|AEG 2 (NO REV)
20|FH_F129053_0_0|CSTM-ALL|CSTM-00|2020|PDM|2107.00|99|0.00|AEG 5  (NO REV)
20|FH_F129053_0_0|SrvcGrp|70746|2022|PDM|1665.00|99|0.00|CPT 28292
20|FH_F129175_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F129175_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F129175_0_0|CSTM-ALL|CSTM-00|2020|PDM|559.00|99|0.00|AEG 3 (NO REV)
20|FH_F129175_0_0|CSTM-ALL|CSTM-00|2020|PDM|917.00|99|0.00|AEG 6 (NO REV)
20|FH_F129175_0_0|SrvcGrp|100923|2022|PDM|292.50|99|0.00|DRUGS
20|FH_F129175_0_0|SrvcGrp|45063|2022|PDM|300.00|99|0.00|CPT 64493  INJECTION CARVE OUT
20|FH_F129175_0_0|SrvcGrp|53066|2022|PDM|107.59|99|0.00|INJECTION(S), LUMBAR OR SACRAL, EACH ADDITIONAL LEVEL
20|FH_F129175_0_0|SrvcGrp|87677|2022|PDM|546.96|99|0.00|CERVICAL OR THORACIC SURGERY
20|FH_F129225_0_0|CSTM-ALL|CSTM-00|2020|PDM|1227.30|99|0.00|2005 ASPG GROUPER VIII
20|FH_F129225_0_0|CSTM-ALL|CSTM-00|2020|PDM|1255.05|99|0.00|2005 ASPG GROUPER VII
20|FH_F129225_0_0|CSTM-ALL|CSTM-00|2020|PDM|420.03|99|0.00|2005 ASPG GROUPER I
20|FH_F129225_0_0|CSTM-ALL|CSTM-00|2020|PDM|643.29|99|0.00|2005 ASPG GROUPER III
20|FH_F129225_0_0|CSTM-ALL|CSTM-00|2020|PDM|794.66|99|0.00|2005 ASPG GROUPER X
20|FH_F129248_0_0|CSTM-ALL|CSTM-00|2020|PDM|460.55|99|0.00|2005 ASPG GROUPER I
20|FH_F129248_0_0|CSTM-ALL|CSTM-00|2020|PDM|705.34|99|0.00|2005 ASPG GROUPER III
20|FH_F129248_0_0|SrvcGrp|14614|2022|PDM|3000.00|99|0.00|LITHOTRIPSY
20|FH_F129254_0_0|CSTM-ALL|CSTM-00|2020|PDM|1227.30|99|0.00|ASPG VIII
20|FH_F129254_0_0|CSTM-ALL|CSTM-00|2020|PDM|420.03|99|0.00|ASPG I
20|FH_F129254_0_0|CSTM-ALL|CSTM-00|2020|PDM|904.39|99|0.00|ASPG V
20|FH_F129260_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|AEG 3 (NO REV)
20|FH_F129260_0_0|CSTM-ALL|CSTM-00|2020|PDM|918.50|99|0.00|AEG 6 (NO REV)
20|FH_F129364_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F129364_0_0|SrvcGrp|108043|2022|PDM|182.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD
20|FH_F129472_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F129472_0_0|CSTM-ALL|CSTM-00|2020|PDM|1056.00|99|0.00|AEG 6 (NO REV)
20|FH_F129472_0_0|CSTM-ALL|CSTM-00|2020|PDM|1329.00|99|0.00|AEG 8 (NO REV)
20|FH_F129472_0_0|CSTM-ALL|CSTM-00|2020|PDM|1741.00|99|0.00|AEG 9 (NO REV)
20|FH_F129472_0_0|CSTM-ALL|CSTM-00|2020|PDM|714.00|99|0.00|AEG 2 (NO REV)
20|FH_F129472_0_0|CSTM-ALL|CSTM-00|2020|PDM|857.00|99|0.00|AEG 4 (NO REV)
20|FH_F129487_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F129487_0_0|SrvcGrp|72992|2022|PDM|1203.00|99|0.00|AEG 2
20|FH_F129487_0_0|SrvcGrp|72996|2022|PDM|1948.00|99|0.00|AEG 4
20|FH_F129487_0_0|SrvcGrp|73002|2022|PDM|2685.00|99|0.00|AEG 7
20|FH_F129487_0_0|SrvcGrp|73004|2022|PDM|2598.00|99|0.00|AEG 8
20|FH_F129487_0_0|SrvcGrp|73006|2022|PDM|3613.00|99|0.00|AEG 9
20|FH_F129487_0_0|SrvcGrp|73008|2022|PDM|917.00|99|0.00|AEG 10
20|FH_F129500_0_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F129509_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F129509_0_0|SrvcGrp|100919|2022|PDM|7175.00|99|0.00|SPINE PROSTH DEVICE
20|FH_F129509_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F129509_0_0|SrvcGrp|111325|2022|PDM|3767.00|99|0.00|SPINAL CORD DECOMPRESS-CERVICAL
20|FH_F129509_0_0|SrvcGrp|111326|2022|PDM|3767.00|99|0.00|SPINAL CORD DECOMPRESS-THOR
20|FH_F129509_0_0|SrvcGrp|36591|2022|PDM|5125.00|99|0.00|CPT 63685
20|FH_F129509_0_0|SrvcGrp|67065|2022|PDM|7175.00|99|0.00|CERVICAL SURGERY
20|FH_F129509_0_0|SrvcGrp|67066|2022|PDM|7175.00|99|0.00|CERVICAL SURGERY
20|FH_F129509_0_0|SrvcGrp|73000|2022|PDM|1210.00|99|0.00|AEG 6
20|FH_F129509_0_0|SrvcGrp|73004|2022|PDM|1427.00|99|0.00|AEG 8
20|FH_F129509_0_0|SrvcGrp|73063|2022|PDM|610.00|99|0.00|OBSERVATION SERVICES
20|FH_F129509_0_0|SrvcGrp|89860|2022|PDM|3767.00|99|0.00|SPINAL DISK SURGERY ADD-ON
20|FH_F129509_0_0|SrvcGrp|92405|2022|PDM|3241.00|99|0.00|PERQ LUMBOSACRAL INJECTION
20|FH_F129509_0_0|SrvcGrp|92410|2022|PDM|5125.00|99|0.00|SPINE FUSION EXTRA SEGMENT
20|FH_F129509_0_0|SrvcGrp|93063|2022|PDM|6445.00|99|0.00|LUMBAR ARTIF DISKECTOMY
20|FH_F129509_0_0|SrvcGrp|99166|2022|PDM|3767.00|99|0.00|CPT 63005
20|FH_F129526_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F129526_0_0|CSTM-ALL|CSTM-00|2020|PDM|1740.70|99|0.00|2005 ASPG GROUPER IX
20|FH_F129526_0_0|CSTM-ALL|CSTM-00|2020|PDM|432.90|99|0.00|2005 ASPG GROUPER I
20|FH_F129526_0_0|CSTM-ALL|CSTM-00|2020|PDM|579.80|99|0.00|2005 ASPG GROUPER II
20|FH_F129526_0_0|CSTM-ALL|CSTM-00|2020|PDM|932.10|99|0.00|2005 ASPG GROUPER V
20|FH_F129535_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F129535_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F129535_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F129535_0_0|SrvcGrp|109800|2022|PDM|725.00|99|0.00|REPAIR ANAL FISTULA
20|FH_F129535_0_0|SrvcGrp|38364|2022|PDM|600.00|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F129535_0_0|SrvcGrp|75481|2022|PDM|425.00|99|0.00|AEG 2
20|FH_F129535_0_0|SrvcGrp|75489|2022|PDM|645.00|99|0.00|AEG 6
20|FH_F129535_0_0|SrvcGrp|75495|2022|PDM|1000.00|99|0.00|AEG 9
20|FH_F129535_0_0|SrvcGrp|79589|2022|PDM|550.00|99|0.00|UPPER GI
20|FH_F129535_0_0|SrvcGrp|86426|2022|PDM|600.00|99|0.00|REMOVE INT/EXT HEM GROUP 2
20|FH_F129536_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F129536_0_0|CSTM-ALL|CSTM-00|2020|PDM|2526.00|99|0.00|DEVICE INSERTION
20|FH_F129536_0_0|CSTM-ALL|CSTM-00|2020|PDM|327.00|99|0.00|AEG 1 (NO REV)
20|FH_F129536_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 4 (NO REV)
20|FH_F129536_0_0|CSTM-ALL|CSTM-00|2020|PDM|975.00|99|0.00|AEG 7 (NO REV)
20|FH_F129536_0_0|SrvcGrp|111357|2022|PDM|1200.00|99|0.00|REVISE/GRAFT EYELID LINING
20|FH_F129536_0_0|SrvcGrp|111358|2022|PDM|1670.00|99|0.00|EYE PROCEDURES
20|FH_F129536_0_0|SrvcGrp|111373|2022|PCT|1.00|99|0.00|PHENYLEPHRINE KETOROLAC INJECTION
20|FH_F129536_0_0|SrvcGrp|46884|2022|PDM|759.00|99|0.00|REPAIR EYELID DEFECT
20|FH_F129536_0_0|SrvcGrp|82570|2022|PDM|797.00|99|0.00|REVISION EYELID/EXCESS SKIN
20|FH_F129536_0_0|SrvcGrp|84935|2022|PDM|900.00|99|0.00|REPAIR IRIS AND CILIARY BODY
20|FH_F129588_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F129596_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F129596_0_0|SrvcGrp|32703|2022|PDM|1900.00|99|0.00|ICU
20|FH_F129597_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F129638_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F129638_0_0|SrvcGrp|15324|2022|PDM|300.00|99|0.00|ER LEVEL II
20|FH_F129639_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F129644_0_0|SrvcGrp|103551|2022|PDM|171.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS
20|FH_F129644_0_0|SrvcGrp|103552|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER
20|FH_F129653_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F129653_0_0|SrvcGrp|109220|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F129653_0_0|SrvcGrp|111401|2022|PDM|2000.00|99|0.00|TREAT SPINAL CANAL LESION 16
20|FH_F129653_0_0|SrvcGrp|67065|2022|PDM|4000.00|99|0.00|CERVICAL SURGERY
20|FH_F129653_0_0|SrvcGrp|67279|2022|PDM|4000.00|99|0.00|CERVICAL SURGERY
20|FH_F129653_0_0|SrvcGrp|72990|2022|PDM|1007.00|99|0.00|AEG 1
20|FH_F129653_0_0|SrvcGrp|72996|2022|PDM|1625.00|99|0.00|AEG 4
20|FH_F129653_0_0|SrvcGrp|73002|2022|PDM|2405.00|99|0.00|AEG 7
20|FH_F129653_0_0|SrvcGrp|74039|2022|PDM|4000.00|99|0.00|LAMINECTOMY
20|FH_F129653_0_0|SrvcGrp|89842|2022|PDM|4000.00|99|0.00|LUMBAR
20|FH_F129653_0_0|SrvcGrp|90976|2022|PDM|2000.00|99|0.00|INJECTION PARAVERTEBRAL FACET JOINT
20|FH_F129659_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F129673_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F129673_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F129673_0_0|CSTM-ALL|CSTM-00|2020|PDM|196.19|99|0.00|HOSPICE ROUTINE HOME CARE (DAYS 0-60)
20|FH_F129673_0_0|SrvcGrp|111404|2022|PDM|69.00|99|0.00|HOME HEALTH AIDE
20|FH_F129713_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F129754_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F129754_0_0|CSTM-ALL|CSTM-00|2020|PDM|1669.94|99|0.00|2005 ASPG GROUPER IX
20|FH_F129754_0_0|CSTM-ALL|CSTM-00|2020|PDM|894.21|99|0.00|2005 ASPG GROUPER V
20|FH_F129785_0_0|SrvcGrp|82981|2022|PDM|140.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F129785_0_0|SrvcGrp|87077|2022|PDM|140.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F129793_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F129793_0_0|CSTM-ALL|CSTM-00|2020|PDM|1445.19|99|0.00|2006 MEDICARE ASPG X
20|FH_F129793_0_0|CSTM-ALL|CSTM-00|2020|PDM|466.99|99|0.00|2006 MEDICARE ASPG I
20|FH_F129793_0_0|CSTM-ALL|CSTM-00|2020|PDM|740.75|99|0.00|2006 MEDICARE ASPG III
20|FH_F129793_0_0|CSTM-ALL|CSTM-00|2020|PDM|915.04|99|0.00|2006 MEDICARE ASPG IV
20|FH_F129888_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F129888_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F129888_0_0|CSTM-ALL|CSTM-00|2020|PDM|1291.00|99|0.00|2005 ASPG GROUPER VI
20|FH_F129888_0_0|CSTM-ALL|CSTM-00|2020|PDM|1555.14|99|0.00|2005 ASPG GROUPER VII
20|FH_F129888_0_0|CSTM-ALL|CSTM-00|2020|PDM|520.47|99|0.00|2005 ASPG GROUPER I
20|FH_F129888_0_0|CSTM-ALL|CSTM-00|2020|PDM|697.08|99|0.00|2005 ASPG GROUPER II
20|FH_F129892_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F129892_0_0|CSTM-ALL|CSTM-00|2020|PDM|596.00|99|0.00|AEG 2 (NO REV)
20|FH_F129892_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F129892_0_0|SrvcGrp|11673|2022|PDM|1495.00|99|0.00|CPT 29888
20|FH_F129892_0_0|SrvcGrp|13187|2022|PCT|1.00|99|0.00|INTRAOCULAR LENSES
20|FH_F129892_0_0|SrvcGrp|41334|2022|PDM|3060.00|99|0.00|TOTAL KNEE
20|FH_F129892_0_0|SrvcGrp|79101|2022|PDM|1495.00|99|0.00|AETNA NASAL ENDOSCOPY
20|FH_F129912_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F129912_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F129912_0_0|CSTM-ALL|CSTM-00|2020|PDM|530.00|99|0.00|AEG 1 (NO REV)
20|FH_F129913_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F129913_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F129913_0_0|CSTM-ALL|CSTM-00|2020|PDM|1254.05|99|0.00|2005 ASPG GROUPER V
20|FH_F130023_0_0|SrvcGrp|79720|2022|PDM|1291.00|99|0.00|ACUTE REHAB II
20|FH_F130025_0_0|SrvcGrp|111476|2022|PDM|279.00|99|0.00|WOUND CARE
20|FH_F130025_0_0|SrvcGrp|592|2022|PDM|461.00|99|0.00|SUB-ACUTE CARE
20|FH_F130025_0_0|SrvcGrp|73601|2022|PDM|1464.00|99|0.00|AETNA INTERMEDIATE ICU/CCU
20|FH_F130035_0_0|SrvcGrp|111470|2022|PDM|120.75|99|0.00|PNEUMOCOCCAL VACCINE
20|FH_F130108_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 248-251, 246-247 CV SURGERY
20|FH_F130108_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 252-254 CV SURGERY
20|FH_F130108_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 691-692 URINARY STONES
20|FH_F130108_0_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|ASPG II
20|FH_F130108_0_0|CSTM-ALL|CSTM-00|2020|PDM|1550.00|99|0.00|ASPG III
20|FH_F130108_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|ASPG V
20|FH_F130108_0_0|SrvcGrp|10964|2022|PDM|1500.00|99|0.00|ACUTE IP MED/SURG SVCS
20|FH_F130108_0_0|SrvcGrp|111493|2022|PDM|6500.00|99|0.00|PTCA ANGIOPLASTY
20|FH_F130108_0_0|SrvcGrp|12163|2022|PCT|0.60|99|0.00|DRUGS
20|FH_F130108_0_0|SrvcGrp|15399|2022|PCT|0.60|99|0.00|COMPUTED TOMOGRAPHY (CT)
20|FH_F130108_0_0|SrvcGrp|18204|2022|PCT|0.75|99|0.00|MS DRG 027
20|FH_F130108_0_0|SrvcGrp|18791|2022|PCT|0.75|99|0.00|MS DRG 215
20|FH_F130108_0_0|SrvcGrp|29817|2022|PDM|2975.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F130112_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F130112_0_0|CSTM-ALL|CSTM-00|2020|PDM|1485.00|99|0.00|AEG 9 (NO REV)
20|FH_F130112_0_0|CSTM-ALL|CSTM-00|2020|PDM|1857.00|99|0.00|AEG 5  (NO REV)
20|FH_F130182_0_0|CSTM-ALL|CSTM-00|2020|PDM|523.00|99|0.00|AEG 10 (NO REV)
20|FH_F130182_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F130182_0_0|SrvcGrp|109451|2022|PDM|1457.00|99|0.00|L HRT ARTERY/VENTRICLE ANGIO
20|FH_F130182_0_0|SrvcGrp|109452|2022|PDM|1457.00|99|0.00|L HRT ART/GRFT ANGIO
20|FH_F130182_0_0|SrvcGrp|109454|2022|PDM|1457.00|99|0.00|R&L HRT ART/VENTRICLE ANGIO
20|FH_F130182_0_0|SrvcGrp|109455|2022|PDM|104.00|99|0.00|HEART FLOW RESERVE MEASURE
20|FH_F130182_0_0|SrvcGrp|97895|2022|PDM|8323.00|99|0.00|REVISE KNEE 2
20|FH_F130182_0_0|SrvcGrp|98267|2022|PDM|8323.00|99|0.00|REVISION OF KNEE JOINT
20|FH_F130302_0_0|SrvcGrp|72992|2022|PDM|1154.00|99|0.00|AEG 2
20|FH_F130302_0_0|SrvcGrp|73002|2022|PDM|2280.00|99|0.00|AEG 7
20|FH_F130302_0_0|SrvcGrp|73008|2022|PDM|1008.00|99|0.00|AEG 10
20|FH_F130302_0_0|SrvcGrp|78504|2022|PDM|4800.00|99|0.00|AETNA CARDIAC CATHETERIZATION
20|FH_F130317_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F130328_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F130328_0_0|SrvcGrp|104226|2022|PDM|190.00|99|0.00|HOSPICE CARE (HCFA)
20|FH_F130328_0_0|SrvcGrp|95661|2022|PDM|706.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F130331_0_0|SrvcGrp|57965|2022|PDM|150.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F130331_0_0|SrvcGrp|57968|2022|PDM|32.50|99|0.00|CONTINUOUS HOMECARE
20|FH_F130350_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F130350_0_0|CSTM-ALL|CSTM-00|2020|PDM|1248.00|99|0.00|AEG 7 (NO REV)
20|FH_F130350_0_0|CSTM-ALL|CSTM-00|2020|PDM|1509.00|99|0.00|AEG 9 (NO REV)
20|FH_F130350_0_0|CSTM-ALL|CSTM-00|2020|PDM|520.00|99|0.00|AEG 1 (NO REV)
20|FH_F130350_0_0|CSTM-ALL|CSTM-00|2020|PDM|780.00|99|0.00|AEG 3 (NO REV)
20|FH_F130350_0_0|CSTM-ALL|CSTM-00|2020|PDM|936.00|99|0.00|AEG 10 (NO REV)
20|FH_F130363_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F130363_0_0|SrvcGrp|82981|2022|PDM|150.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F130371_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F130371_0_0|SrvcGrp|103913|2022|PCT|0.92|99|0.00|OP DIALYSIS
20|FH_F130371_0_0|SrvcGrp|76321|2022|PCT|0.92|99|0.00|AETNA ALL INPATIENT SERVICES
20|FH_F130371_0_0|SrvcGrp|83960|2022|PCT|0.92|99|0.00|CARDIAC CATHETERIZATION
20|FH_F130371_0_0|SrvcGrp|92759|2022|PCT|0.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)
20|FH_F130468_0_0|CSTM-ALL|CSTM-00|2020|PDM|2729.50|99|0.00|AEG 9 (NO REV)
20|FH_F130468_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F130468_0_0|SrvcGrp|111434|2022|PDM|9919.40|99|0.00|ATRAUMATIC DISLOC NO ANESTH
20|FH_F130468_0_0|SrvcGrp|11259|2022|PCT|0.75|99|0.00|DRUGS
20|FH_F130468_0_0|SrvcGrp|36591|2022|PDM|15023.40|99|0.00|CPT 63685
20|FH_F130468_0_0|SrvcGrp|89404|2022|PDM|11776.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F130468_0_0|SrvcGrp|97730|2022|PDM|11776.00|99|0.00|REVERSE HIP JOINT
20|FH_F130468_0_0|SrvcGrp|99161|2022|PDM|11776.00|99|0.00|CPT 27138
20|FH_F130468_0_0|SrvcGrp|99163|2022|PDM|5835.00|99|0.00|CPT 27703
20|FH_F130630_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F130630_0_0|SrvcGrp|82981|2022|PDM|150.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F130654_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING
20|FH_F130676_0_0|SrvcGrp|73485|2022|PDM|1575.00|99|0.00|AETNA REHAB
20|FH_F130682_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|AEG 7 (NO REV)
20|FH_F130682_0_0|CSTM-ALL|CSTM-00|2020|PDM|740.00|99|0.00|AEG 2 (NO REV)
20|FH_F130723_0_0|CSTM-ALL|CSTM-00|2020|PDM|494.00|99|0.00|AEG 10 (NO REV)
20|FH_F130723_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F130747_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F130747_0_0|CSTM-ALL|CSTM-00|2020|PDM|2029.00|99|0.00|AEG 10 (NO REV)
20|FH_F130747_0_0|CSTM-ALL|CSTM-00|2020|PDM|2601.00|99|0.00|AEG 8 (NO REV)
20|FH_F130747_0_0|CSTM-ALL|CSTM-00|2020|PDM|4682.00|99|0.00|AEG 6 (NO REV)
20|FH_F130747_0_0|SrvcGrp|100010|2022|PDM|4682.00|99|0.00|KNEE RECONSTRUCTION
20|FH_F130747_0_0|SrvcGrp|101800|2022|PDM|5202.00|99|0.00|SKELETAL FIXATION
20|FH_F130747_0_0|SrvcGrp|103327|2022|PDM|6242.00|99|0.00|INSJ STABLJ DEV W/DCMPRN
20|FH_F130747_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F130747_0_0|SrvcGrp|111588|2022|PDM|4682.00|99|0.00|REPAIR OF THIGH MUSCLE
20|FH_F130747_0_0|SrvcGrp|11669|2022|PDM|5202.00|99|0.00|OP SURG
20|FH_F130747_0_0|SrvcGrp|16289|2022|PDM|2809.00|99|0.00|CARPAL TUNNEL RELEASE
20|FH_F130747_0_0|SrvcGrp|26274|2022|PDM|5202.00|99|0.00|CPT 29877
20|FH_F130747_0_0|SrvcGrp|41325|2022|PDM|4682.00|99|0.00|OP SURGERY CPT 24342
20|FH_F130747_0_0|SrvcGrp|41334|2022|PDM|26010.00|99|0.00|TOTAL KNEE
20|FH_F130747_0_0|SrvcGrp|58636|2022|PDM|15086.00|99|0.00|CPT 62362
20|FH_F130747_0_0|SrvcGrp|67064|2022|PDM|6763.00|99|0.00|MUSCULOSKELETAL SYSTEM
20|FH_F130747_0_0|SrvcGrp|67072|2022|PDM|8843.00|99|0.00|CPT 22845
20|FH_F130747_0_0|SrvcGrp|70749|2022|PDM|5202.00|99|0.00|CPT 29823
20|FH_F130747_0_0|SrvcGrp|74039|2022|PDM|8843.00|99|0.00|LAMINECTOMY
20|FH_F130747_0_0|SrvcGrp|77021|2022|PDM|8843.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY
20|FH_F130747_0_0|SrvcGrp|82108|2022|PDM|5202.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F130747_0_0|SrvcGrp|82109|2022|PDM|2809.00|99|0.00|REVISE ULNAR NERVE ELBOW
20|FH_F130747_0_0|SrvcGrp|82114|2022|PDM|5202.00|99|0.00|MENISCUS REPAIR MED OR LAT
20|FH_F130747_0_0|SrvcGrp|83846|2022|PDM|5202.00|99|0.00|RELEASE PALM CONTRACTURE
20|FH_F130747_0_0|SrvcGrp|85778|2022|PDM|4682.00|99|0.00|REPAIR OF ANKLE FRACTURE
20|FH_F130747_0_0|SrvcGrp|88160|2022|PDM|8843.00|99|0.00|LAMINECTOMY W/FACETECTOMY
20|FH_F130747_0_0|SrvcGrp|88487|2022|PDM|4162.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION
20|FH_F130747_0_0|SrvcGrp|88491|2022|PDM|8843.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR
20|FH_F130747_0_0|SrvcGrp|90420|2022|PDM|4682.00|99|0.00|REPAIR CLAVICLE FRACTURE
20|FH_F130747_0_0|SrvcGrp|92367|2022|PDM|5202.00|99|0.00|TRANSPLANT HAND TENDON
20|FH_F130747_0_0|SrvcGrp|92415|2022|PDM|8843.00|99|0.00|NECK SPINE DISK SURGERY
20|FH_F130747_0_0|SrvcGrp|92820|2022|PDM|5202.00|99|0.00|HIP ARTHOSCOPY ACETABULOPLASTY
20|FH_F130747_0_0|SrvcGrp|93431|2022|PDM|19768.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT
20|FH_F130747_0_0|SrvcGrp|97730|2022|PDM|26010.00|99|0.00|REVERSE HIP JOINT
20|FH_F130763_0_0|CSTM-ALL|CSTM-00|2020|PDM|2222.00|99|0.00|AEG 10 (NO REV)
20|FH_F130763_0_0|CSTM-ALL|CSTM-00|2020|PDM|2423.00|99|0.00|AEG 6 (NO REV)
20|FH_F130763_0_0|CSTM-ALL|CSTM-00|2020|PDM|2712.00|99|0.00|AEG 4 (NO REV)
20|FH_F130763_0_0|SrvcGrp|100044|2022|PDM|3882.00|99|0.00|INCISION OF HEEL BONE
20|FH_F130763_0_0|SrvcGrp|100065|2022|PDM|3450.00|99|0.00|DEEP ANT OR POSTER TIBIAL
20|FH_F130763_0_0|SrvcGrp|100919|2022|PDM|6239.00|99|0.00|SPINE PROSTH DEVICE
20|FH_F130763_0_0|SrvcGrp|104108|2022|PDM|3951.00|99|0.00|EXCISION OF BREAST LESION ID
20|FH_F130763_0_0|SrvcGrp|106265|2022|PDM|6043.00|99|0.00|NSL/SINS NDSC TOTAL
20|FH_F130763_0_0|SrvcGrp|106267|2022|PDM|6043.00|99|0.00|NSL/SINS NDSC SPHN TISS RMVL
20|FH_F130763_0_0|SrvcGrp|14614|2022|PDM|4714.00|99|0.00|LITHOTRIPSY
20|FH_F130763_0_0|SrvcGrp|16289|2022|PDM|2010.00|99|0.00|CARPAL TUNNEL RELEASE
20|FH_F130763_0_0|SrvcGrp|26273|2022|PDM|3450.00|99|0.00|CPT 29880
20|FH_F130763_0_0|SrvcGrp|33967|2022|PDM|3346.00|99|0.00|CPT 47562
20|FH_F130763_0_0|SrvcGrp|39909|2022|PDM|3345.00|99|0.00|PARTIAL MASTECTOMY
20|FH_F130763_0_0|SrvcGrp|41334|2022|PDM|15683.00|99|0.00|TOTAL KNEE
20|FH_F130763_0_0|SrvcGrp|55084|2022|PDM|4043.00|99|0.00|CPT 52648
20|FH_F130763_0_0|SrvcGrp|63463|2022|PDM|4714.00|99|0.00|CPT 52204
20|FH_F130763_0_0|SrvcGrp|64517|2022|PDM|6796.00|99|0.00|REDUCE MANMMAPLASTY
20|FH_F130763_0_0|SrvcGrp|67066|2022|PDM|15683.00|99|0.00|CERVICAL SURGERY
20|FH_F130763_0_0|SrvcGrp|70749|2022|PDM|4391.00|99|0.00|CPT 29823
20|FH_F130763_0_0|SrvcGrp|77582|2022|PDM|4367.00|99|0.00|CPT 31255
20|FH_F130763_0_0|SrvcGrp|78096|2022|PDM|4705.00|99|0.00|AETNA ARTHROSCOPY BICEPS
20|FH_F130763_0_0|SrvcGrp|79101|2022|PDM|4367.00|99|0.00|AETNA NASAL ENDOSCOPY
20|FH_F130763_0_0|SrvcGrp|83639|2022|PDM|3450.00|99|0.00|CPT 29886
20|FH_F130763_0_0|SrvcGrp|83642|2022|PDM|3450.00|99|0.00|CPT 29883
20|FH_F130763_0_0|SrvcGrp|83839|2022|PDM|6660.00|99|0.00|BREAST RECONSTRUCTION
20|FH_F130763_0_0|SrvcGrp|84180|2022|PDM|4716.00|99|0.00|AETNA DELAYED BREAST PROSTHESIS
20|FH_F130763_0_0|SrvcGrp|84182|2022|PDM|3947.00|99|0.00|AETNA REMOVAL OF BREAST CAPSULE
20|FH_F130763_0_0|SrvcGrp|85778|2022|PDM|4574.00|99|0.00|REPAIR OF ANKLE FRACTURE
20|FH_F130763_0_0|SrvcGrp|86463|2022|PDM|4714.00|99|0.00|FRACTURE NASAL INFERIOR
20|FH_F130763_0_0|SrvcGrp|87055|2022|PDM|4717.00|99|0.00|CYSTOURETHROSCOPY W/STENT INSERTION
20|FH_F130763_0_0|SrvcGrp|88159|2022|PDM|7319.00|99|0.00|LOW BACK DISK SURGERY
20|FH_F130763_0_0|SrvcGrp|88162|2022|PDM|7319.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON
20|FH_F130763_0_0|SrvcGrp|88492|2022|PDM|5823.00|99|0.00|AETNA SPINAL BONE AUTOGRAFT
20|FH_F130763_0_0|SrvcGrp|89980|2022|PDM|5165.00|99|0.00|OPEN TREATMENT OF DISTAL
20|FH_F130763_0_0|SrvcGrp|91879|2022|PDM|4043.00|99|0.00|PROSTATE LASER ENUCLEATION
20|FH_F130763_0_0|SrvcGrp|91941|2022|PDM|4367.00|99|0.00|NASAL/SINUS ENDOSCOPY WITH DILATION
20|FH_F130763_0_0|SrvcGrp|93059|2022|PDM|5823.00|99|0.00|SPINAL BONE AUTOGRAFT
20|FH_F130770_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F130826_0_0|CSTM-ALL|CSTM-00|2020|PDM|576.00|99|0.00|AEG 3 (NO REV)
20|FH_F130826_0_0|CSTM-ALL|CSTM-00|2020|PDM|713.00|99|0.00|AEG 4 (NO REV)
20|FH_F130920_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F130923_0_0|SrvcGrp|82223|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F130923_0_0|SrvcGrp|84185|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F130935_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE
20|FH_F130970_0_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F130985_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.41|99|0.00|GENERAL ACUTE CARE
20|FH_F130985_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.41|99|0.00|OP SVCS
20|FH_F130985_0_0|SrvcGrp|3142|2022|PDM|1695.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F131000_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F131000_0_0|CSTM-ALL|CSTM-00|2020|PDM|1769.00|99|0.00|AEG 10 (NO REV)
20|FH_F131000_0_0|CSTM-ALL|CSTM-00|2020|PDM|2185.00|99|0.00|AEG 5  (NO REV)
20|FH_F131000_0_0|CSTM-ALL|CSTM-00|2020|PDM|2497.00|99|0.00|AEG 7 (NO REV)
20|FH_F131000_0_0|SrvcGrp|108267|2022|PCT|0.00|99|0.00|AETNA IMAGING
20|FH_F131000_0_0|SrvcGrp|16289|2022|PDM|1539.00|99|0.00|CARPAL TUNNEL RELEASE
20|FH_F131000_0_0|SrvcGrp|26274|2022|PDM|3343.00|99|0.00|CPT 29877
20|FH_F131000_0_0|SrvcGrp|26275|2022|PDM|2494.00|99|0.00|CPT 29826
20|FH_F131000_0_0|SrvcGrp|26432|2022|PDM|3343.00|99|0.00|OP SURGICAL SERVICES
20|FH_F131000_0_0|SrvcGrp|27345|2022|PDM|3121.00|99|0.00|OP SURGERY (CPT 49650)
20|FH_F131000_0_0|SrvcGrp|27402|2022|PDM|3795.00|99|0.00|LASER PROCEDURES
20|FH_F131000_0_0|SrvcGrp|34606|2022|PDM|3608.00|99|0.00|CPT 29827
20|FH_F131000_0_0|SrvcGrp|44067|2022|PDM|3608.00|99|0.00|CPT 52240
20|FH_F131000_0_0|SrvcGrp|64517|2022|PDM|5202.00|99|0.00|REDUCE MANMMAPLASTY
20|FH_F131000_0_0|SrvcGrp|65403|2022|PDM|2971.00|99|0.00|CPT 42830
20|FH_F131000_0_0|SrvcGrp|77582|2022|PDM|3343.00|99|0.00|CPT 31255
20|FH_F131000_0_0|SrvcGrp|82107|2022|PDM|3343.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F131000_0_0|SrvcGrp|82114|2022|PDM|3343.00|99|0.00|MENISCUS REPAIR MED OR LAT
20|FH_F131000_0_0|SrvcGrp|84180|2022|PDM|3608.00|99|0.00|AETNA DELAYED BREAST PROSTHESIS
20|FH_F131000_0_0|SrvcGrp|84181|2022|PDM|3024.00|99|0.00|AETNA IMMEDIATE BREAST PROSTHESIS
20|FH_F131000_0_0|SrvcGrp|86463|2022|PDM|3608.00|99|0.00|FRACTURE NASAL INFERIOR
20|FH_F131000_0_0|SrvcGrp|88159|2022|PDM|6155.00|99|0.00|LOW BACK DISK SURGERY
20|FH_F131000_0_0|SrvcGrp|88160|2022|PDM|6450.00|99|0.00|LAMINECTOMY W/FACETECTOMY
20|FH_F131000_0_0|SrvcGrp|88491|2022|PDM|6155.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR
20|FH_F131000_0_0|SrvcGrp|92415|2022|PDM|6155.00|99|0.00|NECK SPINE DISK SURGERY
20|FH_F131000_0_0|SrvcGrp|93059|2022|PDM|4457.00|99|0.00|SPINAL BONE AUTOGRAFT
20|FH_F131087_0_0|SrvcGrp|106906|2022|PDM|511.00|99|0.00|AETNA SURGERY DEFAULT W/O GROUPER 1 & 2
20|FH_F131087_0_0|SrvcGrp|72990|2022|PDM|465.00|99|0.00|AEG 1
20|FH_F131100_0_0|CSTM-ALL|CSTM-00|2020|PDM|1598.00|99|0.00|AEG 4 (NO REV)
20|FH_F131100_0_0|CSTM-ALL|CSTM-00|2020|PDM|1935.00|99|0.00|AEG 10 (NO REV)
20|FH_F131100_0_0|CSTM-ALL|CSTM-00|2020|PDM|1935.00|99|0.00|AEG 5  (NO REV)
20|FH_F131100_0_0|CSTM-ALL|CSTM-00|2020|PDM|2474.00|99|0.00|AEG 7 (NO REV)
20|FH_F131100_0_0|CSTM-ALL|CSTM-00|2020|PDM|525.00|99|0.00|AEG 1 (NO REV)
20|FH_F131100_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F131100_0_0|SrvcGrp|111435|2022|PDM|856.00|99|0.00|ATRAUMATIC DISLOC WITH ANES
20|FH_F131100_0_0|SrvcGrp|98105|2022|PDM|57.00|99|0.00|DRAIN INJ JOINT/BURSA W/O U
20|FH_F131127_0_0|CSTM-ALL|CSTM-00|2020|PDM|4305.00|99|0.00|AEG 8 (NO REV)
20|FH_F131127_0_0|SrvcGrp|64517|2022|PDM|4244.00|99|0.00|REDUCE MANMMAPLASTY
20|FH_F131127_0_0|SrvcGrp|82720|2022|PDM|2732.00|99|0.00|WRIST ENDOSCOPY/SURGERY
20|FH_F131127_0_0|SrvcGrp|84180|2022|PDM|4350.00|99|0.00|AETNA DELAYED BREAST PROSTHESIS
20|FH_F131128_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F131128_0_0|CSTM-ALL|CSTM-00|2020|PDM|1291.00|99|0.00|AEG 5  (NO REV)
20|FH_F131128_0_0|CSTM-ALL|CSTM-00|2020|PDM|607.00|99|0.00|AEG 1 (NO REV)
20|FH_F131128_0_0|CSTM-ALL|CSTM-00|2020|PDM|881.00|99|0.00|AEG 2 (NO REV)
20|FH_F131128_0_0|SrvcGrp|33986|2022|PDM|983.00|99|0.00|CPT 26055
20|FH_F131128_0_0|SrvcGrp|75002|2022|PDM|4774.00|99|0.00|ARTHOSCOPY
20|FH_F131148_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F131148_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F131169_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F131169_0_0|SrvcGrp|108081|2022|PDM|171.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS
20|FH_F131187_0_0|SrvcGrp|108081|2022|PDM|171.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS
20|FH_F131208_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F131208_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F131208_0_0|SrvcGrp|106291|2022|PDM|379.50|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT LEVEL 1 (HCFA)
20|FH_F131208_0_0|SrvcGrp|106317|2022|PDM|786.50|99|0.00|SPECIALTY CARE TRANSPORT (HCFA)
20|FH_F131208_0_0|SrvcGrp|107353|2022|PDM|1001.00|99|0.00|AMB SRVC NEONAT TRNSPRT BS RATE EMERG 1 WAY (HCFA)
20|FH_F131224_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F131282_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F131282_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 5  (NO REV)
20|FH_F131282_0_0|CSTM-ALL|CSTM-00|2020|PDM|1025.00|99|0.00|AEG 6 (NO REV)
20|FH_F131282_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|AEG 1 (NO REV)
20|FH_F131282_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 10 (NO REV)
20|FH_F131282_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F131282_0_0|SrvcGrp|78045|2022|PCT|1.00|99|0.00|AETNA AMNIOTIC MEMBRANE
20|FH_F131286_0_0|SrvcGrp|82981|2022|PDM|110.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F131324_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F131327_0_0|CSTM-ALL|CSTM-00|2020|PDM|1314.00|99|0.00|AEG 9 (NO REV)
20|FH_F131327_0_0|CSTM-ALL|CSTM-00|2020|PDM|438.00|99|0.00|AEG 10 (NO REV)
20|FH_F131327_0_0|CSTM-ALL|CSTM-00|2020|PDM|703.00|99|0.00|AEG 5  (NO REV)
20|FH_F131327_0_0|CSTM-ALL|CSTM-00|2020|PDM|878.00|99|0.00|AEG 2 (NO REV)
20|FH_F131327_0_0|CSTM-ALL|CSTM-00|2020|PDM|957.00|99|0.00|AEG 8 (NO REV)
20|FH_F131331_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F131331_0_0|SrvcGrp|104230|2022|PDM|165.42|99|0.00|RESPITE CARE (HCFA)
20|FH_F131331_0_0|SrvcGrp|73656|2022|PDM|980.13|99|0.00|AETNA HOSPICE SVCS
20|FH_F131331_0_0|SrvcGrp|84185|2022|PDM|165.42|99|0.00|RESPITE CARE
20|FH_F131371_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F131371_0_0|CSTM-ALL|CSTM-00|2020|PDM|6300.00|99|0.00|AEG 5  (NO REV)
20|FH_F131371_0_0|CSTM-ALL|CSTM-00|2020|PDM|7698.00|99|0.00|AEG 8 (NO REV)
20|FH_F131371_0_0|CSTM-ALL|CSTM-00|2020|PDM|7929.00|99|0.00|AEG 9 (NO REV)
20|FH_F131371_0_0|CSTM-ALL|CSTM-00|2020|PDM|8106.00|99|0.00|AEG 7 (NO REV)
20|FH_F131371_0_0|SrvcGrp|106146|2022|PDM|17000.00|99|0.00|REVERSE HIP JOINT
20|FH_F131371_0_0|SrvcGrp|40002|2022|PDM|17000.00|99|0.00|TOTAL HIP
20|FH_F131371_0_0|SrvcGrp|96350|2022|PDM|17000.00|99|0.00|SHOULDER JOINT
20|FH_F131379_0_0|SrvcGrp|108043|2022|PDM|161.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD
20|FH_F131412_0_0|SrvcGrp|83857|2022|PDM|640.15|99|0.00|IP HOSPICE SVCS
20|FH_F131433_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F131472_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F131494_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|AEG 5  (NO REV)
20|FH_F131494_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F131494_0_0|SrvcGrp|33977|2022|PDM|578.00|99|0.00|CPT 59820
20|FH_F131494_0_0|SrvcGrp|68000|2022|PDM|814.00|99|0.00|CPT 58561
20|FH_F131498_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F131498_0_0|SrvcGrp|73656|2022|PDM|475.00|99|0.00|AETNA HOSPICE SVCS
20|FH_F131501_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F131501_0_0|SrvcGrp|24739|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F131501_0_0|SrvcGrp|63119|2022|PDM|23.00|99|0.00|BASIC HOME HOSPICE CARE
20|FH_F131501_0_0|SrvcGrp|80317|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F131501_0_0|SrvcGrp|83519|2022|PDM|100.00|99|0.00|HOSPICE CARE (ALL OTHER)
20|FH_F131501_0_0|SrvcGrp|95441|2022|PDM|100.00|99|0.00|HOSPICE OR HOME CARE
20|FH_F131505_0_0|CSTM-ALL|CSTM-00|2020|PDM|420.00|99|0.00|AEG 8 (NO REV)
20|FH_F131505_0_0|CSTM-ALL|CSTM-00|2020|PDM|420.00|99|0.00|AEG 9 (NO REV)
20|FH_F131505_0_0|SrvcGrp|75282|2022|PDM|265.00|99|0.00|DIAGNOSTIC HYSTEROSCOPY
20|FH_F131529_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F131529_0_0|SrvcGrp|63119|2022|PDM|23.00|99|0.00|BASIC HOME HOSPICE CARE
20|FH_F131529_0_0|SrvcGrp|63297|2022|PDM|100.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F131605_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F131605_0_0|SrvcGrp|75545|2022|PDM|350.00|99|0.00|SUB-ACUTE - LEVEL I AND II
20|FH_F131608_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F131608_0_0|SrvcGrp|63297|2022|PDM|165.42|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F131608_0_0|SrvcGrp|80918|2022|PDM|149.80|99|0.00|RESPITE CARE
20|FH_F131608_0_0|SrvcGrp|83857|2022|PDM|640.15|99|0.00|IP HOSPICE SVCS
20|FH_F131608_0_0|SrvcGrp|89781|2022|PDM|165.42|99|0.00|RESPITE CARE (HCFA)
20|FH_F131609_0_0|SrvcGrp|87077|2022|PDM|100.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F131613_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F131630_0_0|CSTM-ALL|CSTM-00|2020|PDM|1311.00|99|0.00|AEG 2 (NO REV)
20|FH_F131630_0_0|SrvcGrp|70746|2022|PDM|1665.00|99|0.00|CPT 28292
20|FH_F131954_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F131954_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F131954_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.76|99|0.00|HSS ASC
20|FH_F131965_0_0|SrvcGrp|30609|2022|PDM|23.00|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F131965_0_0|SrvcGrp|65720|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F131965_0_0|SrvcGrp|97507|2022|PDM|100.00|99|0.00|AETNA HOSPICE
20|FH_F131974_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F131982_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F131982_0_0|SrvcGrp|29155|2022|PDM|143.00|99|0.00|HOSPICE SVCS
20|FH_F131982_0_0|SrvcGrp|82222|2022|PDM|143.00|99|0.00|HOSPICE CARE
20|FH_F131996_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F131996_0_0|CSTM-ALL|CSTM-00|2020|PDM|1103.00|99|0.00|AEG 7 (NO REV)
20|FH_F131996_0_0|CSTM-ALL|CSTM-00|2020|PDM|1133.00|99|0.00|AEG 6 (NO REV)
20|FH_F132002_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS
20|FH_F132032_0_0|SrvcGrp|82222|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F132032_0_0|SrvcGrp|84185|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F132073_0_0|SrvcGrp|29155|2022|PDM|143.00|99|0.00|HOSPICE SVCS
20|FH_F132073_0_0|SrvcGrp|57966|2022|PDM|556.00|99|0.00|HOSPICE CARE
20|FH_F132073_0_0|SrvcGrp|82222|2022|PDM|143.00|99|0.00|HOSPICE CARE
20|FH_F132080_0_0|SrvcGrp|80918|2022|PDM|169.00|99|0.00|RESPITE CARE
20|FH_F132080_0_0|SrvcGrp|87799|2022|PDM|169.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)
20|FH_F132080_0_0|SrvcGrp|95661|2022|PDM|169.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F132080_0_0|SrvcGrp|97507|2022|PDM|169.00|99|0.00|AETNA HOSPICE
20|FH_F132080_0_0|SrvcGrp|97703|2022|PDM|169.00|99|0.00|HOSPICE IN LTCH (HCFA)
20|FH_F132080_0_0|SrvcGrp|97704|2022|PDM|169.00|99|0.00|HOSPICE IN HOME (HCFA)
20|FH_F132080_0_0|SrvcGrp|97705|2022|PDM|169.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F132092_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F132092_0_0|SrvcGrp|63297|2022|PDM|169.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F132092_0_0|SrvcGrp|89781|2022|PDM|169.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F132092_0_0|SrvcGrp|97507|2022|PDM|169.00|99|0.00|AETNA HOSPICE
20|FH_F132125_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F132125_0_0|SrvcGrp|471|2022|PDM|1300.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F132130_0_0|CSTM-ALL|CSTM-00|2020|PDM|1298.00|99|0.00|AEG 9 (NO REV)
20|FH_F132130_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F132130_0_0|SrvcGrp|111966|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F132133_0_0|CSTM-ALL|CSTM-00|2020|PDM|1125.00|99|0.00|AEG 7 (NO REV)
20|FH_F132133_0_0|CSTM-ALL|CSTM-00|2020|PDM|576.00|99|0.00|AEG 3 (NO REV)
20|FH_F132133_0_0|CSTM-ALL|CSTM-00|2020|PDM|935.00|99|0.00|AEG 6 (NO REV)
20|FH_F132138_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132138_0_0|SrvcGrp|82981|2022|PDM|149.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F132160_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F132160_0_0|CSTM-ALL|CSTM-00|2020|PDM|1196.00|99|0.00|AEG 3 (NO REV)
20|FH_F132160_0_0|CSTM-ALL|CSTM-00|2020|PDM|1473.00|99|0.00|AEG 4 (NO REV)
20|FH_F132160_0_0|CSTM-ALL|CSTM-00|2020|PDM|2338.00|99|0.00|AEG 7 (NO REV)
20|FH_F132160_0_0|SrvcGrp|109348|2022|PDM|2869.00|99|0.00|EXCISION OF LESION OF EYELID
20|FH_F132160_0_0|SrvcGrp|109763|2022|PDM|2869.00|99|0.00|TREAT EYELID LESION
20|FH_F132160_0_0|SrvcGrp|109765|2022|PDM|1721.00|99|0.00|CLOSURE OF LACRIMAL PUNCTUM
20|FH_F132160_0_0|SrvcGrp|109768|2022|PDM|2433.00|99|0.00|COVER EYE W/ MEMBRANE SUTURE
20|FH_F132160_0_0|SrvcGrp|114443|2022|PDM|10328.00|99|0.00|EXTRACAPSULAR CATARACT REMOVAL, INSERT LENS
20|FH_F132160_0_0|SrvcGrp|84280|2022|PDM|9754.00|99|0.00|CORNEAL TRANSPLANT
20|FH_F132160_0_0|SrvcGrp|84934|2022|PDM|6885.00|99|0.00|REMOVAL OF EYE LESION
20|FH_F132160_0_0|SrvcGrp|85966|2022|PDM|7459.00|99|0.00|EXTRACAPSULAR CATARACT
20|FH_F132190_0_0|CSTM-ALL|CSTM-00|2020|PDM|876.00|99|0.00|AEG 10 (NO REV)
20|FH_F132190_0_0|SrvcGrp|101840|2022|PDM|2500.00|99|0.00|REPAIR OF TENDON(S)
20|FH_F132190_0_0|SrvcGrp|109364|2022|PDM|2600.00|99|0.00|REMOVAL OF BONE FOR GRAFT
20|FH_F132190_0_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS
20|FH_F132190_0_0|SrvcGrp|16692|2022|PDM|2500.00|99|0.00|KNEE SCOPE
20|FH_F132190_0_0|SrvcGrp|44461|2022|PDM|2600.00|99|0.00|INSERTION / REPLACEMENT OF SPINAL NEUROSTIMULATOR GENERATOR
20|FH_F132190_0_0|SrvcGrp|96979|2022|PDM|2500.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F132190_0_0|SrvcGrp|98580|2022|PDM|7000.00|99|0.00|ARTHRODESIS SACROILIAC JOINT
20|FH_F132190_0_0|SrvcGrp|98584|2022|PDM|9000.00|99|0.00|TOTAL DISC ARTHROPLASTY
20|FH_F132193_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F132193_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|AEG 1 (NO REV)
20|FH_F132193_0_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|AEG 5  (NO REV)
20|FH_F132193_0_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|AEG 6 (NO REV)
20|FH_F132193_0_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|AEG 8 (NO REV)
20|FH_F132193_0_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|AEG 9 (NO REV)
20|FH_F132193_0_0|SrvcGrp|12664|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F132212_0_0|SrvcGrp|92502|2022|PDM|425.00|99|0.00|HOSPICE GENERAL IP CARE
20|FH_F132212_0_0|SrvcGrp|94781|2022|PDM|90.00|99|0.00|HOSPICE IN LTCH (HCFA)
20|FH_F132235_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F132235_0_0|SrvcGrp|30609|2022|PDM|23.00|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F132235_0_0|SrvcGrp|63297|2022|PDM|100.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F132235_0_0|SrvcGrp|90707|2022|PDM|100.00|99|0.00|AETNA HOSPICE CARE
20|FH_F132247_0_0|SrvcGrp|87077|2022|PDM|150.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F132282_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F132328_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132328_0_0|CSTM-ALL|CSTM-00|2020|PDM|2643.00|99|0.00|AEG 7 (NO REV)
20|FH_F132328_0_0|SrvcGrp|102120|2022|PDM|2081.00|99|0.00|REVISE EYE MUSCLE
20|FH_F132328_0_0|SrvcGrp|103586|2022|PDM|1706.00|99|0.00|REMOVE SPINE INFUSION
20|FH_F132328_0_0|SrvcGrp|103635|2022|PDM|13005.00|99|0.00|AETNA TRLUML PERIP ATHRC LLIAC ART
20|FH_F132328_0_0|SrvcGrp|104171|2022|PDM|2049.00|99|0.00|AETNA ARTHROSCOPY SURGERY SYNOVECT
20|FH_F132328_0_0|SrvcGrp|111949|2022|PDM|2425.00|99|0.00|MALE GENITAL PROCEDURES
20|FH_F132328_0_0|SrvcGrp|111950|2022|PDM|2819.00|99|0.00|HERNIA REPAIR
20|FH_F132328_0_0|SrvcGrp|111954|2022|PDM|2425.00|99|0.00|MALE GENITAL PROCEDURES
20|FH_F132328_0_0|SrvcGrp|15473|2022|PDM|2451.00|99|0.00|CPT CODE 42820
20|FH_F132328_0_0|SrvcGrp|27344|2022|PDM|2229.00|99|0.00|OP SURGERY (CPT 42821)
20|FH_F132328_0_0|SrvcGrp|35669|2022|PDM|1561.00|99|0.00|CPT 63650
20|FH_F132328_0_0|SrvcGrp|36591|2022|PDM|4323.00|99|0.00|CPT 63685
20|FH_F132328_0_0|SrvcGrp|36865|2022|PDM|5108.00|99|0.00|NUCLEOPLASTY
20|FH_F132328_0_0|SrvcGrp|42550|2022|PDM|2653.00|99|0.00|OP SURGERY CPT 66984
20|FH_F132328_0_0|SrvcGrp|45063|2022|PDM|1340.00|99|0.00|CPT 64493  INJECTION CARVE OUT
20|FH_F132328_0_0|SrvcGrp|45583|2022|PDM|3839.00|99|0.00|CPT 65730
20|FH_F132328_0_0|SrvcGrp|46906|2022|PDM|3839.00|99|0.00|CORNEAL TISSUE
20|FH_F132328_0_0|SrvcGrp|49205|2022|PDM|3641.00|99|0.00|REPAIR DETACHED RETINA
20|FH_F132328_0_0|SrvcGrp|58993|2022|PDM|6950.00|99|0.00|DISKECTOMY
20|FH_F132328_0_0|SrvcGrp|67068|2022|PDM|17219.00|99|0.00|LUMBAR SPINE FUSION COMBINED
20|FH_F132328_0_0|SrvcGrp|71221|2022|PDM|2000.00|99|0.00|EGD W/BALLOON DIALATION CPT 43249
20|FH_F132328_0_0|SrvcGrp|71666|2022|PDM|4138.00|99|0.00|CPT 63655
20|FH_F132328_0_0|SrvcGrp|74039|2022|PDM|6097.00|99|0.00|LAMINECTOMY
20|FH_F132328_0_0|SrvcGrp|77445|2022|PDM|2819.00|99|0.00|REMOVAL OF HYDROCELE
20|FH_F132328_0_0|SrvcGrp|77461|2022|PDM|3371.00|99|0.00|CPT 52356
20|FH_F132328_0_0|SrvcGrp|79594|2022|PDM|1800.00|99|0.00|CPT 45380
20|FH_F132328_0_0|SrvcGrp|79595|2022|PDM|1800.00|99|0.00|CPT 45385
20|FH_F132328_0_0|SrvcGrp|82107|2022|PDM|1800.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F132328_0_0|SrvcGrp|82108|2022|PDM|1821.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F132328_0_0|SrvcGrp|82112|2022|PDM|2581.00|99|0.00|KNEE ARTHROSCOPY SURGERY
20|FH_F132328_0_0|SrvcGrp|82570|2022|PDM|2039.00|99|0.00|REVISION EYELID/EXCESS SKIN
20|FH_F132328_0_0|SrvcGrp|83351|2022|PDM|3891.00|99|0.00|AETNA LAPAR ORCHIOPEXY
20|FH_F132328_0_0|SrvcGrp|84318|2022|PDM|9270.00|99|0.00|SPINE INFUSION
20|FH_F132328_0_0|SrvcGrp|84939|2022|PDM|15232.00|99|0.00|SHOULDER JOINT
20|FH_F132328_0_0|SrvcGrp|87055|2022|PDM|2123.00|99|0.00|CYSTOURETHROSCOPY W/STENT INSERTION
20|FH_F132328_0_0|SrvcGrp|88163|2022|PDM|14566.00|99|0.00|LUMBAR SPINE FUSION
20|FH_F132328_0_0|SrvcGrp|88164|2022|PDM|14566.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR
20|FH_F132328_0_0|SrvcGrp|88495|2022|PDM|3153.00|99|0.00|AETNA PERCUTANEOUS INTRADISCAL
20|FH_F132328_0_0|SrvcGrp|88740|2022|PDM|5202.00|99|0.00|SP BONE ALGRFT
20|FH_F132328_0_0|SrvcGrp|89888|2022|PDM|2819.00|99|0.00|AETNA SUSPENSION OF TESTIS
20|FH_F132328_0_0|SrvcGrp|91577|2022|PDM|10592.00|99|0.00|FEM/POPL REVASC STNT & ATHER
20|FH_F132328_0_0|SrvcGrp|96799|2022|PDM|2049.00|99|0.00|DESTROY C/TH FACET JNT ADDL
20|FH_F132328_0_0|SrvcGrp|97363|2022|PDM|1821.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F132372_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F132372_0_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA
20|FH_F132372_0_0|SrvcGrp|82981|2022|PDM|193.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F132372_0_0|SrvcGrp|87077|2022|PDM|193.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F132374_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F132374_0_0|CSTM-ALL|CSTM-00|2020|PDM|1090.39|99|0.00|AEG 2 (NO REV)
20|FH_F132374_0_0|CSTM-ALL|CSTM-00|2020|PDM|1540.18|99|0.00|AEG 4 (NO REV)
20|FH_F132374_0_0|CSTM-ALL|CSTM-00|2020|PDM|2431.80|99|0.00|AEG 7 (NO REV)
20|FH_F132374_0_0|SrvcGrp|83824|2022|PCT|0.00|99|0.00|AETNA CADIAC CATH INCIDENTAL CODES
20|FH_F132374_0_0|SrvcGrp|97467|2022|PDM|3627.06|99|0.00|PARTIAL EXCISION THYROID
20|FH_F132439_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132439_0_0|SrvcGrp|14494|2022|PDM|37.74|99|0.00|CONTINUOUS HOMECARE
20|FH_F132442_0_0|SrvcGrp|87077|2022|PDM|130.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F132487_0_0|SrvcGrp|29155|2022|PDM|100.00|99|0.00|HOSPICE SVCS
20|FH_F132487_0_0|SrvcGrp|82223|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F132487_0_0|SrvcGrp|84185|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F132501_0_0|CSTM-ALL|CSTM-00|2020|PDM|375.00|99|0.00|AEG 1 (NO REV)
20|FH_F132501_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 10 (NO REV)
20|FH_F132501_0_0|CSTM-ALL|CSTM-00|2020|PDM|675.00|99|0.00|AEG 9 (NO REV)
20|FH_F132501_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|AEG 5  (NO REV)
20|FH_F132512_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F132512_0_0|SrvcGrp|89417|2022|PDM|714.00|99|0.00|PARTIAL HOSPITALIZATION
20|FH_F132512_0_0|SrvcGrp|93337|2022|PDM|587.00|99|0.00|AETNA INTENSIVE OP EATING DISORDERS
20|FH_F132544_0_0|CSTM-ALL|CSTM-00|2020|PDM|1779.00|99|0.00|AEG 2 (NO REV)
20|FH_F132544_0_0|CSTM-ALL|CSTM-00|2020|PDM|1989.00|99|0.00|AEG 3 (NO REV)
20|FH_F132544_0_0|CSTM-ALL|CSTM-00|2020|PDM|2616.00|99|0.00|AEG 5  (NO REV)
20|FH_F132544_0_0|SrvcGrp|101107|2022|PDM|8007.00|99|0.00|REVISION OF KNEE JOINT
20|FH_F132544_0_0|SrvcGrp|16669|2022|PDM|3523.00|99|0.00|ACROMINOPLASTY OF SHOULDER
20|FH_F132544_0_0|SrvcGrp|64761|2022|PDM|8007.00|99|0.00|DISCECTOMY
20|FH_F132544_0_0|SrvcGrp|96959|2022|PDM|3523.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F132544_0_0|SrvcGrp|96999|2022|PDM|3523.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F132544_0_0|SrvcGrp|97019|2022|PDM|4270.00|99|0.00|ARTHROSCOPY BICEPS TENODESIS
20|FH_F132544_0_0|SrvcGrp|97059|2022|PDM|3523.00|99|0.00|MENISCUS REPAIR, MED OR LAT
20|FH_F132544_0_0|SrvcGrp|97079|2022|PDM|3454.00|99|0.00|MENISCUS REPAIR, MED OR LAT
20|FH_F132544_0_0|SrvcGrp|97099|2022|PDM|8007.00|99|0.00|SPINAL DISK SURGERY ADD-ON
20|FH_F132544_0_0|SrvcGrp|97119|2022|PDM|8007.00|99|0.00|NECK SPINE DISK SURGERY
20|FH_F132544_0_0|SrvcGrp|97159|2022|PDM|8007.00|99|0.00|TRANSPEDICULAR, 1 SEG, LUMBAR
20|FH_F132544_0_0|SrvcGrp|97199|2022|PDM|8007.00|99|0.00|THORAX SPINE DISK SURGERY
20|FH_F132544_0_0|SrvcGrp|97219|2022|PDM|7850.00|99|0.00|DECOMPRESS SPINE CORD ADD-ON
20|FH_F132544_0_0|SrvcGrp|97319|2022|PDM|7850.00|99|0.00|REVISE SPINE ELTRD PLATE
20|FH_F132545_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132545_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F132559_0_0|CSTM-ALL|CSTM-00|2020|PDM|1339.00|99|0.00|AEG 6 (NO REV)
20|FH_F132559_0_0|CSTM-ALL|CSTM-00|2020|PDM|1510.00|99|0.00|AEG 8 (NO REV)
20|FH_F132559_0_0|CSTM-ALL|CSTM-00|2020|PDM|1751.00|99|0.00|ELECTROSHOCK W/O EATING DISORDER
20|FH_F132559_0_0|CSTM-ALL|CSTM-00|2020|PDM|2284.00|99|0.00|AEG 9 (NO REV)
20|FH_F132559_0_0|SrvcGrp|105235|2022|PDM|3100.00|99|0.00|PARTIAL REMOVAL OF THYROID
20|FH_F132559_0_0|SrvcGrp|78093|2022|PDM|2800.00|99|0.00|AETNA NASAL ENDOSCOPY SURG
20|FH_F132579_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132579_0_0|SrvcGrp|14494|2022|PDM|15.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F132579_0_0|SrvcGrp|92501|2022|PDM|450.00|99|0.00|HOSPICE IP RESPITE CARE
20|FH_F132595_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F132595_0_0|CSTM-ALL|CSTM-00|2020|PDM|1164.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F132595_0_0|SrvcGrp|107733|2022|PDM|5800.00|99|0.00|CESAREAN SECTION
20|FH_F132595_0_0|SrvcGrp|107734|2022|PDM|4058.00|99|0.00|VAGINAL DELIVERY
20|FH_F132595_0_0|SrvcGrp|115|2022|PDM|1021.00|99|0.00|SKILLED NURSING CARE
20|FH_F132595_0_0|SrvcGrp|177|2022|PDM|2374.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F132595_0_0|SrvcGrp|3015|2022|PCT|0.57|99|0.00|SUPPLIES
20|FH_F132595_0_0|SrvcGrp|33793|2022|PDM|6847.00|99|0.00|MSDRG 246-251 ONLY ANGIOPLASTY
20|FH_F132595_0_0|SrvcGrp|360|2022|PDM|1643.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F132595_0_0|SrvcGrp|72|2022|PDM|676.00|99|0.00|NEWBORN NURSERY
20|FH_F132599_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132599_0_0|SrvcGrp|87077|2022|PDM|115.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F93592_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|AEG 3 (NO REV)
20|FH_F93592_0_0|CSTM-ALL|CSTM-00|2020|PDM|909.00|99|0.00|AEG 6 (NO REV)
20|FH_F93740_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F93740_0_0|CSTM-ALL|CSTM-00|2020|PDM|5200.00|99|0.00|IMPLANT PAT-ACTIVE HT RECORD
20|FH_F93740_0_0|CSTM-ALL|CSTM-00|2020|PDM|6500.00|99|0.00|AETNA THROMBECTOMY
20|FH_F93740_0_0|SrvcGrp|91593|2022|PDM|4800.00|99|0.00|PACEMAKER/ACID
20|FH_F93791_0_0|CSTM-ALL|CSTM-00|2020|PDM|2415.00|99|0.00|AEG 4 (NO REV)
20|FH_F93791_0_0|CSTM-ALL|CSTM-00|2020|PDM|3150.00|99|0.00|AEG 5  (NO REV)
20|FH_F93791_0_0|CSTM-ALL|CSTM-00|2020|PDM|683.00|99|0.00|AEG 1 (NO REV)
20|FH_F93791_0_0|SrvcGrp|80617|2022|PDM|4200.00|99|0.00|ARTHOPLASTY
20|FH_F93791_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F93791_0_0|SrvcGrp|93597|2022|PDM|4200.00|99|0.00|REVISE RECONSTRUCT SHOULDER JOINT(HCFA)
20|FH_F93791_0_0|SrvcGrp|93602|2022|PDM|4200.00|99|0.00|TOTAL KNEE(HCFA)
20|FH_F93805_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F93906_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE
20|FH_F93911_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F93948_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F93961_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F93961_0_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|AEG 9 (NO REV)
20|FH_F93961_0_0|CSTM-ALL|CSTM-00|2020|PDM|635.00|99|0.00|AEG 4 (NO REV)
20|FH_F93961_0_0|CSTM-ALL|CSTM-00|2020|PDM|993.00|99|0.00|AEG 7 (NO REV)
20|FH_F94060_0_0|CSTM-ALL|CSTM-00|2020|PCT|74.00|99|0.00|GENERAL ACUTE CARE
20|FH_F94061_0_0|CSTM-ALL|CSTM-00|2020|PCT|50.00|99|0.00|OP SVCS
20|FH_F94100_0_0|CSTM-ALL|CSTM-00|2020|PCT|54.00|99|0.00|OP SVCS
20|FH_F94101_0_0|CSTM-ALL|CSTM-00|2020|PCT|52.00|99|0.00|OP SVCS
20|FH_F94103_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F94165_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|AEG 10 (NO REV)
20|FH_F94165_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|AEG 2 (NO REV)
20|FH_F94165_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|AEG 6 (NO REV)
20|FH_F94165_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|AEG 7 (NO REV)
20|FH_F94165_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|AEG 8 (NO REV)
20|FH_F94165_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|AEG 9 (NO REV)
20|FH_F94165_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|AETNA OP IMAGING ENHANC. SUBSTANCES (IMAGENHANCE)
20|FH_F94165_0_0|SrvcGrp|73461|2022|PCT|0.85|99|0.00|AETNA NICU IV
20|FH_F94165_0_0|SrvcGrp|73483|2022|PCT|0.85|99|0.00|AETNA SUBACUTE III
20|FH_F94165_0_0|SrvcGrp|73485|2022|PCT|0.85|99|0.00|AETNA REHAB
20|FH_F94165_0_0|SrvcGrp|74469|2022|PCT|0.85|99|0.00|AETNA CHEMOTHERAPY
20|FH_F94165_0_0|SrvcGrp|74616|2022|PCT|0.85|99|0.00|AETNA LABORATORY
20|FH_F94280_0_0|CSTM-ALL|CSTM-00|2020|PDM|1127.00|99|0.00|AEG 10 (NO REV)
20|FH_F94280_0_0|CSTM-ALL|CSTM-00|2020|PDM|1257.00|99|0.00|AEG 2 (NO REV)
20|FH_F94280_0_0|CSTM-ALL|CSTM-00|2020|PDM|1690.00|99|0.00|AEG 4 (NO REV)
20|FH_F94280_0_0|SrvcGrp|47544|2022|PDM|2528.00|99|0.00|PERCUTANEOUS IMPLANT OF NEUROSTIMULATOR ELECTRODES
20|FH_F94280_0_0|SrvcGrp|74585|2022|PCT|1.00|99|0.00|AETNA OP IMPLANTS
20|FH_F94280_0_0|SrvcGrp|93121|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F94300_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F94300_0_0|CSTM-ALL|CSTM-00|2020|PDM|3150.00|99|0.00|AEG 5  (NO REV)
20|FH_F94300_0_0|CSTM-ALL|CSTM-00|2020|PDM|3675.00|99|0.00|AEG 6 (NO REV)
20|FH_F94300_0_0|SrvcGrp|705|2022|PCT|1.03|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F94300_0_0|SrvcGrp|80617|2022|PDM|4200.00|99|0.00|ARTHOPLASTY
20|FH_F94300_0_0|SrvcGrp|84181|2022|PDM|2310.00|99|0.00|AETNA IMMEDIATE BREAST PROSTHESIS
20|FH_F94300_0_0|SrvcGrp|93596|2022|PDM|4200.00|99|0.00|SHOULDER JOINT(HCFA)
20|FH_F94300_0_0|SrvcGrp|93666|2022|PDM|2310.00|99|0.00|IMMEDIATE BREAST PROSTHESIS - HCFA
20|FH_F94303_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F94303_0_0|SrvcGrp|78504|2022|PDM|4800.00|99|0.00|AETNA CARDIAC CATHETERIZATION
20|FH_F94340_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F94402_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F94403_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F94403_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F94403_0_0|CSTM-ALL|CSTM-00|2020|PDM|1197.00|99|0.00|AEG 6 (NO REV)
20|FH_F94403_0_0|CSTM-ALL|CSTM-00|2020|PDM|563.00|99|0.00|AEG 10 (NO REV)
20|FH_F94403_0_0|SrvcGrp|11663|2022|PCT|1.05|99|0.00|IMPLANTS
20|FH_F94481_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F94481_0_0|SrvcGrp|471|2022|PDM|580.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F94502_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F94502_0_0|SrvcGrp|59290|2022|PDM|200.00|99|0.00|DAY HOSPITAL HALF DAY
20|FH_F94502_0_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE
20|FH_F94581_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F94662_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F94662_0_0|SrvcGrp|24739|2022|PDM|199.00|99|0.00|RESPITE CARE
20|FH_F94662_0_0|SrvcGrp|29353|2022|PDM|199.00|99|0.00|HOSPICE SVCS
20|FH_F94662_0_0|SrvcGrp|90478|2022|PDM|199.00|99|0.00|HOSPICE
20|FH_F94665_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F94862_0_0|SrvcGrp|12491|2022|PCT|0.50|99|0.00|PACEMAKER
20|FH_F94862_0_0|SrvcGrp|72996|2022|PDM|700.00|99|0.00|AEG 4
20|FH_F94862_0_0|SrvcGrp|72998|2022|PDM|800.00|99|0.00|AEG 5
20|FH_F94862_0_0|SrvcGrp|73000|2022|PDM|900.00|99|0.00|AEG 6
20|FH_F94862_0_0|SrvcGrp|73008|2022|PDM|575.00|99|0.00|AEG 10
20|FH_F94942_0_0|SrvcGrp|36591|2022|PDM|3824.39|99|0.00|CPT 63685
20|FH_F94942_0_0|SrvcGrp|63471|2022|PDM|3824.39|99|0.00|CPT 64590
20|FH_F94942_0_0|SrvcGrp|72996|2022|PDM|929.06|99|0.00|AEG 4
20|FH_F94942_0_0|SrvcGrp|94161|2022|PDM|1854.00|99|0.00|REMOVE TENDON SHEATH LESION
20|FH_F94942_0_0|SrvcGrp|94164|2022|PDM|3278.49|99|0.00|SHOULDER ARTHROSCOPY/SURGERY
20|FH_F95021_0_0|SrvcGrp|42782|2022|PDM|45.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F95021_0_0|SrvcGrp|42784|2022|PDM|45.00|99|0.00|OCCUPATIONAL THERAPY  SRVCS
20|FH_F95021_0_0|SrvcGrp|42785|2022|PDM|45.00|99|0.00|SPEECH THERAPY  SRVCS
20|FH_F95101_0_0|SrvcGrp|471|2022|PDM|580.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F95221_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F95221_0_0|SrvcGrp|72998|2022|PDM|753.00|99|0.00|AEG 5
20|FH_F95221_0_0|SrvcGrp|73008|2022|PDM|499.00|99|0.00|AEG 10
20|FH_F95340_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F95440_0_0|SrvcGrp|63472|2022|PDM|5100.00|99|0.00|CPT 64581
20|FH_F95440_0_0|SrvcGrp|72994|2022|PDM|2523.00|99|0.00|AEG 3
20|FH_F95440_0_0|SrvcGrp|72996|2022|PDM|2626.00|99|0.00|AEG 4
20|FH_F95440_0_0|SrvcGrp|73002|2022|PDM|2781.00|99|0.00|AEG 7
20|FH_F95440_0_0|SrvcGrp|73006|2022|PDM|2884.00|99|0.00|AEG 9
20|FH_F95440_0_0|SrvcGrp|73008|2022|PDM|2781.00|99|0.00|AEG 10
20|FH_F95440_0_0|SrvcGrp|93721|2022|PDM|4635.00|99|0.00|LAP BAND
20|FH_F95440_0_0|SrvcGrp|93723|2022|PDM|2575.00|99|0.00|LAP HERNIA
20|FH_F95440_0_0|SrvcGrp|93726|2022|PDM|3000.00|99|0.00|REMOVE SPINAL CANAL CATHET18
20|FH_F95482_0_0|CSTM-ALL|CSTM-00|2020|PDM|1750.00|99|0.00|AEG 6 (NO REV)
20|FH_F95482_0_0|SrvcGrp|92676|2022|PCT|0.00|99|0.00|IMAGING ENHANCED SUBSTANCE
20|FH_F95629_0_0|SrvcGrp|78878|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F95641_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F95641_0_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F95641_0_0|SrvcGrp|473|2022|PDM|315.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F95800_0_0|CSTM-ALL|CSTM-00|2020|PDM|1074.00|99|0.00|AEG 8 (NO REV)
20|FH_F95800_0_0|CSTM-ALL|CSTM-00|2020|PDM|1483.00|99|0.00|AEG 9 (NO REV)
20|FH_F95800_0_0|SrvcGrp|35669|2022|PDM|1852.00|99|0.00|CPT 63650
20|FH_F95800_0_0|SrvcGrp|85022|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F95800_0_0|SrvcGrp|87677|2022|PDM|884.00|99|0.00|CERVICAL OR THORACIC SURGERY
20|FH_F95900_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F95900_0_0|CSTM-ALL|CSTM-00|2020|PDM|1517.00|99|0.00|AEG 9 (NO REV)
20|FH_F95900_0_0|CSTM-ALL|CSTM-00|2020|PDM|377.00|99|0.00|AEG 10 (NO REV)
20|FH_F95900_0_0|CSTM-ALL|CSTM-00|2020|PDM|714.00|99|0.00|AEG 4 (NO REV)
20|FH_F95900_0_0|CSTM-ALL|CSTM-00|2020|PDM|936.00|99|0.00|AEG 6 (NO REV)
20|FH_F95962_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F96321_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F96321_0_0|CSTM-ALL|CSTM-00|2020|PDM|1001.00|99|0.00|AEG 8 (NO REV)
20|FH_F96321_0_0|CSTM-ALL|CSTM-00|2020|PDM|573.00|99|0.00|AEG 3 (NO REV)
20|FH_F96321_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F96321_0_0|SrvcGrp|108769|2022|PDM|1044.65|99|0.00|UPPER GI ENDOSCOPY/LIGATION
20|FH_F96780_0_0|CSTM-ALL|CSTM-00|2020|PDM|513.00|99|0.00|AEG 2 (NO REV)
20|FH_F96780_0_0|SrvcGrp|28551|2022|PDM|1761.00|99|0.00|REPAIR OF COMPLEX RETINAL DETACHMENT
20|FH_F96780_0_0|SrvcGrp|87386|2022|PDM|1613.00|99|0.00|AMNIOTIC MEMBRANE TRANSPLANTATION
20|FH_F96902_0_0|SrvcGrp|80317|2022|PDM|440.00|99|0.00|RESPITE CARE
20|FH_F96902_0_0|SrvcGrp|89781|2022|PDM|165.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F96902_0_0|SrvcGrp|9529|2022|PDM|660.00|99|0.00|HOSPICE SVCS
20|FH_F97161_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F97161_0_0|CSTM-ALL|CSTM-00|2020|PDM|1304.00|99|0.00|AEG 7 (NO REV)
20|FH_F97161_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 2 (NO REV)
20|FH_F97161_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|AEG 10 (NO REV)
20|FH_F97161_0_0|CSTM-ALL|CSTM-00|2020|PDM|939.00|99|0.00|AEG 5  (NO REV)
20|FH_F97242_0_0|SrvcGrp|42785|2022|PDM|45.00|99|0.00|SPEECH THERAPY  SRVCS
20|FH_F97242_0_0|SrvcGrp|471|2022|PDM|580.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F97242_0_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F97242_0_0|SrvcGrp|76501|2022|PDM|235.00|99|0.00|SUB-ACUTE - LEVEL I
20|FH_F97700_0_0|SrvcGrp|75545|2022|PDM|495.00|99|0.00|SUB-ACUTE - LEVEL I AND II
20|FH_F98161_0_0|SrvcGrp|72992|2022|PDM|513.00|99|0.00|AEG 2
20|FH_F98161_0_0|SrvcGrp|72996|2022|PDM|725.00|99|0.00|AEG 4
20|FH_F98161_0_0|SrvcGrp|73000|2022|PDM|950.00|99|0.00|AEG 6
20|FH_F98161_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F98480_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F98640_0_0|CSTM-ALL|CSTM-00|2020|PDM|1569.00|99|0.00|AEG 10 (NO REV)
20|FH_F98640_0_0|CSTM-ALL|CSTM-00|2020|PDM|1728.00|99|0.00|AEG 5  (NO REV)
20|FH_F98640_0_0|CSTM-ALL|CSTM-00|2020|PDM|2533.00|99|0.00|AEG 7 (NO REV)
20|FH_F98640_0_0|SrvcGrp|95819|2022|PDM|1280.00|99|0.00|GONIOTOMY
20|FH_F98741_0_0|SrvcGrp|82981|2022|PDM|130.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F99021_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F99021_0_0|CSTM-ALL|CSTM-00|2020|PDM|1345.00|99|0.00|AEG 9 (NO REV)
20|FH_F99021_0_0|CSTM-ALL|CSTM-00|2020|PDM|512.00|99|0.00|AEG 10 (NO REV)
20|FH_F99021_0_0|CSTM-ALL|CSTM-00|2020|PDM|977.00|99|0.00|AEG 8 (NO REV)
20|FH_F99100_0_0|CSTM-ALL|CSTM-00|2020|PDM|1197.00|99|0.00|AEG 6 (NO REV)
20|FH_F99100_0_0|CSTM-ALL|CSTM-00|2020|PDM|1942.00|99|0.00|AEG 9 (NO REV)
20|FH_F99100_0_0|CSTM-ALL|CSTM-00|2020|PDM|563.00|99|0.00|AEG 10 (NO REV)
20|FH_F99100_0_0|CSTM-ALL|CSTM-00|2020|PDM|647.00|99|0.00|AEG 2 (NO REV)
20|FH_F99100_0_0|SrvcGrp|37984|2022|PDM|566.50|99|0.00|LUMBAR INJECTIONS PROCEDURE
20|FH_F99100_0_0|SrvcGrp|96059|2022|PDM|1586.20|99|0.00|CATHETER
20|FH_F99100_0_0|SrvcGrp|96099|2022|PDM|1586.20|99|0.00|CATHETER (HCFA)
20|FH_F99161_0_0|SrvcGrp|74585|2022|PCT|1.00|99|0.00|AETNA OP IMPLANTS
20|FH_F99441_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F99441_0_0|CSTM-ALL|CSTM-00|2020|PDM|1061.00|99|0.00|AEG 9 (NO REV)
20|FH_F99441_0_0|CSTM-ALL|CSTM-00|2020|PDM|2601.00|99|0.00|DEVICE INSERTION
20|FH_F99441_0_0|CSTM-ALL|CSTM-00|2020|PDM|345.00|99|0.00|AEG 1 (NO REV)
20|FH_F99441_0_0|CSTM-ALL|CSTM-00|2020|PDM|743.00|99|0.00|AEG 5  (NO REV)
20|FH_F99441_0_0|SrvcGrp|112862|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F99520_0_0|CSTM-ALL|CSTM-00|2020|PCT|46.00|99|0.00|GENERAL ACUTE CARE
20|FH_F99522_0_0|CSTM-ALL|CSTM-00|2020|PCT|47.00|99|0.00|GENERAL ACUTE CARE
20|FH_F99720_0_0|SrvcGrp|103965|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F99720_0_0|SrvcGrp|104734|2022|PDM|1946.00|99|0.00|CORRECTION HALLUX VALGUS
20|FH_F99720_0_0|SrvcGrp|104736|2022|PDM|2560.00|99|0.00|ADD'L NECK SPINE FUSION
20|FH_F99720_0_0|SrvcGrp|104737|2022|PDM|2867.00|99|0.00|RELIEVE SPINAL CORD PRESSURE
20|FH_F99720_0_0|SrvcGrp|104743|2022|PDM|4403.00|99|0.00|KNEE ARTHRO/ ANTER CLIG REP
20|FH_F99720_0_0|SrvcGrp|72998|2022|PDM|2241.00|99|0.00|AEG 5
20|FH_F99720_0_0|SrvcGrp|84939|2022|PDM|12800.00|99|0.00|SHOULDER JOINT
20|FH_F99960_0_0|SrvcGrp|33967|2022|PDM|1760.00|99|0.00|CPT 47562
20|FH_F99960_0_0|SrvcGrp|72994|2022|PDM|785.00|99|0.00|AEG 3
20|FH_F99960_0_0|SrvcGrp|73000|2022|PDM|1304.00|99|0.00|AEG 6
20|FH_F99960_0_0|SrvcGrp|73004|2022|PDM|1534.00|99|0.00|AEG 8
20|FH_F99960_0_0|SrvcGrp|88147|2022|PDM|1760.00|99|0.00|LAPAROSCOPY REMOVE ADNEXA
20|FH_F119888_0_0|SrvcGrp|106294|2022|PDM|418.57|99|0.00|AMBULANCE SERVICE EMERGENCY TRANSPORT LEVEL 1 (HFCA)
20|FH_F119888_0_0|SrvcGrp|106297|2022|PDM|220.30|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT (HCFA)
20|FH_F119888_0_0|SrvcGrp|106300|2022|PDM|352.48|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT (HCFA)
20|FH_F119888_0_0|SrvcGrp|106317|2022|PDM|715.98|99|0.00|SPECIALTY CARE TRANSPORT (HCFA)
20|FH_F119888_0_0|SrvcGrp|107353|2022|PDM|250.61|99|0.00|AMB SRVC NEONAT TRNSPRT BS RATE EMERG 1 WAY (HCFA)
20|FH_F119888_0_0|SrvcGrp|13422|2022|PDM|264.36|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC
20|FH_F119888_0_0|SrvcGrp|13681|2022|PDM|352.48|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT
20|FH_F119888_0_0|SrvcGrp|2067|2022|PDM|715.98|99|0.00|SPECIALTY CARE TRANSPORT
20|FH_F119934_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F119934_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F119934_0_0|SrvcGrp|87077|2022|PDM|185.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F119937_0_0|SrvcGrp|80918|2022|PDM|130.00|99|0.00|RESPITE CARE
20|FH_F119937_0_0|SrvcGrp|82222|2022|PDM|127.00|99|0.00|HOSPICE CARE
20|FH_F119937_0_0|SrvcGrp|82223|2022|PDM|127.00|99|0.00|HOSPICE CARE
20|FH_F119999_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F119999_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F119999_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 2 (NO REV)
20|FH_F119999_0_0|CSTM-ALL|CSTM-00|2020|PDM|2315.00|99|0.00|AEG 10 (NO REV)
20|FH_F119999_0_0|CSTM-ALL|CSTM-00|2020|PDM|4815.00|99|0.00|AEG 7 (NO REV)
20|FH_F119999_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F120001_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F120001_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.32|99|0.00|OP SVCS
20|FH_F120001_0_0|SrvcGrp|73483|2022|PDM|459.00|99|0.00|AETNA SUBACUTE III
20|FH_F120001_0_0|SrvcGrp|73606|2022|PDM|306.00|99|0.00|AETNA SKILLED NURSING CARE
20|FH_F120001_0_0|SrvcGrp|87537|2022|PDM|408.00|99|0.00|MED REHAB DAY PROGRAM (FULL)
20|FH_F120032_0_0|SrvcGrp|79595|2022|PDM|580.00|99|0.00|CPT 45385
20|FH_F120057_0_0|SrvcGrp|107794|2022|PDM|4300.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE
20|FH_F120057_0_0|SrvcGrp|108075|2022|PDM|1698.78|99|0.00|AV FUSION / UPPER ARM VEIN
20|FH_F120057_0_0|SrvcGrp|108077|2022|PDM|1698.78|99|0.00|ARTERIOVENOUS ANASTOMOSIS
20|FH_F120057_0_0|SrvcGrp|108078|2022|PDM|1257.61|99|0.00|ARTERY-VEIN FUSION
20|FH_F120057_0_0|SrvcGrp|72994|2022|PDM|612.00|99|0.00|AEG 3
20|FH_F120058_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F120059_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F120059_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 5  (NO REV)
20|FH_F120059_0_0|SrvcGrp|103974|2022|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES
20|FH_F120059_0_0|SrvcGrp|108114|2022|PDM|2300.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT
20|FH_F120059_0_0|SrvcGrp|108115|2022|PDM|2500.00|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT
20|FH_F120059_0_0|SrvcGrp|108118|2022|PDM|1600.00|99|0.00|ARTERIOVENOUS ANASTOMOSIS
20|FH_F120059_0_0|SrvcGrp|108166|2022|PDM|1800.00|99|0.00|ESTABLISH ACCESS TO AORTA
20|FH_F120089_0_0|SrvcGrp|75483|2022|PDM|505.00|99|0.00|AEG 3
20|FH_F120089_0_0|SrvcGrp|75491|2022|PDM|995.00|99|0.00|AEG 7
20|FH_F120089_0_0|SrvcGrp|75493|2022|PDM|985.00|99|0.00|AEG 8
20|FH_F120089_0_0|SrvcGrp|75497|2022|PDM|718.00|99|0.00|AEG 10
20|FH_F120112_0_0|SrvcGrp|65720|2022|PDM|94.50|99|0.00|RESPITE CARE
20|FH_F120112_0_0|SrvcGrp|89781|2022|PDM|94.50|99|0.00|RESPITE CARE (HCFA)
20|FH_F120112_0_0|SrvcGrp|94780|2022|PDM|94.50|99|0.00|HOSPICE OR HH IN HOME (HCFA)
20|FH_F120119_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F120119_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F120119_0_0|CSTM-ALL|CSTM-00|2020|PDM|492.00|99|0.00|AEG 2 (NO REV)
20|FH_F120119_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F120119_0_0|SrvcGrp|114518|2022|PDM|3126.00|99|0.00|INSERTION DRAINAGE DEVICE
20|FH_F120119_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F120119_0_0|SrvcGrp|42550|2022|PDM|1057.00|99|0.00|OP SURGERY CPT 66984
20|FH_F120123_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F120123_0_0|SrvcGrp|30089|2022|PDM|400.00|99|0.00|HEMODIALYSIS SERVICES
20|FH_F120123_0_0|SrvcGrp|73485|2022|PDM|1071.00|99|0.00|AETNA REHAB
20|FH_F120152_0_0|CSTM-ALL|CSTM-00|2020|PDM|1760.00|99|0.00|AEG 4 (NO REV)
20|FH_F120152_0_0|CSTM-ALL|CSTM-00|2020|PDM|3300.00|99|0.00|AEG 10 (NO REV)
20|FH_F120152_0_0|SrvcGrp|100063|2022|PDM|2420.00|99|0.00|REPAIR FOOT DISLOCATION
20|FH_F120152_0_0|SrvcGrp|100066|2022|PDM|16500.00|99|0.00|REPAIR RADIUS FRACTURE
20|FH_F120152_0_0|SrvcGrp|107984|2022|PDM|4950.00|99|0.00|PARTIAL REMOVAL OF HEEL
20|FH_F120152_0_0|SrvcGrp|108346|2022|PDM|5500.00|99|0.00|SKELETAL FIXATION
20|FH_F120152_0_0|SrvcGrp|108349|2022|PDM|2420.00|99|0.00|REMOVAL OF FINGER LESION
20|FH_F120152_0_0|SrvcGrp|108352|2022|PDM|6600.00|99|0.00|KNEE ARTHROSCOPY
20|FH_F120152_0_0|SrvcGrp|108353|2022|PDM|6050.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F120152_0_0|SrvcGrp|35667|2022|PDM|2200.00|99|0.00|CPT 20680
20|FH_F120152_0_0|SrvcGrp|41334|2022|PDM|24750.00|99|0.00|TOTAL KNEE
20|FH_F120152_0_0|SrvcGrp|58638|2022|PDM|22000.00|99|0.00|CPT 63688
20|FH_F120152_0_0|SrvcGrp|67066|2022|PDM|16500.00|99|0.00|CERVICAL SURGERY
20|FH_F120152_0_0|SrvcGrp|67072|2022|PDM|16500.00|99|0.00|CPT 22845
20|FH_F120152_0_0|SrvcGrp|74039|2022|PDM|11000.00|99|0.00|LAMINECTOMY
20|FH_F120152_0_0|SrvcGrp|88023|2022|PDM|5500.00|99|0.00|REMOVAL OF ANTERIOR INSTRUMENTATION
20|FH_F120152_0_0|SrvcGrp|90420|2022|PDM|5500.00|99|0.00|REPAIR CLAVICLE FRACTURE
20|FH_F120152_0_0|SrvcGrp|92009|2022|PDM|4400.00|99|0.00|CARPAL SCAPHOID FRACTURE
20|FH_F120152_0_0|SrvcGrp|93071|2022|PDM|11000.00|99|0.00|POSTERIOR SEGMENTAL INSTRU
20|FH_F120152_0_0|SrvcGrp|98003|2022|PDM|3850.00|99|0.00|BIMALLEOLAR ANKLE FRACTURE
20|FH_F120152_0_0|SrvcGrp|99067|2022|PDM|5500.00|99|0.00|SPINE PROSTH DEVICE
20|FH_F120207_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F120207_0_0|CSTM-ALL|CSTM-00|2020|PDM|1608.00|99|0.00|AEG 8 (NO REV)
20|FH_F120207_0_0|CSTM-ALL|CSTM-00|2020|PDM|642.00|99|0.00|AEG 1 (NO REV)
20|FH_F120207_0_0|CSTM-ALL|CSTM-00|2020|PDM|919.36|99|0.00|AEG 3 (NO REV)
20|FH_F120207_0_0|SrvcGrp|105286|2022|PDM|2786.00|99|0.00|LAP VENT/ABD HERN PROC COMP
20|FH_F120207_0_0|SrvcGrp|108935|2022|PCT|0.40|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F120207_0_0|SrvcGrp|115169|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F120207_0_0|SrvcGrp|47142|2022|PDM|2705.04|99|0.00|CPT 49650
20|FH_F120207_0_0|SrvcGrp|83839|2022|PDM|5400.00|99|0.00|BREAST RECONSTRUCTION
20|FH_F120207_0_0|SrvcGrp|90803|2022|PDM|3677.00|99|0.00|LAP INC HERNIA REPAIR RECUR
20|FH_F120210_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F120290_0_0|SrvcGrp|82981|2022|PDM|125.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F120291_0_0|SrvcGrp|80918|2022|PDM|242.00|99|0.00|RESPITE CARE
20|FH_F120291_0_0|SrvcGrp|95661|2022|PDM|242.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F120305_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F120332_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F120332_0_0|SrvcGrp|48394|2022|PDM|35.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F120332_0_0|SrvcGrp|48396|2022|PDM|75.00|99|0.00|OT SERVICES
20|FH_F120332_0_0|SrvcGrp|48398|2022|PDM|75.00|99|0.00|PT SERVICES
20|FH_F120332_0_0|SrvcGrp|88620|2022|PDM|87.50|99|0.00|SKILLED NURSING RN
20|FH_F120374_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F120374_0_0|SrvcGrp|107748|2022|PDM|424.00|99|0.00|HEMODIALYSIS IN CENTER
20|FH_F120374_0_0|SrvcGrp|107749|2022|PDM|164.00|99|0.00|CAPD/CCPD
20|FH_F120384_0_0|SrvcGrp|108041|2022|PDM|400.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME
20|FH_F120384_0_0|SrvcGrp|108081|2022|PDM|171.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS
20|FH_F120384_0_0|SrvcGrp|108180|2022|PDM|400.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD
20|FH_F120408_0_0|SrvcGrp|100499|2022|PDM|691.79|99|0.00|PARTIAL HOSPITALIZATION EATING DISORDERS
20|FH_F120408_0_0|SrvcGrp|106248|2022|PDM|481.00|99|0.00|PARTIAL HOSP PSYCH
20|FH_F120408_0_0|SrvcGrp|90572|2022|PDM|287.38|99|0.00|INTENSIVE OP PSYCH (HCFA)
20|FH_F120435_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F120435_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F120435_0_0|SrvcGrp|103551|2022|PDM|171.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS
20|FH_F120512_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F120531_0_0|CSTM-ALL|CSTM-00|2020|PDM|1299.00|99|0.00|AEG 6 (NO REV)
20|FH_F120531_0_0|CSTM-ALL|CSTM-00|2020|PDM|1420.00|99|0.00|AEG 10 (NO REV)
20|FH_F120531_0_0|CSTM-ALL|CSTM-00|2020|PDM|706.00|99|0.00|AEG 2 (NO REV)
20|FH_F120531_0_0|CSTM-ALL|CSTM-00|2020|PDM|806.00|99|0.00|AEG 3 (NO REV)
20|FH_F120605_0_0|SrvcGrp|12663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F120605_0_0|SrvcGrp|72994|2022|PDM|815.00|99|0.00|AEG 3
20|FH_F120605_0_0|SrvcGrp|73004|2022|PDM|1565.00|99|0.00|AEG 8
20|FH_F120617_0_0|CSTM-ALL|CSTM-00|2020|PDM|2072.00|99|0.00|GENERAL ACUTE CARE
20|FH_F120647_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F120647_0_0|SrvcGrp|108081|2022|PDM|171.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS
20|FH_F120658_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|OP SVCS
20|FH_F120670_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F120670_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|AEG 3 (NO REV)
20|FH_F120670_0_0|CSTM-ALL|CSTM-00|2020|PDM|2800.00|99|0.00|AEG 5  (NO REV)
20|FH_F120670_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 1 (NO REV)
20|FH_F120670_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F120670_0_0|SrvcGrp|108933|2022|PDM|2850.00|99|0.00|ARTHROSCOPY
20|FH_F120670_0_0|SrvcGrp|27261|2022|PDM|10750.00|99|0.00|CPT 27446
20|FH_F120670_0_0|SrvcGrp|84939|2022|PDM|16000.00|99|0.00|SHOULDER JOINT
20|FH_F120670_0_0|SrvcGrp|88024|2022|PDM|6500.00|99|0.00|REMOVAL OF POSTERIOR SEGMENTAL INSTRUMENTATION
20|FH_F120670_0_0|SrvcGrp|88065|2022|PDM|16000.00|99|0.00|TOTAL DISC ARTHROPLASTY
20|FH_F120670_0_0|SrvcGrp|88163|2022|PDM|19000.00|99|0.00|LUMBAR SPINE FUSION
20|FH_F120670_0_0|SrvcGrp|93069|2022|PDM|6500.00|99|0.00|POSTERIOR NON-SEGMENTAL INST
20|FH_F120671_0_0|CSTM-ALL|CSTM-00|2020|PDM|2619.00|99|0.00|GENERAL ACUTE CARE
20|FH_F120672_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.87|99|0.00|GENERAL ACUTE CARE
20|FH_F120672_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.87|99|0.00|OP SVCS
20|FH_F120672_0_0|SrvcGrp|103391|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F120672_0_0|SrvcGrp|103913|2022|PCT|0.87|99|0.00|OP DIALYSIS
20|FH_F120672_0_0|SrvcGrp|3378|2022|PCT|0.87|99|0.00|OBSERVATION SVCS
20|FH_F120674_0_0|CSTM-ALL|CSTM-00|2020|PDM|2619.00|99|0.00|GENERAL ACUTE CARE
20|FH_F120679_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F120693_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.00|99|0.00|AETNA THERAPIES
20|FH_F120707_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.89|99|0.00|OP SVCS
20|FH_F120707_0_0|SrvcGrp|103391|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F120707_0_0|SrvcGrp|75505|2022|PCT|0.89|99|0.00|CARDIAC STUDIES
20|FH_F120714_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F120734_0_0|CSTM-ALL|CSTM-00|2020|PDM|2326.00|99|0.00|GENERAL ACUTE CARE
20|FH_F120745_0_0|SrvcGrp|15122|2022|PCT|0.90|99|0.00|CARDIAC CATH LAB SVCS
20|FH_F120767_0_0|SrvcGrp|108041|2022|PDM|400.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME
20|FH_F120767_0_0|SrvcGrp|108082|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER
20|FH_F120788_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F120788_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F120788_0_0|SrvcGrp|107748|2022|PDM|400.00|99|0.00|HEMODIALYSIS IN CENTER
20|FH_F120788_0_0|SrvcGrp|108546|2022|PDM|171.00|99|0.00|PERITONEAL TREATMENTS W/ PATIENT TRAINING
20|FH_F120901_0_0|CSTM-ALL|CSTM-00|2020|PDM|1855.00|99|0.00|AEG 1 (NO REV)
20|FH_F120901_0_0|CSTM-ALL|CSTM-00|2020|PDM|4427.00|99|0.00|AEG 8 (NO REV)
20|FH_F120901_0_0|SrvcGrp|102419|2022|PDM|4427.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F120901_0_0|SrvcGrp|41334|2022|PDM|8973.00|99|0.00|TOTAL KNEE
20|FH_F120901_0_0|SrvcGrp|89404|2022|PDM|8973.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F120924_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F120924_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F120930_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F120930_0_0|CSTM-ALL|CSTM-00|2020|PDM|1214.00|99|0.00|AEG 4 (NO REV)
20|FH_F120930_0_0|CSTM-ALL|CSTM-00|2020|PDM|1625.00|99|0.00|AEG 6 (NO REV)
20|FH_F120930_0_0|CSTM-ALL|CSTM-00|2020|PDM|1792.00|99|0.00|AEG 7 (NO REV)
20|FH_F120930_0_0|SrvcGrp|26273|2022|PDM|2000.00|99|0.00|CPT 29880
20|FH_F120930_0_0|SrvcGrp|26274|2022|PDM|2000.00|99|0.00|CPT 29877
20|FH_F120930_0_0|SrvcGrp|26278|2022|PDM|2000.00|99|0.00|CPT 29881
20|FH_F120930_0_0|SrvcGrp|33984|2022|PDM|2500.00|99|0.00|HAMMERTOE CORRECTION
20|FH_F120930_0_0|SrvcGrp|41335|2022|PDM|8000.00|99|0.00|TOTAL HIP
20|FH_F120930_0_0|SrvcGrp|54943|2022|PDM|2000.00|99|0.00|REPAIR OF SLAP LESION
20|FH_F120930_0_0|SrvcGrp|63471|2022|PDM|7000.00|99|0.00|CPT 64590
20|FH_F120930_0_0|SrvcGrp|65625|2022|PDM|2200.00|99|0.00|CPT 30520
20|FH_F120930_0_0|SrvcGrp|77582|2022|PDM|2200.00|99|0.00|CPT 31255
20|FH_F120930_0_0|SrvcGrp|84939|2022|PDM|5000.00|99|0.00|SHOULDER JOINT
20|FH_F120930_0_0|SrvcGrp|90157|2022|PDM|2000.00|99|0.00|AETNA REMOVAL OF TONSILS
20|FH_F120930_0_0|SrvcGrp|92369|2022|PDM|2500.00|99|0.00|REPAIR OF ANKLE LIGAMENTS
20|FH_F120930_0_0|SrvcGrp|93431|2022|PDM|5000.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT
20|FH_F120930_0_0|SrvcGrp|96539|2022|PDM|2500.00|99|0.00|REVISION OF ANKLE LIGAMENT
20|FH_F120930_0_0|SrvcGrp|96540|2022|PDM|3000.00|99|0.00|EXTENSIVE HYSTERCTOMY
20|FH_F120930_0_0|SrvcGrp|97730|2022|PDM|6500.00|99|0.00|REVERSE HIP JOINT
20|FH_F120930_0_0|SrvcGrp|99161|2022|PDM|5500.00|99|0.00|CPT 27138
20|FH_F120945_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F120954_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F120954_0_0|SrvcGrp|57966|2022|PDM|997.50|99|0.00|HOSPICE CARE
20|FH_F120954_0_0|SrvcGrp|57967|2022|PDM|236.25|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F121078_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F121078_0_0|CSTM-ALL|CSTM-00|2020|PDM|551.00|99|0.00|AEG 1 (NO REV)
20|FH_F121168_0_0|SrvcGrp|63297|2022|PDM|100.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F121168_0_0|SrvcGrp|83521|2022|PDM|100.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F121168_0_0|SrvcGrp|83857|2022|PDM|475.00|99|0.00|IP HOSPICE SVCS
20|FH_F121168_0_0|SrvcGrp|95661|2022|PDM|100.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F121168_0_0|SrvcGrp|97506|2022|PDM|100.00|99|0.00|AETNA HOSPICE ALL OTHER CARE
20|FH_F121168_0_0|SrvcGrp|97702|2022|PDM|100.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)
20|FH_F121219_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F121219_0_0|CSTM-ALL|CSTM-00|2020|PDM|1266.00|99|0.00|AEG 10 (NO REV)
20|FH_F121219_0_0|CSTM-ALL|CSTM-00|2020|PDM|2845.00|99|0.00|AEG 2 (NO REV)
20|FH_F121219_0_0|CSTM-ALL|CSTM-00|2020|PDM|2984.00|99|0.00|AEG 3 (NO REV)
20|FH_F121219_0_0|CSTM-ALL|CSTM-00|2020|PDM|3910.00|99|0.00|AEG 4 (NO REV)
20|FH_F121219_0_0|CSTM-ALL|CSTM-00|2020|PDM|6042.00|99|0.00|AEG 7 (NO REV)
20|FH_F121223_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F121223_0_0|SrvcGrp|108180|2022|PDM|435.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD
20|FH_F121335_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F121335_0_0|CSTM-ALL|CSTM-00|2020|PDM|1194.00|99|0.00|AEG 10 (NO REV)
20|FH_F121335_0_0|CSTM-ALL|CSTM-00|2020|PDM|4199.00|99|0.00|AEG 5  (NO REV)
20|FH_F121335_0_0|SrvcGrp|115359|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F121402_0_0|CSTM-ALL|CSTM-00|2020|PCT|45.00|99|0.00|OP SVCS
20|FH_F121426_0_0|CSTM-ALL|CSTM-00|2020|PDM|1158.00|99|0.00|ASPG IV
20|FH_F121426_0_0|CSTM-ALL|CSTM-00|2020|PDM|1512.00|99|0.00|ASPG VI
20|FH_F121426_0_0|SrvcGrp|14997|2022|PCT|0.50|99|0.00|DRUGS
20|FH_F121472_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|AEG 4 (NO REV)
20|FH_F121472_0_0|CSTM-ALL|CSTM-00|2020|PDM|2300.00|99|0.00|AEG 9 (NO REV)
20|FH_F121472_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|AEG 1 (NO REV)
20|FH_F121476_0_0|SrvcGrp|107441|2022|PDM|1860.00|99|0.00|AETNA CYSTOSCOPY PROSTATIC IMPLANTS
20|FH_F121476_0_0|SrvcGrp|108829|2022|PDM|2081.00|99|0.00|NEUROMEND NERVE WRAP
20|FH_F121476_0_0|SrvcGrp|108831|2022|PDM|52.00|99|0.00|FLEXHD/ALLOPATCHHD/MATRIXHD
20|FH_F121476_0_0|SrvcGrp|108838|2022|PDM|192.00|99|0.00|INTEGRA BMWD
20|FH_F121476_0_0|SrvcGrp|108839|2022|PDM|1670.00|99|0.00|ADHESION BARRIER
20|FH_F121476_0_0|SrvcGrp|108841|2022|PDM|30208.00|99|0.00|CARDIOVERTER DEFIBRILLATOR
20|FH_F121476_0_0|SrvcGrp|108842|2022|PDM|7750.00|99|0.00|LEAD CARDIOVERTER DEFIBRILLATOR
20|FH_F121476_0_0|SrvcGrp|108847|2022|PDM|16599.00|99|0.00|IMPLT NROSTM PLS GEN SNG NON
20|FH_F121476_0_0|SrvcGrp|108848|2022|PDM|14493.00|99|0.00|PENILE PROSTHESIS
20|FH_F121476_0_0|SrvcGrp|108852|2022|PDM|48.00|99|0.00|DERMAGRAFT
20|FH_F121476_0_0|SrvcGrp|108857|2022|PDM|1770.00|99|0.00|SURGICAL SUPPLY
20|FH_F121476_0_0|SrvcGrp|108860|2022|PDM|4664.00|99|0.00|MCP JOINT REPL 2 PC OR MORE
20|FH_F121476_0_0|SrvcGrp|108867|2022|PDM|3551.00|99|0.00|ADAPTOR/EXTENSION
20|FH_F121476_0_0|SrvcGrp|108894|2022|PDM|145.00|99|0.00|CONTRACEPT IUD
20|FH_F121476_0_0|SrvcGrp|111248|2022|PDM|1085.00|99|0.00|LEVONORGESTREL
20|FH_F121476_0_0|SrvcGrp|78743|2022|PDM|925.00|99|0.00|J7300
20|FH_F121476_0_0|SrvcGrp|84706|2022|PDM|1590.00|99|0.00|SYNTHETIC IMPLANT
20|FH_F121476_0_0|SrvcGrp|88265|2022|PDM|6950.00|99|0.00|CONNECTIVE TISSUE
20|FH_F121799_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F121799_0_0|SrvcGrp|29155|2022|PDM|103.00|99|0.00|HOSPICE SVCS
20|FH_F121800_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F121925_0_0|CSTM-ALL|CSTM-00|2020|PDM|616.38|99|0.00|AEG 2 (NO REV)
20|FH_F121925_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F122009_0_0|SrvcGrp|108042|2022|PDM|400.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD
20|FH_F122067_0_0|CSTM-ALL|CSTM-00|2020|PDM|605.00|99|0.00|AEG 2 (NO REV)
20|FH_F122067_0_0|CSTM-ALL|CSTM-00|2020|PDM|962.50|99|0.00|AEG 10 (NO REV)
20|FH_F122067_0_0|SrvcGrp|108978|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F122067_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS
20|FH_F122067_0_0|SrvcGrp|45583|2022|PDM|1980.00|99|0.00|CPT 65730
20|FH_F122067_0_0|SrvcGrp|84280|2022|PDM|1430.00|99|0.00|CORNEAL TRANSPLANT
20|FH_F122200_0_0|SrvcGrp|108152|2022|PDM|660.00|99|0.00|HEMODIALYSIS INCLUDES TRAINING
20|FH_F122200_0_0|SrvcGrp|82498|2022|PDM|305.00|99|0.00|DIALYSIS PROCEDURE OTHER THAN HEMODIALYSIS
20|FH_F122240_0_0|SrvcGrp|107748|2022|PDM|424.00|99|0.00|HEMODIALYSIS IN CENTER
20|FH_F122240_0_0|SrvcGrp|107749|2022|PDM|164.00|99|0.00|CAPD/CCPD
20|FH_F122240_0_0|SrvcGrp|108043|2022|PDM|164.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD
20|FH_F122245_0_0|SrvcGrp|100923|2022|PDM|1017.20|99|0.00|DRUGS
20|FH_F122245_0_0|SrvcGrp|103965|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F122245_0_0|SrvcGrp|27402|2022|PDM|1800.00|99|0.00|LASER PROCEDURES
20|FH_F122245_0_0|SrvcGrp|42550|2022|PDM|1700.00|99|0.00|OP SURGERY CPT 66984
20|FH_F122245_0_0|SrvcGrp|63469|2022|PDM|7468.00|99|0.00|CPT 55700
20|FH_F122245_0_0|SrvcGrp|73002|2022|PDM|1174.00|99|0.00|AEG 7
20|FH_F122245_0_0|SrvcGrp|73008|2022|PDM|900.00|99|0.00|AEG 10
20|FH_F122245_0_0|SrvcGrp|76565|2022|PCT|0.00|99|0.00|AETNA LITHOTRIPSY ESWL INCIDENTAL CODES
20|FH_F122245_0_0|SrvcGrp|77461|2022|PDM|2879.99|99|0.00|CPT 52356
20|FH_F122245_0_0|SrvcGrp|82571|2022|PDM|1500.00|99|0.00|PERCUTANEOUS IMPLANT OF NEURO ELECTRODES
20|FH_F122262_0_0|CSTM-ALL|CSTM-00|2020|PDM|2780.00|99|0.00|AEG 3 (NO REV)
20|FH_F122262_0_0|CSTM-ALL|CSTM-00|2020|PDM|3530.00|99|0.00|AEG 5  (NO REV)
20|FH_F122338_0_0|CSTM-ALL|CSTM-00|2020|PDM|1485.00|99|0.00|AETNA AMBULATORY SURGERY W/O AEG 1 & 2
20|FH_F122388_0_0|SrvcGrp|72990|2022|PDM|385.00|99|0.00|AEG 1
20|FH_F122433_0_0|SrvcGrp|109083|2022|PDM|1400.00|99|0.00|MUSCULOSKELETAL SYSTEM
20|FH_F122433_0_0|SrvcGrp|11663|2022|PCT|0.60|99|0.00|IMPLANTS
20|FH_F122433_0_0|SrvcGrp|71666|2022|PDM|1385.00|99|0.00|CPT 63655
20|FH_F122433_0_0|SrvcGrp|73000|2022|PDM|826.00|99|0.00|AEG 6
20|FH_F122433_0_0|SrvcGrp|73008|2022|PDM|630.00|99|0.00|AEG 10
20|FH_F122433_0_0|SrvcGrp|77461|2022|PDM|1350.00|99|0.00|CPT 52356
20|FH_F122574_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|AETNA OBSERVATION
20|FH_F122574_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE
20|FH_F122627_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|OP SVCS
20|FH_F122648_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F122648_0_0|CSTM-ALL|CSTM-00|2020|PDM|2573.00|99|0.00|IMPLANTS
20|FH_F122648_0_0|CSTM-ALL|CSTM-00|2020|PDM|719.00|99|0.00|AEG 5  (NO REV)
20|FH_F122648_0_0|CSTM-ALL|CSTM-00|2020|PDM|837.00|99|0.00|AEG 6 (NO REV)
20|FH_F122648_0_0|CSTM-ALL|CSTM-00|2020|PDM|984.00|99|0.00|AEG 8 (NO REV)
20|FH_F122648_0_0|SrvcGrp|104358|2022|PDM|1306.00|99|0.00|CONJUNCTIVOPLASTY
20|FH_F122648_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F122648_0_0|SrvcGrp|109174|2022|PDM|992.00|99|0.00|EYE SERVICES
20|FH_F122648_0_0|SrvcGrp|92547|2022|PDM|817.00|99|0.00|SKIN FULL GRAFT PROCEDURE
20|FH_F122649_0_0|SrvcGrp|80918|2022|PDM|112.00|99|0.00|RESPITE CARE
20|FH_F122649_0_0|SrvcGrp|97702|2022|PDM|112.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)
20|FH_F122687_0_0|SrvcGrp|100041|2022|PDM|4371.00|99|0.00|REPAIR HUMERUS FRACTURE I
20|FH_F122687_0_0|SrvcGrp|100043|2022|PDM|4371.00|99|0.00|FUSION OF FOOT BONES
20|FH_F122687_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F122687_0_0|SrvcGrp|109187|2022|PDM|2404.00|99|0.00|OLECRANON BURSA EXCISION
20|FH_F122687_0_0|SrvcGrp|26433|2022|PDM|3825.00|99|0.00|OP SURGICAL SERVICES
20|FH_F122687_0_0|SrvcGrp|27310|2022|PDM|2732.00|99|0.00|ENDOSCOPIC PLANTAR FASCIOTOMY
20|FH_F122687_0_0|SrvcGrp|33982|2022|PDM|2185.00|99|0.00|CPT 28296
20|FH_F122687_0_0|SrvcGrp|35669|2022|PDM|8742.00|99|0.00|CPT 63650
20|FH_F122687_0_0|SrvcGrp|41325|2022|PDM|3825.00|99|0.00|OP SURGERY CPT 24342
20|FH_F122687_0_0|SrvcGrp|58671|2022|PDM|1311.00|99|0.00|ASC CARVE OUT 64721
20|FH_F122687_0_0|SrvcGrp|85778|2022|PDM|3825.00|99|0.00|REPAIR OF ANKLE FRACTURE
20|FH_F122687_0_0|SrvcGrp|88025|2022|PDM|14632.00|99|0.00|LUMBAR SPINE FUSION COMBINED
20|FH_F122687_0_0|SrvcGrp|88491|2022|PDM|8742.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR
20|FH_F122687_0_0|SrvcGrp|89842|2022|PDM|11200.00|99|0.00|LUMBAR
20|FH_F122687_0_0|SrvcGrp|89883|2022|PDM|3825.00|99|0.00|AETNA TREAT HUMERUS FRACTURE
20|FH_F122687_0_0|SrvcGrp|92364|2022|PDM|12402.00|99|0.00|ARTHRODESIS SACROILIAC JOINT
20|FH_F122687_0_0|SrvcGrp|92410|2022|PDM|5464.00|99|0.00|SPINE FUSION EXTRA SEGMENT
20|FH_F122841_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F122841_0_0|CSTM-ALL|CSTM-00|2020|PDM|1391.00|99|0.00|AEG 4 W/O EYE AND OCULAR SERVICES
20|FH_F122841_0_0|CSTM-ALL|CSTM-00|2020|PDM|1607.00|99|0.00|AEG 5 W/O CARVEOUTS
20|FH_F122841_0_0|CSTM-ALL|CSTM-00|2020|PDM|2215.00|99|0.00|AEG 7 (NO REV)
20|FH_F122841_0_0|CSTM-ALL|CSTM-00|2020|PDM|2273.00|99|0.00|AEG 9 (NO REV)
20|FH_F122841_0_0|SrvcGrp|109237|2022|PDM|1349.00|99|0.00|REPAIR OF BLEPHAROPTOSIS
20|FH_F122841_0_0|SrvcGrp|112136|2022|PDM|2235.00|99|0.00|XCAPSL CTRC RMVL CPLX W/ECP
20|FH_F122841_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F122841_0_0|SrvcGrp|28548|2022|PDM|2497.00|99|0.00|VITRECTOMY
20|FH_F122841_0_0|SrvcGrp|38909|2022|PDM|2287.00|99|0.00|CPT 67036 - VITRECTOMY, MECHANICAL
20|FH_F122841_0_0|SrvcGrp|42428|2022|PDM|208.00|99|0.00|OP SURGERY CPT 65855
20|FH_F122841_0_0|SrvcGrp|84123|2022|PDM|2178.00|99|0.00|INSERT ANT SEGMENT DRAIN EXT
20|FH_F122926_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F122926_0_0|CSTM-ALL|CSTM-00|2020|PDM|425.00|99|0.00|AEG 2 (NO REV)
20|FH_F122926_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F122930_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F122930_0_0|SrvcGrp|109251|2022|PDM|3274.00|99|0.00|CILIARY BODY DESTRUCTION
20|FH_F122930_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F122930_0_0|SrvcGrp|73000|2022|PDM|3274.00|99|0.00|AEG 6
20|FH_F122930_0_0|SrvcGrp|95819|2022|PDM|3898.00|99|0.00|GONIOTOMY
20|FH_F122933_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F122933_0_0|SrvcGrp|72992|2022|PDM|660.00|99|0.00|AEG 2
20|FH_F122953_0_0|SrvcGrp|84185|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F123036_0_0|CSTM-ALL|CSTM-00|2020|PCT|2.20|99|0.00|HSS ASC
20|FH_F123036_0_0|SrvcGrp|108830|2022|PDM|18203.00|99|0.00|IMPLT NROSTM PLS GEN DUA NON
20|FH_F123036_0_0|SrvcGrp|109249|2022|PDM|6051.00|99|0.00|RADIOFQ TRSMTR FOR IMPLT NEU
20|FH_F123036_0_0|SrvcGrp|40002|2022|PDM|13393.00|99|0.00|TOTAL HIP
20|FH_F123036_0_0|SrvcGrp|57607|2022|PCT|0.63|99|0.00|LABORATORY/PATHOLOGY
20|FH_F123036_0_0|SrvcGrp|98565|2022|PDM|16423.00|99|0.00|LUMBAR SPINE FUSION COMBINED
20|FH_F123036_0_0|SrvcGrp|98584|2022|PDM|13393.00|99|0.00|TOTAL DISC ARTHROPLASTY
20|FH_F123083_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F123083_0_0|CSTM-ALL|CSTM-00|2020|PDM|1149.00|99|0.00|AEG 6 (NO REV)
20|FH_F123083_0_0|CSTM-ALL|CSTM-00|2020|PDM|465.00|99|0.00|AEG 1 (NO REV)
20|FH_F123083_0_0|CSTM-ALL|CSTM-00|2020|PDM|807.00|99|0.00|AEG 3 (NO REV)
20|FH_F123144_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F123144_0_0|SrvcGrp|72994|2022|PDM|523.00|99|0.00|AEG 3
20|FH_F123144_0_0|SrvcGrp|72996|2022|PDM|653.00|99|0.00|AEG 4
20|FH_F123154_0_0|SrvcGrp|87077|2022|PDM|120.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F123157_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F123157_0_0|SrvcGrp|114519|2022|PDM|4000.00|99|0.00|INSERTION DRAINAGE DEVICE
20|FH_F123157_0_0|SrvcGrp|75495|2022|PDM|1300.00|99|0.00|AEG 9
20|FH_F123158_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F123158_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 9 (NO REV)
20|FH_F123158_0_0|CSTM-ALL|CSTM-00|2020|PDM|485.00|99|0.00|AEG 3 (NO REV)
20|FH_F123158_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F123158_0_0|SrvcGrp|87054|2022|PDM|850.00|99|0.00|CYSTOSCOPY CHEMODENERVATION
20|FH_F123162_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F123162_0_0|CSTM-ALL|CSTM-00|2020|PDM|485.00|99|0.00|AEG 3 (NO REV)
20|FH_F123162_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 4 (NO REV)
20|FH_F123170_0_0|CSTM-ALL|CSTM-00|2020|PDM|1314.00|99|0.00|AEG 8 (NO REV)
20|FH_F123170_0_0|CSTM-ALL|CSTM-00|2020|PDM|1343.00|99|0.00|AEG 7 (NO REV)
20|FH_F123170_0_0|CSTM-ALL|CSTM-00|2020|PDM|602.00|99|0.00|AEG 2 (NO REV)
20|FH_F123170_0_0|CSTM-ALL|CSTM-00|2020|PDM|851.00|99|0.00|AEG 4 (NO REV)
20|FH_F123170_0_0|SrvcGrp|11663|2022|PCT|1.10|99|0.00|IMPLANTS
20|FH_F123185_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F123185_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F123185_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS
20|FH_F123185_0_0|SrvcGrp|72992|2022|PDM|531.00|99|0.00|AEG 2
20|FH_F123185_0_0|SrvcGrp|73008|2022|PDM|735.00|99|0.00|AEG 10
20|FH_F123185_0_0|SrvcGrp|78045|2022|PCT|1.00|99|0.00|AETNA AMNIOTIC MEMBRANE
20|FH_F123185_0_0|SrvcGrp|78046|2022|PCT|1.00|99|0.00|AETNA AQUEOUS SHUNT
20|FH_F123317_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS
20|FH_F123324_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.52|99|0.00|OP SVCS
20|FH_F123324_0_0|CSTM-ALL|CSTM-00|2020|PDM|837.00|99|0.00|CD ADULT REHAB
20|FH_F123324_0_0|SrvcGrp|10667|2022|PDM|657.00|99|0.00|BOARDER BABY SVCS
20|FH_F123324_0_0|SrvcGrp|15363|2022|PCT|0.52|99|0.00|DME/ORTHOTICS/PROSTHETICS/IMPLANTS
20|FH_F123324_0_0|SrvcGrp|30623|2022|PDM|6237.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788
20|FH_F123324_0_0|SrvcGrp|3178|2022|PDM|837.00|99|0.00|ACUTE PSYCH
20|FH_F123324_0_0|SrvcGrp|3418|2022|PDM|2914.00|99|0.00|NEONATAL INTENSIVE CARE UNIT
20|FH_F123324_0_0|SrvcGrp|62963|2022|PCT|0.52|99|0.00|SURGICAL
20|FH_F123325_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F123325_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|IMPLANTS
20|FH_F123371_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F123371_0_0|SrvcGrp|30609|2022|PDM|38.00|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F123371_0_0|SrvcGrp|95661|2022|PDM|600.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F123372_0_0|CSTM-ALL|CSTM-00|2020|PDM|1711.00|99|0.00|GENERAL ACUTE CARE
20|FH_F123372_0_0|SrvcGrp|12918|2022|PDM|2367.00|99|0.00|GYNECOLOGICAL MED/SURG
20|FH_F123372_0_0|SrvcGrp|16|2022|PDM|1711.00|99|0.00|ACUTE REHABILITATION
20|FH_F123372_0_0|SrvcGrp|22899|2022|PDM|2914.00|99|0.00|ICU
20|FH_F123372_0_0|SrvcGrp|29817|2022|PDM|4548.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F123373_0_0|SrvcGrp|30623|2022|PDM|6237.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788
20|FH_F123373_0_0|SrvcGrp|3178|2022|PDM|837.00|99|0.00|ACUTE PSYCH
20|FH_F123373_0_0|SrvcGrp|3418|2022|PDM|2914.00|99|0.00|NEONATAL INTENSIVE CARE UNIT
20|FH_F123377_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.44|99|0.00|OP SVCS
20|FH_F123386_0_0|SrvcGrp|15363|2022|PCT|0.50|99|0.00|DME/ORTHOTICS/PROSTHETICS/IMPLANTS
20|FH_F123445_0_0|SrvcGrp|30609|2022|PDM|44.74|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F123445_0_0|SrvcGrp|95660|2022|PDM|706.00|99|0.00|HOSPICE SERVICES (HCFA)
20|FH_F123489_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F123570_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F123570_0_0|SrvcGrp|72990|2022|PDM|471.02|99|0.00|AEG 1
20|FH_F123570_0_0|SrvcGrp|72994|2022|PDM|721.38|99|0.00|AEG 3
20|FH_F123570_0_0|SrvcGrp|73000|2022|PDM|1180.20|99|0.00|AEG 6
20|FH_F123570_0_0|SrvcGrp|89404|2022|PDM|3502.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F123620_0_0|SrvcGrp|106300|2022|PDM|247.00|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT (HCFA)
20|FH_F123620_0_0|SrvcGrp|106317|2022|PDM|823.00|99|0.00|SPECIALTY CARE TRANSPORT (HCFA)
20|FH_F123620_0_0|SrvcGrp|13422|2022|PDM|271.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC
20|FH_F123627_0_0|SrvcGrp|87077|2022|PDM|125.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F123638_0_0|SrvcGrp|108042|2022|PDM|993.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD
20|FH_F123638_0_0|SrvcGrp|108043|2022|PDM|398.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD
20|FH_F123638_0_0|SrvcGrp|109020|2022|PCT|0.90|99|0.00|PARSABIV INJECTION ETELCALCETIDE 0.1 MG
20|FH_F123644_0_0|SrvcGrp|86723|2022|PDM|300.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)
20|FH_F123644_0_0|SrvcGrp|89417|2022|PDM|300.00|99|0.00|PARTIAL HOSPITALIZATION
20|FH_F123726_0_0|CSTM-ALL|CSTM-00|2020|PDM|1034.00|99|0.00|AEG 6 (NO REV)
20|FH_F123726_0_0|CSTM-ALL|CSTM-00|2020|PDM|692.00|99|0.00|AEG 4 (NO REV)
20|FH_F123745_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 10 (NO REV)
20|FH_F123745_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|AEG 4 (NO REV)
20|FH_F123745_0_0|CSTM-ALL|CSTM-00|2020|PDM|5500.00|99|0.00|AEG 7 (NO REV)
20|FH_F123745_0_0|SrvcGrp|109188|2022|PDM|7500.00|99|0.00|TIBIAL RODDING
20|FH_F123745_0_0|SrvcGrp|109528|2022|PDM|7500.00|99|0.00|LOW BACK DISK SURGERY
20|FH_F123745_0_0|SrvcGrp|16289|2022|PDM|2200.00|99|0.00|CARPAL TUNNEL RELEASE
20|FH_F123745_0_0|SrvcGrp|27343|2022|PDM|6800.00|99|0.00|OP SURGERY (CPT 25607 - 25609)
20|FH_F123745_0_0|SrvcGrp|27918|2022|PDM|8500.00|99|0.00|CPT 23410, 23412
20|FH_F123745_0_0|SrvcGrp|67065|2022|PDM|9500.00|99|0.00|CERVICAL SURGERY
20|FH_F123745_0_0|SrvcGrp|76603|2022|PDM|2500.00|99|0.00|CPT 25111
20|FH_F123745_0_0|SrvcGrp|82109|2022|PDM|2200.00|99|0.00|REVISE ULNAR NERVE ELBOW
20|FH_F123745_0_0|SrvcGrp|84939|2022|PDM|16000.00|99|0.00|SHOULDER JOINT
20|FH_F123745_0_0|SrvcGrp|89989|2022|PDM|7500.00|99|0.00|FUSION OF BIG TOE JOINT
20|FH_F123745_0_0|SrvcGrp|93069|2022|PDM|3600.00|99|0.00|POSTERIOR NON-SEGMENTAL INST
20|FH_F123774_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F123774_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F123774_0_0|SrvcGrp|72990|2022|PDM|485.00|99|0.00|AEG 1
20|FH_F123774_0_0|SrvcGrp|72992|2022|PDM|628.00|99|0.00|AEG 2
20|FH_F123774_0_0|SrvcGrp|73002|2022|PDM|1222.00|99|0.00|AEG 7
20|FH_F123774_0_0|SrvcGrp|73004|2022|PDM|1298.00|99|0.00|AEG 8
20|FH_F123844_0_0|SrvcGrp|104228|2022|PDM|190.00|99|0.00|HOSPICE CARE (HCFA)
20|FH_F123844_0_0|SrvcGrp|63297|2022|PDM|198.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F123844_0_0|SrvcGrp|87799|2022|PDM|190.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)
20|FH_F123844_0_0|SrvcGrp|95660|2022|PDM|706.00|99|0.00|HOSPICE SERVICES (HCFA)
20|FH_F123844_0_0|SrvcGrp|95661|2022|PDM|692.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F123850_0_0|SrvcGrp|80920|2022|PDM|678.00|99|0.00|HOSPICE SERVICES
20|FH_F123850_0_0|SrvcGrp|87799|2022|PDM|190.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)
20|FH_F123850_0_0|SrvcGrp|89781|2022|PDM|194.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F123850_0_0|SrvcGrp|94780|2022|PDM|198.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)
20|FH_F123915_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F123915_0_0|SrvcGrp|65720|2022|PDM|194.00|99|0.00|RESPITE CARE
20|FH_F123915_0_0|SrvcGrp|80918|2022|PDM|678.00|99|0.00|RESPITE CARE
20|FH_F123915_0_0|SrvcGrp|80920|2022|PDM|678.00|99|0.00|HOSPICE SERVICES
20|FH_F123915_0_0|SrvcGrp|89781|2022|PDM|198.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F123926_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F123926_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 1 (NO REV)
20|FH_F123926_0_0|CSTM-ALL|CSTM-00|2020|PDM|446.00|99|0.00|AEG 2 (NO REV)
20|FH_F123926_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|AEG 3 (NO REV)
20|FH_F123926_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|AEG 7 (NO REV)
20|FH_F123926_0_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F123963_0_0|CSTM-ALL|CSTM-00|2020|PDM|1545.33|99|0.00|AEG 4 (NO REV)
20|FH_F123963_0_0|CSTM-ALL|CSTM-00|2020|PDM|1699.23|99|0.00|AEG 5  (NO REV)
20|FH_F123963_0_0|CSTM-ALL|CSTM-00|2020|PDM|2534.35|99|0.00|AEG 7 (NO REV)
20|FH_F123963_0_0|CSTM-ALL|CSTM-00|2020|PDM|3116.44|99|0.00|AEG 9 (NO REV)
20|FH_F124017_0_0|CSTM-ALL|CSTM-00|2020|PDM|1900.00|99|0.00|AEG 3 (NO REV)
20|FH_F124017_0_0|CSTM-ALL|CSTM-00|2020|PDM|2600.00|99|0.00|AEG 5  (NO REV)
20|FH_F124017_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|AEG 10 (NO REV)
20|FH_F124017_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 1 (NO REV)
20|FH_F124017_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|AEG 6 (NO REV)
20|FH_F124017_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F124017_0_0|SrvcGrp|109671|2022|PDM|5200.00|99|0.00|NECK SPINE DISK SURGERY
20|FH_F124017_0_0|SrvcGrp|31674|2022|PDM|4500.00|99|0.00|NEUROSTIMULATOR
20|FH_F124017_0_0|SrvcGrp|40003|2022|PDM|12800.00|99|0.00|TOTAL KNEE
20|FH_F124017_0_0|SrvcGrp|98560|2022|PDM|8500.00|99|0.00|LUMBAR
20|FH_F124044_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F124044_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F124112_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F124112_0_0|SrvcGrp|87077|2022|PDM|130.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F124180_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F124180_0_0|SrvcGrp|106170|2022|PDM|2462.50|99|0.00|NASAL/SINUS ENDOSCOPY
20|FH_F124180_0_0|SrvcGrp|109737|2022|PDM|3161.00|99|0.00|NSL/SINS NDSC SPHN TISS RMVL
20|FH_F124180_0_0|SrvcGrp|109743|2022|PDM|1450.00|99|0.00|REPAIR OF EARDRUM
20|FH_F124180_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F124180_0_0|SrvcGrp|57864|2022|PDM|1900.00|99|0.00|SUBMUCOUS RESECTION
20|FH_F124180_0_0|SrvcGrp|68800|2022|PDM|2863.50|99|0.00|REPAIR OF RETINAL DETACHMENT
20|FH_F124180_0_0|SrvcGrp|72998|2022|PDM|2495.00|99|0.00|AEG 5
20|FH_F124180_0_0|SrvcGrp|77490|2022|PDM|1900.00|99|0.00|AETNA SEPTOPLASTY
20|FH_F124180_0_0|SrvcGrp|84160|2022|PDM|3000.00|99|0.00|OCCULAR RECONST/AMNIOTIC MEMB
20|FH_F124180_0_0|SrvcGrp|85898|2022|PDM|2700.00|99|0.00|CPT 67312
20|FH_F124180_0_0|SrvcGrp|86035|2022|PDM|3500.00|99|0.00|CORNEAL TRANSPLANT
20|FH_F124180_0_0|SrvcGrp|98363|2022|PDM|2859.50|99|0.00|AETNA NASAL ENDOSCOPY SURG
20|FH_F124254_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F124262_0_0|CSTM-ALL|CSTM-00|2020|PDM|882.00|99|0.00|AMBULATORY SURGERY W/O AEG 1 & 2
20|FH_F124369_0_0|CSTM-ALL|CSTM-00|2020|PDM|2544.00|99|0.00|AEG 4 (NO REV)
20|FH_F124369_0_0|CSTM-ALL|CSTM-00|2020|PDM|3344.00|99|0.00|AEG 6 (NO REV)
20|FH_F124369_0_0|SrvcGrp|100013|2022|PDM|12100.00|99|0.00|REPAIR/GRAFT ACHILLES TENDON
20|FH_F124369_0_0|SrvcGrp|100045|2022|PDM|4400.00|99|0.00|REVISION OF FOOT TENDON
20|FH_F124369_0_0|SrvcGrp|102479|2022|PDM|12155.00|99|0.00|AETNA CPT 29895
20|FH_F124369_0_0|SrvcGrp|105632|2022|PDM|3850.00|99|0.00|AMPUTATION OF TOE
20|FH_F124369_0_0|SrvcGrp|107008|2022|PDM|5610.00|99|0.00|REMOVAL OF BONE FOR GRAFT
20|FH_F124369_0_0|SrvcGrp|107985|2022|PDM|8415.00|99|0.00|DECOMPRESSION OF TIBIA NERVE
20|FH_F124369_0_0|SrvcGrp|109068|2022|PDM|2544.30|99|0.00|PARTIAL REMOVAL OF FOOT BONE
20|FH_F124369_0_0|SrvcGrp|33982|2022|PDM|7480.00|99|0.00|CPT 28296
20|FH_F124369_0_0|SrvcGrp|33984|2022|PDM|5610.00|99|0.00|HAMMERTOE CORRECTION
20|FH_F124369_0_0|SrvcGrp|89988|2022|PDM|2544.30|99|0.00|REPAIR HALLUX RIGIDUS
20|FH_F124369_0_0|SrvcGrp|95462|2022|PDM|4400.00|99|0.00|REPAIR OF ANKLE LIGAMENT
20|FH_F124369_0_0|SrvcGrp|98468|2022|PDM|2113.10|99|0.00|EXC FOOT/TOE TUM DEEP
20|FH_F124369_0_0|SrvcGrp|99073|2022|PDM|1.38|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F124371_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F124371_0_0|SrvcGrp|106300|2022|PDM|289.81|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT (HCFA)
20|FH_F124372_0_0|SrvcGrp|107749|2022|PDM|164.00|99|0.00|CAPD/CCPD
20|FH_F124388_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F124388_0_0|CSTM-ALL|CSTM-00|2020|PDM|1188.00|99|0.00|AEG 10 (NO REV)
20|FH_F124388_0_0|CSTM-ALL|CSTM-00|2020|PDM|1370.00|99|0.00|AEG 6 (NO REV)
20|FH_F124388_0_0|CSTM-ALL|CSTM-00|2020|PDM|551.00|99|0.00|AEG 1 (NO REV)
20|FH_F124388_0_0|CSTM-ALL|CSTM-00|2020|PDM|741.00|99|0.00|AEG 2 (NO REV)
20|FH_F124395_0_0|SrvcGrp|87077|2022|PDM|140.45|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F124407_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F124438_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F124441_0_0|CSTM-ALL|CSTM-00|2020|PDM|1520.00|99|0.00|AEG 3 (NO REV)
20|FH_F124441_0_0|CSTM-ALL|CSTM-00|2020|PDM|2612.50|99|0.00|AEG 6 (NO REV)
20|FH_F124441_0_0|CSTM-ALL|CSTM-00|2020|PDM|807.50|99|0.00|AEG 1 (NO REV)
20|FH_F124441_0_0|SrvcGrp|100001|2022|PDM|14250.00|99|0.00|WRIST REPLACEMNT TOT WRIST
20|FH_F124441_0_0|SrvcGrp|106264|2022|PDM|3800.00|99|0.00|NSL/SINS NDSC W/ SINS DILATION
20|FH_F124441_0_0|SrvcGrp|106266|2022|PDM|3325.00|99|0.00|NSL/SINS NDSC TOT W/ SPHENDT
20|FH_F124441_0_0|SrvcGrp|107835|2022|PDM|2375.00|99|0.00|NERVE REPAIR
20|FH_F124441_0_0|SrvcGrp|109145|2022|PDM|14250.00|99|0.00|ARTIFICIAL DISC
20|FH_F124441_0_0|SrvcGrp|109833|2022|PDM|14250.00|99|0.00|REPLACE ELBOW JOINT
20|FH_F124441_0_0|SrvcGrp|109834|2022|PDM|3040.00|99|0.00|REPAIR HUMERUS FRACTURE
20|FH_F124441_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F124441_0_0|SrvcGrp|16289|2022|PDM|1425.00|99|0.00|CARPAL TUNNEL RELEASE
20|FH_F124441_0_0|SrvcGrp|63471|2022|PDM|23750.00|99|0.00|CPT 64590
20|FH_F124441_0_0|SrvcGrp|67069|2022|PDM|5225.00|99|0.00|CPT 22634
20|FH_F124441_0_0|SrvcGrp|67119|2022|PDM|9975.00|99|0.00|ARTHODESIS
20|FH_F124441_0_0|SrvcGrp|84307|2022|PDM|3040.00|99|0.00|TENDON REPAIR
20|FH_F124441_0_0|SrvcGrp|84939|2022|PDM|14250.00|99|0.00|SHOULDER JOINT
20|FH_F124441_0_0|SrvcGrp|85778|2022|PDM|3040.00|99|0.00|REPAIR OF ANKLE FRACTURE
20|FH_F124441_0_0|SrvcGrp|88491|2022|PDM|6175.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR
20|FH_F124441_0_0|SrvcGrp|89860|2022|PDM|5700.00|99|0.00|SPINAL DISK SURGERY ADD-ON
20|FH_F124443_0_0|SrvcGrp|82981|2022|PDM|130.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F124443_0_0|SrvcGrp|87077|2022|PDM|130.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F124444_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F124444_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F124486_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|AEG 6 (NO REV)
20|FH_F124486_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|AEG 7 (NO REV)
20|FH_F124486_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F124486_0_0|SrvcGrp|109847|2022|PDM|1803.00|99|0.00|INSERT ANT DRAINAGE DEVICE (HCFA)
20|FH_F124486_0_0|SrvcGrp|109848|2022|PDM|1009.00|99|0.00|REINFORCE/GRAFT EYE WALL (HCFA)
20|FH_F124486_0_0|SrvcGrp|46890|2022|PDM|1803.00|99|0.00|IMPLANT EYE SHUNT
20|FH_F124486_0_0|SrvcGrp|91032|2022|PDM|1803.00|99|0.00|AQUEOUS SHUNT EYE W/GRAFT (HCFA)
20|FH_F124486_0_0|SrvcGrp|95819|2022|PDM|1803.00|99|0.00|GONIOTOMY
20|FH_F124505_0_0|SrvcGrp|80539|2022|PDM|496.00|99|0.00|AETNA MEDICARE OUTPATIENT GROUPER 3
20|FH_F124542_0_0|SrvcGrp|80537|2022|PDM|323.00|99|0.00|AETNA MEDICARE OUTPATIENT GROUPER 1
20|FH_F124542_0_0|SrvcGrp|80542|2022|PDM|813.00|99|0.00|AETNA MEDICARE OUTPATIENT GROUPER 6
20|FH_F124542_0_0|SrvcGrp|80544|2022|PDM|956.00|99|0.00|AETNA MEDICARE OUTPATIENT GROUPER 8
20|FH_F124608_0_0|CSTM-ALL|CSTM-00|2020|PDM|1751.00|99|0.00|AEG 3 (NO REV)
20|FH_F124608_0_0|CSTM-ALL|CSTM-00|2020|PDM|1758.00|99|0.00|AEG 4 (NO REV)
20|FH_F124608_0_0|CSTM-ALL|CSTM-00|2020|PDM|1841.00|99|0.00|AEG 6 (NO REV)
20|FH_F124608_0_0|SrvcGrp|36591|2022|PDM|4080.00|99|0.00|CPT 63685
20|FH_F124608_0_0|SrvcGrp|88065|2022|PDM|7956.00|99|0.00|TOTAL DISC ARTHROPLASTY
20|FH_F124608_0_0|SrvcGrp|88155|2022|PDM|7650.00|99|0.00|REVISE KNEECAP WITH IMPLANT
20|FH_F124608_0_0|SrvcGrp|89404|2022|PDM|9149.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F124608_0_0|SrvcGrp|89842|2022|PDM|8160.00|99|0.00|LUMBAR
20|FH_F124608_0_0|SrvcGrp|92412|2022|PDM|6452.00|99|0.00|SPINAL CRD DECOMP->2 CERVIC
20|FH_F124608_0_0|SrvcGrp|92820|2022|PDM|2747.00|99|0.00|HIP ARTHOSCOPY ACETABULOPLASTY
20|FH_F124660_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F124660_0_0|SrvcGrp|73002|2022|PDM|1175.00|99|0.00|AEG 7
20|FH_F124710_0_0|SrvcGrp|82981|2022|PDM|120.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F124711_0_0|CSTM-ALL|CSTM-00|2020|PDM|315.00|99|0.00|AEG 1 (NO REV)
20|FH_F124711_0_0|CSTM-ALL|CSTM-00|2020|PDM|425.00|99|0.00|AEG 2 (NO REV)
20|FH_F124711_0_0|CSTM-ALL|CSTM-00|2020|PDM|485.00|99|0.00|AEG 3 (NO REV)
20|FH_F124711_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 7 (NO REV)
20|FH_F124727_0_0|SrvcGrp|108082|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER
20|FH_F124738_0_0|SrvcGrp|72990|2022|PDM|330.00|99|0.00|AEG 1
20|FH_F124738_0_0|SrvcGrp|72992|2022|PDM|440.00|99|0.00|AEG 2
20|FH_F124743_0_0|SrvcGrp|30609|2022|PDM|30.00|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F124743_0_0|SrvcGrp|80918|2022|PDM|125.00|99|0.00|RESPITE CARE
20|FH_F124743_0_0|SrvcGrp|83857|2022|PDM|575.00|99|0.00|IP HOSPICE SVCS
20|FH_F124788_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F124788_0_0|SrvcGrp|72996|2022|PDM|630.00|99|0.00|AEG 4
20|FH_F124788_0_0|SrvcGrp|93759|2022|PCT|0.00|99|0.00|CARDIAC CATH
20|FH_F124854_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F124854_0_0|SrvcGrp|63297|2022|PDM|100.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F124927_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F124927_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 8 (NO REV)
20|FH_F124927_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 3 (NO REV)
20|FH_F124927_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|AEG 4 (NO REV)
20|FH_F124927_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F124965_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F124965_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F124965_0_0|SrvcGrp|72994|2022|PDM|950.00|99|0.00|AEG 3
20|FH_F124965_0_0|SrvcGrp|73006|2022|PDM|1500.00|99|0.00|AEG 9
20|FH_F124976_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F124976_0_0|SrvcGrp|106048|2022|PDM|998.00|99|0.00|AETNA IP REHAB ALCOHOL DRUG
20|FH_F124976_0_0|SrvcGrp|86722|2022|PDM|247.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)
20|FH_F124976_0_0|SrvcGrp|88819|2022|PDM|651.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY
20|FH_F124976_0_0|SrvcGrp|89417|2022|PDM|531.00|99|0.00|PARTIAL HOSPITALIZATION
20|FH_F125020_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F125020_0_0|CSTM-ALL|CSTM-00|2020|PCT|9000.00|99|0.00|TIMELY FILING
20|FH_F125053_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F125053_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F125053_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F125053_0_0|SrvcGrp|72998|2022|PDM|889.00|99|0.00|AEG 5
20|FH_F125053_0_0|SrvcGrp|73004|2022|PDM|950.00|99|0.00|AEG 8
20|FH_F125103_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F125103_0_0|SrvcGrp|110070|2022|PDM|550.00|99|0.00|HEMODIALYSIS PHYSICIAN EVALUATION
20|FH_F125103_0_0|SrvcGrp|26471|2022|PDM|215.00|99|0.00|CPT CODE 90945
20|FH_F125110_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F125110_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F125110_0_0|CSTM-ALL|CSTM-00|2020|PDM|1245.00|99|0.00|AEG 6 (NO REV)
20|FH_F125110_0_0|CSTM-ALL|CSTM-00|2020|PDM|770.00|99|0.00|AEG 3 (NO REV)
20|FH_F125110_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 4 (NO REV)
20|FH_F125113_0_0|CSTM-ALL|CSTM-00|2020|PDM|1751.00|99|0.00|AEG 6 (NO REV)
20|FH_F125113_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|AEG 10 (NO REV)
20|FH_F125113_0_0|CSTM-ALL|CSTM-00|2020|PDM|945.00|99|0.00|AEG 2 (NO REV)
20|FH_F125113_0_0|SrvcGrp|44461|2022|PDM|23707.00|99|0.00|INSERTION / REPLACEMENT OF SPINAL NEUROSTIMULATOR GENERATOR
20|FH_F125113_0_0|SrvcGrp|80139|2022|PDM|14707.00|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F125115_0_0|SrvcGrp|87077|2022|PDM|110.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F125124_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F125124_0_0|SrvcGrp|67989|2022|PDM|2370.00|99|0.00|CPT 49320
20|FH_F125124_0_0|SrvcGrp|72998|2022|PDM|889.00|99|0.00|AEG 5
20|FH_F125124_0_0|SrvcGrp|73000|2022|PDM|905.00|99|0.00|AEG 6
20|FH_F125124_0_0|SrvcGrp|73002|2022|PDM|1077.00|99|0.00|AEG 7
20|FH_F125124_0_0|SrvcGrp|79590|2022|PDM|1884.00|99|0.00|CPT 43248
20|FH_F125124_0_0|SrvcGrp|85000|2022|PDM|2410.00|99|0.00|CPT 45384
20|FH_F125134_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F125134_0_0|SrvcGrp|107746|2022|PCT|0.90|99|0.00|PARSABIV
20|FH_F125134_0_0|SrvcGrp|108081|2022|PDM|171.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS
20|FH_F125134_0_0|SrvcGrp|110068|2022|PDM|150.00|99|0.00|DIALYSIS PATIENT TRAINING
20|FH_F125163_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F125163_0_0|SrvcGrp|107746|2022|PCT|0.90|99|0.00|PARSABIV
20|FH_F125182_0_0|SrvcGrp|67989|2022|PDM|2370.00|99|0.00|CPT 49320
20|FH_F125182_0_0|SrvcGrp|72990|2022|PDM|360.00|99|0.00|AEG 1
20|FH_F125182_0_0|SrvcGrp|72994|2022|PDM|549.00|99|0.00|AEG 3
20|FH_F125182_0_0|SrvcGrp|72998|2022|PDM|889.00|99|0.00|AEG 5
20|FH_F125182_0_0|SrvcGrp|73004|2022|PDM|950.00|99|0.00|AEG 8
20|FH_F125182_0_0|SrvcGrp|73006|2022|PDM|1547.00|99|0.00|AEG 9
20|FH_F125182_0_0|SrvcGrp|73008|2022|PDM|360.00|99|0.00|AEG 10
20|FH_F125182_0_0|SrvcGrp|78286|2022|PDM|8280.00|99|0.00|CPT 49322
20|FH_F125182_0_0|SrvcGrp|79589|2022|PDM|1923.00|99|0.00|UPPER GI
20|FH_F125182_0_0|SrvcGrp|79593|2022|PDM|1962.00|99|0.00|CPT 45378
20|FH_F125182_0_0|SrvcGrp|79594|2022|PDM|2259.00|99|0.00|CPT 45380
20|FH_F125182_0_0|SrvcGrp|82301|2022|PDM|2233.50|99|0.00|HEMORRHOIDECTOMY
20|FH_F125206_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F125206_0_0|CSTM-ALL|CSTM-00|2020|PDM|2148.00|99|0.00|COVENTRY ENHANCED GROUPER 4
20|FH_F125206_0_0|CSTM-ALL|CSTM-00|2020|PDM|3014.00|99|0.00|COVENTRY ENHANCED GROUPER 8
20|FH_F125206_0_0|SrvcGrp|12491|2022|PCT|0.55|99|0.00|PACEMAKER
20|FH_F125244_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 5  (NO REV)
20|FH_F125244_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 6 (NO REV)
20|FH_F125244_0_0|SrvcGrp|101525|2022|PDM|5500.00|99|0.00|MYOMECTOMY
20|FH_F125244_0_0|SrvcGrp|103515|2022|PDM|5000.00|99|0.00|VAGINAL HYSTERECTOMY
20|FH_F125244_0_0|SrvcGrp|110094|2022|PDM|5000.00|99|0.00|APPENDECTOMY ADD-ON
20|FH_F125244_0_0|SrvcGrp|33977|2022|PDM|1500.00|99|0.00|CPT 59820
20|FH_F125244_0_0|SrvcGrp|41546|2022|PDM|5000.00|99|0.00|LAPAROSCOPIC APPENDECTOMY
20|FH_F125244_0_0|SrvcGrp|88147|2022|PDM|4000.00|99|0.00|LAPAROSCOPY REMOVE ADNEXA
20|FH_F125244_0_0|SrvcGrp|97921|2022|PDM|5500.00|99|0.00|MYOMECTOMY ABDOM METHOD
20|FH_F125249_0_0|CSTM-ALL|CSTM-00|2020|PDM|1216.00|99|0.00|AEG 4 W/O MUSCULOSKELETAL (NO REV)
20|FH_F125249_0_0|CSTM-ALL|CSTM-00|2020|PDM|1317.00|99|0.00|AEG 5  (NO REV)
20|FH_F125249_0_0|SrvcGrp|100040|2022|PDM|1800.00|99|0.00|REPAIR HUMERUS FRACTURE
20|FH_F125249_0_0|SrvcGrp|100059|2022|PDM|1200.00|99|0.00|REPAIR ULNA FRACTURE
20|FH_F125249_0_0|SrvcGrp|100067|2022|PDM|1800.00|99|0.00|ANKLE ARTHROSCOPY SURGERY
20|FH_F125249_0_0|SrvcGrp|100076|2022|PDM|1200.00|99|0.00|FUSION OF HAND BONES
20|FH_F125249_0_0|SrvcGrp|104112|2022|PDM|1200.00|99|0.00|REPAIR OF ANKLE FRACTURE
20|FH_F125249_0_0|SrvcGrp|105253|2022|PDM|1400.00|99|0.00|REMOVAL/TRANSPLANT TENDON
20|FH_F125249_0_0|SrvcGrp|108256|2022|PDM|1400.00|99|0.00|AETNA TREATMENT OF FRACTURE
20|FH_F125249_0_0|SrvcGrp|35671|2022|PDM|1100.00|99|0.00|TRANSPLANT FOREARM TENDON
20|FH_F125249_0_0|SrvcGrp|35672|2022|PDM|3200.00|99|0.00|CPT 23412
20|FH_F125249_0_0|SrvcGrp|41325|2022|PDM|1200.00|99|0.00|OP SURGERY CPT 24342
20|FH_F125249_0_0|SrvcGrp|54962|2022|PDM|2200.00|99|0.00|RECONSTRUCTION OF SHOULDER CUFF (ROTATOR)
20|FH_F125249_0_0|SrvcGrp|89404|2022|PDM|16500.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F125249_0_0|SrvcGrp|94689|2022|PDM|1700.00|99|0.00|SHOULDER ARTHROSCOPY DX
20|FH_F125259_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F125259_0_0|CSTM-ALL|CSTM-00|2020|PDM|1035.00|99|0.00|AEG 4 (NO REV)
20|FH_F125259_0_0|CSTM-ALL|CSTM-00|2020|PDM|1615.00|99|0.00|AEG 8 (NO REV)
20|FH_F125259_0_0|CSTM-ALL|CSTM-00|2020|PDM|537.00|99|0.00|AEG 1 (NO REV)
20|FH_F125259_0_0|CSTM-ALL|CSTM-00|2020|PDM|820.00|99|0.00|AEG 3 (NO REV)
20|FH_F125259_0_0|SrvcGrp|104098|2022|PDM|4000.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT
20|FH_F125259_0_0|SrvcGrp|108116|2022|PDM|1750.00|99|0.00|AV FUSION / UPPER ARM VEIN
20|FH_F125259_0_0|SrvcGrp|110099|2022|PDM|1750.00|99|0.00|AV FISTULA REVISION
20|FH_F125259_0_0|SrvcGrp|110100|2022|PDM|1750.00|99|0.00|AV FISTULA REVISION
20|FH_F125260_0_0|SrvcGrp|48398|2022|PDM|202.86|99|0.00|PT SERVICES
20|FH_F125328_0_0|SrvcGrp|72996|2022|PDM|680.00|99|0.00|AEG 4
20|FH_F125328_0_0|SrvcGrp|78286|2022|PDM|8280.00|99|0.00|CPT 49322
20|FH_F125473_0_0|CSTM-ALL|CSTM-00|2020|PDM|2526.00|99|0.00|AEG 10 (NO REV)
20|FH_F125473_0_0|CSTM-ALL|CSTM-00|2020|PDM|4256.00|99|0.00|AEG 6 (NO REV)
20|FH_F125473_0_0|CSTM-ALL|CSTM-00|2020|PDM|5518.00|99|0.00|AEG 9 (NO REV)
20|FH_F125473_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F125515_0_0|SrvcGrp|87077|2022|PDM|135.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F125657_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F125772_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F125772_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F125772_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|AEG 3 (NO REV)
20|FH_F125772_0_0|CSTM-ALL|CSTM-00|2020|PDM|1384.00|99|0.00|AEG 2 (NO REV)
20|FH_F125772_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|AEG 7 (NO REV)
20|FH_F125816_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F125816_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F125824_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F125870_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS
20|FH_F125870_0_0|SrvcGrp|28551|2022|PDM|2445.00|99|0.00|REPAIR OF COMPLEX RETINAL DETACHMENT
20|FH_F125870_0_0|SrvcGrp|46887|2022|PDM|2445.00|99|0.00|REPAIR DETACHED RETINA
20|FH_F125870_0_0|SrvcGrp|46890|2022|PDM|3095.00|99|0.00|IMPLANT EYE SHUNT
20|FH_F125870_0_0|SrvcGrp|49205|2022|PDM|2445.00|99|0.00|REPAIR DETACHED RETINA
20|FH_F125870_0_0|SrvcGrp|72996|2022|PDM|1295.00|99|0.00|AEG 4
20|FH_F125870_0_0|SrvcGrp|73000|2022|PDM|1295.00|99|0.00|AEG 6
20|FH_F125870_0_0|SrvcGrp|73004|2022|PDM|1495.00|99|0.00|AEG 8
20|FH_F125870_0_0|SrvcGrp|73006|2022|PDM|1187.00|99|0.00|AEG 9
20|FH_F125870_0_0|SrvcGrp|90601|2022|PDM|2445.00|99|0.00|REMOVAL OF LENS MATERIAL
20|FH_F125870_0_0|SrvcGrp|95819|2022|PDM|2445.00|99|0.00|GONIOTOMY
20|FH_F125910_0_0|SrvcGrp|82981|2022|PDM|113.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F125928_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F125938_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE
20|FH_F125938_0_0|SrvcGrp|13927|2022|PCT|0.75|99|0.00|DAY HOSPITAL FULL DAY
20|FH_F125946_0_0|SrvcGrp|22596|2022|PDM|285.00|99|0.00|HOSPICE CARE
20|FH_F125946_0_0|SrvcGrp|81599|2022|PDM|552.00|99|0.00|IP HOSPICE SERVICES
20|FH_F125946_0_0|SrvcGrp|89199|2022|PDM|552.00|99|0.00|RESIDENTIAL HOSPICE SERVICES
20|FH_F125946_0_0|SrvcGrp|92502|2022|PDM|1260.00|99|0.00|HOSPICE GENERAL IP CARE
20|FH_F126070_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F126070_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F126070_0_0|SrvcGrp|72990|2022|PDM|466.00|99|0.00|AEG 1
20|FH_F126073_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F126073_0_0|SrvcGrp|82981|2022|PDM|90.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F126116_0_0|CSTM-ALL|CSTM-00|2020|PDM|1128.00|99|0.00|AEG 3 (NO REV)
20|FH_F126116_0_0|CSTM-ALL|CSTM-00|2020|PDM|1608.00|99|0.00|AEG 10 (NO REV)
20|FH_F126116_0_0|SrvcGrp|108193|2022|PDM|6327.00|99|0.00|TIB/PER REVASC W/TLA
20|FH_F126116_0_0|SrvcGrp|109505|2022|PDM|14747.00|99|0.00|REMV & REPLC PM GEN MULT LEADS
20|FH_F126116_0_0|SrvcGrp|67994|2022|PDM|982.00|99|0.00|CPT 58120
20|FH_F126116_0_0|SrvcGrp|68000|2022|PDM|1125.00|99|0.00|CPT 58561
20|FH_F126116_0_0|SrvcGrp|83817|2022|PDM|1125.00|99|0.00|LAPAROSCOPY LYSIS ADHESIONS
20|FH_F126116_0_0|SrvcGrp|84939|2022|PDM|13500.00|99|0.00|SHOULDER JOINT
20|FH_F126249_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|OP SVCS
20|FH_F126339_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F126345_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F126345_0_0|SrvcGrp|16732|2022|PDM|3209.00|99|0.00|HYSTEROSCOPY ABLATION
20|FH_F126345_0_0|SrvcGrp|72996|2022|PDM|859.00|99|0.00|AEG 4
20|FH_F126345_0_0|SrvcGrp|73002|2022|PDM|1360.00|99|0.00|AEG 7
20|FH_F126345_0_0|SrvcGrp|73004|2022|PDM|1336.00|99|0.00|AEG 8
20|FH_F126489_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F126489_0_0|SrvcGrp|108082|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER
20|FH_F126523_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F126523_0_0|SrvcGrp|72990|2022|PDM|565.00|99|0.00|AEG 1
20|FH_F126523_0_0|SrvcGrp|72996|2022|PDM|935.00|99|0.00|AEG 4
20|FH_F126523_0_0|SrvcGrp|73002|2022|PDM|1350.00|99|0.00|AEG 7
20|FH_F126523_0_0|SrvcGrp|73008|2022|PDM|800.00|99|0.00|AEG 10
20|FH_F126525_0_0|SrvcGrp|107749|2022|PDM|175.00|99|0.00|CAPD/CCPD
20|FH_F126525_0_0|SrvcGrp|108443|2022|PDM|450.00|99|0.00|HEMODIALYSIS W/ TRAINING
20|FH_F126527_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F126527_0_0|SrvcGrp|84185|2022|PDM|110.00|99|0.00|RESPITE CARE
20|FH_F126554_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F126554_0_0|SrvcGrp|35670|2022|PDM|16500.00|99|0.00|SPINAL NEUROSTIMULATORS PROCEDURE
20|FH_F126554_0_0|SrvcGrp|88487|2022|PDM|3300.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION
20|FH_F126554_0_0|SrvcGrp|92408|2022|PDM|3300.00|99|0.00|PERQ VERTEBRAL AUGMENTATION
20|FH_F126567_0_0|SrvcGrp|107745|2022|PDM|1200.00|99|0.00|DIALYSIS ULTRAFILTRATION
20|FH_F126567_0_0|SrvcGrp|107749|2022|PDM|650.00|99|0.00|CAPD/CCPD
20|FH_F126567_0_0|SrvcGrp|107750|2022|PDM|1250.00|99|0.00|TRAINING INCL A TREATMENT
20|FH_F126600_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F126600_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F126672_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F126672_0_0|CSTM-ALL|CSTM-00|2020|PDM|1071.00|99|0.00|AEG 6 (NO REV)
20|FH_F126672_0_0|CSTM-ALL|CSTM-00|2020|PDM|1326.00|99|0.00|AEG 7 (NO REV)
20|FH_F126672_0_0|CSTM-ALL|CSTM-00|2020|PDM|408.00|99|0.00|AEG 1 (NO REV)
20|FH_F126672_0_0|CSTM-ALL|CSTM-00|2020|PDM|663.00|99|0.00|AEG 3 (NO REV)
20|FH_F126672_0_0|CSTM-ALL|CSTM-00|2020|PDM|816.00|99|0.00|AEG 4 (NO REV)
20|FH_F126698_0_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F126759_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS
20|FH_F126817_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS
20|FH_F126882_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F126904_0_0|SrvcGrp|29155|2022|PDM|100.00|99|0.00|HOSPICE SVCS
20|FH_F126904_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F126904_0_0|SrvcGrp|82222|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F126930_0_0|SrvcGrp|109330|2022|PCT|0.00|99|0.00|OUTPATIENT THERAPY SERVICES
20|FH_F126930_0_0|SrvcGrp|110598|2022|PDM|228.00|99|0.00|ALCOHOL & DRUG SERVICE
20|FH_F126990_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AMBULATORY SURGERY W/O CPT SAME DOS
20|FH_F126990_0_0|SrvcGrp|110375|2022|PCT|1.00|99|0.00|PHYSICAL THERAPY (UB) SAME DOS
20|FH_F127073_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F127132_0_0|SrvcGrp|108042|2022|PDM|400.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD
20|FH_F127132_0_0|SrvcGrp|108043|2022|PDM|171.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD
20|FH_F127132_0_0|SrvcGrp|108082|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER
20|FH_F127138_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F127199_0_0|SrvcGrp|63297|2022|PDM|114.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F127199_0_0|SrvcGrp|89781|2022|PDM|114.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F127199_0_0|SrvcGrp|89783|2022|PDM|114.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F127199_0_0|SrvcGrp|93098|2022|PDM|114.00|99|0.00|HOSPICE CARE
20|FH_F127199_0_0|SrvcGrp|94780|2022|PDM|114.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)
20|FH_F127199_0_0|SrvcGrp|94781|2022|PDM|114.00|99|0.00|HOSPICE IN LTCH (HCFA)
20|FH_F127207_0_0|SrvcGrp|104230|2022|PDM|90.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F127324_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AEG 1 (NO REV)
20|FH_F127324_0_0|CSTM-ALL|CSTM-00|2020|PDM|770.00|99|0.00|AEG 2 (NO REV)
20|FH_F127324_0_0|SrvcGrp|103538|2022|PDM|3105.00|99|0.00|ARTHROSCOPY HIP W/ FEMOROPLASTY
20|FH_F127324_0_0|SrvcGrp|87061|2022|PDM|14830.00|99|0.00|TOTAL HIP ARTHROPLASTY
20|FH_F127324_0_0|SrvcGrp|87062|2022|PDM|1725.00|99|0.00|REVISE ULNAR NERVE AT ELBOW
20|FH_F127325_0_0|SrvcGrp|72992|2022|PDM|427.00|99|0.00|AEG 2
20|FH_F127325_0_0|SrvcGrp|73000|2022|PDM|794.00|99|0.00|AEG 6
20|FH_F127325_0_0|SrvcGrp|73002|2022|PDM|953.00|99|0.00|AEG 7
20|FH_F127326_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE
20|FH_F127343_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 4 (NO REV)
20|FH_F127343_0_0|CSTM-ALL|CSTM-00|2020|PDM|770.00|99|0.00|AEG 2 (NO REV)
20|FH_F127343_0_0|CSTM-ALL|CSTM-00|2020|PDM|908.00|99|0.00|AEG 3 (NO REV)
20|FH_F127343_0_0|SrvcGrp|12664|2022|PCT|0.50|99|0.00|IMPLANTS
20|FH_F127343_0_0|SrvcGrp|93962|2022|PDM|11480.00|99|0.00|NEURO STIMULATOR
20|FH_F127399_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F127399_0_0|SrvcGrp|101526|2022|PDM|4786.00|99|0.00|LAPARO-ASST VAG HYSTERECTOMY
20|FH_F127399_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F127399_0_0|SrvcGrp|105283|2022|PDM|3537.00|99|0.00|LAP INC HERN REPAIR COMP
20|FH_F127399_0_0|SrvcGrp|105287|2022|PDM|3537.00|99|0.00|LAP INC HERN RECUR COMP
20|FH_F127399_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F127399_0_0|SrvcGrp|26275|2022|PDM|3121.00|99|0.00|CPT 29826
20|FH_F127399_0_0|SrvcGrp|34606|2022|PDM|3017.00|99|0.00|CPT 29827
20|FH_F127399_0_0|SrvcGrp|41334|2022|PDM|14045.00|99|0.00|TOTAL KNEE
20|FH_F127399_0_0|SrvcGrp|54963|2022|PDM|3329.00|99|0.00|CORACOACROMIAL LIGAMENT RELEASE
20|FH_F127399_0_0|SrvcGrp|73000|2022|PDM|3121.00|99|0.00|AEG 6
20|FH_F127399_0_0|SrvcGrp|88163|2022|PDM|7283.00|99|0.00|LUMBAR SPINE FUSION
20|FH_F127399_0_0|SrvcGrp|90802|2022|PDM|3537.00|99|0.00|LAP INC HERNIA REPAIR
20|FH_F127399_0_0|SrvcGrp|92007|2022|PDM|5202.00|99|0.00|PROXIMAL HUMERAL
20|FH_F127399_0_0|SrvcGrp|92368|2022|PDM|1665.00|99|0.00|REPAIR OF LEG TENDON
20|FH_F127399_0_0|SrvcGrp|92820|2022|PDM|6763.00|99|0.00|HIP ARTHOSCOPY ACETABULOPLASTY
20|FH_F127399_0_0|SrvcGrp|96559|2022|PDM|5930.00|99|0.00|TOTAL HYSTERCECTOMY
20|FH_F127399_0_0|SrvcGrp|97895|2022|PDM|14045.00|99|0.00|REVISE KNEE 2
20|FH_F127399_0_0|SrvcGrp|97896|2022|PDM|14045.00|99|0.00|TREAT KNEE
20|FH_F127418_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE
20|FH_F127418_0_0|SrvcGrp|108350|2022|PDM|18957.29|99|0.00|REPAIR OF DURAL/CSF LEAK
20|FH_F127418_0_0|SrvcGrp|110761|2022|PDM|8039.06|99|0.00|SPINAL OSTEREOTACTIC
20|FH_F127418_0_0|SrvcGrp|67064|2022|PDM|7137.38|99|0.00|MUSCULOSKELETAL SYSTEM
20|FH_F127418_0_0|SrvcGrp|67066|2022|PDM|8294.74|99|0.00|CERVICAL SURGERY
20|FH_F127418_0_0|SrvcGrp|67069|2022|PDM|24871.88|99|0.00|CPT 22634
20|FH_F127418_0_0|SrvcGrp|88740|2022|PDM|6121.50|99|0.00|SP BONE ALGRFT
20|FH_F127418_0_0|SrvcGrp|89840|2022|PDM|26026.88|99|0.00|THORAX SPINE FUSION
20|FH_F127418_0_0|SrvcGrp|90973|2022|PDM|7387.19|99|0.00|CERVICAL OR THORACIC INJECTION
20|FH_F127418_0_0|SrvcGrp|93063|2022|PDM|72664.26|99|0.00|LUMBAR ARTIF DISKECTOMY
20|FH_F127418_0_0|SrvcGrp|93071|2022|PDM|15837.41|99|0.00|POSTERIOR SEGMENTAL INSTRU
20|FH_F127418_0_0|SrvcGrp|96819|2022|PDM|5958.75|99|0.00|DESTROY L/S FACET JNT ADDL
20|FH_F127422_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F127422_0_0|SrvcGrp|72998|2022|PDM|717.00|99|0.00|AEG 5
20|FH_F127422_0_0|SrvcGrp|73000|2022|PDM|826.00|99|0.00|AEG 6
20|FH_F127422_0_0|SrvcGrp|73004|2022|PDM|973.00|99|0.00|AEG 8
20|FH_F127422_0_0|SrvcGrp|73006|2022|PDM|1339.00|99|0.00|AEG 9
20|FH_F127422_0_0|SrvcGrp|91759|2022|PCT|1.00|99|0.00|OCULAR IMPLANT
20|FH_F127448_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F127448_0_0|SrvcGrp|107792|2022|PDM|5600.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE
20|FH_F127448_0_0|SrvcGrp|107793|2022|PDM|9000.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE
20|FH_F127448_0_0|SrvcGrp|72992|2022|PDM|710.00|99|0.00|AEG 2
20|FH_F127448_0_0|SrvcGrp|73000|2022|PDM|1250.00|99|0.00|AEG 6
20|FH_F127448_0_0|SrvcGrp|73004|2022|PDM|1500.00|99|0.00|AEG 8
20|FH_F127711_0_0|CSTM-ALL|CSTM-00|2020|PDM|1886.00|99|0.00|AEG 10 (NO REV)
20|FH_F127711_0_0|CSTM-ALL|CSTM-00|2020|PDM|2284.00|99|0.00|AEG 6 (NO REV)
20|FH_F127711_0_0|CSTM-ALL|CSTM-00|2020|PDM|874.00|99|0.00|AEG 1 (NO REV)
20|FH_F127711_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F127711_0_0|SrvcGrp|12663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F127711_0_0|SrvcGrp|14614|2022|PDM|4213.00|99|0.00|LITHOTRIPSY
20|FH_F127711_0_0|SrvcGrp|63469|2022|PDM|1255.00|99|0.00|CPT 55700
20|FH_F127998_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F128027_0_0|SrvcGrp|64718|2022|PDM|1190.00|99|0.00|CPT 45384
20|FH_F128027_0_0|SrvcGrp|82455|2022|PDM|1120.00|99|0.00|DIAGNOSTIC COLONOSCOPY
20|FH_F128031_0_0|SrvcGrp|72996|2022|PDM|957.00|99|0.00|AEG 4
20|FH_F128031_0_0|SrvcGrp|72998|2022|PDM|1001.00|99|0.00|AEG 5
20|FH_F128031_0_0|SrvcGrp|73006|2022|PDM|1803.00|99|0.00|AEG 9
20|FH_F128031_0_0|SrvcGrp|73616|2022|PDM|1141.00|99|0.00|AETNA WRIST ENDOSCOPY
20|FH_F128073_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F128073_0_0|SrvcGrp|87077|2022|PDM|100.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F128148_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANESTHESIOLOGIST/CRNA (HAN1)
20|FH_F128148_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|GENERAL ACUTE CARE
20|FH_F128148_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|NON-ANESTHESIOLOGIST/CRNA (HAN3)
20|FH_F128148_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|NON-ANESTHESIOLOGY (HANE) (HSMI) (SAMD)
20|FH_F128148_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS
20|FH_F128185_0_0|CSTM-ALL|CSTM-00|2020|PDM|1062.00|99|0.00|AEG 6 (NO REV)
20|FH_F128188_0_0|SrvcGrp|472|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F128188_0_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II
20|FH_F128237_0_0|SrvcGrp|83857|2022|PDM|475.00|99|0.00|IP HOSPICE SVCS
20|FH_F128246_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F128246_0_0|CSTM-ALL|CSTM-00|2020|PDM|673.00|99|0.00|AMBULATORY SURGERY W/O EYE AND OCULAR SERVICES
20|FH_F128246_0_0|SrvcGrp|111035|2022|PDM|588.00|99|0.00|ECTROPION THERMOCAUTERIZATIN
20|FH_F128246_0_0|SrvcGrp|111040|2022|PDM|726.00|99|0.00|REMOVE EYELID LINING LESION
20|FH_F128246_0_0|SrvcGrp|79795|2022|PDM|1176.00|99|0.00|EYE/OCULAR ADNEXA SURGERY
20|FH_F128246_0_0|SrvcGrp|85880|2022|PDM|726.00|99|0.00|CPT 66850
20|FH_F128246_0_0|SrvcGrp|92548|2022|PDM|673.00|99|0.00|REMOVAL OF EYE LESION
20|FH_F128270_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F128270_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F128270_0_0|SrvcGrp|42785|2022|PDM|80.00|99|0.00|SPEECH THERAPY  SRVCS
20|FH_F128270_0_0|SrvcGrp|471|2022|PDM|725.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F128274_81501_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F128360_0_0|SrvcGrp|35669|2022|PDM|5200.00|99|0.00|CPT 63650
20|FH_F128360_0_0|SrvcGrp|93807|2022|PDM|3500.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY
20|FH_F128378_0_0|SrvcGrp|29155|2022|PDM|160.00|99|0.00|HOSPICE SVCS
20|FH_F128378_0_0|SrvcGrp|83857|2022|PDM|580.00|99|0.00|IP HOSPICE SVCS
20|FH_F128379_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F128379_0_0|CSTM-ALL|CSTM-00|2020|PDM|1831.00|99|0.00|AEG 6 (NO REV)
20|FH_F128379_0_0|CSTM-ALL|CSTM-00|2020|PDM|2403.00|99|0.00|AEG 9 (NO REV)
20|FH_F128379_0_0|CSTM-ALL|CSTM-00|2020|PDM|830.00|99|0.00|AEG 1 (NO REV)
20|FH_F128379_0_0|SrvcGrp|67065|2022|PDM|14306.00|99|0.00|CERVICAL SURGERY
20|FH_F128379_0_0|SrvcGrp|88740|2022|PDM|2861.00|99|0.00|SP BONE ALGRFT
20|FH_F128379_0_0|SrvcGrp|89842|2022|PDM|14306.00|99|0.00|LUMBAR
20|FH_F128379_0_0|SrvcGrp|89848|2022|PDM|7553.00|99|0.00|SPINE FUSION EXTRA SEGMENT
20|FH_F128379_0_0|SrvcGrp|99073|2022|PDM|1.38|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F128379_0_0|SrvcGrp|99164|2022|PDM|7553.00|99|0.00|CPT 22846
20|FH_F128384_0_0|CSTM-ALL|CSTM-00|2020|PCT|45.00|99|0.00|OP SVCS
20|FH_F128390_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F128390_0_0|SrvcGrp|63297|2022|PDM|115.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F128397_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F128397_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F128430_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F128430_0_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F128446_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F128446_0_0|SrvcGrp|87077|2022|PDM|161.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F128550_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F128550_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F128550_0_0|SrvcGrp|87077|2022|PDM|165.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F128580_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F128580_0_0|CSTM-ALL|CSTM-00|2020|PDM|1024.00|99|0.00|AEG 7 (NO REV)
20|FH_F128580_0_0|SrvcGrp|108077|2022|PDM|2248.00|99|0.00|ARTERIOVENOUS ANASTOMOSIS
20|FH_F128580_0_0|SrvcGrp|108078|2022|PDM|1306.00|99|0.00|ARTERY-VEIN FUSION
20|FH_F128580_0_0|SrvcGrp|73610|2022|PCT|0.00|99|0.00|AETNA IMPLANTS
20|FH_F128580_0_0|SrvcGrp|74670|2022|PCT|0.00|99|0.00|AETNA OP INTRAOCULAR LENS
20|FH_F128699_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F128699_0_0|SrvcGrp|29155|2022|PDM|90.00|99|0.00|HOSPICE SVCS
20|FH_F128804_0_0|CSTM-ALL|CSTM-00|2020|PDM|2090.00|99|0.00|AEG 10 (NO REV)
20|FH_F128804_0_0|CSTM-ALL|CSTM-00|2020|PDM|3520.00|99|0.00|AEG 9 (NO REV)
20|FH_F128804_0_0|SrvcGrp|106265|2022|PDM|4263.00|99|0.00|NSL/SINS NDSC TOTAL
20|FH_F128821_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F128821_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F128821_0_0|SrvcGrp|107748|2022|PDM|424.00|99|0.00|HEMODIALYSIS IN CENTER
20|FH_F128833_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F128839_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F128880_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F128893_0_0|SrvcGrp|80918|2022|PDM|150.00|99|0.00|RESPITE CARE
20|FH_F128893_0_0|SrvcGrp|80920|2022|PDM|600.00|99|0.00|HOSPICE SERVICES
20|FH_F128927_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F128977_0_0|SrvcGrp|87077|2022|PDM|265.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F128988_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F128988_0_0|SrvcGrp|29155|2022|PDM|100.00|99|0.00|HOSPICE SVCS
20|FH_F128988_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F128988_0_0|SrvcGrp|82222|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F128988_0_0|SrvcGrp|83857|2022|PDM|475.00|99|0.00|IP HOSPICE SVCS
20|FH_F128990_0_0|CSTM-ALL|CSTM-00|2020|PCT|54.00|99|0.00|OP SVCS
20|FH_F129046_0_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F129053_0_0|CSTM-ALL|CSTM-00|2020|PDM|2429.00|99|0.00|AEG 6 (NO REV)
20|FH_F129053_0_0|CSTM-ALL|CSTM-00|2020|PDM|2918.00|99|0.00|AEG 7 (NO REV)
20|FH_F129053_0_0|CSTM-ALL|CSTM-00|2020|PDM|3928.00|99|0.00|AEG 9 (NO REV)
20|FH_F129053_0_0|CSTM-ALL|CSTM-00|2020|PDM|884.00|99|0.00|AEG 1 (NO REV)
20|FH_F129053_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F129053_0_0|SrvcGrp|36991|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F129053_0_0|SrvcGrp|59840|2022|PDM|1873.00|99|0.00|TYMPANOSTOMY
20|FH_F129053_0_0|SrvcGrp|88596|2022|PDM|2549.00|99|0.00|EXC OF TRIANG FIBROCARTILAGE
20|FH_F129175_0_0|CSTM-ALL|CSTM-00|2020|PDM|1089.00|99|0.00|AEG 7 (NO REV)
20|FH_F129175_0_0|SrvcGrp|110765|2022|PDM|93.53|99|0.00|2ND LEVEL INJ PARAVERT F JNT C/T
20|FH_F129175_0_0|SrvcGrp|110767|2022|PDM|95.81|99|0.00|2ND LEVEL INJ PARAVERT F JNT L/S
20|FH_F129175_0_0|SrvcGrp|35669|2022|PDM|4561.00|99|0.00|CPT 63650
20|FH_F129175_0_0|SrvcGrp|53065|2022|PDM|292.50|99|0.00|INJECTION(S), LUMBAR OR SACRAL, SINGLE LEVEL
20|FH_F129175_0_0|SrvcGrp|87679|2022|PDM|555.83|99|0.00|LUMBAR OR SACRAL SURGERY
20|FH_F129175_0_0|SrvcGrp|93759|2022|PCT|0.00|99|0.00|CARDIAC CATH
20|FH_F129175_0_0|SrvcGrp|96819|2022|PDM|150.13|99|0.00|DESTROY L/S FACET JNT ADDL
20|FH_F129189_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F129225_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F129225_0_0|CSTM-ALL|CSTM-00|2020|PDM|794.66|99|0.00|2005 ASPG GROUPER IV
20|FH_F129248_0_0|CSTM-ALL|CSTM-00|2020|PDM|1142.38|99|0.00|2005 ASPG GROUPER VI
20|FH_F129248_0_0|CSTM-ALL|CSTM-00|2020|PDM|1851.87|99|0.00|2005 ASPG GROUPER IX
20|FH_F129248_0_0|CSTM-ALL|CSTM-00|2020|PDM|991.63|99|0.00|2005 ASPG GROUPER V
20|FH_F129248_0_0|SrvcGrp|90318|2022|PCT|1.10|99|0.00|IMPLANTS/PROSTHETICS
20|FH_F129254_0_0|CSTM-ALL|CSTM-00|2020|PDM|1041.88|99|0.00|ASPG VI
20|FH_F129254_0_0|CSTM-ALL|CSTM-00|2020|PDM|794.66|99|0.00|ASPG X
20|FH_F129254_0_0|SrvcGrp|90318|2022|PCT|1.10|99|0.00|IMPLANTS/PROSTHETICS
20|FH_F129260_0_0|CSTM-ALL|CSTM-00|2020|PDM|697.40|99|0.00|AEG 9 (NO REV)
20|FH_F129260_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|AEG 5  (NO REV)
20|FH_F129310_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F129364_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F129472_0_0|CSTM-ALL|CSTM-00|2020|PDM|1201.00|99|0.00|AEG 7 (NO REV)
20|FH_F129472_0_0|CSTM-ALL|CSTM-00|2020|PDM|480.00|99|0.00|AEG 1 (NO REV)
20|FH_F129487_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F129487_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F129487_0_0|SrvcGrp|89988|2022|PDM|2369.00|99|0.00|REPAIR HALLUX RIGIDUS
20|FH_F129509_0_0|SrvcGrp|103327|2022|PDM|7688.00|99|0.00|INSJ STABLJ DEV W/DCMPRN
20|FH_F129509_0_0|SrvcGrp|109220|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F129509_0_0|SrvcGrp|67279|2022|PDM|5125.00|99|0.00|CERVICAL SURGERY
20|FH_F129509_0_0|SrvcGrp|71666|2022|PDM|3075.00|99|0.00|CPT 63655
20|FH_F129509_0_0|SrvcGrp|72990|2022|PDM|612.00|99|0.00|AEG 1
20|FH_F129509_0_0|SrvcGrp|72994|2022|PDM|744.00|99|0.00|AEG 3
20|FH_F129509_0_0|SrvcGrp|73006|2022|PDM|1685.00|99|0.00|AEG 9
20|FH_F129509_0_0|SrvcGrp|73008|2022|PDM|959.00|99|0.00|AEG 10
20|FH_F129509_0_0|SrvcGrp|77484|2022|PDM|610.00|99|0.00|AETNA OBSERVATION
20|FH_F129509_0_0|SrvcGrp|88158|2022|PDM|3767.00|99|0.00|NECK SPINE DISK SURGERY
20|FH_F129509_0_0|SrvcGrp|88159|2022|PDM|3767.00|99|0.00|LOW BACK DISK SURGERY
20|FH_F129509_0_0|SrvcGrp|88161|2022|PDM|3767.00|99|0.00|LAMINECTOMY W/FACE-THORACIC
20|FH_F129509_0_0|SrvcGrp|88162|2022|PDM|3767.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON
20|FH_F129509_0_0|SrvcGrp|89842|2022|PDM|3659.00|99|0.00|LUMBAR
20|FH_F129526_0_0|CSTM-ALL|CSTM-00|2020|PDM|1264.90|99|0.00|2005 ASPG GROUPER VIII
20|FH_F129526_0_0|CSTM-ALL|CSTM-00|2020|PDM|1293.50|99|0.00|2005 ASPG GROUPER VII
20|FH_F129526_0_0|CSTM-ALL|CSTM-00|2020|PDM|663.00|99|0.00|2005 ASPG GROUPER III
20|FH_F129526_0_0|SrvcGrp|111372|2022|PCT|1.05|99|0.00|IMPLANTS/PROSTHETICS
20|FH_F129535_0_0|SrvcGrp|111365|2022|PDM|550.00|99|0.00|CORRECT RECTAL PROLAPSE
20|FH_F129535_0_0|SrvcGrp|75479|2022|PDM|315.00|99|0.00|AEG 1
20|FH_F129535_0_0|SrvcGrp|75491|2022|PDM|950.00|99|0.00|AEG 7
20|FH_F129535_0_0|SrvcGrp|77292|2022|PDM|450.00|99|0.00|AETNA REMV TUNNLD CVAD W/SUBQ PORT
20|FH_F129535_0_0|SrvcGrp|79583|2022|PDM|550.00|99|0.00|CPT 45381
20|FH_F129535_0_0|SrvcGrp|82307|2022|PDM|550.00|99|0.00|COLORECTAL CANCER SCREENING
20|FH_F129535_0_0|SrvcGrp|85000|2022|PDM|550.00|99|0.00|CPT 45384
20|FH_F129536_0_0|CSTM-ALL|CSTM-00|2020|PDM|327.00|99|0.00|AEG 9 (NO REV)
20|FH_F129536_0_0|CSTM-ALL|CSTM-00|2020|PDM|618.00|99|0.00|AEG 10 (NO REV)
20|FH_F129536_0_0|CSTM-ALL|CSTM-00|2020|PDM|703.00|99|0.00|AEG 5  (NO REV)
20|FH_F129536_0_0|SrvcGrp|108386|2022|PCT|1.00|99|0.00|OCULAR IMPLANT
20|FH_F129536_0_0|SrvcGrp|46890|2022|PDM|2200.00|99|0.00|IMPLANT EYE SHUNT
20|FH_F129576_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F129588_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F129596_0_0|SrvcGrp|12118|2022|PDM|350.00|99|0.00|COMPUTED TOMOGRAPHY (CT)
20|FH_F129596_0_0|SrvcGrp|21975|2022|PDM|1575.00|99|0.00|INPATIENT SERVICES
20|FH_F129596_0_0|SrvcGrp|8950|2022|PDM|1730.00|99|0.00|INTERMEDIATE ICU/CCU
20|FH_F129597_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F129597_0_0|SrvcGrp|82223|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F129638_0_0|SrvcGrp|15326|2022|PDM|1350.00|99|0.00|ER LEVEL IV
20|FH_F129653_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F129653_0_0|SrvcGrp|103592|2022|PDM|4000.00|99|0.00|VERTEBRAL ART
20|FH_F129653_0_0|SrvcGrp|35669|2022|PDM|4000.00|99|0.00|CPT 63650
20|FH_F129653_0_0|SrvcGrp|45063|2022|PDM|2000.00|99|0.00|CPT 64493  INJECTION CARVE OUT
20|FH_F129653_0_0|SrvcGrp|53065|2022|PDM|2000.00|99|0.00|INJECTION(S), LUMBAR OR SACRAL, SINGLE LEVEL
20|FH_F129653_0_0|SrvcGrp|53066|2022|PDM|2000.00|99|0.00|INJECTION(S), LUMBAR OR SACRAL, EACH ADDITIONAL LEVEL
20|FH_F129653_0_0|SrvcGrp|72992|2022|PDM|1235.00|99|0.00|AEG 2
20|FH_F129653_0_0|SrvcGrp|72998|2022|PDM|1755.00|99|0.00|AEG 5
20|FH_F129653_0_0|SrvcGrp|73008|2022|PDM|2047.00|99|0.00|AEG 10
20|FH_F129653_0_0|SrvcGrp|88065|2022|PDM|4000.00|99|0.00|TOTAL DISC ARTHROPLASTY
20|FH_F129659_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F129659_0_0|SrvcGrp|82981|2022|PDM|170.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F129659_0_0|SrvcGrp|87077|2022|PDM|170.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F129754_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F129754_0_0|CSTM-ALL|CSTM-00|2020|PDM|785.71|99|0.00|2005 ASPG GROUPER X
20|FH_F129767_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F129785_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F129793_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F129793_0_0|CSTM-ALL|CSTM-00|2020|PDM|1041.40|99|0.00|2006 MEDICARE ASPG V
20|FH_F129793_0_0|CSTM-ALL|CSTM-00|2020|PDM|1445.19|99|0.00|2006 MEDICARE ASPG VII
20|FH_F129793_0_0|CSTM-ALL|CSTM-00|2020|PDM|1944.83|99|0.00|2006 MEDICARE ASPG IX
20|FH_F129793_0_0|SrvcGrp|90318|2022|PCT|1.10|99|0.00|IMPLANTS/PROSTHETICS
20|FH_F129802_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE
20|FH_F129802_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS
20|FH_F129828_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F129828_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F129888_0_0|CSTM-ALL|CSTM-00|2020|PDM|1120.64|99|0.00|2005 ASPG GROUPER V
20|FH_F129888_0_0|SrvcGrp|90318|2022|PCT|1.10|99|0.00|IMPLANTS/PROSTHETICS
20|FH_F129892_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F129892_0_0|CSTM-ALL|CSTM-00|2020|PDM|1108.00|99|0.00|AEG 6 (NO REV)
20|FH_F129892_0_0|CSTM-ALL|CSTM-00|2020|PDM|1792.00|99|0.00|AEG 9 (NO REV)
20|FH_F129892_0_0|CSTM-ALL|CSTM-00|2020|PDM|446.00|99|0.00|AEG 1 (NO REV)
20|FH_F129892_0_0|CSTM-ALL|CSTM-00|2020|PDM|843.00|99|0.00|AEG 4 (NO REV)
20|FH_F129892_0_0|CSTM-ALL|CSTM-00|2020|PDM|958.00|99|0.00|AEG 5  (NO REV)
20|FH_F129892_0_0|SrvcGrp|111432|2022|PDM|1715.00|99|0.00|KNEE ARTHROSCOPY
20|FH_F129892_0_0|SrvcGrp|26275|2022|PDM|1495.00|99|0.00|CPT 29826
20|FH_F129892_0_0|SrvcGrp|27261|2022|PDM|1530.00|99|0.00|CPT 27446
20|FH_F129892_0_0|SrvcGrp|34606|2022|PDM|1715.00|99|0.00|CPT 29827
20|FH_F129892_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F129892_0_0|SrvcGrp|70749|2022|PDM|1495.00|99|0.00|CPT 29823
20|FH_F129892_0_0|SrvcGrp|89853|2022|PDM|1495.00|99|0.00|NASAL/SINUS ENDOSCOPY-SURG
20|FH_F129892_0_0|SrvcGrp|93641|2022|PDM|1715.00|99|0.00|KNEE ARTHROSCOPIC SURGERY
20|FH_F129913_0_0|CSTM-ALL|CSTM-00|2020|PDM|1701.80|99|0.00|2005 ASPG GROUPER VIII
20|FH_F129913_0_0|CSTM-ALL|CSTM-00|2020|PDM|780.66|99|0.00|2005 ASPG GROUPER II
20|FH_F129913_0_0|CSTM-ALL|CSTM-00|2020|PDM|892.00|99|0.00|2005 ASPG GROUPER III
20|FH_F130023_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F130023_0_0|SrvcGrp|111476|2022|PDM|279.00|99|0.00|WOUND CARE
20|FH_F130023_0_0|SrvcGrp|11283|2022|PDM|580.00|99|0.00|HYPERBARIC CHAMBER
20|FH_F130023_0_0|SrvcGrp|16|2022|PDM|1004.00|99|0.00|ACUTE REHABILITATION
20|FH_F130025_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F130025_0_0|SrvcGrp|17100|2022|PDM|1102.00|99|0.00|SKILLED NURSING
20|FH_F130025_0_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS
20|FH_F130025_0_0|SrvcGrp|93924|2022|PDM|1391.00|99|0.00|AETNA MEDICAL SERVICES
20|FH_F130035_0_0|SrvcGrp|108042|2022|PDM|473.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD
20|FH_F130035_0_0|SrvcGrp|109020|2022|PCT|0.90|99|0.00|PARSABIV INJECTION ETELCALCETIDE 0.1 MG
20|FH_F130035_0_0|SrvcGrp|111468|2022|PDM|222.00|99|0.00|DIALYSIS PATIENT TRAINING
20|FH_F130035_0_0|SrvcGrp|111469|2022|PDM|56.70|99|0.00|INFLUENZA VACCINE
20|FH_F130108_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 417-419
20|FH_F130108_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|ASPG I
20|FH_F130108_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|ACUTE PSYCH
20|FH_F130108_0_0|SrvcGrp|10904|2022|PDM|750.00|99|0.00|EMERGENCY ROOM LEVEL II
20|FH_F130108_0_0|SrvcGrp|10905|2022|PCT|0.75|99|0.00|EMERGENCY ROOM LEVEL III
20|FH_F130108_0_0|SrvcGrp|10906|2022|PCT|0.75|99|0.00|EMERGENCY ROOM LEVEL IV
20|FH_F130108_0_0|SrvcGrp|10946|2022|PCT|0.75|99|0.00|EMERGENCY ROOM
20|FH_F130108_0_0|SrvcGrp|111492|2022|PCT|0.60|99|0.00|RADIATION ONCOLOGY
20|FH_F130108_0_0|SrvcGrp|15350|2022|PCT|0.75|99|0.00|TRAUMA ACTIVATION
20|FH_F130108_0_0|SrvcGrp|15353|2022|PCT|0.60|99|0.00|OP TRAUMA ACTIVATION
20|FH_F130108_0_0|SrvcGrp|15355|2022|PCT|0.60|99|0.00|MAGNETIC RESONANCE IMAGING (MRI)
20|FH_F130108_0_0|SrvcGrp|15363|2022|PCT|0.60|99|0.00|DME/ORTHOTICS/PROSTHETICS/IMPLANTS
20|FH_F130108_0_0|SrvcGrp|15370|2022|PCT|0.60|99|0.00|OTHER DIAGNOSTIC
20|FH_F130108_0_0|SrvcGrp|15967|2022|PDM|1800.00|99|0.00|ICU
20|FH_F130108_0_0|SrvcGrp|16301|2022|PDM|4500.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F130108_0_0|SrvcGrp|3029|2022|PDM|500.00|99|0.00|NEWBORN NURSERY
20|FH_F130108_0_0|SrvcGrp|360|2022|PDM|725.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F130108_0_0|SrvcGrp|83885|2022|PDM|6000.00|99|0.00|CARDIAC CATH
20|FH_F130108_0_0|SrvcGrp|9511|2022|PCT|0.60|99|0.00|OBSERVATION SVCS
20|FH_F130108_0_0|SrvcGrp|9938|2022|PCT|0.75|99|0.00|SPEECH THERAPY
20|FH_F130112_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F130112_0_0|CSTM-ALL|CSTM-00|2020|PDM|1788.00|99|0.00|AEG 8 (NO REV)
20|FH_F130112_0_0|CSTM-ALL|CSTM-00|2020|PDM|2228.00|99|0.00|AEG 7 (NO REV)
20|FH_F130112_0_0|CSTM-ALL|CSTM-00|2020|PDM|637.00|99|0.00|AEG 1 (NO REV)
20|FH_F130112_0_0|SrvcGrp|77453|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F130146_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F130146_0_0|SrvcGrp|108443|2022|PDM|400.00|99|0.00|HEMODIALYSIS W/ TRAINING
20|FH_F130182_0_0|CSTM-ALL|CSTM-00|2020|PDM|1198.00|99|0.00|AEG 6 (NO REV)
20|FH_F130182_0_0|CSTM-ALL|CSTM-00|2020|PDM|503.00|99|0.00|AEG 1 (NO REV)
20|FH_F130182_0_0|CSTM-ALL|CSTM-00|2020|PDM|769.00|99|0.00|AEG 3 (NO REV) WITHOUT 37765-37766
20|FH_F130182_0_0|SrvcGrp|109444|2022|PDM|1457.00|99|0.00|RIGHT HEART CATH
20|FH_F130182_0_0|SrvcGrp|109449|2022|PDM|1457.00|99|0.00|R HRT CORONARY ARTERY ANGIO
20|FH_F130182_0_0|SrvcGrp|109453|2022|PDM|1457.00|99|0.00|R&L HRT ART/VENTRICLE ANGIO
20|FH_F130182_0_0|SrvcGrp|111514|2022|PDM|1457.00|99|0.00|L HRT CATH TRNSPTL PUNCTURE
20|FH_F130182_0_0|SrvcGrp|111518|2022|PDM|364.00|99|0.00|STAB PHLEBECT VV 1 EXT
20|FH_F130302_0_0|SrvcGrp|103737|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F130317_0_0|SrvcGrp|87537|2022|PDM|660.00|99|0.00|MED REHAB DAY PROGRAM (FULL)
20|FH_F130317_0_0|SrvcGrp|95665|2022|PDM|2276.20|99|0.00|ACUTE REHABILITATION/COMPLEX MEDICAL CARE
20|FH_F130328_0_0|SrvcGrp|104230|2022|PDM|198.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F130328_0_0|SrvcGrp|30609|2022|PDM|40.00|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F130328_0_0|SrvcGrp|33722|2022|PDM|43.00|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F130328_0_0|SrvcGrp|80920|2022|PDM|600.00|99|0.00|HOSPICE SERVICES
20|FH_F130328_0_0|SrvcGrp|87799|2022|PDM|176.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)
20|FH_F130328_0_0|SrvcGrp|89781|2022|PDM|176.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F130328_0_0|SrvcGrp|94781|2022|PDM|176.00|99|0.00|HOSPICE IN LTCH (HCFA)
20|FH_F130328_0_0|SrvcGrp|95660|2022|PDM|678.00|99|0.00|HOSPICE SERVICES (HCFA)
20|FH_F130330_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F130331_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F130350_0_0|CSTM-ALL|CSTM-00|2020|PDM|936.00|99|0.00|AEG 4 (NO REV)
20|FH_F130371_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|OP SVCS
20|FH_F130371_0_0|SrvcGrp|75505|2022|PCT|0.92|99|0.00|CARDIAC STUDIES
20|FH_F130468_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F130468_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F130468_0_0|CSTM-ALL|CSTM-00|2020|PDM|1721.30|99|0.00|AEG 2 (NO REV)
20|FH_F130468_0_0|CSTM-ALL|CSTM-00|2020|PDM|1888.20|99|0.00|AEG 3 (NO REV)
20|FH_F130468_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.80|99|0.00|AEG 8 (NO REV)
20|FH_F130468_0_0|SrvcGrp|111435|2022|PDM|9919.40|99|0.00|ATRAUMATIC DISLOC WITH ANES
20|FH_F130468_0_0|SrvcGrp|41334|2022|PDM|19232.00|99|0.00|TOTAL KNEE
20|FH_F130468_0_0|SrvcGrp|86233|2022|PDM|5835.00|99|0.00|AETNA RECONSTRUCT ANKLE JOINT
20|FH_F130468_0_0|SrvcGrp|88156|2022|PDM|12602.50|99|0.00|REVISION OF KNEE JOINT
20|FH_F130468_0_0|SrvcGrp|88219|2022|PDM|2847.40|99|0.00|ARTHROSCOPY KNEE/SURGICAL
20|FH_F130468_0_0|SrvcGrp|93433|2022|PDM|11086.40|99|0.00|PARTIAL HIP REPLACEMENT
20|FH_F130468_0_0|SrvcGrp|95559|2022|PDM|11776.00|99|0.00|HIP JOINT
20|FH_F130468_0_0|SrvcGrp|97895|2022|PDM|21005.80|99|0.00|REVISE KNEE 2
20|FH_F130468_0_0|SrvcGrp|99073|2022|PDM|1.38|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F130630_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F130630_0_0|SrvcGrp|87077|2022|PDM|150.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F130654_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F130654_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|CARDIAC STUDIES
20|FH_F130654_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F130676_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F130676_0_0|SrvcGrp|80258|2022|PCT|0.00|99|0.00|AETNA SKILLED CARE
20|FH_F130682_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F130682_0_0|CSTM-ALL|CSTM-00|2020|PDM|1613.00|99|0.00|AEG 8 (NO REV)
20|FH_F130682_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F130682_0_0|SrvcGrp|27344|2022|PDM|4980.00|99|0.00|OP SURGERY (CPT 42821)
20|FH_F130707_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS
20|FH_F130723_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F130723_0_0|CSTM-ALL|CSTM-00|2020|PDM|432.00|99|0.00|AEG 2 (NO REV)
20|FH_F130723_0_0|CSTM-ALL|CSTM-00|2020|PDM|494.00|99|0.00|AEG 3 (NO REV)
20|FH_F130723_0_0|CSTM-ALL|CSTM-00|2020|PDM|695.00|99|0.00|AEG 5  (NO REV)
20|FH_F130747_0_0|SrvcGrp|108260|2022|PDM|2601.00|99|0.00|AETNA FIXATION OF KNEE JOINT
20|FH_F130747_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F130747_0_0|SrvcGrp|109526|2022|PDM|2601.00|99|0.00|TREATMENT OF ANKLE FRACTURE
20|FH_F130747_0_0|SrvcGrp|11673|2022|PDM|5202.00|99|0.00|CPT 29888
20|FH_F130747_0_0|SrvcGrp|26276|2022|PDM|5202.00|99|0.00|CPT 29819
20|FH_F130747_0_0|SrvcGrp|27315|2022|PDM|5306.00|99|0.00|TENDON REPAIR
20|FH_F130747_0_0|SrvcGrp|35671|2022|PDM|4682.00|99|0.00|TRANSPLANT FOREARM TENDON
20|FH_F130747_0_0|SrvcGrp|67066|2022|PDM|20808.00|99|0.00|CERVICAL SURGERY
20|FH_F130747_0_0|SrvcGrp|72121|2022|PDM|5202.00|99|0.00|ARTHOSCOPY
20|FH_F130747_0_0|SrvcGrp|82107|2022|PDM|5202.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F130747_0_0|SrvcGrp|82720|2022|PDM|5202.00|99|0.00|WRIST ENDOSCOPY/SURGERY
20|FH_F130747_0_0|SrvcGrp|85792|2022|PDM|6763.00|99|0.00|OPEN TREATMENT OF DISTAL
20|FH_F130747_0_0|SrvcGrp|88065|2022|PDM|24970.00|99|0.00|TOTAL DISC ARTHROPLASTY
20|FH_F130747_0_0|SrvcGrp|88157|2022|PDM|26010.00|99|0.00|TOTAL HIP ARTHROPLASTY
20|FH_F130747_0_0|SrvcGrp|88159|2022|PDM|8843.00|99|0.00|LOW BACK DISK SURGERY
20|FH_F130747_0_0|SrvcGrp|88163|2022|PDM|29131.00|99|0.00|LUMBAR SPINE FUSION
20|FH_F130747_0_0|SrvcGrp|88164|2022|PDM|36414.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR
20|FH_F130747_0_0|SrvcGrp|88492|2022|PDM|6763.00|99|0.00|AETNA SPINAL BONE AUTOGRAFT
20|FH_F130747_0_0|SrvcGrp|88596|2022|PDM|5202.00|99|0.00|EXC OF TRIANG FIBROCARTILAGE
20|FH_F130747_0_0|SrvcGrp|88740|2022|PDM|6763.00|99|0.00|SP BONE ALGRFT
20|FH_F130747_0_0|SrvcGrp|89848|2022|PDM|32252.00|99|0.00|SPINE FUSION EXTRA SEGMENT
20|FH_F130747_0_0|SrvcGrp|92010|2022|PDM|5202.00|99|0.00|LESION OF TENDON SHEATH OR JOINT CAPSULE
20|FH_F130747_0_0|SrvcGrp|92408|2022|PDM|4162.00|99|0.00|PERQ VERTEBRAL AUGMENTATION
20|FH_F130747_0_0|SrvcGrp|92410|2022|PDM|36414.00|99|0.00|SPINE FUSION EXTRA SEGMENT
20|FH_F130747_0_0|SrvcGrp|92416|2022|PDM|8843.00|99|0.00|CERVICAL LAMINOTOMY
20|FH_F130747_0_0|SrvcGrp|93071|2022|PDM|8843.00|99|0.00|POSTERIOR SEGMENTAL INSTRU
20|FH_F130747_0_0|SrvcGrp|93432|2022|PDM|19768.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT
20|FH_F130747_0_0|SrvcGrp|95559|2022|PDM|26010.00|99|0.00|HIP JOINT
20|FH_F130747_0_0|SrvcGrp|97895|2022|PDM|26010.00|99|0.00|REVISE KNEE 2
20|FH_F130747_0_0|SrvcGrp|99161|2022|PDM|26010.00|99|0.00|CPT 27138
20|FH_F130751_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F130763_0_0|CSTM-ALL|CSTM-00|2020|PDM|1013.00|99|0.00|AEG 1 (NO REV)
20|FH_F130763_0_0|CSTM-ALL|CSTM-00|2020|PDM|1417.00|99|0.00|AEG 2 (NO REV)
20|FH_F130763_0_0|SrvcGrp|100067|2022|PDM|4159.00|99|0.00|ANKLE ARTHROSCOPY SURGERY
20|FH_F130763_0_0|SrvcGrp|102480|2022|PDM|3258.00|99|0.00|CPT 29897
20|FH_F130763_0_0|SrvcGrp|106266|2022|PDM|6043.00|99|0.00|NSL/SINS NDSC TOT W/ SPHENDT
20|FH_F130763_0_0|SrvcGrp|111602|2022|PDM|3050.00|99|0.00|LARYNGOSCOPY
20|FH_F130763_0_0|SrvcGrp|27402|2022|PDM|4714.00|99|0.00|LASER PROCEDURES
20|FH_F130763_0_0|SrvcGrp|33985|2022|PDM|3299.00|99|0.00|CPT 19120
20|FH_F130763_0_0|SrvcGrp|34605|2022|PDM|3137.00|99|0.00|CPT 28299
20|FH_F130763_0_0|SrvcGrp|36864|2022|PDM|13330.00|99|0.00|COCHLEAR IMPLANTS
20|FH_F130763_0_0|SrvcGrp|63466|2022|PDM|4714.00|99|0.00|CPT 52005
20|FH_F130763_0_0|SrvcGrp|65403|2022|PDM|3882.00|99|0.00|CPT 42830
20|FH_F130763_0_0|SrvcGrp|77461|2022|PDM|4020.00|99|0.00|CPT 52356
20|FH_F130763_0_0|SrvcGrp|82113|2022|PDM|3450.00|99|0.00|KNEE ARTHROSCOPY SURGERY
20|FH_F130763_0_0|SrvcGrp|82114|2022|PDM|3450.00|99|0.00|MENISCUS REPAIR MED OR LAT
20|FH_F130763_0_0|SrvcGrp|84181|2022|PDM|3951.00|99|0.00|AETNA IMMEDIATE BREAST PROSTHESIS
20|FH_F130763_0_0|SrvcGrp|84910|2022|PDM|4367.00|99|0.00|ENDOSCOPY
20|FH_F130763_0_0|SrvcGrp|88491|2022|PDM|7319.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR
20|FH_F130763_0_0|SrvcGrp|88599|2022|PDM|4367.00|99|0.00|ENDOSCOPY MAXILLARY SINUS
20|FH_F130763_0_0|SrvcGrp|88740|2022|PDM|5823.00|99|0.00|SP BONE ALGRFT
20|FH_F130763_0_0|SrvcGrp|89989|2022|PDM|4914.00|99|0.00|FUSION OF BIG TOE JOINT
20|FH_F130763_0_0|SrvcGrp|90418|2022|PDM|4717.00|99|0.00|ENLARGE BREAST WITH IMPLANT
20|FH_F130763_0_0|SrvcGrp|90795|2022|PDM|3639.00|99|0.00|EXCISION INFERIOR TURBINATE
20|FH_F130763_0_0|SrvcGrp|90822|2022|PDM|4367.00|99|0.00|NASAL/SINUS ENDOSCOPY SURGERY
20|FH_F130763_0_0|SrvcGrp|92415|2022|PDM|7319.00|99|0.00|NECK SPINE DISK SURGERY
20|FH_F130763_0_0|SrvcGrp|99073|2022|PDM|1.45|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F130763_0_0|SrvcGrp|99174|2022|PDM|3189.00|99|0.00|CPT 30140
20|FH_F130770_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.20|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE
20|FH_F130796_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F130826_0_0|CSTM-ALL|CSTM-00|2020|PDM|1101.00|99|0.00|AEG 8 (NO REV)
20|FH_F130826_0_0|CSTM-ALL|CSTM-00|2020|PDM|1125.00|99|0.00|AEG 7 (NO REV)
20|FH_F130826_0_0|CSTM-ALL|CSTM-00|2020|PDM|935.00|99|0.00|AEG 6 (NO REV)
20|FH_F130861_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F130923_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F130928_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.22|99|0.00|OP SVCS
20|FH_F130935_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS
20|FH_F130970_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F130977_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.41|99|0.00|GENERAL ACUTE CARE
20|FH_F130978_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F130978_0_0|SrvcGrp|108042|2022|PDM|400.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD
20|FH_F130978_0_0|SrvcGrp|108081|2022|PDM|171.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS
20|FH_F130978_0_0|SrvcGrp|108082|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER
20|FH_F130985_0_0|SrvcGrp|13188|2022|PCT|0.47|99|0.00|DRUGS
20|FH_F130985_0_0|SrvcGrp|33659|2022|PDM|400.00|99|0.00|DIALYSIS SERVICES
20|FH_F131000_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F131000_0_0|CSTM-ALL|CSTM-00|2020|PDM|1128.00|99|0.00|AEG 2 (NO REV)
20|FH_F131000_0_0|CSTM-ALL|CSTM-00|2020|PDM|2159.00|99|0.00|AEG 4 (NO REV)
20|FH_F131000_0_0|CSTM-ALL|CSTM-00|2020|PDM|3096.00|99|0.00|AEG 9 (NO REV)
20|FH_F131000_0_0|SrvcGrp|104108|2022|PDM|3024.00|99|0.00|EXCISION OF BREAST LESION ID
20|FH_F131000_0_0|SrvcGrp|106266|2022|PDM|5114.00|99|0.00|NSL/SINS NDSC TOT W/ SPHENDT
20|FH_F131000_0_0|SrvcGrp|106267|2022|PDM|5114.00|99|0.00|NSL/SINS NDSC SPHN TISS RMVL
20|FH_F131000_0_0|SrvcGrp|11673|2022|PDM|5836.00|99|0.00|CPT 29888
20|FH_F131000_0_0|SrvcGrp|14614|2022|PDM|3608.00|99|0.00|LITHOTRIPSY
20|FH_F131000_0_0|SrvcGrp|15473|2022|PDM|2494.00|99|0.00|CPT CODE 42820
20|FH_F131000_0_0|SrvcGrp|27261|2022|PDM|13265.00|99|0.00|CPT 27446
20|FH_F131000_0_0|SrvcGrp|27344|2022|PDM|2494.00|99|0.00|OP SURGERY (CPT 42821)
20|FH_F131000_0_0|SrvcGrp|27346|2022|PDM|4457.00|99|0.00|REPAIR BLADDER DEFECT
20|FH_F131000_0_0|SrvcGrp|33985|2022|PDM|2494.00|99|0.00|CPT 19120
20|FH_F131000_0_0|SrvcGrp|41335|2022|PDM|15086.00|99|0.00|TOTAL HIP
20|FH_F131000_0_0|SrvcGrp|59840|2022|PDM|2123.00|99|0.00|TYMPANOSTOMY
20|FH_F131000_0_0|SrvcGrp|59841|2022|PDM|2441.00|99|0.00|SUBMUCOUS RESECTION
20|FH_F131000_0_0|SrvcGrp|67065|2022|PDM|15494.00|99|0.00|CERVICAL SURGERY
20|FH_F131000_0_0|SrvcGrp|78093|2022|PDM|3608.00|99|0.00|AETNA NASAL ENDOSCOPY SURG
20|FH_F131000_0_0|SrvcGrp|78098|2022|PDM|2494.00|99|0.00|AETNA REMOVAL OF TONSILS
20|FH_F131000_0_0|SrvcGrp|82112|2022|PDM|3343.00|99|0.00|KNEE ARTHROSCOPY SURGERY
20|FH_F131000_0_0|SrvcGrp|83646|2022|PDM|3343.00|99|0.00|CPT 31276
20|FH_F131000_0_0|SrvcGrp|84182|2022|PDM|3024.00|99|0.00|AETNA REMOVAL OF BREAST CAPSULE
20|FH_F131000_0_0|SrvcGrp|84910|2022|PDM|3343.00|99|0.00|ENDOSCOPY
20|FH_F131000_0_0|SrvcGrp|85778|2022|PDM|3502.00|99|0.00|REPAIR OF ANKLE FRACTURE
20|FH_F131000_0_0|SrvcGrp|87054|2022|PDM|3608.00|99|0.00|CYSTOSCOPY CHEMODENERVATION
20|FH_F131000_0_0|SrvcGrp|90822|2022|PDM|3343.00|99|0.00|NASAL/SINUS ENDOSCOPY SURGERY
20|FH_F131000_0_0|SrvcGrp|91941|2022|PDM|3343.00|99|0.00|NASAL/SINUS ENDOSCOPY WITH DILATION
20|FH_F131000_0_0|SrvcGrp|96539|2022|PDM|4033.00|99|0.00|REVISION OF ANKLE LIGAMENT
20|FH_F131087_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F131087_0_0|SrvcGrp|72992|2022|PDM|700.00|99|0.00|AEG 2
20|FH_F131100_0_0|CSTM-ALL|CSTM-00|2020|PDM|1274.00|99|0.00|AEG 3 (NO REV)
20|FH_F131100_0_0|CSTM-ALL|CSTM-00|2020|PDM|1542.00|99|0.00|AEG 8 (NO REV)
20|FH_F131100_0_0|CSTM-ALL|CSTM-00|2020|PDM|1655.00|99|0.00|AEG 9 (NO REV)
20|FH_F131100_0_0|CSTM-ALL|CSTM-00|2020|PDM|740.00|99|0.00|AEG 2 (NO REV)
20|FH_F131100_0_0|SrvcGrp|105000|2022|PDM|3260.00|99|0.00|REPAIR OF KNEECAP FRACTURE
20|FH_F131100_0_0|SrvcGrp|108260|2022|PDM|856.00|99|0.00|AETNA FIXATION OF KNEE JOINT
20|FH_F131100_0_0|SrvcGrp|111739|2022|PDM|1500.00|99|0.00|DRAINAGE OF PELVIS LESION
20|FH_F131113_0_0|SrvcGrp|87077|2022|PDM|100.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F131127_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F131127_0_0|CSTM-ALL|CSTM-00|2020|PDM|2065.00|99|0.00|AEG 3 (NO REV)
20|FH_F131127_0_0|CSTM-ALL|CSTM-00|2020|PDM|2543.00|99|0.00|AEG 4 (NO REV)
20|FH_F131127_0_0|SrvcGrp|86460|2022|PDM|3278.00|99|0.00|REVISE BREAST RECONSTRUCTION
20|FH_F131128_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F131128_0_0|CSTM-ALL|CSTM-00|2020|PDM|1477.00|99|0.00|AEG 6 (NO REV)
20|FH_F131128_0_0|CSTM-ALL|CSTM-00|2020|PDM|2387.00|99|0.00|AEG 9 (NO REV)
20|FH_F131128_0_0|CSTM-ALL|CSTM-00|2020|PDM|965.00|99|0.00|AEG 3 (NO REV)
20|FH_F131128_0_0|SrvcGrp|89980|2022|PDM|4774.00|99|0.00|OPEN TREATMENT OF DISTAL
20|FH_F131128_0_0|SrvcGrp|90365|2022|PDM|3278.00|99|0.00|REPAIR METACARPAL FRACTURE
20|FH_F131169_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F131169_0_0|SrvcGrp|108042|2022|PDM|400.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD
20|FH_F131187_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F131187_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F131187_0_0|SrvcGrp|108043|2022|PDM|171.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD
20|FH_F131187_0_0|SrvcGrp|108082|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER
20|FH_F131224_0_0|SrvcGrp|87077|2022|PDM|170.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F131282_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F131282_0_0|CSTM-ALL|CSTM-00|2020|PDM|2600.00|99|0.00|DEVICE INSERTION
20|FH_F131282_0_0|CSTM-ALL|CSTM-00|2020|PDM|3200.00|99|0.00|INSERT ANT SEGMENT DRAIN
20|FH_F131282_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 2 (NO REV)
20|FH_F131282_0_0|SrvcGrp|108434|2022|PDM|2600.00|99|0.00|INSJ AQUEOUS DRAIN DEV 1ST
20|FH_F131282_0_0|SrvcGrp|111373|2022|PDM|465.00|99|0.00|PHENYLEPHRINE KETOROLAC INJECTION
20|FH_F131282_0_0|SrvcGrp|111426|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F131282_0_0|SrvcGrp|77507|2022|PCT|1.00|99|0.00|AETNA CORNEAL TISSUE HANDLING
20|FH_F131282_0_0|SrvcGrp|85566|2022|PDM|817.00|99|0.00|REMOVAL OF EYE LESION
20|FH_F131286_0_0|SrvcGrp|87077|2022|PDM|110.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F131324_0_0|CSTM-ALL|CSTM-00|2020|PDM|925.00|99|0.00|AMBULATORY SURGERY W/O AEG 1 & 2
20|FH_F131327_0_0|CSTM-ALL|CSTM-00|2020|PDM|618.00|99|0.00|AEG 4 (NO REV)
20|FH_F131327_0_0|CSTM-ALL|CSTM-00|2020|PDM|657.00|99|0.00|AEG 1 (NO REV)
20|FH_F131327_0_0|CSTM-ALL|CSTM-00|2020|PDM|814.00|99|0.00|AEG 6 (NO REV)
20|FH_F131331_0_0|SrvcGrp|82222|2022|PDM|55.66|99|0.00|HOSPICE CARE
20|FH_F131371_0_0|CSTM-ALL|CSTM-00|2020|PDM|1397.00|99|0.00|AEG 2 (NO REV)
20|FH_F131371_0_0|CSTM-ALL|CSTM-00|2020|PDM|6598.00|99|0.00|AEG 6 (NO REV)
20|FH_F131371_0_0|CSTM-ALL|CSTM-00|2020|PDM|699.00|99|0.00|AEG 1 (NO REV)
20|FH_F131371_0_0|SrvcGrp|101114|2022|PDM|17000.00|99|0.00|ARTHOPLASTY
20|FH_F131371_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F131371_0_0|SrvcGrp|109723|2022|PDM|15836.00|99|0.00|APPLICATION OF A MULTIPLAN
20|FH_F131371_0_0|SrvcGrp|111809|2022|PDM|7367.00|99|0.00|APPLY BONE FIXATION DEVICE
20|FH_F131371_0_0|SrvcGrp|111810|2022|PDM|17000.00|99|0.00|REVISION OF KNEE JOINT
20|FH_F131371_0_0|SrvcGrp|111811|2022|PDM|5489.00|99|0.00|ADJUST BONE FIXATION DEVICE
20|FH_F131371_0_0|SrvcGrp|84442|2022|PDM|17000.00|99|0.00|REVISION KNEE
20|FH_F131379_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F131379_0_0|SrvcGrp|107749|2022|PDM|161.00|99|0.00|CAPD/CCPD
20|FH_F131379_0_0|SrvcGrp|108153|2022|PCT|0.90|99|0.00|PARSABIV
20|FH_F131412_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F131464_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F131464_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F131494_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F131494_0_0|CSTM-ALL|CSTM-00|2020|PDM|210.00|99|0.00|AEG 1 (NO REV)
20|FH_F131494_0_0|CSTM-ALL|CSTM-00|2020|PDM|420.00|99|0.00|AEG 6 (NO REV)
20|FH_F131494_0_0|CSTM-ALL|CSTM-00|2020|PDM|546.00|99|0.00|AEG 3 W/O HYSTEROSCOPY (NO REV)
20|FH_F131494_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|AEG 10 (NO REV)
20|FH_F131494_0_0|SrvcGrp|101523|2022|PDM|252.00|99|0.00|CERCLAGE OF CERVIX
20|FH_F131494_0_0|SrvcGrp|101820|2022|PDM|578.00|99|0.00|HYSTEROSCOPY RESECT SEPTUM
20|FH_F131494_0_0|SrvcGrp|67994|2022|PDM|299.00|99|0.00|CPT 58120
20|FH_F131498_0_0|SrvcGrp|63297|2022|PDM|100.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F131498_0_0|SrvcGrp|83519|2022|PDM|100.00|99|0.00|HOSPICE CARE (ALL OTHER)
20|FH_F131505_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F131505_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|AEG 5  (NO REV)
20|FH_F131505_0_0|CSTM-ALL|CSTM-00|2020|PDM|420.00|99|0.00|AEG 7 (NO REV)
20|FH_F131505_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|AEG 10 (NO REV)
20|FH_F131505_0_0|SrvcGrp|101527|2022|PDM|481.00|99|0.00|HYSTEROSCOPY LYSIS
20|FH_F131505_0_0|SrvcGrp|101820|2022|PDM|578.00|99|0.00|HYSTEROSCOPY RESECT SEPTUM
20|FH_F131505_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F131505_0_0|SrvcGrp|111848|2022|PDM|484.00|99|0.00|REVISION OF CERVIX
20|FH_F131505_0_0|SrvcGrp|33977|2022|PDM|578.00|99|0.00|CPT 59820
20|FH_F131505_0_0|SrvcGrp|67994|2022|PDM|299.00|99|0.00|CPT 58120
20|FH_F131505_0_0|SrvcGrp|68000|2022|PDM|814.00|99|0.00|CPT 58561
20|FH_F131529_0_0|SrvcGrp|95441|2022|PDM|100.00|99|0.00|HOSPICE OR HOME CARE
20|FH_F131605_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F131608_0_0|SrvcGrp|93098|2022|PDM|34.91|99|0.00|HOSPICE CARE
20|FH_F131608_0_0|SrvcGrp|95221|2022|PDM|149.80|99|0.00|RESPITE CARE (HCFA)
20|FH_F131609_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F131613_0_0|SrvcGrp|16|2022|PDM|1050.00|99|0.00|ACUTE REHABILITATION
20|FH_F131613_0_0|SrvcGrp|30089|2022|PDM|400.00|99|0.00|HEMODIALYSIS SERVICES
20|FH_F131630_0_0|CSTM-ALL|CSTM-00|2020|PDM|1847.00|99|0.00|AEG 4 (NO REV)
20|FH_F131630_0_0|CSTM-ALL|CSTM-00|2020|PDM|2861.00|99|0.00|AEG 8 (NO REV)
20|FH_F131630_0_0|CSTM-ALL|CSTM-00|2020|PDM|884.00|99|0.00|AEG 1 (NO REV)
20|FH_F131630_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F131630_0_0|SrvcGrp|26275|2022|PDM|2861.00|99|0.00|CPT 29826
20|FH_F131630_0_0|SrvcGrp|59840|2022|PDM|1873.00|99|0.00|TYMPANOSTOMY
20|FH_F131965_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F131965_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F131965_0_0|SrvcGrp|83522|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F131965_0_0|SrvcGrp|90707|2022|PDM|100.00|99|0.00|AETNA HOSPICE CARE
20|FH_F131965_0_0|SrvcGrp|97506|2022|PDM|100.00|99|0.00|AETNA HOSPICE ALL OTHER CARE
20|FH_F131974_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F131996_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|AEG 10 (NO REV)
20|FH_F131996_0_0|CSTM-ALL|CSTM-00|2020|PDM|1133.00|99|0.00|AEG 3 (NO REV)
20|FH_F131996_0_0|CSTM-ALL|CSTM-00|2020|PDM|1318.00|99|0.00|AEG 4 (NO REV)
20|FH_F131996_0_0|CSTM-ALL|CSTM-00|2020|PDM|1318.00|99|0.00|AEG 5  (NO REV)
20|FH_F131996_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F132002_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132016_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F132073_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F132073_0_0|SrvcGrp|57965|2022|PDM|131.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F132080_0_0|SrvcGrp|83521|2022|PDM|169.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F132080_0_0|SrvcGrp|93098|2022|PDM|169.00|99|0.00|HOSPICE CARE
20|FH_F132080_0_0|SrvcGrp|94781|2022|PDM|169.00|99|0.00|HOSPICE IN LTCH (HCFA)
20|FH_F132080_0_0|SrvcGrp|97702|2022|PDM|169.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)
20|FH_F132092_0_0|SrvcGrp|83521|2022|PDM|169.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F132092_0_0|SrvcGrp|83522|2022|PDM|169.00|99|0.00|RESPITE CARE
20|FH_F132092_0_0|SrvcGrp|83857|2022|PDM|675.00|99|0.00|IP HOSPICE SVCS
20|FH_F132092_0_0|SrvcGrp|94781|2022|PDM|169.00|99|0.00|HOSPICE IN LTCH (HCFA)
20|FH_F132092_0_0|SrvcGrp|97703|2022|PDM|169.00|99|0.00|HOSPICE IN LTCH (HCFA)
20|FH_F132125_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F132125_0_0|SrvcGrp|472|2022|PDM|1000.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F132130_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132130_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F132130_0_0|CSTM-ALL|CSTM-00|2020|PDM|494.00|99|0.00|AEG 10 (NO REV)
20|FH_F132130_0_0|CSTM-ALL|CSTM-00|2020|PDM|695.00|99|0.00|AEG 5  (NO REV)
20|FH_F132130_0_0|CSTM-ALL|CSTM-00|2020|PDM|805.00|99|0.00|AEG 6 (NO REV)
20|FH_F132130_0_0|CSTM-ALL|CSTM-00|2020|PDM|964.00|99|0.00|AEG 7 (NO REV)
20|FH_F132133_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132133_0_0|CSTM-ALL|CSTM-00|2020|PDM|1516.00|99|0.00|AEG 9 (NO REV)
20|FH_F132133_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F132138_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F132160_0_0|CSTM-ALL|CSTM-00|2020|PDM|1078.00|99|0.00|AEG 2 (NO REV)
20|FH_F132160_0_0|CSTM-ALL|CSTM-00|2020|PDM|1473.00|99|0.00|AEG 10 (NO REV)
20|FH_F132160_0_0|CSTM-ALL|CSTM-00|2020|PDM|2265.00|99|0.00|AEG 8 (NO REV)
20|FH_F132160_0_0|CSTM-ALL|CSTM-00|2020|PDM|2952.00|99|0.00|AEG 9 (NO REV)
20|FH_F132160_0_0|CSTM-ALL|CSTM-00|2020|PDM|781.00|99|0.00|AEG 1 (NO REV)
20|FH_F132160_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F132160_0_0|SrvcGrp|109346|2022|PDM|4590.00|99|0.00|EXCISION OF CHALAZION DIFFERENT LIDS
20|FH_F132160_0_0|SrvcGrp|109759|2022|PDM|5738.00|99|0.00|REMOVAL CORNEAL EPITHELIUM
20|FH_F132160_0_0|SrvcGrp|109760|2022|PDM|6885.00|99|0.00|TRANSLUM DIL EYE CANAL
20|FH_F132160_0_0|SrvcGrp|109762|2022|PDM|4590.00|99|0.00|REMOVE EYELID LESION(S)
20|FH_F132160_0_0|SrvcGrp|109769|2022|PCT|0.00|99|0.00|COVER EYE W/ MEMBRANE SUTURE INCIDENTAL CODES
20|FH_F132160_0_0|SrvcGrp|114442|2022|PDM|12049.00|99|0.00|EXTRACAPSULAR CATARACT REMOVAL, INSERT LENS
20|FH_F132160_0_0|SrvcGrp|42427|2022|PDM|6885.00|99|0.00|OP SURGERY CPT 65420
20|FH_F132160_0_0|SrvcGrp|42429|2022|PDM|1721.00|99|0.00|OP SURGERY CPT 66761
20|FH_F132160_0_0|SrvcGrp|45583|2022|PDM|9754.00|99|0.00|CPT 65730
20|FH_F132160_0_0|SrvcGrp|46886|2022|PDM|4590.00|99|0.00|REMOVAL OF EYELID LESION
20|FH_F132160_0_0|SrvcGrp|46906|2022|PDM|9754.00|99|0.00|CORNEAL TISSUE
20|FH_F132160_0_0|SrvcGrp|84278|2022|PDM|9754.00|99|0.00|CORNEAL TRANSPLANT
20|FH_F132160_0_0|SrvcGrp|84279|2022|PDM|9754.00|99|0.00|CORNEAL TRANSPLANT
20|FH_F132160_0_0|SrvcGrp|95107|2022|PDM|5738.00|99|0.00|INTRAOCULAR LENS PROSTHESIS
20|FH_F132190_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F132190_0_0|CSTM-ALL|CSTM-00|2020|PDM|1296.00|99|0.00|AEG 7 (NO REV)
20|FH_F132190_0_0|CSTM-ALL|CSTM-00|2020|PDM|690.00|99|0.00|AEG 2 (NO REV)
20|FH_F132190_0_0|CSTM-ALL|CSTM-00|2020|PDM|933.00|99|0.00|AEG 5  (NO REV)
20|FH_F132190_0_0|SrvcGrp|101839|2022|PDM|2500.00|99|0.00|KNEE ARTHROSCOPY
20|FH_F132190_0_0|SrvcGrp|107495|2022|PDM|1600.00|99|0.00|AETNA - ARTHROSCOPY OF JOINT
20|FH_F132190_0_0|SrvcGrp|16669|2022|PDM|2500.00|99|0.00|ACROMINOPLASTY OF SHOULDER
20|FH_F132190_0_0|SrvcGrp|16694|2022|PDM|2500.00|99|0.00|KNEE SCOPE, CHONDROPLASTY
20|FH_F132190_0_0|SrvcGrp|85198|2022|PDM|3000.00|99|0.00|AETNA KNEE ARTHROSCOPY
20|FH_F132190_0_0|SrvcGrp|96999|2022|PDM|2500.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F132190_0_0|SrvcGrp|99073|2022|PDM|1.25|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F132193_0_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|AEG 3 (NO REV)
20|FH_F132193_0_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|AEG 7 (NO REV)
20|FH_F132193_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F132212_0_0|SrvcGrp|60856|2022|PDM|90.00|99|0.00|HOSPICE SERVICE - ROUTINE HOME CARE
20|FH_F132212_0_0|SrvcGrp|63297|2022|PDM|90.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F132212_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F132212_0_0|SrvcGrp|94780|2022|PDM|90.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)
20|FH_F132212_0_0|SrvcGrp|95661|2022|PDM|100.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F132235_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F132235_0_0|SrvcGrp|93098|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F132275_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132275_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F132275_0_0|SrvcGrp|87077|2022|PDM|158.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F132328_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F132328_0_0|CSTM-ALL|CSTM-00|2020|PDM|1701.00|99|0.00|AEG 4 (NO REV)
20|FH_F132328_0_0|CSTM-ALL|CSTM-00|2020|PDM|1754.00|99|0.00|AEG 10 (NO REV)
20|FH_F132328_0_0|CSTM-ALL|CSTM-00|2020|PDM|3525.00|99|0.00|AEG 9 (NO REV)
20|FH_F132328_0_0|SrvcGrp|103543|2022|PDM|1425.00|99|0.00|REMOVE SPINAL CANAL CATHE
20|FH_F132328_0_0|SrvcGrp|103643|2022|PDM|12849.00|99|0.00|AETNA FEM/POPL REVASE W/ STENT
20|FH_F132328_0_0|SrvcGrp|103644|2022|PDM|10592.00|99|0.00|AETNA TIB/ PER REVASE W/ ATHER
20|FH_F132328_0_0|SrvcGrp|103645|2022|PDM|10592.00|99|0.00|AETNA TIB/ PER REVASE W/ STENT
20|FH_F132328_0_0|SrvcGrp|104002|2022|PDM|2383.00|99|0.00|ELBOW ARTHROSCOPY
20|FH_F132328_0_0|SrvcGrp|107544|2022|PDM|9270.00|99|0.00|ILIAC REVASC W/ STENT
20|FH_F132328_0_0|SrvcGrp|107778|2022|PDM|2143.00|99|0.00|ARTHROSCOPIC FRACTURE TX
20|FH_F132328_0_0|SrvcGrp|109960|2022|PDM|2851.00|99|0.00|IMPLNT SPINAL CANAL CATHETER
20|FH_F132328_0_0|SrvcGrp|109974|2022|PDM|2383.00|99|0.00|ELBOW ARTHROSCOPY / SURGERY
20|FH_F132328_0_0|SrvcGrp|111956|2022|PDM|2425.00|99|0.00|MALE GENITAL PROCEDURES
20|FH_F132328_0_0|SrvcGrp|111958|2022|PDM|1821.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F132328_0_0|SrvcGrp|11673|2022|PDM|3715.00|99|0.00|CPT 29888
20|FH_F132328_0_0|SrvcGrp|26274|2022|PDM|2195.00|99|0.00|CPT 29877
20|FH_F132328_0_0|SrvcGrp|26276|2022|PDM|1800.00|99|0.00|CPT 29819
20|FH_F132328_0_0|SrvcGrp|26277|2022|PDM|2049.00|99|0.00|CPT 29874
20|FH_F132328_0_0|SrvcGrp|34606|2022|PDM|2241.00|99|0.00|CPT 29827
20|FH_F132328_0_0|SrvcGrp|35668|2022|PDM|2205.00|99|0.00|CPT 29824
20|FH_F132328_0_0|SrvcGrp|44064|2022|PDM|2425.00|99|0.00|CPT 52351
20|FH_F132328_0_0|SrvcGrp|54943|2022|PDM|2913.00|99|0.00|REPAIR OF SLAP LESION
20|FH_F132328_0_0|SrvcGrp|58636|2022|PDM|5234.00|99|0.00|CPT 62362
20|FH_F132328_0_0|SrvcGrp|59840|2022|PDM|1717.00|99|0.00|TYMPANOSTOMY
20|FH_F132328_0_0|SrvcGrp|65403|2022|PDM|3612.00|99|0.00|CPT 42830
20|FH_F132328_0_0|SrvcGrp|66307|2022|PDM|1259.00|99|0.00|CPT 53020
20|FH_F132328_0_0|SrvcGrp|67065|2022|PDM|10404.00|99|0.00|CERVICAL SURGERY
20|FH_F132328_0_0|SrvcGrp|67069|2022|PDM|14566.00|99|0.00|CPT 22634
20|FH_F132328_0_0|SrvcGrp|79593|2022|PDM|1500.00|99|0.00|CPT 45378
20|FH_F132328_0_0|SrvcGrp|82110|2022|PDM|2049.00|99|0.00|KNEE ARTHROSCOPY DIAGNOSTIC
20|FH_F132328_0_0|SrvcGrp|83642|2022|PDM|2049.00|99|0.00|CPT 29883
20|FH_F132328_0_0|SrvcGrp|83646|2022|PDM|5264.00|99|0.00|CPT 31276
20|FH_F132328_0_0|SrvcGrp|86233|2022|PDM|2066.00|99|0.00|AETNA RECONSTRUCT ANKLE JOINT
20|FH_F132328_0_0|SrvcGrp|87677|2022|PDM|2049.00|99|0.00|CERVICAL OR THORACIC SURGERY
20|FH_F132328_0_0|SrvcGrp|88158|2022|PDM|6097.00|99|0.00|NECK SPINE DISK SURGERY
20|FH_F132328_0_0|SrvcGrp|88160|2022|PDM|6097.00|99|0.00|LAMINECTOMY W/FACETECTOMY
20|FH_F132328_0_0|SrvcGrp|88161|2022|PDM|6097.00|99|0.00|LAMINECTOMY W/FACE-THORACIC
20|FH_F132328_0_0|SrvcGrp|88492|2022|PDM|5202.00|99|0.00|AETNA SPINAL BONE AUTOGRAFT
20|FH_F132328_0_0|SrvcGrp|88597|2022|PDM|2049.00|99|0.00|INTERNAL FIX FOR FRACT/INSTA
20|FH_F132328_0_0|SrvcGrp|88599|2022|PDM|4734.00|99|0.00|ENDOSCOPY MAXILLARY SINUS
20|FH_F132328_0_0|SrvcGrp|89404|2022|PDM|13213.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F132328_0_0|SrvcGrp|90798|2022|PDM|3974.00|99|0.00|IMPLANT SPINE INFUSION PUMP19
20|FH_F132328_0_0|SrvcGrp|93057|2022|PDM|5202.00|99|0.00|SPINAL BONE AUTOGRAFT
20|FH_F132328_0_0|SrvcGrp|93059|2022|PDM|5202.00|99|0.00|SPINAL BONE AUTOGRAFT
20|FH_F132328_0_0|SrvcGrp|98268|2022|PDM|2143.00|99|0.00|HIP ARTHROSCOPY DX
20|FH_F132328_0_0|SrvcGrp|98404|2022|PDM|2143.00|99|0.00|ARTHROSCOPIC FRACTURE TX
20|FH_F132372_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132374_0_0|CSTM-ALL|CSTM-00|2020|PDM|1247.13|99|0.00|AEG 3 (NO REV)
20|FH_F132374_0_0|CSTM-ALL|CSTM-00|2020|PDM|3273.44|99|0.00|AEG 9 (NO REV)
20|FH_F132374_0_0|CSTM-ALL|CSTM-00|2020|PDM|813.25|99|0.00|AEG 1 (NO REV)
20|FH_F132374_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F132374_0_0|SrvcGrp|79561|2022|PDM|2431.80|99|0.00|AETNA CARDIAC CATH
20|FH_F132439_0_0|SrvcGrp|92502|2022|PDM|693.10|99|0.00|HOSPICE GENERAL IP CARE
20|FH_F132487_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F132487_0_0|SrvcGrp|82222|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F132501_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F132512_0_0|SrvcGrp|73842|2022|PDM|408.00|99|0.00|AETNA INTENSIVE OUTPATIENT
20|FH_F132512_0_0|SrvcGrp|86722|2022|PDM|408.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)
20|FH_F132512_0_0|SrvcGrp|86723|2022|PDM|714.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)
20|FH_F132544_0_0|CSTM-ALL|CSTM-00|2020|PDM|2407.00|99|0.00|AEG 10 (NO REV)
20|FH_F132544_0_0|CSTM-ALL|CSTM-00|2020|PDM|2407.00|99|0.00|AEG 4 (NO REV)
20|FH_F132544_0_0|CSTM-ALL|CSTM-00|2020|PDM|3630.00|99|0.00|AEG 8 (NO REV)
20|FH_F132544_0_0|SrvcGrp|106557|2022|PDM|8007.00|99|0.00|REVISE KNEE 2
20|FH_F132544_0_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F132544_0_0|SrvcGrp|19920|2022|PDM|3454.00|99|0.00|ARTHROSCOPY OF SHOULDER
20|FH_F132544_0_0|SrvcGrp|19922|2022|PDM|4186.00|99|0.00|ARTHROSCOPY OF SHOULDER
20|FH_F132544_0_0|SrvcGrp|19991|2022|PDM|7850.00|99|0.00|NERVOUS SYSTEM SERVICES
20|FH_F132544_0_0|SrvcGrp|40003|2022|PDM|7850.00|99|0.00|TOTAL KNEE
20|FH_F132544_0_0|SrvcGrp|44461|2022|PDM|7850.00|99|0.00|INSERTION / REPLACEMENT OF SPINAL NEUROSTIMULATOR GENERATOR
20|FH_F132544_0_0|SrvcGrp|96354|2022|PDM|8007.00|99|0.00|REMOVAL OF ANKLE JOINT
20|FH_F132544_0_0|SrvcGrp|96899|2022|PDM|7850.00|99|0.00|LUMBAR ARTIF DISCECTOMY
20|FH_F132544_0_0|SrvcGrp|96919|2022|PDM|4186.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F132544_0_0|SrvcGrp|96939|2022|PDM|4270.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F132544_0_0|SrvcGrp|96979|2022|PDM|3454.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F132544_0_0|SrvcGrp|97139|2022|PDM|8007.00|99|0.00|LAMINECTOMY W/FACETECTOMY
20|FH_F132544_0_0|SrvcGrp|97239|2022|PDM|7850.00|99|0.00|DISKECTOMY CERVICAL SINGLE
20|FH_F132544_0_0|SrvcGrp|97299|2022|PDM|7850.00|99|0.00|REMOVE SPINE ELTRD PLATE
20|FH_F132545_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|EMERGENCY ROOM
20|FH_F132545_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F132559_0_0|CSTM-ALL|CSTM-00|2020|PDM|927.00|99|0.00|AEG 2 (NO REV)
20|FH_F132559_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F132559_0_0|SrvcGrp|105233|2022|PDM|3100.00|99|0.00|REMOVAL OF THYROID
20|FH_F132559_0_0|SrvcGrp|27344|2022|PDM|1635.00|99|0.00|OP SURGERY (CPT 42821)
20|FH_F132559_0_0|SrvcGrp|59840|2022|PDM|1635.00|99|0.00|TYMPANOSTOMY
20|FH_F132559_0_0|SrvcGrp|65403|2022|PDM|1635.00|99|0.00|CPT 42830
20|FH_F132585_0_0|SrvcGrp|112034|2022|PCT|0.65|99|0.00|IMPLANTS/PROSTHETIC
20|FH_F132595_0_0|SrvcGrp|23477|2022|PDM|5871.00|99|0.00|MSDRG 286-287 ONLY CARDIAC CATH
20|FH_F132595_0_0|SrvcGrp|3078|2022|PCT|0.57|99|0.00|DRUGS
20|FH_F132599_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F132599_0_0|SrvcGrp|82981|2022|PDM|115.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F132606_0_0|SrvcGrp|11673|2022|PDM|2500.00|99|0.00|CPT 29888
20|FH_F132606_0_0|SrvcGrp|35668|2022|PDM|1305.00|99|0.00|CPT 29824
20|FH_F132606_0_0|SrvcGrp|35672|2022|PDM|1873.00|99|0.00|CPT 23412
20|FH_F132606_0_0|SrvcGrp|41334|2022|PDM|3537.36|99|0.00|TOTAL KNEE
20|FH_F132606_0_0|SrvcGrp|77021|2022|PDM|3075.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY
20|FH_F132609_0_0|CSTM-ALL|CSTM-00|2020|PDM|1952.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132609_0_0|SrvcGrp|107733|2022|PDM|5274.00|99|0.00|CESAREAN SECTION
20|FH_F132609_0_0|SrvcGrp|51672|2022|PDM|3989.00|99|0.00|MS DRG 286-287 ONLY
20|FH_F132609_0_0|SrvcGrp|701|2022|PDM|2872.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F132611_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.53|99|0.00|OP SVCS
20|FH_F132611_0_0|SrvcGrp|112034|2022|PCT|0.60|99|0.00|IMPLANTS/PROSTHETIC
20|FH_F132612_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.69|99|0.00|OP SVCS
20|FH_F132612_0_0|SrvcGrp|12280|2022|PCT|0.67|99|0.00|IMPLANTS
20|FH_F132612_0_0|SrvcGrp|705|2022|PCT|0.67|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F132627_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F132627_0_0|SrvcGrp|10577|2022|PDM|7.14|99|0.00|HOME ADMINISTRATION DRUG THERAPY
20|FH_F132627_0_0|SrvcGrp|111526|2022|PDM|291.00|99|0.00|HOME INFUSION THERAPY (HCFA)
20|FH_F132627_0_0|SrvcGrp|112083|2022|PDM|1031.00|99|0.00|HOSPICE GENERAL OP CARE
20|FH_F132627_0_0|SrvcGrp|13929|2022|PDM|43.86|99|0.00|GROWTH HORMONE
20|FH_F132627_0_0|SrvcGrp|14944|2022|PDM|18.36|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN
20|FH_F132627_0_0|SrvcGrp|16559|2022|PDM|16.32|99|0.00|HOME INFUSION THERAPY
20|FH_F132627_0_0|SrvcGrp|17007|2022|PDM|80.58|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 6HRS
20|FH_F132627_0_0|SrvcGrp|17008|2022|PDM|80.58|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 4HRS
20|FH_F132627_0_0|SrvcGrp|17014|2022|PDM|80.58|99|0.00|HOME INFUSION THERAPY
20|FH_F132627_0_0|SrvcGrp|17015|2022|PDM|43.86|99|0.00|HOME INFUSION THERAPY
20|FH_F132627_0_0|SrvcGrp|17016|2022|PDM|80.58|99|0.00|HOME INFUSION THERAPY
20|FH_F132627_0_0|SrvcGrp|22591|2022|PDM|69.36|99|0.00|IMPLANTED PUMP
20|FH_F132627_0_0|SrvcGrp|22593|2022|PDM|18.36|99|0.00|ANIT-HEMOPHILIC FACTORS
20|FH_F132627_0_0|SrvcGrp|24745|2022|PDM|69.36|99|0.00|HOME INFUSION THERAPY, PAIN MGMT
20|FH_F132627_0_0|SrvcGrp|29076|2022|PDM|80.58|99|0.00|TOCOLYTIC INFUSION THERAPY
20|FH_F132627_0_0|SrvcGrp|31973|2022|PDM|43.86|99|0.00|HOME THERAPY
20|FH_F132627_0_0|SrvcGrp|44424|2022|PDM|144.00|99|0.00|MEDICAL SOCIAL WORKER (VISIT LVL)
20|FH_F132627_0_0|SrvcGrp|44427|2022|PDM|144.00|99|0.00|PHYSICAL THERAPY SVCS (VISIT LVL)
20|FH_F132627_0_0|SrvcGrp|44430|2022|PDM|144.00|99|0.00|SPEECH THERAPY SVCS (VISIT LVL)
20|FH_F132627_0_0|SrvcGrp|47183|2022|PDM|133.00|99|0.00|HOME INFUSION NURSING SVCS
20|FH_F132627_0_0|SrvcGrp|53502|2022|PDM|144.00|99|0.00|DIETICIAN
20|FH_F132627_0_0|SrvcGrp|78534|2022|PDM|0.35|99|0.00|AETNA MED RECORD
20|FH_F132627_0_0|SrvcGrp|88620|2022|PDM|133.00|99|0.00|SKILLED NURSING RN
20|FH_F132627_0_0|SrvcGrp|88621|2022|PDM|80.58|99|0.00|SKILLED NURSING LPN
20|FH_F132672_0_0|CSTM-ALL|CSTM-00|2020|PDM|825.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F132693_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132693_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|AEG 3 (NO REV)
20|FH_F132693_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|AEG 6 (NO REV)
20|FH_F132693_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|AEG 7 (NO REV)
20|FH_F132693_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F132694_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.49|99|0.00|OP SVCS
20|FH_F132711_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F132711_0_0|SrvcGrp|73485|2022|PDM|970.00|99|0.00|AETNA REHAB
20|FH_F132720_0_0|SrvcGrp|3078|2022|PCT|0.65|99|0.00|DRUGS
20|FH_F132720_0_0|SrvcGrp|47427|2022|PCT|0.65|99|0.00|IMPLANTS
20|FH_F132720_0_0|SrvcGrp|58|2022|PDM|9667.00|99|0.00|IP LITHOTRIPSY SVCS
20|FH_F132721_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.63|99|0.00|OP SVCS
20|FH_F132721_0_0|SrvcGrp|107733|2022|PDM|6266.00|99|0.00|CESAREAN SECTION
20|FH_F132721_0_0|SrvcGrp|112077|2022|PDM|48747.00|99|0.00|CV SURGERY
20|FH_F132721_0_0|SrvcGrp|33793|2022|PDM|13426.00|99|0.00|MSDRG 246-251 ONLY ANGIOPLASTY
20|FH_F132721_0_0|SrvcGrp|40820|2022|PDM|3088.00|99|0.00|ICU/CCU
20|FH_F132721_0_0|SrvcGrp|47427|2022|PCT|0.65|99|0.00|IMPLANTS
20|FH_F132721_0_0|SrvcGrp|58|2022|PDM|9668.00|99|0.00|IP LITHOTRIPSY SVCS
20|FH_F132728_0_0|SrvcGrp|3409|2022|PDM|600.00|99|0.00|NEWBORN NURSERY
20|FH_F132728_0_0|SrvcGrp|360|2022|PDM|2059.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F132728_0_0|SrvcGrp|58|2022|PDM|9668.00|99|0.00|IP LITHOTRIPSY SVCS
20|FH_F132728_0_0|SrvcGrp|941|2022|PDM|4141.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F132729_0_0|CSTM-ALL|CSTM-00|2020|PDM|2059.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132729_0_0|SrvcGrp|3078|2022|PCT|0.65|99|0.00|DRUGS
20|FH_F132729_0_0|SrvcGrp|33793|2022|PDM|13426.00|99|0.00|MSDRG 246-251 ONLY ANGIOPLASTY
20|FH_F132729_0_0|SrvcGrp|51672|2022|PDM|7161.00|99|0.00|MS DRG 286-287 ONLY
20|FH_F132732_0_0|SrvcGrp|107734|2022|PDM|3859.00|99|0.00|VAGINAL DELIVERY
20|FH_F132732_0_0|SrvcGrp|51672|2022|PDM|4229.00|99|0.00|MS DRG 286-287 ONLY
20|FH_F132733_0_0|SrvcGrp|107734|2022|PDM|4593.00|99|0.00|VAGINAL DELIVERY
20|FH_F132733_0_0|SrvcGrp|3078|2022|PCT|0.96|99|0.00|DRUGS
20|FH_F132733_0_0|SrvcGrp|361|2022|PDM|3147.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F132736_0_0|SrvcGrp|360|2022|PDM|2059.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F132736_0_0|SrvcGrp|40820|2022|PDM|3088.00|99|0.00|ICU/CCU
20|FH_F132736_0_0|SrvcGrp|51672|2022|PDM|7161.00|99|0.00|MS DRG 286-287 ONLY
20|FH_F132736_0_0|SrvcGrp|58|2022|PDM|9668.00|99|0.00|IP LITHOTRIPSY SVCS
20|FH_F132737_0_0|SrvcGrp|112077|2022|PDM|46309.00|99|0.00|CV SURGERY
20|FH_F132737_0_0|SrvcGrp|16|2022|PDM|1532.00|99|0.00|ACUTE REHABILITATION
20|FH_F132737_0_0|SrvcGrp|33793|2022|PDM|12757.00|99|0.00|MSDRG 246-251 ONLY ANGIOPLASTY
20|FH_F132737_0_0|SrvcGrp|3409|2022|PDM|570.00|99|0.00|NEWBORN NURSERY
20|FH_F132737_0_0|SrvcGrp|58|2022|PDM|9184.00|99|0.00|IP LITHOTRIPSY SVCS
20|FH_F132738_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F132738_0_0|CSTM-ALL|CSTM-00|2020|PDM|904.00|99|0.00|ACUTE PSYCH
20|FH_F132768_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F132768_0_0|SrvcGrp|22529|2022|PDM|550.00|99|0.00|DAY HOSPITAL HALF DAY
20|FH_F132772_0_0|SrvcGrp|112096|2022|PDM|284.00|99|0.00|DIALYSIS
20|FH_F132779_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F132779_0_0|SrvcGrp|29755|2022|PDM|39419.00|99|0.00|MS DRG 245 ONLY
20|FH_F132779_0_0|SrvcGrp|32539|2022|PDM|42703.00|99|0.00|MS DRG 222-227 ONLY
20|FH_F132779_0_0|SrvcGrp|360|2022|PDM|2492.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F132779_0_0|SrvcGrp|361|2022|PDM|2758.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F132779_0_0|SrvcGrp|87307|2022|PDM|32847.00|99|0.00|MSDRG 270 ONLY
20|FH_F132779_0_0|SrvcGrp|87311|2022|PDM|19709.00|99|0.00|MSDRG 274 ONLY
20|FH_F132779_0_0|SrvcGrp|97|2022|PDM|8707.00|99|0.00|C-SECTION
20|FH_F132779_0_0|SrvcGrp|99068|2022|PDM|39419.00|99|0.00|MS DRG 228-229 ONLY OTHER CARDIOTHORACIC PROC
20|FH_F132827_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F132827_0_0|SrvcGrp|92501|2022|PDM|450.00|99|0.00|HOSPICE IP RESPITE CARE
20|FH_F132849_0_0|SrvcGrp|112131|2022|PDM|957.00|99|0.00|CAT SCAN
20|FH_F132849_0_0|SrvcGrp|177|2022|PDM|1556.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F132849_0_0|SrvcGrp|24537|2022|PDM|558.00|99|0.00|DIALYSIS
20|FH_F132849_0_0|SrvcGrp|33793|2022|PDM|10843.00|99|0.00|MSDRG 246-251 ONLY ANGIOPLASTY
20|FH_F132849_0_0|SrvcGrp|35950|2022|PDM|1515.00|99|0.00|CD DETOX
20|FH_F132849_0_0|SrvcGrp|360|2022|PDM|1435.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F132849_0_0|SrvcGrp|72|2022|PDM|398.00|99|0.00|NEWBORN NURSERY
20|FH_F132860_0_0|SrvcGrp|112077|2022|PDM|44791.00|99|0.00|CV SURGERY
20|FH_F132860_0_0|SrvcGrp|112275|2022|PDM|1268.00|99|0.00|MRI
20|FH_F132860_0_0|SrvcGrp|361|2022|PDM|1605.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F132860_0_0|SrvcGrp|38|2022|PDM|3127.00|99|0.00|NORMAL DELIVERY
20|FH_F132860_0_0|SrvcGrp|97|2022|PDM|5238.00|99|0.00|C-SECTION
20|FH_F132878_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132886_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F132886_0_0|SrvcGrp|106291|2022|PDM|359.00|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT LEVEL 1 (HCFA)
20|FH_F132886_0_0|SrvcGrp|106314|2022|PDM|412.00|99|0.00|ADVANCED LIFE SUPPORT LEVEL 2 (ALS2) (HCFA)
20|FH_F132886_0_0|SrvcGrp|107353|2022|PDM|439.00|99|0.00|AMB SRVC NEONAT TRNSPRT BS RATE EMERG 1 WAY (HCFA)
20|FH_F132887_0_0|CSTM-ALL|CSTM-00|2020|PCT|64.00|99|0.00|OP SVCS
20|FH_F132915_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F132915_0_0|CSTM-ALL|CSTM-00|2020|PDM|1339.00|99|0.00|AEG 9 (NO REV)
20|FH_F132915_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 10 (NO REV)
20|FH_F132915_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|AEG 4 (NO REV)
20|FH_F132915_0_0|CSTM-ALL|CSTM-00|2020|PDM|973.00|99|0.00|AEG 8 (NO REV)
20|FH_F132915_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F132915_0_0|SrvcGrp|111966|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F132988_0_0|CSTM-ALL|CSTM-00|2020|PDM|1952.00|99|0.00|AEG 3 (NO REV)
20|FH_F132988_0_0|CSTM-ALL|CSTM-00|2020|PDM|2750.00|99|0.00|AEG 6 (NO REV)
20|FH_F132988_0_0|CSTM-ALL|CSTM-00|2020|PDM|2750.00|99|0.00|AEG 9 (NO REV)
20|FH_F132988_0_0|CSTM-ALL|CSTM-00|2020|PDM|771.00|99|0.00|AEG 10 (NO REV)
20|FH_F132988_0_0|SrvcGrp|100000|2022|PDM|19032.77|99|0.00|RECONSTRUCT WRIST DIST ULNA
20|FH_F132988_0_0|SrvcGrp|100006|2022|PDM|8647.09|99|0.00|RECONSTRUCT ELBOW MED LIGMNT
20|FH_F132988_0_0|SrvcGrp|100009|2022|PDM|4493.01|99|0.00|REPAIR/GRAFT WRIST BONE
20|FH_F132988_0_0|SrvcGrp|100040|2022|PDM|8647.09|99|0.00|REPAIR HUMERUS FRACTURE
20|FH_F132988_0_0|SrvcGrp|100042|2022|PDM|11223.07|99|0.00|REPAIR HUMERUS FRACTURE II
20|FH_F132988_0_0|SrvcGrp|100043|2022|PDM|12171.25|99|0.00|FUSION OF FOOT BONES
20|FH_F132988_0_0|SrvcGrp|100059|2022|PDM|5817.50|99|0.00|REPAIR ULNA FRACTURE
20|FH_F132988_0_0|SrvcGrp|100068|2022|PDM|4493.01|99|0.00|REPAIR DEGENERATED KNEECAP
20|FH_F132988_0_0|SrvcGrp|100079|2022|PDM|4493.01|99|0.00|RECONSTRUCT ULNA/RADIOLULNAR
20|FH_F132988_0_0|SrvcGrp|103570|2022|PDM|6530.93|99|0.00|ARTHROSCOPIC FRACTURE
20|FH_F132988_0_0|SrvcGrp|104112|2022|PDM|5945.23|99|0.00|REPAIR OF ANKLE FRACTURE
20|FH_F132988_0_0|SrvcGrp|104387|2022|PDM|4493.01|99|0.00|REMOVAL OF BONE FOR GRAFT
20|FH_F132988_0_0|SrvcGrp|107095|2022|PDM|1766.05|99|0.00|COMPLEX  WOUND DRAINAGE
20|FH_F132988_0_0|SrvcGrp|107839|2022|PDM|2057.62|99|0.00|INCISE FLEXOR CARPI RADIALIS
20|FH_F132988_0_0|SrvcGrp|108351|2022|PDM|13432.78|99|0.00|REPAIR RADIUS FRACTURE
20|FH_F132988_0_0|SrvcGrp|109789|2022|PDM|12268.93|99|0.00|REPAIR OF FOOT BONES
20|FH_F132988_0_0|SrvcGrp|110679|2022|PDM|12488.67|99|0.00|REPAIR HUMERUS FRACTURE
20|FH_F132988_0_0|SrvcGrp|112140|2022|PDM|4493.01|99|0.00|REMOVE/GRAFT BONE LESION
20|FH_F132988_0_0|SrvcGrp|112141|2022|PDM|4493.01|99|0.00|HAND TENDON RECONSTRUCTION
20|FH_F132988_0_0|SrvcGrp|112142|2022|PDM|4493.01|99|0.00|REPAIR NON-UNION HAND
20|FH_F132988_0_0|SrvcGrp|112151|2022|PDM|3144.78|99|0.00|REPAIR ARM/LEG NERVE
20|FH_F132988_0_0|SrvcGrp|112152|2022|PDM|3144.78|99|0.00|NERVE PEDICLE TRANSFER
20|FH_F132988_0_0|SrvcGrp|112153|2022|PDM|2057.62|99|0.00|REPAIR FOREARM TENDON/MUSCLE
20|FH_F132988_0_0|SrvcGrp|112155|2022|PDM|2057.62|99|0.00|PIN HAND DISLOCATION
20|FH_F132988_0_0|SrvcGrp|112157|2022|PDM|2057.62|99|0.00|REPAIR FINGER DISLOCATION
20|FH_F132988_0_0|SrvcGrp|112168|2022|PDM|4493.01|99|0.00|REMOVE WRIST JOINT IMPLANT
20|FH_F132988_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F132988_0_0|SrvcGrp|11669|2022|PDM|4493.01|99|0.00|OP SURG
20|FH_F132988_0_0|SrvcGrp|33980|2022|PDM|4493.01|99|0.00|CPT 28298
20|FH_F132988_0_0|SrvcGrp|72120|2022|PDM|4493.01|99|0.00|TENOTOMY
20|FH_F132988_0_0|SrvcGrp|72121|2022|PDM|4493.01|99|0.00|ARTHOSCOPY
20|FH_F132988_0_0|SrvcGrp|75002|2022|PDM|6358.80|99|0.00|ARTHOSCOPY
20|FH_F132988_0_0|SrvcGrp|77021|2022|PDM|4493.01|99|0.00|LAMINOTOMY/HEMILAMINECTOMY
20|FH_F132988_0_0|SrvcGrp|83643|2022|PDM|4493.01|99|0.00|CPT 29885
20|FH_F132988_0_0|SrvcGrp|85778|2022|PDM|5841.62|99|0.00|REPAIR OF ANKLE FRACTURE
20|FH_F132988_0_0|SrvcGrp|87679|2022|PDM|1279.81|99|0.00|LUMBAR OR SACRAL SURGERY
20|FH_F132988_0_0|SrvcGrp|88163|2022|PDM|8647.09|99|0.00|LUMBAR SPINE FUSION
20|FH_F132988_0_0|SrvcGrp|90063|2022|PDM|4493.01|99|0.00|REPAIR BICEPS TENDON RUPTURE
20|FH_F132988_0_0|SrvcGrp|90361|2022|PDM|6242.51|99|0.00|REPAIR FRACTURE RADIUS/ULNA
20|FH_F132988_0_0|SrvcGrp|90417|2022|PDM|4493.01|99|0.00|TREATMENT OF JOINT
20|FH_F132988_0_0|SrvcGrp|90421|2022|PDM|5994.26|99|0.00|REPAIR OF ANKLE FRACTURE
20|FH_F132988_0_0|SrvcGrp|90423|2022|PDM|11924.64|99|0.00|FUSION GRAFT OF WRIST JOINT
20|FH_F132988_0_0|SrvcGrp|93807|2022|PDM|7118.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY
20|FH_F132988_0_0|SrvcGrp|94904|2022|PDM|4493.01|99|0.00|REPAIR/REVISE WRIST JOINT
20|FH_F132988_0_0|SrvcGrp|98007|2022|PDM|2057.62|99|0.00|FINGER/THUMB AMPUTATION
20|FH_F132988_0_0|SrvcGrp|99171|2022|PDM|5849.23|99|0.00|CPT 28485
20|FH_F133002_0_0|SrvcGrp|72998|2022|PDM|816.10|99|0.00|AEG 5
20|FH_F133002_0_0|SrvcGrp|73004|2022|PDM|1238.00|99|0.00|AEG 8
20|FH_F133002_0_0|SrvcGrp|84278|2022|PDM|1716.00|99|0.00|CORNEAL TRANSPLANT
20|FH_F133011_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F133011_0_0|CSTM-ALL|CSTM-00|2020|PDM|2028.00|99|0.00|AEG 8 (NO REV)
20|FH_F133011_0_0|CSTM-ALL|CSTM-00|2020|PDM|759.00|99|0.00|AEG 3 (NO REV)
20|FH_F133011_0_0|CSTM-ALL|CSTM-00|2020|PDM|759.00|99|0.00|AEG 9 (NO REV)
20|FH_F133025_0_0|CSTM-ALL|CSTM-00|2020|PDM|1257.00|99|0.00|AEG 8 (NO REV)
20|FH_F133025_0_0|CSTM-ALL|CSTM-00|2020|PDM|1731.00|99|0.00|AEG 9 (NO REV)
20|FH_F133025_0_0|CSTM-ALL|CSTM-00|2020|PDM|926.00|99|0.00|AEG 5  (NO REV)
20|FH_F133025_0_0|SrvcGrp|13187|2022|PCT|0.00|99|0.00|INTRAOCULAR LENSES
20|FH_F133100_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F133100_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|AEG 8 (NO REV)
20|FH_F133100_0_0|CSTM-ALL|CSTM-00|2020|PDM|725.00|99|0.00|AEG 3 (NO REV)
20|FH_F133100_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|AEG 4 (NO REV)
20|FH_F133132_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F133140_0_0|CSTM-ALL|CSTM-00|2020|PDM|380.00|99|0.00|AEG 2 (NO REV)
20|FH_F133140_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 9 (NO REV)
20|FH_F133140_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F133155_0_0|SrvcGrp|63297|2022|PDM|100.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F133155_0_0|SrvcGrp|83522|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F133175_0_0|SrvcGrp|46482|2022|PDM|175.00|99|0.00|S9083 PER VISIT
20|FH_F133178_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|AEG 1 (NO REV)
20|FH_F133178_0_0|SrvcGrp|103837|2022|PDM|833.00|99|0.00|AETNA DESTRUCTION PENIS LESION
20|FH_F133178_0_0|SrvcGrp|67994|2022|PDM|1255.00|99|0.00|CPT 58120
20|FH_F133178_0_0|SrvcGrp|89869|2022|PDM|1255.00|99|0.00|SPONTANEOUS ABORTION
20|FH_F133207_0_0|CSTM-ALL|CSTM-00|2020|PDM|2072.00|99|0.00|AEG 3 (NO REV)
20|FH_F133207_0_0|CSTM-ALL|CSTM-00|2020|PDM|2072.00|99|0.00|AEG 6 (NO REV)
20|FH_F133207_0_0|CSTM-ALL|CSTM-00|2020|PDM|868.00|99|0.00|AEG 1 (NO REV)
20|FH_F133207_0_0|SrvcGrp|100045|2022|PDM|3136.00|99|0.00|REVISION OF FOOT TENDON
20|FH_F133207_0_0|SrvcGrp|104108|2022|PDM|3192.00|99|0.00|EXCISION OF BREAST LESION ID
20|FH_F133207_0_0|SrvcGrp|106266|2022|PDM|5293.00|99|0.00|NSL/SINS NDSC TOT W/ SPHENDT
20|FH_F133207_0_0|SrvcGrp|106267|2022|PDM|5293.00|99|0.00|NSL/SINS NDSC SPHN TISS RMVL
20|FH_F133207_0_0|SrvcGrp|112221|2022|PDM|4774.00|99|0.00|INCISION OF METATARSAL
20|FH_F133207_0_0|SrvcGrp|112222|2022|PDM|6496.00|99|0.00|SPINAL SURGERY
20|FH_F133207_0_0|SrvcGrp|14614|2022|PDM|3809.00|99|0.00|LITHOTRIPSY
20|FH_F133207_0_0|SrvcGrp|35668|2022|PDM|3527.00|99|0.00|CPT 29824
20|FH_F133207_0_0|SrvcGrp|36864|2022|PDM|14001.00|99|0.00|COCHLEAR IMPLANTS
20|FH_F133207_0_0|SrvcGrp|39909|2022|PDM|2632.00|99|0.00|PARTIAL MASTECTOMY
20|FH_F133207_0_0|SrvcGrp|41334|2022|PDM|15065.00|99|0.00|TOTAL KNEE
20|FH_F133207_0_0|SrvcGrp|44066|2022|PDM|4704.00|99|0.00|CPT 57288
20|FH_F133207_0_0|SrvcGrp|44067|2022|PDM|3809.00|99|0.00|CPT 52240
20|FH_F133207_0_0|SrvcGrp|54943|2022|PDM|3809.00|99|0.00|REPAIR OF SLAP LESION
20|FH_F133207_0_0|SrvcGrp|58671|2022|PDM|1624.00|99|0.00|ASC CARVE OUT 64721
20|FH_F133207_0_0|SrvcGrp|65625|2022|PDM|2577.00|99|0.00|CPT 30520
20|FH_F133207_0_0|SrvcGrp|87055|2022|PDM|3809.00|99|0.00|CYSTOURETHROSCOPY W/STENT INSERTION
20|FH_F133207_0_0|SrvcGrp|89404|2022|PDM|16126.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F133207_0_0|SrvcGrp|89853|2022|PDM|3529.00|99|0.00|NASAL/SINUS ENDOSCOPY-SURG
20|FH_F133207_0_0|SrvcGrp|90418|2022|PDM|3809.00|99|0.00|ENLARGE BREAST WITH IMPLANT
20|FH_F133207_0_0|SrvcGrp|91880|2022|PDM|10081.00|99|0.00|OSSEOINTEGRATED IMPLANT
20|FH_F133207_0_0|SrvcGrp|95819|2022|PDM|3183.00|99|0.00|GONIOTOMY
20|FH_F133209_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.70|99|0.00|HSS ASC
20|FH_F133211_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F133211_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.91|99|0.00|GENERAL ACUTE CARE
20|FH_F133211_0_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB
20|FH_F133215_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F133223_0_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB
20|FH_F133223_0_0|SrvcGrp|112223|2022|PDM|95.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)
20|FH_F133224_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE
20|FH_F133232_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F133247_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F133327_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F133474_0_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA
20|FH_F133474_0_0|SrvcGrp|111930|2022|PDM|15.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB
20|FH_F133474_0_0|SrvcGrp|112762|2022|PDM|45.23|99|0.00|INFECTIOUS AGENT ANTIGEN DETECTION
20|FH_F133474_0_0|SrvcGrp|112884|2022|PDM|20.00|99|0.00|ADD'L SUPPLIES, MATERIALS, STAFF; PUBLIC HEALTH EMERGENCY
20|FH_F133519_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F133519_0_0|CSTM-ALL|CSTM-00|2020|PDM|1726.00|99|0.00|AEG 9 (NO REV)
20|FH_F133519_0_0|SrvcGrp|103513|2022|PDM|74.00|99|0.00|VAGINA EXAMINATION & BIOPSY
20|FH_F133519_0_0|SrvcGrp|103837|2022|PDM|833.00|99|0.00|AETNA DESTRUCTION PENIS LESION
20|FH_F133519_0_0|SrvcGrp|33977|2022|PDM|1255.00|99|0.00|CPT 59820
20|FH_F133519_0_0|SrvcGrp|89869|2022|PDM|1255.00|99|0.00|SPONTANEOUS ABORTION
20|FH_F133529_0_0|SrvcGrp|79644|2022|PCT|1.00|99|0.00|AETNA IMPLANTS
20|FH_F133536_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F133536_0_0|CSTM-ALL|CSTM-00|2020|PDM|1320.00|99|0.00|AEG 3 (NO REV)
20|FH_F133536_0_0|CSTM-ALL|CSTM-00|2020|PDM|1420.00|99|0.00|AEG 4 (NO REV)
20|FH_F133536_0_0|CSTM-ALL|CSTM-00|2020|PDM|1870.00|99|0.00|AEG 7 (NO REV)
20|FH_F133536_0_0|CSTM-ALL|CSTM-00|2020|PDM|693.00|99|0.00|AEG 1 (NO REV)
20|FH_F133536_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F133536_0_0|SrvcGrp|107779|2022|PDM|3215.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F133536_0_0|SrvcGrp|26274|2022|PDM|3145.00|99|0.00|CPT 29877
20|FH_F133536_0_0|SrvcGrp|35669|2022|PDM|3183.00|99|0.00|CPT 63650
20|FH_F133536_0_0|SrvcGrp|65350|2022|PDM|4950.00|99|0.00|KNEE ARTHRO/ANTER
20|FH_F133536_0_0|SrvcGrp|67066|2022|PDM|9500.00|99|0.00|CERVICAL SURGERY
20|FH_F133536_0_0|SrvcGrp|69971|2022|PDM|1149.00|99|0.00|CPT 27047
20|FH_F133536_0_0|SrvcGrp|69977|2022|PDM|2068.00|99|0.00|CPT 28322, 28725
20|FH_F133536_0_0|SrvcGrp|69981|2022|PDM|2802.00|99|0.00|CPT 24358
20|FH_F133536_0_0|SrvcGrp|69982|2022|PDM|1000.00|99|0.00|HCPC E0673
20|FH_F133536_0_0|SrvcGrp|72120|2022|PDM|1149.00|99|0.00|TENOTOMY
20|FH_F133536_0_0|SrvcGrp|82112|2022|PDM|3215.00|99|0.00|KNEE ARTHROSCOPY SURGERY
20|FH_F133536_0_0|SrvcGrp|82114|2022|PDM|1700.00|99|0.00|MENISCUS REPAIR MED OR LAT
20|FH_F133536_0_0|SrvcGrp|90061|2022|PDM|20350.00|99|0.00|AETNA RECONSTRUCT SHOULDER JOINT
20|FH_F133536_0_0|SrvcGrp|90376|2022|PDM|23760.00|99|0.00|REVISION OF KNEE JOINTLANT
20|FH_F133536_0_0|SrvcGrp|90436|2022|PDM|18700.00|99|0.00|TOTAL HIP ARTHROPLASTY
20|FH_F133536_0_0|SrvcGrp|98404|2022|PDM|3215.00|99|0.00|ARTHROSCOPIC FRACTURE TX
20|FH_F133579_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F133579_0_0|CSTM-ALL|CSTM-00|2020|PDM|1102.00|99|0.00|AEG 2 (NO REV)
20|FH_F133579_0_0|CSTM-ALL|CSTM-00|2020|PDM|1526.00|99|0.00|AEG 10 (NO REV)
20|FH_F133579_0_0|CSTM-ALL|CSTM-00|2020|PDM|2642.00|99|0.00|AEG 9 (NO REV)
20|FH_F133579_0_0|SrvcGrp|103585|2022|PDM|3248.00|99|0.00|REMOVE SPINE ELTRD PLATE
20|FH_F133579_0_0|SrvcGrp|104003|2022|PDM|1749.00|99|0.00|INSERT AQUEOUS DRAIN DEVICES
20|FH_F133579_0_0|SrvcGrp|28547|2022|PDM|2175.00|99|0.00|VITRECTOMY
20|FH_F133579_0_0|SrvcGrp|28549|2022|PDM|2175.00|99|0.00|VITRECTOMY
20|FH_F133579_0_0|SrvcGrp|28551|2022|PDM|2205.00|99|0.00|REPAIR OF COMPLEX RETINAL DETACHMENT
20|FH_F133579_0_0|SrvcGrp|36591|2022|PDM|3770.00|99|0.00|CPT 63685
20|FH_F133579_0_0|SrvcGrp|49205|2022|PDM|2205.00|99|0.00|REPAIR DETACHED RETINA
20|FH_F133579_0_0|SrvcGrp|71666|2022|PDM|3248.00|99|0.00|CPT 63655
20|FH_F133585_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F133585_0_0|CSTM-ALL|CSTM-00|2020|PDM|591.00|99|0.00|AEG 2 (NO REV)
20|FH_F133585_0_0|SrvcGrp|105285|2022|PDM|768.00|99|0.00|TEMPORAL ARTERY
20|FH_F133585_0_0|SrvcGrp|107792|2022|PDM|8416.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE
20|FH_F133585_0_0|SrvcGrp|107794|2022|PDM|5571.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE
20|FH_F133585_0_0|SrvcGrp|107879|2022|PDM|3829.00|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT
20|FH_F133585_0_0|SrvcGrp|107884|2022|PDM|2852.00|99|0.00|TRLUML BALO ANGIOP 1ST ART
20|FH_F133585_0_0|SrvcGrp|108075|2022|PDM|3092.00|99|0.00|AV FUSION / UPPER ARM VEIN
20|FH_F133585_0_0|SrvcGrp|108076|2022|PDM|3092.00|99|0.00|AV FUSION / FOREARM VEIN
20|FH_F133585_0_0|SrvcGrp|108078|2022|PDM|1786.00|99|0.00|ARTERY-VEIN FUSION
20|FH_F133585_0_0|SrvcGrp|108190|2022|PDM|3092.00|99|0.00|ARTERY-VEIN GRAFT
20|FH_F133585_0_0|SrvcGrp|109137|2022|PDM|3092.00|99|0.00|AV FISTULA REVISION
20|FH_F133585_0_0|SrvcGrp|109429|2022|PDM|105.00|99|0.00|INTRVASC US NONCORONARY ADDL
20|FH_F133585_0_0|SrvcGrp|109467|2022|PDM|342.00|99|0.00|INS CATH ABD/L-EXT ART 1ST
20|FH_F133585_0_0|SrvcGrp|112386|2022|PDM|195.00|99|0.00|CONTRAST X-RAY EXAM OF AORTA (HCFA)
20|FH_F133585_0_0|SrvcGrp|112390|2022|PDM|51.00|99|0.00|US GUID VASC ACSS SITE PERM (HCFA)
20|FH_F133632_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F133632_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|AEG 8 (NO REV)
20|FH_F133632_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|AEG 9 (NO REV)
20|FH_F133632_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F133701_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F133701_0_0|SrvcGrp|82981|2022|PDM|162.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F133891_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F133969_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F133969_0_0|CSTM-ALL|CSTM-00|2020|PDM|501.11|99|0.00|AEG 2 (NO REV)
20|FH_F133969_0_0|CSTM-ALL|CSTM-00|2020|PDM|572.60|99|0.00|AEG 3 (NO REV)
20|FH_F133969_0_0|CSTM-ALL|CSTM-00|2020|PDM|931.48|99|0.00|AEG 6 (NO REV)
20|FH_F133969_0_0|SrvcGrp|75182|2022|PCT|1.00|99|0.00|AETNA IMPLANTS
20|FH_F133990_0_0|CSTM-ALL|CSTM-00|2020|PCT|41.00|99|0.00|IMPLANTS
20|FH_F134027_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F134027_0_0|SrvcGrp|11663|2022|PCT|1.10|99|0.00|IMPLANTS
20|FH_F134087_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F134087_0_0|CSTM-ALL|CSTM-00|2020|PDM|1155.00|99|0.00|AEG 2 (NO REV)
20|FH_F134087_0_0|CSTM-ALL|CSTM-00|2020|PDM|930.00|99|0.00|AEG 1 (NO REV)
20|FH_F134087_0_0|SrvcGrp|100001|2022|PDM|10455.00|99|0.00|WRIST REPLACEMNT TOT WRIST
20|FH_F134087_0_0|SrvcGrp|112162|2022|PDM|10455.00|99|0.00|RECONSTRUCT WRIST-LUNATE
20|FH_F134087_0_0|SrvcGrp|112554|2022|PDM|3607.00|99|0.00|HEMICRT INTRCLRY ALGRFT PRTL
20|FH_F134087_0_0|SrvcGrp|112556|2022|PDM|3607.00|99|0.00|REPAIR OF TENDON(S)
20|FH_F134087_0_0|SrvcGrp|41334|2022|PDM|10455.00|99|0.00|TOTAL KNEE
20|FH_F134087_0_0|SrvcGrp|67065|2022|PDM|6712.00|99|0.00|CERVICAL SURGERY
20|FH_F134087_0_0|SrvcGrp|67066|2022|PDM|6712.00|99|0.00|CERVICAL SURGERY
20|FH_F134087_0_0|SrvcGrp|67068|2022|PDM|10220.00|99|0.00|LUMBAR SPINE FUSION COMBINED
20|FH_F134087_0_0|SrvcGrp|80617|2022|PDM|10455.00|99|0.00|ARTHOPLASTY
20|FH_F134087_0_0|SrvcGrp|84318|2022|PDM|5410.00|99|0.00|SPINE INFUSION
20|FH_F134087_0_0|SrvcGrp|88159|2022|PDM|5332.00|99|0.00|LOW BACK DISK SURGERY
20|FH_F134087_0_0|SrvcGrp|88491|2022|PDM|6011.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR
20|FH_F134087_0_0|SrvcGrp|89861|2022|PDM|5771.00|99|0.00|LUMBAR LAMINOTOMY
20|FH_F134087_0_0|SrvcGrp|93057|2022|PDM|3607.00|99|0.00|SPINAL BONE AUTOGRAFT
20|FH_F134087_0_0|SrvcGrp|93059|2022|PDM|3607.00|99|0.00|SPINAL BONE AUTOGRAFT
20|FH_F134087_0_0|SrvcGrp|97730|2022|PDM|10455.00|99|0.00|REVERSE HIP JOINT
20|FH_F134192_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F134192_0_0|CSTM-ALL|CSTM-00|2020|PDM|2425.00|99|0.00|AEG 6 (NO REV)
20|FH_F134192_0_0|CSTM-ALL|CSTM-00|2020|PDM|3455.00|99|0.00|AEG 9 (NO REV)
20|FH_F134192_0_0|CSTM-ALL|CSTM-00|2020|PDM|981.00|99|0.00|AEG 1 (NO REV)
20|FH_F134202_0_0|CSTM-ALL|CSTM-00|2020|PDM|1252.65|99|0.00|AEG 7 (NO REV)
20|FH_F134202_0_0|SrvcGrp|104448|2022|PDM|6043.25|99|0.00|CYSTOSCOPY IMPLANT 4 OR MORE
20|FH_F134202_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F134202_0_0|SrvcGrp|112540|2022|PDM|1890.00|99|0.00|ARTHROSCOPY
20|FH_F134202_0_0|SrvcGrp|35669|2022|PDM|4133.98|99|0.00|CPT 63650
20|FH_F134202_0_0|SrvcGrp|63471|2022|PDM|3150.00|99|0.00|CPT 64590
20|FH_F134229_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F134229_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.45|99|0.00|HSS ASC
20|FH_F134229_0_0|SrvcGrp|112538|2022|PDM|15000.00|99|0.00|KNEE REPLACEMENT
20|FH_F134229_0_0|SrvcGrp|112539|2022|PDM|15000.00|99|0.00|HIP REPLACEMENT
20|FH_F134236_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS
20|FH_F134265_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F134265_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS
20|FH_F134267_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F134267_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F134267_0_0|SrvcGrp|82981|2022|PDM|128.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F134270_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|AEG 5  (NO REV)
20|FH_F134270_0_0|CSTM-ALL|CSTM-00|2020|PDM|3150.00|99|0.00|AEG 6 (NO REV)
20|FH_F134270_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|AEG 1 (NO REV)
20|FH_F134270_0_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|AEG 8 (NO REV)
20|FH_F134270_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|AEG 9 (NO REV)
20|FH_F134270_0_0|SrvcGrp|13697|2022|PCT|0.00|99|0.00|PROSTHETICS, ORTHOTICS, IOLS
20|FH_F134270_0_0|SrvcGrp|34606|2022|PDM|8000.00|99|0.00|CPT 29827
20|FH_F134270_0_0|SrvcGrp|41334|2022|PDM|19000.00|99|0.00|TOTAL KNEE
20|FH_F134287_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F134317_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F134317_0_0|SrvcGrp|80259|2022|PDM|500.00|99|0.00|AETNA SUBACUTE CARE
20|FH_F134368_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F134371_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F134371_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F134398_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|AEG 10 (NO REV)
20|FH_F134398_0_0|CSTM-ALL|CSTM-00|2020|PDM|824.00|99|0.00|AEG 6 (NO REV)
20|FH_F134398_0_0|CSTM-ALL|CSTM-00|2020|PDM|986.00|99|0.00|AEG 7 (NO REV)
20|FH_F134507_0_0|SrvcGrp|69359|2022|PDM|1800.00|99|0.00|SKILLED NURSING LEVEL 2
20|FH_F134603_0_0|CSTM-ALL|CSTM-00|2020|PDM|2743.00|99|0.00|AEG 4 (NO REV)
20|FH_F134603_0_0|CSTM-ALL|CSTM-00|2020|PDM|3545.00|99|0.00|AEG 6 (NO REV)
20|FH_F134603_0_0|CSTM-ALL|CSTM-00|2020|PDM|3604.00|99|0.00|AEG 10 (NO REV)
20|FH_F134603_0_0|CSTM-ALL|CSTM-00|2020|PDM|3604.00|99|0.00|AEG 5  (NO REV)
20|FH_F134603_0_0|CSTM-ALL|CSTM-00|2020|PDM|6424.00|99|0.00|AEG 9 (NO REV)
20|FH_F134603_0_0|SrvcGrp|78403|2022|PDM|0.15|99|0.00|AETNA MED RECORD
20|FH_F134612_0_0|CSTM-ALL|CSTM-00|2020|PDM|1051.00|99|0.00|AEG 10 (NO REV)
20|FH_F134612_0_0|CSTM-ALL|CSTM-00|2020|PDM|1101.00|99|0.00|AEG 6 (NO REV)
20|FH_F134612_0_0|CSTM-ALL|CSTM-00|2020|PDM|1205.00|99|0.00|AEG 3 (NO REV)
20|FH_F134612_0_0|CSTM-ALL|CSTM-00|2020|PDM|1205.00|99|0.00|AEG 4 (NO REV)
20|FH_F134612_0_0|CSTM-ALL|CSTM-00|2020|PDM|1332.00|99|0.00|AEG 5  (NO REV)
20|FH_F134612_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F134612_0_0|SrvcGrp|108177|2022|PDM|2300.00|99|0.00|TRLUML BALO ANGIOP 1ST VEIN
20|FH_F134612_0_0|SrvcGrp|112593|2022|PDM|6200.00|99|0.00|VASC EMBOLIZE/OCCLUDE ARTERY
20|FH_F134612_0_0|SrvcGrp|112594|2022|PDM|500.00|99|0.00|TRLUML BALO ANGIOP 1ST ART
20|FH_F134651_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS
20|FH_F134654_0_0|SrvcGrp|110058|2022|PDM|16.63|99|0.00|BEHAVIOR ASSESSMENT 15 MINS
20|FH_F134654_0_0|SrvcGrp|110061|2022|PDM|75.00|99|0.00|ADAPTIVE BH TREATMENT 15 MINS
20|FH_F134654_0_0|SrvcGrp|110064|2022|PDM|22.43|99|0.00|GROUP BH TREATMENT 15 MINS
20|FH_F134676_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F134676_0_0|SrvcGrp|107749|2022|PDM|164.00|99|0.00|CAPD/CCPD
20|FH_F134707_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA CADIAC CATH INCIDENTAL CODES
20|FH_F134707_0_0|CSTM-ALL|CSTM-00|2020|PDM|1550.70|99|0.00|AEG 1 (NO REV)
20|FH_F134707_0_0|CSTM-ALL|CSTM-00|2020|PDM|3651.00|99|0.00|AEG 6 (NO REV)
20|FH_F134707_0_0|CSTM-ALL|CSTM-00|2020|PDM|4413.00|99|0.00|AEG 8 (NO REV)
20|FH_F134707_0_0|CSTM-ALL|CSTM-00|2020|PDM|6424.00|99|0.00|AEG 9 (NO REV)
20|FH_F134732_0_0|CSTM-ALL|CSTM-00|2020|PDM|1024.00|99|0.00|AEG 7 (NO REV)
20|FH_F134732_0_0|CSTM-ALL|CSTM-00|2020|PDM|1373.00|99|0.00|AEG 9 (NO REV)
20|FH_F134732_0_0|CSTM-ALL|CSTM-00|2020|PDM|737.00|99|0.00|AEG 10 (NO REV)
20|FH_F134732_0_0|SrvcGrp|107794|2022|PDM|4058.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE
20|FH_F134732_0_0|SrvcGrp|107877|2022|PDM|522.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT
20|FH_F134732_0_0|SrvcGrp|109136|2022|PDM|2248.00|99|0.00|AV FISTULA REVISION
20|FH_F134738_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F134738_0_0|CSTM-ALL|CSTM-00|2020|PDM|1850.00|99|0.00|NASAL ENDO EUSTACHIAN TUBE
20|FH_F134738_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F134797_0_0|SrvcGrp|105233|2022|PDM|2500.00|99|0.00|REMOVAL OF THYROID
20|FH_F134797_0_0|SrvcGrp|12664|2022|PCT|0.34|99|0.00|IMPLANTS
20|FH_F134797_0_0|SrvcGrp|72996|2022|PDM|1205.00|99|0.00|AEG 4
20|FH_F134797_0_0|SrvcGrp|72998|2022|PDM|1332.00|99|0.00|AEG 5
20|FH_F134809_0_0|SrvcGrp|87536|2022|PDM|210.00|99|0.00|MED REHAB DAY PROGRAM (HALF)
20|FH_F134813_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F134819_0_0|CSTM-ALL|CSTM-00|2020|PDM|1097.00|99|0.00|AEG 4 (NO REV)
20|FH_F134819_0_0|CSTM-ALL|CSTM-00|2020|PDM|1189.00|99|0.00|AEG 5  (NO REV)
20|FH_F134819_0_0|CSTM-ALL|CSTM-00|2020|PDM|1379.00|99|0.00|AEG 6 (NO REV)
20|FH_F134819_0_0|CSTM-ALL|CSTM-00|2020|PDM|579.00|99|0.00|AEG 1 (NO REV)
20|FH_F134819_0_0|SrvcGrp|106169|2022|PDM|1364.00|99|0.00|FRACTURE NASAL INFERIOR
20|FH_F134819_0_0|SrvcGrp|106178|2022|PDM|1773.00|99|0.00|REMOVAL TONSILS AND ADENOIDS
20|FH_F134819_0_0|SrvcGrp|22915|2022|PDM|1773.00|99|0.00|CPT CODE 42820
20|FH_F134819_0_0|SrvcGrp|91382|2022|PDM|1773.00|99|0.00|REMOVAL OF TONSILS
20|FH_F134830_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F134830_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F134847_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F134847_0_0|CSTM-ALL|CSTM-00|2020|PDM|1910.00|99|0.00|AEG 10 (NO REV)
20|FH_F134847_0_0|CSTM-ALL|CSTM-00|2020|PDM|2218.00|99|0.00|AEG 4 (NO REV)
20|FH_F134847_0_0|SrvcGrp|111966|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F134847_0_0|SrvcGrp|27348|2022|PDM|3258.00|99|0.00|OP SURGERY (CPT 58662)
20|FH_F134847_0_0|SrvcGrp|28549|2022|PDM|3496.00|99|0.00|VITRECTOMY
20|FH_F134847_0_0|SrvcGrp|33982|2022|PDM|2541.00|99|0.00|CPT 28296
20|FH_F134847_0_0|SrvcGrp|35670|2022|PDM|8525.00|99|0.00|SPINAL NEUROSTIMULATORS PROCEDURE
20|FH_F134847_0_0|SrvcGrp|36865|2022|PDM|5429.00|99|0.00|NUCLEOPLASTY
20|FH_F134847_0_0|SrvcGrp|38364|2022|PDM|5091.00|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F134847_0_0|SrvcGrp|58993|2022|PDM|6110.00|99|0.00|DISKECTOMY
20|FH_F134847_0_0|SrvcGrp|65625|2022|PDM|2774.00|99|0.00|CPT 30520
20|FH_F134847_0_0|SrvcGrp|67064|2022|PDM|5135.00|99|0.00|MUSCULOSKELETAL SYSTEM
20|FH_F134847_0_0|SrvcGrp|71666|2022|PDM|5429.00|99|0.00|CPT 63655
20|FH_F134847_0_0|SrvcGrp|74039|2022|PDM|6110.00|99|0.00|LAMINECTOMY
20|FH_F134847_0_0|SrvcGrp|80617|2022|PDM|12381.00|99|0.00|ARTHOPLASTY
20|FH_F134847_0_0|SrvcGrp|83641|2022|PDM|5926.00|99|0.00|CPT 29889
20|FH_F134847_0_0|SrvcGrp|84939|2022|PDM|14238.00|99|0.00|SHOULDER JOINT
20|FH_F134847_0_0|SrvcGrp|87026|2022|PDM|1182.00|99|0.00|CYSTOSCOPY AND TREATMENT
20|FH_F134847_0_0|SrvcGrp|88158|2022|PDM|5429.00|99|0.00|NECK SPINE DISK SURGERY
20|FH_F134847_0_0|SrvcGrp|88492|2022|PDM|5135.00|99|0.00|AETNA SPINAL BONE AUTOGRAFT
20|FH_F134847_0_0|SrvcGrp|88494|2022|PDM|8756.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION
20|FH_F134847_0_0|SrvcGrp|89856|2022|PDM|5129.00|99|0.00|LAMIN EXCIS EXTRADURAL LUMB
20|FH_F134847_0_0|SrvcGrp|89860|2022|PDM|8145.00|99|0.00|SPINAL DISK SURGERY ADD-ON
20|FH_F134847_0_0|SrvcGrp|92405|2022|PDM|4345.00|99|0.00|PERQ LUMBOSACRAL INJECTION
20|FH_F134847_0_0|SrvcGrp|92409|2022|PDM|4345.00|99|0.00|PERQ CERVICOTHORACIC INJECT
20|FH_F134847_0_0|SrvcGrp|95564|2022|PDM|6788.00|99|0.00|NASAL SINUS ENDOSCOPY SURGICAL
20|FH_F134847_0_0|SrvcGrp|99073|2022|PDM|1.60|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F134876_0_0|SrvcGrp|57968|2022|PDM|58.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F134876_0_0|SrvcGrp|92502|2022|PDM|1308.00|99|0.00|HOSPICE GENERAL IP CARE
20|FH_F134894_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE
20|FH_F134894_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F134895_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|AEG 8 (NO REV)
20|FH_F134904_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F134904_0_0|CSTM-ALL|CSTM-00|2020|PDM|1297.00|99|0.00|AEG 8 (NO REV)
20|FH_F134904_0_0|CSTM-ALL|CSTM-00|2020|PDM|446.00|99|0.00|AEG 1 (NO REV)
20|FH_F134904_0_0|CSTM-ALL|CSTM-00|2020|PDM|971.00|99|0.00|AEG 5  (NO REV)
20|FH_F134917_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F134917_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F134917_0_0|CSTM-ALL|CSTM-00|2020|PDM|1401.61|99|0.00|AEG 9 (NO REV)
20|FH_F134928_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F134928_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F134930_0_0|SrvcGrp|16|2022|PCT|0.00|99|0.00|ACUTE REHABILITATION
20|FH_F134930_0_0|SrvcGrp|17100|2022|PCT|0.00|99|0.00|SKILLED NURSING
20|FH_F134939_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.20|99|0.00|GENERAL ACUTE CARE
20|FH_F134968_0_0|CSTM-ALL|CSTM-00|2020|PCT|12000.00|99|0.00|TIMELY FILING
20|FH_F135027_0_0|SrvcGrp|46482|2022|PDM|125.00|99|0.00|S9083 PER VISIT
20|FH_F135069_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F135069_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 7 (NO REV)
20|FH_F135093_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F135093_0_0|SrvcGrp|79720|2022|PDM|1104.00|99|0.00|ACUTE REHAB II
20|FH_F135093_0_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE
20|FH_F135149_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE
20|FH_F135179_0_0|SrvcGrp|107749|2022|PDM|164.00|99|0.00|CAPD/CCPD
20|FH_F135239_0_0|SrvcGrp|22596|2022|PDM|192.50|99|0.00|HOSPICE CARE
20|FH_F135263_0_0|CSTM-ALL|CSTM-00|2020|PDM|1195.00|99|0.00|AEG 8 (NO REV)
20|FH_F135263_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 10 (NO REV)
20|FH_F135263_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F135263_0_0|SrvcGrp|112741|2022|PDM|900.00|99|0.00|TOTAL KNEE ARTHROPLASTY
20|FH_F135316_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F135316_0_0|SrvcGrp|73485|2022|PDM|1050.00|99|0.00|AETNA REHAB
20|FH_F135327_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F135327_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F135327_0_0|CSTM-ALL|CSTM-00|2020|PDM|1055.00|99|0.00|AEG 5  (NO REV)
20|FH_F135327_0_0|CSTM-ALL|CSTM-00|2020|PDM|578.00|99|0.00|AEG 2 (NO REV)
20|FH_F135327_0_0|CSTM-ALL|CSTM-00|2020|PDM|722.00|99|0.00|AEG 3 (NO REV)
20|FH_F135327_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F135351_0_0|CSTM-ALL|CSTM-00|2020|PDM|1197.00|99|0.00|AEG 6 (NO REV)
20|FH_F135351_0_0|CSTM-ALL|CSTM-00|2020|PDM|1942.00|99|0.00|AEG 9 (NO REV)
20|FH_F135351_0_0|CSTM-ALL|CSTM-00|2020|PDM|693.00|99|0.00|AEG 2 (NO REV)
20|FH_F135351_0_0|SrvcGrp|103813|2022|PDM|891.00|99|0.00|SPINE INJECTION
20|FH_F135351_0_0|SrvcGrp|110571|2022|PDM|897.00|99|0.00|NERVE BLOCK INJECTION 8
20|FH_F135351_0_0|SrvcGrp|113710|2022|PDM|2388.00|99|0.00|APPLY/REMOVE FIXATION DEVICE
20|FH_F135351_0_0|SrvcGrp|36591|2022|PDM|58652.00|99|0.00|CPT 63685
20|FH_F135351_0_0|SrvcGrp|87677|2022|PDM|1199.00|99|0.00|CERVICAL OR THORACIC SURGERY
20|FH_F135450_0_0|SrvcGrp|87077|2022|PDM|120.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F135456_0_0|CSTM-ALL|CSTM-00|2020|PDM|511.00|99|0.00|AEG 1 (NO REV)
20|FH_F135466_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F135466_0_0|CSTM-ALL|CSTM-00|2020|PDM|1682.00|99|0.00|AEG 2 (NO REV)
20|FH_F135466_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 10 (NO REV)
20|FH_F135491_0_0|CSTM-ALL|CSTM-00|2020|PDM|1539.00|99|0.00|AEG 9 (NO REV)
20|FH_F135491_0_0|CSTM-ALL|CSTM-00|2020|PDM|715.00|99|0.00|AEG 3 (NO REV)
20|FH_F135491_0_0|SrvcGrp|112136|2022|PDM|2640.00|99|0.00|XCAPSL CTRC RMVL CPLX W/ECP
20|FH_F135491_0_0|SrvcGrp|112137|2022|PDM|2640.00|99|0.00|XCAPSL CTRC RMVL W/ECP
20|FH_F135491_0_0|SrvcGrp|112817|2022|PCT|1.21|99|0.00|INJ BIMATOPROST INTRACAMERAL IMPLANT
20|FH_F135491_0_0|SrvcGrp|46906|2022|PDM|1980.00|99|0.00|CORNEAL TISSUE
20|FH_F135491_0_0|SrvcGrp|62740|2022|PDM|1084.00|99|0.00|SURGERY CARVE OUTS
20|FH_F135491_0_0|SrvcGrp|74670|2022|PCT|0.00|99|0.00|AETNA OP INTRAOCULAR LENS
20|FH_F135491_0_0|SrvcGrp|78045|2022|PCT|1.21|99|0.00|AETNA AMNIOTIC MEMBRANE
20|FH_F135491_0_0|SrvcGrp|85966|2022|PDM|1143.00|99|0.00|EXTRACAPSULAR CATARACT
20|FH_F135491_0_0|SrvcGrp|90606|2022|PDM|1084.00|99|0.00|INSERT LENS PROSTHESIS
20|FH_F135580_0_0|CSTM-ALL|CSTM-00|2020|PDM|1276.00|99|0.00|AEG 9 (NO REV)
20|FH_F135580_0_0|CSTM-ALL|CSTM-00|2020|PDM|425.00|99|0.00|AEG 10 (NO REV)
20|FH_F135580_0_0|CSTM-ALL|CSTM-00|2020|PDM|948.00|99|0.00|AEG 7 (NO REV)
20|FH_F135613_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F135613_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|HSS ASC
20|FH_F135649_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F135650_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F135651_0_0|SrvcGrp|93736|2022|PDM|128.00|99|0.00|URGENT CARE
20|FH_F135653_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F135653_0_0|CSTM-ALL|CSTM-00|2020|PDM|1089.00|99|0.00|AEG 3 (NO REV)
20|FH_F135653_0_0|CSTM-ALL|CSTM-00|2020|PDM|1990.00|99|0.00|AEG 7 (NO REV)
20|FH_F135653_0_0|CSTM-ALL|CSTM-00|2020|PDM|987.00|99|0.00|AEG 2 (NO REV)
20|FH_F135653_0_0|SrvcGrp|112581|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F135653_0_0|SrvcGrp|13187|2022|PCT|1.00|99|0.00|INTRAOCULAR LENSES
20|FH_F135653_0_0|SrvcGrp|3932|2022|PDM|3700.00|99|0.00|LITHOTRIPSY
20|FH_F135653_0_0|SrvcGrp|40002|2022|PDM|14000.00|99|0.00|TOTAL HIP
20|FH_F135653_0_0|SrvcGrp|40003|2022|PDM|14000.00|99|0.00|TOTAL KNEE
20|FH_F135688_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F135764_0_0|SrvcGrp|73601|2022|PDM|1350.00|99|0.00|AETNA INTERMEDIATE ICU/CCU
20|FH_F135771_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F135771_0_0|SrvcGrp|92501|2022|PDM|151.98|99|0.00|HOSPICE IP RESPITE CARE
20|FH_F135779_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F135779_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F135779_0_0|SrvcGrp|109330|2022|PCT|0.00|99|0.00|OUTPATIENT THERAPY SERVICES
20|FH_F135840_0_0|SrvcGrp|75479|2022|PDM|350.00|99|0.00|AEG 1
20|FH_F135840_0_0|SrvcGrp|75489|2022|PDM|867.00|99|0.00|AEG 6
20|FH_F135840_0_0|SrvcGrp|75491|2022|PDM|1045.00|99|0.00|AEG 7
20|FH_F135840_0_0|SrvcGrp|79589|2022|PDM|550.00|99|0.00|UPPER GI
20|FH_F135840_0_0|SrvcGrp|79594|2022|PDM|550.00|99|0.00|CPT 45380
20|FH_F135840_0_0|SrvcGrp|79595|2022|PDM|550.00|99|0.00|CPT 45385
20|FH_F135840_0_0|SrvcGrp|82310|2022|PDM|550.00|99|0.00|COLORECTAL CANCER SCREENING
20|FH_F135840_0_0|SrvcGrp|85000|2022|PDM|550.00|99|0.00|CPT 45384
20|FH_F135891_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F135891_0_0|SrvcGrp|73483|2022|PDM|500.00|99|0.00|AETNA SUBACUTE III
20|FH_F135891_0_0|SrvcGrp|87536|2022|PDM|300.00|99|0.00|MED REHAB DAY PROGRAM (HALF)
20|FH_F135897_0_0|CSTM-ALL|CSTM-00|2020|PDM|1197.00|99|0.00|AEG 6 (NO REV)
20|FH_F135897_0_0|CSTM-ALL|CSTM-00|2020|PDM|1942.00|99|0.00|AEG 9 (NO REV)
20|FH_F135897_0_0|CSTM-ALL|CSTM-00|2020|PDM|2640.00|99|0.00|DEVICE INSERTION
20|FH_F135897_0_0|CSTM-ALL|CSTM-00|2020|PDM|693.00|99|0.00|AEG 2 (NO REV)
20|FH_F135897_0_0|SrvcGrp|111044|2022|PDM|1210.00|99|0.00|REMOVAL OF EYE LESION
20|FH_F135897_0_0|SrvcGrp|54084|2022|PDM|2475.00|99|0.00|IMPLANT EYE SHUNT
20|FH_F135897_0_0|SrvcGrp|85906|2022|PDM|792.00|99|0.00|CPT 66710
20|FH_F135897_0_0|SrvcGrp|92544|2022|PDM|935.00|99|0.00|FOLLOW-UP SURGERY OF EYE
20|FH_F135900_0_0|SrvcGrp|73606|2022|PDM|500.00|99|0.00|AETNA SKILLED NURSING CARE
20|FH_F135929_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.30|99|0.00|OP SVCS
20|FH_F135982_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F136002_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F136002_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F136002_0_0|SrvcGrp|22596|2022|PDM|110.16|99|0.00|HOSPICE CARE
20|FH_F136002_0_0|SrvcGrp|48385|2022|PDM|81.60|99|0.00|SPEECH THERAPY
20|FH_F136002_0_0|SrvcGrp|48394|2022|PDM|25.50|99|0.00|SKILLED NURSING SERVICES
20|FH_F136002_0_0|SrvcGrp|48396|2022|PDM|81.60|99|0.00|OT SERVICES
20|FH_F136002_0_0|SrvcGrp|88620|2022|PDM|86.70|99|0.00|SKILLED NURSING RN
20|FH_F136037_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F136037_0_0|SrvcGrp|108484|2022|PDM|655.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY
20|FH_F136037_0_0|SrvcGrp|89149|2022|PDM|233.00|99|0.00|OP INTENSIVE
20|FH_F136092_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F136092_0_0|SrvcGrp|83857|2022|PDM|475.00|99|0.00|IP HOSPICE SVCS
20|FH_F136092_0_0|SrvcGrp|97506|2022|PDM|105.00|99|0.00|AETNA HOSPICE ALL OTHER CARE
20|FH_F136189_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS
20|FH_F136191_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F136191_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F136207_0_0|SrvcGrp|73559|2022|PDM|1989.00|99|0.00|AETNA INTENSIVE CARE
20|FH_F136207_0_0|SrvcGrp|78579|2022|PDM|1668.00|99|0.00|AETNA ACUTE IP MEDICAL SVCS
20|FH_F136318_0_0|SrvcGrp|86638|2022|PDM|1103.00|99|0.00|AETNA IP PSYCHIATRIC (>=18 YRS)
20|FH_F136318_0_0|SrvcGrp|88905|2022|PDM|1208.00|99|0.00|PSYCHIATRIC CARE (AGE 0-17)
20|FH_F136330_0_0|SrvcGrp|3327|2022|PDM|159.00|99|0.00|HOSPICE SERVICE - IP RESPITE
20|FH_F136330_0_0|SrvcGrp|80098|2022|PDM|40.00|99|0.00|AETNA HOSPICE CONTINUOUS HOME CARE
20|FH_F136355_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F136355_0_0|SrvcGrp|82981|2022|PDM|155.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F136359_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F136359_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|AEG 7 (NO REV)
20|FH_F136359_0_0|CSTM-ALL|CSTM-00|2020|PDM|4300.00|99|0.00|AEG 9 (NO REV)
20|FH_F136359_0_0|SrvcGrp|100002|2022|PDM|6025.00|99|0.00|REPAIR SHOULDER CAPSULE
20|FH_F136359_0_0|SrvcGrp|100043|2022|PDM|8600.00|99|0.00|FUSION OF FOOT BONES
20|FH_F136359_0_0|SrvcGrp|102120|2022|PDM|2875.00|99|0.00|REVISE EYE MUSCLE
20|FH_F136359_0_0|SrvcGrp|103236|2022|PDM|8100.00|99|0.00|AETNA INSJ STABLJ DEV
20|FH_F136359_0_0|SrvcGrp|109790|2022|PDM|8600.00|99|0.00|FUSION OF FOOT BONES
20|FH_F136359_0_0|SrvcGrp|112853|2022|PDM|6275.00|99|0.00|SPINAL SERVICES
20|FH_F136359_0_0|SrvcGrp|112862|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F136359_0_0|SrvcGrp|26275|2022|PDM|3915.00|99|0.00|CPT 29826
20|FH_F136359_0_0|SrvcGrp|28547|2022|PDM|4000.00|99|0.00|VITRECTOMY
20|FH_F136359_0_0|SrvcGrp|28551|2022|PDM|3850.00|99|0.00|REPAIR OF COMPLEX RETINAL DETACHMENT
20|FH_F136359_0_0|SrvcGrp|35668|2022|PDM|2795.00|99|0.00|CPT 29824
20|FH_F136359_0_0|SrvcGrp|35669|2022|PDM|8000.00|99|0.00|CPT 63650
20|FH_F136359_0_0|SrvcGrp|35672|2022|PDM|6025.00|99|0.00|CPT 23412
20|FH_F136359_0_0|SrvcGrp|64517|2022|PDM|5275.00|99|0.00|REDUCE MANMMAPLASTY
20|FH_F136359_0_0|SrvcGrp|65625|2022|PDM|2875.00|99|0.00|CPT 30520
20|FH_F136359_0_0|SrvcGrp|82107|2022|PDM|2825.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F136359_0_0|SrvcGrp|87387|2022|PDM|3325.00|99|0.00|REMOVE EYE IMPLANT MATERIAL
20|FH_F136359_0_0|SrvcGrp|88162|2022|PDM|8500.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON
20|FH_F136359_0_0|SrvcGrp|88494|2022|PDM|9680.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION
20|FH_F136359_0_0|SrvcGrp|92364|2022|PDM|20750.00|99|0.00|ARTHRODESIS SACROILIAC JOINT
20|FH_F136376_0_0|SrvcGrp|89149|2022|PDM|205.00|99|0.00|OP INTENSIVE
20|FH_F136382_0_0|CSTM-ALL|CSTM-00|2020|PDM|1025.00|99|0.00|AEG 4 (NO REV)
20|FH_F136382_0_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|AEG 6 (NO REV)
20|FH_F136382_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|AEG 9 (NO REV)
20|FH_F136382_0_0|SrvcGrp|112892|2022|PDM|1600.00|99|0.00|ESOPHAGOSCOPY
20|FH_F136382_0_0|SrvcGrp|12664|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F136382_0_0|SrvcGrp|83991|2022|PDM|1350.00|99|0.00|REMOVE BY LIGAT INT HEM GRPS
20|FH_F136393_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|AEG 10 (NO REV)
20|FH_F136393_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|AEG 3 (NO REV)
20|FH_F136393_0_0|CSTM-ALL|CSTM-00|2020|PDM|6000.00|99|0.00|AETNA OP AICD 33249
20|FH_F136393_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F136393_0_0|SrvcGrp|108192|2022|PDM|6400.00|99|0.00|FEM/POPL REVAS W/TLA
20|FH_F136393_0_0|SrvcGrp|112881|2022|PDM|2000.00|99|0.00|REMOVE PACEMAKER SYSTEM
20|FH_F136393_0_0|SrvcGrp|112882|2022|PDM|3200.00|99|0.00|ILIAC REVASC
20|FH_F136393_0_0|SrvcGrp|11306|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F136393_0_0|SrvcGrp|91959|2022|PDM|6000.00|99|0.00|INSERT PULSE GENERATOR
20|FH_F136393_0_0|SrvcGrp|95339|2022|PDM|3200.00|99|0.00|INSERT PACING LEAD & CONNECT
20|FH_F136393_0_0|SrvcGrp|96385|2022|PDM|3200.00|99|0.00|AETNA IMPLANT DEFIBRILLATOR
20|FH_F136395_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 10 (NO REV)
20|FH_F136395_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|AEG 6 (NO REV)
20|FH_F136401_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F136401_0_0|SrvcGrp|82981|2022|PDM|154.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F136407_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AEG 10 (NO REV)
20|FH_F136407_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F136407_0_0|CSTM-ALL|CSTM-00|2020|PDM|1595.00|99|0.00|AEG 2 (NO REV) W/O NOSE EXCISION
20|FH_F136407_0_0|CSTM-ALL|CSTM-00|2020|PDM|3960.00|99|0.00|AEG 4 (NO REV)
20|FH_F136407_0_0|CSTM-ALL|CSTM-00|2020|PDM|3960.00|99|0.00|AEG 5  (NO REV)
20|FH_F136407_0_0|CSTM-ALL|CSTM-00|2020|PDM|4950.00|99|0.00|AEG 7 (NO REV) W/O INNER EAR PROCEDURES
20|FH_F136407_0_0|SrvcGrp|15473|2022|PDM|3960.00|99|0.00|CPT CODE 42820
20|FH_F136407_0_0|SrvcGrp|91880|2022|PDM|12100.00|99|0.00|OSSEOINTEGRATED IMPLANT
20|FH_F136410_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F136410_0_0|CSTM-ALL|CSTM-00|2020|PDM|1273.00|99|0.00|AETNA AMBULATORY SURGERY (NO REV)
20|FH_F136417_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F136417_0_0|SrvcGrp|111786|2022|PCT|0.00|99|0.00|MENTAL HEALTH CRISIS INTERVENTION
20|FH_F136417_0_0|SrvcGrp|82981|2022|PDM|232.20|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F136417_0_0|SrvcGrp|87077|2022|PDM|232.20|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F136429_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|AEG 1 (NO REV)
20|FH_F136429_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|AEG 3 (NO REV)
20|FH_F136429_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|AEG 8 (NO REV)
20|FH_F136429_0_0|SrvcGrp|71221|2022|PDM|665.00|99|0.00|EGD W/BALLOON DIALATION CPT 43249
20|FH_F136467_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|DEVICE INSERTION
20|FH_F136467_0_0|CSTM-ALL|CSTM-00|2020|PDM|2640.00|99|0.00|AEG 9 (NO REV)
20|FH_F136467_0_0|CSTM-ALL|CSTM-00|2020|PDM|2975.00|99|0.00|AEG 7 (NO REV)
20|FH_F136467_0_0|SrvcGrp|34606|2022|PDM|3022.00|99|0.00|CPT 29827
20|FH_F136467_0_0|SrvcGrp|84102|2022|PDM|910.00|99|0.00|AEG 2 W/O CPT 64721
20|FH_F136473_0_0|CSTM-ALL|CSTM-00|2020|PDM|1035.00|99|0.00|AEG 4 (NO REV)
20|FH_F136490_0_0|CSTM-ALL|CSTM-00|2020|PDM|1330.00|99|0.00|AEG 8 (NO REV)
20|FH_F136490_0_0|CSTM-ALL|CSTM-00|2020|PDM|1830.00|99|0.00|AEG 9 (NO REV)
20|FH_F136490_0_0|CSTM-ALL|CSTM-00|2020|PDM|455.00|99|0.00|AEG 1 (NO REV)
20|FH_F136490_0_0|CSTM-ALL|CSTM-00|2020|PDM|609.00|99|0.00|AEG 2 (NO REV)
20|FH_F136490_0_0|CSTM-ALL|CSTM-00|2020|PDM|860.00|99|0.00|AEG 4 (NO REV)
20|FH_F136490_0_0|CSTM-ALL|CSTM-00|2020|PDM|979.00|99|0.00|AEG 5  (NO REV)
20|FH_F136490_0_0|SrvcGrp|75182|2022|PCT|1.00|99|0.00|AETNA IMPLANTS
20|FH_F136493_0_0|SrvcGrp|83521|2022|PDM|166.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F136493_0_0|SrvcGrp|83857|2022|PDM|980.00|99|0.00|IP HOSPICE SVCS
20|FH_F136493_0_0|SrvcGrp|97506|2022|PDM|56.00|99|0.00|AETNA HOSPICE ALL OTHER CARE
20|FH_F136499_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F136507_0_0|SrvcGrp|80918|2022|PDM|130.00|99|0.00|RESPITE CARE
20|FH_F136507_0_0|SrvcGrp|80920|2022|PDM|525.00|99|0.00|HOSPICE SERVICES
20|FH_F136507_0_0|SrvcGrp|83521|2022|PDM|120.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F136510_0_0|CSTM-ALL|CSTM-00|2020|PDM|1110.00|99|0.00|AEG 2 (NO REV)
20|FH_F136510_0_0|CSTM-ALL|CSTM-00|2020|PDM|1517.00|99|0.00|AEG 10 (NO REV)
20|FH_F136510_0_0|SrvcGrp|104357|2022|PDM|2886.00|99|0.00|DACRYOCYSTORHINOSTOMY
20|FH_F136510_0_0|SrvcGrp|106235|2022|PDM|5746.00|99|0.00|CYPASS
20|FH_F136510_0_0|SrvcGrp|109251|2022|PDM|2142.00|99|0.00|CILIARY BODY DESTRUCTION
20|FH_F136510_0_0|SrvcGrp|46890|2022|PDM|5206.00|99|0.00|IMPLANT EYE SHUNT
20|FH_F136541_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.94|99|0.00|GENERAL ACUTE CARE
20|FH_F136541_0_0|SrvcGrp|111931|2022|PDM|35.91|99|0.00|COVID-19 CDC TESTING LAB
20|FH_F136541_0_0|SrvcGrp|111934|2022|PDM|51.31|99|0.00|COVID-19 NUCLEIC ACID
20|FH_F136541_0_0|SrvcGrp|112813|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER
20|FH_F136571_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F136591_0_0|SrvcGrp|3178|2022|PDM|798.78|99|0.00|ACUTE PSYCH
20|FH_F136592_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F136592_0_0|CSTM-ALL|CSTM-00|2020|PDM|1295.00|99|0.00|AEG 9 (NO REV)
20|FH_F136592_0_0|CSTM-ALL|CSTM-00|2020|PDM|393.00|99|0.00|AEG 10 (NO REV)
20|FH_F136592_0_0|CSTM-ALL|CSTM-00|2020|PDM|921.00|99|0.00|AEG 5  (NO REV)
20|FH_F136592_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F136592_0_0|SrvcGrp|107877|2022|PDM|530.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT
20|FH_F136592_0_0|SrvcGrp|107885|2022|PDM|1990.00|99|0.00|TRLUML BALO ANGIOP 1ST VEIN
20|FH_F136592_0_0|SrvcGrp|68546|2022|PDM|1240.00|99|0.00|CPT 36558
20|FH_F136608_0_0|SrvcGrp|108043|2022|PDM|164.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD
20|FH_F136654_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|AEG 1 (NO REV)
20|FH_F136654_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|AEG 10 (NO REV)
20|FH_F136654_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|AEG 9 (NO REV)
20|FH_F136668_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F136677_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F136677_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F136677_0_0|CSTM-ALL|CSTM-00|2020|PDM|1486.00|99|0.00|AEG 8 (NO REV)
20|FH_F136677_0_0|CSTM-ALL|CSTM-00|2020|PDM|567.00|99|0.00|AEG 2 (NO REV)
20|FH_F136677_0_0|CSTM-ALL|CSTM-00|2020|PDM|976.00|99|0.00|AEG 5  (NO REV)
20|FH_F136677_0_0|SrvcGrp|112581|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F136684_0_0|CSTM-ALL|CSTM-00|2020|PDM|783.00|99|0.00|AEG 5  (NO REV)
20|FH_F136684_0_0|SrvcGrp|112581|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F136684_0_0|SrvcGrp|112917|2022|PCT|1.00|99|0.00|AQUEOUS DRAIN OCULAR IMPLANT
20|FH_F136684_0_0|SrvcGrp|112919|2022|PDM|70.75|99|0.00|BEVACIZUMAB INJECTION (HCFA)
20|FH_F136690_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F136690_0_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F136735_0_0|CSTM-ALL|CSTM-00|2020|PDM|1457.00|99|0.00|AEG 9 (NO REV)
20|FH_F136735_0_0|CSTM-ALL|CSTM-00|2020|PDM|1821.00|99|0.00|AEG 5  (NO REV)
20|FH_F136735_0_0|SrvcGrp|108434|2022|PDM|2000.00|99|0.00|INSJ AQUEOUS DRAIN DEV 1ST
20|FH_F136735_0_0|SrvcGrp|68800|2022|PDM|875.00|99|0.00|REPAIR OF RETINAL DETACHMENT
20|FH_F136751_0_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|AEG 9 (NO REV)
20|FH_F136751_0_0|SrvcGrp|27261|2022|PDM|20500.00|99|0.00|CPT 27446
20|FH_F136751_0_0|SrvcGrp|67065|2022|PDM|16000.00|99|0.00|CERVICAL SURGERY
20|FH_F136751_0_0|SrvcGrp|67072|2022|PDM|16000.00|99|0.00|CPT 22845
20|FH_F136751_0_0|SrvcGrp|74039|2022|PDM|9500.00|99|0.00|LAMINECTOMY
20|FH_F136751_0_0|SrvcGrp|88157|2022|PDM|20500.00|99|0.00|TOTAL HIP ARTHROPLASTY
20|FH_F136751_0_0|SrvcGrp|88162|2022|PDM|9500.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON
20|FH_F136751_0_0|SrvcGrp|89404|2022|PDM|20500.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F136751_0_0|SrvcGrp|89842|2022|PDM|16000.00|99|0.00|LUMBAR
20|FH_F136751_0_0|SrvcGrp|92819|2022|PDM|9200.00|99|0.00|HIP ARTHOSCOPY
20|FH_F136751_0_0|SrvcGrp|92821|2022|PDM|9200.00|99|0.00|HIP ARTHROSCOPY W/ LABRAL REPAIR
20|FH_F136751_0_0|SrvcGrp|97741|2022|PDM|20500.00|99|0.00|REVISE KNEE
20|FH_F136756_0_0|SrvcGrp|38364|2022|PDM|5372.00|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F136756_0_0|SrvcGrp|72990|2022|PDM|447.70|99|0.00|AEG 1
20|FH_F136756_0_0|SrvcGrp|72996|2022|PDM|917.40|99|0.00|AEG 4
20|FH_F136756_0_0|SrvcGrp|73006|2022|PDM|1423.40|99|0.00|AEG 9
20|FH_F136779_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F136779_0_0|CSTM-ALL|CSTM-00|2020|PDM|1211.00|99|0.00|AEG 5  (NO REV)
20|FH_F136779_0_0|CSTM-ALL|CSTM-00|2020|PDM|844.00|99|0.00|AEG 10 (NO REV)
20|FH_F136779_0_0|SrvcGrp|101840|2022|PDM|3362.00|99|0.00|REPAIR OF TENDON(S)
20|FH_F136779_0_0|SrvcGrp|112922|2022|PDM|2364.00|99|0.00|REMOVE SPINE ELTRD PERQ ARAY
20|FH_F136779_0_0|SrvcGrp|112929|2022|PDM|10609.00|99|0.00|INSRT PULSE GEN W/ DUAL LEADS
20|FH_F136779_0_0|SrvcGrp|112931|2022|PDM|7725.00|99|0.00|PACEMAKER
20|FH_F136779_0_0|SrvcGrp|3932|2022|PDM|3677.00|99|0.00|LITHOTRIPSY
20|FH_F136790_0_0|CSTM-ALL|CSTM-00|2020|PDM|154.00|99|0.00|CPT 99201
20|FH_F136790_0_0|SrvcGrp|13640|2022|PDM|154.00|99|0.00|CPT 99202
20|FH_F136790_0_0|SrvcGrp|3403|2022|PDM|154.00|99|0.00|CPT 99203
20|FH_F136790_0_0|SrvcGrp|3404|2022|PDM|154.00|99|0.00|CPT 99211
20|FH_F136793_0_0|CSTM-ALL|CSTM-00|2020|PDM|743.00|99|0.00|AEG 10 (NO REV)
20|FH_F136806_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F136806_0_0|CSTM-ALL|CSTM-00|2020|PDM|1458.00|99|0.00|AEG 6 (NO REV)
20|FH_F136806_0_0|SrvcGrp|105488|2022|PDM|2154.00|99|0.00|SHOULDER ANDOSCOPY PROCEDURES
20|FH_F136806_0_0|SrvcGrp|105489|2022|PDM|2218.00|99|0.00|SHOULDER ARTHOSCOPY PROCEDURES
20|FH_F136806_0_0|SrvcGrp|105491|2022|PDM|2218.00|99|0.00|KNEE ARTHROCOPY PROCEDURES
20|FH_F136806_0_0|SrvcGrp|106710|2022|PDM|3546.00|99|0.00|PAIN STIM SURGERY
20|FH_F136806_0_0|SrvcGrp|112862|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F136806_0_0|SrvcGrp|16289|2022|PDM|1174.00|99|0.00|CARPAL TUNNEL RELEASE
20|FH_F136806_0_0|SrvcGrp|99073|2022|PDM|1.35|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F136812_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F136812_0_0|SrvcGrp|108443|2022|PDM|500.00|99|0.00|HEMODIALYSIS W/ TRAINING
20|FH_F136818_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 6 (NO REV)
20|FH_F136818_0_0|CSTM-ALL|CSTM-00|2020|PDM|693.00|99|0.00|AEG 2 (NO REV)
20|FH_F136818_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 4 (NO REV)
20|FH_F136818_0_0|SrvcGrp|112937|2022|PDM|2155.00|99|0.00|SURGICAL SERVICES
20|FH_F136818_0_0|SrvcGrp|112938|2022|PDM|2000.00|99|0.00|SURGICAL SERVICES
20|FH_F136843_0_0|SrvcGrp|108043|2022|PDM|164.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD
20|FH_F136887_0_0|CSTM-ALL|CSTM-00|2020|PDM|2303.00|99|0.00|AEG 6 (NO REV)
20|FH_F136887_0_0|CSTM-ALL|CSTM-00|2020|PDM|2717.00|99|0.00|AEG 5  (NO REV)
20|FH_F136887_0_0|CSTM-ALL|CSTM-00|2020|PDM|2938.00|99|0.00|AEG 8 (NO REV)
20|FH_F136887_0_0|SrvcGrp|112965|2022|PDM|4751.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F136887_0_0|SrvcGrp|112975|2022|PDM|8755.00|99|0.00|KNEE ARTHROSCOPY
20|FH_F136947_0_0|SrvcGrp|13262|2022|PDM|12.00|99|0.00|GROUND MILEAGE, PER STATUTE MILE
20|FH_F136947_0_0|SrvcGrp|13595|2022|PDM|525.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC
20|FH_F136947_0_0|SrvcGrp|13681|2022|PDM|450.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT
20|FH_F137067_0_0|CSTM-ALL|CSTM-00|2020|PDM|2319.00|99|0.00|AEG 9 (NO REV)
20|FH_F137067_0_0|CSTM-ALL|CSTM-00|2020|PDM|576.00|99|0.00|AEG 1 (NO REV)
20|FH_F137067_0_0|CSTM-ALL|CSTM-00|2020|PDM|884.00|99|0.00|AEG 3 (NO REV)
20|FH_F137067_0_0|SrvcGrp|102481|2022|PDM|2625.00|99|0.00|CPT 29898
20|FH_F137067_0_0|SrvcGrp|104170|2022|PDM|2625.00|99|0.00|AETNA ARTHROSCOPY SURGERY
20|FH_F137067_0_0|SrvcGrp|112959|2022|PDM|21000.00|99|0.00|REVISION OF KNEE JOINT
20|FH_F137067_0_0|SrvcGrp|26273|2022|PDM|3491.00|99|0.00|CPT 29880
20|FH_F137067_0_0|SrvcGrp|26275|2022|PDM|3150.00|99|0.00|CPT 29826
20|FH_F137067_0_0|SrvcGrp|88065|2022|PDM|18900.00|99|0.00|TOTAL DISC ARTHROPLASTY
20|FH_F137067_0_0|SrvcGrp|88162|2022|PDM|6983.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON
20|FH_F137067_0_0|SrvcGrp|92413|2022|PDM|5250.00|99|0.00|SPINAL CRD DECOMP->2 THORAC
20|FH_F137067_0_0|SrvcGrp|93065|2022|PDM|18900.00|99|0.00|LUMB ARTIF DISKECTOMY ADDL
20|FH_F137067_0_0|SrvcGrp|93431|2022|PDM|25200.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT
20|FH_F137067_0_0|SrvcGrp|95559|2022|PDM|28875.00|99|0.00|HIP JOINT
20|FH_F137067_0_0|SrvcGrp|97730|2022|PDM|28875.00|99|0.00|REVERSE HIP JOINT
20|FH_F137067_0_0|SrvcGrp|98498|2022|PDM|5250.00|99|0.00|TRANSPEDICULAR 1 SEG THORACIC
20|FH_F137067_0_0|SrvcGrp|99161|2022|PDM|28875.00|99|0.00|CPT 27138
20|FH_F137087_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F137087_0_0|CSTM-ALL|CSTM-00|2020|PDM|2650.00|99|0.00|AEG 3 (NO REV)
20|FH_F137087_0_0|CSTM-ALL|CSTM-00|2020|PDM|2750.00|99|0.00|AEG 4 (NO REV)
20|FH_F137087_0_0|CSTM-ALL|CSTM-00|2020|PDM|3670.00|99|0.00|AEG 7 (NO REV)
20|FH_F137087_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F137087_0_0|SrvcGrp|113020|2022|PDM|4000.00|99|0.00|LAMINECTOMY
20|FH_F137087_0_0|SrvcGrp|113022|2022|PDM|20000.00|99|0.00|HIP SERVICES
20|FH_F137239_0_0|SrvcGrp|73605|2022|PDM|995.00|99|0.00|AETNA ACUTE PSYCH
20|FH_F137239_0_0|SrvcGrp|73841|2022|PDM|451.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP
20|FH_F137239_0_0|SrvcGrp|89417|2022|PDM|451.00|99|0.00|PARTIAL HOSPITALIZATION
20|FH_F137243_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F137248_0_0|SrvcGrp|112581|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F137248_0_0|SrvcGrp|113067|2022|PDM|1530.00|99|0.00|SKIN TISSUE REARRANGE ADD-ON
20|FH_F137248_0_0|SrvcGrp|19991|2022|PDM|5610.00|99|0.00|NERVOUS SYSTEM SERVICES
20|FH_F137248_0_0|SrvcGrp|83236|2022|PDM|4058.00|99|0.00|AETNA ANKLE REPAIR
20|FH_F137248_0_0|SrvcGrp|99063|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F137248_0_0|SrvcGrp|99073|2022|PDM|1.34|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F137287_0_0|SrvcGrp|113071|2022|PDM|600.00|99|0.00|FULL DAY OP THERAPY
20|FH_F137288_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F137288_0_0|SrvcGrp|113070|2022|PDM|1050.00|99|0.00|IP DAY HOSPITAL
20|FH_F137310_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F137350_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F137353_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F137353_0_0|SrvcGrp|82981|2022|PDM|90.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F137359_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F137362_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F137362_0_0|SrvcGrp|113090|2022|PDM|500.00|99|0.00|HEMODIALYSIS
20|FH_F137362_0_0|SrvcGrp|25688|2022|PDM|500.00|99|0.00|HOME HEMODIALYSIS
20|FH_F137363_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F137363_0_0|CSTM-ALL|CSTM-00|2020|PDM|1545.00|99|0.00|AEG 9 (NO REV)
20|FH_F137363_0_0|CSTM-ALL|CSTM-00|2020|PDM|921.85|99|0.00|AEG 6 (NO REV)
20|FH_F137363_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F137363_0_0|SrvcGrp|113094|2022|PDM|1854.00|99|0.00|ENDOSCOPIC PROCEDURES
20|FH_F137363_0_0|SrvcGrp|13187|2022|PCT|0.00|99|0.00|INTRAOCULAR LENSES
20|FH_F137363_0_0|SrvcGrp|14614|2022|PDM|3090.00|99|0.00|LITHOTRIPSY
20|FH_F137447_0_0|SrvcGrp|106291|2022|PDM|257.25|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT LEVEL 1 (HCFA)
20|FH_F137447_0_0|SrvcGrp|106300|2022|PDM|234.69|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT (HCFA)
20|FH_F137447_0_0|SrvcGrp|13597|2022|PDM|226.23|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT
20|FH_F137530_0_0|SrvcGrp|107878|2022|PDM|4847.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT
20|FH_F137530_0_0|SrvcGrp|77278|2022|PDM|3035.00|99|0.00|AETNA REPL TUNNLD CNTRL CVC W/O PORT/PUMP
20|FH_F137530_0_0|SrvcGrp|77290|2022|PDM|721.00|99|0.00|AETNA REMV TUNNLD CVC W/O SUBQ PORT
20|FH_F137567_0_0|SrvcGrp|82981|2022|PDM|105.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F137567_0_0|SrvcGrp|87077|2022|PDM|105.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F137587_0_0|SrvcGrp|107748|2022|PDM|678.00|99|0.00|HEMODIALYSIS IN CENTER
20|FH_F137610_0_0|SrvcGrp|108484|2022|PDM|411.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY
20|FH_F137638_0_0|SrvcGrp|86723|2022|PDM|484.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)
20|FH_F137638_0_0|SrvcGrp|89417|2022|PDM|484.00|99|0.00|PARTIAL HOSPITALIZATION
20|FH_F137639_0_0|SrvcGrp|13127|2022|PDM|385.00|99|0.00|DIALYSIS
20|FH_F137798_0_0|SrvcGrp|104226|2022|PDM|128.00|99|0.00|HOSPICE CARE (HCFA)
20|FH_F137799_0_0|SrvcGrp|80920|2022|PDM|475.00|99|0.00|HOSPICE SERVICES
20|FH_F137902_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F137902_0_0|SrvcGrp|73842|2022|PDM|161.00|99|0.00|AETNA INTENSIVE OUTPATIENT
20|FH_F137902_0_0|SrvcGrp|86723|2022|PDM|269.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)
20|FH_F137902_0_0|SrvcGrp|89149|2022|PDM|161.00|99|0.00|OP INTENSIVE
20|FH_F137906_0_0|SrvcGrp|104229|2022|PDM|100.00|99|0.00|HOSPICE IN HOME (HCFA)
20|FH_F137906_0_0|SrvcGrp|33722|2022|PDM|25.00|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F137906_0_0|SrvcGrp|80920|2022|PDM|475.00|99|0.00|HOSPICE SERVICES
20|FH_F137906_0_0|SrvcGrp|82223|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F137906_0_0|SrvcGrp|95660|2022|PDM|475.00|99|0.00|HOSPICE SERVICES (HCFA)
20|FH_F137933_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F137933_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F137933_0_0|CSTM-ALL|CSTM-00|2020|PDM|6000.00|99|0.00|AEG 5  (NO REV)
20|FH_F137933_0_0|CSTM-ALL|CSTM-00|2020|PDM|8000.00|99|0.00|AEG 8 (NO REV)
20|FH_F137933_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F137933_0_0|SrvcGrp|111530|2022|PDM|13200.00|99|0.00|INSERT PENILE PROSTH-INFLAT
20|FH_F137933_0_0|SrvcGrp|113161|2022|PDM|4300.00|99|0.00|PERC CRYO ABLATE RENAL TUM
20|FH_F137933_0_0|SrvcGrp|113163|2022|PDM|12900.00|99|0.00|REMOVE/REPLACE UR SPHINCTER
20|FH_F137933_0_0|SrvcGrp|77452|2022|PDM|13300.00|99|0.00|CPT 54405
20|FH_F137940_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F137940_0_0|SrvcGrp|100961|2022|PDM|345.36|99|0.00|AMB SRVC NEONAT TRNSPRT BS RATE EMERG 1 WAY
20|FH_F137940_0_0|SrvcGrp|106294|2022|PDM|348.22|99|0.00|AMBULANCE SERVICE EMERGENCY TRANSPORT LEVEL 1 (HFCA)
20|FH_F137940_0_0|SrvcGrp|106300|2022|PDM|293.23|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT (HCFA)
20|FH_F137940_0_0|SrvcGrp|13595|2022|PDM|348.22|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC
20|FH_F137940_0_0|SrvcGrp|13597|2022|PDM|183.28|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT
20|FH_F137943_0_0|SrvcGrp|16427|2022|PDM|610.00|99|0.00|OP SURGERY
20|FH_F137943_0_0|SrvcGrp|23936|2022|PDM|1401.74|99|0.00|CORNEAL TISSUE SVCS
20|FH_F137943_0_0|SrvcGrp|45863|2022|PDM|3000.00|99|0.00|CPT 65730
20|FH_F137943_0_0|SrvcGrp|68283|2022|PDM|1700.00|99|0.00|CPT 67043
20|FH_F137943_0_0|SrvcGrp|85565|2022|PDM|1660.00|99|0.00|PARTIAL REMOVAL OF EYE FLUID
20|FH_F137943_0_0|SrvcGrp|86036|2022|PDM|3000.00|99|0.00|CORNEAL TRANSPLANT
20|FH_F137946_0_0|SrvcGrp|111926|2022|PDM|35.92|99|0.00|COVID-19 LAB TESTING
20|FH_F137946_0_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC
20|FH_F137946_0_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA
20|FH_F137946_0_0|SrvcGrp|112762|2022|PDM|45.23|99|0.00|INFECTIOUS AGENT ANTIGEN DETECTION
20|FH_F137946_0_0|SrvcGrp|113223|2022|PDM|42.13|99|0.00|COVID-19 ANTIBODY SARS-COV-2 TITER(S)
20|FH_F137946_0_0|SrvcGrp|113246|2022|PDM|105.33|99|0.00|COVID-19 NEUTRLZG ANTB SARSCOV2 TITER (HCFA)
20|FH_F137946_0_0|SrvcGrp|113247|2022|PDM|45.23|99|0.00|COVID19 SARSCOV CORONAVIRUS AG IA (HCFA)
20|FH_F137950_0_0|CSTM-ALL|CSTM-00|2020|PDM|1210.00|99|0.00|AEG 3 (NO REV)
20|FH_F137950_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F137950_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F137951_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F137951_0_0|CSTM-ALL|CSTM-00|2020|PDM|1600.00|99|0.00|AEG 7 (NO REV)
20|FH_F137951_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|AEG 1 (NO REV)
20|FH_F137951_0_0|SrvcGrp|113170|2022|PDM|1458.00|99|0.00|UPPER GI OPTIC ENDOMICROSCOPY
20|FH_F137951_0_0|SrvcGrp|26274|2022|PDM|1436.00|99|0.00|CPT 29877
20|FH_F137951_0_0|SrvcGrp|35672|2022|PDM|3132.00|99|0.00|CPT 23412
20|FH_F137951_0_0|SrvcGrp|72121|2022|PDM|3131.00|99|0.00|ARTHOSCOPY
20|FH_F137951_0_0|SrvcGrp|75002|2022|PDM|4509.00|99|0.00|ARTHOSCOPY
20|FH_F137951_0_0|SrvcGrp|77021|2022|PDM|3000.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY
20|FH_F137951_0_0|SrvcGrp|79757|2022|PDM|1436.00|99|0.00|ESOPHAGUS ENDOSCOPY REPAIR
20|FH_F137951_0_0|SrvcGrp|80063|2022|PDM|1228.00|99|0.00|HEMORRHOIDECTOMY
20|FH_F137951_0_0|SrvcGrp|82114|2022|PDM|1478.00|99|0.00|MENISCUS REPAIR MED OR LAT
20|FH_F137951_0_0|SrvcGrp|85792|2022|PDM|4490.00|99|0.00|OPEN TREATMENT OF DISTAL
20|FH_F137951_0_0|SrvcGrp|90365|2022|PDM|1436.00|99|0.00|REPAIR METACARPAL FRACTURE
20|FH_F137951_0_0|SrvcGrp|92408|2022|PDM|3000.00|99|0.00|PERQ VERTEBRAL AUGMENTATION
20|FH_F137972_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F137972_0_0|CSTM-ALL|CSTM-00|2020|PDM|1040.00|99|0.00|AEG 5  (NO REV)
20|FH_F137972_0_0|CSTM-ALL|CSTM-00|2020|PDM|1410.00|99|0.00|AEG 8 (NO REV)
20|FH_F137972_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 4 (NO REV)
20|FH_F137972_0_0|SrvcGrp|95819|2022|PDM|1980.00|99|0.00|GONIOTOMY
20|FH_F137984_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F137986_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|AEG 8 (NO REV)
20|FH_F137986_0_0|CSTM-ALL|CSTM-00|2020|PDM|725.00|99|0.00|AEG 2 (NO REV)
20|FH_F137986_0_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F137986_0_0|SrvcGrp|113167|2022|PDM|1436.00|99|0.00|PERCUTANEOUS SKELETAL FIX
20|FH_F137986_0_0|SrvcGrp|113169|2022|PDM|3130.00|99|0.00|REMOVAL OF KNEECAP
20|FH_F137986_0_0|SrvcGrp|16289|2022|PDM|890.00|99|0.00|CARPAL TUNNEL RELEASE
20|FH_F137986_0_0|SrvcGrp|26273|2022|PDM|1436.00|99|0.00|CPT 29880
20|FH_F137986_0_0|SrvcGrp|41335|2022|PDM|10500.00|99|0.00|TOTAL HIP
20|FH_F137986_0_0|SrvcGrp|58634|2022|PDM|3000.00|99|0.00|NEUROELECTRODES IMPLANT
20|FH_F137986_0_0|SrvcGrp|79578|2022|PDM|1458.00|99|0.00|CPT 43246
20|FH_F137986_0_0|SrvcGrp|79757|2022|PDM|1436.00|99|0.00|ESOPHAGUS ENDOSCOPY REPAIR
20|FH_F137986_0_0|SrvcGrp|84939|2022|PDM|12000.00|99|0.00|SHOULDER JOINT
20|FH_F137986_0_0|SrvcGrp|90420|2022|PDM|4296.00|99|0.00|REPAIR CLAVICLE FRACTURE
20|FH_F137986_0_0|SrvcGrp|92408|2022|PDM|3000.00|99|0.00|PERQ VERTEBRAL AUGMENTATION
20|FH_F138010_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F138010_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F138010_0_0|SrvcGrp|65720|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F138021_0_0|CSTM-ALL|CSTM-00|2020|PDM|1435.00|99|0.00|AEG 9 (NO REV)
20|FH_F138054_0_0|SrvcGrp|44042|2022|PDM|159.00|99|0.00|SKILLED NURSING - LPN
20|FH_F138054_0_0|SrvcGrp|46605|2022|PDM|161.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES
20|FH_F138054_0_0|SrvcGrp|48385|2022|PDM|144.00|99|0.00|SPEECH THERAPY
20|FH_F138054_0_0|SrvcGrp|88620|2022|PDM|159.00|99|0.00|SKILLED NURSING RN
20|FH_F138191_0_0|SrvcGrp|87077|2022|PDM|120.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F138196_0_0|CSTM-ALL|CSTM-00|2020|PDM|1208.00|99|0.00|AEG 8 (NO REV)
20|FH_F138196_0_0|CSTM-ALL|CSTM-00|2020|PDM|1212.00|99|0.00|AEG 7 (NO REV)
20|FH_F138196_0_0|CSTM-ALL|CSTM-00|2020|PDM|873.00|99|0.00|AEG 5  (NO REV)
20|FH_F138197_0_0|CSTM-ALL|CSTM-00|2020|PDM|1089.90|99|0.00|AEG 10 (NO REV)
20|FH_F138197_0_0|CSTM-ALL|CSTM-00|2020|PDM|1393.00|99|0.00|DEVICE INSERTION
20|FH_F138197_0_0|CSTM-ALL|CSTM-00|2020|PDM|1683.15|99|0.00|AEG 8 (NO REV)
20|FH_F138197_0_0|CSTM-ALL|CSTM-00|2020|PDM|1720.95|99|0.00|AEG 7 (NO REV)
20|FH_F138197_0_0|CSTM-ALL|CSTM-00|2020|PDM|575.40|99|0.00|AEG 1 (NO REV)
20|FH_F138197_0_0|SrvcGrp|44461|2022|PDM|3689.00|99|0.00|INSERTION / REPLACEMENT OF SPINAL NEUROSTIMULATOR GENERATOR
20|FH_F138197_0_0|SrvcGrp|90567|2022|PDM|880.00|99|0.00|CILIARY BODY DESTRUCTION
20|FH_F138213_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F138214_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F138215_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F138215_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F138219_0_0|SrvcGrp|81023|2022|PDM|164.00|99|0.00|AETNA CAPD CCPD IPD DIALYSIS PROC
20|FH_F138236_0_0|SrvcGrp|104228|2022|PDM|105.00|99|0.00|HOSPICE CARE (HCFA)
20|FH_F138236_0_0|SrvcGrp|84185|2022|PDM|105.00|99|0.00|RESPITE CARE
20|FH_F138283_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F138283_0_0|SrvcGrp|113278|2022|PDM|107.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F138283_0_0|SrvcGrp|26160|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE VISIT
20|FH_F138283_0_0|SrvcGrp|53145|2022|PDM|107.00|99|0.00|SOCIAL WORKER
20|FH_F138283_0_0|SrvcGrp|73523|2022|PDM|107.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F138283_0_0|SrvcGrp|90339|2022|PDM|100.00|99|0.00|SKILLED NURSING RN
20|FH_F138296_0_0|CSTM-ALL|CSTM-00|2020|PCT|12000.00|99|0.00|TIMELY FILING
20|FH_F138350_0_0|CSTM-ALL|CSTM-00|2020|PDM|1167.00|99|0.00|AEG 6 (NO REV)
20|FH_F138350_0_0|CSTM-ALL|CSTM-00|2020|PDM|1527.00|99|0.00|AEG 8 (NO REV)
20|FH_F138350_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|AEG 1 (NO REV)
20|FH_F138350_0_0|SrvcGrp|112556|2022|PDM|2122.00|99|0.00|REPAIR OF TENDON(S)
20|FH_F138353_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F138353_0_0|CSTM-ALL|CSTM-00|2020|PDM|672.00|99|0.00|AEG 10 (NO REV)
20|FH_F138353_0_0|CSTM-ALL|CSTM-00|2020|PDM|672.00|99|0.00|AEG 2 (NO REV)
20|FH_F138353_0_0|CSTM-ALL|CSTM-00|2020|PDM|672.00|99|0.00|AEG 3 (NO REV)
20|FH_F138353_0_0|CSTM-ALL|CSTM-00|2020|PDM|672.00|99|0.00|AEG 4 (NO REV)
20|FH_F138353_0_0|CSTM-ALL|CSTM-00|2020|PDM|672.00|99|0.00|AEG 8 (NO REV)
20|FH_F138416_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F138416_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|HOSPICE CARE
20|FH_F138417_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|AETNA DME
20|FH_F138420_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F138420_0_0|CSTM-ALL|CSTM-00|2020|PDM|1260.00|99|0.00|AEG 3 (NO REV)
20|FH_F138420_0_0|CSTM-ALL|CSTM-00|2020|PDM|1554.00|99|0.00|AEG 4 (NO REV)
20|FH_F138420_0_0|CSTM-ALL|CSTM-00|2020|PDM|2454.00|99|0.00|AEG 7 (NO REV)
20|FH_F138420_0_0|SrvcGrp|111966|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F138422_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F138422_0_0|CSTM-ALL|CSTM-00|2020|PDM|562.00|99|0.00|AEG 5  (NO REV)
20|FH_F138422_0_0|CSTM-ALL|CSTM-00|2020|PDM|562.00|99|0.00|AEG 9 (NO REV)
20|FH_F138450_0_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB
20|FH_F138451_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F138451_0_0|SrvcGrp|111823|2022|PCT|0.90|99|0.00|CARDIAC CATHETERIZATION
20|FH_F138452_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|AETNA HIGH COST DRUGS
20|FH_F138457_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F138460_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|ACUTE PSYCH
20|FH_F138460_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|AETNA INTENSIVE OUTPATIENT
20|FH_F138460_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|AETNA OP THERAPY SERVICE
20|FH_F138460_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F138478_0_0|SrvcGrp|107877|2022|PDM|510.32|99|0.00|INTRO CATH DIALYSIS CIRCUIT
20|FH_F138478_0_0|SrvcGrp|109494|2022|PDM|6955.89|99|0.00|INSRT HEART PM ATRIAL & VENT
20|FH_F138478_0_0|SrvcGrp|109497|2022|PDM|1193.56|99|0.00|REPOSITION PACING-DEFIB LEA
20|FH_F138478_0_0|SrvcGrp|109501|2022|PDM|1892.62|99|0.00|REPAIR LEAD PACE-DEFIB DUAL
20|FH_F138478_0_0|SrvcGrp|109508|2022|PDM|4763.37|99|0.00|REMOVAL OF PM GENERATOR
20|FH_F138478_0_0|SrvcGrp|113286|2022|PDM|2066.18|99|0.00|HEMODIALYSIS
20|FH_F138478_0_0|SrvcGrp|11663|2022|PCT|0.63|99|0.00|IMPLANTS
20|FH_F138478_0_0|SrvcGrp|88482|2022|PDM|1341.77|99|0.00|AETNA REMOVE PULSE GENERATOR
20|FH_F138478_0_0|SrvcGrp|92407|2022|PDM|17599.99|99|0.00|REMOVAL & REPLACE PULSE GEN 2 LEAD
20|FH_F138478_0_0|SrvcGrp|95339|2022|PDM|6974.46|99|0.00|INSERT PACING LEAD & CONNECT
20|FH_F138488_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F138488_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F138488_0_0|SrvcGrp|113114|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F138532_0_0|SrvcGrp|107746|2022|PCT|0.90|99|0.00|PARSABIV
20|FH_F138533_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F138533_0_0|CSTM-ALL|CSTM-00|2020|PDM|430.00|99|0.00|AEG 1 (NO REV)
20|FH_F138540_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F138540_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING
20|FH_F138588_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE
20|FH_F138589_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F138611_0_0|CSTM-ALL|CSTM-00|2020|PDM|1807.00|99|0.00|AEG 1 (NO REV)
20|FH_F138611_0_0|CSTM-ALL|CSTM-00|2020|PDM|2778.00|99|0.00|AEG 3 (NO REV)
20|FH_F138611_0_0|CSTM-ALL|CSTM-00|2020|PDM|5321.00|99|0.00|AEG 8 (NO REV)
20|FH_F138611_0_0|SrvcGrp|95559|2022|PDM|14894.00|99|0.00|HIP JOINT
20|FH_F138636_0_0|CSTM-ALL|CSTM-00|2020|PDM|471.00|99|0.00|AEG 1 (NO REV)
20|FH_F138636_0_0|CSTM-ALL|CSTM-00|2020|PDM|705.00|99|0.00|AEG 2 (NO REV)
20|FH_F138636_0_0|CSTM-ALL|CSTM-00|2020|PDM|705.00|99|0.00|AETNA SURGERY DEFAULT WITHOUT GROUPER 1 & 2
20|FH_F138649_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS
20|FH_F138654_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F138682_0_0|CSTM-ALL|CSTM-00|2020|PDM|483.00|99|0.00|AEG 3 (NO REV)
20|FH_F138682_0_0|CSTM-ALL|CSTM-00|2020|PDM|483.00|99|0.00|AEG 4 (NO REV)
20|FH_F138682_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|AEG 2 (NO REV)
20|FH_F138710_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F138827_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F138873_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F138873_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 8 (NO REV)
20|FH_F138873_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|AEG 10 (NO REV)
20|FH_F138873_0_0|CSTM-ALL|CSTM-00|2020|PDM|938.00|99|0.00|AEG 5  (NO REV)
20|FH_F138873_0_0|CSTM-ALL|CSTM-00|2020|PDM|946.00|99|0.00|AEG 6 (NO REV)
20|FH_F138882_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F138882_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 1 (NO REV)
20|FH_F138882_0_0|CSTM-ALL|CSTM-00|2020|PDM|2937.00|99|0.00|AEG 8 (NO REV)
20|FH_F138882_0_0|CSTM-ALL|CSTM-00|2020|PDM|2941.00|99|0.00|AEG 10 (NO REV)
20|FH_F138929_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 3 (NO REV)
20|FH_F138929_0_0|CSTM-ALL|CSTM-00|2020|PDM|1210.00|99|0.00|AEG 10 (NO REV)
20|FH_F138929_0_0|CSTM-ALL|CSTM-00|2020|PDM|1320.00|99|0.00|AEG 5  (NO REV)
20|FH_F138929_0_0|CSTM-ALL|CSTM-00|2020|PDM|1485.00|99|0.00|AEG 6 (NO REV)
20|FH_F138929_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AEG 1 (NO REV)
20|FH_F138929_0_0|SrvcGrp|103236|2022|PDM|13750.00|99|0.00|AETNA INSJ STABLJ DEV
20|FH_F138929_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F138929_0_0|SrvcGrp|13187|2022|PCT|0.00|99|0.00|INTRAOCULAR LENSES
20|FH_F138929_0_0|SrvcGrp|26273|2022|PDM|3300.00|99|0.00|CPT 29880
20|FH_F138929_0_0|SrvcGrp|35669|2022|PDM|4730.00|99|0.00|CPT 63650
20|FH_F138929_0_0|SrvcGrp|55071|2022|PDM|3520.00|99|0.00|ARTHROSCOPY SHOULDER
20|FH_F138929_0_0|SrvcGrp|58634|2022|PDM|5500.00|99|0.00|NEUROELECTRODES IMPLANT
20|FH_F138929_0_0|SrvcGrp|67068|2022|PDM|13750.00|99|0.00|LUMBAR SPINE FUSION COMBINED
20|FH_F138929_0_0|SrvcGrp|80617|2022|PDM|14750.00|99|0.00|ARTHOPLASTY
20|FH_F138929_0_0|SrvcGrp|82108|2022|PDM|3520.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F138929_0_0|SrvcGrp|88065|2022|PDM|13750.00|99|0.00|TOTAL DISC ARTHROPLASTY
20|FH_F138929_0_0|SrvcGrp|88157|2022|PDM|17600.00|99|0.00|TOTAL HIP ARTHROPLASTY
20|FH_F138929_0_0|SrvcGrp|88164|2022|PDM|13750.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR
20|FH_F138929_0_0|SrvcGrp|88487|2022|PDM|4290.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION
20|FH_F138929_0_0|SrvcGrp|90420|2022|PDM|5005.00|99|0.00|REPAIR CLAVICLE FRACTURE
20|FH_F138929_0_0|SrvcGrp|92366|2022|PDM|4400.00|99|0.00|REPAIR ACHILLES TENDON
20|FH_F138929_0_0|SrvcGrp|92408|2022|PDM|4290.00|99|0.00|PERQ VERTEBRAL AUGMENTATION
20|FH_F138929_0_0|SrvcGrp|97741|2022|PDM|15400.00|99|0.00|REVISE KNEE
20|FH_F138932_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F138934_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|AEG 3 (NO REV)
20|FH_F138963_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F138987_0_0|SrvcGrp|113451|2022|PDM|30.00|99|0.00|HOSPICE CARE
20|FH_F138987_0_0|SrvcGrp|65720|2022|PDM|134.00|99|0.00|RESPITE CARE
20|FH_F138987_0_0|SrvcGrp|80918|2022|PDM|145.00|99|0.00|RESPITE CARE
20|FH_F138987_0_0|SrvcGrp|80920|2022|PDM|685.00|99|0.00|HOSPICE SERVICES
20|FH_F138987_0_0|SrvcGrp|93098|2022|PDM|627.00|99|0.00|HOSPICE CARE
20|FH_F138995_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F138995_0_0|CSTM-ALL|CSTM-00|2020|PDM|1050.00|99|0.00|AEG 4 (NO REV)
20|FH_F138995_0_0|CSTM-ALL|CSTM-00|2020|PDM|1175.00|99|0.00|AEG 5  (NO REV)
20|FH_F138995_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|AEG 3 (NO REV)
20|FH_F138995_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F138995_0_0|SrvcGrp|15473|2022|PDM|2300.00|99|0.00|CPT CODE 42820
20|FH_F138995_0_0|SrvcGrp|36865|2022|PDM|4590.00|99|0.00|NUCLEOPLASTY
20|FH_F138995_0_0|SrvcGrp|86505|2022|PDM|1300.00|99|0.00|DENTAL SURGERY
20|FH_F138995_0_0|SrvcGrp|87677|2022|PDM|800.00|99|0.00|CERVICAL OR THORACIC SURGERY
20|FH_F138995_0_0|SrvcGrp|88599|2022|PDM|1895.00|99|0.00|ENDOSCOPY MAXILLARY SINUS
20|FH_F138995_0_0|SrvcGrp|91421|2022|PDM|1199.00|99|0.00|REMOVAL OF ADENOIDS
20|FH_F138995_0_0|SrvcGrp|91422|2022|PDM|1199.00|99|0.00|REMOVAL OF ADENOIDS
20|FH_F138995_0_0|SrvcGrp|91940|2022|PDM|886.00|99|0.00|TYMPANIC MEMBRANE REPAIR
20|FH_F139048_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|AEG 9 (NO REV)
20|FH_F139048_0_0|CSTM-ALL|CSTM-00|2020|PDM|2860.00|99|0.00|DEVICE INSERTION
20|FH_F139048_0_0|SrvcGrp|93762|2022|PDM|1815.00|99|0.00|EXTRACAPSULAR CATARACT
20|FH_F139147_0_0|CSTM-ALL|CSTM-00|2020|PDM|1611.00|99|0.00|AEG 1 (NO REV)
20|FH_F139147_0_0|CSTM-ALL|CSTM-00|2020|PDM|2360.00|99|0.00|AEG 4 (NO REV)
20|FH_F139147_0_0|CSTM-ALL|CSTM-00|2020|PDM|2717.00|99|0.00|AEG 5  (NO REV)
20|FH_F139147_0_0|CSTM-ALL|CSTM-00|2020|PDM|3069.00|99|0.00|AEG 9 (NO REV)
20|FH_F139147_0_0|SrvcGrp|112862|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F139147_0_0|SrvcGrp|112965|2022|PDM|4751.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F139147_0_0|SrvcGrp|58671|2022|PDM|4244.00|99|0.00|ASC CARVE OUT 64721
20|FH_F139147_0_0|SrvcGrp|65625|2022|PDM|5150.00|99|0.00|CPT 30520
20|FH_F139147_0_0|SrvcGrp|79588|2022|PDM|1804.00|99|0.00|CPT 43235
20|FH_F139147_0_0|SrvcGrp|79589|2022|PDM|1751.00|99|0.00|UPPER GI
20|FH_F139147_0_0|SrvcGrp|89882|2022|PDM|5305.00|99|0.00|AETNA REMOVAL OF TONSILS
20|FH_F139147_0_0|SrvcGrp|91422|2022|PDM|5305.00|99|0.00|REMOVAL OF ADENOIDS
20|FH_F139164_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F139169_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F139169_0_0|CSTM-ALL|CSTM-00|2020|PDM|1059.00|99|0.00|AEG 4 (NO REV)
20|FH_F139169_0_0|CSTM-ALL|CSTM-00|2020|PDM|571.17|99|0.00|AEG 1 (NO REV)
20|FH_F139169_0_0|SrvcGrp|104911|2022|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES
20|FH_F139169_0_0|SrvcGrp|36591|2022|PDM|7500.00|99|0.00|CPT 63685
20|FH_F139169_0_0|SrvcGrp|58636|2022|PDM|6500.00|99|0.00|CPT 62362
20|FH_F139169_0_0|SrvcGrp|86505|2022|PDM|650.00|99|0.00|DENTAL SURGERY
20|FH_F139169_0_0|SrvcGrp|88739|2022|PDM|4000.00|99|0.00|IMPLANT SPINAL CANAL
20|FH_F139173_0_0|SrvcGrp|48385|2022|PDM|192.00|99|0.00|SPEECH THERAPY
20|FH_F139173_0_0|SrvcGrp|48396|2022|PDM|192.00|99|0.00|OT SERVICES
20|FH_F139173_0_0|SrvcGrp|80918|2022|PDM|409.24|99|0.00|RESPITE CARE
20|FH_F139173_0_0|SrvcGrp|80920|2022|PDM|911.62|99|0.00|HOSPICE SERVICES
20|FH_F139173_0_0|SrvcGrp|88620|2022|PDM|176.00|99|0.00|SKILLED NURSING RN
20|FH_F139173_0_0|SrvcGrp|93078|2022|PDM|450.00|99|0.00|CERVICAL ARTHRODESIS (HCFA)
20|FH_F139173_0_0|SrvcGrp|95661|2022|PDM|409.24|99|0.00|RESPITE CARE (HCFA)
20|FH_F139173_0_0|SrvcGrp|97702|2022|PDM|172.09|99|0.00|HOSPICE OR HH IN HOME (HCFA)
20|FH_F139177_0_0|SrvcGrp|11259|2022|PCT|0.26|99|0.00|DRUGS
20|FH_F139177_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F139207_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE
20|FH_F139207_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F139236_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F139236_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F139236_0_0|CSTM-ALL|CSTM-00|2020|PDM|1336.00|99|0.00|AEG 6 (NO REV)
20|FH_F139238_0_0|CSTM-ALL|CSTM-00|2020|PDM|1345.30|99|0.00|AEG 6 (NO REV)
20|FH_F139238_0_0|CSTM-ALL|CSTM-00|2020|PDM|1566.40|99|0.00|AEG 8 (NO REV)
20|FH_F139238_0_0|CSTM-ALL|CSTM-00|2020|PDM|1934.90|99|0.00|AEG 9 (NO REV)
20|FH_F139238_0_0|CSTM-ALL|CSTM-00|2020|PDM|997.70|99|0.00|AEG 4 (NO REV)
20|FH_F139238_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F139241_0_0|CSTM-ALL|CSTM-00|2020|PDM|1061.00|99|0.00|AEG 6 (NO REV)
20|FH_F139241_0_0|CSTM-ALL|CSTM-00|2020|PDM|443.00|99|0.00|AEG 1 (NO REV)
20|FH_F139241_0_0|CSTM-ALL|CSTM-00|2020|PDM|836.00|99|0.00|AEG 4 (NO REV)
20|FH_F139241_0_0|SrvcGrp|104761|2022|PDM|1420.00|99|0.00|LAPAROSCOPY
20|FH_F139241_0_0|SrvcGrp|33984|2022|PDM|1420.00|99|0.00|HAMMERTOE CORRECTION
20|FH_F139241_0_0|SrvcGrp|65625|2022|PDM|1530.00|99|0.00|CPT 30520
20|FH_F139241_0_0|SrvcGrp|77585|2022|PDM|1858.00|99|0.00|CPT 58558 - 58563
20|FH_F139274_0_0|CSTM-ALL|CSTM-00|2020|PDM|1040.00|99|0.00|AEG 5  (NO REV)
20|FH_F139274_0_0|CSTM-ALL|CSTM-00|2020|PDM|1942.00|99|0.00|AEG 9 (NO REV)
20|FH_F139274_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 4 (NO REV)
20|FH_F139274_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F139289_0_0|SrvcGrp|82224|2022|PDM|58.52|99|0.00|HOSPICE CONT HOME CARE
20|FH_F139293_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|OP SVCS
20|FH_F139299_0_0|SrvcGrp|89149|2022|PDM|230.00|99|0.00|OP INTENSIVE
20|FH_F139299_0_0|SrvcGrp|90854|2022|PDM|875.00|99|0.00|AETNA IP DETOXIFICATION SERVICES
20|FH_F139309_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F139309_0_0|SrvcGrp|87077|2022|PDM|125.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F139450_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F139509_0_0|CSTM-ALL|CSTM-00|2020|PDM|966.00|99|0.00|AEG 7 (NO REV)
20|FH_F139509_0_0|SrvcGrp|113114|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F139515_0_0|CSTM-ALL|CSTM-00|2020|PDM|1236.00|99|0.00|AEG 5  (NO REV)
20|FH_F139515_0_0|CSTM-ALL|CSTM-00|2020|PDM|1772.00|99|0.00|AEG 8 (NO REV)
20|FH_F139515_0_0|CSTM-ALL|CSTM-00|2020|PDM|824.00|99|0.00|AEG 3 (NO REV)
20|FH_F139515_0_0|SrvcGrp|106264|2022|PDM|4352.00|99|0.00|NSL/SINS NDSC W/ SINS DILATION
20|FH_F139515_0_0|SrvcGrp|109958|2022|PDM|15862.00|99|0.00|REVISE LUMBAR ARTIF DISC
20|FH_F139515_0_0|SrvcGrp|109959|2022|PDM|10300.00|99|0.00|IMPLANT NEURORECEIVER
20|FH_F139515_0_0|SrvcGrp|109965|2022|PDM|8549.00|99|0.00|THORAX SPINE DISK SURGERY
20|FH_F139515_0_0|SrvcGrp|113576|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F139515_0_0|SrvcGrp|27261|2022|PDM|12200.00|99|0.00|CPT 27446
20|FH_F139515_0_0|SrvcGrp|35669|2022|PDM|8549.00|99|0.00|CPT 63650
20|FH_F139515_0_0|SrvcGrp|41334|2022|PDM|11330.00|99|0.00|TOTAL KNEE
20|FH_F139515_0_0|SrvcGrp|58636|2022|PDM|14420.00|99|0.00|CPT 62362
20|FH_F139515_0_0|SrvcGrp|64517|2022|PDM|2724.00|99|0.00|REDUCE MANMMAPLASTY
20|FH_F139515_0_0|SrvcGrp|67072|2022|PDM|10197.00|99|0.00|CPT 22845
20|FH_F139515_0_0|SrvcGrp|77582|2022|PDM|2926.00|99|0.00|CPT 31255
20|FH_F139515_0_0|SrvcGrp|78282|2022|PDM|3348.00|99|0.00|CPT 47563
20|FH_F139515_0_0|SrvcGrp|78911|2022|PDM|2850.00|99|0.00|LAPARO HERNIA REPAIR RECUR
20|FH_F139515_0_0|SrvcGrp|82115|2022|PDM|2395.00|99|0.00|REPAIR UMBIL HERNIA
20|FH_F139515_0_0|SrvcGrp|83640|2022|PDM|3425.00|99|0.00|CPT 29887
20|FH_F139515_0_0|SrvcGrp|84939|2022|PDM|10686.00|99|0.00|SHOULDER JOINT
20|FH_F139515_0_0|SrvcGrp|86426|2022|PDM|1648.00|99|0.00|REMOVE INT/EXT HEM GROUP 2
20|FH_F139515_0_0|SrvcGrp|88065|2022|PDM|14420.00|99|0.00|TOTAL DISC ARTHROPLASTY
20|FH_F139515_0_0|SrvcGrp|88157|2022|PDM|10686.00|99|0.00|TOTAL HIP ARTHROPLASTY
20|FH_F139515_0_0|SrvcGrp|88161|2022|PDM|8549.00|99|0.00|LAMINECTOMY W/FACE-THORACIC
20|FH_F139515_0_0|SrvcGrp|88492|2022|PDM|2122.00|99|0.00|AETNA SPINAL BONE AUTOGRAFT
20|FH_F139515_0_0|SrvcGrp|88494|2022|PDM|4917.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION
20|FH_F139515_0_0|SrvcGrp|88740|2022|PDM|2122.00|99|0.00|SP BONE ALGRFT
20|FH_F139515_0_0|SrvcGrp|89842|2022|PDM|31261.00|99|0.00|LUMBAR
20|FH_F139515_0_0|SrvcGrp|89848|2022|PDM|9289.00|99|0.00|SPINE FUSION EXTRA SEGMENT
20|FH_F139515_0_0|SrvcGrp|89983|2022|PDM|1942.00|99|0.00|KNEE ARTHROSCOPY / SURGERY
20|FH_F139515_0_0|SrvcGrp|90062|2022|PDM|8549.00|99|0.00|TRANSPEDICULAR PROCEDURE
20|FH_F139515_0_0|SrvcGrp|92412|2022|PDM|8549.00|99|0.00|SPINAL CRD DECOMP->2 CERVIC
20|FH_F139515_0_0|SrvcGrp|99164|2022|PDM|10197.00|99|0.00|CPT 22846
20|FH_F139530_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F139551_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F139551_0_0|CSTM-ALL|CSTM-00|2020|PDM|1345.00|99|0.00|AEG 2 (NO REV)
20|FH_F139551_0_0|CSTM-ALL|CSTM-00|2020|PDM|1825.00|99|0.00|AEG 10 (NO REV)
20|FH_F139551_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|AEG 4 (NO REV)
20|FH_F139551_0_0|SrvcGrp|100920|2022|PDM|4411.00|99|0.00|SPINE PRO DEVICE
20|FH_F139551_0_0|SrvcGrp|26278|2022|PDM|2800.00|99|0.00|CPT 29881
20|FH_F139551_0_0|SrvcGrp|35669|2022|PDM|6000.00|99|0.00|CPT 63650
20|FH_F139551_0_0|SrvcGrp|35921|2022|PDM|7700.00|99|0.00|BARIATRIC SURGERY
20|FH_F139551_0_0|SrvcGrp|41334|2022|PDM|17500.00|99|0.00|TOTAL KNEE
20|FH_F139551_0_0|SrvcGrp|67072|2022|PDM|4411.00|99|0.00|CPT 22845
20|FH_F139551_0_0|SrvcGrp|72121|2022|PDM|3921.00|99|0.00|ARTHOSCOPY
20|FH_F139551_0_0|SrvcGrp|75002|2022|PDM|5000.00|99|0.00|ARTHOSCOPY
20|FH_F139551_0_0|SrvcGrp|78096|2022|PDM|5500.00|99|0.00|AETNA ARTHROSCOPY BICEPS
20|FH_F139551_0_0|SrvcGrp|82108|2022|PDM|2788.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F139551_0_0|SrvcGrp|82112|2022|PDM|2537.00|99|0.00|KNEE ARTHROSCOPY SURGERY
20|FH_F139551_0_0|SrvcGrp|82114|2022|PDM|2950.00|99|0.00|MENISCUS REPAIR MED OR LAT
20|FH_F139551_0_0|SrvcGrp|84307|2022|PDM|3335.00|99|0.00|TENDON REPAIR
20|FH_F139551_0_0|SrvcGrp|84313|2022|PDM|1850.00|99|0.00|TENDON REPAIR
20|FH_F139551_0_0|SrvcGrp|84939|2022|PDM|17500.00|99|0.00|SHOULDER JOINT
20|FH_F139551_0_0|SrvcGrp|87055|2022|PDM|2625.00|99|0.00|CYSTOURETHROSCOPY W/STENT INSERTION
20|FH_F139551_0_0|SrvcGrp|87844|2022|PDM|5382.00|99|0.00|LAPARASCOPY - GASTRIC
20|FH_F139551_0_0|SrvcGrp|88161|2022|PDM|5769.00|99|0.00|LAMINECTOMY W/FACE-THORACIC
20|FH_F139551_0_0|SrvcGrp|97730|2022|PDM|16500.00|99|0.00|REVERSE HIP JOINT
20|FH_F139551_0_0|SrvcGrp|97895|2022|PDM|17500.00|99|0.00|REVISE KNEE 2
20|FH_F139551_0_0|SrvcGrp|99161|2022|PDM|16500.00|99|0.00|CPT 27138
20|FH_F139565_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F139565_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F139565_0_0|SrvcGrp|109759|2022|PDM|5738.00|99|0.00|REMOVAL CORNEAL EPITHELIUM
20|FH_F139565_0_0|SrvcGrp|109761|2022|PDM|4590.00|99|0.00|REMOVE EYELID LESIONS
20|FH_F139565_0_0|SrvcGrp|109765|2022|PDM|1721.00|99|0.00|CLOSURE OF LACRIMAL PUNCTUM
20|FH_F139565_0_0|SrvcGrp|109767|2022|PDM|2869.00|99|0.00|COVER EYE W/ MEMBRANE INCIDENTAL CODES
20|FH_F139565_0_0|SrvcGrp|42428|2022|PDM|1721.00|99|0.00|OP SURGERY CPT 65855
20|FH_F139565_0_0|SrvcGrp|42550|2022|PDM|5738.00|99|0.00|OP SURGERY CPT 66984
20|FH_F139565_0_0|SrvcGrp|46906|2022|PDM|9754.00|99|0.00|CORNEAL TISSUE
20|FH_F139565_0_0|SrvcGrp|84934|2022|PDM|6885.00|99|0.00|REMOVAL OF EYE LESION
20|FH_F139565_0_0|SrvcGrp|85966|2022|PDM|7459.00|99|0.00|EXTRACAPSULAR CATARACT
20|FH_F139565_0_0|SrvcGrp|95107|2022|PDM|5738.00|99|0.00|INTRAOCULAR LENS PROSTHESIS
20|FH_F139565_0_0|SrvcGrp|95819|2022|PDM|6885.00|99|0.00|GONIOTOMY
20|FH_F139566_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F139576_0_0|CSTM-ALL|CSTM-00|2020|PDM|1997.00|99|0.00|AEG 5  (NO REV)
20|FH_F139576_0_0|CSTM-ALL|CSTM-00|2020|PDM|2717.00|99|0.00|AEG 7 (NO REV)
20|FH_F139576_0_0|CSTM-ALL|CSTM-00|2020|PDM|930.00|99|0.00|AEG 1 (NO REV)
20|FH_F139576_0_0|SrvcGrp|113721|2022|PDM|2308.00|99|0.00|CYSTOURETHROSCOPY
20|FH_F139576_0_0|SrvcGrp|17955|2022|PDM|2393.00|99|0.00|HYSTEROSCOPY
20|FH_F139576_0_0|SrvcGrp|19920|2022|PDM|2448.00|99|0.00|ARTHROSCOPY OF SHOULDER
20|FH_F139580_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F139587_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F139587_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F139594_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F139594_0_0|CSTM-ALL|CSTM-00|2020|PDM|1239.00|99|0.00|AEG 3 (NO REV)
20|FH_F139594_0_0|CSTM-ALL|CSTM-00|2020|PDM|930.00|99|0.00|AEG 2 (NO REV)
20|FH_F139594_0_0|SrvcGrp|77444|2022|PDM|960.00|99|0.00|VASECTOMY
20|FH_F139607_0_0|CSTM-ALL|CSTM-00|2020|PDM|2653.00|99|0.00|AEG 9 W/O SURG CARVEOUT (NO REV)
20|FH_F139607_0_0|SrvcGrp|106264|2022|PDM|2598.00|99|0.00|NSL/SINS NDSC W/ SINS DILATION
20|FH_F139607_0_0|SrvcGrp|107695|2022|PDM|1645.00|99|0.00|LAPAROSCOPY SERVICES
20|FH_F139607_0_0|SrvcGrp|113463|2022|PDM|6877.00|99|0.00|LITHOTRIPSY ESWL INCIDENTAL CODES
20|FH_F139689_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F139689_0_0|SrvcGrp|107749|2022|PDM|232.00|99|0.00|CAPD/CCPD
20|FH_F139689_0_0|SrvcGrp|107750|2022|PDM|25.76|99|0.00|TRAINING INCL A TREATMENT
20|FH_F139689_0_0|SrvcGrp|108043|2022|PDM|232.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD
20|FH_F139689_0_0|SrvcGrp|113580|2022|PDM|155.00|99|0.00|DIALYSIS PATIENT TRAINING
20|FH_F139690_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F139690_0_0|SrvcGrp|108153|2022|PCT|0.90|99|0.00|PARSABIV
20|FH_F139715_0_0|SrvcGrp|112101|2022|PDM|30125.00|99|0.00|TOTAL JOINT
20|FH_F139719_0_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB
20|FH_F139750_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE
20|FH_F139758_0_0|SrvcGrp|82981|2022|PDM|90.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F139779_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F139779_0_0|CSTM-ALL|CSTM-00|2020|PCT|50.00|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F139789_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F139825_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F139825_0_0|CSTM-ALL|CSTM-00|2020|PDM|1499.00|99|0.00|AEG 5  (NO REV)
20|FH_F139825_0_0|CSTM-ALL|CSTM-00|2020|PDM|1916.00|99|0.00|AEG 6 (NO REV)
20|FH_F139825_0_0|CSTM-ALL|CSTM-00|2020|PDM|2265.00|99|0.00|AEG 8 (NO REV)
20|FH_F139825_0_0|CSTM-ALL|CSTM-00|2020|PDM|4590.00|99|0.00|IMPLANTS
20|FH_F139825_0_0|CSTM-ALL|CSTM-00|2020|PDM|6885.00|99|0.00|DEVICE INSERTION
20|FH_F139825_0_0|SrvcGrp|109348|2022|PDM|2869.00|99|0.00|EXCISION OF LESION OF EYELID
20|FH_F139825_0_0|SrvcGrp|109760|2022|PDM|6885.00|99|0.00|TRANSLUM DIL EYE CANAL
20|FH_F139825_0_0|SrvcGrp|109761|2022|PDM|4590.00|99|0.00|REMOVE EYELID LESIONS
20|FH_F139825_0_0|SrvcGrp|114443|2022|PDM|10178.00|99|0.00|EXTRACAPSULAR CATARACT REMOVAL, INSERT LENS
20|FH_F139825_0_0|SrvcGrp|42427|2022|PDM|6885.00|99|0.00|OP SURGERY CPT 65420
20|FH_F139825_0_0|SrvcGrp|42428|2022|PDM|1721.00|99|0.00|OP SURGERY CPT 65855
20|FH_F139825_0_0|SrvcGrp|78046|2022|PCT|1.00|99|0.00|AETNA AQUEOUS SHUNT
20|FH_F139825_0_0|SrvcGrp|82570|2022|PDM|4590.00|99|0.00|REVISION EYELID/EXCESS SKIN
20|FH_F139825_0_0|SrvcGrp|92549|2022|PDM|5738.00|99|0.00|REMOVAL OF EYE LESION
20|FH_F139825_0_0|SrvcGrp|95107|2022|PDM|5738.00|99|0.00|INTRAOCULAR LENS PROSTHESIS
20|FH_F139873_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F139873_0_0|CSTM-ALL|CSTM-00|2020|PDM|943.00|99|0.00|AEG 2 (NO REV)
20|FH_F139873_0_0|SrvcGrp|13990|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F139873_0_0|SrvcGrp|26274|2022|PDM|2215.00|99|0.00|CPT 29877
20|FH_F139873_0_0|SrvcGrp|26275|2022|PDM|2215.00|99|0.00|CPT 29826
20|FH_F139873_0_0|SrvcGrp|26278|2022|PDM|2215.00|99|0.00|CPT 29881
20|FH_F139873_0_0|SrvcGrp|41336|2022|PDM|2215.00|99|0.00|VAGINAL HYSTERECTOMY
20|FH_F139873_0_0|SrvcGrp|84280|2022|PDM|2992.00|99|0.00|CORNEAL TRANSPLANT
20|FH_F139887_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F139887_0_0|SrvcGrp|109788|2022|PDM|1848.00|99|0.00|REVISION OF HAMMERTOE
20|FH_F139887_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F139887_0_0|SrvcGrp|113590|2022|PDM|1848.00|99|0.00|PART REMOVAL OF METATARSAL
20|FH_F139887_0_0|SrvcGrp|41327|2022|PDM|1848.00|99|0.00|OP SURGERY CPT 28308
20|FH_F139916_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F139927_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.74|99|0.00|OP SVCS
20|FH_F139927_0_0|SrvcGrp|33166|2022|PDM|702.00|99|0.00|SKILLED NURSING - LEVEL III
20|FH_F139952_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F139952_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F139952_0_0|CSTM-ALL|CSTM-00|2020|PDM|888.00|99|0.00|AEG 2 (NO REV)
20|FH_F140007_0_0|CSTM-ALL|CSTM-00|2020|PDM|1824.00|99|0.00|AEG 2 (NO REV)
20|FH_F140007_0_0|CSTM-ALL|CSTM-00|2020|PDM|2418.00|99|0.00|AEG 4 (NO REV)
20|FH_F140007_0_0|CSTM-ALL|CSTM-00|2020|PDM|3647.00|99|0.00|AEG 8 (NO REV)
20|FH_F140007_0_0|CSTM-ALL|CSTM-00|2020|PDM|4076.00|99|0.00|AEG 7 (NO REV)
20|FH_F140007_0_0|CSTM-ALL|CSTM-00|2020|PDM|4312.00|99|0.00|AEG 9 (NO REV)
20|FH_F140007_0_0|SrvcGrp|16669|2022|PDM|3470.00|99|0.00|ACROMINOPLASTY OF SHOULDER
20|FH_F140007_0_0|SrvcGrp|16694|2022|PDM|3539.00|99|0.00|KNEE SCOPE, CHONDROPLASTY
20|FH_F140007_0_0|SrvcGrp|19920|2022|PDM|3539.00|99|0.00|ARTHROSCOPY OF SHOULDER
20|FH_F140007_0_0|SrvcGrp|19921|2022|PDM|4828.00|99|0.00|ARTHROSCOPICALLY LIGAMENT REPAIR
20|FH_F140007_0_0|SrvcGrp|38015|2022|PDM|7887.00|99|0.00|ARTHRODESIS
20|FH_F140007_0_0|SrvcGrp|3932|2022|PDM|4505.00|99|0.00|LITHOTRIPSY
20|FH_F140007_0_0|SrvcGrp|44461|2022|PDM|7887.00|99|0.00|INSERTION / REPLACEMENT OF SPINAL NEUROSTIMULATOR GENERATOR
20|FH_F140007_0_0|SrvcGrp|64761|2022|PDM|8045.00|99|0.00|DISCECTOMY
20|FH_F140007_0_0|SrvcGrp|80139|2022|PDM|7887.00|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F140007_0_0|SrvcGrp|96350|2022|PDM|7887.00|99|0.00|SHOULDER JOINT
20|FH_F140007_0_0|SrvcGrp|96959|2022|PDM|3539.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F140007_0_0|SrvcGrp|96999|2022|PDM|3470.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F140007_0_0|SrvcGrp|97139|2022|PDM|8045.00|99|0.00|LAMINECTOMY W/FACETECTOMY
20|FH_F140007_0_0|SrvcGrp|97199|2022|PDM|8045.00|99|0.00|THORAX SPINE DISK SURGERY
20|FH_F140007_0_0|SrvcGrp|97279|2022|PDM|8045.00|99|0.00|REMOVE SPINE ELTRD PERQ ARAY
20|FH_F140007_0_0|SrvcGrp|97299|2022|PDM|7887.00|99|0.00|REMOVE SPINE ELTRD PLATE
20|FH_F140007_0_0|SrvcGrp|97319|2022|PDM|8045.00|99|0.00|REVISE SPINE ELTRD PLATE
20|FH_F140035_0_0|SrvcGrp|42971|2022|PDM|211.00|99|0.00|SKN RN
20|FH_F140035_0_0|SrvcGrp|44042|2022|PDM|176.00|99|0.00|SKILLED NURSING - LPN
20|FH_F140035_0_0|SrvcGrp|46424|2022|PDM|206.00|99|0.00|HI TECH SKILLED NURSING SERVICES
20|FH_F140035_0_0|SrvcGrp|46605|2022|PDM|192.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES
20|FH_F140035_0_0|SrvcGrp|48398|2022|PDM|192.00|99|0.00|PT SERVICES
20|FH_F140035_0_0|SrvcGrp|84778|2022|PDM|1030.00|99|0.00|HOSPICE SERVICES
20|FH_F140102_0_0|SrvcGrp|104228|2022|PDM|105.00|99|0.00|HOSPICE CARE (HCFA)
20|FH_F140102_0_0|SrvcGrp|113620|2022|PDM|105.00|99|0.00|HOSPICE CARE
20|FH_F140102_0_0|SrvcGrp|29155|2022|PDM|105.00|99|0.00|HOSPICE SVCS
20|FH_F140102_0_0|SrvcGrp|80918|2022|PDM|105.00|99|0.00|RESPITE CARE
20|FH_F140102_0_0|SrvcGrp|82222|2022|PDM|105.00|99|0.00|HOSPICE CARE
20|FH_F140102_0_0|SrvcGrp|83857|2022|PDM|550.00|99|0.00|IP HOSPICE SVCS
20|FH_F140105_0_0|CSTM-ALL|CSTM-00|2020|PDM|871.00|99|0.00|AEG 4 (NO REV)
20|FH_F140105_0_0|CSTM-ALL|CSTM-00|2020|PDM|871.00|99|0.00|AEG 8 (NO REV)
20|FH_F140105_0_0|CSTM-ALL|CSTM-00|2020|PDM|871.00|99|0.00|AEG 9 (NO REV)
20|FH_F140105_0_0|CSTM-ALL|CSTM-00|2020|PDM|888.00|99|0.00|AEG 6 (NO REV)
20|FH_F140209_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F140209_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|AEG 7 (NO REV)
20|FH_F140209_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 1 (NO REV)
20|FH_F140247_0_0|CSTM-ALL|CSTM-00|2020|PCT|300.00|99|0.00|HSS ASC
20|FH_F140295_0_0|CSTM-ALL|CSTM-00|2020|PDM|1342.00|99|0.00|AEG 1 (NO REV)
20|FH_F140295_0_0|CSTM-ALL|CSTM-00|2020|PDM|2117.00|99|0.00|AEG 4 (NO REV)
20|FH_F140295_0_0|SrvcGrp|100000|2022|PDM|18566.00|99|0.00|RECONSTRUCT WRIST DIST ULNA
20|FH_F140295_0_0|SrvcGrp|109967|2022|PDM|4319.00|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F140295_0_0|SrvcGrp|113629|2022|PDM|8755.00|99|0.00|RECONSTRUCT ELBOW JOINT
20|FH_F140295_0_0|SrvcGrp|27261|2022|PDM|11219.00|99|0.00|CPT 27446
20|FH_F140295_0_0|SrvcGrp|35672|2022|PDM|6715.00|99|0.00|CPT 23412
20|FH_F140295_0_0|SrvcGrp|58634|2022|PDM|2157.00|99|0.00|NEUROELECTRODES IMPLANT
20|FH_F140295_0_0|SrvcGrp|69981|2022|PDM|3378.00|99|0.00|CPT 24358
20|FH_F140295_0_0|SrvcGrp|70749|2022|PDM|3395.00|99|0.00|CPT 29823
20|FH_F140295_0_0|SrvcGrp|71666|2022|PDM|6668.00|99|0.00|CPT 63655
20|FH_F140295_0_0|SrvcGrp|76604|2022|PDM|3574.00|99|0.00|CPT 25447
20|FH_F140295_0_0|SrvcGrp|78096|2022|PDM|4635.00|99|0.00|AETNA ARTHROSCOPY BICEPS
20|FH_F140295_0_0|SrvcGrp|82113|2022|PDM|3543.00|99|0.00|KNEE ARTHROSCOPY SURGERY
20|FH_F140295_0_0|SrvcGrp|82720|2022|PDM|5103.00|99|0.00|WRIST ENDOSCOPY/SURGERY
20|FH_F140295_0_0|SrvcGrp|88157|2022|PDM|13905.00|99|0.00|TOTAL HIP ARTHROPLASTY
20|FH_F140295_0_0|SrvcGrp|90343|2022|PDM|7068.00|99|0.00|CERVICE CORPECTOMY 1 LEVEL
20|FH_F140295_0_0|SrvcGrp|92363|2022|PDM|3502.00|99|0.00|OSTEOCHONDRAL ALLOGRAFT KNEE
20|FH_F140295_0_0|SrvcGrp|92821|2022|PDM|5974.00|99|0.00|HIP ARTHROSCOPY W/ LABRAL REPAIR
20|FH_F140295_0_0|SrvcGrp|99161|2022|PDM|11845.00|99|0.00|CPT 27138
20|FH_F140349_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F140349_0_0|CSTM-ALL|CSTM-00|2020|PDM|280.00|99|0.00|AEG 1 (NO REV)
20|FH_F140349_0_0|CSTM-ALL|CSTM-00|2020|PDM|374.00|99|0.00|AEG 2 (NO REV)
20|FH_F140349_0_0|CSTM-ALL|CSTM-00|2020|PDM|428.00|99|0.00|AEG 7 (NO REV)
20|FH_F140349_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F140349_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F140373_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F140373_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F140373_0_0|CSTM-ALL|CSTM-00|2020|PDM|1068.00|99|0.00|AEG 4 (NO REV)
20|FH_F140373_0_0|CSTM-ALL|CSTM-00|2020|PDM|986.00|99|0.00|AEG 10 (NO REV)
20|FH_F140373_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F140427_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|AEG 6 (NO REV)
20|FH_F140427_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|AEG 4 (NO REV)
20|FH_F140427_0_0|CSTM-ALL|CSTM-00|2020|PDM|825.00|99|0.00|AEG 2 (NO REV)
20|FH_F140427_0_0|SrvcGrp|104924|2022|PCT|1.00|99|0.00|GUIDE WIRE
20|FH_F140427_0_0|SrvcGrp|109506|2022|PDM|2500.00|99|0.00|INSRT PULSE GEN W/ DUAL LEADS
20|FH_F140427_0_0|SrvcGrp|113624|2022|PDM|2750.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F140427_0_0|SrvcGrp|88481|2022|PDM|2500.00|99|0.00|AETNA RMVL & RPLCMT DFB GEN MLT LEAD
20|FH_F140427_0_0|SrvcGrp|91959|2022|PDM|2500.00|99|0.00|INSERT PULSE GENERATOR
20|FH_F140472_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F140472_0_0|SrvcGrp|17100|2022|PDM|600.00|99|0.00|SKILLED NURSING
20|FH_F140472_0_0|SrvcGrp|8950|2022|PDM|850.00|99|0.00|INTERMEDIATE ICU/CCU
20|FH_F140578_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F140581_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F140581_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F140583_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F140608_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F140608_0_0|SrvcGrp|29346|2022|PDM|122.00|99|0.00|SKILLED NURSING- LPN
20|FH_F140608_0_0|SrvcGrp|46605|2022|PDM|134.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES
20|FH_F140608_0_0|SrvcGrp|88621|2022|PDM|120.00|99|0.00|SKILLED NURSING LPN
20|FH_F140629_0_0|CSTM-ALL|CSTM-00|2020|PDM|1098.00|99|0.00|AEG 10 (NO REV)
20|FH_F140629_0_0|CSTM-ALL|CSTM-00|2020|PDM|873.00|99|0.00|AEG 2 (NO REV)
20|FH_F140629_0_0|CSTM-ALL|CSTM-00|2020|PDM|918.00|99|0.00|AEG 3 (NO REV)
20|FH_F140629_0_0|SrvcGrp|103835|2022|PDM|1016.00|99|0.00|AETNA REMOVE BLADDER STONE
20|FH_F140629_0_0|SrvcGrp|107440|2022|PDM|1016.00|99|0.00|AETNA CYSTOSCOPY
20|FH_F140629_0_0|SrvcGrp|107778|2022|PDM|2497.00|99|0.00|ARTHROSCOPIC FRACTURE TX
20|FH_F140629_0_0|SrvcGrp|109132|2022|PDM|2497.00|99|0.00|ARTHROSCOPIC FRACTURE TX
20|FH_F140629_0_0|SrvcGrp|113666|2022|PDM|2497.00|99|0.00|LAPAROSCOPY
20|FH_F140629_0_0|SrvcGrp|113690|2022|PDM|2497.00|99|0.00|KNEE ARTHROSCOPY
20|FH_F140629_0_0|SrvcGrp|113691|2022|PDM|2497.00|99|0.00|LAPAROSCOPY
20|FH_F140629_0_0|SrvcGrp|26280|2022|PDM|2497.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F140629_0_0|SrvcGrp|33985|2022|PDM|1016.00|99|0.00|CPT 19120
20|FH_F140629_0_0|SrvcGrp|47142|2022|PDM|2497.00|99|0.00|CPT 49650
20|FH_F140629_0_0|SrvcGrp|77448|2022|PDM|1016.00|99|0.00|CYSTOSCOPY AND TREATMENT
20|FH_F140629_0_0|SrvcGrp|77460|2022|PDM|2497.00|99|0.00|CPT 38571
20|FH_F140629_0_0|SrvcGrp|78286|2022|PDM|78286.00|99|0.00|CPT 49322
20|FH_F140629_0_0|SrvcGrp|78911|2022|PDM|2497.00|99|0.00|LAPARO HERNIA REPAIR RECUR
20|FH_F140629_0_0|SrvcGrp|82115|2022|PDM|1302.00|99|0.00|REPAIR UMBIL HERNIA
20|FH_F140629_0_0|SrvcGrp|83647|2022|PDM|2497.00|99|0.00|CPT 47564
20|FH_F140629_0_0|SrvcGrp|87053|2022|PDM|1016.00|99|0.00|CYSTOSCOPY AND TREATMENT
20|FH_F140629_0_0|SrvcGrp|87841|2022|PDM|2497.00|99|0.00|LAPAROSCOPE PROCEDURE - STOMACH
20|FH_F140629_0_0|SrvcGrp|88144|2022|PDM|2497.00|99|0.00|LAPAROSCOPY BIOPSY
20|FH_F140629_0_0|SrvcGrp|88597|2022|PDM|2497.00|99|0.00|INTERNAL FIX FOR FRACT/INSTA
20|FH_F140629_0_0|SrvcGrp|90801|2022|PDM|1302.00|99|0.00|REPAIR EPIGASTRIC HERNIA REDUCED
20|FH_F140629_0_0|SrvcGrp|92019|2022|PDM|2497.00|99|0.00|ARTHROSCOPY
20|FH_F140651_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F140651_0_0|CSTM-ALL|CSTM-00|2020|PDM|2024.00|99|0.00|AEG 3 (NO REV)
20|FH_F140651_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F140689_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F140690_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F140762_0_0|CSTM-ALL|CSTM-00|2020|PDM|1401.00|99|0.00|AEG 8 (NO REV)
20|FH_F140762_0_0|CSTM-ALL|CSTM-00|2020|PDM|1654.00|99|0.00|AEG 9 (NO REV)
20|FH_F140762_0_0|SrvcGrp|113693|2022|PDM|956.42|99|0.00|INCISE INNER EYE ADHESIONS
20|FH_F140762_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS
20|FH_F140790_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 8 (NO REV)
20|FH_F140790_0_0|CSTM-ALL|CSTM-00|2020|PDM|779.00|99|0.00|AEG 4 (NO REV)
20|FH_F140790_0_0|CSTM-ALL|CSTM-00|2020|PDM|886.00|99|0.00|AEG 5  (NO REV)
20|FH_F140790_0_0|SrvcGrp|113187|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F140790_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F140790_0_0|SrvcGrp|28548|2022|PDM|2750.00|99|0.00|VITRECTOMY
20|FH_F140790_0_0|SrvcGrp|46887|2022|PDM|2750.00|99|0.00|REPAIR DETACHED RETINA
20|FH_F140808_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F140808_0_0|CSTM-ALL|CSTM-00|2020|PDM|541.00|99|0.00|AEG 1 (NO REV)
20|FH_F140827_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F140827_0_0|CSTM-ALL|CSTM-00|2020|PDM|1179.00|99|0.00|AEG 3 (NO REV)
20|FH_F140827_0_0|CSTM-ALL|CSTM-00|2020|PDM|1270.00|99|0.00|AEG 4 (NO REV)
20|FH_F140827_0_0|CSTM-ALL|CSTM-00|2020|PDM|2048.00|99|0.00|AEG 7 (NO REV)
20|FH_F140827_0_0|CSTM-ALL|CSTM-00|2020|PDM|3061.00|99|0.00|AEG 9 (NO REV)
20|FH_F140827_0_0|CSTM-ALL|CSTM-00|2020|PDM|804.00|99|0.00|AEG 2 (NO REV)
20|FH_F140827_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F140827_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F140873_0_0|SrvcGrp|29155|2022|PDM|152.00|99|0.00|HOSPICE SVCS
20|FH_F140873_0_0|SrvcGrp|95661|2022|PDM|145.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F140987_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F140987_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|AEG 10 (NO REV)
20|FH_F140987_0_0|CSTM-ALL|CSTM-00|2020|PDM|3750.00|99|0.00|AEG 5  (NO REV)
20|FH_F140987_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|AEG 4 (NO REV)
20|FH_F140987_0_0|SrvcGrp|86233|2022|PDM|3750.00|99|0.00|AETNA RECONSTRUCT ANKLE JOINT
20|FH_F140990_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F141004_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F141004_0_0|SrvcGrp|82981|2022|PDM|90.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F141021_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F141021_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F141021_0_0|SrvcGrp|109812|2022|PDM|640.00|99|0.00|PARTIAL HOSPITALIZATION EATING DISORDERS
20|FH_F141034_0_0|SrvcGrp|109079|2022|PDM|150.00|99|0.00|SELF DIALYSIS TRAINING CAPD
20|FH_F141035_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F141035_0_0|CSTM-ALL|CSTM-00|2020|PDM|1363.00|99|0.00|AEG 2 (NO REV)
20|FH_F141035_0_0|CSTM-ALL|CSTM-00|2020|PDM|1559.00|99|0.00|AEG 3 (NO REV)
20|FH_F141035_0_0|CSTM-ALL|CSTM-00|2020|PDM|2525.00|99|0.00|AEG 6 (NO REV)
20|FH_F141035_0_0|CSTM-ALL|CSTM-00|2020|PDM|2973.00|99|0.00|AEG 8 (NO REV)
20|FH_F141035_0_0|CSTM-ALL|CSTM-00|2020|PDM|3042.00|99|0.00|AEG 7 (NO REV)
20|FH_F141035_0_0|SrvcGrp|103564|2022|PDM|3932.00|99|0.00|REPAIR FINGER TENDON
20|FH_F141035_0_0|SrvcGrp|107836|2022|PDM|7396.00|99|0.00|REPAIR FOREARM TENDON/MUSCLE
20|FH_F141035_0_0|SrvcGrp|112148|2022|PDM|10711.00|99|0.00|REPAIR OF DIGIT NERVE
20|FH_F141035_0_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F141035_0_0|SrvcGrp|113712|2022|PDM|7008.00|99|0.00|REMOVE WRIST JOINT LINING
20|FH_F141035_0_0|SrvcGrp|82109|2022|PDM|4359.00|99|0.00|REVISE ULNAR NERVE ELBOW
20|FH_F141035_0_0|SrvcGrp|91886|2022|PDM|7008.00|99|0.00|REPAIR FLEXOR TENDON ZONE 2
20|FH_F141035_0_0|SrvcGrp|92367|2022|PDM|7129.00|99|0.00|TRANSPLANT HAND TENDON
20|FH_F141035_0_0|SrvcGrp|98006|2022|PDM|7129.00|99|0.00|PHALANGEAL SHAFT FRACTURE
20|FH_F141129_0_0|SrvcGrp|24028|2022|PDM|23.00|99|0.00|LICENSED PRACTICAL NURSE
20|FH_F141129_0_0|SrvcGrp|24029|2022|PDM|34.00|99|0.00|RN HOURLY
20|FH_F141129_0_0|SrvcGrp|72784|2022|PDM|55.00|99|0.00|MEDICAL SOCIAL WORKER - VISIT LEVEL
20|FH_F141167_0_0|SrvcGrp|107747|2022|PDM|400.00|99|0.00|HOME HEMODIALYSIS
20|FH_F141167_0_0|SrvcGrp|107748|2022|PDM|500.00|99|0.00|HEMODIALYSIS IN CENTER
20|FH_F141167_0_0|SrvcGrp|108043|2022|PDM|214.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD
20|FH_F141169_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F141169_0_0|CSTM-ALL|CSTM-00|2020|PDM|369.00|99|0.00|AEG 1 (NO REV)
20|FH_F141169_0_0|SrvcGrp|74670|2022|PCT|0.00|99|0.00|AETNA OP INTRAOCULAR LENS
20|FH_F141169_0_0|SrvcGrp|85980|2022|PDM|2468.00|99|0.00|CPT 58670
20|FH_F141169_0_0|SrvcGrp|85981|2022|PDM|2468.00|99|0.00|CPT 58671
20|FH_F141170_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F141170_0_0|CSTM-ALL|CSTM-00|2020|PDM|1265.00|99|0.00|AEG 5  (NO REV)
20|FH_F141170_0_0|CSTM-ALL|CSTM-00|2020|PDM|1613.00|99|0.00|AEG 8 (NO REV)
20|FH_F141170_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|AEG 7 (NO REV)
20|FH_F141170_0_0|SrvcGrp|103587|2022|PDM|6000.00|99|0.00|THORACIC AORTA
20|FH_F141170_0_0|SrvcGrp|103594|2022|PDM|6000.00|99|0.00|INTRACRANIAL ART
20|FH_F141170_0_0|SrvcGrp|110761|2022|PDM|1000.00|99|0.00|SPINAL OSTEREOTACTIC
20|FH_F141170_0_0|SrvcGrp|58638|2022|PDM|3740.00|99|0.00|CPT 63688
20|FH_F141170_0_0|SrvcGrp|67069|2022|PDM|8000.00|99|0.00|CPT 22634
20|FH_F141170_0_0|SrvcGrp|67119|2022|PDM|17500.00|99|0.00|ARTHODESIS
20|FH_F141170_0_0|SrvcGrp|88163|2022|PDM|8010.00|99|0.00|LUMBAR SPINE FUSION
20|FH_F141170_0_0|SrvcGrp|88164|2022|PDM|18000.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR
20|FH_F141170_0_0|SrvcGrp|89842|2022|PDM|18500.00|99|0.00|LUMBAR
20|FH_F141170_0_0|SrvcGrp|92410|2022|PDM|8000.00|99|0.00|SPINE FUSION EXTRA SEGMENT
20|FH_F141170_0_0|SrvcGrp|93724|2022|PDM|2001.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY
20|FH_F141170_0_0|SrvcGrp|93807|2022|PDM|4770.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY
20|FH_F141170_0_0|SrvcGrp|96839|2022|PDM|12980.00|99|0.00|REVISE SPINE ELTRD PLATE
20|FH_F141207_0_0|SrvcGrp|65720|2022|PDM|485.00|99|0.00|RESPITE CARE
20|FH_F141207_0_0|SrvcGrp|89781|2022|PDM|485.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F141207_0_0|SrvcGrp|93098|2022|PDM|205.00|99|0.00|HOSPICE CARE
20|FH_F141207_0_0|SrvcGrp|94780|2022|PDM|205.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)
20|FH_F141207_0_0|SrvcGrp|95661|2022|PDM|485.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F141210_0_0|CSTM-ALL|CSTM-00|2020|PDM|2034.00|99|0.00|AEG 5  (NO REV)
20|FH_F141210_0_0|CSTM-ALL|CSTM-00|2020|PDM|2303.00|99|0.00|AEG 6 (NO REV)
20|FH_F141210_0_0|SrvcGrp|106273|2022|PDM|5150.00|99|0.00|REMOVE TONSILS AND ADENOIDS
20|FH_F141210_0_0|SrvcGrp|16289|2022|PDM|4120.00|99|0.00|CARPAL TUNNEL RELEASE
20|FH_F141210_0_0|SrvcGrp|41334|2022|PDM|13648.00|99|0.00|TOTAL KNEE
20|FH_F141210_0_0|SrvcGrp|78283|2022|PDM|5305.00|99|0.00|CPT 49505
20|FH_F141211_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F141211_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F141211_0_0|CSTM-ALL|CSTM-00|2020|PDM|1133.00|99|0.00|AEG 1 (NO REV)
20|FH_F141211_0_0|CSTM-ALL|CSTM-00|2020|PDM|2957.00|99|0.00|AEG 8 (NO REV)
20|FH_F141211_0_0|SrvcGrp|11306|2022|PCT|0.45|99|0.00|IMPLANTS
20|FH_F141217_0_0|CSTM-ALL|CSTM-00|2020|PDM|728.00|99|0.00|AEG 10 (NO REV)
20|FH_F141217_0_0|SrvcGrp|73610|2022|PCT|0.97|99|0.00|AETNA IMPLANTS
20|FH_F141217_0_0|SrvcGrp|89404|2022|PDM|9500.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F141217_0_0|SrvcGrp|99163|2022|PDM|9500.00|99|0.00|CPT 27703
20|FH_F141267_0_0|SrvcGrp|104229|2022|PDM|172.00|99|0.00|HOSPICE IN HOME (HCFA)
20|FH_F141267_0_0|SrvcGrp|104230|2022|PDM|90.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F141267_0_0|SrvcGrp|106927|2022|PDM|172.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)
20|FH_F141267_0_0|SrvcGrp|29155|2022|PDM|172.00|99|0.00|HOSPICE SVCS
20|FH_F141274_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F141274_0_0|CSTM-ALL|CSTM-00|2020|PDM|10.00|99|0.00|LABORATORY (MOD 26)
20|FH_F141411_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 10 (NO REV)
20|FH_F141411_0_0|CSTM-ALL|CSTM-00|2020|PDM|250.00|99|0.00|AEG 1 (NO REV)
20|FH_F141411_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 3 (NO REV)
20|FH_F141411_0_0|SrvcGrp|107095|2022|PDM|4500.00|99|0.00|COMPLEX  WOUND DRAINAGE
20|FH_F141411_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F141411_0_0|SrvcGrp|113761|2022|PDM|8000.00|99|0.00|CMPLX RPR E/N/E/L 2.6-7.5 CM
20|FH_F141411_0_0|SrvcGrp|86462|2022|PDM|9000.00|99|0.00|AREOLA RECONSTRUCTION
20|FH_F141447_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 5  (NO REV)
20|FH_F141447_0_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F141447_0_0|SrvcGrp|58755|2022|PDM|1452.00|99|0.00|INJECTION PROC FOR JOINT
20|FH_F141471_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F141471_0_0|CSTM-ALL|CSTM-00|2020|PDM|2400.00|99|0.00|AEG 7 (NO REV)
20|FH_F141471_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 4 (NO REV)
20|FH_F141471_0_0|SrvcGrp|107794|2022|PDM|3877.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE
20|FH_F141471_0_0|SrvcGrp|113777|2022|PDM|7500.00|99|0.00|PERCUTANEOUS AVF
20|FH_F141507_0_0|CSTM-ALL|CSTM-00|2020|PDM|1339.00|99|0.00|AEG 4 (NO REV) W/O EYE PROCEDURE
20|FH_F141507_0_0|CSTM-ALL|CSTM-00|2020|PDM|2419.00|99|0.00|AEG 9 (NO REV)
20|FH_F141507_0_0|SrvcGrp|106235|2022|PDM|2400.00|99|0.00|CYPASS
20|FH_F141507_0_0|SrvcGrp|12491|2022|PCT|0.00|99|0.00|PACEMAKER
20|FH_F141507_0_0|SrvcGrp|26916|2022|PCT|0.00|99|0.00|IMPLANTS/PROSHETICS/ORTHOTICS
20|FH_F141507_0_0|SrvcGrp|74670|2022|PCT|0.00|99|0.00|AETNA OP INTRAOCULAR LENS
20|FH_F141507_0_0|SrvcGrp|95819|2022|PDM|1890.00|99|0.00|GONIOTOMY
20|FH_F141511_0_0|SrvcGrp|36093|2022|PCT|0.00|99|0.00|ACUTE REHABILITATION
20|FH_F141651_0_0|CSTM-ALL|CSTM-00|2020|PDM|1375.00|99|0.00|AEG 7 (NO REV)
20|FH_F141651_0_0|CSTM-ALL|CSTM-00|2020|PDM|715.00|99|0.00|AEG 2 (NO REV)
20|FH_F141651_0_0|CSTM-ALL|CSTM-00|2020|PDM|891.00|99|0.00|AEG 4 (NO REV)
20|FH_F141651_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F141651_0_0|SrvcGrp|111209|2022|PDM|1870.00|99|0.00|TONGUE BASE VOL REDUCTION
20|FH_F141651_0_0|SrvcGrp|113814|2022|PDM|3850.00|99|0.00|LYSIS INTRANASAL SYNECHIA
20|FH_F141651_0_0|SrvcGrp|59705|2022|PDM|2750.00|99|0.00|SEPTOPLASTY
20|FH_F141651_0_0|SrvcGrp|59841|2022|PDM|2200.00|99|0.00|SUBMUCOUS RESECTION
20|FH_F141651_0_0|SrvcGrp|83644|2022|PDM|3300.00|99|0.00|CPT 30465
20|FH_F141651_0_0|SrvcGrp|86463|2022|PDM|2310.00|99|0.00|FRACTURE NASAL INFERIOR
20|FH_F141651_0_0|SrvcGrp|89853|2022|PDM|2200.00|99|0.00|NASAL/SINUS ENDOSCOPY-SURG
20|FH_F141651_0_0|SrvcGrp|89882|2022|PDM|3850.00|99|0.00|AETNA REMOVAL OF TONSILS
20|FH_F141651_0_0|SrvcGrp|90366|2022|PDM|3850.00|99|0.00|RHINOPLASTY COMPLETE EXT PRT
20|FH_F141651_0_0|SrvcGrp|91422|2022|PDM|2200.00|99|0.00|REMOVAL OF ADENOIDS
20|FH_F141651_0_0|SrvcGrp|94989|2022|PDM|3850.00|99|0.00|SINUS ENDO W/ BALLOON DILATION
20|FH_F141707_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|AEG 4 (NO REV)
20|FH_F141829_0_0|SrvcGrp|106294|2022|PDM|295.57|99|0.00|AMBULANCE SERVICE EMERGENCY TRANSPORT LEVEL 1 (HFCA)
20|FH_F141829_0_0|SrvcGrp|106314|2022|PDM|659.39|99|0.00|ADVANCED LIFE SUPPORT LEVEL 2 (ALS2) (HCFA)
20|FH_F141829_0_0|SrvcGrp|13597|2022|PDM|247.28|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT
20|FH_F141837_0_0|SrvcGrp|100961|2022|PDM|1000.00|99|0.00|AMB SRVC NEONAT TRNSPRT BS RATE EMERG 1 WAY
20|FH_F141837_0_0|SrvcGrp|106291|2022|PDM|450.00|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT LEVEL 1 (HCFA)
20|FH_F141861_0_0|CSTM-ALL|CSTM-00|2020|PDM|519.00|99|0.00|AEG 2 (NO REV)
20|FH_F141861_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 6 (NO REV)
20|FH_F141873_0_0|SrvcGrp|74694|2022|PDM|702.00|99|0.00|AETNA INPATIENT SERVICES
20|FH_F141873_0_0|SrvcGrp|75419|2022|PDM|407.00|99|0.00|OP PARTIAL HOSPITALIZATION
20|FH_F141874_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F141874_0_0|SrvcGrp|92501|2022|PDM|379.05|99|0.00|HOSPICE IP RESPITE CARE
20|FH_F141874_0_0|SrvcGrp|92502|2022|PDM|854.25|99|0.00|HOSPICE GENERAL IP CARE
20|FH_F141877_0_0|CSTM-ALL|CSTM-00|2020|PDM|307.00|99|0.00|AEG 1 (NO REV)
20|FH_F141877_0_0|CSTM-ALL|CSTM-00|2020|PDM|412.00|99|0.00|AEG 2 (NO REV)
20|FH_F141877_0_0|CSTM-ALL|CSTM-00|2020|PDM|468.00|99|0.00|AEG 3 (NO REV)
20|FH_F141877_0_0|CSTM-ALL|CSTM-00|2020|PDM|919.00|99|0.00|AEG 7 (NO REV)
20|FH_F141877_0_0|SrvcGrp|83825|2022|PCT|0.00|99|0.00|CARDIAC CATH
20|FH_F141901_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F141901_0_0|CSTM-ALL|CSTM-00|2020|PDM|1168.16|99|0.00|ASPG VIII
20|FH_F141937_0_0|SrvcGrp|82981|2022|PDM|90.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F142007_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE
20|FH_F142070_0_0|SrvcGrp|108042|2022|PDM|700.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD
20|FH_F142070_0_0|SrvcGrp|113580|2022|PDM|150.00|99|0.00|DIALYSIS PATIENT TRAINING
20|FH_F142073_0_0|CSTM-ALL|CSTM-00|2020|PDM|1195.00|99|0.00|AEG 4 (NO REV)
20|FH_F142073_0_0|CSTM-ALL|CSTM-00|2020|PDM|1890.00|99|0.00|AEG 8 (NO REV)
20|FH_F142073_0_0|CSTM-ALL|CSTM-00|2020|PDM|890.00|99|0.00|AEG 2 (NO REV)
20|FH_F142073_0_0|SrvcGrp|101102|2022|PDM|11900.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT
20|FH_F142073_0_0|SrvcGrp|101279|2022|PDM|11900.00|99|0.00|ADDL NECK SPINE FUSION
20|FH_F142073_0_0|SrvcGrp|101280|2022|PDM|11900.00|99|0.00|TOTAL HIP ARTHROPLASTY
20|FH_F142073_0_0|SrvcGrp|109965|2022|PDM|5980.00|99|0.00|THORAX SPINE DISK SURGERY
20|FH_F142073_0_0|SrvcGrp|16692|2022|PDM|1500.00|99|0.00|KNEE SCOPE
20|FH_F142073_0_0|SrvcGrp|19920|2022|PDM|2300.00|99|0.00|ARTHROSCOPY OF SHOULDER
20|FH_F142073_0_0|SrvcGrp|19922|2022|PDM|2400.00|99|0.00|ARTHROSCOPY OF SHOULDER
20|FH_F142073_0_0|SrvcGrp|26273|2022|PDM|1500.00|99|0.00|CPT 29880
20|FH_F142073_0_0|SrvcGrp|26278|2022|PDM|1500.00|99|0.00|CPT 29881
20|FH_F142073_0_0|SrvcGrp|27261|2022|PDM|11900.00|99|0.00|CPT 27446
20|FH_F142073_0_0|SrvcGrp|33982|2022|PDM|1400.00|99|0.00|CPT 28296
20|FH_F142073_0_0|SrvcGrp|34606|2022|PDM|2400.00|99|0.00|CPT 29827
20|FH_F142073_0_0|SrvcGrp|40002|2022|PDM|11900.00|99|0.00|TOTAL HIP
20|FH_F142073_0_0|SrvcGrp|67066|2022|PDM|11900.00|99|0.00|CERVICAL SURGERY
20|FH_F142073_0_0|SrvcGrp|69884|2022|PDM|11900.00|99|0.00|ARTHRODESIS
20|FH_F142073_0_0|SrvcGrp|76603|2022|PDM|990.00|99|0.00|CPT 25111
20|FH_F142073_0_0|SrvcGrp|78096|2022|PDM|2400.00|99|0.00|AETNA ARTHROSCOPY BICEPS
20|FH_F142073_0_0|SrvcGrp|80617|2022|PDM|11900.00|99|0.00|ARTHOPLASTY
20|FH_F142073_0_0|SrvcGrp|82107|2022|PDM|1700.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F142073_0_0|SrvcGrp|84442|2022|PDM|11900.00|99|0.00|REVISION KNEE
20|FH_F142073_0_0|SrvcGrp|88156|2022|PDM|11900.00|99|0.00|REVISION OF KNEE JOINT
20|FH_F142073_0_0|SrvcGrp|88158|2022|PDM|5980.00|99|0.00|NECK SPINE DISK SURGERY
20|FH_F142073_0_0|SrvcGrp|88161|2022|PDM|5980.00|99|0.00|LAMINECTOMY W/FACE-THORACIC
20|FH_F142073_0_0|SrvcGrp|88162|2022|PDM|5980.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON
20|FH_F142073_0_0|SrvcGrp|92413|2022|PDM|5980.00|99|0.00|SPINAL CRD DECOMP->2 THORAC
20|FH_F142073_0_0|SrvcGrp|92416|2022|PDM|5980.00|99|0.00|CERVICAL LAMINOTOMY
20|FH_F142073_0_0|SrvcGrp|97179|2022|PDM|5980.00|99|0.00|DECOMPRESS SPINE CORD ADD-ON
20|FH_F142073_0_0|SrvcGrp|98203|2022|PDM|1400.00|99|0.00|BUNION CORRECTION
20|FH_F142073_0_0|SrvcGrp|98498|2022|PDM|5980.00|99|0.00|TRANSPEDICULAR 1 SEG THORACIC
20|FH_F142073_0_0|SrvcGrp|98572|2022|PDM|5980.00|99|0.00|SPINE INFUSION
20|FH_F142087_0_0|SrvcGrp|113851|2022|PDM|15000.00|99|0.00|ARTHRDSIS LAT MINI DISKECT
20|FH_F142229_0_0|CSTM-ALL|CSTM-00|2020|PCT|54.80|99|0.00|OP SVCS
20|FH_F142327_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F142327_0_0|SrvcGrp|113922|2022|PDM|450.00|99|0.00|ANTERIOR CHAMBER INTRAOCULAR
20|FH_F142327_0_0|SrvcGrp|113923|2022|PDM|450.00|99|0.00|IRIS SUPPORTED INTRAOCULAR
20|FH_F142327_0_0|SrvcGrp|36273|2022|PDM|450.00|99|0.00|INTRAOCULAR LENS
20|FH_F142327_0_0|SrvcGrp|42550|2022|PDM|1500.00|99|0.00|OP SURGERY CPT 66984
20|FH_F142327_0_0|SrvcGrp|95819|2022|PDM|2800.00|99|0.00|GONIOTOMY
20|FH_F142332_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F142332_0_0|SrvcGrp|53144|2022|PDM|70.00|99|0.00|SPEECH THERAPY
20|FH_F142332_0_0|SrvcGrp|88620|2022|PDM|118.00|99|0.00|SKILLED NURSING RN
20|FH_F142370_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F142370_0_0|SrvcGrp|113174|2022|PDM|28.39|99|0.00|COVID-19 IMMUN ADMIN 2ND DOSE - PFIZER
20|FH_F142370_0_0|SrvcGrp|113175|2022|PDM|16.94|99|0.00|COVID-19 IMMUN ADMIN 1ST DOSE - MODERNA
20|FH_F142370_0_0|SrvcGrp|113542|2022|PDM|142.63|99|0.00|COVID-19 SARSCOV2 & INF A&B AMP PRB
20|FH_F142370_0_0|SrvcGrp|113549|2022|PDM|35.92|99|0.00|COVID-19 DIAGNOSTIC
20|FH_F142370_0_0|SrvcGrp|113552|2022|PDM|75.00|99|0.00|COVID-19 TEST NON-CDC HGH THRU
20|FH_F142370_0_0|SrvcGrp|113920|2022|PDM|7.00|99|0.00|COVID-19 SPECIMEN HANDLING OFFICE-LAB (HCFA)
20|FH_F142370_0_0|SrvcGrp|73483|2022|PDM|770.00|99|0.00|AETNA SUBACUTE III
20|FH_F142376_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F142376_0_0|CSTM-ALL|CSTM-00|2020|PDM|1460.00|99|0.00|AEG 10 (NO REV)
20|FH_F142376_0_0|CSTM-ALL|CSTM-00|2020|PDM|2132.00|99|0.00|AEG 8 (NO REV)
20|FH_F142376_0_0|SrvcGrp|101279|2022|PDM|7405.00|99|0.00|ADDL NECK SPINE FUSION
20|FH_F142376_0_0|SrvcGrp|110443|2022|PDM|1159.00|99|0.00|REMOVE SPINAL CANAL CATHET
20|FH_F142376_0_0|SrvcGrp|112515|2022|PDM|2805.00|99|0.00|SPINAL BONE AUTOGRAFT
20|FH_F142376_0_0|SrvcGrp|113967|2022|PDM|5666.00|99|0.00|PERQ LAMOT/LAM LUMBAR
20|FH_F142376_0_0|SrvcGrp|113974|2022|PDM|1100.00|99|0.00|NJX INTERLAMINAR CRV/THRC
20|FH_F142376_0_0|SrvcGrp|113975|2022|PDM|1100.00|99|0.00|NJX INTERLAMINAR LMBR/SAC
20|FH_F142376_0_0|SrvcGrp|113981|2022|PDM|1159.00|99|0.00|RF ABLTJ NRV NRVTG SI JT
20|FH_F142376_0_0|SrvcGrp|113982|2022|PDM|7069.00|99|0.00|SPINAL CORD DECOMPRESS
20|FH_F142376_0_0|SrvcGrp|11663|2022|PCT|0.00|99|0.00|IMPLANTS
20|FH_F142376_0_0|SrvcGrp|12491|2022|PCT|0.00|99|0.00|PACEMAKER
20|FH_F142376_0_0|SrvcGrp|44461|2022|PDM|34431.00|99|0.00|INSERTION / REPLACEMENT OF SPINAL NEUROSTIMULATOR GENERATOR
20|FH_F142376_0_0|SrvcGrp|80135|2022|PDM|19877.00|99|0.00|INSERT SPINAL INFUSION
20|FH_F142376_0_0|SrvcGrp|80136|2022|PDM|19380.00|99|0.00|IMPLANT SPINAL INFUSION
20|FH_F142376_0_0|SrvcGrp|87122|2022|PDM|1159.00|99|0.00|DESTROY CERV/THOR FACET JNT
20|FH_F142376_0_0|SrvcGrp|93740|2022|PDM|2640.00|99|0.00|REVISE/REMOVE NEURO RECEIVER
20|FH_F142376_0_0|SrvcGrp|96355|2022|PDM|7405.00|99|0.00|SPINE FIXATION
20|FH_F142376_0_0|SrvcGrp|98561|2022|PDM|1815.00|99|0.00|ARTHRODESIS POSTERIOR TECH
20|FH_F142376_0_0|SrvcGrp|98570|2022|PDM|7405.00|99|0.00|INSERT SPINE FIXATION DEVICE
20|FH_F142376_0_0|SrvcGrp|98590|2022|PDM|6892.00|99|0.00|NEUROELECTRODES IMPLANT
20|FH_F142376_0_0|SrvcGrp|98603|2022|PDM|4219.00|99|0.00|PERQ VERTEBRAL AUGMENTATION
20|FH_F142454_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F142454_0_0|CSTM-ALL|CSTM-00|2020|PDM|366.00|99|0.00|AEG 1 (NO REV)
20|FH_F142454_0_0|CSTM-ALL|CSTM-00|2020|PDM|560.00|99|0.00|AEG 3 (NO REV)
20|FH_F142454_0_0|CSTM-ALL|CSTM-00|2020|PDM|788.00|99|0.00|AEG 10 (NO REV)
20|FH_F142454_0_0|SrvcGrp|109760|2022|PDM|6000.00|99|0.00|TRANSLUM DIL EYE CANAL
20|FH_F142454_0_0|SrvcGrp|82570|2022|PDM|2800.00|99|0.00|REVISION EYELID/EXCESS SKIN
20|FH_F142611_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F142655_0_0|SrvcGrp|82981|2022|PDM|90.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F142673_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F142694_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F142710_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F142710_0_0|SrvcGrp|82222|2022|PDM|105.00|99|0.00|HOSPICE CARE
20|FH_F142785_0_0|SrvcGrp|82981|2022|PDM|100.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F142894_0_0|SrvcGrp|29155|2022|PDM|100.00|99|0.00|HOSPICE SVCS
20|FH_F142894_0_0|SrvcGrp|84185|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F142930_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F142930_0_0|SrvcGrp|113620|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F142930_0_0|SrvcGrp|33722|2022|PDM|25.00|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F142930_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F142930_0_0|SrvcGrp|82223|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F142992_0_0|SrvcGrp|82981|2022|PDM|250.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F143035_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F143036_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F143036_0_0|SrvcGrp|82981|2022|PDM|90.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F143050_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F143050_0_0|SrvcGrp|113574|2022|PDM|31500.00|99|0.00|AMBULANCE AIR TRANSPORT (HCFA)
20|FH_F143067_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F143067_0_0|SrvcGrp|105357|2022|PDM|735.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD
20|FH_F143067_0_0|SrvcGrp|111388|2022|PDM|279.00|99|0.00|ACUTE KIDNEY INJURY - IPD/CAPD/CCPD - NO ESRD
20|FH_F143067_0_0|SrvcGrp|114010|2022|PDM|750.00|99|0.00|HEMODIALYSIS PROC, OP OR HOME
20|FH_F143201_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F143289_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F143289_0_0|SrvcGrp|74668|2022|PDM|206.00|99|0.00|AETNA INTENSIVE OUTPATIENT
20|FH_F143297_0_0|CSTM-ALL|CSTM-00|2020|PDM|699.00|99|0.00|AEG 2 (NO REV)
20|FH_F143297_0_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F143335_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F143388_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F143388_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F143388_0_0|SrvcGrp|82222|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F143388_0_0|SrvcGrp|82223|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F143450_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F143450_0_0|CSTM-ALL|CSTM-00|2020|PDM|1010.00|99|0.00|AEG 6 (NO REV)
20|FH_F143450_0_0|CSTM-ALL|CSTM-00|2020|PDM|1226.00|99|0.00|AEG 8 (NO REV)
20|FH_F143450_0_0|CSTM-ALL|CSTM-00|2020|PDM|405.00|99|0.00|AEG 1 (NO REV)
20|FH_F143450_0_0|CSTM-ALL|CSTM-00|2020|PDM|560.00|99|0.00|AEG 2 (NO REV)
20|FH_F143450_0_0|CSTM-ALL|CSTM-00|2020|PDM|642.00|99|0.00|AEG 3 (NO REV)
20|FH_F143450_0_0|SrvcGrp|113576|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F143450_0_0|SrvcGrp|114023|2022|PDM|706.00|99|0.00|ESOPH ENDOSCOPY W/US EXAM
20|FH_F143450_0_0|SrvcGrp|91862|2022|PDM|706.00|99|0.00|COLONOSCOPY PROCEDURES 2
20|FH_F143457_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F143457_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|HSS ASC
20|FH_F143467_0_0|CSTM-ALL|CSTM-00|2020|PDM|1870.00|99|0.00|AEG 4 (NO REV)
20|FH_F143467_0_0|CSTM-ALL|CSTM-00|2020|PDM|2439.80|99|0.00|AEG 9 (NO REV)
20|FH_F143467_0_0|CSTM-ALL|CSTM-00|2020|PDM|880.00|99|0.00|AEG 10 (NO REV)
20|FH_F143467_0_0|SrvcGrp|100045|2022|PDM|3140.00|99|0.00|REVISION OF FOOT TENDON
20|FH_F143467_0_0|SrvcGrp|100060|2022|PDM|4157.00|99|0.00|REPAIR MIDFOOT FRACTURE EACH
20|FH_F143467_0_0|SrvcGrp|104008|2022|PDM|4753.00|99|0.00|CORRECTION HALUX RIDGUS W IMPLANTS
20|FH_F143467_0_0|SrvcGrp|112221|2022|PDM|3140.00|99|0.00|INCISION OF METATARSAL
20|FH_F143467_0_0|SrvcGrp|85778|2022|PDM|4200.00|99|0.00|REPAIR OF ANKLE FRACTURE
20|FH_F143467_0_0|SrvcGrp|90357|2022|PDM|3140.00|99|0.00|REPAIR OF ANKLE FRACTURE
20|FH_F143467_0_0|SrvcGrp|92366|2022|PDM|3140.00|99|0.00|REPAIR ACHILLES TENDON
20|FH_F143467_0_0|SrvcGrp|96542|2022|PDM|3140.00|99|0.00|REPAIR OF LEG TENDON
20|FH_F143467_0_0|SrvcGrp|99171|2022|PDM|4231.00|99|0.00|CPT 28485
20|FH_F143487_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F143487_0_0|CSTM-ALL|CSTM-00|2020|PDM|874.00|99|0.00|AEG SURGERY DEFAULT W/O AEG 1
20|FH_F143487_0_0|CSTM-ALL|CSTM-00|2020|PDM|976.00|99|0.00|AEG 2 (NO REV)
20|FH_F143528_0_0|CSTM-ALL|CSTM-00|2020|PDM|2625.00|99|0.00|AEG 5  (NO REV) W/O SURGERY
20|FH_F143528_0_0|CSTM-ALL|CSTM-00|2020|PDM|2625.00|99|0.00|AEG 8 (NO REV)
20|FH_F143528_0_0|CSTM-ALL|CSTM-00|2020|PDM|4042.50|99|0.00|AEG 7 (NO REV)
20|FH_F143528_0_0|SrvcGrp|107187|2022|PDM|2459.10|99|0.00|REVISE TWO EYE MUSCLES
20|FH_F143528_0_0|SrvcGrp|111958|2022|PDM|2625.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F143528_0_0|SrvcGrp|114090|2022|PDM|4861.50|99|0.00|ARTHROSCOPIC SERVICES
20|FH_F143528_0_0|SrvcGrp|27344|2022|PDM|1914.15|99|0.00|OP SURGERY (CPT 42821)
20|FH_F143528_0_0|SrvcGrp|36591|2022|PDM|8400.00|99|0.00|CPT 63685
20|FH_F143528_0_0|SrvcGrp|58993|2022|PDM|5250.00|99|0.00|DISKECTOMY
20|FH_F143528_0_0|SrvcGrp|71666|2022|PDM|15750.00|99|0.00|CPT 63655
20|FH_F143528_0_0|SrvcGrp|72121|2022|PDM|4359.60|99|0.00|ARTHOSCOPY
20|FH_F143528_0_0|SrvcGrp|88158|2022|PDM|4359.60|99|0.00|NECK SPINE DISK SURGERY
20|FH_F143528_0_0|SrvcGrp|88162|2022|PDM|5250.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON
20|FH_F143528_0_0|SrvcGrp|88487|2022|PDM|4861.50|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION
20|FH_F143528_0_0|SrvcGrp|89842|2022|PDM|10500.00|99|0.00|LUMBAR
20|FH_F143528_0_0|SrvcGrp|89860|2022|PDM|5250.00|99|0.00|SPINAL DISK SURGERY ADD-ON
20|FH_F143528_0_0|SrvcGrp|89882|2022|PDM|4076.10|99|0.00|AETNA REMOVAL OF TONSILS
20|FH_F143528_0_0|SrvcGrp|90430|2022|PDM|4861.50|99|0.00|REPAIR ACHILLES TENDON
20|FH_F143528_0_0|SrvcGrp|92415|2022|PDM|5250.00|99|0.00|NECK SPINE DISK SURGERY
20|FH_F143528_0_0|SrvcGrp|92416|2022|PDM|2520.00|99|0.00|CERVICAL LAMINOTOMY
20|FH_F143528_0_0|SrvcGrp|93724|2022|PDM|1575.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY
20|FH_F143528_0_0|SrvcGrp|96839|2022|PDM|8400.00|99|0.00|REVISE SPINE ELTRD PLATE
20|FH_F143528_0_0|SrvcGrp|98497|2022|PDM|10500.00|99|0.00|ARTHRODESIS POSTERIOR TECH
20|FH_F143528_0_0|SrvcGrp|99167|2022|PDM|5250.00|99|0.00|CPT 63057
20|FH_F143530_0_0|SrvcGrp|29155|2022|PDM|100.00|99|0.00|HOSPICE SVCS
20|FH_F143530_0_0|SrvcGrp|82223|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F143539_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F143539_0_0|CSTM-ALL|CSTM-00|2020|PDM|1423.00|99|0.00|AEG 10 (NO REV)
20|FH_F143539_0_0|CSTM-ALL|CSTM-00|2020|PDM|1851.00|99|0.00|AEG 6 (NO REV)
20|FH_F143539_0_0|CSTM-ALL|CSTM-00|2020|PDM|2259.00|99|0.00|AEG 7 (NO REV)
20|FH_F143539_0_0|CSTM-ALL|CSTM-00|2020|PDM|2851.94|99|0.00|AEG 9 (NO REV)
20|FH_F143539_0_0|SrvcGrp|114518|2022|PDM|6427.00|99|0.00|INSERTION DRAINAGE DEVICE
20|FH_F143539_0_0|SrvcGrp|95819|2022|PDM|6427.00|99|0.00|GONIOTOMY
20|FH_F143539_0_0|SrvcGrp|99073|2022|PDM|1.81|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F143542_0_0|CSTM-ALL|CSTM-00|2020|PDM|1196.00|99|0.00|AEG 3 (NO REV)
20|FH_F143542_0_0|CSTM-ALL|CSTM-00|2020|PDM|1916.00|99|0.00|AEG 6 (NO REV)
20|FH_F143542_0_0|SrvcGrp|106235|2022|PDM|6885.00|99|0.00|CYPASS
20|FH_F143542_0_0|SrvcGrp|109762|2022|PDM|4590.00|99|0.00|REMOVE EYELID LESION(S)
20|FH_F143542_0_0|SrvcGrp|109765|2022|PDM|1721.00|99|0.00|CLOSURE OF LACRIMAL PUNCTUM
20|FH_F143542_0_0|SrvcGrp|114443|2022|PDM|10328.00|99|0.00|EXTRACAPSULAR CATARACT REMOVAL, INSERT LENS
20|FH_F143542_0_0|SrvcGrp|42429|2022|PDM|1721.00|99|0.00|OP SURGERY CPT 66761
20|FH_F143542_0_0|SrvcGrp|42551|2022|PDM|1721.00|99|0.00|OP SURGERY
20|FH_F143542_0_0|SrvcGrp|46886|2022|PDM|4590.00|99|0.00|REMOVAL OF EYELID LESION
20|FH_F143542_0_0|SrvcGrp|62740|2022|PDM|5738.00|99|0.00|SURGERY CARVE OUTS
20|FH_F143542_0_0|SrvcGrp|84934|2022|PDM|6885.00|99|0.00|REMOVAL OF EYE LESION
20|FH_F143542_0_0|SrvcGrp|92549|2022|PDM|5738.00|99|0.00|REMOVAL OF EYE LESION
20|FH_F143564_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F143564_0_0|SrvcGrp|35921|2022|PDM|12484.00|99|0.00|BARIATRIC SURGERY
20|FH_F143564_0_0|SrvcGrp|92417|2022|PDM|3800.00|99|0.00|LAPAROSCOPY
20|FH_F143571_0_0|SrvcGrp|90478|2022|PDM|153.00|99|0.00|HOSPICE
20|FH_F143577_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F143577_0_0|SrvcGrp|82981|2022|PDM|125.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F143580_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F143648_0_0|CSTM-ALL|CSTM-00|2020|PDM|831.00|99|0.00|AEG 10 (NO REV)
20|FH_F143648_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F143648_0_0|SrvcGrp|113889|2022|PDM|1008.00|99|0.00|LYSIS OF LABIAL LESION
20|FH_F143648_0_0|SrvcGrp|11663|2022|PCT|0.00|99|0.00|IMPLANTS
20|FH_F143648_0_0|SrvcGrp|17327|2022|PDM|6000.00|99|0.00|HYSTEROSCOPY
20|FH_F143650_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F143650_0_0|SrvcGrp|26275|2022|PDM|1800.00|99|0.00|CPT 29826
20|FH_F143650_0_0|SrvcGrp|26432|2022|PDM|1800.00|99|0.00|OP SURGICAL SERVICES
20|FH_F143650_0_0|SrvcGrp|35672|2022|PDM|4000.00|99|0.00|CPT 23412
20|FH_F143650_0_0|SrvcGrp|70749|2022|PDM|1800.00|99|0.00|CPT 29823
20|FH_F143650_0_0|SrvcGrp|72994|2022|PDM|1700.00|99|0.00|AEG 3
20|FH_F143650_0_0|SrvcGrp|73006|2022|PDM|4200.00|99|0.00|AEG 9
20|FH_F143650_0_0|SrvcGrp|82107|2022|PDM|1800.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F143650_0_0|SrvcGrp|82108|2022|PDM|1800.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F143650_0_0|SrvcGrp|82110|2022|PDM|1800.00|99|0.00|KNEE ARTHROSCOPY DIAGNOSTIC
20|FH_F143650_0_0|SrvcGrp|89980|2022|PDM|3900.00|99|0.00|OPEN TREATMENT OF DISTAL
20|FH_F143668_0_0|SrvcGrp|114059|2022|PDM|600.00|99|0.00|PNEUMATIC COMPRESSOR (MOD NU)
20|FH_F143668_0_0|SrvcGrp|114066|2022|PDM|220.00|99|0.00|SEGMENTAL PNEUMATIC (MOD NU)
20|FH_F143668_0_0|SrvcGrp|114071|2022|PDM|225.00|99|0.00|PNEUMATIC COMPRESSION DEVICE (MOD RR)
20|FH_F143668_0_0|SrvcGrp|114072|2022|PDM|2250.00|99|0.00|PNEUMATIC COMPRESSION DEVICE (MOD NU)
20|FH_F143668_0_0|SrvcGrp|115710|2022|PDM|450.00|99|0.00|PNEUMATIC COMPRESSOR SEGMEN (MOD UE)
20|FH_F143668_0_0|SrvcGrp|115714|2022|PDM|165.00|99|0.00|SEGMENTAL PNEUMATIC (MOD UE)
20|FH_F143668_0_0|SrvcGrp|115716|2022|PDM|82.50|99|0.00|SEGMENTAL PNEUMATIC (MOD UE)
20|FH_F143668_0_0|SrvcGrp|115717|2022|PDM|1687.50|99|0.00|PNEUMATIC COMPRESSION DEVICE (MOD UE)
20|FH_F143684_0_0|CSTM-ALL|CSTM-00|2020|PDM|2571.00|99|0.00|AEG 8 (NO REV)
20|FH_F143684_0_0|CSTM-ALL|CSTM-00|2020|PDM|2787.00|99|0.00|AEG 9 (NO REV)
20|FH_F143684_0_0|CSTM-ALL|CSTM-00|2020|PDM|676.00|99|0.00|AEG 1 (NO REV)
20|FH_F143684_0_0|SrvcGrp|35669|2022|PDM|8323.00|99|0.00|CPT 63650
20|FH_F143684_0_0|SrvcGrp|88494|2022|PDM|5202.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION
20|FH_F143771_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F143771_0_0|SrvcGrp|29155|2022|PDM|136.00|99|0.00|HOSPICE SVCS
20|FH_F143771_0_0|SrvcGrp|83857|2022|PDM|690.00|99|0.00|IP HOSPICE SVCS
20|FH_F143771_0_0|SrvcGrp|84185|2022|PDM|133.00|99|0.00|RESPITE CARE
20|FH_F143783_0_0|SrvcGrp|80918|2022|PDM|105.00|99|0.00|RESPITE CARE
20|FH_F143783_0_0|SrvcGrp|80920|2022|PDM|105.00|99|0.00|HOSPICE SERVICES
20|FH_F143783_0_0|SrvcGrp|83522|2022|PDM|105.00|99|0.00|RESPITE CARE
20|FH_F143783_0_0|SrvcGrp|83857|2022|PDM|525.00|99|0.00|IP HOSPICE SVCS
20|FH_F143783_0_0|SrvcGrp|97702|2022|PDM|105.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)
20|FH_F143783_0_0|SrvcGrp|97704|2022|PDM|105.00|99|0.00|HOSPICE IN HOME (HCFA)
20|FH_F143828_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F143828_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|AEG 1 (NO REV)
20|FH_F143828_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AMBULATORY SURGERY W/O AEG 1
20|FH_F143832_0_0|CSTM-ALL|CSTM-00|2020|PDM|1462.99|99|0.00|AEG 5  (NO REV)
20|FH_F143832_0_0|CSTM-ALL|CSTM-00|2020|PDM|2194.73|99|0.00|AEG 6 (NO REV)
20|FH_F143832_0_0|SrvcGrp|106799|2022|PDM|5060.10|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT
20|FH_F143832_0_0|SrvcGrp|108172|2022|PDM|2429.11|99|0.00|AETNA FEM/POPL REVASE W/ATHER
20|FH_F143832_0_0|SrvcGrp|113618|2022|PDM|3133.75|99|0.00|AVF USE MAGNETIC/ART/VEN
20|FH_F143848_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F143898_0_0|SrvcGrp|110638|2022|PDM|665.00|99|0.00|HOSPICE GENERAL INPATIENT CARE
20|FH_F143898_0_0|SrvcGrp|33722|2022|PDM|36.00|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F143898_0_0|SrvcGrp|80918|2022|PDM|160.00|99|0.00|RESPITE CARE
20|FH_F143898_0_0|SrvcGrp|92501|2022|PDM|160.00|99|0.00|HOSPICE IP RESPITE CARE
20|FH_F144014_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F144021_0_0|SrvcGrp|108042|2022|PDM|497.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD
20|FH_F144029_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F144029_0_0|SrvcGrp|107747|2022|PDM|475.00|99|0.00|HOME HEMODIALYSIS
20|FH_F144029_0_0|SrvcGrp|108042|2022|PDM|500.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD
20|FH_F144039_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F144039_0_0|CSTM-ALL|CSTM-00|2020|PDM|1196.00|99|0.00|AEG 3 (NO REV)
20|FH_F144039_0_0|CSTM-ALL|CSTM-00|2020|PDM|2338.00|99|0.00|AEG 7 (NO REV)
20|FH_F144039_0_0|SrvcGrp|109758|2022|PDM|11475.00|99|0.00|COLLAGEN CROSSLINKING CORNEA
20|FH_F144039_0_0|SrvcGrp|109763|2022|PDM|2869.00|99|0.00|TREAT EYELID LESION
20|FH_F144039_0_0|SrvcGrp|109767|2022|PCT|0.00|99|0.00|COVER EYE W/ MEMBRANE INCIDENTAL CODES
20|FH_F144039_0_0|SrvcGrp|114442|2022|PDM|12049.00|99|0.00|EXTRACAPSULAR CATARACT REMOVAL, INSERT LENS
20|FH_F144039_0_0|SrvcGrp|46906|2022|PDM|9754.00|99|0.00|CORNEAL TISSUE
20|FH_F144039_0_0|SrvcGrp|84279|2022|PDM|9754.00|99|0.00|CORNEAL TRANSPLANT
20|FH_F144039_0_0|SrvcGrp|84280|2022|PDM|9754.00|99|0.00|CORNEAL TRANSPLANT
20|FH_F144191_0_0|CSTM-ALL|CSTM-00|2020|PDM|1551.00|99|0.00|AEG 8 (NO REV)
20|FH_F144191_0_0|SrvcGrp|35668|2022|PDM|3183.00|99|0.00|CPT 29824
20|FH_F144191_0_0|SrvcGrp|99073|2022|PDM|1.38|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F144228_0_0|CSTM-ALL|CSTM-00|2020|PDM|1417.00|99|0.00|AEG 2 (NO REV)
20|FH_F144228_0_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|AEG 4 (NO REV)
20|FH_F144228_0_0|CSTM-ALL|CSTM-00|2020|PDM|3685.00|99|0.00|AEG 9 (NO REV)
20|FH_F144228_0_0|CSTM-ALL|CSTM-00|2020|PDM|4093.00|99|0.00|AEG 7 (NO REV)
20|FH_F144228_0_0|SrvcGrp|101843|2022|PDM|5560.00|99|0.00|OPEN TREATMENT OF DISTAL RADIAL
20|FH_F144228_0_0|SrvcGrp|106175|2022|PDM|2374.00|99|0.00|EXCISE PAROTID GLAND/LESION
20|FH_F144228_0_0|SrvcGrp|108306|2022|PDM|5695.00|99|0.00|AETNA REPAIR ULNA FRACTURE
20|FH_F144228_0_0|SrvcGrp|113940|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F144228_0_0|SrvcGrp|114141|2022|PDM|3112.00|99|0.00|REPAIR LOWER JAW FRACTURE
20|FH_F144228_0_0|SrvcGrp|114143|2022|PDM|6626.00|99|0.00|DRILL FOR OSTEOCH/BONE GRFT
20|FH_F144228_0_0|SrvcGrp|114151|2022|PDM|7161.00|99|0.00|REBUILD OUTER EAR CANAL
20|FH_F144228_0_0|SrvcGrp|114152|2022|PDM|13158.00|99|0.00|OSSEOINTEGRATED IMPLANT
20|FH_F144228_0_0|SrvcGrp|57864|2022|PDM|3247.00|99|0.00|SUBMUCOUS RESECTION
20|FH_F144228_0_0|SrvcGrp|64736|2022|PDM|1099.00|99|0.00|CPT 45338
20|FH_F144228_0_0|SrvcGrp|98133|2022|PDM|1770.00|99|0.00|AMPUTATION TOE
20|FH_F144248_0_0|CSTM-ALL|CSTM-00|2020|PDM|2338.00|99|0.00|AEG 7 (NO REV)
20|FH_F144248_0_0|CSTM-ALL|CSTM-00|2020|PDM|2952.00|99|0.00|AEG 9 (NO REV)
20|FH_F144248_0_0|SrvcGrp|42428|2022|PDM|1721.00|99|0.00|OP SURGERY CPT 65855
20|FH_F144248_0_0|SrvcGrp|42429|2022|PDM|1721.00|99|0.00|OP SURGERY CPT 66761
20|FH_F144248_0_0|SrvcGrp|84279|2022|PDM|9754.00|99|0.00|CORNEAL TRANSPLANT
20|FH_F144248_0_0|SrvcGrp|92549|2022|PDM|5738.00|99|0.00|REMOVAL OF EYE LESION
20|FH_F144248_0_0|SrvcGrp|95819|2022|PDM|6885.00|99|0.00|GONIOTOMY
20|FH_F144291_0_0|SrvcGrp|108043|2022|PDM|182.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD
20|FH_F144291_0_0|SrvcGrp|108082|2022|PDM|25.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER
20|FH_F144548_0_0|SrvcGrp|82981|2022|PDM|90.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F144648_0_0|SrvcGrp|108082|2022|PDM|25.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER
20|FH_F144648_0_0|SrvcGrp|111468|2022|PDM|150.00|99|0.00|DIALYSIS PATIENT TRAINING
20|FH_F144651_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F144651_0_0|SrvcGrp|114170|2022|PDM|10000.00|99|0.00|LUMB ARTIF DISKECTOMY ADDL
20|FH_F144651_0_0|SrvcGrp|114173|2022|PDM|3000.00|99|0.00|CARDIAC CATHERIZATION INCL INJECTIONS
20|FH_F144651_0_0|SrvcGrp|40003|2022|PDM|15000.00|99|0.00|TOTAL KNEE
20|FH_F144651_0_0|SrvcGrp|96899|2022|PDM|15000.00|99|0.00|LUMBAR ARTIF DISCECTOMY
20|FH_F144651_0_0|SrvcGrp|98560|2022|PDM|15000.00|99|0.00|LUMBAR
20|FH_F144769_0_0|SrvcGrp|104457|2022|PDM|7386.00|99|0.00|MATERNITY CARE (C-SECTION)
20|FH_F144769_0_0|SrvcGrp|11258|2022|PCT|0.21|99|0.00|DRUGS
20|FH_F144769_0_0|SrvcGrp|73605|2022|PDM|1155.00|99|0.00|AETNA ACUTE PSYCH
20|FH_F144808_0_0|CSTM-ALL|CSTM-00|2020|PDM|2336.00|99|0.00|AEG 5  (NO REV)
20|FH_F144808_0_0|CSTM-ALL|CSTM-00|2020|PDM|2408.00|99|0.00|AEG 7 (NO REV)
20|FH_F144808_0_0|CSTM-ALL|CSTM-00|2020|PDM|2789.00|99|0.00|AEG 8 (NO REV)
20|FH_F144808_0_0|SrvcGrp|104042|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATHERTERIZATION
20|FH_F144808_0_0|SrvcGrp|114177|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F144808_0_0|SrvcGrp|27261|2022|PDM|8662.00|99|0.00|CPT 27446
20|FH_F144808_0_0|SrvcGrp|54943|2022|PDM|2888.00|99|0.00|REPAIR OF SLAP LESION
20|FH_F144808_0_0|SrvcGrp|72121|2022|PDM|2888.00|99|0.00|ARTHOSCOPY
20|FH_F144808_0_0|SrvcGrp|88159|2022|PDM|7215.00|99|0.00|LOW BACK DISK SURGERY
20|FH_F144808_0_0|SrvcGrp|89404|2022|PDM|7215.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F144808_0_0|SrvcGrp|89840|2022|PDM|7699.00|99|0.00|THORAX SPINE FUSION
20|FH_F144808_0_0|SrvcGrp|89842|2022|PDM|7699.00|99|0.00|LUMBAR
20|FH_F144808_0_0|SrvcGrp|98493|2022|PDM|7699.00|99|0.00|THORACIC
20|FH_F144808_0_0|SrvcGrp|98494|2022|PDM|7699.00|99|0.00|ARTHRODESIS PRE-SACRAL
20|FH_F144808_0_0|SrvcGrp|98496|2022|PDM|7699.00|99|0.00|ARTHRODESIS POSTERIOR ATLAS
20|FH_F144808_0_0|SrvcGrp|98497|2022|PDM|7699.00|99|0.00|ARTHRODESIS POSTERIOR TECH
20|FH_F144808_0_0|SrvcGrp|98499|2022|PDM|7215.00|99|0.00|INCISE SPINAL COLUMN NERVES
20|FH_F144808_0_0|SrvcGrp|98500|2022|PDM|7215.00|99|0.00|INCISE SPINAL COLUMN NERVES
20|FH_F144828_0_0|CSTM-ALL|CSTM-00|2020|PDM|1540.00|99|0.00|AEG 3 (NO REV) W/O CPT 14041, 14060-14061
20|FH_F144828_0_0|CSTM-ALL|CSTM-00|2020|PDM|990.00|99|0.00|AEG 2 (NO REV)
20|FH_F144828_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F144828_0_0|SrvcGrp|114191|2022|PDM|3850.00|99|0.00|EXCISION EXCESSIVE SKIN
20|FH_F144828_0_0|SrvcGrp|114195|2022|PDM|1320.00|99|0.00|SKIN TISSUE REARRANGEMENT
20|FH_F144828_0_0|SrvcGrp|114199|2022|PDM|1176.00|99|0.00|SKIN TISSUE REARRANGEMENT
20|FH_F144828_0_0|SrvcGrp|114200|2022|PDM|1176.00|99|0.00|SKIN TISSUE REARRANGEMENT
20|FH_F144848_0_0|CSTM-ALL|CSTM-00|2020|PDM|1061.00|99|0.00|AEG 8 (NO REV)
20|FH_F144848_0_0|SrvcGrp|113729|2022|PDM|16163.00|99|0.00|INSJ STABLJ DEV W/DCMPRN
20|FH_F144848_0_0|SrvcGrp|58755|2022|PDM|5959.00|99|0.00|INJECTION PROC FOR JOINT
20|FH_F144848_0_0|SrvcGrp|98580|2022|PDM|16570.00|99|0.00|ARTHRODESIS SACROILIAC JOINT
20|FH_F144988_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F144988_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F145188_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F145188_0_0|CSTM-ALL|CSTM-00|2020|PDM|369.00|99|0.00|AEG 9 (NO REV)
20|FH_F145188_0_0|CSTM-ALL|CSTM-00|2020|PDM|795.00|99|0.00|AEG 5  (NO REV)
20|FH_F145268_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F145448_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 1 (NO REV)
20|FH_F145448_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|AEG 5  (NO REV)
20|FH_F145508_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F145508_0_0|SrvcGrp|104226|2022|PDM|181.21|99|0.00|HOSPICE CARE (HCFA)
20|FH_F145508_0_0|SrvcGrp|104230|2022|PDM|181.21|99|0.00|RESPITE CARE (HCFA)
20|FH_F145508_0_0|SrvcGrp|80918|2022|PDM|448.40|99|0.00|RESPITE CARE
20|FH_F145508_0_0|SrvcGrp|84185|2022|PDM|181.21|99|0.00|RESPITE CARE
20|FH_F145508_0_0|SrvcGrp|95661|2022|PDM|448.40|99|0.00|RESPITE CARE (HCFA)
20|FH_F145543_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F145543_0_0|CSTM-ALL|CSTM-00|2020|PDM|311.00|99|0.00|AEG 10 (NO REV)
20|FH_F145543_0_0|CSTM-ALL|CSTM-00|2020|PDM|589.00|99|0.00|AEG 4 (NO REV)
20|FH_F145543_0_0|SrvcGrp|113197|2022|PDM|931.00|99|0.00|FISTULIZATION OF SCLERA
20|FH_F145543_0_0|SrvcGrp|54084|2022|PDM|1339.00|99|0.00|IMPLANT EYE SHUNT
20|FH_F145583_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F145583_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|OP SVCS
20|FH_F145583_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.30|99|0.00|HSS ASC
20|FH_F145587_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F145587_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F145587_0_0|CSTM-ALL|CSTM-00|2020|PDM|1179.61|99|0.00|AEG 6 (NO REV)
20|FH_F145587_0_0|CSTM-ALL|CSTM-00|2020|PDM|1205.40|99|0.00|AEG 8 (NO REV)
20|FH_F145587_0_0|SrvcGrp|113988|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F145587_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F145587_0_0|SrvcGrp|26432|2022|PDM|1262.70|99|0.00|OP SURGICAL SERVICES
20|FH_F145587_0_0|SrvcGrp|33984|2022|PDM|1262.70|99|0.00|HAMMERTOE CORRECTION
20|FH_F145587_0_0|SrvcGrp|82108|2022|PDM|1262.70|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F145587_0_0|SrvcGrp|82112|2022|PDM|1262.70|99|0.00|KNEE ARTHROSCOPY SURGERY
20|FH_F145587_0_0|SrvcGrp|98523|2022|PDM|1262.70|99|0.00|CAPSULOTOMY
20|FH_F145599_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F145664_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.62|99|0.00|GENERAL ACUTE CARE
20|FH_F145674_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.62|99|0.00|OP SVCS
20|FH_F145690_0_0|SrvcGrp|82981|2022|PDM|90.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F145690_0_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F145721_0_0|SrvcGrp|110926|2022|PDM|413.00|99|0.00|IP HOSPICE RESPITE CARE
20|FH_F145721_0_0|SrvcGrp|82223|2022|PDM|135.00|99|0.00|HOSPICE CARE
20|FH_F145739_0_0|CSTM-ALL|CSTM-00|2020|PDM|1125.00|99|0.00|AEG 7 (NO REV)
20|FH_F145739_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|AEG 10 (NO REV)
20|FH_F145739_0_0|CSTM-ALL|CSTM-00|2020|PDM|533.00|99|0.00|AEG 2 (NO REV)
20|FH_F145739_0_0|CSTM-ALL|CSTM-00|2020|PDM|713.00|99|0.00|AEG 4 (NO REV)
20|FH_F145762_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F145762_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F145762_0_0|CSTM-ALL|CSTM-00|2020|PDM|1287.00|99|0.00|AEG 7 (NO REV)
20|FH_F145762_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AEG 3 (NO REV)
20|FH_F145762_0_0|CSTM-ALL|CSTM-00|2020|PDM|870.00|99|0.00|AEG 10 (NO REV)
20|FH_F145762_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F145781_0_0|CSTM-ALL|CSTM-00|2020|PDM|615.00|99|0.00|AEG 3 (NO REV)
20|FH_F145781_0_0|CSTM-ALL|CSTM-00|2020|PDM|860.00|99|0.00|AEG 5  (NO REV)
20|FH_F145781_0_0|SrvcGrp|113940|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F145781_0_0|SrvcGrp|114303|2022|PDM|2200.00|99|0.00|PARTIAL REMOVAL COLLARBONE
20|FH_F145781_0_0|SrvcGrp|114306|2022|PDM|1300.00|99|0.00|REMOVAL OF EYE LESION
20|FH_F145781_0_0|SrvcGrp|89404|2022|PDM|11500.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F145784_0_0|SrvcGrp|64517|2022|PDM|2750.00|99|0.00|REDUCE MANMMAPLASTY
20|FH_F145870_0_0|CSTM-ALL|CSTM-00|2020|PDM|504.00|99|0.00|AEG 1 (NO REV)
20|FH_F145870_0_0|CSTM-ALL|CSTM-00|2020|PDM|951.00|99|0.00|AEG 4 (NO REV)
20|FH_F145870_0_0|SrvcGrp|110821|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F145877_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.34|99|0.00|GENERAL ACUTE CARE
20|FH_F145877_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.34|99|0.00|OP SVCS
20|FH_F145885_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F145885_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F145920_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F145920_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 2 (NO REV)
20|FH_F145920_0_0|CSTM-ALL|CSTM-00|2020|PDM|2346.00|99|0.00|AEG 4 (NO REV)
20|FH_F145920_0_0|CSTM-ALL|CSTM-00|2020|PDM|2900.00|99|0.00|AEG 6 (NO REV)
20|FH_F145920_0_0|CSTM-ALL|CSTM-00|2020|PDM|3060.00|99|0.00|AEG 5  (NO REV)
20|FH_F145920_0_0|CSTM-ALL|CSTM-00|2020|PDM|918.00|99|0.00|AEG 1 (NO REV)
20|FH_F145920_0_0|SrvcGrp|108935|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F145920_0_0|SrvcGrp|114014|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES
20|FH_F145920_0_0|SrvcGrp|114371|2022|PDM|1645.00|99|0.00|EXC BACK LES SC = 3 CM
20|FH_F145920_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F145920_0_0|SrvcGrp|79593|2022|PDM|1931.00|99|0.00|CPT 45378
20|FH_F145946_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F146040_0_0|SrvcGrp|87077|2022|PDM|182.35|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F146043_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F146043_0_0|CSTM-ALL|CSTM-00|2020|PDM|1386.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F146117_0_0|CSTM-ALL|CSTM-00|2020|PDM|2804.00|99|0.00|AEG 5  (NO REV)
20|FH_F146125_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|AEG 2 (NO REV)
20|FH_F146125_0_0|SrvcGrp|11673|2022|PDM|3197.00|99|0.00|CPT 29888
20|FH_F146125_0_0|SrvcGrp|13990|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F146125_0_0|SrvcGrp|83835|2022|PDM|2100.00|99|0.00|REPLACE TISSUE EXPANDER
20|FH_F146125_0_0|SrvcGrp|86460|2022|PDM|2182.00|99|0.00|REVISE BREAST RECONSTRUCTION
20|FH_F146204_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F146204_0_0|CSTM-ALL|CSTM-00|2020|PDM|1040.00|99|0.00|AEG 5  (NO REV)
20|FH_F146204_0_0|SrvcGrp|101524|2022|PDM|1500.00|99|0.00|MISSED ABORTION SECOND TRIMESTER
20|FH_F146204_0_0|SrvcGrp|109258|2022|PDM|2873.00|99|0.00|WEDGE RESECTION
20|FH_F146204_0_0|SrvcGrp|112207|2022|PDM|900.00|99|0.00|DESTROY VULVA LESIONS
20|FH_F146204_0_0|SrvcGrp|33977|2022|PDM|1500.00|99|0.00|CPT 59820
20|FH_F146217_0_0|SrvcGrp|82223|2022|PDM|178.66|99|0.00|HOSPICE CARE
20|FH_F146239_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F146260_0_0|CSTM-ALL|CSTM-00|2020|PCT|63.20|99|0.00|GENERAL ACUTE CARE
20|FH_F146266_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F146266_0_0|CSTM-ALL|CSTM-00|2020|PDM|1433.00|99|0.00|AEG 2 (NO REV)
20|FH_F146266_0_0|CSTM-ALL|CSTM-00|2020|PDM|2722.00|99|0.00|AEG 6 (NO REV)
20|FH_F146266_0_0|SrvcGrp|104007|2022|PDM|6199.00|99|0.00|ENDOSCOPIC DCMPR 1
20|FH_F146266_0_0|SrvcGrp|107361|2022|PDM|15794.00|99|0.00|SECOND LEVEL CER DISKECTOMY
20|FH_F146266_0_0|SrvcGrp|114327|2022|PDM|4433.00|99|0.00|PARTIAL REMOVAL OF ULNA
20|FH_F146266_0_0|SrvcGrp|12664|2022|PCT|0.00|99|0.00|IMPLANTS
20|FH_F146266_0_0|SrvcGrp|27261|2022|PDM|11700.00|99|0.00|CPT 27446
20|FH_F146266_0_0|SrvcGrp|27315|2022|PDM|2375.00|99|0.00|TENDON REPAIR
20|FH_F146266_0_0|SrvcGrp|33986|2022|PDM|1450.00|99|0.00|CPT 26055
20|FH_F146266_0_0|SrvcGrp|35668|2022|PDM|3200.00|99|0.00|CPT 29824
20|FH_F146266_0_0|SrvcGrp|67064|2022|PDM|5719.00|99|0.00|MUSCULOSKELETAL SYSTEM
20|FH_F146266_0_0|SrvcGrp|67066|2022|PDM|18996.00|99|0.00|CERVICAL SURGERY
20|FH_F146266_0_0|SrvcGrp|69964|2022|PDM|5350.00|99|0.00|CPT 23120
20|FH_F146266_0_0|SrvcGrp|76603|2022|PDM|1825.00|99|0.00|CPT 25111
20|FH_F146266_0_0|SrvcGrp|76604|2022|PDM|2775.00|99|0.00|CPT 25447
20|FH_F146266_0_0|SrvcGrp|77021|2022|PDM|5455.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY
20|FH_F146266_0_0|SrvcGrp|82109|2022|PDM|1440.00|99|0.00|REVISE ULNAR NERVE ELBOW
20|FH_F146266_0_0|SrvcGrp|82114|2022|PDM|2690.00|99|0.00|MENISCUS REPAIR MED OR LAT
20|FH_F146266_0_0|SrvcGrp|85792|2022|PDM|4030.00|99|0.00|OPEN TREATMENT OF DISTAL
20|FH_F146266_0_0|SrvcGrp|86233|2022|PDM|17338.00|99|0.00|AETNA RECONSTRUCT ANKLE JOINT
20|FH_F146266_0_0|SrvcGrp|88065|2022|PDM|11590.00|99|0.00|TOTAL DISC ARTHROPLASTY
20|FH_F146266_0_0|SrvcGrp|88159|2022|PDM|7145.00|99|0.00|LOW BACK DISK SURGERY
20|FH_F146266_0_0|SrvcGrp|88160|2022|PDM|8444.00|99|0.00|LAMINECTOMY W/FACETECTOMY
20|FH_F146266_0_0|SrvcGrp|88163|2022|PDM|20512.00|99|0.00|LUMBAR SPINE FUSION
20|FH_F146266_0_0|SrvcGrp|89857|2022|PDM|8444.00|99|0.00|REMOVAL OF SPINAL LAMINA
20|FH_F146266_0_0|SrvcGrp|89860|2022|PDM|7231.00|99|0.00|SPINAL DISK SURGERY ADD-ON
20|FH_F146266_0_0|SrvcGrp|92410|2022|PDM|15190.00|99|0.00|SPINE FUSION EXTRA SEGMENT
20|FH_F146266_0_0|SrvcGrp|93432|2022|PDM|8501.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT
20|FH_F146266_0_0|SrvcGrp|95560|2022|PDM|5618.00|99|0.00|REMOVAL OF SHOULDER BONE
20|FH_F146266_0_0|SrvcGrp|98496|2022|PDM|14196.00|99|0.00|ARTHRODESIS POSTERIOR ATLAS
20|FH_F146266_0_0|SrvcGrp|99163|2022|PDM|8501.00|99|0.00|CPT 27703
20|FH_F146266_0_0|SrvcGrp|99172|2022|PDM|7658.00|99|0.00|CPT 28740
20|FH_F146284_0_0|CSTM-ALL|CSTM-00|2020|PDM|2419.00|99|0.00|GENERAL ACUTE CARE
20|FH_F146288_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.54|99|0.00|OP SVCS
20|FH_F146289_0_0|CSTM-ALL|CSTM-00|2020|PDM|2419.00|99|0.00|GENERAL ACUTE CARE
20|FH_F146290_0_0|CSTM-ALL|CSTM-00|2020|PDM|2419.00|99|0.00|GENERAL ACUTE CARE
20|FH_F146292_0_0|CSTM-ALL|CSTM-00|2020|PDM|2419.00|99|0.00|GENERAL ACUTE CARE
20|FH_F146293_0_0|CSTM-ALL|CSTM-00|2020|PDM|2419.00|99|0.00|GENERAL ACUTE CARE
20|FH_F146369_0_0|SrvcGrp|73605|2022|PDM|1030.00|99|0.00|AETNA ACUTE PSYCH
20|FH_F146369_0_0|SrvcGrp|75419|2022|PDM|515.00|99|0.00|OP PARTIAL HOSPITALIZATION
20|FH_F146399_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F146399_0_0|SrvcGrp|107748|2022|PDM|424.00|99|0.00|HEMODIALYSIS IN CENTER
20|FH_F146568_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F146569_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F146569_0_0|SrvcGrp|65720|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F146595_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F146647_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.40|99|0.00|HSS ASC
20|FH_F146659_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F146661_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F146760_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F146760_0_0|SrvcGrp|107748|2022|PDM|424.00|99|0.00|HEMODIALYSIS IN CENTER
20|FH_F146760_0_0|SrvcGrp|107749|2022|PDM|182.00|99|0.00|CAPD/CCPD
20|FH_F146760_0_0|SrvcGrp|111468|2022|PDM|150.00|99|0.00|DIALYSIS PATIENT TRAINING
20|FH_F146765_0_0|SrvcGrp|29155|2022|PDM|100.00|99|0.00|HOSPICE SVCS
20|FH_F146765_0_0|SrvcGrp|33722|2022|PDM|25.00|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F146765_0_0|SrvcGrp|82223|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F146785_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.70|99|0.00|OP SVCS
20|FH_F146789_0_0|CSTM-ALL|CSTM-00|2020|PCT|63.70|99|0.00|GENERAL ACUTE CARE
20|FH_F146790_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 10 (NO REV)
20|FH_F146790_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 2 (NO REV)
20|FH_F146790_0_0|CSTM-ALL|CSTM-00|2020|PDM|2100.00|99|0.00|AEG 5  (NO REV)
20|FH_F146790_0_0|SrvcGrp|113114|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F146790_0_0|SrvcGrp|114755|2022|PDM|3200.00|99|0.00|PROSTATE PROCEDURES
20|FH_F146792_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F146792_0_0|CSTM-ALL|CSTM-00|2020|PDM|2437.00|99|0.00|AEG 4 (NO REV)
20|FH_F146803_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 10 (NO REV)
20|FH_F146803_0_0|CSTM-ALL|CSTM-00|2020|PDM|2100.00|99|0.00|AEG 5  (NO REV)
20|FH_F146803_0_0|CSTM-ALL|CSTM-00|2020|PDM|3600.00|99|0.00|AEG 9 (NO REV)
20|FH_F146803_0_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F146803_0_0|SrvcGrp|114755|2022|PDM|3200.00|99|0.00|PROSTATE PROCEDURES
20|FH_F146807_28655_0|SrvcGrp|114014|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES
20|FH_F146807_28655_0|SrvcGrp|114616|2022|PCT|0.85|99|0.00|CARDIAC CATHETERIZATION
20|FH_F146807_28655_0|SrvcGrp|75506|2022|PCT|0.85|99|0.00|VASCULAR DIAGNOSTIC STUDIES
20|FH_F146859_0_0|CSTM-ALL|CSTM-00|2020|PDM|1001.00|99|0.00|AEG 3 (NO REV)
20|FH_F146859_0_0|CSTM-ALL|CSTM-00|2020|PDM|1254.00|99|0.00|AEG 4 (NO REV)
20|FH_F146859_0_0|SrvcGrp|105505|2022|PDM|2484.00|99|0.00|CORRECTION HALUX RIDGUS W IMPLANTS
20|FH_F146859_0_0|SrvcGrp|11043|2022|PDM|1809.00|99|0.00|CARPAL TUNNEL RELEASE
20|FH_F146859_0_0|SrvcGrp|114836|2022|PDM|2320.00|99|0.00|ANKLE ARTHROSCOPY
20|FH_F146859_0_0|SrvcGrp|114837|2022|PDM|1080.00|99|0.00|FOOT/TOES PROCEDURES
20|FH_F146859_0_0|SrvcGrp|114838|2022|PDM|2108.00|99|0.00|FOOT BONE PARTIAL REMOVAL
20|FH_F146859_0_0|SrvcGrp|114848|2022|PDM|1791.00|99|0.00|REMOVAL OF IMPLANT
20|FH_F146859_0_0|SrvcGrp|114853|2022|PDM|2046.00|99|0.00|MCP JOINT ARTHROSCOPY
20|FH_F146859_0_0|SrvcGrp|114855|2022|PDM|4511.00|99|0.00|NECK SPINE FUSE
20|FH_F146859_0_0|SrvcGrp|114861|2022|PDM|4354.00|99|0.00|LOW BACK DISK SURGERY
20|FH_F146859_0_0|SrvcGrp|16242|2022|PDM|3711.00|99|0.00|ROTATOR CUFF
20|FH_F146859_0_0|SrvcGrp|87673|2022|PDM|549.00|99|0.00|INJECTION(S) LUMBAR OR SACRAL SINGLE LEVEL
20|FH_F146859_0_0|SrvcGrp|93740|2022|PDM|3867.00|99|0.00|REVISE/REMOVE NEURO RECEIVER
20|FH_F146859_0_0|SrvcGrp|98200|2022|PDM|1465.00|99|0.00|BUNION CORRECTION
20|FH_F146885_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F146885_0_0|SrvcGrp|46903|2022|PDM|650.00|99|0.00|RESIDENTIAL TREATMENT
20|FH_F146909_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.75|99|0.00|HSS ASC
20|FH_F146940_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F146940_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F146940_0_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F146986_0_0|SrvcGrp|87077|2022|PDM|174.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F147009_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F147009_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|AEG 4 (NO REV)
20|FH_F147009_0_0|CSTM-ALL|CSTM-00|2020|PDM|973.00|99|0.00|AEG 8 (NO REV)
20|FH_F147162_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|OP SVCS
20|FH_F147163_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS
20|FH_F147164_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.90|99|0.00|OP SVCS
20|FH_F147211_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|IP MULTI ROOM COMPARISON
20|FH_F147211_0_0|SrvcGrp|108622|2022|PDM|574.00|99|0.00|SUB ACUTE CARE LEVEL II
20|FH_F147211_0_0|SrvcGrp|109459|2022|PDM|375.00|99|0.00|HEMODIALYSIS
20|FH_F147212_0_0|SrvcGrp|13722|2022|PDM|155.00|99|0.00|HOSPICE SERVICE - ROUTINE HOME CARE
20|FH_F147340_0_0|SrvcGrp|34831|2022|PDM|1519.00|99|0.00|HEMODIALYSIS - ULTRAFILTRATION
20|FH_F147340_0_0|SrvcGrp|82498|2022|PDM|651.00|99|0.00|DIALYSIS PROCEDURE OTHER THAN HEMODIALYSIS
20|FH_F147363_0_0|SrvcGrp|79720|2022|PDM|1000.00|99|0.00|ACUTE REHAB II
20|FH_F147372_0_0|SrvcGrp|74668|2022|PDM|400.00|99|0.00|AETNA INTENSIVE OUTPATIENT
20|FH_F147403_0_0|SrvcGrp|87077|2022|PDM|250.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F147418_0_0|CSTM-ALL|CSTM-00|2020|PDM|2145.00|99|0.00|AEG 3 (NO REV)
20|FH_F147418_0_0|CSTM-ALL|CSTM-00|2020|PDM|2755.00|99|0.00|AEG 7 (NO REV)
20|FH_F147418_0_0|SrvcGrp|112538|2022|PDM|13000.00|99|0.00|KNEE REPLACEMENT
20|FH_F147418_0_0|SrvcGrp|115020|2022|PDM|7000.00|99|0.00|ORTHO
20|FH_F147418_0_0|SrvcGrp|115023|2022|PDM|13000.00|99|0.00|HIP REVISION
20|FH_F147418_0_0|SrvcGrp|115024|2022|PDM|7000.00|99|0.00|NECK SPINE FUSE
20|FH_F147502_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F147502_0_0|SrvcGrp|104229|2022|PDM|150.00|99|0.00|HOSPICE IN HOME (HCFA)
20|FH_F147502_0_0|SrvcGrp|29155|2022|PDM|150.00|99|0.00|HOSPICE SVCS
20|FH_F147502_0_0|SrvcGrp|46605|2022|PDM|85.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES
20|FH_F147502_0_0|SrvcGrp|48394|2022|PDM|45.50|99|0.00|SKILLED NURSING SERVICES
20|FH_F147502_0_0|SrvcGrp|48398|2022|PDM|110.00|99|0.00|PT SERVICES
20|FH_F147502_0_0|SrvcGrp|80918|2022|PDM|150.00|99|0.00|RESPITE CARE
20|FH_F147502_0_0|SrvcGrp|80920|2022|PDM|575.00|99|0.00|HOSPICE SERVICES
20|FH_F147502_0_0|SrvcGrp|82223|2022|PDM|150.00|99|0.00|HOSPICE CARE
20|FH_F147502_0_0|SrvcGrp|84185|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F147661_0_0|CSTM-ALL|CSTM-00|2020|PDM|1008.00|99|0.00|AEG 6 (NO REV)
20|FH_F147661_0_0|CSTM-ALL|CSTM-00|2020|PDM|1486.00|99|0.00|AEG 7 (NO REV)
20|FH_F147661_0_0|CSTM-ALL|CSTM-00|2020|PDM|527.00|99|0.00|AEG 2 (NO REV)
20|FH_F147661_0_0|CSTM-ALL|CSTM-00|2020|PDM|603.00|99|0.00|AEG 3 (NO REV)
20|FH_F147661_0_0|SrvcGrp|114924|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F147745_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS
20|FH_F147800_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F147800_0_0|CSTM-ALL|CSTM-00|2020|PDM|493.00|99|0.00|AEG 2 (NO REV)
20|FH_F147800_0_0|CSTM-ALL|CSTM-00|2020|PDM|696.00|99|0.00|AEG 4 (NO REV)
20|FH_F147800_0_0|SrvcGrp|105640|2022|PDM|900.00|99|0.00|NJX INTERLAMINAR CRV/THRC
20|FH_F147800_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F147800_0_0|SrvcGrp|110765|2022|PDM|458.00|99|0.00|2ND LEVEL INJ PARAVERT F JNT C/T
20|FH_F147800_0_0|SrvcGrp|110766|2022|PDM|458.00|99|0.00|3RD LEVEL INJ PARAVERT F JNT C/T
20|FH_F147800_0_0|SrvcGrp|113271|2022|PDM|1650.00|99|0.00|GENICULAR NERVE BLOCK
20|FH_F147800_0_0|SrvcGrp|115146|2022|PDM|206.00|99|0.00|CHEMODENERV MUSC NECK DYSTON
20|FH_F147800_0_0|SrvcGrp|115148|2022|PDM|138.00|99|0.00|CHEMODENERV TRUNK MUSC 6
20|FH_F147800_0_0|SrvcGrp|115149|2022|PDM|132.00|99|0.00|NJX AA&/STRD II IH NERVES
20|FH_F147800_0_0|SrvcGrp|89862|2022|PDM|275.00|99|0.00|FLUOROSCOPIC GUIDANCE
20|FH_F147800_0_0|SrvcGrp|92408|2022|PDM|6050.00|99|0.00|PERQ VERTEBRAL AUGMENTATION
20|FH_F147800_0_0|SrvcGrp|96781|2022|PDM|99.00|99|0.00|INJECTION FOR NERVE BLOCK 5
20|FH_F147800_0_0|SrvcGrp|98102|2022|PDM|99.00|99|0.00|DRAIN INJ JOING/BURSA W/US
20|FH_F147899_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F147899_0_0|CSTM-ALL|CSTM-00|2020|PDM|580.00|99|0.00|AEG 2 (NO REV)
20|FH_F147899_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|AMBULATORY SURGERY W/O AEG 1 & 2
20|FH_F147899_0_0|SrvcGrp|38364|2022|PDM|6000.00|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F147980_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F147980_0_0|SrvcGrp|104229|2022|PDM|95.00|99|0.00|HOSPICE IN HOME (HCFA)
20|FH_F147980_0_0|SrvcGrp|80920|2022|PDM|450.00|99|0.00|HOSPICE SERVICES
20|FH_F148008_0_0|SrvcGrp|75545|2022|PDM|472.00|99|0.00|SUB-ACUTE - LEVEL I AND II
20|FH_F148020_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F148020_0_0|SrvcGrp|471|2022|PDM|603.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F148020_0_0|SrvcGrp|75545|2022|PDM|472.00|99|0.00|SUB-ACUTE - LEVEL I AND II
20|FH_F148103_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F148166_0_0|SrvcGrp|106792|2022|PDM|190.00|99|0.00|HOSPICE ROUTINE HOME CARE
20|FH_F148166_0_0|SrvcGrp|14494|2022|PDM|56.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F148181_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F148181_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F148181_0_0|SrvcGrp|80920|2022|PDM|1000.00|99|0.00|HOSPICE SERVICES
20|FH_F148181_0_0|SrvcGrp|89781|2022|PDM|155.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F148181_0_0|SrvcGrp|94781|2022|PDM|155.00|99|0.00|HOSPICE IN LTCH (HCFA)
20|FH_F148181_0_0|SrvcGrp|95660|2022|PDM|1000.00|99|0.00|HOSPICE SERVICES (HCFA)
20|FH_F148186_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F148186_0_0|SrvcGrp|106291|2022|PDM|285.00|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT LEVEL 1 (HCFA)
20|FH_F148186_0_0|SrvcGrp|106294|2022|PDM|300.00|99|0.00|AMBULANCE SERVICE EMERGENCY TRANSPORT LEVEL 1 (HFCA)
20|FH_F148186_0_0|SrvcGrp|13595|2022|PDM|300.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC
20|FH_F148186_0_0|SrvcGrp|13681|2022|PDM|247.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT
20|FH_F148186_0_0|SrvcGrp|13683|2022|PDM|675.00|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2
20|FH_F148243_0_0|CSTM-ALL|CSTM-00|2020|PDM|379.00|99|0.00|AEG 1 (NO REV)
20|FH_F148243_0_0|SrvcGrp|33984|2022|PDM|1450.00|99|0.00|HAMMERTOE CORRECTION
20|FH_F148243_0_0|SrvcGrp|35669|2022|PDM|6500.00|99|0.00|CPT 63650
20|FH_F148243_0_0|SrvcGrp|42550|2022|PDM|1570.00|99|0.00|OP SURGERY CPT 66984
20|FH_F148243_0_0|SrvcGrp|45063|2022|PDM|400.00|99|0.00|CPT 64493  INJECTION CARVE OUT
20|FH_F148243_0_0|SrvcGrp|58636|2022|PDM|13000.00|99|0.00|CPT 62362
20|FH_F148243_0_0|SrvcGrp|79583|2022|PDM|770.00|99|0.00|CPT 45381
20|FH_F148243_0_0|SrvcGrp|79589|2022|PDM|650.00|99|0.00|UPPER GI
20|FH_F148243_0_0|SrvcGrp|79595|2022|PDM|770.00|99|0.00|CPT 45385
20|FH_F148243_0_0|SrvcGrp|85966|2022|PDM|1250.00|99|0.00|EXTRACAPSULAR CATARACT
20|FH_F148243_0_0|SrvcGrp|90976|2022|PDM|400.00|99|0.00|INJECTION PARAVERTEBRAL FACET JOINT
20|FH_F148243_0_0|SrvcGrp|91989|2022|PDM|770.00|99|0.00|COLONOSCOPY LESION REMOVAL
20|FH_F148243_0_0|SrvcGrp|99073|2022|PDM|1.28|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F148244_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F148244_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F148260_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F148260_0_0|CSTM-ALL|CSTM-00|2020|PDM|1474.00|99|0.00|AEG 1 (NO REV)
20|FH_F148260_0_0|CSTM-ALL|CSTM-00|2020|PDM|9954.00|99|0.00|AEG 9 (NO REV)
20|FH_F148260_0_0|SrvcGrp|101520|2022|PDM|14871.00|99|0.00|T1H W/T/O (<250G)
20|FH_F148260_0_0|SrvcGrp|27346|2022|PDM|9480.00|99|0.00|REPAIR BLADDER DEFECT
20|FH_F148325_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F148325_0_0|SrvcGrp|104745|2022|PDM|169.46|99|0.00|HOSPICE
20|FH_F148326_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F148326_0_0|CSTM-ALL|CSTM-00|2020|PDM|2808.72|99|0.00|AEG 6 (NO REV)
20|FH_F148326_0_0|CSTM-ALL|CSTM-00|2020|PDM|3362.00|99|0.00|AEG 8 (NO REV)
20|FH_F148326_0_0|SrvcGrp|114924|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F148344_0_0|SrvcGrp|108484|2022|PDM|736.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY
20|FH_F148344_0_0|SrvcGrp|46903|2022|PDM|754.00|99|0.00|RESIDENTIAL TREATMENT
20|FH_F148345_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F148345_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F148345_0_0|CSTM-ALL|CSTM-00|2020|PDM|792.00|99|0.00|AEG 2 (NO REV)
20|FH_F148345_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F148346_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE
20|FH_F148347_0_0|CSTM-ALL|CSTM-00|2020|PDM|739.00|99|0.00|AEG 3 (NO REV)
20|FH_F148347_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 10 (NO REV)
20|FH_F148347_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F148347_0_0|SrvcGrp|105287|2022|PDM|4677.20|99|0.00|LAP INC HERN RECUR COMP
20|FH_F148347_0_0|SrvcGrp|115376|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES
20|FH_F148347_0_0|SrvcGrp|115377|2022|PDM|1980.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F148347_0_0|SrvcGrp|75885|2022|PDM|2686.00|99|0.00|AETNA CPT 49560
20|FH_F148347_0_0|SrvcGrp|79589|2022|PDM|1932.00|99|0.00|UPPER GI
20|FH_F148347_0_0|SrvcGrp|79594|2022|PDM|2125.20|99|0.00|CPT 45380
20|FH_F148347_0_0|SrvcGrp|84908|2022|PDM|4252.00|99|0.00|LAPAROSCOPY
20|FH_F148347_0_0|SrvcGrp|86426|2022|PDM|2338.00|99|0.00|REMOVE INT/EXT HEM GROUP 2
20|FH_F148347_0_0|SrvcGrp|86461|2022|PDM|2955.00|99|0.00|AREOLA RECONSTRUCTION
20|FH_F148347_0_0|SrvcGrp|92417|2022|PDM|12778.00|99|0.00|LAPAROSCOPY
20|FH_F148347_0_0|SrvcGrp|92418|2022|PDM|11616.00|99|0.00|LAPAROSCOPY
20|FH_F148347_0_0|SrvcGrp|99073|2022|PDM|1.38|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F148429_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F148429_0_0|SrvcGrp|79720|2022|PDM|1372.00|99|0.00|ACUTE REHAB II
20|FH_F148439_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F148439_0_0|SrvcGrp|73485|2022|PDM|1500.00|99|0.00|AETNA REHAB
20|FH_F148439_0_0|SrvcGrp|87536|2022|PCT|0.00|99|0.00|MED REHAB DAY PROGRAM (HALF)
20|FH_F148488_0_0|SrvcGrp|74668|2022|PDM|180.00|99|0.00|AETNA INTENSIVE OUTPATIENT
20|FH_F148489_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F148489_0_0|SrvcGrp|75419|2022|PDM|440.00|99|0.00|OP PARTIAL HOSPITALIZATION
20|FH_F148494_0_0|SrvcGrp|101102|2022|PDM|15000.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT
20|FH_F148494_0_0|SrvcGrp|114171|2022|PDM|1250.00|99|0.00|STENT PACEMT ANTE COROTID
20|FH_F148494_0_0|SrvcGrp|114174|2022|PDM|6600.00|99|0.00|REMOVE/REINSER SPINE FIXATION DEVICE
20|FH_F148494_0_0|SrvcGrp|114175|2022|PDM|6000.00|99|0.00|SPINE PROCEDURES
20|FH_F148494_0_0|SrvcGrp|114176|2022|PDM|6000.00|99|0.00|SPINE PROCEDURES
20|FH_F148494_0_0|SrvcGrp|40002|2022|PDM|15500.00|99|0.00|TOTAL HIP
20|FH_F148494_0_0|SrvcGrp|96353|2022|PDM|16400.00|99|0.00|RECONSTRUCT ANKLE JOINT
20|FH_F148521_0_0|SrvcGrp|47544|2022|PDM|4461.00|99|0.00|PERCUTANEOUS IMPLANT OF NEUROSTIMULATOR ELECTRODES
20|FH_F148541_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.60|99|0.00|HSS ASC INVOICE
20|FH_F148546_0_0|SrvcGrp|79720|2022|PDM|1000.00|99|0.00|ACUTE REHAB II
20|FH_F148555_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F148555_0_0|CSTM-ALL|CSTM-00|2020|PDM|1124.00|99|0.00|AEG 7 (NO REV)
20|FH_F148555_0_0|CSTM-ALL|CSTM-00|2020|PDM|1512.00|99|0.00|AEG 9 (NO REV)
20|FH_F148555_0_0|CSTM-ALL|CSTM-00|2020|PDM|712.00|99|0.00|AEG 4 (NO REV)
20|FH_F148555_0_0|CSTM-ALL|CSTM-00|2020|PDM|810.00|99|0.00|AEG 5  (NO REV)
20|FH_F148555_0_0|CSTM-ALL|CSTM-00|2020|PDM|932.00|99|0.00|AEG 6 (NO REV)
20|FH_F148555_0_0|SrvcGrp|108183|2022|PDM|4635.00|99|0.00|REMOVE & REPLACEMENT PULSE
20|FH_F148555_0_0|SrvcGrp|115439|2022|PDM|4120.00|99|0.00|UPGRADE OF IMPLANTED PACEMAKER
20|FH_F148555_0_0|SrvcGrp|115441|2022|PDM|3090.00|99|0.00|INSERT 1 ELECTRODE PM DEFIB
20|FH_F148555_0_0|SrvcGrp|115453|2022|PDM|3502.00|99|0.00|REMOVAL OF PM GENERATOR
20|FH_F148555_0_0|SrvcGrp|115455|2022|PDM|3337.00|99|0.00|REMOVE PACEMAKER ELECTRODE
20|FH_F148555_0_0|SrvcGrp|115460|2022|PDM|5871.00|99|0.00|REMOVE & REPLACE DEFIB GEN MULTI LEAD
20|FH_F148555_0_0|SrvcGrp|115498|2022|PDM|5522.00|99|0.00|TX ATRIAL FIB PULM VEIN ISOL
20|FH_F148555_0_0|SrvcGrp|115502|2022|PDM|1288.00|99|0.00|INTRACARDIAC ECG (ICE)
20|FH_F148555_0_0|SrvcGrp|115503|2022|PDM|10300.00|99|0.00|EP & ABLATE SUPRAVENT ARRHYT
20|FH_F148555_0_0|SrvcGrp|28400|2022|PDM|3090.00|99|0.00|CPT CODE 93621
20|FH_F148555_0_0|SrvcGrp|28401|2022|PDM|3090.00|99|0.00|CPT CODE 93622
20|FH_F148601_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F148639_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F148639_0_0|CSTM-ALL|CSTM-00|2020|PDM|1392.00|99|0.00|AEG 8 (NO REV)
20|FH_F148639_0_0|CSTM-ALL|CSTM-00|2020|PDM|1423.00|99|0.00|AEG 7 (NO REV)
20|FH_F148639_0_0|CSTM-ALL|CSTM-00|2020|PDM|1690.00|99|0.00|AEG 9 (NO REV)
20|FH_F148639_0_0|CSTM-ALL|CSTM-00|2020|PDM|952.00|99|0.00|AEG 4 (NO REV)
20|FH_F148639_0_0|SrvcGrp|115359|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F148639_0_0|SrvcGrp|33986|2022|PDM|1163.00|99|0.00|CPT 26055
20|FH_F148639_0_0|SrvcGrp|36591|2022|PDM|5000.00|99|0.00|CPT 63685
20|FH_F148639_0_0|SrvcGrp|63471|2022|PDM|5000.00|99|0.00|CPT 64590
20|FH_F148639_0_0|SrvcGrp|71666|2022|PDM|6105.00|99|0.00|CPT 63655
20|FH_F148645_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F148645_0_0|CSTM-ALL|CSTM-00|2020|PDM|1578.35|99|0.00|AEG 2 (NO REV)
20|FH_F148645_0_0|CSTM-ALL|CSTM-00|2020|PDM|2514.93|99|0.00|AEG 4 (NO REV)
20|FH_F148645_0_0|SrvcGrp|115169|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F148645_0_0|SrvcGrp|99073|2022|PCT|0.00|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F148667_0_0|CSTM-ALL|CSTM-00|2020|PDM|2856.00|99|0.00|AHC J CODES %BC
20|FH_F148667_0_0|SrvcGrp|104112|2022|PDM|2856.00|99|0.00|REPAIR OF ANKLE FRACTURE
20|FH_F148667_0_0|SrvcGrp|107835|2022|PDM|5861.00|99|0.00|NERVE REPAIR
20|FH_F148667_0_0|SrvcGrp|108347|2022|PDM|2856.00|99|0.00|REPAIR OF KNEE FRACTURE
20|FH_F148667_0_0|SrvcGrp|108351|2022|PDM|2856.00|99|0.00|REPAIR RADIUS FRACTURE
20|FH_F148667_0_0|SrvcGrp|11673|2022|PDM|3115.00|99|0.00|CPT 29888
20|FH_F148667_0_0|SrvcGrp|26278|2022|PDM|2856.00|99|0.00|CPT 29881
20|FH_F148667_0_0|SrvcGrp|27261|2022|PDM|11000.00|99|0.00|CPT 27446
20|FH_F148667_0_0|SrvcGrp|31112|2022|PCT|0.00|99|0.00|IMPLANTS
20|FH_F148667_0_0|SrvcGrp|33986|2022|PDM|2856.00|99|0.00|CPT 26055
20|FH_F148667_0_0|SrvcGrp|70749|2022|PDM|2856.00|99|0.00|CPT 29823
20|FH_F148667_0_0|SrvcGrp|72121|2022|PDM|2584.00|99|0.00|ARTHOSCOPY
20|FH_F148667_0_0|SrvcGrp|82112|2022|PDM|2856.00|99|0.00|KNEE ARTHROSCOPY SURGERY
20|FH_F148667_0_0|SrvcGrp|92007|2022|PDM|2856.00|99|0.00|PROXIMAL HUMERAL
20|FH_F148700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F148700_0_0|CSTM-ALL|CSTM-00|2020|PDM|1428.00|99|0.00|RESIDENT TRTMNT-EATING DISORDERS
20|FH_F148720_0_0|SrvcGrp|107634|2022|PDM|325.00|99|0.00|PERITONEAL TREATMENTS W/ PATIENT TRAINGING
20|FH_F148720_0_0|SrvcGrp|114156|2022|PDM|450.00|99|0.00|DIALYSIS PATIENT TRAINING
20|FH_F148720_0_0|SrvcGrp|15423|2022|PDM|115.00|99|0.00|ENGERIX-B HEPATITIS B
20|FH_F148779_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F148779_0_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F148839_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F148839_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F148839_0_0|CSTM-ALL|CSTM-00|2020|PDM|1081.00|99|0.00|AEG 8 (NO REV)
20|FH_F148839_0_0|CSTM-ALL|CSTM-00|2020|PDM|634.00|99|0.00|AEG 4 (NO REV)
20|FH_F148839_0_0|CSTM-ALL|CSTM-00|2020|PDM|722.00|99|0.00|AEG 5  (NO REV)
20|FH_F148839_0_0|CSTM-ALL|CSTM-00|2020|PDM|933.00|99|0.00|AEG 6 (NO REV)
20|FH_F148839_0_0|SrvcGrp|109760|2022|PDM|1919.00|99|0.00|TRANSLUM DIL EYE CANAL
20|FH_F148859_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F148859_0_0|SrvcGrp|112616|2022|PDM|36.72|99|0.00|BRACHYTX 125
20|FH_F148859_0_0|SrvcGrp|115511|2022|PDM|788.00|99|0.00|BLADDER STONE REMOVAL
20|FH_F148859_0_0|SrvcGrp|16469|2022|PDM|3378.00|99|0.00|PROSTATE RESECTION
20|FH_F148859_0_0|SrvcGrp|85978|2022|PDM|1270.00|99|0.00|CPT 52351
20|FH_F148859_0_0|SrvcGrp|89596|2022|PDM|25.50|99|0.00|SPECIAL RADIATION TREATMENT
20|FH_F148859_0_0|SrvcGrp|89655|2022|PDM|18.36|99|0.00|SPECIAL RADIATION DOSIMETRY
20|FH_F148860_0_0|SrvcGrp|89238|2022|PCT|0.00|99|0.00|LITHOTRIPSY ESWL INCIDENTAL CODES
20|FH_F148865_0_0|SrvcGrp|63297|2022|PDM|140.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F148865_0_0|SrvcGrp|80920|2022|PDM|550.00|99|0.00|HOSPICE SERVICES
20|FH_F148883_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F148892_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F148892_0_0|CSTM-ALL|CSTM-00|2020|PDM|1397.11|99|0.00|AEG 8 (NO REV)
20|FH_F148892_0_0|CSTM-ALL|CSTM-00|2020|PDM|640.64|99|0.00|AEG 2 (NO REV)
20|FH_F148892_0_0|CSTM-ALL|CSTM-00|2020|PDM|762.19|99|0.00|AEG 4 (NO REV)
20|FH_F148892_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F148892_0_0|SrvcGrp|35669|2022|PDM|7183.00|99|0.00|CPT 63650
20|FH_F148892_0_0|SrvcGrp|53065|2022|PDM|668.00|99|0.00|INJECTION(S), LUMBAR OR SACRAL, SINGLE LEVEL
20|FH_F148892_0_0|SrvcGrp|90976|2022|PDM|668.00|99|0.00|INJECTION PARAVERTEBRAL FACET JOINT
20|FH_F148892_0_0|SrvcGrp|92364|2022|PDM|16453.00|99|0.00|ARTHRODESIS SACROILIAC JOINT
20|FH_F148900_0_0|CSTM-ALL|CSTM-00|2020|PDM|762.19|99|0.00|AEG 4 (NO REV)
20|FH_F148900_0_0|SrvcGrp|110571|2022|PDM|668.00|99|0.00|NERVE BLOCK INJECTION 8
20|FH_F148900_0_0|SrvcGrp|36591|2022|PDM|38367.00|99|0.00|CPT 63685
20|FH_F148900_0_0|SrvcGrp|58638|2022|PDM|2940.00|99|0.00|CPT 63688
20|FH_F148900_0_0|SrvcGrp|88487|2022|PDM|4704.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION
20|FH_F148900_0_0|SrvcGrp|92409|2022|PDM|2133.00|99|0.00|PERQ CERVICOTHORACIC INJECT
20|FH_F148901_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.70|99|0.00|GENERAL ACUTE CARE
20|FH_F148927_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F148927_0_0|SrvcGrp|13990|2022|PCT|0.47|99|0.00|PACEMAKER
20|FH_F148927_0_0|SrvcGrp|23585|2022|PCT|0.47|99|0.00|IMPLANTS
20|FH_F148927_0_0|SrvcGrp|99073|2022|PCT|0.00|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F148981_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F148981_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|AEG 1 (NO REV)
20|FH_F148981_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|AEG 3 (NO REV)
20|FH_F148981_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|AEG 8 (NO REV)
20|FH_F149024_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F149024_0_0|CSTM-ALL|CSTM-00|2020|PDM|578.60|99|0.00|AEG 1 (NO REV)
20|FH_F149024_0_0|CSTM-ALL|CSTM-00|2020|PDM|886.60|99|0.00|AEG 3 (NO REV)
20|FH_F149028_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F149083_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|IMPLANTS
20|FH_F149083_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OBSERVATION SVCS
20|FH_F149085_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F149086_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F149086_0_0|SrvcGrp|29155|2022|PDM|169.00|99|0.00|HOSPICE SVCS
20|FH_F149086_0_0|SrvcGrp|82222|2022|PDM|169.00|99|0.00|HOSPICE CARE
20|FH_F149086_0_0|SrvcGrp|82223|2022|PDM|169.00|99|0.00|HOSPICE CARE
20|FH_F149120_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F149179_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F149179_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 1 (NO REV)
20|FH_F149179_0_0|CSTM-ALL|CSTM-00|2020|PDM|1836.00|99|0.00|AEG 2 (NO REV)
20|FH_F149179_0_0|SrvcGrp|115612|2022|PDM|5610.00|99|0.00|HIP ARTHRO W/ FEMOROPLASTY
20|FH_F149179_0_0|SrvcGrp|36591|2022|PDM|4058.00|99|0.00|CPT 63685
20|FH_F149179_0_0|SrvcGrp|88030|2022|PDM|6763.00|99|0.00|REVISION OF KNEE JOINT
20|FH_F149179_0_0|SrvcGrp|93641|2022|PDM|3519.00|99|0.00|KNEE ARTHROSCOPIC SURGERY
20|FH_F149240_0_0|SrvcGrp|29155|2022|PDM|717.20|99|0.00|HOSPICE SVCS
20|FH_F149240_0_0|SrvcGrp|82223|2022|PDM|144.84|99|0.00|HOSPICE CARE
20|FH_F149248_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|AEG 10 (NO REV)
20|FH_F149263_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F149263_0_0|CSTM-ALL|CSTM-00|2020|PDM|1530.00|99|0.00|AEG 10 (NO REV)
20|FH_F149263_0_0|SrvcGrp|115607|2022|PDM|3450.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F149263_0_0|SrvcGrp|115611|2022|PDM|7283.00|99|0.00|CATH DIALYSIS CIRCUIT
20|FH_F149263_0_0|SrvcGrp|115612|2022|PDM|5610.00|99|0.00|HIP ARTHRO W/ FEMOROPLASTY
20|FH_F149263_0_0|SrvcGrp|75182|2022|PCT|1.00|99|0.00|AETNA IMPLANTS
20|FH_F149263_0_0|SrvcGrp|93641|2022|PDM|3589.00|99|0.00|KNEE ARTHROSCOPIC SURGERY
20|FH_F149267_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F149267_0_0|CSTM-ALL|CSTM-00|2020|PDM|2341.00|99|0.00|AEG 5  (NO REV)
20|FH_F149271_0_0|SrvcGrp|87077|2022|PDM|240.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F149273_0_0|CSTM-ALL|CSTM-00|2020|PDM|1530.00|99|0.00|AEG 10 (NO REV)
20|FH_F149273_0_0|CSTM-ALL|CSTM-00|2020|PDM|2400.00|99|0.00|AEG 4 (NO REV)
20|FH_F149273_0_0|SrvcGrp|115359|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F149273_0_0|SrvcGrp|115607|2022|PDM|3589.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F149273_0_0|SrvcGrp|115610|2022|PDM|4488.00|99|0.00|VENTRAL HERN INIT REPAIR
20|FH_F149344_0_0|SrvcGrp|100961|2022|PDM|248.94|99|0.00|AMB SRVC NEONAT TRNSPRT BS RATE EMERG 1 WAY
20|FH_F149344_0_0|SrvcGrp|13262|2022|PDM|3.68|99|0.00|GROUND MILEAGE, PER STATUTE MILE
20|FH_F149373_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F149373_0_0|SrvcGrp|109036|2022|PDM|726.00|99|0.00|PARTIAL HOSPITALIZATION
20|FH_F149373_0_0|SrvcGrp|110811|2022|PDM|302.00|99|0.00|INTENSIVE OP PSYCH
20|FH_F149373_0_0|SrvcGrp|23587|2022|PDM|750.00|99|0.00|RESIDENTIAL TREATMENT - PSYCH
20|FH_F149404_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|OP SVCS
20|FH_F149442_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F149442_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F149442_0_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB
20|FH_F149442_0_0|SrvcGrp|112224|2022|PDM|95.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)
20|FH_F149442_0_0|SrvcGrp|112225|2022|PDM|23.00|99|0.00|COVID-19 SPECIMEN COLLECTION
20|FH_F149513_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F149513_0_0|SrvcGrp|11442|2022|PDM|994.20|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)
20|FH_F149513_0_0|SrvcGrp|13722|2022|PDM|188.74|99|0.00|HOSPICE SERVICE - ROUTINE HOME CARE
20|FH_F149513_0_0|SrvcGrp|80098|2022|PDM|55.94|99|0.00|AETNA HOSPICE CONTINUOUS HOME CARE
20|FH_F149517_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F149517_0_0|SrvcGrp|30609|2022|PDM|43.00|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F149517_0_0|SrvcGrp|89781|2022|PDM|194.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F149523_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F149523_0_0|SrvcGrp|101102|2022|PDM|15000.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT
20|FH_F149523_0_0|SrvcGrp|101103|2022|PDM|15000.00|99|0.00|REVIS SHOULDER JOINT
20|FH_F149523_0_0|SrvcGrp|114174|2022|PDM|6600.00|99|0.00|REMOVE/REINSER SPINE FIXATION DEVICE
20|FH_F149523_0_0|SrvcGrp|98560|2022|PDM|15000.00|99|0.00|LUMBAR
20|FH_F149523_0_0|SrvcGrp|98564|2022|PDM|15000.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR
20|FH_F149523_0_0|SrvcGrp|98565|2022|PDM|15000.00|99|0.00|LUMBAR SPINE FUSION COMBINED
20|FH_F149523_0_0|SrvcGrp|98566|2022|PDM|15000.00|99|0.00|ARTHRDSIS LAT MINI DISKECT
20|FH_F149528_0_0|SrvcGrp|46903|2022|PDM|730.00|99|0.00|RESIDENTIAL TREATMENT
20|FH_F149543_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F149543_0_0|SrvcGrp|108043|2022|PDM|182.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD
20|FH_F149543_0_0|SrvcGrp|111468|2022|PDM|150.00|99|0.00|DIALYSIS PATIENT TRAINING
20|FH_F149581_0_0|SrvcGrp|79720|2022|PDM|1008.00|99|0.00|ACUTE REHAB II
20|FH_F149603_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|HSS ASC
20|FH_F149605_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F149605_0_0|SrvcGrp|74546|2022|PDM|543.00|99|0.00|HOSPICE SERVICES
20|FH_F149605_0_0|SrvcGrp|83519|2022|PDM|153.00|99|0.00|HOSPICE CARE (ALL OTHER)
20|FH_F149605_0_0|SrvcGrp|89822|2022|PDM|153.00|99|0.00|HOSPICE ROUTINE HOME CARE
20|FH_F149605_0_0|SrvcGrp|90478|2022|PDM|153.00|99|0.00|HOSPICE
20|FH_F149660_0_0|SrvcGrp|115763|2022|PDM|12.00|99|0.00|NON-EMERGENCY TRANSPORTATION
20|FH_F149660_0_0|SrvcGrp|2067|2022|PDM|1119.00|99|0.00|SPECIALTY CARE TRANSPORT
20|FH_F149661_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F149661_0_0|SrvcGrp|14510|2022|PDM|800.00|99|0.00|SKILLED NURSING
20|FH_F149679_0_0|SrvcGrp|13681|2022|PDM|172.33|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT
20|FH_F149699_0_0|SrvcGrp|11442|2022|PDM|1100.00|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)
20|FH_F149699_0_0|SrvcGrp|13722|2022|PDM|203.00|99|0.00|HOSPICE SERVICE - ROUTINE HOME CARE
20|FH_F149701_0_0|SrvcGrp|30089|2022|PDM|400.00|99|0.00|HEMODIALYSIS SERVICES
20|FH_F149719_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F149779_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F149779_0_0|CSTM-ALL|CSTM-00|2020|PDM|1576.00|99|0.00|AEG 1 (NO REV)
20|FH_F149779_0_0|SrvcGrp|115762|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F149868_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F149868_0_0|SrvcGrp|33722|2022|PDM|45.00|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F149868_0_0|SrvcGrp|65720|2022|PDM|198.00|99|0.00|RESPITE CARE
20|FH_F149868_0_0|SrvcGrp|83519|2022|PDM|198.00|99|0.00|HOSPICE CARE (ALL OTHER)
20|FH_F149882_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F149899_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F149899_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F149980_0_0|CSTM-ALL|CSTM-00|2020|PDM|780.00|99|0.00|AEG 3 (NO REV) W/O ESOPHAGOGASTRODUODENOSCOPY
20|FH_F149980_0_0|SrvcGrp|113195|2022|PDM|1280.00|99|0.00|REINFORCE/GRAFT EYE WALL
20|FH_F149980_0_0|SrvcGrp|114519|2022|PDM|1921.00|99|0.00|INSERTION DRAINAGE DEVICE
20|FH_F149980_0_0|SrvcGrp|115169|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F149980_0_0|SrvcGrp|115789|2022|PDM|3300.00|99|0.00|EXTRACAPSULAR CATARACT REMOVAL INSERT LENS
20|FH_F149980_0_0|SrvcGrp|115791|2022|PDM|2954.00|99|0.00|REPAIR RETINAL DETACHMENT
20|FH_F149980_0_0|SrvcGrp|115797|2022|PDM|2500.00|99|0.00|CORNEAL TRANSPLANT
20|FH_F150025_0_0|SrvcGrp|65720|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F150025_0_0|SrvcGrp|93098|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F150026_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F150026_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F150026_0_0|SrvcGrp|63297|2022|PDM|100.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F150026_0_0|SrvcGrp|90707|2022|PDM|100.00|99|0.00|AETNA HOSPICE CARE
20|FH_F150079_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F150102_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F150102_0_0|CSTM-ALL|CSTM-00|2020|PDM|2150.00|99|0.00|AEG 10 (NO REV)
20|FH_F150102_0_0|CSTM-ALL|CSTM-00|2020|PDM|2767.00|99|0.00|AEG 9 (NO REV)
20|FH_F150102_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F150164_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F150164_0_0|SrvcGrp|63297|2022|PDM|100.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F150164_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F150200_0_0|CSTM-ALL|CSTM-00|2020|PDM|1785.00|99|0.00|AEG 4 (NO REV)
20|FH_F150220_0_0|CSTM-ALL|CSTM-00|2020|PDM|1896.00|99|0.00|AEG 4 (NO REV)
20|FH_F150220_0_0|CSTM-ALL|CSTM-00|2020|PDM|2115.00|99|0.00|AEG 5  (NO REV)
20|FH_F150220_0_0|CSTM-ALL|CSTM-00|2020|PDM|2466.00|99|0.00|AEG 6 (NO REV)
20|FH_F150220_0_0|CSTM-ALL|CSTM-00|2020|PDM|2994.00|99|0.00|AEG 7 (NO REV)
20|FH_F150220_0_0|SrvcGrp|115826|2022|PCT|1.00|99|0.00|IMPLANTS/PROSTHETICS
20|FH_F150224_0_0|SrvcGrp|57968|2022|PDM|43.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F150226_0_0|SrvcGrp|13597|2022|PDM|166.11|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT
20|FH_F150280_0_0|SrvcGrp|3259|2022|PDM|1509.00|99|0.00|ACUTE REHABILITATION
20|FH_F150314_0_0|SrvcGrp|89337|2022|PDM|800.00|99|0.00|DETOXIFICATION
20|FH_F150324_0_0|SrvcGrp|87077|2022|PDM|125.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F150520_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F150520_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F150535_0_0|CSTM-ALL|CSTM-00|2020|PCT|50.00|99|0.00|OP SVCS
20|FH_F150536_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F150599_0_0|CSTM-ALL|CSTM-00|2020|PDM|509.00|99|0.00|AEG 1 (NO REV)
20|FH_F150619_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F150619_0_0|SrvcGrp|16719|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F150619_0_0|SrvcGrp|23585|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F150660_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F150660_0_0|SrvcGrp|82981|2022|PDM|90.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F150699_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F150699_0_0|SrvcGrp|109494|2022|PDM|12296.00|99|0.00|INSRT HEART PM ATRIAL & VENT
20|FH_F150699_0_0|SrvcGrp|109497|2022|PDM|3317.00|99|0.00|REPOSITION PACING-DEFIB LEA
20|FH_F150699_0_0|SrvcGrp|109500|2022|PDM|3988.00|99|0.00|REPAIR LEAD PACE-DEFIB ONE
20|FH_F150699_0_0|SrvcGrp|109506|2022|PDM|30061.00|99|0.00|INSRT PULSE GEN W/ DUAL LEADS
20|FH_F150699_0_0|SrvcGrp|112878|2022|PDM|9639.00|99|0.00|INSERT 1 ELECTRODE PM DEFIB
20|FH_F150699_0_0|SrvcGrp|76023|2022|PDM|38065.00|99|0.00|OP AICD 33249
20|FH_F150759_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F150759_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 10 (NO REV)
20|FH_F150759_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|AEG 3 (NO REV)
20|FH_F150759_0_0|CSTM-ALL|CSTM-00|2020|PDM|973.00|99|0.00|AEG 8 (NO REV)
20|FH_F150759_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|AEG 7 (NO REV)
20|FH_F150763_0_0|CSTM-ALL|CSTM-00|2020|PDM|3698.00|99|0.00|AEG 8 (NO REV)
20|FH_F150763_0_0|SrvcGrp|114926|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES
20|FH_F150819_0_0|CSTM-ALL|CSTM-00|2020|PCT|91.00|99|0.00|OP SVCS
20|FH_F150906_0_0|SrvcGrp|115868|2022|PDM|50.00|99|0.00|HOSPICE  HOME CARE
20|FH_F150906_0_0|SrvcGrp|115901|2022|PDM|983.00|99|0.00|HOSPICE IN SNF
20|FH_F150910_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F150910_0_0|SrvcGrp|113856|2022|PDM|10000.00|99|0.00|SPINE PROCEDURES
20|FH_F150910_0_0|SrvcGrp|67068|2022|PDM|10500.00|99|0.00|LUMBAR SPINE FUSION COMBINED
20|FH_F150910_0_0|SrvcGrp|84939|2022|PDM|10500.00|99|0.00|SHOULDER JOINT
20|FH_F150910_0_0|SrvcGrp|86233|2022|PDM|11960.00|99|0.00|AETNA RECONSTRUCT ANKLE JOINT
20|FH_F150910_0_0|SrvcGrp|88164|2022|PDM|10500.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR
20|FH_F150910_0_0|SrvcGrp|89404|2022|PDM|10950.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F150939_0_0|SrvcGrp|100243|2022|PCT|0.00|99|0.00|CULTURE SCREEN
20|FH_F150939_0_0|SrvcGrp|100253|2022|PDM|73.00|99|0.00|REPAIR SUPERFICIAL WOUND(S) (12.6 - 20.0 CM)
20|FH_F150939_0_0|SrvcGrp|100260|2022|PDM|125.00|99|0.00|REPAIR SUPERFICIAL WOUND(S) (OVER 30.0 CM)
20|FH_F150939_0_0|SrvcGrp|100264|2022|PDM|24.00|99|0.00|REMOVE IMPACTED EAR WAX
20|FH_F150939_0_0|SrvcGrp|100265|2022|PDM|2.00|99|0.00|CHEMISTRY
20|FH_F150939_0_0|SrvcGrp|100268|2022|PDM|9.00|99|0.00|ADENOVIRUS ASSAY W/ OPTIC
20|FH_F150939_0_0|SrvcGrp|100279|2022|PDM|0.17|99|0.00|ALBUTEROL NON-COMPOUNDED
20|FH_F150939_0_0|SrvcGrp|101742|2022|PDM|3.00|99|0.00|IMMUN ADMIN ORAL/NASAL ADDL
20|FH_F150939_0_0|SrvcGrp|101744|2022|PDM|5.00|99|0.00|IM ADMIN EACH ADDL COMPONENT
20|FH_F150939_0_0|SrvcGrp|104054|2022|PDM|65.26|99|0.00|INFLUENZA VACCINE - PRESERVATIVE FREE
20|FH_F150939_0_0|SrvcGrp|105327|2022|PDM|2.98|99|0.00|METHILPREDNISO ACET 80MG/2MX
20|FH_F150939_0_0|SrvcGrp|108435|2022|PDM|21.64|99|0.00|AETNA IMMUNIZATION
20|FH_F150939_0_0|SrvcGrp|112230|2022|PDM|29.94|99|0.00|CCIIV4 VACCINE IM CULT PRSV FREE 0.5 ML
20|FH_F150939_0_0|SrvcGrp|25383|2022|PCT|0.00|99|0.00|MEDICINE SERVICES
20|FH_F150939_0_0|SrvcGrp|73362|2022|PDM|10.00|99|0.00|VACCINE SERVICES
20|FH_F150939_0_0|SrvcGrp|82737|2022|PCT|0.00|99|0.00|URINALYSIS
20|FH_F150939_0_0|SrvcGrp|85259|2022|PCT|0.00|99|0.00|PERIODIC REEVALUATION
20|FH_F150939_0_0|SrvcGrp|91631|2022|PDM|48.00|99|0.00|OFFICE VISIT
20|FH_F150948_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.11|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE
20|FH_F150948_0_0|SrvcGrp|113854|2022|PDM|4740.00|99|0.00|REMOVE/REINSER SPINE FIXATION DEVICE
20|FH_F150948_0_0|SrvcGrp|41334|2022|PDM|10500.00|99|0.00|TOTAL KNEE
20|FH_F150948_0_0|SrvcGrp|67068|2022|PDM|10500.00|99|0.00|LUMBAR SPINE FUSION COMBINED
20|FH_F150948_0_0|SrvcGrp|86233|2022|PDM|11960.00|99|0.00|AETNA RECONSTRUCT ANKLE JOINT
20|FH_F150948_0_0|SrvcGrp|88164|2022|PDM|10500.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR
20|FH_F150948_0_0|SrvcGrp|93063|2022|PDM|10500.00|99|0.00|LUMBAR ARTIF DISKECTOMY
20|FH_F150948_0_0|SrvcGrp|93065|2022|PDM|9000.00|99|0.00|LUMB ARTIF DISKECTOMY ADDL
20|FH_F150948_0_0|SrvcGrp|93431|2022|PDM|10500.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT
20|FH_F150949_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.11|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE
20|FH_F150949_0_0|SrvcGrp|108093|2022|PDM|10950.00|99|0.00|REVISE HIP ARTHROPLASTY
20|FH_F150949_0_0|SrvcGrp|113854|2022|PDM|4740.00|99|0.00|REMOVE/REINSER SPINE FIXATION DEVICE
20|FH_F150949_0_0|SrvcGrp|113855|2022|PDM|3000.00|99|0.00|SPINE FIXATION
20|FH_F150949_0_0|SrvcGrp|41334|2022|PDM|10500.00|99|0.00|TOTAL KNEE
20|FH_F150949_0_0|SrvcGrp|86233|2022|PDM|11960.00|99|0.00|AETNA RECONSTRUCT ANKLE JOINT
20|FH_F150949_0_0|SrvcGrp|88164|2022|PDM|10500.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR
20|FH_F150949_0_0|SrvcGrp|89404|2022|PDM|10950.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F150949_0_0|SrvcGrp|89842|2022|PDM|10500.00|99|0.00|LUMBAR
20|FH_F150949_0_0|SrvcGrp|93432|2022|PDM|10500.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT
20|FH_F150951_0_0|SrvcGrp|103911|2022|PDM|100.00|99|0.00|HOSPICE CARE PROVIDED IN INPATIENT HOSPICE FACILITY
20|FH_F150951_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F150951_0_0|SrvcGrp|82223|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F150959_0_0|CSTM-ALL|CSTM-00|2020|PDM|1870.00|99|0.00|AEG 4 (NO REV)
20|FH_F150959_0_0|CSTM-ALL|CSTM-00|2020|PDM|990.00|99|0.00|AEG 2 (NO REV)
20|FH_F150982_0_0|CSTM-ALL|CSTM-00|2020|PDM|1322.00|99|0.00|AEG 4 (NO REV)
20|FH_F150982_0_0|CSTM-ALL|CSTM-00|2020|PDM|1927.00|99|0.00|AEG 7 (NO REV)
20|FH_F150982_0_0|CSTM-ALL|CSTM-00|2020|PDM|2423.00|99|0.00|AEG 9 (NO REV)
20|FH_F150982_0_0|SrvcGrp|101527|2022|PDM|1930.00|99|0.00|HYSTEROSCOPY LYSIS
20|FH_F150982_0_0|SrvcGrp|102240|2022|PDM|2202.00|99|0.00|AETNA BLEPHARAPLASTY UPPER EYELID
20|FH_F150982_0_0|SrvcGrp|103570|2022|PDM|2202.00|99|0.00|ARTHROSCOPIC FRACTURE
20|FH_F150982_0_0|SrvcGrp|104248|2022|PDM|1382.00|99|0.00|SKIN TISSUE REARRANGEMENT
20|FH_F150982_0_0|SrvcGrp|104256|2022|PDM|1382.00|99|0.00|SKIN TISSUE REARRANGEMENT
20|FH_F150982_0_0|SrvcGrp|105235|2022|PDM|4955.00|99|0.00|PARTIAL REMOVAL OF THYROID
20|FH_F150982_0_0|SrvcGrp|105632|2022|PDM|1976.00|99|0.00|AMPUTATION OF TOE
20|FH_F150982_0_0|SrvcGrp|107165|2022|PDM|7228.00|99|0.00|EAR CARTILAGE GRAFT
20|FH_F150982_0_0|SrvcGrp|115930|2022|PDM|2600.00|99|0.00|EYELID REVISION
20|FH_F150982_0_0|SrvcGrp|115931|2022|PDM|1382.00|99|0.00|PALM CONTRACTURE RELEASE
20|FH_F150982_0_0|SrvcGrp|16732|2022|PDM|4184.00|99|0.00|HYSTEROSCOPY ABLATION
20|FH_F150982_0_0|SrvcGrp|27348|2022|PDM|4371.00|99|0.00|OP SURGERY (CPT 58662)
20|FH_F150982_0_0|SrvcGrp|28549|2022|PDM|2392.00|99|0.00|VITRECTOMY
20|FH_F150982_0_0|SrvcGrp|33965|2022|PDM|2527.00|99|0.00|CPT 58552
20|FH_F150982_0_0|SrvcGrp|33986|2022|PDM|1382.00|99|0.00|CPT 26055
20|FH_F150982_0_0|SrvcGrp|35669|2022|PDM|4404.00|99|0.00|CPT 63650
20|FH_F150982_0_0|SrvcGrp|36591|2022|PDM|8320.00|99|0.00|CPT 63685
20|FH_F150982_0_0|SrvcGrp|36991|2022|PCT|0.60|99|0.00|IMPLANTS
20|FH_F150982_0_0|SrvcGrp|42472|2022|PDM|4184.00|99|0.00|CPT 58670
20|FH_F150982_0_0|SrvcGrp|44066|2022|PDM|4184.00|99|0.00|CPT 57288
20|FH_F150982_0_0|SrvcGrp|45583|2022|PDM|2392.00|99|0.00|CPT 65730
20|FH_F150982_0_0|SrvcGrp|46885|2022|PDM|2202.00|99|0.00|REPAIR BROW DEFECT
20|FH_F150982_0_0|SrvcGrp|59840|2022|PDM|1872.00|99|0.00|TYMPANOSTOMY
20|FH_F150982_0_0|SrvcGrp|63469|2022|PDM|1652.00|99|0.00|CPT 55700
20|FH_F150982_0_0|SrvcGrp|65403|2022|PDM|2202.00|99|0.00|CPT 42830
20|FH_F150982_0_0|SrvcGrp|76602|2022|PDM|1382.00|99|0.00|CPT 25000
20|FH_F150982_0_0|SrvcGrp|76603|2022|PDM|1382.00|99|0.00|CPT 25111
20|FH_F150982_0_0|SrvcGrp|77444|2022|PDM|1652.00|99|0.00|VASECTOMY
20|FH_F150982_0_0|SrvcGrp|78096|2022|PDM|3854.00|99|0.00|AETNA ARTHROSCOPY BICEPS
20|FH_F150982_0_0|SrvcGrp|78285|2022|PDM|4184.00|99|0.00|CPT 58671
20|FH_F150982_0_0|SrvcGrp|82112|2022|PDM|2202.00|99|0.00|KNEE ARTHROSCOPY SURGERY
20|FH_F150982_0_0|SrvcGrp|82113|2022|PDM|2202.00|99|0.00|KNEE ARTHROSCOPY SURGERY
20|FH_F150982_0_0|SrvcGrp|82720|2022|PDM|2228.00|99|0.00|WRIST ENDOSCOPY/SURGERY
20|FH_F150982_0_0|SrvcGrp|83639|2022|PDM|2202.00|99|0.00|CPT 29886
20|FH_F150982_0_0|SrvcGrp|83646|2022|PDM|2753.00|99|0.00|CPT 31276
20|FH_F150982_0_0|SrvcGrp|84704|2022|PDM|1927.00|99|0.00|CYSTOURETHROSCOPY W/ REMOVAL OF FOREIGN BODY
20|FH_F150982_0_0|SrvcGrp|87385|2022|PDM|1382.00|99|0.00|PARTIAL REMOVAL OF EYE FLUID
20|FH_F150982_0_0|SrvcGrp|88147|2022|PDM|4184.00|99|0.00|LAPAROSCOPY REMOVE ADNEXA
20|FH_F150982_0_0|SrvcGrp|89404|2022|PDM|24223.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F150982_0_0|SrvcGrp|89842|2022|PDM|13213.00|99|0.00|LUMBAR
20|FH_F150982_0_0|SrvcGrp|90369|2022|PDM|1382.00|99|0.00|PROBE NASOLACRIMAL DUCT
20|FH_F150982_0_0|SrvcGrp|90779|2022|PDM|2753.00|99|0.00|HERNIA PROCEDURES
20|FH_F150982_0_0|SrvcGrp|92408|2022|PDM|7268.00|99|0.00|PERQ VERTEBRAL AUGMENTATION
20|FH_F150982_0_0|SrvcGrp|92819|2022|PDM|16516.00|99|0.00|HIP ARTHOSCOPY
20|FH_F150982_0_0|SrvcGrp|93069|2022|PDM|3854.00|99|0.00|POSTERIOR NON-SEGMENTAL INST
20|FH_F150982_0_0|SrvcGrp|93071|2022|PDM|3854.00|99|0.00|POSTERIOR SEGMENTAL INSTRU
20|FH_F150982_0_0|SrvcGrp|97467|2022|PDM|2835.00|99|0.00|PARTIAL EXCISION THYROID
20|FH_F151002_0_0|SrvcGrp|16719|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F151045_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F151139_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F151139_0_0|SrvcGrp|115963|2022|PDM|12.00|99|0.00|NON-EMERGENT FIXED WING AIR MILEAGE (MOD NE)
20|FH_F151139_0_0|SrvcGrp|12868|2022|PDM|24000.00|99|0.00|AIR AMBULANCE
20|FH_F151143_0_0|SrvcGrp|100959|2022|PDM|7500.00|99|0.00|AMB SRVC CONVNTION AIR TRANSPORT 1 WAY
20|FH_F151143_0_0|SrvcGrp|12868|2022|PDM|24000.00|99|0.00|AIR AMBULANCE
20|FH_F151156_0_0|CSTM-ALL|CSTM-00|2020|PDM|36.00|99|0.00|AEG 3 (NO REV)
20|FH_F151156_0_0|CSTM-ALL|CSTM-00|2020|PDM|36.00|99|0.00|AEG 6 (NO REV)
20|FH_F151157_0_0|CSTM-ALL|CSTM-00|2020|PDM|961.00|99|0.00|AEG 2 (NO REV) W/ GASTROESOPHOGEAL
20|FH_F151158_0_0|CSTM-ALL|CSTM-00|2020|PCT|12000.00|99|0.00|TIMELY FILING
20|FH_F151202_0_0|SrvcGrp|46903|2022|PDM|450.00|99|0.00|RESIDENTIAL TREATMENT
20|FH_F151225_0_0|SrvcGrp|74546|2022|PDM|837.00|99|0.00|HOSPICE SERVICES
20|FH_F151225_0_0|SrvcGrp|76531|2022|PDM|208.00|99|0.00|HOSPICE IN HOME
20|FH_F151399_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F151399_0_0|SrvcGrp|12869|2022|PDM|118.00|99|0.00|AIR AMBULANCE
20|FH_F151399_0_0|SrvcGrp|13262|2022|PDM|24.00|99|0.00|GROUND MILEAGE, PER STATUTE MILE
20|FH_F151400_0_0|CSTM-ALL|CSTM-00|2020|PDM|1417.00|99|0.00|AEG 2 (NO REV)
20|FH_F151400_0_0|CSTM-ALL|CSTM-00|2020|PDM|2680.00|99|0.00|AEG 8 (NO REV)
20|FH_F151400_0_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|AEG 4 (NO REV)
20|FH_F151400_0_0|SrvcGrp|115169|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F151400_0_0|SrvcGrp|115762|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F151400_0_0|SrvcGrp|44461|2022|PDM|5142.00|99|0.00|INSERTION / REPLACEMENT OF SPINAL NEUROSTIMULATOR GENERATOR
20|FH_F151400_0_0|SrvcGrp|58755|2022|PDM|3500.00|99|0.00|INJECTION PROC FOR JOINT
20|FH_F151400_0_0|SrvcGrp|93740|2022|PDM|2205.00|99|0.00|REVISE/REMOVE NEURO RECEIVER
20|FH_F151400_0_0|SrvcGrp|97279|2022|PDM|1500.00|99|0.00|REMOVE SPINE ELTRD PERQ ARAY
20|FH_F151400_0_0|SrvcGrp|97299|2022|PDM|3181.00|99|0.00|REMOVE SPINE ELTRD PLATE
20|FH_F151400_0_0|SrvcGrp|98563|2022|PDM|6439.00|99|0.00|LUMBAR SPINE FUSION
20|FH_F151423_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|OP SVCS
20|FH_F151500_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F151559_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F151559_0_0|SrvcGrp|116054|2022|PDM|800.00|99|0.00|SAME DAY NEWBORN DISCHARGE
20|FH_F151559_0_0|SrvcGrp|78420|2022|PDM|625.00|99|0.00|INTERIM LABOR
20|FH_F151607_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|OP SVCS
20|FH_F151663_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F151751_0_0|CSTM-ALL|CSTM-00|2020|PDM|1228.79|99|0.00|AEG 5  (NO REV)
20|FH_F151751_0_0|CSTM-ALL|CSTM-00|2020|PDM|542.00|99|0.00|AEG 1 (NO REV)
20|FH_F151751_0_0|CSTM-ALL|CSTM-00|2020|PDM|755.00|99|0.00|AEG 2 (NO REV)
20|FH_F151780_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F151780_0_0|SrvcGrp|87077|2022|PDM|140.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F31003_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31032_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31036_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31036_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F31056_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.83|99|0.00|OP SVCS
20|FH_F31087_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.97|99|0.00|GENERAL ACUTE CARE
20|FH_F31087_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.97|99|0.00|OP SVCS
20|FH_F31087_0_0|SrvcGrp|10519|2022|PDM|140.00|99|0.00|MEDICAL SOCIAL WORKER VISIT
20|FH_F31087_0_0|SrvcGrp|10520|2022|PDM|110.00|99|0.00|OCCUPATIONAL THERAPY VISIT
20|FH_F31087_0_0|SrvcGrp|10623|2022|PDM|110.00|99|0.00|SPEECH THERAPY SERVICES
20|FH_F31096_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OP SVCS
20|FH_F31111_0_0|SrvcGrp|112054|2022|PDM|65.00|99|0.00|COVID-19 ANTIBODY
20|FH_F31111_0_0|SrvcGrp|112106|2022|PDM|87.00|99|0.00|COVID-19 AMP PRB (HCFA)
20|FH_F31111_0_0|SrvcGrp|112479|2022|PDM|65.00|99|0.00|COVID-19 ANTIBODY (HCFA)
20|FH_F31150_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F31150_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|ACUTE IP MED SVCS
20|FH_F31152_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31152_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F31166_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F31178_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31184_0_0|CSTM-ALL|CSTM-00|2020|PDM|16100.00|99|0.00|MS DRG 247
20|FH_F31184_0_0|CSTM-ALL|CSTM-00|2020|PDM|19500.00|99|0.00|MS DRG 242-244 PACEMAKER IMPLANT W/ACUTE INFARCTION
20|FH_F31184_0_0|CSTM-ALL|CSTM-00|2020|PDM|21500.00|99|0.00|MS DRG 235
20|FH_F31184_0_0|CSTM-ALL|CSTM-00|2020|PDM|28000.00|99|0.00|MS DRG 228
20|FH_F31184_0_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|ASPG X
20|FH_F31184_0_0|CSTM-ALL|CSTM-00|2020|PDM|39300.00|99|0.00|MS DRG 224
20|FH_F31184_0_0|CSTM-ALL|CSTM-00|2020|PDM|41600.00|99|0.00|MS DRG 222
20|FH_F31184_0_0|CSTM-ALL|CSTM-00|2020|PDM|42800.00|99|0.00|MS DRG 216
20|FH_F31184_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|ACUTE PSYCH
20|FH_F31184_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F31184_0_0|CSTM-ALL|CSTM-00|2020|PDM|9100.00|99|0.00|CARDIAC PACE DEV REPLACEMNT MS DRG 258-259
20|FH_F31184_0_0|CSTM-ALL|CSTM-00|2020|PDM|9100.00|99|0.00|CARDIAC PACE REVISION MS DRG 260-262
20|FH_F31184_0_0|SrvcGrp|361|2022|PDM|1100.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F31184_0_0|SrvcGrp|9501|2022|PDM|1900.00|99|0.00|ACUTE IP MED/SURG SVCS
20|FH_F31204_0_0|CSTM-ALL|CSTM-00|2020|PDM|210.00|99|0.00|CRISIS EVALUATION
20|FH_F31204_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|EATING DISORDER
20|FH_F31204_0_0|SrvcGrp|11975|2022|PDM|520.00|99|0.00|ELECTRO CONVULSIVE THERAPY
20|FH_F31218_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F31220_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31229_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31244_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F31253_0_0|SrvcGrp|11606|2022|PDM|1125.00|99|0.00|ACUTE CARE (MEDICAL & SURGICAL)
20|FH_F31253_0_0|SrvcGrp|3259|2022|PDM|850.00|99|0.00|ACUTE REHABILITATION
20|FH_F31309_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31381_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F31381_0_0|CSTM-ALL|CSTM-00|2020|PDM|1080.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31405_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31433_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|ORGAN ACQUISITION
20|FH_F31446_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F31446_0_0|CSTM-ALL|CSTM-00|2020|PDM|150.00|99|0.00|CD SVCS (ADULT)
20|FH_F31446_0_0|SrvcGrp|52|2022|PDM|50.00|99|0.00|RESIDENTIAL TREATMENT SVCS
20|FH_F31464_0_0|CSTM-ALL|CSTM-00|2020|PDM|5000.00|99|0.00|OP SVCS
20|FH_F31466_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F31486_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31519_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.00|99|0.00|OP SVCS
20|FH_F31524_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS
20|FH_F31525_0_0|SrvcGrp|109|2022|PDM|490.00|99|0.00|CD - DETOX
20|FH_F31525_0_0|SrvcGrp|6|2022|PCT|0.75|99|0.00|OP SURGERY
20|FH_F31525_0_0|SrvcGrp|65|2022|PDM|4135.00|99|0.00|OBSTETRICAL CARE
20|FH_F31525_0_0|SrvcGrp|701|2022|PDM|1745.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F31530_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|GENERAL ACUTE CARE
20|FH_F31537_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31542_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP LAB SVCS
20|FH_F31542_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|RADIOLOGY SVCS
20|FH_F31542_0_0|CSTM-ALL|CSTM-00|2020|PDM|1050.00|99|0.00|ASPG II
20|FH_F31542_0_0|CSTM-ALL|CSTM-00|2020|PDM|2343.00|99|0.00|ASPG VII
20|FH_F31542_0_0|SrvcGrp|10708|2022|PDM|90.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F31542_0_0|SrvcGrp|3420|2022|PDM|4000.00|99|0.00|OP LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F31542_0_0|SrvcGrp|411|2022|PDM|3600.00|99|0.00|OP CARDIAC CATH
20|FH_F31542_0_0|SrvcGrp|9793|2022|PDM|250.00|99|0.00|NEWBORN NURSERY
20|FH_F31563_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31563_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|OP SVCS
20|FH_F31594_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F31595_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|BOARDER BABY
20|FH_F31595_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|GENERAL ACUTE CARE
20|FH_F31595_0_0|SrvcGrp|9230|2022|PDM|92.00|99|0.00|HOME IV THERAPY SVCS
20|FH_F31612_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.10|99|0.00|GENERAL ACUTE CARE
20|FH_F31688_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31736_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31736_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS
20|FH_F31754_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31754_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F31783_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|MSDRG 219-221 CARDIAC VLV PX+OTR MJR CARDIOTHORAIC W/CC OLR
20|FH_F31783_0_0|CSTM-ALL|CSTM-00|2020|PDM|13545.00|99|0.00|MS DRG 243-244
20|FH_F31783_0_0|CSTM-ALL|CSTM-00|2020|PDM|29505.00|99|0.00|MS DRGS 222-225 CV SURGERY
20|FH_F31783_0_0|CSTM-ALL|CSTM-00|2020|PDM|35490.00|99|0.00|MSDRG 231-232 CORONARY BYPASS
20|FH_F31783_0_0|SrvcGrp|19671|2022|PDM|8925.00|99|0.00|MS DRG 286 ONLY CIRCULATORY DISORDERS W/CARD CATH COMPLEX DX
20|FH_F31783_0_0|SrvcGrp|21354|2022|PDM|10606.00|99|0.00|MS DRG 250-251 ONLY
20|FH_F31796_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F31798_0_0|CSTM-ALL|CSTM-00|2020|PDM|1840.00|99|0.00|ACUTE IP MED SVCS
20|FH_F31798_0_0|SrvcGrp|10427|2022|PCT|0.85|99|0.00|TRAUMA CARE
20|FH_F31798_0_0|SrvcGrp|115|2022|PCT|0.85|99|0.00|SKILLED NURSING CARE
20|FH_F31798_0_0|SrvcGrp|13294|2022|PDM|473.00|99|0.00|MRI
20|FH_F31798_0_0|SrvcGrp|16|2022|PDM|1234.00|99|0.00|ACUTE REHABILITATION
20|FH_F31798_0_0|SrvcGrp|903|2022|PCT|0.75|99|0.00|PTC ANGIOPLASTY
20|FH_F31798_0_0|SrvcGrp|941|2022|PCT|0.85|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F31814_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31814_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F31824_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|OBSTETRICAL CARE (MOTHER & BABY)
20|FH_F31826_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS
20|FH_F31827_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31836_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31861_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31872_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31878_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31878_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS
20|FH_F31884_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F31904_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31904_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F31927_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F31928_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|MRI/CT SCAN
20|FH_F31928_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|OP SVCS
20|FH_F31928_0_0|SrvcGrp|3271|2022|PDM|790.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F31928_0_0|SrvcGrp|9511|2022|PDM|790.00|99|0.00|OBSERVATION SVCS
20|FH_F31940_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F31944_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.97|99|0.00|GENERAL ACUTE CARE
20|FH_F31944_0_0|CSTM-ALL|CSTM-00|2020|PDM|75.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F31955_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31955_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS
20|FH_F31959_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31991_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31996_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F32000_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32002_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F32010_0_0|CSTM-ALL|CSTM-00|2020|PCT|86.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32033_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F32056_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32073_0_0|CSTM-ALL|CSTM-00|2020|PDM|1516.00|99|0.00|TRAUMATIC BRAIN INJURY
20|FH_F32073_0_0|SrvcGrp|17710|2022|PDM|2205.00|99|0.00|RESPIRATORY DEPENDENT PATIENT
20|FH_F32073_0_0|SrvcGrp|3259|2022|PDM|1103.00|99|0.00|ACUTE REHABILITATION
20|FH_F32080_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32088_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|OP SVCS
20|FH_F32108_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F32112_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS
20|FH_F32116_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F32118_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32154_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F32168_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32168_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F32177_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F32189_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32192_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS
20|FH_F32198_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32214_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32214_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F32215_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32220_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32221_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32221_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS
20|FH_F32222_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F32227_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS
20|FH_F32236_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS
20|FH_F32260_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS
20|FH_F32275_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS
20|FH_F32281_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32283_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32288_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32289_0_0|CSTM-ALL|CSTM-00|2020|PCT|99.00|99|0.00|OP SVCS
20|FH_F32293_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32299_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32299_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS
20|FH_F32366_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS
20|FH_F32369_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F32371_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32373_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32373_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F32374_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F32388_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32389_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32389_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F32393_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32413_0_0|CSTM-ALL|CSTM-00|2020|PCT|59.00|99|0.00|OP SVCS
20|FH_F32413_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32424_0_0|CSTM-ALL|CSTM-00|2020|PCT|48.00|99|0.00|OP SVCS
20|FH_F32453_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32461_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|OP SVCS
20|FH_F32466_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS
20|FH_F32478_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32478_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS
20|FH_F32482_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32487_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32501_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F32509_0_0|SrvcGrp|11029|2022|PDM|19795.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F32509_0_0|SrvcGrp|9808|2022|PDM|16970.00|99|0.00|PTCA WITH STENT
20|FH_F32513_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F32522_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32523_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32524_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.25|99|0.00|OP SVCS
20|FH_F32525_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|OP SVCS
20|FH_F32533_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32534_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS
20|FH_F32538_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32538_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F32565_0_0|CSTM-ALL|CSTM-00|2020|PCT|86.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32573_0_0|CSTM-ALL|CSTM-00|2020|PCT|43.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32573_0_0|CSTM-ALL|CSTM-00|2020|PCT|43.00|99|0.00|OP SVCS
20|FH_F32574_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32574_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F32589_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32604_0_0|CSTM-ALL|CSTM-00|2020|PDM|90.00|99|0.00|RN VISIT
20|FH_F32612_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F32613_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32613_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F32614_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|OP SVCS
20|FH_F32617_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS
20|FH_F32620_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.00|99|0.00|OP SVCS
20|FH_F32621_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32640_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F32653_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|OP SVCS
20|FH_F32657_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F32683_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32693_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F32704_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32707_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32707_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS
20|FH_F32718_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F32720_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32736_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32737_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32739_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING
20|FH_F32740_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32740_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F32742_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32762_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F32770_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|OP SVCS
20|FH_F32772_0_0|SrvcGrp|115031|2022|PCT|0.95|99|0.00|CARDIAC CATHETERIZATION
20|FH_F32777_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F32778_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F32780_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32783_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F32784_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32786_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32802_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32802_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS
20|FH_F32803_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F32803_0_0|SrvcGrp|115|2022|PDM|450.00|99|0.00|SKILLED NURSING CARE
20|FH_F32803_0_0|SrvcGrp|12350|2022|PDM|458.00|99|0.00|BOARDER BABY SERVICES
20|FH_F32803_0_0|SrvcGrp|12901|2022|PCT|0.65|99|0.00|ANGIOPLASTY
20|FH_F32803_0_0|SrvcGrp|3064|2022|PDM|1599.00|99|0.00|ICU/CCU
20|FH_F32803_0_0|SrvcGrp|3259|2022|PDM|944.00|99|0.00|ACUTE REHABILITATION
20|FH_F32804_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32825_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|MS DRG 480
20|FH_F32825_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|MSDRG 466-470 MAJOR JOINT/LIMB PROCS
20|FH_F32825_0_0|SrvcGrp|12674|2022|PCT|0.60|99|0.00|IMPLANTS
20|FH_F32825_0_0|SrvcGrp|16|2022|PDM|776.00|99|0.00|ACUTE REHABILITATION
20|FH_F32825_0_0|SrvcGrp|360|2022|PDM|1582.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F32825_0_0|SrvcGrp|361|2022|PDM|1638.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F32825_0_0|SrvcGrp|97|2022|PDM|3447.00|99|0.00|C-SECTION
20|FH_F32826_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32833_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32848_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS
20|FH_F32869_0_0|CSTM-ALL|CSTM-00|2020|PDM|17500.00|99|0.00|MS DRG 329-331 BCIR
20|FH_F32869_0_0|CSTM-ALL|CSTM-00|2020|PDM|22000.00|99|0.00|MSDRG 219-221 CARDIAC VLV PX+OTR MJR CARDIOTHORACIC PX W/CC
20|FH_F32869_0_0|CSTM-ALL|CSTM-00|2020|PDM|22000.00|99|0.00|MSDRG 233-234 CORONARY BYPASS
20|FH_F32869_0_0|CSTM-ALL|CSTM-00|2020|PDM|33000.00|99|0.00|MS DRG 309-310 CARDIAC ARRHYTHMIA
20|FH_F32869_0_0|CSTM-ALL|CSTM-00|2020|PDM|8800.00|99|0.00|MS DRG 258-259 CARDIAC PACE DEV REPL
20|FH_F32869_0_0|SrvcGrp|19661|2022|PDM|30000.00|99|0.00|MS DRG 216-218 ONLY CARDIAC VALVE PROCEDURE W/CARDIAC CATH
20|FH_F32869_0_0|SrvcGrp|19671|2022|PDM|5000.00|99|0.00|MS DRG 286 ONLY CIRCULATORY DISORDERS W/CARD CATH COMPLEX DX
20|FH_F32869_0_0|SrvcGrp|361|2022|PDM|500.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F32869_0_0|SrvcGrp|411|2022|PDM|4000.00|99|0.00|OP CARDIAC CATH
20|FH_F32886_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F32910_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32911_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.00|99|0.00|OP SVCS
20|FH_F32913_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32926_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32928_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32928_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F32930_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32933_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS
20|FH_F32935_0_0|SrvcGrp|118|2022|PDM|1339.00|99|0.00|LONG-TERM CARE
20|FH_F32935_0_0|SrvcGrp|3069|2022|PCT|0.35|99|0.00|IMPLANTS
20|FH_F32936_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32938_0_0|CSTM-ALL|CSTM-00|2020|PDM|1485.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F32938_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|ACUTE PSYCH
20|FH_F32938_0_0|SrvcGrp|9774|2022|PDM|1800.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F32958_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32972_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F32980_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS
20|FH_F32995_0_0|CSTM-ALL|CSTM-00|2020|PDM|2343.00|99|0.00|ASPG VII
20|FH_F32995_0_0|CSTM-ALL|CSTM-00|2020|PDM|2658.00|99|0.00|ASPG VIII
20|FH_F32995_0_0|SrvcGrp|10922|2022|PDM|5345.00|99|0.00|PTCA W/NON DRUG ELUTING STENT
20|FH_F32995_0_0|SrvcGrp|10924|2022|PDM|4832.00|99|0.00|PTCA W/O STENT
20|FH_F32995_0_0|SrvcGrp|10927|2022|PDM|575.00|99|0.00|COMPUTED TOMOGRAPHY (CT)
20|FH_F32995_0_0|SrvcGrp|12118|2022|PDM|575.00|99|0.00|COMPUTED TOMOGRAPHY (CT)
20|FH_F32995_0_0|SrvcGrp|14546|2022|PDM|90.00|99|0.00|SPEECH THERAPY SVCS
20|FH_F32995_0_0|SrvcGrp|15768|2022|PDM|750.00|99|0.00|MRI
20|FH_F32995_0_0|SrvcGrp|9911|2022|PCT|0.65|99|0.00|EMERGENCY ROOM SVCS
20|FH_F32996_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F32996_0_0|CSTM-ALL|CSTM-00|2020|PDM|1944.00|99|0.00|MS DRG 767-768, 774-775 NORMAL DELIVERY
20|FH_F32996_0_0|CSTM-ALL|CSTM-00|2020|PDM|3240.00|99|0.00|INTENSIVE/INTERMEDIATE CARE UNIT
20|FH_F32996_0_0|SrvcGrp|1943|2022|PDM|3240.00|99|0.00|NEONATAL INTENSVE CARE II & III
20|FH_F32996_0_0|SrvcGrp|24|2022|PCT|0.75|99|0.00|CARDIAC CATH
20|FH_F32998_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33002_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33002_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F33003_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33010_0_0|CSTM-ALL|CSTM-00|2020|PCT|56.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33010_0_0|CSTM-ALL|CSTM-00|2020|PCT|56.00|99|0.00|OP SVCS
20|FH_F33015_0_0|SrvcGrp|3259|2022|PDM|295.00|99|0.00|ACUTE REHABILITATION
20|FH_F33019_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33019_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F33025_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.00|99|0.00|OP SVCS
20|FH_F33047_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F33063_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F33126_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE
20|FH_F33139_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33139_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F33181_0_0|CSTM-ALL|CSTM-00|2020|PDM|17000.00|99|0.00|MS DRGS 216-221 CARDIAC VALVE
20|FH_F33182_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33183_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F33225_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS
20|FH_F33233_0_0|SrvcGrp|12436|2022|PDM|132.30|99|0.00|PT/OT INITIAL EVAL
20|FH_F33233_0_0|SrvcGrp|696|2022|PDM|0.50|99|0.00|BLOOD PLASMA/TRANSPORTATION
20|FH_F33241_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F33241_0_0|CSTM-ALL|CSTM-00|2020|PDM|2343.00|99|0.00|ASPG VII
20|FH_F33241_0_0|CSTM-ALL|CSTM-00|2020|PDM|3153.00|99|0.00|ASPG IX
20|FH_F33241_0_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|ASPG X
20|FH_F33241_0_0|SrvcGrp|10924|2022|PDM|3800.00|99|0.00|PTCA W/O STENT
20|FH_F33241_0_0|SrvcGrp|411|2022|PDM|3600.00|99|0.00|OP CARDIAC CATH
20|FH_F33241_0_0|SrvcGrp|9774|2022|PDM|1400.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F33249_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33249_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F33255_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33271_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33287_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33311_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS
20|FH_F33322_0_0|SrvcGrp|14727|2022|PCT|0.90|99|0.00|TRAUMA CARE
20|FH_F33335_0_0|CSTM-ALL|CSTM-00|2020|PCT|68.00|99|0.00|OP SVCS
20|FH_F33346_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33381_0_0|CSTM-ALL|CSTM-00|2020|PDM|1004.00|99|0.00|ACUTE PSYCH
20|FH_F33381_0_0|CSTM-ALL|CSTM-00|2020|PDM|16926.00|99|0.00|MS DRG 247
20|FH_F33381_0_0|CSTM-ALL|CSTM-00|2020|PDM|17909.00|99|0.00|MS DRG 248
20|FH_F33381_0_0|SrvcGrp|16|2022|PDM|1004.00|99|0.00|ACUTE REHABILITATION
20|FH_F33381_0_0|SrvcGrp|6|2022|PDM|4219.00|99|0.00|OP SURGERY
20|FH_F33385_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS
20|FH_F33389_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|DIALYSIS SVCS
20|FH_F33389_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|OP SVCS
20|FH_F33389_0_0|CSTM-ALL|CSTM-00|2020|PDM|1430.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33389_0_0|SrvcGrp|12299|2022|PCT|0.70|99|0.00|PROSTHETICS/IMPLANTS/DEVICES
20|FH_F33389_0_0|SrvcGrp|13188|2022|PCT|0.70|99|0.00|DRUGS
20|FH_F33389_0_0|SrvcGrp|16|2022|PDM|1013.00|99|0.00|ACUTE REHABILITATION
20|FH_F33390_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|OP SVCS
20|FH_F33411_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F33415_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F33451_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F33460_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F33483_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS
20|FH_F33498_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|GENERAL ACUTE CARE
20|FH_F33498_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|OP SVCS
20|FH_F33500_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33504_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F33504_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|BURN INTENSIVE CARE
20|FH_F33504_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|BURN SERVICES
20|FH_F33509_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33512_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F33512_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|ACUTE MEDICAL/SURGICAL SVCS
20|FH_F33515_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33517_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33527_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33530_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33530_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|BURN INTENSIVE CARE
20|FH_F33535_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F33537_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|SKILLED NURSING CARE
20|FH_F33558_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33566_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F33566_0_0|SrvcGrp|20075|2022|PDM|7427.00|99|0.00|MS DRG 286 ONLY
20|FH_F33566_0_0|SrvcGrp|20297|2022|PDM|37143.00|99|0.00|MS DRG 219-221 ONLY CARDIAC VALVE PROC
20|FH_F33566_0_0|SrvcGrp|21350|2022|PDM|5836.00|99|0.00|MS DRG 287 ONLY
20|FH_F33566_0_0|SrvcGrp|7|2022|PDM|1750.00|99|0.00|NEONATAL INTENSIVE
20|FH_F33581_0_0|CSTM-ALL|CSTM-00|2020|PDM|1944.00|99|0.00|MS DRG 765-766 C-SECTION
20|FH_F33581_0_0|CSTM-ALL|CSTM-00|2020|PDM|3240.00|99|0.00|INTENSIVE/INTERMEDIATE CARE UNIT
20|FH_F33581_0_0|SrvcGrp|11606|2022|PDM|918.00|99|0.00|ACUTE CARE (MEDICAL & SURGICAL)
20|FH_F33581_0_0|SrvcGrp|6|2022|PCT|0.70|99|0.00|OP SURGERY
20|FH_F33581_0_0|SrvcGrp|941|2022|PDM|3240.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F33592_0_0|SrvcGrp|11442|2022|PDM|480.00|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)
20|FH_F33601_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33601_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F33618_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|OP SVCS
20|FH_F33618_0_0|SrvcGrp|6|2022|PCT|0.95|99|0.00|OP SURGERY
20|FH_F33629_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F33635_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33642_0_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|ASPG II
20|FH_F33642_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|ASPG V
20|FH_F33642_0_0|CSTM-ALL|CSTM-00|2020|PDM|2900.00|99|0.00|ASPG VI
20|FH_F33642_0_0|CSTM-ALL|CSTM-00|2020|PDM|2900.00|99|0.00|ASPG VII
20|FH_F33642_0_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|ASPG X
20|FH_F33642_0_0|SrvcGrp|12146|2022|PDM|1800.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F33642_0_0|SrvcGrp|12163|2022|PCT|0.60|99|0.00|DRUGS
20|FH_F33642_0_0|SrvcGrp|12406|2022|PCT|0.60|99|0.00|DRUGS
20|FH_F33642_0_0|SrvcGrp|15351|2022|PDM|6500.00|99|0.00|PTCA ANGIOPLASTY
20|FH_F33642_0_0|SrvcGrp|15363|2022|PCT|0.60|99|0.00|DME/ORTHOTICS/PROSTHETICS/IMPLANTS
20|FH_F33642_0_0|SrvcGrp|15399|2022|PCT|0.60|99|0.00|COMPUTED TOMOGRAPHY (CT)
20|FH_F33642_0_0|SrvcGrp|3029|2022|PDM|500.00|99|0.00|NEWBORN NURSERY
20|FH_F33642_0_0|SrvcGrp|360|2022|PDM|725.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F33642_0_0|SrvcGrp|361|2022|PDM|900.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F33642_0_0|SrvcGrp|48950|2022|PCT|0.60|99|0.00|RADIOLOGY (WITHOUT MRI AND CT SCANS)
20|FH_F33642_0_0|SrvcGrp|9511|2022|PCT|0.60|99|0.00|OBSERVATION SVCS
20|FH_F33642_0_0|SrvcGrp|9938|2022|PCT|0.75|99|0.00|SPEECH THERAPY
20|FH_F33645_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F33649_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F33649_0_0|SrvcGrp|110|2022|PDM|625.00|99|0.00|CD - REHABILITATION
20|FH_F33659_0_0|SrvcGrp|15391|2022|PDM|95.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F33664_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.91|99|0.00|OP SVCS
20|FH_F33664_0_0|SrvcGrp|29817|2022|PDM|4751.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F33685_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F33688_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33712_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 216-221, 231-232 CV SURGERY
20|FH_F33712_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 248-251, 246-247 CV SURGERY
20|FH_F33712_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 471-473 CERVICAL FUSION
20|FH_F33712_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|ASPG I
20|FH_F33712_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33712_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|ASPG V
20|FH_F33712_0_0|CSTM-ALL|CSTM-00|2020|PDM|3400.00|99|0.00|ASPG VIII
20|FH_F33712_0_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|OP SVCS
20|FH_F33712_0_0|SrvcGrp|10904|2022|PDM|750.00|99|0.00|EMERGENCY ROOM LEVEL II
20|FH_F33712_0_0|SrvcGrp|15355|2022|PCT|0.60|99|0.00|MAGNETIC RESONANCE IMAGING (MRI)
20|FH_F33712_0_0|SrvcGrp|18197|2022|PCT|0.75|99|0.00|MS DRG 025
20|FH_F33712_0_0|SrvcGrp|18204|2022|PCT|0.75|99|0.00|MS DRG 027
20|FH_F33712_0_0|SrvcGrp|3029|2022|PDM|500.00|99|0.00|NEWBORN NURSERY
20|FH_F33712_0_0|SrvcGrp|360|2022|PDM|725.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F33712_0_0|SrvcGrp|3932|2022|PDM|5250.00|99|0.00|LITHOTRIPSY
20|FH_F33712_0_0|SrvcGrp|9510|2022|PDM|575.00|99|0.00|SKILLED NURSING CARE
20|FH_F33712_0_0|SrvcGrp|9936|2022|PCT|0.75|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F33712_0_0|SrvcGrp|9937|2022|PCT|0.75|99|0.00|OCCUPATIONAL THERAPY
20|FH_F33712_0_0|SrvcGrp|9938|2022|PCT|0.75|99|0.00|SPEECH THERAPY
20|FH_F33719_0_0|CSTM-ALL|CSTM-00|2020|PDM|3351.00|99|0.00|MS DRGS 215-221, 231-236 CV SURGERY
20|FH_F33719_0_0|SrvcGrp|115|2022|PDM|522.00|99|0.00|SKILLED NURSING CARE
20|FH_F33719_0_0|SrvcGrp|16|2022|PDM|1178.00|99|0.00|ACUTE REHABILITATION
20|FH_F33719_0_0|SrvcGrp|360|2022|PDM|1234.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F33725_0_0|CSTM-ALL|CSTM-00|2020|PDM|35.00|99|0.00|HOME HEALTH AIDE
20|FH_F33725_0_0|CSTM-ALL|CSTM-00|2020|PDM|75.00|99|0.00|SPEECH THERAPY
20|FH_F33744_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F33744_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|MS DRG 927-929, 933-935 BURN SVCS
20|FH_F33744_0_0|CSTM-ALL|CSTM-00|2020|PDM|1738.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F33744_0_0|CSTM-ALL|CSTM-00|2020|PDM|19080.00|99|0.00|MS DRG 216-227, 231-236 CV SURGERY
20|FH_F33744_0_0|CSTM-ALL|CSTM-00|2020|PDM|7950.00|99|0.00|MS DRG 243-244
20|FH_F33744_0_0|SrvcGrp|115|2022|PDM|663.00|99|0.00|SKILLED NURSING CARE
20|FH_F33744_0_0|SrvcGrp|361|2022|PCT|0.75|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F33744_0_0|SrvcGrp|97|2022|PDM|4982.00|99|0.00|C-SECTION
20|FH_F33782_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.97|99|0.00|GENERAL ACUTE CARE
20|FH_F33782_0_0|SrvcGrp|12157|2022|PDM|100.00|99|0.00|RN VISIT
20|FH_F33782_0_0|SrvcGrp|12160|2022|PDM|35.00|99|0.00|HOME HEALTH AID
20|FH_F33782_0_0|SrvcGrp|14112|2022|PDM|75.00|99|0.00|OCCUPATIONAL THERAPY SVCS
20|FH_F33782_0_0|SrvcGrp|14114|2022|PDM|75.00|99|0.00|SPEECH THERAPY SVCS
20|FH_F33785_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|ADOLESCENT PSYCHIATRIC
20|FH_F33785_0_0|SrvcGrp|11083|2022|PDM|2400.00|99|0.00|NORMAL DELIVERY (MOTHER ONLY)
20|FH_F33785_0_0|SrvcGrp|11086|2022|PDM|3300.00|99|0.00|CSECT (MOTHER ONLY)
20|FH_F33785_0_0|SrvcGrp|15554|2022|PDM|1700.00|99|0.00|ONCOLOGY
20|FH_F33785_0_0|SrvcGrp|3448|2022|PDM|850.00|99|0.00|MRI
20|FH_F33788_0_0|SrvcGrp|10111|2022|PCT|0.70|99|0.00|IMPLANTS
20|FH_F33788_0_0|SrvcGrp|10962|2022|PCT|0.70|99|0.00|INPATIENT LAPAROSCOPIC SURGERY
20|FH_F33788_0_0|SrvcGrp|12674|2022|PCT|0.70|99|0.00|IMPLANTS
20|FH_F33788_0_0|SrvcGrp|177|2022|PDM|1250.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F33788_0_0|SrvcGrp|58|2022|PDM|5200.00|99|0.00|IP LITHOTRIPSY SVCS
20|FH_F33789_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|GENERAL ACUTE CARE
20|FH_F33791_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F33791_0_0|SrvcGrp|3178|2022|PDM|300.00|99|0.00|ACUTE PSYCH
20|FH_F33800_0_0|CSTM-ALL|CSTM-00|2020|PCT|76.40|99|0.00|GENERAL ACUTE CARE
20|FH_F33821_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33821_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F33855_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|OP SVCS
20|FH_F33856_0_0|SrvcGrp|701|2022|PDM|1400.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F33856_0_0|SrvcGrp|97|2022|PDM|3000.00|99|0.00|C-SECTION
20|FH_F33866_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|CLINIC VISIT
20|FH_F33866_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33899_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F33900_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33908_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.90|99|0.00|OP SVCS
20|FH_F33916_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33930_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F34005_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34020_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34040_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.00|99|0.00|OP SVCS
20|FH_F34048_0_0|SrvcGrp|39|2022|PCT|0.65|99|0.00|TISSUE PLASMINOGEN ACTIVATOR
20|FH_F34048_0_0|SrvcGrp|65861|2022|PCT|0.65|99|0.00|PHARMACY SERVICES
20|FH_F34050_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34057_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34100_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34102_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|OP SVCS
20|FH_F34104_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F34112_0_0|CSTM-ALL|CSTM-00|2020|PDM|535.00|99|0.00|ADULT PSYCHIATRIC
20|FH_F34112_0_0|SrvcGrp|24|2022|PDM|4700.00|99|0.00|CARDIAC CATH
20|FH_F34112_0_0|SrvcGrp|361|2022|PDM|1540.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F34112_0_0|SrvcGrp|63|2022|PDM|825.00|99|0.00|SUBACUTE CARE
20|FH_F34112_0_0|SrvcGrp|708|2022|PDM|4025.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F34145_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE
20|FH_F34154_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34161_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS
20|FH_F34177_0_0|CSTM-ALL|CSTM-00|2020|PCT|74.30|99|0.00|GENERAL ACUTE CARE
20|FH_F34182_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 619-621
20|FH_F34182_0_0|CSTM-ALL|CSTM-00|2020|PDM|10805.00|99|0.00|MS DRG 258-259 CARDIAC PACE DEV REPL
20|FH_F34182_0_0|CSTM-ALL|CSTM-00|2020|PDM|2729.00|99|0.00|MS DRG 236
20|FH_F34182_0_0|CSTM-ALL|CSTM-00|2020|PDM|2729.00|99|0.00|MS DRG 246
20|FH_F34182_0_0|CSTM-ALL|CSTM-00|2020|PDM|2729.00|99|0.00|MSDRG 228-230
20|FH_F34182_0_0|CSTM-ALL|CSTM-00|2020|PDM|8646.00|99|0.00|MS DRG 281-282 CIRCULATORY DISORDER
20|FH_F34182_0_0|SrvcGrp|12117|2022|PDM|736.00|99|0.00|MAGNETIC RESONANCE IMAGING
20|FH_F34182_0_0|SrvcGrp|16|2022|PDM|2278.00|99|0.00|ACUTE REHABILITATION
20|FH_F34182_0_0|SrvcGrp|16137|2022|PCT|0.78|99|0.00|PHARMACY SVCS
20|FH_F34182_0_0|SrvcGrp|16138|2022|PDM|2278.00|99|0.00|ACUTE MEDICAL SVCS
20|FH_F34182_0_0|SrvcGrp|18791|2022|PDM|10805.00|99|0.00|MS DRG 215
20|FH_F34182_0_0|SrvcGrp|3044|2022|PCT|0.80|99|0.00|TRANSITIONAL CARE UNIT
20|FH_F34182_0_0|SrvcGrp|9774|2022|PDM|3565.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F34229_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F34253_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS
20|FH_F34258_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F34262_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F34266_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F34269_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34273_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34276_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE
20|FH_F34276_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F34280_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34283_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34316_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F34349_0_0|CSTM-ALL|CSTM-00|2020|PDM|2100.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34371_0_0|SrvcGrp|10537|2022|PDM|52.00|99|0.00|NURSING CARE
20|FH_F34375_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34375_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F34378_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F34398_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.81|99|0.00|GENERAL ACUTE CARE
20|FH_F34399_0_0|CSTM-ALL|CSTM-00|2020|PCT|69.00|99|0.00|OP SVCS
20|FH_F34403_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34408_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34408_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F34412_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE
20|FH_F34412_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F34413_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|IP SURGICAL SVCS
20|FH_F34413_0_0|CSTM-ALL|CSTM-00|2020|PDM|975.00|99|0.00|ACUTE IP MED SVCS
20|FH_F34413_0_0|SrvcGrp|16|2022|PDM|700.00|99|0.00|ACUTE REHABILITATION
20|FH_F34413_0_0|SrvcGrp|177|2022|PDM|1000.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F34438_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F34454_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34454_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F34454_0_0|SrvcGrp|12401|2022|PDM|85.50|99|0.00|RN VISIT
20|FH_F34454_0_0|SrvcGrp|13703|2022|PDM|26.75|99|0.00|LICENSED PRACTICAL NURSE- HOURLY
20|FH_F34454_0_0|SrvcGrp|22954|2022|PDM|94.50|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F34454_0_0|SrvcGrp|9829|2022|PDM|85.50|99|0.00|PT SVCS
20|FH_F34463_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|TRAUMA CARE
20|FH_F34472_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34480_0_0|CSTM-ALL|CSTM-00|2020|PDM|575.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34498_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F34498_0_0|SrvcGrp|12692|2022|PDM|573.00|99|0.00|CAPD/CCPD SUPPLEMENT
20|FH_F34498_0_0|SrvcGrp|16705|2022|PDM|1348.00|99|0.00|ULTRAFILTRATION
20|FH_F34532_0_0|SrvcGrp|13631|2022|PDM|65.00|99|0.00|CPT 99213
20|FH_F34546_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F34546_0_0|SrvcGrp|38|2022|PDM|1100.00|99|0.00|NORMAL DELIVERY
20|FH_F34546_0_0|SrvcGrp|8950|2022|PDM|1000.00|99|0.00|INTERMEDIATE ICU/CCU
20|FH_F34546_0_0|SrvcGrp|9518|2022|PCT|0.90|99|0.00|EMERGENCY ROOM
20|FH_F34550_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|MS DRG 619-621
20|FH_F34550_0_0|CSTM-ALL|CSTM-00|2020|PDM|3406.00|99|0.00|MSDRG 286-287 CARDIAC CATH
20|FH_F34550_0_0|SrvcGrp|12670|2022|PCT|0.60|99|0.00|IMPLANTS/PROSTHETICS/DEVICES
20|FH_F34550_0_0|SrvcGrp|290|2022|PDM|5200.00|99|0.00|IP LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F34550_0_0|SrvcGrp|38|2022|PDM|2184.00|99|0.00|NORMAL DELIVERY
20|FH_F34626_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE
20|FH_F34626_0_0|SrvcGrp|15846|2022|PDM|50.00|99|0.00|HOME VISIT
20|FH_F34626_0_0|SrvcGrp|42973|2022|PDM|95.00|99|0.00|SPEECH  THERAPIST
20|FH_F34641_0_0|CSTM-ALL|CSTM-00|2020|PDM|275.00|99|0.00|CD INTENSIVE OUTPATIENT SVCS
20|FH_F34641_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34641_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|ADOLESCENT PSYCHIATRIC
20|FH_F34641_0_0|SrvcGrp|11241|2022|PDM|950.00|99|0.00|CD - DETOXIFICATION
20|FH_F34641_0_0|SrvcGrp|40222|2022|PDM|350.00|99|0.00|OP SVCS
20|FH_F34652_0_0|CSTM-ALL|CSTM-00|2020|PDM|882.00|99|0.00|ACUTE PSYCH
20|FH_F34652_0_0|CSTM-ALL|CSTM-00|2020|PDM|882.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F34652_0_0|CSTM-ALL|CSTM-00|2020|PDM|912.00|99|0.00|MS DRG 792 & REV 172 TRANSITIONAL NURSERY
20|FH_F34652_0_0|SrvcGrp|38|2022|PDM|4737.00|99|0.00|NORMAL DELIVERY
20|FH_F34652_0_0|SrvcGrp|701|2022|PDM|2055.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F34652_0_0|SrvcGrp|997|2022|PCT|0.60|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F34661_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F34685_0_0|CSTM-ALL|CSTM-00|2020|PCT|67.00|99|0.00|OP SVCS
20|FH_F34686_0_0|CSTM-ALL|CSTM-00|2020|PCT|50.00|99|0.00|DRUGS
20|FH_F34691_0_0|SrvcGrp|13188|2022|PCT|0.75|99|0.00|DRUGS
20|FH_F34691_0_0|SrvcGrp|14886|2022|PCT|0.75|99|0.00|TRANSPORTATION
20|FH_F34691_0_0|SrvcGrp|15645|2022|PDM|721.00|99|0.00|COMPUTED TOMOGRAPHY (CT)
20|FH_F34696_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34710_0_0|SrvcGrp|22596|2022|PDM|140.00|99|0.00|HOSPICE CARE
20|FH_F34719_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34719_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F34759_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34759_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|OP SVCS
20|FH_F34777_0_0|SrvcGrp|13811|2022|PDM|355.00|99|0.00|PSYCH PARTIAL HOSP
20|FH_F34777_0_0|SrvcGrp|14373|2022|PDM|4052.00|99|0.00|LITHOTRIPSY SVCS
20|FH_F34777_0_0|SrvcGrp|16197|2022|PDM|593.00|99|0.00|NEWBORN NURSERY
20|FH_F34777_0_0|SrvcGrp|177|2022|PDM|3010.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F34777_0_0|SrvcGrp|24|2022|PDM|5557.00|99|0.00|CARDIAC CATH
20|FH_F34777_0_0|SrvcGrp|3598|2022|PDM|3820.00|99|0.00|ELECTROPHYSIOLOGY
20|FH_F34777_0_0|SrvcGrp|65|2022|PDM|3346.00|99|0.00|OBSTETRICAL CARE
20|FH_F34783_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F34792_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34795_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.00|99|0.00|OP SVCS
20|FH_F34795_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34797_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F34806_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34838_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F34852_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|IMPLANTS
20|FH_F34852_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE
20|FH_F34852_0_0|SrvcGrp|131|2022|PCT|0.70|99|0.00|PACEMAKER DEVICE
20|FH_F34852_0_0|SrvcGrp|3224|2022|PDM|750.00|99|0.00|EMERGENCY ROOM SVCS
20|FH_F34852_0_0|SrvcGrp|97|2022|PDM|5000.00|99|0.00|C-SECTION
20|FH_F34852_0_0|SrvcGrp|997|2022|PCT|0.70|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F34854_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F34854_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34854_0_0|SrvcGrp|453|2022|PDM|325.00|99|0.00|PSYCH PARTIAL HOSP
20|FH_F34888_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F34894_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS
20|FH_F34904_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34918_0_0|SrvcGrp|3029|2022|PDM|564.00|99|0.00|NEWBORN NURSERY
20|FH_F34924_0_0|SrvcGrp|38|2022|PDM|3000.00|99|0.00|NORMAL DELIVERY
20|FH_F34951_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34951_0_0|CSTM-ALL|CSTM-00|2020|PDM|70.00|99|0.00|577036 SPLS PT,OT,ST
20|FH_F34963_0_0|SrvcGrp|1168|2022|PDM|140.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F34971_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS
20|FH_F34975_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34979_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34979_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F34998_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.72|99|0.00|OP SVCS
20|FH_F34998_0_0|SrvcGrp|65|2022|PDM|1450.00|99|0.00|OBSTETRICAL CARE
20|FH_F34999_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35013_0_0|CSTM-ALL|CSTM-00|2020|PCT|50.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35042_0_0|CSTM-ALL|CSTM-00|2020|PDM|2163.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35042_0_0|CSTM-ALL|CSTM-00|2020|PDM|936.00|99|0.00|ACUTE PSYCH
20|FH_F35042_0_0|SrvcGrp|361|2022|PDM|2562.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F35042_0_0|SrvcGrp|43|2022|PCT|0.65|99|0.00|IMPLANTS
20|FH_F35056_0_0|CSTM-ALL|CSTM-00|2020|PDM|2550.00|99|0.00|ASPG IV
20|FH_F35056_0_0|CSTM-ALL|CSTM-00|2020|PDM|2900.00|99|0.00|ASPG V
20|FH_F35056_0_0|CSTM-ALL|CSTM-00|2020|PDM|3975.00|99|0.00|ASPG VIII
20|FH_F35056_0_0|CSTM-ALL|CSTM-00|2020|PDM|4125.00|99|0.00|ASPG IX
20|FH_F35056_0_0|SrvcGrp|10387|2022|PDM|3200.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F35056_0_0|SrvcGrp|13805|2022|PDM|3200.00|99|0.00|CARDIAC CATH LAB IP SVCS
20|FH_F35056_0_0|SrvcGrp|14997|2022|PCT|0.78|99|0.00|DRUGS
20|FH_F35056_0_0|SrvcGrp|28177|2022|PDM|2550.00|99|0.00|ASPG SURG UNGROUPABLE
20|FH_F35069_0_0|CSTM-ALL|CSTM-00|2020|PDM|118.00|99|0.00|OP URGENT CARE
20|FH_F35086_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35088_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|MSDRG 226-227 CV SURG CARDIAC DEFIBRILLATOR
20|FH_F35088_0_0|SrvcGrp|16|2022|PDM|1515.00|99|0.00|ACUTE REHABILITATION
20|FH_F35088_0_0|SrvcGrp|16777|2022|PCT|1.00|99|0.00|ORGAN ACQUISITION
20|FH_F35088_0_0|SrvcGrp|997|2022|PCT|0.50|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F35093_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS
20|FH_F35100_0_0|CSTM-ALL|CSTM-00|2020|PCT|99.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35100_0_0|CSTM-ALL|CSTM-00|2020|PCT|99.00|99|0.00|OP SVCS
20|FH_F35103_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35133_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|TRAUMA CARE
20|FH_F35133_0_0|CSTM-ALL|CSTM-00|2020|PDM|28200.00|99|0.00|MSDRG 228-230
20|FH_F35133_0_0|SrvcGrp|361|2022|PDM|2250.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F35166_0_0|CSTM-ALL|CSTM-00|2020|PCT|50.00|99|0.00|DRUGS
20|FH_F35167_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|MS DRG 216-221, 231-236 CV SURGERY
20|FH_F35167_0_0|CSTM-ALL|CSTM-00|2020|PDM|860.00|99|0.00|MULTIPLE BIRTH
20|FH_F35167_0_0|SrvcGrp|72|2022|PDM|860.00|99|0.00|NEWBORN NURSERY
20|FH_F35173_0_0|CSTM-ALL|CSTM-00|2020|PDM|2361.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F35173_0_0|SrvcGrp|43|2022|PCT|0.70|99|0.00|IMPLANTS
20|FH_F35174_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|TRAUMA CARE
20|FH_F35174_0_0|SrvcGrp|16|2022|PDM|1957.00|99|0.00|ACUTE REHABILITATION
20|FH_F35174_0_0|SrvcGrp|20077|2022|PCT|0.75|99|0.00|MS DRG 226-227 ONLY CARDIAC DEFIBRILLATOR
20|FH_F35174_0_0|SrvcGrp|20900|2022|PCT|0.75|99|0.00|MS DRG 248 ONLY
20|FH_F35174_0_0|SrvcGrp|20908|2022|PCT|0.75|99|0.00|MS DRG 247 ONLY
20|FH_F35174_0_0|SrvcGrp|3140|2022|PCT|0.75|99|0.00|PHARMACY SERVICES
20|FH_F35174_0_0|SrvcGrp|360|2022|PDM|3893.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F35174_0_0|SrvcGrp|537|2022|PCT|0.76|99|0.00|OBSERVATION SERVICES
20|FH_F35174_0_0|SrvcGrp|6|2022|PCT|0.71|99|0.00|OP SURGERY
20|FH_F35174_0_0|SrvcGrp|8968|2022|PDM|4822.00|99|0.00|NICU LEVEL III & IV
20|FH_F35174_0_0|SrvcGrp|97|2022|PDM|6875.00|99|0.00|C-SECTION
20|FH_F35176_0_0|SrvcGrp|3809|2022|PDM|483.00|99|0.00|HOSPICE CARE
20|FH_F35176_0_0|SrvcGrp|9827|2022|PDM|85.50|99|0.00|RN INTERMITTENT VISIT
20|FH_F35176_0_0|SrvcGrp|9830|2022|PDM|85.50|99|0.00|OT SVCS
20|FH_F35202_0_0|SrvcGrp|12856|2022|PDM|42.00|99|0.00|NURSING CARE
20|FH_F35202_0_0|SrvcGrp|3810|2022|PDM|94.50|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F35202_0_0|SrvcGrp|9832|2022|PDM|84.00|99|0.00|ST SVCS
20|FH_F35210_0_0|CSTM-ALL|CSTM-00|2020|PDM|744.00|99|0.00|MULTIPLE BIRTH
20|FH_F35210_0_0|SrvcGrp|115|2022|PDM|1227.00|99|0.00|SKILLED NURSING CARE
20|FH_F35210_0_0|SrvcGrp|24|2022|PCT|0.65|99|0.00|CARDIAC CATH
20|FH_F35210_0_0|SrvcGrp|3015|2022|PCT|0.50|99|0.00|SUPPLIES
20|FH_F35210_0_0|SrvcGrp|43|2022|PCT|0.50|99|0.00|IMPLANTS
20|FH_F35210_0_0|SrvcGrp|537|2022|PCT|0.68|99|0.00|OBSERVATION SERVICES
20|FH_F35210_0_0|SrvcGrp|70252|2022|PCT|0.50|99|0.00|HIGH COST DRUGS
20|FH_F35210_0_0|SrvcGrp|72220|2022|PCT|0.65|99|0.00|IP LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F35210_0_0|SrvcGrp|903|2022|PCT|0.65|99|0.00|PTC ANGIOPLASTY
20|FH_F35212_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35212_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F35212_0_0|SrvcGrp|12263|2022|PDM|17.50|99|0.00|HOME HEALTH AIDE- HOURLY
20|FH_F35212_0_0|SrvcGrp|13703|2022|PDM|26.75|99|0.00|LICENSED PRACTICAL NURSE- HOURLY
20|FH_F35212_0_0|SrvcGrp|22954|2022|PDM|94.50|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F35216_0_0|CSTM-ALL|CSTM-00|2020|PDM|11750.00|99|0.00|MS DRG 254
20|FH_F35216_0_0|CSTM-ALL|CSTM-00|2020|PDM|13500.00|99|0.00|MS DRG 242 PERMANENT CARDIAC PACEMAKER
20|FH_F35216_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|ASPG III
20|FH_F35216_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|ASPG IV
20|FH_F35216_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|ASPG VIII
20|FH_F35216_0_0|CSTM-ALL|CSTM-00|2020|PDM|6000.00|99|0.00|MSDRG 286-287 CARDIAC CATH
20|FH_F35216_0_0|SrvcGrp|11259|2022|PCT|0.60|99|0.00|DRUGS
20|FH_F35216_0_0|SrvcGrp|11336|2022|PCT|0.60|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F35216_0_0|SrvcGrp|1943|2022|PDM|850.00|99|0.00|NEONATAL INTENSVE CARE II & III
20|FH_F35216_0_0|SrvcGrp|21124|2022|PDM|11000.00|99|0.00|MS DRG 471 ONLY
20|FH_F35216_0_0|SrvcGrp|3029|2022|PDM|300.00|99|0.00|NEWBORN NURSERY
20|FH_F35216_0_0|SrvcGrp|9984|2022|PCT|0.75|99|0.00|URGENT CARE
20|FH_F35217_0_0|CSTM-ALL|CSTM-00|2020|PDM|1877.00|99|0.00|MS DRG 052-053 W/ REV CODES
20|FH_F35221_0_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|OP SVCS
20|FH_F35221_0_0|SrvcGrp|38|2022|PDM|2600.00|99|0.00|NORMAL DELIVERY
20|FH_F35245_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE
20|FH_F35245_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F35245_0_0|SrvcGrp|9460|2022|PDM|800.00|99|0.00|ACUTE REHABILITATION
20|FH_F35259_0_0|CSTM-ALL|CSTM-00|2020|PDM|3456.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35259_0_0|SrvcGrp|23|2022|PCT|0.68|99|0.00|BONE MARROW TRANSPLANT
20|FH_F35259_0_0|SrvcGrp|24|2022|PDM|8759.00|99|0.00|CARDIAC CATH
20|FH_F35259_0_0|SrvcGrp|361|2022|PDM|5624.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F35259_0_0|SrvcGrp|411|2022|PDM|8759.00|99|0.00|OP CARDIAC CATH
20|FH_F35271_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F35271_0_0|SrvcGrp|361|2022|PDM|650.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F35278_0_0|SrvcGrp|16746|2022|PDM|70.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F35357_0_0|CSTM-ALL|CSTM-00|2020|PDM|770.00|99|0.00|ACUTE PSYCH
20|FH_F35365_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35365_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|OP SVCS
20|FH_F35368_0_0|CSTM-ALL|CSTM-00|2020|PDM|25708.00|99|0.00|MS DRG 216-227, 231-236 CV SURGERY
20|FH_F35368_0_0|SrvcGrp|12218|2022|PDM|3300.00|99|0.00|VALVULOPLASTY
20|FH_F35368_0_0|SrvcGrp|14197|2022|PCT|1.05|99|0.00|IMPLANTS
20|FH_F35368_0_0|SrvcGrp|15179|2022|PCT|1.05|99|0.00|TISSUE PLASMINOGEN ACTIVATOR
20|FH_F35368_0_0|SrvcGrp|29|2022|PDM|3465.00|99|0.00|ELECTROPHYSIOLOGY
20|FH_F35368_0_0|SrvcGrp|474|2022|PDM|550.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F35368_0_0|SrvcGrp|56743|2022|PDM|6879.00|99|0.00|PTC ANGIOPLASTY
20|FH_F35369_0_0|SrvcGrp|10|2022|PDM|3500.00|99|0.00|ANGIOPLASTY
20|FH_F35369_0_0|SrvcGrp|13292|2022|PCT|1.15|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F35381_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|EPILEPSY PROGRAM
20|FH_F35381_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|ACUTE GERIATRIC PSYCHIATRIC
20|FH_F35381_0_0|SrvcGrp|13666|2022|PCT|0.75|99|0.00|CHEMOTHERAPY DRUGS
20|FH_F35381_0_0|SrvcGrp|3029|2022|PDM|351.00|99|0.00|NEWBORN NURSERY
20|FH_F35381_0_0|SrvcGrp|360|2022|PDM|1450.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F35384_0_0|SrvcGrp|11083|2022|PDM|1117.00|99|0.00|NORMAL DELIVERY (MOTHER ONLY)
20|FH_F35384_0_0|SrvcGrp|360|2022|PDM|1234.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F35384_0_0|SrvcGrp|8968|2022|PDM|1830.00|99|0.00|NICU LEVEL III & IV
20|FH_F35387_0_0|CSTM-ALL|CSTM-00|2020|PDM|3351.00|99|0.00|MS DRGS 215-221, 231-236 CV SURGERY
20|FH_F35387_0_0|CSTM-ALL|CSTM-00|2020|PDM|535.00|99|0.00|ACUTE PSYCH
20|FH_F35387_0_0|SrvcGrp|115|2022|PDM|552.00|99|0.00|SKILLED NURSING CARE
20|FH_F35388_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F35388_0_0|CSTM-ALL|CSTM-00|2020|PDM|1185.00|99|0.00|ACUTE MEDICAL/SURGICAL SVCS
20|FH_F35388_0_0|SrvcGrp|16873|2022|PDM|1200.00|99|0.00|MAGNETIC RESONANCE ANGIOGRAPHY
20|FH_F35388_0_0|SrvcGrp|919|2022|PDM|100.00|99|0.00|OP URGENT CARE
20|FH_F35388_0_0|SrvcGrp|9774|2022|PDM|1835.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F35388_0_0|SrvcGrp|9793|2022|PDM|400.00|99|0.00|NEWBORN NURSERY
20|FH_F35404_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS
20|FH_F35404_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|CV SURGERY
20|FH_F35404_0_0|SrvcGrp|10927|2022|PDM|1200.00|99|0.00|COMPUTED TOMOGRAPHY (CT)
20|FH_F35404_0_0|SrvcGrp|6|2022|PCT|0.55|99|0.00|OP SURGERY
20|FH_F35404_0_0|SrvcGrp|9793|2022|PDM|455.00|99|0.00|NEWBORN NURSERY
20|FH_F35404_0_0|SrvcGrp|9937|2022|PDM|120.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F35405_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35408_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F35408_0_0|SrvcGrp|16897|2022|PDM|240.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC
20|FH_F35411_0_0|CSTM-ALL|CSTM-00|2020|PDM|15189.00|99|0.00|NON-CARDIAC BRACHYTHERAPY
20|FH_F35411_0_0|CSTM-ALL|CSTM-00|2020|PDM|26312.00|99|0.00|CV SURGERY
20|FH_F35411_0_0|CSTM-ALL|CSTM-00|2020|PDM|8050.00|99|0.00|MSDRG 242-244, 258-262 PACEMAKER INSERTION/REVISION
20|FH_F35411_0_0|SrvcGrp|13150|2022|PDM|8050.00|99|0.00|ELECTROPHYSIOLOGY
20|FH_F35411_0_0|SrvcGrp|16|2022|PDM|1355.00|99|0.00|ACUTE REHABILITATION
20|FH_F35411_0_0|SrvcGrp|6|2022|PCT|0.65|99|0.00|OP SURGERY
20|FH_F35411_0_0|SrvcGrp|9795|2022|PDM|997.00|99|0.00|SUBACUTE REHAB
20|FH_F35416_0_0|SrvcGrp|12906|2022|PDM|6000.00|99|0.00|IP LITHOTRIPSY
20|FH_F35416_0_0|SrvcGrp|147|2022|PCT|0.80|99|0.00|HOME HEALTH CARE
20|FH_F35416_0_0|SrvcGrp|361|2022|PDM|2070.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F35416_0_0|SrvcGrp|72|2022|PDM|780.00|99|0.00|NEWBORN NURSERY
20|FH_F35432_0_0|CSTM-ALL|CSTM-00|2020|PDM|5315.00|99|0.00|MS DRG 765-766 C-SECTION
20|FH_F35432_0_0|SrvcGrp|177|2022|PDM|1575.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F35432_0_0|SrvcGrp|3208|2022|PDM|529.00|99|0.00|SUBACUTE CARE
20|FH_F35432_0_0|SrvcGrp|8950|2022|PDM|1518.00|99|0.00|INTERMEDIATE ICU/CCU
20|FH_F35442_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F35446_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F35446_0_0|CSTM-ALL|CSTM-00|2020|PDM|117.00|99|0.00|INTENSIVE PSYCH SVCS
20|FH_F35446_0_0|SrvcGrp|16|2022|PDM|893.00|99|0.00|ACUTE REHABILITATION
20|FH_F35446_0_0|SrvcGrp|177|2022|PDM|2652.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F35446_0_0|SrvcGrp|38|2022|PDM|1464.00|99|0.00|NORMAL DELIVERY
20|FH_F35446_0_0|SrvcGrp|701|2022|PDM|2076.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F35446_0_0|SrvcGrp|941|2022|PDM|2076.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F35446_0_0|SrvcGrp|97|2022|PDM|1815.00|99|0.00|C-SECTION
20|FH_F35453_0_0|SrvcGrp|290|2022|PDM|4140.00|99|0.00|IP LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F35453_0_0|SrvcGrp|38|2022|PDM|1955.00|99|0.00|NORMAL DELIVERY
20|FH_F35458_0_0|CSTM-ALL|CSTM-00|2020|PDM|1460.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35458_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|ASPG VI
20|FH_F35458_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|ASPG VIII
20|FH_F35458_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|ASPG X
20|FH_F35458_0_0|SrvcGrp|63|2022|PDM|650.00|99|0.00|SUBACUTE CARE
20|FH_F35476_0_0|CSTM-ALL|CSTM-00|2020|PDM|6407.00|99|0.00|MS DRG 776
20|FH_F35498_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35506_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F35513_0_0|CSTM-ALL|CSTM-00|2020|PDM|75.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F35513_0_0|CSTM-ALL|CSTM-00|2020|PDM|75.00|99|0.00|PHYSICAL THERAPY
20|FH_F35513_0_0|SrvcGrp|16494|2022|PDM|425.00|99|0.00|MULTIPLE SLEEP LATENCY
20|FH_F35513_0_0|SrvcGrp|16495|2022|PDM|850.00|99|0.00|POLYSOMNOGRAPHY
20|FH_F35527_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.97|99|0.00|GENERAL ACUTE CARE
20|FH_F35527_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.97|99|0.00|OP SVCS
20|FH_F35534_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35534_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|OP SVCS
20|FH_F35567_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|CT SERVICES
20|FH_F35575_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35587_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35615_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35622_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35678_0_0|CSTM-ALL|CSTM-00|2020|PDM|11300.00|99|0.00|MS DRG 248
20|FH_F35678_0_0|CSTM-ALL|CSTM-00|2020|PDM|11300.00|99|0.00|MS DRG 249
20|FH_F35678_0_0|CSTM-ALL|CSTM-00|2020|PDM|11300.00|99|0.00|MS DRG 250
20|FH_F35678_0_0|CSTM-ALL|CSTM-00|2020|PDM|11300.00|99|0.00|MS DRG 251
20|FH_F35678_0_0|CSTM-ALL|CSTM-00|2020|PDM|11300.00|99|0.00|MS DRG 280
20|FH_F35678_0_0|CSTM-ALL|CSTM-00|2020|PDM|16952.00|99|0.00|MS DRG 031
20|FH_F35678_0_0|CSTM-ALL|CSTM-00|2020|PDM|16952.00|99|0.00|MS DRG 041
20|FH_F35678_0_0|CSTM-ALL|CSTM-00|2020|PDM|4237.00|99|0.00|MS DRG 765-766 C-SECTION
20|FH_F35678_0_0|CSTM-ALL|CSTM-00|2020|PDM|6357.00|99|0.00|MS DRG 286
20|FH_F35678_0_0|CSTM-ALL|CSTM-00|2020|PDM|8476.00|99|0.00|MS DRG 028
20|FH_F35678_0_0|SrvcGrp|11336|2022|PCT|0.75|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F35678_0_0|SrvcGrp|11920|2022|PCT|0.75|99|0.00|PHARMACY SVCS
20|FH_F35678_0_0|SrvcGrp|20402|2022|PDM|16952.00|99|0.00|MS DRG 025-027 ONLY CRANIOTOMY
20|FH_F35678_0_0|SrvcGrp|941|2022|PDM|2119.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F35678_0_0|SrvcGrp|9774|2022|PDM|2119.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F35730_0_0|CSTM-ALL|CSTM-00|2020|PDM|90.00|99|0.00|RN VISIT
20|FH_F35740_0_0|CSTM-ALL|CSTM-00|2020|PDM|300.00|99|0.00|ALBERMARLE GASTRO ENDO MOD SU
20|FH_F35748_0_0|CSTM-ALL|CSTM-00|2020|PDM|70.00|99|0.00|SPEECH THERAPY
20|FH_F35806_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35806_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F35857_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F35857_0_0|CSTM-ALL|CSTM-00|2020|PDM|915.00|99|0.00|AEG 2 (NO REV)
20|FH_F35904_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35904_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F35927_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35927_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS
20|FH_F35928_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35930_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS
20|FH_F35942_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35942_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS
20|FH_F35966_0_0|SrvcGrp|16901|2022|PDM|5.35|99|0.00|GROUND MILEAGE, PER STATUTE MILE
20|FH_F35966_0_0|SrvcGrp|16996|2022|PDM|55.00|99|0.00|AMBULANCE RESPONSE/TREATMENT - NO TRANSPORT
20|FH_F35966_0_0|SrvcGrp|19605|2022|PDM|0.83|99|0.00|WHEELCHAIR VAN MILEAGE-PER MILE
20|FH_F35967_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35975_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F35982_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35982_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F35982_0_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|ASPG VII
20|FH_F35982_0_0|CSTM-ALL|CSTM-00|2020|PDM|1620.00|99|0.00|ASPG VIII
20|FH_F35987_0_0|CSTM-ALL|CSTM-00|2020|PDM|1029.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F35987_0_0|SrvcGrp|22148|2022|PDM|261.00|99|0.00|PSYCH PARTIAL HOSP (FULL DAY)
20|FH_F35987_0_0|SrvcGrp|3029|2022|PDM|601.00|99|0.00|NEWBORN NURSERY
20|FH_F35987_0_0|SrvcGrp|361|2022|PDM|2063.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F35987_0_0|SrvcGrp|37389|2022|PDM|5219.00|99|0.00|MS DRG 286-287 ONLY CARDIAC CATH
20|FH_F35987_0_0|SrvcGrp|38|2022|PDM|3608.00|99|0.00|NORMAL DELIVERY
20|FH_F35987_0_0|SrvcGrp|70921|2022|PDM|39526.00|99|0.00|CV SURGERY
20|FH_F35987_0_0|SrvcGrp|97|2022|PDM|5156.00|99|0.00|C-SECTION
20|FH_F35990_0_0|SrvcGrp|22147|2022|PDM|127.00|99|0.00|PSYCH PARTIAL HOSP (HALF DAY)
20|FH_F35990_0_0|SrvcGrp|3015|2022|PCT|0.60|99|0.00|SUPPLIES
20|FH_F35990_0_0|SrvcGrp|3078|2022|PCT|0.60|99|0.00|DRUGS
20|FH_F35990_0_0|SrvcGrp|360|2022|PDM|1461.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F35990_0_0|SrvcGrp|361|2022|PDM|2063.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F35990_0_0|SrvcGrp|38|2022|PDM|3608.00|99|0.00|NORMAL DELIVERY
20|FH_F35990_0_0|SrvcGrp|70921|2022|PDM|39526.00|99|0.00|CV SURGERY
20|FH_F35990_0_0|SrvcGrp|97|2022|PDM|5156.00|99|0.00|C-SECTION
20|FH_F35999_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35999_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS
20|FH_F36002_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F36036_0_0|SrvcGrp|10764|2022|PDM|75.00|99|0.00|CPT CODE 93226
20|FH_F36036_0_0|SrvcGrp|22091|2022|PDM|23.00|99|0.00|HCPCS A4663
20|FH_F36049_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F36053_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36053_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|OP SVCS
20|FH_F36101_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36107_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36118_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE
20|FH_F36118_0_0|SrvcGrp|10410|2022|PDM|47.00|99|0.00|SKILLED NURSING CARE
20|FH_F36118_0_0|SrvcGrp|12401|2022|PDM|88.00|99|0.00|RN VISIT
20|FH_F36118_0_0|SrvcGrp|13703|2022|PDM|40.00|99|0.00|LICENSED PRACTICAL NURSE- HOURLY
20|FH_F36118_0_0|SrvcGrp|9832|2022|PDM|102.00|99|0.00|ST SVCS
20|FH_F36154_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|CV SURGERY
20|FH_F36154_0_0|CSTM-ALL|CSTM-00|2020|PDM|1553.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36155_0_0|SrvcGrp|1171|2022|PCT|0.80|99|0.00|IMPLANTS
20|FH_F36171_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE
20|FH_F36202_0_0|CSTM-ALL|CSTM-00|2020|PDM|2034.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36202_0_0|SrvcGrp|29817|2022|PDM|4347.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F36202_0_0|SrvcGrp|30623|2022|PDM|6319.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788
20|FH_F36207_0_0|SrvcGrp|16897|2022|PDM|415.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC
20|FH_F36207_0_0|SrvcGrp|16899|2022|PDM|275.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT
20|FH_F36207_0_0|SrvcGrp|16901|2022|PDM|5.35|99|0.00|GROUND MILEAGE, PER STATUTE MILE
20|FH_F36207_0_0|SrvcGrp|16996|2022|PDM|55.00|99|0.00|AMBULANCE RESPONSE/TREATMENT - NO TRANSPORT
20|FH_F36207_0_0|SrvcGrp|19605|2022|PDM|0.83|99|0.00|WHEELCHAIR VAN MILEAGE-PER MILE
20|FH_F36207_0_0|SrvcGrp|19609|2022|PDM|38.50|99|0.00|NONEMERGENCY TRANSPORTATION, WHEELCHAIR VAN
20|FH_F36211_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36217_0_0|SrvcGrp|13807|2022|PCT|0.70|99|0.00|OBSERVATION SVCS
20|FH_F36258_0_0|CSTM-ALL|CSTM-00|2020|PDM|45.00|99|0.00|PT
20|FH_F36258_0_0|CSTM-ALL|CSTM-00|2020|PDM|45.00|99|0.00|SPEECH THERAPY
20|FH_F36261_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36274_0_0|SrvcGrp|10410|2022|PDM|45.00|99|0.00|SKILLED NURSING CARE
20|FH_F36274_0_0|SrvcGrp|12263|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE- HOURLY
20|FH_F36274_0_0|SrvcGrp|9832|2022|PDM|90.00|99|0.00|ST SVCS
20|FH_F36280_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F36299_0_0|CSTM-ALL|CSTM-00|2020|PDM|1195.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36299_0_0|SrvcGrp|13402|2022|PCT|0.70|99|0.00|OP SURGERY
20|FH_F36299_0_0|SrvcGrp|16|2022|PDM|1085.00|99|0.00|ACUTE REHABILITATION
20|FH_F36299_0_0|SrvcGrp|22775|2022|PDM|628.00|99|0.00|SUBACUTE WITH VENTILATOR
20|FH_F36299_0_0|SrvcGrp|72|2022|PDM|530.00|99|0.00|NEWBORN NURSERY
20|FH_F36323_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F36328_0_0|CSTM-ALL|CSTM-00|2020|PDM|885.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36341_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F36341_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|ASPG X
20|FH_F36341_0_0|CSTM-ALL|CSTM-00|2020|PDM|2060.00|99|0.00|ASPG VI
20|FH_F36341_0_0|CSTM-ALL|CSTM-00|2020|PDM|2109.00|99|0.00|ASPG VII
20|FH_F36341_0_0|CSTM-ALL|CSTM-00|2020|PDM|588.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F36341_0_0|SrvcGrp|11663|2022|PCT|0.50|99|0.00|IMPLANTS
20|FH_F36348_0_0|SrvcGrp|3780|2022|PDM|28875.00|99|0.00|BARIATRIC SERVICES
20|FH_F36350_0_0|SrvcGrp|11606|2022|PDM|477.00|99|0.00|ACUTE CARE (MEDICAL & SURGICAL)
20|FH_F36350_0_0|SrvcGrp|30623|2022|PDM|4084.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788
20|FH_F36363_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS
20|FH_F36366_0_0|SrvcGrp|12044|2022|PDM|998.00|99|0.00|SLEEP STUDIES
20|FH_F36366_0_0|SrvcGrp|12045|2022|PDM|791.00|99|0.00|SLEEP STUDIES
20|FH_F36366_0_0|SrvcGrp|13627|2022|PDM|246.00|99|0.00|SLEEP STUDY
20|FH_F36381_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS
20|FH_F36381_0_0|SrvcGrp|972|2022|PCT|0.55|99|0.00|OP DIALYSIS
20|FH_F36383_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.87|99|0.00|OP SVCS
20|FH_F36383_0_0|SrvcGrp|177|2022|PDM|2250.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F36383_0_0|SrvcGrp|72|2022|PDM|475.00|99|0.00|NEWBORN NURSERY
20|FH_F36385_0_0|CSTM-ALL|CSTM-00|2020|PDM|4374.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36386_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36386_0_0|SrvcGrp|1168|2022|PDM|25.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F36397_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36403_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE
20|FH_F36403_0_0|SrvcGrp|12512|2022|PDM|385.00|99|0.00|ACUTE REHABILITATION
20|FH_F36403_0_0|SrvcGrp|473|2022|PDM|650.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F36403_0_0|SrvcGrp|474|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F36409_0_0|SrvcGrp|13722|2022|PDM|94.50|99|0.00|HOSPICE SERVICE - ROUTINE HOME CARE
20|FH_F36418_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F36420_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F36420_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|ACUTE IP MED SVCS
20|FH_F36420_0_0|SrvcGrp|131|2022|PCT|0.80|99|0.00|PACEMAKER DEVICE
20|FH_F36431_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36431_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|IMPLANTS/PROSTHETICS/DEVICES
20|FH_F36433_0_0|CSTM-ALL|CSTM-00|2020|PDM|12360.00|99|0.00|MS DRG 469-470
20|FH_F36433_0_0|CSTM-ALL|CSTM-00|2020|PDM|486.00|99|0.00|ACUTE PSYCH
20|FH_F36433_0_0|SrvcGrp|24|2022|PDM|2812.00|99|0.00|CARDIAC CATH
20|FH_F36433_0_0|SrvcGrp|3029|2022|PDM|378.00|99|0.00|NEWBORN NURSERY
20|FH_F36439_0_0|SrvcGrp|22999|2022|PCT|0.30|99|0.00|V5298
20|FH_F36439_0_0|SrvcGrp|23002|2022|PDM|1300.00|99|0.00|V5259
20|FH_F36439_0_0|SrvcGrp|23006|2022|PDM|650.00|99|0.00|V5255
20|FH_F36439_0_0|SrvcGrp|23012|2022|PDM|650.00|99|0.00|V5247
20|FH_F36439_0_0|SrvcGrp|24405|2022|PDM|500.00|99|0.00|HEARING AIDE
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|106.24|99|0.00|SALLY BALIN,999182,ASC 225
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|106.24|99|0.00|SALLY BALIN,999182,ASC 310
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|1156.17|99|0.00|SALLY BALIN,999182,ASC 702
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|116.24|99|0.00|SALLY BALIN,999182,ASC 224
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|120.65|99|0.00|SALLY BALIN,999182,ASC 309
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|148.06|99|0.00|SALLY BALIN,999182,ASC 119
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|161.85|99|0.00|SALLY BALIN,999182,ASC 116
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|168.81|99|0.00|SALLY BALIN,999182,ASC 115
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|275.28|99|0.00|SALLY BALIN,999182,ASC 217
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|363.37|99|0.00|SALLY BALIN,999182,ASC 103
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|376.42|99|0.00|SALLY BALIN,999182,ASC 102
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|376.42|99|0.00|SALLY BALIN,999182,ASC 211
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|376.42|99|0.00|SALLY BALIN,999182,ASC 305
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|387.74|99|0.00|SALLY BALIN,999182,ASC 101
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|460.82|99|0.00|SALLY BALIN,999182,ASC 206
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|476.61|99|0.00|SALLY BALIN,999182,ASC 204
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|519.31|99|0.00|SALLY BALIN,999182,ASC 201
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|55.10|99|0.00|SALLY BALIN,999182,ASC 126
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|77.92|99|0.00|SALLY BALIN,999182,ASC 125
20|FH_F36454_0_0|SrvcGrp|23585|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F36458_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36462_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F36472_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE
20|FH_F36472_0_0|SrvcGrp|10107|2022|PCT|0.65|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F36476_0_0|SrvcGrp|6|2022|PCT|0.70|99|0.00|OP SURGERY
20|FH_F36476_0_0|SrvcGrp|997|2022|PCT|1.10|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F36479_0_0|SrvcGrp|13472|2022|PDM|1748.00|99|0.00|ICU/CCU
20|FH_F36479_0_0|SrvcGrp|16|2022|PDM|803.00|99|0.00|ACUTE REHABILITATION
20|FH_F36479_0_0|SrvcGrp|38|2022|PDM|1476.00|99|0.00|NORMAL DELIVERY
20|FH_F36492_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F36492_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS
20|FH_F36492_0_0|SrvcGrp|73000|2022|PDM|1428.00|99|0.00|AEG 6
20|FH_F36524_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F36541_0_0|CSTM-ALL|CSTM-00|2020|PDM|2222.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36552_0_0|CSTM-ALL|CSTM-00|2020|PDM|17955.00|99|0.00|MS DRG 242
20|FH_F36552_0_0|CSTM-ALL|CSTM-00|2020|PDM|20890.00|99|0.00|MS DRG 236
20|FH_F36552_0_0|CSTM-ALL|CSTM-00|2020|PDM|28250.00|99|0.00|MS DRG 233
20|FH_F36552_0_0|CSTM-ALL|CSTM-00|2020|PDM|28250.00|99|0.00|MS DRG 234
20|FH_F36552_0_0|CSTM-ALL|CSTM-00|2020|PDM|29840.00|99|0.00|MS DRG 228
20|FH_F36552_0_0|CSTM-ALL|CSTM-00|2020|PDM|37410.00|99|0.00|MS DRG 217
20|FH_F36552_0_0|CSTM-ALL|CSTM-00|2020|PDM|37410.00|99|0.00|MS DRG 218
20|FH_F36552_0_0|CSTM-ALL|CSTM-00|2020|PDM|37915.00|99|0.00|MS DRG 232
20|FH_F36552_0_0|CSTM-ALL|CSTM-00|2020|PDM|5395.00|99|0.00|MS DRG 287
20|FH_F36552_0_0|CSTM-ALL|CSTM-00|2020|PDM|6685.00|99|0.00|MS DRG 261
20|FH_F36552_0_0|CSTM-ALL|CSTM-00|2020|PDM|7250.00|99|0.00|MS DRG 286
20|FH_F36552_0_0|CSTM-ALL|CSTM-00|2020|PDM|7845.00|99|0.00|MS DRG 283
20|FH_F36552_0_0|CSTM-ALL|CSTM-00|2020|PDM|7845.00|99|0.00|MS DRG 284
20|FH_F36552_0_0|CSTM-ALL|CSTM-00|2020|PDM|8005.00|99|0.00|MS DRG 259
20|FH_F36552_0_0|SrvcGrp|313|2022|PCT|0.60|99|0.00|DRUGS
20|FH_F36552_0_0|SrvcGrp|997|2022|PCT|0.60|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F36555_0_0|SrvcGrp|44883|2022|PDM|22.00|99|0.00|RT/PT/ST/OT
20|FH_F36576_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F36576_0_0|SrvcGrp|115|2022|PDM|642.00|99|0.00|SKILLED NURSING CARE
20|FH_F36576_0_0|SrvcGrp|97|2022|PDM|3910.00|99|0.00|C-SECTION
20|FH_F36590_0_0|SrvcGrp|131|2022|PCT|0.70|99|0.00|PACEMAKER DEVICE
20|FH_F36590_0_0|SrvcGrp|16|2022|PDM|855.00|99|0.00|ACUTE REHABILITATION
20|FH_F36590_0_0|SrvcGrp|65|2022|PDM|1597.00|99|0.00|OBSTETRICAL CARE
20|FH_F36594_0_0|SrvcGrp|11442|2022|PDM|600.00|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)
20|FH_F36594_0_0|SrvcGrp|1168|2022|PDM|25.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F36596_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36620_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36620_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F36634_0_0|CSTM-ALL|CSTM-00|2020|PDM|3748.00|99|0.00|CV SURGERY
20|FH_F36646_0_0|CSTM-ALL|CSTM-00|2020|PDM|42.00|99|0.00|PT OT ST
20|FH_F36646_0_0|SrvcGrp|474|2022|PDM|275.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F36667_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F36669_0_0|SrvcGrp|16304|2022|PDM|585.52|99|0.00|HOSPICE CARE
20|FH_F36681_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.66|99|0.00|OP SVCS
20|FH_F36681_0_0|CSTM-ALL|CSTM-00|2020|PDM|1115.00|99|0.00|ASPG VI
20|FH_F36681_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|ASPG IV
20|FH_F36681_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|ASPG X
20|FH_F36683_0_0|CSTM-ALL|CSTM-00|2020|PDM|23413.00|99|0.00|MS DRG 233
20|FH_F36683_0_0|CSTM-ALL|CSTM-00|2020|PDM|26758.00|99|0.00|MS DRG 232
20|FH_F36683_0_0|CSTM-ALL|CSTM-00|2020|PDM|27873.00|99|0.00|MS DRG 219
20|FH_F36701_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36704_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|MS DRG 927-929, 933-935 & REV 207 BURN SVCS
20|FH_F36704_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|MSDRG 219-221 CARDIAC VLV PX+OTR MJR CARDIOTHORAIC W/CC OLR
20|FH_F36704_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F36704_0_0|CSTM-ALL|CSTM-00|2020|PDM|2700.00|99|0.00|MSDRG 216-218 CARDIAC VALVE PROCEDURE W/ CARDIAC CATH
20|FH_F36704_0_0|CSTM-ALL|CSTM-00|2020|PDM|2700.00|99|0.00|MSDRG 219-221 CARDIAC VLV PX+OTR MJR CARDIOTHORACIC PX W/CC
20|FH_F36704_0_0|SrvcGrp|10427|2022|PCT|0.85|99|0.00|TRAUMA CARE
20|FH_F36704_0_0|SrvcGrp|19906|2022|PDM|2700.00|99|0.00|OBSTETRICAL CARE
20|FH_F36704_0_0|SrvcGrp|9793|2022|PDM|450.00|99|0.00|NEWBORN NURSERY
20|FH_F36704_0_0|SrvcGrp|9911|2022|PDM|350.00|99|0.00|EMERGENCY ROOM SVCS
20|FH_F36715_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|CV SURGERY
20|FH_F36715_0_0|CSTM-ALL|CSTM-00|2020|PDM|758.00|99|0.00|ACUTE PSYCH
20|FH_F36715_0_0|SrvcGrp|20576|2022|PDM|13000.00|99|0.00|MS DRG 619-621 BARIATRIC SURGERY
20|FH_F36715_0_0|SrvcGrp|413|2022|PCT|0.75|99|0.00|TRANSPLANT SVCS
20|FH_F36715_0_0|SrvcGrp|43|2022|PCT|0.80|99|0.00|IMPLANTS
20|FH_F36715_0_0|SrvcGrp|8950|2022|PDM|2472.00|99|0.00|INTERMEDIATE ICU/CCU
20|FH_F36715_0_0|SrvcGrp|8968|2022|PDM|2921.00|99|0.00|NICU LEVEL III & IV
20|FH_F36719_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F36737_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36743_0_0|CSTM-ALL|CSTM-00|2020|PDM|2040.00|99|0.00|POST CARDIAC CARE UNIT
20|FH_F36743_0_0|CSTM-ALL|CSTM-00|2020|PDM|3900.00|99|0.00|CV SURGERY (MS DRG 215-238)
20|FH_F36743_0_0|SrvcGrp|43|2022|PCT|0.65|99|0.00|IMPLANTS
20|FH_F36743_0_0|SrvcGrp|51|2022|PDM|12500.00|99|0.00|KNEE REPLACEMENT
20|FH_F36749_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36767_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36788_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS
20|FH_F36789_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36803_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|CV SURGERY
20|FH_F36803_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F36803_0_0|SrvcGrp|701|2022|PDM|2027.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F36822_0_0|CSTM-ALL|CSTM-00|2020|PDM|11814.00|99|0.00|MS DRG 242-244 PACEMAKER IMPLANT
20|FH_F36822_0_0|SrvcGrp|12274|2022|PDM|329.00|99|0.00|ACUTE PSYCH
20|FH_F36830_0_0|CSTM-ALL|CSTM-00|2020|PCT|59.40|99|0.00|GENERAL ACUTE CARE
20|FH_F36852_0_0|CSTM-ALL|CSTM-00|2020|PCT|62.40|99|0.00|OP SVCS
20|FH_F36854_0_0|SrvcGrp|16|2022|PDM|1100.00|99|0.00|ACUTE REHABILITATION
20|FH_F36861_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F36883_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.52|99|0.00|OP SVCS
20|FH_F36883_0_0|SrvcGrp|73605|2022|PDM|756.08|99|0.00|AETNA ACUTE PSYCH
20|FH_F36883_0_0|SrvcGrp|90356|2022|PCT|0.52|99|0.00|OP DIALYSIS
20|FH_F36883_0_0|SrvcGrp|90854|2022|PDM|756.08|99|0.00|AETNA IP DETOXIFICATION SERVICES
20|FH_F36895_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36908_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36915_0_0|SrvcGrp|23587|2022|PDM|325.00|99|0.00|RESIDENTIAL TREATMENT - PSYCH
20|FH_F36915_0_0|SrvcGrp|9811|2022|PDM|325.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F36917_0_0|SrvcGrp|23587|2022|PDM|325.00|99|0.00|RESIDENTIAL TREATMENT - PSYCH
20|FH_F36917_0_0|SrvcGrp|3577|2022|PDM|200.00|99|0.00|PARTIAL HOSPITALIZATION
20|FH_F36917_0_0|SrvcGrp|80|2022|PDM|755.00|99|0.00|ACUTE PSYCH
20|FH_F36921_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.00|99|0.00|OP SVCS
20|FH_F36936_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS
20|FH_F36952_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36952_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS
20|FH_F36998_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37000_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37000_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F37067_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37078_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F37078_0_0|SrvcGrp|471|2022|PDM|546.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F37078_0_0|SrvcGrp|474|2022|PDM|234.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F37081_0_0|CSTM-ALL|CSTM-00|2020|PDM|10300.00|99|0.00|MS DRG 481
20|FH_F37081_0_0|CSTM-ALL|CSTM-00|2020|PDM|11600.00|99|0.00|MS DRG 219-221
20|FH_F37081_0_0|CSTM-ALL|CSTM-00|2020|PDM|17669.00|99|0.00|MS DRG 459
20|FH_F37081_0_0|CSTM-ALL|CSTM-00|2020|PDM|19600.00|99|0.00|MS DRG 249
20|FH_F37081_0_0|CSTM-ALL|CSTM-00|2020|PDM|19600.00|99|0.00|MSDRG 250-251 PERCUTANEOUS CARDIO PROC
20|FH_F37081_0_0|CSTM-ALL|CSTM-00|2020|PDM|20200.00|99|0.00|MS DRG 243
20|FH_F37081_0_0|CSTM-ALL|CSTM-00|2020|PDM|6950.00|99|0.00|MS DRG 286
20|FH_F37092_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE
20|FH_F37094_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.90|99|0.00|OP SVCS
20|FH_F37104_0_0|CSTM-ALL|CSTM-00|2020|PDM|596.00|99|0.00|ASPG III
20|FH_F37104_0_0|CSTM-ALL|CSTM-00|2020|PDM|838.00|99|0.00|ASPG V
20|FH_F37146_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE
20|FH_F37171_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F37173_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F37174_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37181_0_0|SrvcGrp|701|2022|PDM|1900.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F37183_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37183_0_0|CSTM-ALL|CSTM-00|2020|PDM|52.00|99|0.00|OP SVCS
20|FH_F37187_0_0|CSTM-ALL|CSTM-00|2020|PDM|60.00|99|0.00|OP SVCS
20|FH_F37189_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37191_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37191_0_0|CSTM-ALL|CSTM-00|2020|PDM|75.00|99|0.00|OP SVCS
20|FH_F37192_0_0|CSTM-ALL|CSTM-00|2020|PDM|110.00|99|0.00|OP SVCS
20|FH_F37194_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37198_0_0|SrvcGrp|11259|2022|PCT|0.40|99|0.00|DRUGS
20|FH_F37198_0_0|SrvcGrp|16|2022|PCT|0.75|99|0.00|ACUTE REHABILITATION
20|FH_F37198_0_0|SrvcGrp|69665|2022|PDM|1400.00|99|0.00|MRI
20|FH_F37198_0_0|SrvcGrp|9510|2022|PCT|0.75|99|0.00|SKILLED NURSING CARE
20|FH_F37215_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37227_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37227_0_0|CSTM-ALL|CSTM-00|2020|PDM|515.00|99|0.00|ASPG II
20|FH_F37230_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F37230_0_0|CSTM-ALL|CSTM-00|2020|PDM|117.00|99|0.00|RN VISIT
20|FH_F37230_0_0|SrvcGrp|15388|2022|PDM|117.00|99|0.00|SPEECH THERAPY
20|FH_F37257_0_0|CSTM-ALL|CSTM-00|2020|PDM|1950.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37257_0_0|SrvcGrp|13123|2022|PDM|450.00|99|0.00|COMPUTED TOMOGRAPHY (CT)
20|FH_F37257_0_0|SrvcGrp|13199|2022|PCT|0.95|99|0.00|TRAUMA CARE
20|FH_F37257_0_0|SrvcGrp|6|2022|PCT|0.80|99|0.00|OP SURGERY
20|FH_F37267_0_0|SrvcGrp|26001|2022|PDM|94.50|99|0.00|HOSPICE RESPITE SVCS
20|FH_F37267_0_0|SrvcGrp|9829|2022|PDM|85.50|99|0.00|PT SVCS
20|FH_F37267_0_0|SrvcGrp|9830|2022|PDM|85.50|99|0.00|OT SVCS
20|FH_F37267_0_0|SrvcGrp|9832|2022|PDM|84.50|99|0.00|ST SVCS
20|FH_F37285_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37285_0_0|CSTM-ALL|CSTM-00|2020|PDM|1025.00|99|0.00|AEG 4 (NO REV)
20|FH_F37294_0_0|SrvcGrp|20825|2022|PCT|0.80|99|0.00|HEART TRANSPLANT
20|FH_F37294_0_0|SrvcGrp|299|2022|PDM|28017.00|99|0.00|GAMMA KNIFE
20|FH_F37294_0_0|SrvcGrp|33154|2022|PDM|1391.00|99|0.00|NICU LEVEL III & IV
20|FH_F37294_0_0|SrvcGrp|89|2022|PCT|0.80|99|0.00|LIVER TRANSPLANT
20|FH_F37346_0_0|CSTM-ALL|CSTM-00|2020|PDM|35.00|99|0.00|OP SVCS
20|FH_F37361_0_0|SrvcGrp|8962|2022|PDM|88.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F37364_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|ACUTE PSYCH
20|FH_F37364_0_0|SrvcGrp|9863|2022|PDM|2000.00|99|0.00|INTENSIVE CARE/CORONARY CARE UNIT
20|FH_F37365_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37394_0_0|SrvcGrp|473|2022|PDM|725.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F37408_0_0|CSTM-ALL|CSTM-00|2020|PCT|67.89|99|0.00|OP SVCS
20|FH_F37422_0_0|SrvcGrp|471|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F37443_0_0|CSTM-ALL|CSTM-00|2020|PDM|7000.00|99|0.00|C-SECTION
20|FH_F37443_0_0|CSTM-ALL|CSTM-00|2020|PDM|910.00|99|0.00|ACUTE PSYCH
20|FH_F37443_0_0|SrvcGrp|110|2022|PDM|910.00|99|0.00|CD - REHABILITATION
20|FH_F37443_0_0|SrvcGrp|16|2022|PDM|953.00|99|0.00|ACUTE REHABILITATION
20|FH_F37443_0_0|SrvcGrp|23929|2022|PCT|0.45|99|0.00|HIGH COST DRUGS
20|FH_F37444_0_0|SrvcGrp|16618|2022|PCT|0.72|99|0.00|ST SVCS
20|FH_F37444_0_0|SrvcGrp|3611|2022|PCT|0.70|99|0.00|DURABLE MEDICAL EQUIPMENT
20|FH_F37444_0_0|SrvcGrp|9934|2022|PDM|1100.00|99|0.00|GENERAL ACUTE CARE W/VENTILATOR SVCS
20|FH_F37444_0_0|SrvcGrp|997|2022|PCT|0.70|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F37475_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37475_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F37478_0_0|CSTM-ALL|CSTM-00|2020|PDM|1747.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37487_0_0|SrvcGrp|16617|2022|PDM|79.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F37487_0_0|SrvcGrp|9861|2022|PCT|0.70|99|0.00|ACUTE REHABILITATION
20|FH_F37490_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37490_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F37490_0_0|CSTM-ALL|CSTM-00|2020|PDM|1444.59|99|0.00|ASPG VII
20|FH_F37490_0_0|CSTM-ALL|CSTM-00|2020|PDM|2250.00|99|0.00|OP SURGICAL SERVICES
20|FH_F37490_0_0|CSTM-ALL|CSTM-00|2020|PDM|483.04|99|0.00|ASPG I
20|FH_F37490_0_0|CSTM-ALL|CSTM-00|2020|PDM|741.17|99|0.00|ASPG III
20|FH_F37490_0_0|CSTM-ALL|CSTM-00|2020|PDM|741.17|99|0.00|ASPG IX
20|FH_F37490_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.75|99|0.00|ASPG IV
20|FH_F37490_0_0|SrvcGrp|11673|2022|PDM|4250.00|99|0.00|CPT 29888
20|FH_F37490_0_0|SrvcGrp|26430|2022|PDM|5000.00|99|0.00|OP SURGICAL SERVICES
20|FH_F37490_0_0|SrvcGrp|26432|2022|PDM|741.17|99|0.00|OP SURGICAL SERVICES
20|FH_F37490_0_0|SrvcGrp|26433|2022|PDM|647.57|99|0.00|OP SURGICAL SERVICES
20|FH_F37491_0_0|CSTM-ALL|CSTM-00|2020|PDM|420.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37493_0_0|CSTM-ALL|CSTM-00|2020|PDM|1003.00|99|0.00|ACUTE PSYCH
20|FH_F37493_0_0|SrvcGrp|12492|2022|PCT|0.50|99|0.00|PROSTHETICS
20|FH_F37493_0_0|SrvcGrp|38|2022|PDM|5905.00|99|0.00|NORMAL DELIVERY
20|FH_F37493_0_0|SrvcGrp|453|2022|PDM|570.00|99|0.00|PSYCH PARTIAL HOSP
20|FH_F37493_0_0|SrvcGrp|73308|2022|PDM|2099.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F37493_0_0|SrvcGrp|97|2022|PDM|7928.00|99|0.00|C-SECTION
20|FH_F37494_0_0|CSTM-ALL|CSTM-00|2020|PDM|1368.48|99|0.00|ASPG V
20|FH_F37494_0_0|CSTM-ALL|CSTM-00|2020|PDM|635.53|99|0.00|ASPG I
20|FH_F37494_0_0|CSTM-ALL|CSTM-00|2020|PDM|851.20|99|0.00|ASPG II
20|FH_F37546_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37566_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37566_0_0|SrvcGrp|23387|2022|PDM|60.00|99|0.00|PT/OT/ST
20|FH_F37590_0_0|SrvcGrp|13703|2022|PDM|26.25|99|0.00|LICENSED PRACTICAL NURSE- HOURLY
20|FH_F37590_0_0|SrvcGrp|9828|2022|PDM|35.70|99|0.00|HOME HEALTH AIDE
20|FH_F37590_0_0|SrvcGrp|9829|2022|PDM|84.00|99|0.00|PT SVCS
20|FH_F37590_0_0|SrvcGrp|9830|2022|PDM|84.00|99|0.00|OT SVCS
20|FH_F37593_0_0|CSTM-ALL|CSTM-00|2020|PDM|507.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37611_0_0|SrvcGrp|474|2022|PDM|250.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F37650_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|OP SVCS
20|FH_F37655_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37659_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 001-002 & REV CODE & PROC CODES HEART TRANSPLANT OTLR
20|FH_F37659_0_0|CSTM-ALL|CSTM-00|2020|PDM|549.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F37659_0_0|SrvcGrp|13236|2022|PDM|2305.00|99|0.00|ICU/CCU
20|FH_F37659_0_0|SrvcGrp|361|2022|PDM|1654.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F37667_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|BONE MARROW TRANSPLANT
20|FH_F37679_0_0|SrvcGrp|14944|2022|PDM|6.50|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN
20|FH_F37679_0_0|SrvcGrp|14949|2022|PDM|80.00|99|0.00|HOME INFUSION
20|FH_F37679_0_0|SrvcGrp|17002|2022|PDM|110.00|99|0.00|TOTAL PARENTERAL NUTRITION; LESS THAN 3 LITERS
20|FH_F37679_0_0|SrvcGrp|17003|2022|PDM|110.00|99|0.00|TOTAL PARENTERAL NUTRITION;MORE THAN 3 LITERS
20|FH_F37679_0_0|SrvcGrp|17006|2022|PDM|61.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 12HRS
20|FH_F37679_0_0|SrvcGrp|17009|2022|PDM|61.00|99|0.00|HOME INFUSION THERAPY
20|FH_F37679_0_0|SrvcGrp|17016|2022|PDM|61.00|99|0.00|HOME INFUSION THERAPY
20|FH_F37679_0_0|SrvcGrp|22588|2022|PDM|61.00|99|0.00|CHEMOTHERAPY
20|FH_F37679_0_0|SrvcGrp|22590|2022|PDM|61.00|99|0.00|PAIN MANAGAMENT - INTERMITTENT
20|FH_F37679_0_0|SrvcGrp|22593|2022|PDM|61.00|99|0.00|ANIT-HEMOPHILIC FACTORS
20|FH_F37679_0_0|SrvcGrp|24752|2022|PDM|15.00|99|0.00|HORMONE INJECTION THERAPY
20|FH_F37679_0_0|SrvcGrp|26843|2022|PDM|30.50|99|0.00|CONTINUOUS ANTICOAGULANT THERAPY (MOD SH)
20|FH_F37679_0_0|SrvcGrp|26846|2022|PDM|15.25|99|0.00|IMMUNOTHERAPY (MOD SJ)
20|FH_F37679_0_0|SrvcGrp|26847|2022|PDM|30.50|99|0.00|ANTI-HEMOPHILIC (MOD SH)
20|FH_F37679_0_0|SrvcGrp|26850|2022|PDM|15.25|99|0.00|HOME INFUSION THERAPY (SJ)
20|FH_F37679_0_0|SrvcGrp|26852|2022|PDM|15.25|99|0.00|ANTI-EMETICS INFUSION THERAPY (SJ)
20|FH_F37679_0_0|SrvcGrp|26854|2022|PDM|15.25|99|0.00|CHELATION THERAPY (MOD SJ)
20|FH_F37679_0_0|SrvcGrp|26857|2022|PDM|30.50|99|0.00|HOME INFUSION THERAPY (MOD SH)
20|FH_F37679_0_0|SrvcGrp|26865|2022|PDM|30.50|99|0.00|CORTICOSTEROID THERAPY (MOD SH)
20|FH_F37679_0_0|SrvcGrp|26866|2022|PDM|15.25|99|0.00|CORTICOSTEROID THERAPY (MOD SJ)
20|FH_F37679_0_0|SrvcGrp|26867|2022|PDM|61.00|99|0.00|ANTI-EMETICS INFUSION THERAPY
20|FH_F37679_0_0|SrvcGrp|26868|2022|PDM|61.00|99|0.00|DIURETIC IV THERAPY
20|FH_F37679_0_0|SrvcGrp|27034|2022|PDM|55.00|99|0.00|TOTAL PARENTERAL NUTRITION;ONE LITER PER DAY(MOD SH)
20|FH_F37679_0_0|SrvcGrp|27037|2022|PDM|27.50|99|0.00|TOTAL PARENTERAL NUTRITION; LESS THAN 2 LITERS (MOD SJ)
20|FH_F37679_0_0|SrvcGrp|27039|2022|PDM|27.50|99|0.00|TOTAL PARENTERAL NUTRITION; LESS THAN 3 LITERS (MOD SJ)
20|FH_F37679_0_0|SrvcGrp|27042|2022|PDM|30.50|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 24HRS(MOD SH)
20|FH_F37679_0_0|SrvcGrp|27052|2022|PDM|30.50|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 3HRS(MOD SH)
20|FH_F37679_0_0|SrvcGrp|27061|2022|PDM|9.75|99|0.00|HYDRATION THERAPY - 3+ LITERS (MOD SJ)
20|FH_F37679_0_0|SrvcGrp|27067|2022|PDM|15.25|99|0.00|HOME INFUSION THERAPY, PAIN MGMT (MOD SJ)
20|FH_F37679_0_0|SrvcGrp|27071|2022|PDM|1.63|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN (MOD SJ)
20|FH_F37679_0_0|SrvcGrp|27076|2022|PDM|40.00|99|0.00|HOME INFUSION (MOD SH)
20|FH_F37679_0_0|SrvcGrp|27081|2022|PDM|25.00|99|0.00|PICC LINE INSERTION (MID-LINE) (MOD SJ)
20|FH_F37679_0_0|SrvcGrp|27128|2022|PDM|7.50|99|0.00|INTERMITTENT ANTICOAGULANT THERAPY (MOD SH)
20|FH_F37679_0_0|SrvcGrp|27130|2022|PDM|7.50|99|0.00|HORMONE INJECTION THERAPY (MOD SH)
20|FH_F37679_0_0|SrvcGrp|27139|2022|PDM|3.75|99|0.00|INTERFERON INJECTION THERAPY (MOD SJ)
20|FH_F37680_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37698_0_0|SrvcGrp|27168|2022|PCT|0.50|99|0.00|DRUGS/IMPANTS/PROSTHETICS/ORTHOTICS
20|FH_F37698_0_0|SrvcGrp|9793|2022|PDM|300.00|99|0.00|NEWBORN NURSERY
20|FH_F37703_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37708_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37708_0_0|SrvcGrp|13631|2022|PDM|90.00|99|0.00|CPT 99213
20|FH_F37733_0_0|SrvcGrp|27214|2022|PDM|250.00|99|0.00|SKILLED NURSING - LEVEL II
20|FH_F37733_0_0|SrvcGrp|27215|2022|PDM|350.00|99|0.00|SKILLED NURSING - LEVEL III
20|FH_F37733_0_0|SrvcGrp|9466|2022|PDM|450.00|99|0.00|SKILLED NURSING - LEVEL IV
20|FH_F37738_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F37743_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F37753_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F37753_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|SPLINTS - HCPCS
20|FH_F37771_0_0|SrvcGrp|44302|2022|PDM|60.00|99|0.00|PT & OT (VISIT LVL) PT MOD GP
20|FH_F37771_0_0|SrvcGrp|76207|2022|PDM|60.00|99|0.00|SPEECH THERAPY (VISIT LVL) MOD GN
20|FH_F37777_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F37777_0_0|CSTM-ALL|CSTM-00|2020|PDM|390.00|99|0.00|STROKE, NEURO DAY TREATMENT
20|FH_F37777_0_0|CSTM-ALL|CSTM-00|2020|PDM|934.00|99|0.00|STROKE, NEURO
20|FH_F37777_0_0|SrvcGrp|11259|2022|PCT|0.80|99|0.00|DRUGS
20|FH_F37777_0_0|SrvcGrp|26179|2022|PDM|30.00|99|0.00|OT
20|FH_F37778_0_0|CSTM-ALL|CSTM-00|2020|PDM|1105.00|99|0.00|ASPG IV
20|FH_F37778_0_0|CSTM-ALL|CSTM-00|2020|PDM|1105.00|99|0.00|ASPG X
20|FH_F37778_0_0|CSTM-ALL|CSTM-00|2020|PDM|1749.00|99|0.00|ASPG VII
20|FH_F37778_0_0|CSTM-ALL|CSTM-00|2020|PDM|1749.00|99|0.00|TYMPANOPLASTY
20|FH_F37778_0_0|CSTM-ALL|CSTM-00|2020|PDM|2350.00|99|0.00|ASPG IX
20|FH_F37778_0_0|SrvcGrp|11663|2022|PCT|0.50|99|0.00|IMPLANTS
20|FH_F37778_0_0|SrvcGrp|27310|2022|PDM|2350.00|99|0.00|ENDOSCOPIC PLANTAR FASCIOTOMY
20|FH_F37809_0_0|CSTM-ALL|CSTM-00|2020|PDM|2915.00|99|0.00|ASPG V
20|FH_F37809_0_0|SrvcGrp|27398|2022|PDM|6360.00|99|0.00|OP SURGERY
20|FH_F37812_0_0|CSTM-ALL|CSTM-00|2020|PCT|22500.00|99|0.00|PT SERVICES
20|FH_F37812_0_0|CSTM-ALL|CSTM-00|2020|PCT|28800.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES
20|FH_F37812_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|HOME HEALTH
20|FH_F37812_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|EMERGENCY ROOM SVCS
20|FH_F37847_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37847_0_0|SrvcGrp|8962|2022|PDM|93.50|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F37850_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|OP SVCS
20|FH_F37850_0_0|SrvcGrp|16|2022|PDM|757.00|99|0.00|ACUTE REHABILITATION
20|FH_F37850_0_0|SrvcGrp|22661|2022|PCT|0.68|99|0.00|ANGIOPLASTY
20|FH_F37875_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37878_0_0|SrvcGrp|100947|2022|PDM|80.00|99|0.00|HOME HEALTH RN SERVICE
20|FH_F37882_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.70|99|0.00|GENERAL ACUTE CARE
20|FH_F37897_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS
20|FH_F37904_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37910_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F37910_0_0|SrvcGrp|13368|2022|PCT|0.85|99|0.00|OP SURGERY
20|FH_F37910_0_0|SrvcGrp|16|2022|PCT|0.85|99|0.00|ACUTE REHABILITATION
20|FH_F37934_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F37937_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F37937_0_0|CSTM-ALL|CSTM-00|2020|PDM|45.00|99|0.00|SKILLED LPN HOURLY
20|FH_F37937_0_0|SrvcGrp|11068|2022|PDM|100.00|99|0.00|PT SVCS
20|FH_F37937_0_0|SrvcGrp|11073|2022|PDM|85.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F37937_0_0|SrvcGrp|27766|2022|PDM|100.00|99|0.00|SKILLED IV NURSING VISIT
20|FH_F37937_0_0|SrvcGrp|27767|2022|PDM|45.00|99|0.00|SKILLED IV NURSING HOURLY
20|FH_F37943_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F37960_0_0|SrvcGrp|14990|2022|PCT|0.80|99|0.00|OBSERVATION SVCS (23 HOURS)
20|FH_F37960_0_0|SrvcGrp|27726|2022|PCT|0.80|99|0.00|OP SURGERY
20|FH_F37963_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|OP SVCS
20|FH_F37987_0_0|CSTM-ALL|CSTM-00|2020|PDM|1095.00|99|0.00|ASPG VII
20|FH_F37987_0_0|CSTM-ALL|CSTM-00|2020|PDM|366.00|99|0.00|ASPG I
20|FH_F37987_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|ASPG III
20|FH_F37987_0_0|CSTM-ALL|CSTM-00|2020|PDM|789.00|99|0.00|ASPG V
20|FH_F37996_0_0|SrvcGrp|472|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F37996_0_0|SrvcGrp|474|2022|PDM|250.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F38007_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|OP SVCS
20|FH_F38007_0_0|CSTM-ALL|CSTM-00|2020|PDM|3365.00|99|0.00|ONCOLOGY CARE UNIT
20|FH_F38007_0_0|SrvcGrp|360|2022|PDM|2155.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F38007_0_0|SrvcGrp|3944|2022|PDM|3385.00|99|0.00|CORONARY CARE UNIT
20|FH_F38016_0_0|CSTM-ALL|CSTM-00|2020|PDM|3245.00|99|0.00|MS DRG 246
20|FH_F38016_0_0|SrvcGrp|115|2022|PDM|487.00|99|0.00|SKILLED NURSING CARE
20|FH_F38016_0_0|SrvcGrp|97|2022|PDM|3461.00|99|0.00|C-SECTION
20|FH_F38023_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38023_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F38025_0_0|SrvcGrp|25155|2022|PDM|60.00|99|0.00|PT/OT/ST
20|FH_F38034_0_0|SrvcGrp|10024|2022|PDM|3634.00|99|0.00|ICU/CCU
20|FH_F38034_0_0|SrvcGrp|12359|2022|PDM|2797.00|99|0.00|TELEMETRY SVCS
20|FH_F38034_0_0|SrvcGrp|22976|2022|PCT|0.90|99|0.00|CPT CODES 93600-93660
20|FH_F38034_0_0|SrvcGrp|27883|2022|PCT|0.90|99|0.00|ELECTROPHYSIOLOGY
20|FH_F38034_0_0|SrvcGrp|97|2022|PDM|2264.00|99|0.00|C-SECTION
20|FH_F38037_0_0|SrvcGrp|8962|2022|PDM|88.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F38037_0_0|SrvcGrp|9828|2022|PDM|40.70|99|0.00|HOME HEALTH AIDE
20|FH_F38037_0_0|SrvcGrp|9830|2022|PDM|88.00|99|0.00|OT SVCS
20|FH_F38039_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38039_0_0|SrvcGrp|9830|2022|PDM|82.50|99|0.00|OT SVCS
20|FH_F38047_0_0|SrvcGrp|177|2022|PDM|2299.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F38047_0_0|SrvcGrp|65|2022|PDM|2418.00|99|0.00|OBSTETRICAL CARE
20|FH_F38049_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38051_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38051_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F38061_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|IMPLANTS/PROSTHETICS/DEVICES
20|FH_F38061_0_0|CSTM-ALL|CSTM-00|2020|PDM|1159.40|99|0.00|ASPG VII
20|FH_F38061_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|ASPG X
20|FH_F38061_0_0|CSTM-ALL|CSTM-00|2020|PDM|734.80|99|0.00|ASPG IV
20|FH_F38061_0_0|CSTM-ALL|CSTM-00|2020|PDM|917.40|99|0.00|ASPG VI
20|FH_F38080_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F38080_0_0|CSTM-ALL|CSTM-00|2020|PDM|1725.00|99|0.00|AEG 7 (NO REV)
20|FH_F38081_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38088_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F38089_0_0|CSTM-ALL|CSTM-00|2020|PDM|35439.00|99|0.00|CORONARY VALVE PROCEDURE (MS DRG)
20|FH_F38089_0_0|SrvcGrp|26893|2022|PCT|0.70|99|0.00|PROSTHETICS/ORTHOTICS/IMPLANTS
20|FH_F38089_0_0|SrvcGrp|3055|2022|PDM|1134.00|99|0.00|MAGNETIC RESONANCE IMAGING
20|FH_F38089_0_0|SrvcGrp|3140|2022|PCT|0.70|99|0.00|PHARMACY SERVICES
20|FH_F38089_0_0|SrvcGrp|360|2022|PDM|1276.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F38090_0_0|CSTM-ALL|CSTM-00|2020|PDM|32366.00|99|0.00|MS DRG 216-221, 226-227, 231-236 CV SURGERY
20|FH_F38090_0_0|SrvcGrp|16|2022|PDM|788.00|99|0.00|ACUTE REHABILITATION
20|FH_F38120_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F38135_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F38135_0_0|CSTM-ALL|CSTM-00|2020|PDM|1213.00|99|0.00|PEDIATRIC MEDICINE
20|FH_F38135_0_0|CSTM-ALL|CSTM-00|2020|PDM|1686.00|99|0.00|ADULT SURGICAL SERVICES
20|FH_F38135_0_0|CSTM-ALL|CSTM-00|2020|PDM|1872.00|99|0.00|PEDIATRIC SURGICAL SERVICES
20|FH_F38135_0_0|SrvcGrp|13551|2022|PDM|392.00|99|0.00|NEWBORN NURSERY
20|FH_F38135_0_0|SrvcGrp|14394|2022|PCT|0.75|99|0.00|DIAGNOSTIC CARDIAC CATH
20|FH_F38135_0_0|SrvcGrp|439|2022|PDM|2839.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F38151_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F38151_0_0|SrvcGrp|28280|2022|PCT|0.85|99|0.00|ANGIOPLASTY
20|FH_F38151_0_0|SrvcGrp|3432|2022|PCT|0.85|99|0.00|IMPLANTS
20|FH_F38172_0_0|CSTM-ALL|CSTM-00|2020|PDM|75.00|99|0.00|GA STANDARD THERAPY CODES
20|FH_F38183_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|AMBULANCE SVCS
20|FH_F38187_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS
20|FH_F38190_0_0|CSTM-ALL|CSTM-00|2020|PDM|100.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38190_0_0|CSTM-ALL|CSTM-00|2020|PDM|100.00|99|0.00|OP SVCS
20|FH_F38218_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|OP SVCS
20|FH_F38221_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.83|99|0.00|OP SVCS
20|FH_F38227_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F38238_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38238_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F38242_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38249_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|REHABILITATION
20|FH_F38249_0_0|SrvcGrp|3029|2022|PDM|175.00|99|0.00|NEWBORN NURSERY
20|FH_F38250_0_0|SrvcGrp|11232|2022|PDM|283.00|99|0.00|PARTIAL HOSPITALIZATION
20|FH_F38280_0_0|CSTM-ALL|CSTM-00|2020|PDM|60.00|99|0.00|PT/ST/OT
20|FH_F38288_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38288_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F38288_0_0|CSTM-ALL|CSTM-00|2020|PDM|1095.00|99|0.00|ASPG VII
20|FH_F38297_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38297_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F38297_0_0|SrvcGrp|3810|2022|PDM|103.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F38332_0_0|CSTM-ALL|CSTM-00|2020|PDM|12064.00|99|0.00|MS DRG 238
20|FH_F38332_0_0|CSTM-ALL|CSTM-00|2020|PDM|12064.00|99|0.00|MS DRG 241
20|FH_F38332_0_0|CSTM-ALL|CSTM-00|2020|PDM|12064.00|99|0.00|MS DRG 243
20|FH_F38332_0_0|CSTM-ALL|CSTM-00|2020|PDM|12064.00|99|0.00|MS DRG 244
20|FH_F38332_0_0|CSTM-ALL|CSTM-00|2020|PDM|15759.00|99|0.00|MS DRG 620
20|FH_F38332_0_0|CSTM-ALL|CSTM-00|2020|PDM|1725.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38332_0_0|CSTM-ALL|CSTM-00|2020|PDM|42216.00|99|0.00|MS DRG 229
20|FH_F38332_0_0|CSTM-ALL|CSTM-00|2020|PDM|42216.00|99|0.00|MS DRG 232
20|FH_F38332_0_0|CSTM-ALL|CSTM-00|2020|PDM|42216.00|99|0.00|MS DRG 234
20|FH_F38332_0_0|SrvcGrp|115|2022|PDM|497.00|99|0.00|SKILLED NURSING CARE
20|FH_F38332_0_0|SrvcGrp|131|2022|PCT|0.50|99|0.00|PACEMAKER DEVICE
20|FH_F38332_0_0|SrvcGrp|72|2022|PDM|363.00|99|0.00|NEWBORN NURSERY
20|FH_F38366_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38366_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F38372_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F38372_0_0|CSTM-ALL|CSTM-00|2020|PDM|325.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38372_0_0|SrvcGrp|109|2022|PDM|350.00|99|0.00|CD - DETOX
20|FH_F38372_0_0|SrvcGrp|110|2022|PDM|325.00|99|0.00|CD - REHABILITATION
20|FH_F38380_0_0|CSTM-ALL|CSTM-00|2020|PCT|36500.00|99|0.00|TIMELY FILING
20|FH_F38380_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F38383_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38383_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F38383_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|TRANSPLANT SVCS
20|FH_F38387_0_0|SrvcGrp|22954|2022|PDM|120.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F38410_0_0|CSTM-ALL|CSTM-00|2020|PDM|45.00|99|0.00|LPN HI TECH - HOURLY
20|FH_F38410_0_0|CSTM-ALL|CSTM-00|2020|PDM|73.00|99|0.00|LPN VISIT
20|FH_F38410_0_0|SrvcGrp|10615|2022|PDM|120.00|99|0.00|HOME HEALTH AIDE
20|FH_F38411_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 009
20|FH_F38411_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 462
20|FH_F38411_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 483
20|FH_F38411_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 799
20|FH_F38411_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 809
20|FH_F38411_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 913
20|FH_F38411_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|AIR AMBULANCE
20|FH_F38411_0_0|CSTM-ALL|CSTM-00|2020|PDM|3050.00|99|0.00|ACUTE SURGICAL SERVICES
20|FH_F38411_0_0|CSTM-ALL|CSTM-00|2020|PDM|3400.00|99|0.00|MS DRG 767-768, 774-775 NORMAL DELIVERY
20|FH_F38411_0_0|SrvcGrp|12116|2022|PCT|0.80|99|0.00|DRUGS
20|FH_F38411_0_0|SrvcGrp|14264|2022|PDM|3250.00|99|0.00|ICU/CCU
20|FH_F38411_0_0|SrvcGrp|15|2022|PDM|3450.00|99|0.00|PEDIATRIC INTENSIVE CARE UNIT
20|FH_F38411_0_0|SrvcGrp|20077|2022|PCT|0.80|99|0.00|MS DRG 226-227 ONLY CARDIAC DEFIBRILLATOR
20|FH_F38411_0_0|SrvcGrp|20402|2022|PCT|0.80|99|0.00|MS DRG 025-027 ONLY CRANIOTOMY
20|FH_F38411_0_0|SrvcGrp|4109|2022|PDM|900.00|99|0.00|ACUTE PSYCH
20|FH_F38417_0_0|CSTM-ALL|CSTM-00|2020|PDM|491.00|99|0.00|ASPG II
20|FH_F38417_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|ASPG III
20|FH_F38421_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38425_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38425_0_0|SrvcGrp|10543|2022|PDM|110.00|99|0.00|SPEECH THERAPY SVCS
20|FH_F38425_0_0|SrvcGrp|15846|2022|PDM|47.00|99|0.00|HOME VISIT
20|FH_F38450_0_0|SrvcGrp|472|2022|PDM|460.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F38473_0_0|CSTM-ALL|CSTM-00|2020|PDM|102.00|99|0.00|SKILLED NURSING
20|FH_F38473_0_0|SrvcGrp|10545|2022|PDM|115.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F38473_0_0|SrvcGrp|11798|2022|PDM|112.00|99|0.00|HOME INFUSION NURSING SVCS
20|FH_F38473_0_0|SrvcGrp|15846|2022|PDM|47.00|99|0.00|HOME VISIT
20|FH_F38475_0_0|SrvcGrp|10540|2022|PDM|22.00|99|0.00|HOME HEALTH AIDE
20|FH_F38475_0_0|SrvcGrp|10542|2022|PDM|110.00|99|0.00|OCCUPATIONAL THERAPY SVCS
20|FH_F38475_0_0|SrvcGrp|10543|2022|PDM|110.00|99|0.00|SPEECH THERAPY SVCS
20|FH_F38476_0_0|CSTM-ALL|CSTM-00|2020|PDM|45.00|99|0.00|LPN HI TECH - HOURLY
20|FH_F38476_0_0|CSTM-ALL|CSTM-00|2020|PDM|73.00|99|0.00|LPN VISIT
20|FH_F38476_0_0|SrvcGrp|10541|2022|PDM|110.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F38476_0_0|SrvcGrp|10543|2022|PDM|110.00|99|0.00|SPEECH THERAPY SVCS
20|FH_F38476_0_0|SrvcGrp|10545|2022|PDM|115.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F38476_0_0|SrvcGrp|10624|2022|PDM|68.00|99|0.00|CPT CODE 99347
20|FH_F38476_0_0|SrvcGrp|11798|2022|PDM|112.00|99|0.00|HOME INFUSION NURSING SVCS
20|FH_F38526_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.79|99|0.00|OP SVCS
20|FH_F38526_0_0|CSTM-ALL|CSTM-00|2020|PDM|3900.00|99|0.00|CV SURGERY (MS DRG 215-238)
20|FH_F132606_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132606_0_0|CSTM-ALL|CSTM-00|2020|PDM|1123.63|99|0.00|AEG 6 (NO REV)
20|FH_F132606_0_0|CSTM-ALL|CSTM-00|2020|PDM|1342.12|99|0.00|AEG 7 (NO REV)
20|FH_F132606_0_0|SrvcGrp|111994|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES
20|FH_F132606_0_0|SrvcGrp|27261|2022|PDM|3537.36|99|0.00|CPT 27446
20|FH_F132606_0_0|SrvcGrp|67065|2022|PDM|3641.40|99|0.00|CERVICAL SURGERY
20|FH_F132606_0_0|SrvcGrp|70749|2022|PDM|1305.00|99|0.00|CPT 29823
20|FH_F132606_0_0|SrvcGrp|88159|2022|PDM|2809.00|99|0.00|LOW BACK DISK SURGERY
20|FH_F132609_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F132609_0_0|SrvcGrp|10107|2022|PCT|0.67|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F132609_0_0|SrvcGrp|112077|2022|PDM|49727.00|99|0.00|CV SURGERY
20|FH_F132609_0_0|SrvcGrp|360|2022|PDM|1520.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F132609_0_0|SrvcGrp|705|2022|PCT|0.67|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F132612_0_0|CSTM-ALL|CSTM-00|2020|PDM|1952.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132612_0_0|SrvcGrp|10107|2022|PCT|0.67|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F132612_0_0|SrvcGrp|107733|2022|PDM|5274.00|99|0.00|CESAREAN SECTION
20|FH_F132612_0_0|SrvcGrp|51672|2022|PDM|3989.00|99|0.00|MS DRG 286-287 ONLY
20|FH_F132612_0_0|SrvcGrp|58|2022|PCT|0.66|99|0.00|IP LITHOTRIPSY SVCS
20|FH_F132627_0_0|SrvcGrp|10578|2022|PDM|64.26|99|0.00|HYDRATION THERAPY - 1 LITER
20|FH_F132627_0_0|SrvcGrp|10579|2022|PDM|64.26|99|0.00|HYDRATION THERAPY - 2 LITERS
20|FH_F132627_0_0|SrvcGrp|16750|2022|PDM|220.00|99|0.00|HOME INFUSION THERAPY
20|FH_F132627_0_0|SrvcGrp|17002|2022|PDM|220.00|99|0.00|TOTAL PARENTERAL NUTRITION; LESS THAN 3 LITERS
20|FH_F132627_0_0|SrvcGrp|17003|2022|PDM|220.00|99|0.00|TOTAL PARENTERAL NUTRITION;MORE THAN 3 LITERS
20|FH_F132627_0_0|SrvcGrp|17302|2022|PDM|64.26|99|0.00|HYDRATION THERAPY - 3+ LITERS
20|FH_F132627_0_0|SrvcGrp|22590|2022|PDM|69.36|99|0.00|PAIN MANAGAMENT - INTERMITTENT
20|FH_F132627_0_0|SrvcGrp|22592|2022|PDM|80.58|99|0.00|CONTINUOUS ANTI-COAGULANTS
20|FH_F132627_0_0|SrvcGrp|22594|2022|PDM|80.58|99|0.00|IMIGLUCERASE
20|FH_F132627_0_0|SrvcGrp|22596|2022|PDM|185.00|99|0.00|HOSPICE CARE
20|FH_F132627_0_0|SrvcGrp|24744|2022|PDM|153.00|99|0.00|PICC LINE INSERTION
20|FH_F132627_0_0|SrvcGrp|24754|2022|PDM|43.86|99|0.00|INTERFERON INJECTION THERAPY
20|FH_F132627_0_0|SrvcGrp|26869|2022|PDM|18.36|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC
20|FH_F132627_0_0|SrvcGrp|27968|2022|PDM|80.58|99|0.00|SKILLED NURSING LPN
20|FH_F132627_0_0|SrvcGrp|81857|2022|PDM|29.58|99|0.00|HOME HEALTH AIDE SERVICES
20|FH_F132627_0_0|SrvcGrp|86832|2022|PDM|18.36|99|0.00|HCPCS S5498 (HCFA)
20|FH_F132627_0_0|SrvcGrp|92675|2022|PCT|0.90|99|0.00|AETNA DRUGS/AGENTS/INJ DRUGS/NUTRITION SOLUTIONS
20|FH_F132672_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132672_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F132693_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 10 (NO REV)
20|FH_F132693_0_0|CSTM-ALL|CSTM-00|2020|PDM|446.00|99|0.00|AEG 2 (NO REV)
20|FH_F132693_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|AEG 5  (NO REV)
20|FH_F132693_0_0|CSTM-ALL|CSTM-00|2020|PDM|973.00|99|0.00|AEG 8 (NO REV)
20|FH_F132720_0_0|SrvcGrp|112077|2022|PDM|48747.00|99|0.00|CV SURGERY
20|FH_F132720_0_0|SrvcGrp|16|2022|PDM|1611.00|99|0.00|ACUTE REHABILITATION
20|FH_F132720_0_0|SrvcGrp|51672|2022|PDM|7160.00|99|0.00|MS DRG 286-287 ONLY
20|FH_F132721_0_0|SrvcGrp|3078|2022|PCT|0.65|99|0.00|DRUGS
20|FH_F132728_0_0|SrvcGrp|107733|2022|PDM|6266.00|99|0.00|CESAREAN SECTION
20|FH_F132728_0_0|SrvcGrp|107734|2022|PDM|4476.00|99|0.00|VAGINAL DELIVERY
20|FH_F132728_0_0|SrvcGrp|3078|2022|PCT|0.65|99|0.00|DRUGS
20|FH_F132728_0_0|SrvcGrp|33793|2022|PDM|13426.00|99|0.00|MSDRG 246-251 ONLY ANGIOPLASTY
20|FH_F132728_0_0|SrvcGrp|361|2022|PDM|3088.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F132729_0_0|SrvcGrp|3409|2022|PDM|600.00|99|0.00|NEWBORN NURSERY
20|FH_F132729_0_0|SrvcGrp|58|2022|PDM|9668.00|99|0.00|IP LITHOTRIPSY SVCS
20|FH_F132732_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F132732_0_0|SrvcGrp|16|2022|PDM|1788.00|99|0.00|ACUTE REHABILITATION
20|FH_F132732_0_0|SrvcGrp|3409|2022|PDM|614.00|99|0.00|NEWBORN NURSERY
20|FH_F132732_0_0|SrvcGrp|360|2022|PDM|1844.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F132733_0_0|SrvcGrp|107733|2022|PDM|4834.00|99|0.00|CESAREAN SECTION
20|FH_F132733_0_0|SrvcGrp|16|2022|PDM|1616.00|99|0.00|ACUTE REHABILITATION
20|FH_F132733_0_0|SrvcGrp|33793|2022|PDM|12757.00|99|0.00|MSDRG 246-251 ONLY ANGIOPLASTY
20|FH_F132733_0_0|SrvcGrp|360|2022|PDM|2306.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F132733_0_0|SrvcGrp|40820|2022|PDM|3147.00|99|0.00|ICU/CCU
20|FH_F132733_0_0|SrvcGrp|413|2022|PCT|0.74|99|0.00|TRANSPLANT SVCS
20|FH_F132733_0_0|SrvcGrp|47427|2022|PCT|0.65|99|0.00|IMPLANTS
20|FH_F132736_0_0|CSTM-ALL|CSTM-00|2020|PDM|2059.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132736_0_0|SrvcGrp|107734|2022|PDM|4476.00|99|0.00|VAGINAL DELIVERY
20|FH_F132736_0_0|SrvcGrp|112077|2022|PDM|48747.00|99|0.00|CV SURGERY
20|FH_F132736_0_0|SrvcGrp|3078|2022|PCT|0.65|99|0.00|DRUGS
20|FH_F132737_0_0|SrvcGrp|107734|2022|PDM|3742.00|99|0.00|VAGINAL DELIVERY
20|FH_F132737_0_0|SrvcGrp|112088|2022|PCT|0.65|99|0.00|CARDIAC ABLATION
20|FH_F132737_0_0|SrvcGrp|360|2022|PDM|1957.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F132737_0_0|SrvcGrp|361|2022|PDM|2933.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F132737_0_0|SrvcGrp|51672|2022|PDM|6804.00|99|0.00|MS DRG 286-287 ONLY
20|FH_F132737_0_0|SrvcGrp|941|2022|PDM|3912.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F132738_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132738_0_0|SrvcGrp|109|2022|PDM|887.00|99|0.00|CD - DETOX
20|FH_F132738_0_0|SrvcGrp|1306|2022|PDM|444.00|99|0.00|OP PSYCH PARTIAL HOSP
20|FH_F132738_0_0|SrvcGrp|15|2022|PDM|887.00|99|0.00|PEDIATRIC INTENSIVE CARE UNIT
20|FH_F132768_0_0|SrvcGrp|22528|2022|PDM|950.00|99|0.00|DAY HOSPITAL FULL DAY
20|FH_F132768_0_0|SrvcGrp|471|2022|PDM|1150.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F132772_0_0|SrvcGrp|108041|2022|PDM|465.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME
20|FH_F132772_0_0|SrvcGrp|112095|2022|PDM|217.00|99|0.00|DIALYSIS
20|FH_F132772_0_0|SrvcGrp|112097|2022|PDM|191.00|99|0.00|DIALYSIS
20|FH_F132779_0_0|CSTM-ALL|CSTM-00|2020|PDM|936.00|99|0.00|ACUTE PSYCH
20|FH_F132779_0_0|SrvcGrp|112236|2022|PDM|16096.00|99|0.00|KNEE AND JOINT REPLACEMENT
20|FH_F132779_0_0|SrvcGrp|112238|2022|PDM|16096.00|99|0.00|KNEE AND JOINT SERVICES
20|FH_F132779_0_0|SrvcGrp|29067|2022|PDM|2415.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F132779_0_0|SrvcGrp|87308|2022|PDM|32027.00|99|0.00|MSDRG 271 ONLY
20|FH_F132779_0_0|SrvcGrp|8950|2022|PDM|1806.00|99|0.00|INTERMEDIATE ICU/CCU
20|FH_F132779_0_0|SrvcGrp|941|2022|PDM|2758.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F132801_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132824_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F132827_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132827_0_0|SrvcGrp|22596|2022|PDM|150.00|99|0.00|HOSPICE CARE
20|FH_F132827_0_0|SrvcGrp|92502|2022|PDM|900.00|99|0.00|HOSPICE GENERAL IP CARE
20|FH_F132849_0_0|CSTM-ALL|CSTM-00|2020|PDM|797.00|99|0.00|ADULT PSYCHIATRIC
20|FH_F132849_0_0|SrvcGrp|112113|2022|PDM|8770.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F132849_0_0|SrvcGrp|112130|2022|PDM|8770.00|99|0.00|HYSTERECTOMY
20|FH_F132849_0_0|SrvcGrp|32541|2022|PDM|36675.00|99|0.00|MS DRG 231-236 ONLY
20|FH_F132849_0_0|SrvcGrp|51672|2022|PDM|4783.00|99|0.00|MS DRG 286-287 ONLY
20|FH_F132849_0_0|SrvcGrp|537|2022|PCT|0.61|99|0.00|OBSERVATION SERVICES
20|FH_F132860_0_0|CSTM-ALL|CSTM-00|2020|PDM|1910.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132878_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|INTRAOCULAR LENSES
20|FH_F132878_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS
20|FH_F132886_0_0|SrvcGrp|106300|2022|PDM|381.00|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT (HCFA)
20|FH_F132886_0_0|SrvcGrp|13597|2022|PDM|327.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT
20|FH_F132887_0_0|CSTM-ALL|CSTM-00|2020|PCT|64.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132960_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132960_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F132968_0_0|SrvcGrp|82981|2022|PDM|120.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F132988_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F132988_0_0|CSTM-ALL|CSTM-00|2020|PDM|1435.00|99|0.00|AEG 2 (NO REV)
20|FH_F132988_0_0|CSTM-ALL|CSTM-00|2020|PDM|2266.00|99|0.00|AEG 4 (NO REV)
20|FH_F132988_0_0|SrvcGrp|100012|2022|PDM|4493.01|99|0.00|REPAIR SHOULDER CAPSULE
20|FH_F132988_0_0|SrvcGrp|100013|2022|PDM|4493.01|99|0.00|REPAIR/GRAFT ACHILLES TENDON
20|FH_F132988_0_0|SrvcGrp|100020|2022|PDM|11914.06|99|0.00|TREATMENT OF FRACTURE I
20|FH_F132988_0_0|SrvcGrp|100039|2022|PDM|6151.60|99|0.00|REPAIR OF HEEL FRACTURE
20|FH_F132988_0_0|SrvcGrp|100064|2022|PDM|4493.01|99|0.00|REPAIR OF ANKLE FRACTURE
20|FH_F132988_0_0|SrvcGrp|103542|2022|PDM|5763.38|99|0.00|ANKLE ARTHROSCOPY/SURGERY
20|FH_F132988_0_0|SrvcGrp|105631|2022|PDM|1154.35|99|0.00|REMOVE BONE FIXATION DEVICE
20|FH_F132988_0_0|SrvcGrp|105634|2022|PDM|4493.01|99|0.00|KNEE JOINT LINING
20|FH_F132988_0_0|SrvcGrp|105658|2022|PDM|5954.10|99|0.00|REPAIR FRACTURE OF RADIUS
20|FH_F132988_0_0|SrvcGrp|107091|2022|PDM|1766.05|99|0.00|BONE BIOPSY OPEN SUPERFICIAL
20|FH_F132988_0_0|SrvcGrp|107778|2022|PDM|12296.59|99|0.00|ARTHROSCOPIC FRACTURE TX
20|FH_F132988_0_0|SrvcGrp|108257|2022|PDM|5981.60|99|0.00|AETNA FUSION HAND BONES WITH GRAFT
20|FH_F132988_0_0|SrvcGrp|109131|2022|PDM|11531.54|99|0.00|RECONSTRUCTION, KNEE
20|FH_F132988_0_0|SrvcGrp|109790|2022|PDM|12889.12|99|0.00|FUSION OF FOOT BONES
20|FH_F132988_0_0|SrvcGrp|109834|2022|PDM|4493.01|99|0.00|REPAIR HUMERUS FRACTURE
20|FH_F132988_0_0|SrvcGrp|112147|2022|PDM|4493.01|99|0.00|OPTX POST ANKLE FX
20|FH_F132988_0_0|SrvcGrp|112154|2022|PDM|2057.62|99|0.00|REPAIR THUMB FRACTURE
20|FH_F132988_0_0|SrvcGrp|112156|2022|PDM|2057.62|99|0.00|PIN FINGER DISLOCATION
20|FH_F132988_0_0|SrvcGrp|112161|2022|PDM|1279.81|99|0.00|NERVE DECOMPRESSION
20|FH_F132988_0_0|SrvcGrp|112164|2022|PDM|11979.18|99|0.00|REPAIR OF HUMERUS
20|FH_F132988_0_0|SrvcGrp|112165|2022|PDM|11824.53|99|0.00|REPAIR/GRAFT HEEL FRACTURE
20|FH_F132988_0_0|SrvcGrp|112166|2022|PDM|6253.92|99|0.00|RECONSTRUCT WRIST-TRAPEZIUM
20|FH_F132988_0_0|SrvcGrp|27330|2022|PDM|771.00|99|0.00|CPT 27096
20|FH_F132988_0_0|SrvcGrp|35669|2022|PDM|7285.50|99|0.00|CPT 63650
20|FH_F132988_0_0|SrvcGrp|41327|2022|PDM|2057.62|99|0.00|OP SURGERY CPT 28308
20|FH_F132988_0_0|SrvcGrp|54943|2022|PDM|4493.01|99|0.00|REPAIR OF SLAP LESION
20|FH_F132988_0_0|SrvcGrp|58634|2022|PDM|7439.17|99|0.00|NEUROELECTRODES IMPLANT
20|FH_F132988_0_0|SrvcGrp|67065|2022|PDM|12555.41|99|0.00|CERVICAL SURGERY
20|FH_F132988_0_0|SrvcGrp|74039|2022|PDM|4493.01|99|0.00|LAMINECTOMY
20|FH_F132988_0_0|SrvcGrp|78096|2022|PDM|4493.01|99|0.00|AETNA ARTHROSCOPY BICEPS
20|FH_F132988_0_0|SrvcGrp|82634|2022|PDM|4493.01|99|0.00|REPAIR OF KNEE LIGAMENTS
20|FH_F132988_0_0|SrvcGrp|83641|2022|PDM|8647.09|99|0.00|CPT 29889
20|FH_F132988_0_0|SrvcGrp|84307|2022|PDM|4493.01|99|0.00|TENDON REPAIR
20|FH_F132988_0_0|SrvcGrp|88065|2022|PDM|18566.99|99|0.00|TOTAL DISC ARTHROPLASTY
20|FH_F132988_0_0|SrvcGrp|88159|2022|PDM|4493.01|99|0.00|LOW BACK DISK SURGERY
20|FH_F132988_0_0|SrvcGrp|89946|2022|PDM|4493.01|99|0.00|REPAIR OF KNEE LIGAMENT
20|FH_F132988_0_0|SrvcGrp|89989|2022|PDM|6374.03|99|0.00|FUSION OF BIG TOE JOINT
20|FH_F132988_0_0|SrvcGrp|90357|2022|PDM|4493.01|99|0.00|REPAIR OF ANKLE FRACTURE
20|FH_F132988_0_0|SrvcGrp|92007|2022|PDM|12347.87|99|0.00|PROXIMAL HUMERAL
20|FH_F132988_0_0|SrvcGrp|92009|2022|PDM|4493.01|99|0.00|CARPAL SCAPHOID FRACTURE
20|FH_F132988_0_0|SrvcGrp|92369|2022|PDM|6323.70|99|0.00|REPAIR OF ANKLE LIGAMENTS
20|FH_F132988_0_0|SrvcGrp|92820|2022|PDM|4493.01|99|0.00|HIP ARTHOSCOPY ACETABULOPLASTY
20|FH_F132988_0_0|SrvcGrp|92821|2022|PDM|4493.01|99|0.00|HIP ARTHROSCOPY W/ LABRAL REPAIR
20|FH_F132988_0_0|SrvcGrp|96539|2022|PDM|4493.01|99|0.00|REVISION OF ANKLE LIGAMENT
20|FH_F132988_0_0|SrvcGrp|97363|2022|PDM|4493.01|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F133002_0_0|CSTM-ALL|CSTM-00|2020|PDM|2834.00|99|0.00|DEVICE INSERTION
20|FH_F133002_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F133002_0_0|SrvcGrp|111966|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F133002_0_0|SrvcGrp|45583|2022|PDM|1716.00|99|0.00|CPT 65730
20|FH_F133002_0_0|SrvcGrp|72990|2022|PDM|422.00|99|0.00|AEG 1
20|FH_F133002_0_0|SrvcGrp|72992|2022|PDM|562.00|99|0.00|AEG 2
20|FH_F133002_0_0|SrvcGrp|72996|2022|PDM|792.00|99|0.00|AEG 4
20|FH_F133002_0_0|SrvcGrp|73002|2022|PDM|1267.00|99|0.00|AEG 7
20|FH_F133002_0_0|SrvcGrp|73006|2022|PDM|562.00|99|0.00|AEG 9
20|FH_F133011_0_0|CSTM-ALL|CSTM-00|2020|PDM|375.00|99|0.00|AEG 1 (NO REV)
20|FH_F133025_0_0|CSTM-ALL|CSTM-00|2020|PDM|429.00|99|0.00|AEG 1 (NO REV)
20|FH_F133025_0_0|CSTM-ALL|CSTM-00|2020|PDM|578.00|99|0.00|AEG 2 (NO REV)
20|FH_F133025_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AEG 3 (NO REV)
20|FH_F133025_0_0|CSTM-ALL|CSTM-00|2020|PDM|815.00|99|0.00|AEG 10 (NO REV)
20|FH_F133025_0_0|CSTM-ALL|CSTM-00|2020|PDM|815.00|99|0.00|AEG 4 (NO REV)
20|FH_F133100_0_0|CSTM-ALL|CSTM-00|2020|PDM|1025.00|99|0.00|AEG 5  (NO REV)
20|FH_F133100_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|AEG 10 (NO REV)
20|FH_F133100_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F133100_0_0|SrvcGrp|111630|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F133140_0_0|CSTM-ALL|CSTM-00|2020|PDM|300.00|99|0.00|AEG 1 (NO REV)
20|FH_F133140_0_0|CSTM-ALL|CSTM-00|2020|PDM|420.00|99|0.00|AEG 3 (NO REV)
20|FH_F133140_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|AEG 8 (NO REV)
20|FH_F133140_0_0|SrvcGrp|111966|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F133155_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F133155_0_0|SrvcGrp|30609|2022|PDM|23.00|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F133155_0_0|SrvcGrp|83521|2022|PDM|100.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F133175_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F133175_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F133178_0_0|CSTM-ALL|CSTM-00|2020|PDM|1040.00|99|0.00|AEG 5  (NO REV)
20|FH_F133178_0_0|CSTM-ALL|CSTM-00|2020|PDM|584.00|99|0.00|AEG 2 (NO REV)
20|FH_F133178_0_0|SrvcGrp|112207|2022|PDM|832.00|99|0.00|DESTROY VULVA LESIONS
20|FH_F133207_0_0|CSTM-ALL|CSTM-00|2020|PDM|1214.00|99|0.00|AEG 2 (NO REV)
20|FH_F133207_0_0|CSTM-ALL|CSTM-00|2020|PDM|2324.00|99|0.00|AEG 4 (NO REV)
20|FH_F133207_0_0|SrvcGrp|100920|2022|PDM|5040.00|99|0.00|SPINE PRO DEVICE
20|FH_F133207_0_0|SrvcGrp|26275|2022|PDM|2632.00|99|0.00|CPT 29826
20|FH_F133207_0_0|SrvcGrp|26432|2022|PDM|3529.00|99|0.00|OP SURGICAL SERVICES
20|FH_F133207_0_0|SrvcGrp|59840|2022|PDM|2241.00|99|0.00|TYMPANOSTOMY
20|FH_F133207_0_0|SrvcGrp|63463|2022|PDM|3809.00|99|0.00|CPT 52204
20|FH_F133207_0_0|SrvcGrp|63466|2022|PDM|3809.00|99|0.00|CPT 52005
20|FH_F133207_0_0|SrvcGrp|65403|2022|PDM|3136.00|99|0.00|CPT 42830
20|FH_F133207_0_0|SrvcGrp|67065|2022|PDM|16353.00|99|0.00|CERVICAL SURGERY
20|FH_F133207_0_0|SrvcGrp|67066|2022|PDM|16353.00|99|0.00|CERVICAL SURGERY
20|FH_F133207_0_0|SrvcGrp|70749|2022|PDM|3527.00|99|0.00|CPT 29823
20|FH_F133207_0_0|SrvcGrp|73610|2022|PCT|0.00|99|0.00|AETNA IMPLANTS
20|FH_F133207_0_0|SrvcGrp|76604|2022|PDM|3136.00|99|0.00|CPT 25447
20|FH_F133207_0_0|SrvcGrp|80617|2022|PDM|14004.00|99|0.00|ARTHOPLASTY
20|FH_F133207_0_0|SrvcGrp|82108|2022|PDM|3527.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F133207_0_0|SrvcGrp|82112|2022|PDM|3529.00|99|0.00|KNEE ARTHROSCOPY SURGERY
20|FH_F133207_0_0|SrvcGrp|82114|2022|PDM|3529.00|99|0.00|MENISCUS REPAIR MED OR LAT
20|FH_F133207_0_0|SrvcGrp|84181|2022|PDM|3192.00|99|0.00|AETNA IMMEDIATE BREAST PROSTHESIS
20|FH_F133207_0_0|SrvcGrp|84910|2022|PDM|3529.00|99|0.00|ENDOSCOPY
20|FH_F133207_0_0|SrvcGrp|86463|2022|PDM|3809.00|99|0.00|FRACTURE NASAL INFERIOR
20|FH_F133207_0_0|SrvcGrp|90795|2022|PDM|2941.00|99|0.00|EXCISION INFERIOR TURBINATE
20|FH_F133207_0_0|SrvcGrp|92197|2022|PDM|6684.00|99|0.00|CORRECTION OF BUNION
20|FH_F133207_0_0|SrvcGrp|99073|2022|PDM|1.41|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F133209_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F133211_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.91|99|0.00|OP SVCS
20|FH_F133211_0_0|SrvcGrp|111928|2022|PDM|95.00|99|0.00|COVID-19 BARTONELLA
20|FH_F133211_0_0|SrvcGrp|112225|2022|PDM|23.00|99|0.00|COVID-19 SPECIMEN COLLECTION
20|FH_F133215_0_0|SrvcGrp|90707|2022|PDM|100.00|99|0.00|AETNA HOSPICE CARE
20|FH_F133215_0_0|SrvcGrp|93098|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F133223_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F133223_0_0|SrvcGrp|111927|2022|PDM|95.00|99|0.00|COVID-19 NON CDC
20|FH_F133223_0_0|SrvcGrp|111928|2022|PDM|95.00|99|0.00|COVID-19 BARTONELLA
20|FH_F133223_0_0|SrvcGrp|112224|2022|PDM|95.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)
20|FH_F133247_0_0|CSTM-ALL|CSTM-00|2020|PCT|12000.00|99|0.00|TIMELY FILING
20|FH_F133327_0_0|SrvcGrp|82981|2022|PDM|150.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F133403_0_0|SrvcGrp|82981|2022|PDM|156.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F133474_0_0|SrvcGrp|111929|2022|PDM|15.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB
20|FH_F133474_0_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)
20|FH_F133474_0_0|SrvcGrp|112676|2022|PDM|42.13|99|0.00|COVID-19 SARS-COV-2 ANTIBODY
20|FH_F133485_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F133485_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.40|99|0.00|HSS ASC
20|FH_F133492_0_0|SrvcGrp|106906|2022|PDM|30.00|99|0.00|AETNA SURGERY DEFAULT W/O GROUPER 1 & 2
20|FH_F133492_0_0|SrvcGrp|71219|2022|PDM|1809.00|99|0.00|COLONOSCOPY CPT 45382
20|FH_F133519_0_0|CSTM-ALL|CSTM-00|2020|PDM|1262.00|99|0.00|AEG 8 (NO REV)
20|FH_F133519_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|AEG 10 (NO REV)
20|FH_F133519_0_0|CSTM-ALL|CSTM-00|2020|PDM|831.00|99|0.00|AEG 4 (NO REV)
20|FH_F133519_0_0|SrvcGrp|106719|2022|PDM|1255.00|99|0.00|INDUCED ABORTION BY DILATION AND EVACUATION
20|FH_F133529_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F133536_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F133536_0_0|SrvcGrp|100980|2022|PDM|1100.00|99|0.00|NERVOUS SYSTEM
20|FH_F133536_0_0|SrvcGrp|103841|2022|PDM|3215.00|99|0.00|INSERT SPINAL FIXATION DEVICE SURGICAL PROCEDURE
20|FH_F133536_0_0|SrvcGrp|105430|2022|PDM|9500.00|99|0.00|AETNA ARTHRODESIS INTERNAL TECH
20|FH_F133536_0_0|SrvcGrp|111994|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES
20|FH_F133536_0_0|SrvcGrp|112379|2022|PDM|1250.00|99|0.00|OP SURGERY
20|FH_F133536_0_0|SrvcGrp|26275|2022|PDM|3300.00|99|0.00|CPT 29826
20|FH_F133536_0_0|SrvcGrp|26278|2022|PDM|3300.00|99|0.00|CPT 29881
20|FH_F133536_0_0|SrvcGrp|26432|2022|PDM|3000.00|99|0.00|OP SURGICAL SERVICES
20|FH_F133536_0_0|SrvcGrp|82107|2022|PDM|2750.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F133536_0_0|SrvcGrp|88065|2022|PDM|9500.00|99|0.00|TOTAL DISC ARTHROPLASTY
20|FH_F133536_0_0|SrvcGrp|93431|2022|PDM|20350.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT
20|FH_F133536_0_0|SrvcGrp|96539|2022|PDM|1149.00|99|0.00|REVISION OF ANKLE LIGAMENT
20|FH_F133536_0_0|SrvcGrp|99158|2022|PDM|3215.00|99|0.00|KNEE ARTHROSCOPY/DIAGNOSTIC
20|FH_F133579_0_0|CSTM-ALL|CSTM-00|2020|PDM|1159.00|99|0.00|AEG 3 (NO REV)
20|FH_F133579_0_0|CSTM-ALL|CSTM-00|2020|PDM|1741.00|99|0.00|AEG 5  (NO REV)
20|FH_F133579_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F133579_0_0|SrvcGrp|28548|2022|PDM|2175.00|99|0.00|VITRECTOMY
20|FH_F133579_0_0|SrvcGrp|45583|2022|PDM|2551.00|99|0.00|CPT 65730
20|FH_F133579_0_0|SrvcGrp|46887|2022|PDM|2205.00|99|0.00|REPAIR DETACHED RETINA
20|FH_F133579_0_0|SrvcGrp|46906|2022|PDM|2551.00|99|0.00|CORNEAL TISSUE
20|FH_F133579_0_0|SrvcGrp|93724|2022|PDM|3248.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY
20|FH_F133585_0_0|CSTM-ALL|CSTM-00|2020|PDM|1290.00|99|0.00|AEG 8 (NO REV)
20|FH_F133585_0_0|CSTM-ALL|CSTM-00|2020|PDM|676.00|99|0.00|AEG 10 (NO REV)
20|FH_F133585_0_0|CSTM-ALL|CSTM-00|2020|PDM|676.00|99|0.00|AEG 3 (NO REV)
20|FH_F133585_0_0|SrvcGrp|103638|2022|PDM|7918.00|99|0.00|AETNA OPEN/PERQ PLACE STENT 1ST
20|FH_F133585_0_0|SrvcGrp|103640|2022|PDM|8249.00|99|0.00|AETNA OPEN/PERQ PLACE STENT SAME
20|FH_F133585_0_0|SrvcGrp|103646|2022|PDM|14182.00|99|0.00|AETNA TIB/ PER REVASE STENT & ATHER
20|FH_F133585_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F133585_0_0|SrvcGrp|107877|2022|PDM|764.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT
20|FH_F133585_0_0|SrvcGrp|107882|2022|PDM|289.00|99|0.00|DIALYSIS CIRCUIT EMBOLJ
20|FH_F133585_0_0|SrvcGrp|107885|2022|PDM|2852.00|99|0.00|TRLUML BALO ANGIOP 1ST VEIN
20|FH_F133585_0_0|SrvcGrp|108195|2022|PDM|2922.00|99|0.00|LAP INSERT TUNNEL IP CATH
20|FH_F133585_0_0|SrvcGrp|109462|2022|PDM|201.00|99|0.00|PLACE CATHETER IN AORTA
20|FH_F133585_0_0|SrvcGrp|109469|2022|PDM|433.00|99|0.00|INS CATH ABD/L-EXT ART 3RD
20|FH_F133585_0_0|SrvcGrp|109470|2022|PDM|70.00|99|0.00|INS CATH ABD/L-EXT ART ADDL
20|FH_F133585_0_0|SrvcGrp|111139|2022|PDM|3092.00|99|0.00|ARTERY-VEIN GRAFT
20|FH_F133585_0_0|SrvcGrp|111519|2022|PDM|364.00|99|0.00|STAB PHLEBECT VV 1 EXT; >20
20|FH_F133585_0_0|SrvcGrp|112381|2022|PDM|1092.00|99|0.00|NJX NONCMPND SCLRSNT 1 VEIN
20|FH_F133585_0_0|SrvcGrp|112383|2022|PDM|3092.00|99|0.00|INSERTION OF CANNULA
20|FH_F133585_0_0|SrvcGrp|112385|2022|PDM|51.00|99|0.00|US GUID VASC ACSS SITE PERM
20|FH_F133585_0_0|SrvcGrp|112391|2022|PDM|121.00|99|0.00|ACTIVASE (HCFA)
20|FH_F133585_0_0|SrvcGrp|35664|2022|PDM|1786.00|99|0.00|VNUS CLOSURE
20|FH_F133585_0_0|SrvcGrp|68546|2022|PDM|1786.00|99|0.00|CPT 36558
20|FH_F133585_0_0|SrvcGrp|73610|2022|PCT|0.00|99|0.00|AETNA IMPLANTS
20|FH_F133585_0_0|SrvcGrp|74670|2022|PCT|0.00|99|0.00|AETNA OP INTRAOCULAR LENS
20|FH_F133585_0_0|SrvcGrp|77292|2022|PDM|424.00|99|0.00|AETNA REMV TUNNLD CVAD W/SUBQ PORT
20|FH_F133585_0_0|SrvcGrp|78760|2022|PDM|580.00|99|0.00|AETNA PTCA REVASC W/STENT AND ATHERECTOMY
20|FH_F133585_0_0|SrvcGrp|89424|2022|PDM|245.00|99|0.00|ARTERY XRAYS ARMS/LEGS
20|FH_F133632_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|AEG 4 (NO REV)
20|FH_F133632_0_0|SrvcGrp|111994|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES
20|FH_F133701_0_0|SrvcGrp|87077|2022|PDM|162.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F133891_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F133907_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F133969_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|AEG 10 (NO REV)
20|FH_F133969_0_0|CSTM-ALL|CSTM-00|2020|PDM|1503.35|99|0.00|AEG 9 (NO REV)
20|FH_F133969_0_0|CSTM-ALL|CSTM-00|2020|PDM|707.33|99|0.00|AEG 4 (NO REV)
20|FH_F133990_0_0|CSTM-ALL|CSTM-00|2020|PCT|36500.00|99|0.00|TIMELY FILING
20|FH_F133990_0_0|CSTM-ALL|CSTM-00|2020|PCT|41.00|99|0.00|AEG 9 (NO REV)
20|FH_F134002_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F134002_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F134027_0_0|CSTM-ALL|CSTM-00|2020|PDM|1548.00|99|0.00|AEG 7 (NO REV)
20|FH_F134027_0_0|CSTM-ALL|CSTM-00|2020|PDM|1838.00|99|0.00|AEG 9 (NO REV)
20|FH_F134027_0_0|SrvcGrp|76847|2022|PDM|2223.00|99|0.00|AETNA ARTHROSCOPY
20|FH_F134087_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F134087_0_0|CSTM-ALL|CSTM-00|2020|PDM|1730.00|99|0.00|AEG 10 (NO REV)
20|FH_F134087_0_0|CSTM-ALL|CSTM-00|2020|PDM|1804.00|99|0.00|AEG 5  (NO REV)
20|FH_F134087_0_0|SrvcGrp|107835|2022|PDM|6796.00|99|0.00|NERVE REPAIR
20|FH_F134087_0_0|SrvcGrp|112553|2022|PDM|3607.00|99|0.00|OSTEOART ALGRFT W/ SURF & B1
20|FH_F134087_0_0|SrvcGrp|112557|2022|PDM|1945.00|99|0.00|REPAIR OF TIBIA FRACTURE
20|FH_F134087_0_0|SrvcGrp|88163|2022|PDM|9017.00|99|0.00|LUMBAR SPINE FUSION
20|FH_F134087_0_0|SrvcGrp|88492|2022|PDM|2195.00|99|0.00|AETNA SPINAL BONE AUTOGRAFT
20|FH_F134087_0_0|SrvcGrp|88740|2022|PDM|2195.00|99|0.00|SP BONE ALGRFT
20|FH_F134087_0_0|SrvcGrp|89980|2022|PDM|5332.00|99|0.00|OPEN TREATMENT OF DISTAL
20|FH_F134087_0_0|SrvcGrp|92415|2022|PDM|5410.00|99|0.00|NECK SPINE DISK SURGERY
20|FH_F134087_0_0|SrvcGrp|93432|2022|PDM|10455.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT
20|FH_F134192_0_0|CSTM-ALL|CSTM-00|2020|PDM|1450.00|99|0.00|AEG 2 (NO REV)
20|FH_F134192_0_0|CSTM-ALL|CSTM-00|2020|PDM|2285.00|99|0.00|AEG 4 (NO REV)
20|FH_F134192_0_0|CSTM-ALL|CSTM-00|2020|PDM|2350.00|99|0.00|AEG 5  (NO REV)
20|FH_F134192_0_0|SrvcGrp|106798|2022|PDM|4100.00|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT
20|FH_F134202_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F134202_0_0|CSTM-ALL|CSTM-00|2020|PDM|1685.25|99|0.00|AEG 9 (NO REV)
20|FH_F134202_0_0|CSTM-ALL|CSTM-00|2020|PDM|435.75|99|0.00|AEG 1 (NO REV)
20|FH_F134202_0_0|CSTM-ALL|CSTM-00|2020|PDM|892.50|99|0.00|AEG 4 (NO REV)
20|FH_F134202_0_0|SrvcGrp|14614|2022|PDM|1780.20|99|0.00|LITHOTRIPSY
20|FH_F134202_0_0|SrvcGrp|34606|2022|PDM|1890.00|99|0.00|CPT 29827
20|FH_F134202_0_0|SrvcGrp|38364|2022|PDM|4260.90|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F134229_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.20|99|0.00|OP SVCS
20|FH_F134229_0_0|SrvcGrp|104642|2022|PDM|15000.00|99|0.00|RECONSTRUCT SHOULDER JOINT
20|FH_F134236_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F134267_0_0|SrvcGrp|87077|2022|PDM|128.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F134270_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F134270_0_0|CSTM-ALL|CSTM-00|2020|PDM|3200.00|99|0.00|AEG 7 (NO REV)
20|FH_F134270_0_0|SrvcGrp|88065|2022|PDM|14000.00|99|0.00|TOTAL DISC ARTHROPLASTY
20|FH_F134287_0_0|SrvcGrp|112538|2022|PDM|15000.00|99|0.00|KNEE REPLACEMENT
20|FH_F134287_0_0|SrvcGrp|112539|2022|PDM|15000.00|99|0.00|HIP REPLACEMENT
20|FH_F134317_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F134317_0_0|SrvcGrp|30089|2022|PDM|450.00|99|0.00|HEMODIALYSIS SERVICES
20|FH_F134317_0_0|SrvcGrp|73485|2022|PDM|950.00|99|0.00|AETNA REHAB
20|FH_F134317_0_0|SrvcGrp|80258|2022|PDM|500.00|99|0.00|AETNA SKILLED CARE
20|FH_F134317_0_0|SrvcGrp|87536|2022|PCT|0.00|99|0.00|MED REHAB DAY PROGRAM (HALF)
20|FH_F134317_0_0|SrvcGrp|87537|2022|PCT|0.00|99|0.00|MED REHAB DAY PROGRAM (FULL)
20|FH_F134371_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.43|99|0.00|GENERAL ACUTE CARE
20|FH_F134398_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F134398_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F134398_0_0|CSTM-ALL|CSTM-00|2020|PDM|329.00|99|0.00|AEG 9 (NO REV)
20|FH_F134398_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|AEG 1 (NO REV)
20|FH_F134398_0_0|CSTM-ALL|CSTM-00|2020|PDM|477.00|99|0.00|AEG 2 (NO REV)
20|FH_F134398_0_0|CSTM-ALL|CSTM-00|2020|PDM|659.00|99|0.00|AEG 4 (NO REV)
20|FH_F134398_0_0|SrvcGrp|112574|2022|PDM|647.00|99|0.00|SKIN FULL GRAFT PROCEDURE
20|FH_F134507_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F134507_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F134507_0_0|SrvcGrp|104049|2022|PDM|416.00|99|0.00|RENAL DIALYSIS
20|FH_F134507_0_0|SrvcGrp|82804|2022|PDM|416.00|99|0.00|INHALATION SERVICES
20|FH_F134603_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F134603_0_0|SrvcGrp|12491|2022|PCT|0.44|99|0.00|PACEMAKER
20|FH_F134603_0_0|SrvcGrp|79561|2022|PDM|4700.00|99|0.00|AETNA CARDIAC CATH
20|FH_F134603_0_0|SrvcGrp|83824|2022|PCT|0.00|99|0.00|AETNA CADIAC CATH INCIDENTAL CODES
20|FH_F134612_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F134612_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F134612_0_0|SrvcGrp|104098|2022|PDM|6170.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT
20|FH_F134612_0_0|SrvcGrp|108115|2022|PDM|3100.00|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT
20|FH_F134612_0_0|SrvcGrp|110101|2022|PDM|2400.00|99|0.00|TRLUML BALO ANGIOP 1ST ART
20|FH_F134612_0_0|SrvcGrp|111995|2022|PDM|10000.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F134654_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F134654_0_0|SrvcGrp|110042|2022|PDM|75.00|99|0.00|BEHAVIOR IDENTIFICATION ASSESSMENT 15 MINS
20|FH_F134654_0_0|SrvcGrp|110059|2022|PDM|37.50|99|0.00|ADAPTIVE BH 15 MINS
20|FH_F134654_0_0|SrvcGrp|110060|2022|PDM|16.63|99|0.00|GROUP BH TREATMENT 15 MINS
20|FH_F134654_0_0|SrvcGrp|110063|2022|PDM|22.43|99|0.00|MULTIPLE FAMILY ADAPTIVE BH TREATMENT 15 MINS
20|FH_F134676_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F134707_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F134707_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F134707_0_0|CSTM-ALL|CSTM-00|2020|PDM|2350.00|99|0.00|AEG 3 (NO REV)
20|FH_F134707_0_0|CSTM-ALL|CSTM-00|2020|PDM|3499.00|99|0.00|AEG 5  (NO REV)
20|FH_F134707_0_0|CSTM-ALL|CSTM-00|2020|PDM|3917.00|99|0.00|AEG 7 (NO REV)
20|FH_F134732_0_0|CSTM-ALL|CSTM-00|2020|PDM|1002.00|99|0.00|AEG 8 (NO REV)
20|FH_F134732_0_0|CSTM-ALL|CSTM-00|2020|PDM|456.00|99|0.00|AEG 2 (NO REV)
20|FH_F134732_0_0|CSTM-ALL|CSTM-00|2020|PDM|849.00|99|0.00|AEG 6 (NO REV)
20|FH_F134732_0_0|SrvcGrp|107793|2022|PDM|9725.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE
20|FH_F134732_0_0|SrvcGrp|108075|2022|PDM|2248.00|99|0.00|AV FUSION / UPPER ARM VEIN
20|FH_F134732_0_0|SrvcGrp|108076|2022|PDM|2248.00|99|0.00|AV FUSION / FOREARM VEIN
20|FH_F134732_0_0|SrvcGrp|108077|2022|PDM|2248.00|99|0.00|ARTERIOVENOUS ANASTOMOSIS
20|FH_F134732_0_0|SrvcGrp|111139|2022|PDM|2248.00|99|0.00|ARTERY-VEIN GRAFT
20|FH_F134738_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|AEG 4 (NO REV)
20|FH_F134738_0_0|CSTM-ALL|CSTM-00|2020|PDM|2375.00|99|0.00|AEG 5  (NO REV)
20|FH_F134738_0_0|CSTM-ALL|CSTM-00|2020|PDM|2750.00|99|0.00|AEG 6 (NO REV)
20|FH_F134738_0_0|CSTM-ALL|CSTM-00|2020|PDM|3750.00|99|0.00|AEG 8 (NO REV)
20|FH_F134738_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|AEG 1 (NO REV)
20|FH_F134738_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F134738_0_0|SrvcGrp|27316|2022|PDM|2100.00|99|0.00|TONSILS & ADENOIDS (42820)
20|FH_F134738_0_0|SrvcGrp|65403|2022|PDM|2475.00|99|0.00|CPT 42830
20|FH_F134797_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F134797_0_0|SrvcGrp|112680|2022|PDM|1527.00|99|0.00|HAND FLEXOR TENDON REPAIR
20|FH_F134797_0_0|SrvcGrp|72992|2022|PDM|579.00|99|0.00|AEG 2
20|FH_F134797_0_0|SrvcGrp|73000|2022|PDM|1101.00|99|0.00|AEG 6
20|FH_F134809_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F134819_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F134819_0_0|CSTM-ALL|CSTM-00|2020|PDM|2219.00|99|0.00|AEG 9 (NO REV)
20|FH_F134819_0_0|CSTM-ALL|CSTM-00|2020|PDM|887.00|99|0.00|AEG 3 (NO REV)
20|FH_F134819_0_0|SrvcGrp|16692|2022|PDM|1561.00|99|0.00|KNEE SCOPE
20|FH_F134819_0_0|SrvcGrp|17955|2022|PDM|2128.00|99|0.00|HYSTEROSCOPY
20|FH_F134819_0_0|SrvcGrp|28513|2022|PDM|2955.00|99|0.00|HYSTEROSCOPY
20|FH_F134819_0_0|SrvcGrp|57863|2022|PDM|1364.00|99|0.00|NASAL/SINUS ENDOSCOPY
20|FH_F134830_0_0|SrvcGrp|57968|2022|PDM|55.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F134830_0_0|SrvcGrp|92501|2022|PDM|450.00|99|0.00|HOSPICE IP RESPITE CARE
20|FH_F134847_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F134847_0_0|SrvcGrp|112645|2022|PDM|4764.00|99|0.00|SINUS PROCEDURES
20|FH_F134847_0_0|SrvcGrp|26275|2022|PDM|3585.00|99|0.00|CPT 29826
20|FH_F134847_0_0|SrvcGrp|28547|2022|PDM|3629.00|99|0.00|VITRECTOMY
20|FH_F134847_0_0|SrvcGrp|35669|2022|PDM|4536.00|99|0.00|CPT 63650
20|FH_F134847_0_0|SrvcGrp|41334|2022|PDM|13619.00|99|0.00|TOTAL KNEE
20|FH_F134847_0_0|SrvcGrp|41335|2022|PDM|14238.00|99|0.00|TOTAL HIP
20|FH_F134847_0_0|SrvcGrp|49205|2022|PDM|3486.00|99|0.00|REPAIR DETACHED RETINA
20|FH_F134847_0_0|SrvcGrp|65403|2022|PDM|2785.00|99|0.00|CPT 42830
20|FH_F134847_0_0|SrvcGrp|67065|2022|PDM|17648.00|99|0.00|CERVICAL SURGERY
20|FH_F134847_0_0|SrvcGrp|67072|2022|PDM|5135.00|99|0.00|CPT 22845
20|FH_F134847_0_0|SrvcGrp|67993|2022|PDM|1968.00|99|0.00|CPT58555 58558-58559 58562
20|FH_F134847_0_0|SrvcGrp|77021|2022|PDM|5429.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY
20|FH_F134847_0_0|SrvcGrp|77451|2022|PDM|5429.00|99|0.00|CPT 53440
20|FH_F134847_0_0|SrvcGrp|84318|2022|PDM|9503.00|99|0.00|SPINE INFUSION
20|FH_F134847_0_0|SrvcGrp|88160|2022|PDM|6110.00|99|0.00|LAMINECTOMY W/FACETECTOMY
20|FH_F134847_0_0|SrvcGrp|88740|2022|PDM|3793.00|99|0.00|SP BONE ALGRFT
20|FH_F134847_0_0|SrvcGrp|93057|2022|PDM|5135.00|99|0.00|SPINAL BONE AUTOGRAFT
20|FH_F134894_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.81|99|0.00|HSS ASC
20|FH_F134895_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|AEG 7 (NO REV)
20|FH_F134895_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F134895_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F134904_0_0|CSTM-ALL|CSTM-00|2020|PDM|1103.00|99|0.00|AEG 6 (NO REV)
20|FH_F134904_0_0|CSTM-ALL|CSTM-00|2020|PDM|1328.00|99|0.00|AEG 7 (NO REV)
20|FH_F134917_0_0|CSTM-ALL|CSTM-00|2020|PDM|466.85|99|0.00|AEG 2 (NO REV)
20|FH_F134928_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F134928_0_0|SrvcGrp|73601|2022|PDM|2300.00|99|0.00|AETNA INTERMEDIATE ICU/CCU
20|FH_F134930_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F134930_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F134930_0_0|SrvcGrp|13928|2022|PCT|0.00|99|0.00|DAY HOSPITAL HALF DAY
20|FH_F135069_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 4 (NO REV)
20|FH_F135069_0_0|CSTM-ALL|CSTM-00|2020|PDM|685.00|99|0.00|AEG 5  (NO REV)
20|FH_F135179_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F135179_0_0|SrvcGrp|108043|2022|PDM|164.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD
20|FH_F135239_0_0|SrvcGrp|14494|2022|PDM|60.50|99|0.00|CONTINUOUS HOMECARE
20|FH_F135239_0_0|SrvcGrp|92501|2022|PDM|495.00|99|0.00|HOSPICE IP RESPITE CARE
20|FH_F135239_0_0|SrvcGrp|92502|2022|PDM|1072.50|99|0.00|HOSPICE GENERAL IP CARE
20|FH_F135263_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F135263_0_0|CSTM-ALL|CSTM-00|2020|PDM|975.00|99|0.00|AEG 6 (NO REV)
20|FH_F135315_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|OP SVCS
20|FH_F135327_0_0|CSTM-ALL|CSTM-00|2020|PDM|1171.00|99|0.00|AEG 6 (NO REV)
20|FH_F135327_0_0|CSTM-ALL|CSTM-00|2020|PDM|1431.00|99|0.00|AEG 7 (NO REV)
20|FH_F135327_0_0|CSTM-ALL|CSTM-00|2020|PDM|1575.00|99|0.00|AEG 8 (NO REV)
20|FH_F135327_0_0|SrvcGrp|112736|2022|PDM|1080.00|99|0.00|VITRECTOMY
20|FH_F135327_0_0|SrvcGrp|112737|2022|PDM|1168.00|99|0.00|FOOT PROCEDURES
20|FH_F135351_0_0|CSTM-ALL|CSTM-00|2020|PDM|1040.00|99|0.00|AEG 5  (NO REV)
20|FH_F135351_0_0|CSTM-ALL|CSTM-00|2020|PDM|1410.00|99|0.00|AEG 8 (NO REV)
20|FH_F135351_0_0|CSTM-ALL|CSTM-00|2020|PDM|743.00|99|0.00|AEG 3 (NO REV)
20|FH_F135351_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 4 (NO REV)
20|FH_F135351_0_0|SrvcGrp|16289|2022|PDM|2655.00|99|0.00|CARPAL TUNNEL RELEASE
20|FH_F135351_0_0|SrvcGrp|35669|2022|PDM|30498.00|99|0.00|CPT 63650
20|FH_F135351_0_0|SrvcGrp|74039|2022|PDM|7370.00|99|0.00|LAMINECTOMY
20|FH_F135351_0_0|SrvcGrp|82107|2022|PDM|4382.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F135351_0_0|SrvcGrp|88160|2022|PDM|7370.00|99|0.00|LAMINECTOMY W/FACETECTOMY
20|FH_F135351_0_0|SrvcGrp|88491|2022|PDM|7370.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR
20|FH_F135351_0_0|SrvcGrp|89404|2022|PDM|16500.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F135491_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F135491_0_0|CSTM-ALL|CSTM-00|2020|PDM|1146.00|99|0.00|AETNA AEG 8 WITHOUT 66982-66984
20|FH_F135491_0_0|CSTM-ALL|CSTM-00|2020|PDM|517.00|99|0.00|AEG 2 (NO REV)
20|FH_F135491_0_0|CSTM-ALL|CSTM-00|2020|PDM|957.00|99|0.00|AEG 6 (NO REV)
20|FH_F135491_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F135491_0_0|SrvcGrp|114442|2022|PDM|5236.00|99|0.00|EXTRACAPSULAR CATARACT REMOVAL, INSERT LENS
20|FH_F135491_0_0|SrvcGrp|114518|2022|PDM|4950.00|99|0.00|INSERTION DRAINAGE DEVICE
20|FH_F135491_0_0|SrvcGrp|12994|2022|PCT|1.21|99|0.00|UNCLASSIFIED DRUGS
20|FH_F135491_0_0|SrvcGrp|45583|2022|PDM|1980.00|99|0.00|CPT 65730
20|FH_F135491_0_0|SrvcGrp|84278|2022|PDM|1980.00|99|0.00|CORNEAL TRANSPLANT
20|FH_F135491_0_0|SrvcGrp|92547|2022|PDM|1980.00|99|0.00|SKIN FULL GRAFT PROCEDURE
20|FH_F135580_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F135580_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F135580_0_0|CSTM-ALL|CSTM-00|2020|PDM|425.00|99|0.00|AEG 2 (NO REV)
20|FH_F135580_0_0|CSTM-ALL|CSTM-00|2020|PDM|486.00|99|0.00|AEG 3 (NO REV)
20|FH_F135613_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F135649_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F135649_0_0|CSTM-ALL|CSTM-00|2020|PDM|703.00|99|0.00|AMBULATORY SURGERY W/O AEG 1 & 2
20|FH_F135651_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F135651_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F135653_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 9 (NO REV)
20|FH_F135653_0_0|CSTM-ALL|CSTM-00|2020|PDM|1388.00|99|0.00|AEG 4 (NO REV)
20|FH_F135653_0_0|CSTM-ALL|CSTM-00|2020|PDM|1440.00|99|0.00|AEG 5  (NO REV)
20|FH_F135653_0_0|CSTM-ALL|CSTM-00|2020|PDM|2075.00|99|0.00|AEG 8 (NO REV)
20|FH_F135653_0_0|CSTM-ALL|CSTM-00|2020|PDM|775.00|99|0.00|AEG 1 (NO REV)
20|FH_F135653_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F135764_0_0|SrvcGrp|73485|2022|PDM|1100.00|99|0.00|AETNA REHAB
20|FH_F135771_0_0|SrvcGrp|22596|2022|PDM|169.46|99|0.00|HOSPICE CARE
20|FH_F135771_0_0|SrvcGrp|94780|2022|PDM|169.46|99|0.00|HOSPICE OR HH IN HOME (HCFA)
20|FH_F135779_0_0|SrvcGrp|73841|2022|PDM|467.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP
20|FH_F135840_0_0|SrvcGrp|75483|2022|PDM|536.00|99|0.00|AEG 3
20|FH_F135840_0_0|SrvcGrp|75487|2022|PDM|753.00|99|0.00|AEG 5
20|FH_F135840_0_0|SrvcGrp|75495|2022|PDM|1406.00|99|0.00|AEG 9
20|FH_F135840_0_0|SrvcGrp|75497|2022|PDM|350.00|99|0.00|AEG 10
20|FH_F135840_0_0|SrvcGrp|79593|2022|PDM|550.00|99|0.00|CPT 45378
20|FH_F135840_0_0|SrvcGrp|87186|2022|PDM|550.00|99|0.00|CPT 43242
20|FH_F135840_0_0|SrvcGrp|87187|2022|PDM|550.00|99|0.00|CPT 43259
20|FH_F135891_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F135897_0_0|CSTM-ALL|CSTM-00|2020|PDM|1442.00|99|0.00|AEG 7 (NO REV)
20|FH_F135897_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 1 (NO REV)
20|FH_F135897_0_0|CSTM-ALL|CSTM-00|2020|PDM|743.00|99|0.00|AEG 3 (NO REV)
20|FH_F135897_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 4 (NO REV)
20|FH_F135897_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F135900_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F135900_0_0|SrvcGrp|75399|2022|PDM|0.10|99|0.00|MED RECORD COPY
20|FH_F135930_0_0|CSTM-ALL|CSTM-00|2020|PCT|36500.00|99|0.00|TIMELY FILING
20|FH_F136002_0_0|SrvcGrp|112811|2022|PDM|86.70|99|0.00|LPN CARE
20|FH_F136002_0_0|SrvcGrp|48398|2022|PDM|81.60|99|0.00|PT SERVICES
20|FH_F136037_0_0|SrvcGrp|89417|2022|PDM|416.00|99|0.00|PARTIAL HOSPITALIZATION
20|FH_F136092_0_0|SrvcGrp|63297|2022|PDM|105.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F136092_0_0|SrvcGrp|90707|2022|PDM|105.00|99|0.00|AETNA HOSPICE CARE
20|FH_F136092_0_0|SrvcGrp|97507|2022|PDM|105.00|99|0.00|AETNA HOSPICE
20|FH_F136132_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE
20|FH_F136132_0_0|SrvcGrp|111931|2022|PDM|35.91|99|0.00|COVID-19 CDC TESTING LAB
20|FH_F136132_0_0|SrvcGrp|111932|2022|PDM|51.31|99|0.00|COVID-19 NON-CDC TESTING LAB
20|FH_F136132_0_0|SrvcGrp|112812|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER
20|FH_F136189_0_0|CSTM-ALL|CSTM-00|2020|PCT|12000.00|99|0.00|TIMELY FILING
20|FH_F136195_0_0|SrvcGrp|87077|2022|PDM|120.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F136207_0_0|SrvcGrp|73485|2022|PDM|850.00|99|0.00|AETNA REHAB
20|FH_F136276_0_0|SrvcGrp|82981|2022|PDM|154.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F136318_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F136318_0_0|SrvcGrp|46903|2022|PDM|796.00|99|0.00|RESIDENTIAL TREATMENT
20|FH_F136359_0_0|CSTM-ALL|CSTM-00|2020|PDM|1675.00|99|0.00|AEG 2 (NO REV)
20|FH_F136359_0_0|CSTM-ALL|CSTM-00|2020|PDM|1850.00|99|0.00|AEG 3 (NO REV)
20|FH_F136359_0_0|CSTM-ALL|CSTM-00|2020|PDM|2275.00|99|0.00|AEG 5  (NO REV)
20|FH_F136359_0_0|CSTM-ALL|CSTM-00|2020|PDM|2375.00|99|0.00|AEG 4 (NO REV)
20|FH_F136359_0_0|SrvcGrp|102481|2022|PDM|2895.00|99|0.00|CPT 29898
20|FH_F136359_0_0|SrvcGrp|104481|2022|PDM|2450.00|99|0.00|ECHO GUIDE FOR BIOPSY
20|FH_F136359_0_0|SrvcGrp|104856|2022|PDM|6125.00|99|0.00|PERCUTANEIOUS VERTEBROPLASY
20|FH_F136359_0_0|SrvcGrp|112851|2022|PDM|5980.00|99|0.00|SHOULDER SERVICES
20|FH_F136359_0_0|SrvcGrp|112855|2022|PDM|3700.00|99|0.00|FOOT AND TOE PROCEDURES
20|FH_F136359_0_0|SrvcGrp|112857|2022|PDM|5180.00|99|0.00|REPAIR / REVISION / RECONSTRUCTION OF FOOT OR TOES
20|FH_F136359_0_0|SrvcGrp|63472|2022|PDM|5100.00|99|0.00|CPT 64581
20|FH_F136359_0_0|SrvcGrp|67065|2022|PDM|18120.00|99|0.00|CERVICAL SURGERY
20|FH_F136359_0_0|SrvcGrp|77021|2022|PDM|6875.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY
20|FH_F136359_0_0|SrvcGrp|83644|2022|PDM|5780.00|99|0.00|CPT 30465
20|FH_F136359_0_0|SrvcGrp|89856|2022|PDM|5850.00|99|0.00|LAMIN EXCIS EXTRADURAL LUMB
20|FH_F136359_0_0|SrvcGrp|89989|2022|PDM|5500.00|99|0.00|FUSION OF BIG TOE JOINT
20|FH_F136359_0_0|SrvcGrp|99073|2022|PDM|1.75|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F136376_0_0|SrvcGrp|86722|2022|PDM|205.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)
20|FH_F136376_0_0|SrvcGrp|89417|2022|PDM|447.00|99|0.00|PARTIAL HOSPITALIZATION
20|FH_F136382_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F136382_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|AEG 8 (NO REV)
20|FH_F136382_0_0|CSTM-ALL|CSTM-00|2020|PDM|825.00|99|0.00|AEG 3 (NO REV)
20|FH_F136393_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F136393_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 4 (NO REV)
20|FH_F136393_0_0|CSTM-ALL|CSTM-00|2020|PDM|1450.00|99|0.00|AEG 5  (NO REV)
20|FH_F136393_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 1 (NO REV)
20|FH_F136393_0_0|SrvcGrp|103638|2022|PDM|6400.00|99|0.00|AETNA OPEN/PERQ PLACE STENT 1ST
20|FH_F136393_0_0|SrvcGrp|108193|2022|PDM|6400.00|99|0.00|TIB/PER REVASC W/TLA
20|FH_F136393_0_0|SrvcGrp|109501|2022|PDM|2000.00|99|0.00|REPAIR LEAD PACE-DEFIB DUAL
20|FH_F136393_0_0|SrvcGrp|109502|2022|PDM|3200.00|99|0.00|INSERT PULSE GEN MULT LEADS
20|FH_F136393_0_0|SrvcGrp|110709|2022|PDM|8000.00|99|0.00|TIB/PER REVASC W/ATHER
20|FH_F136393_0_0|SrvcGrp|112581|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F136393_0_0|SrvcGrp|112876|2022|PDM|3200.00|99|0.00|INSERTION OF HEART ELECTRODE
20|FH_F136393_0_0|SrvcGrp|112877|2022|PDM|6000.00|99|0.00|INSERT PULSE GEN SNGL LEAD
20|FH_F136393_0_0|SrvcGrp|112879|2022|PDM|1760.00|99|0.00|L VENTRIC PACING LEAD ADD ON
20|FH_F136395_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F136395_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 1 (NO REV)
20|FH_F136395_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 2 (NO REV)
20|FH_F136395_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|AEG 3 (NO REV)
20|FH_F136395_0_0|CSTM-ALL|CSTM-00|2020|PDM|2600.00|99|0.00|AEG 7 (NO REV)
20|FH_F136395_0_0|SrvcGrp|14188|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F136407_0_0|CSTM-ALL|CSTM-00|2020|PDM|1980.00|99|0.00|AEG 8 (NO REV)
20|FH_F136407_0_0|CSTM-ALL|CSTM-00|2020|PDM|638.00|99|0.00|AEG 1 (NO REV)
20|FH_F136407_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F136407_0_0|SrvcGrp|12664|2022|PCT|0.00|99|0.00|IMPLANTS
20|FH_F136407_0_0|SrvcGrp|88599|2022|PDM|3960.00|99|0.00|ENDOSCOPY MAXILLARY SINUS
20|FH_F136407_0_0|SrvcGrp|90822|2022|PDM|3960.00|99|0.00|NASAL/SINUS ENDOSCOPY SURGERY
20|FH_F136410_0_0|CSTM-ALL|CSTM-00|2020|PDM|1671.00|99|0.00|AEG 2 (NO REV)
20|FH_F136417_0_0|SrvcGrp|111785|2022|PDM|834.00|99|0.00|MENTAL HEALTH CRISIS INTERVENTION
20|FH_F136429_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|AEG 10 (NO REV)
20|FH_F136429_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|AEG 7 (NO REV)
20|FH_F136429_0_0|SrvcGrp|79583|2022|PDM|710.50|99|0.00|CPT 45381
20|FH_F136429_0_0|SrvcGrp|79591|2022|PDM|490.00|99|0.00|CPT 43450
20|FH_F136429_0_0|SrvcGrp|79593|2022|PDM|710.50|99|0.00|CPT 45378
20|FH_F136429_0_0|SrvcGrp|79594|2022|PDM|700.00|99|0.00|CPT 45380
20|FH_F136467_0_0|SrvcGrp|69981|2022|PDM|1118.00|99|0.00|CPT 24358
20|FH_F136473_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 9 (NO REV)
20|FH_F136473_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|AEG 3 (NO REV)
20|FH_F136473_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F136490_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F136493_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F136493_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F136493_0_0|SrvcGrp|63297|2022|PDM|166.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F136493_0_0|SrvcGrp|65720|2022|PDM|166.00|99|0.00|RESPITE CARE
20|FH_F136493_0_0|SrvcGrp|83522|2022|PDM|166.00|99|0.00|RESPITE CARE
20|FH_F136493_0_0|SrvcGrp|90707|2022|PDM|56.00|99|0.00|AETNA HOSPICE CARE
20|FH_F136499_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F136507_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F136507_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F136507_0_0|SrvcGrp|97507|2022|PDM|120.00|99|0.00|AETNA HOSPICE
20|FH_F136510_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F136510_0_0|CSTM-ALL|CSTM-00|2020|PDM|1231.00|99|0.00|AEG 3 (NO REV)
20|FH_F136510_0_0|CSTM-ALL|CSTM-00|2020|PDM|1517.00|99|0.00|AEG 4 (NO REV)
20|FH_F136510_0_0|CSTM-ALL|CSTM-00|2020|PDM|1543.00|99|0.00|AEG 5  (NO REV)
20|FH_F136510_0_0|CSTM-ALL|CSTM-00|2020|PDM|2331.00|99|0.00|AEG 8 (NO REV)
20|FH_F136510_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F136510_0_0|SrvcGrp|107611|2022|PDM|3882.00|99|0.00|IMPLTJ NTRSTRML CRNL RNG SEGMENTS
20|FH_F136510_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F136510_0_0|SrvcGrp|28547|2022|PDM|3882.00|99|0.00|VITRECTOMY
20|FH_F136510_0_0|SrvcGrp|28549|2022|PDM|3882.00|99|0.00|VITRECTOMY
20|FH_F136510_0_0|SrvcGrp|38909|2022|PDM|3882.00|99|0.00|CPT 67036 - VITRECTOMY, MECHANICAL
20|FH_F136510_0_0|SrvcGrp|46887|2022|PDM|3882.00|99|0.00|REPAIR DETACHED RETINA
20|FH_F136510_0_0|SrvcGrp|49205|2022|PDM|3882.00|99|0.00|REPAIR DETACHED RETINA
20|FH_F136510_0_0|SrvcGrp|74670|2022|PCT|0.00|99|0.00|AETNA OP INTRAOCULAR LENS
20|FH_F136510_0_0|SrvcGrp|84279|2022|PDM|3882.00|99|0.00|CORNEAL TRANSPLANT
20|FH_F136510_0_0|SrvcGrp|84280|2022|PDM|3882.00|99|0.00|CORNEAL TRANSPLANT
20|FH_F136510_0_0|SrvcGrp|90566|2022|PDM|2142.00|99|0.00|REMOVE EYE IMPLANT MATERIAL
20|FH_F136541_0_0|SrvcGrp|112812|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER
20|FH_F136547_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F136591_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|GENERAL ACUTE CARE
20|FH_F136591_0_0|SrvcGrp|11606|2022|PDM|1345.15|99|0.00|ACUTE CARE (MEDICAL & SURGICAL)
20|FH_F136592_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F136592_0_0|CSTM-ALL|CSTM-00|2020|PDM|1173.00|99|0.00|AEG 7 (NO REV)
20|FH_F136592_0_0|CSTM-ALL|CSTM-00|2020|PDM|395.00|99|0.00|AEG 1 (NO REV)
20|FH_F136592_0_0|CSTM-ALL|CSTM-00|2020|PDM|572.00|99|0.00|AEG 2 (NO REV)
20|FH_F136592_0_0|CSTM-ALL|CSTM-00|2020|PDM|812.00|99|0.00|AEG 4 (NO REV)
20|FH_F136592_0_0|CSTM-ALL|CSTM-00|2020|PDM|999.00|99|0.00|AEG 6 (NO REV)
20|FH_F136592_0_0|SrvcGrp|107794|2022|PDM|3880.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE
20|FH_F136629_0_0|CSTM-ALL|CSTM-00|2020|PCT|81.50|99|0.00|OP SVCS
20|FH_F136654_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F136654_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|AEG 2 (NO REV)
20|FH_F136654_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|AEG 3 (NO REV)
20|FH_F136654_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|AEG 5  (NO REV)
20|FH_F136654_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|AEG 7 (NO REV)
20|FH_F136654_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|AEG 8 (NO REV)
20|FH_F136668_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F136668_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 10 (NO REV)
20|FH_F136668_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|AEG 6 (NO REV)
20|FH_F136677_0_0|CSTM-ALL|CSTM-00|2020|PDM|1155.00|99|0.00|AEG 7 (NO REV)
20|FH_F136677_0_0|SrvcGrp|112862|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F136684_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F136684_0_0|CSTM-ALL|CSTM-00|2020|PDM|1248.00|99|0.00|AEG 9 (NO REV)
20|FH_F136684_0_0|CSTM-ALL|CSTM-00|2020|PDM|356.00|99|0.00|AEG 1 (NO REV)
20|FH_F136684_0_0|CSTM-ALL|CSTM-00|2020|PDM|477.00|99|0.00|AEG 2 (NO REV)
20|FH_F136684_0_0|CSTM-ALL|CSTM-00|2020|PDM|688.00|99|0.00|AEG 4 (NO REV)
20|FH_F136684_0_0|CSTM-ALL|CSTM-00|2020|PDM|783.00|99|0.00|AEG 10 (NO REV)
20|FH_F136684_0_0|CSTM-ALL|CSTM-00|2020|PDM|899.00|99|0.00|AEG 6 (NO REV)
20|FH_F136690_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F136728_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F136735_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F136735_0_0|CSTM-ALL|CSTM-00|2020|PDM|2185.00|99|0.00|AEG 7 (NO REV)
20|FH_F136735_0_0|CSTM-ALL|CSTM-00|2020|PDM|624.00|99|0.00|AEG 1 (NO REV)
20|FH_F136735_0_0|CSTM-ALL|CSTM-00|2020|PDM|857.00|99|0.00|AEG 2 (NO REV)
20|FH_F136735_0_0|SrvcGrp|104719|2022|PDM|1495.66|99|0.00|RELIEVE INNER EYE PRESSURE
20|FH_F136735_0_0|SrvcGrp|91759|2022|PCT|1.00|99|0.00|OCULAR IMPLANT
20|FH_F136751_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F136751_0_0|CSTM-ALL|CSTM-00|2020|PDM|1995.00|99|0.00|AEG 2 (NO REV)
20|FH_F136751_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F136751_0_0|SrvcGrp|112581|2022|PDM|4535.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F136751_0_0|SrvcGrp|11673|2022|PDM|9200.00|99|0.00|CPT 29888
20|FH_F136751_0_0|SrvcGrp|41334|2022|PDM|20500.00|99|0.00|TOTAL KNEE
20|FH_F136751_0_0|SrvcGrp|80617|2022|PDM|16000.00|99|0.00|ARTHOPLASTY
20|FH_F136751_0_0|SrvcGrp|88065|2022|PDM|16000.00|99|0.00|TOTAL DISC ARTHROPLASTY
20|FH_F136751_0_0|SrvcGrp|88163|2022|PDM|16000.00|99|0.00|LUMBAR SPINE FUSION
20|FH_F136751_0_0|SrvcGrp|88164|2022|PDM|16000.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR
20|FH_F136751_0_0|SrvcGrp|88491|2022|PDM|9500.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR
20|FH_F136751_0_0|SrvcGrp|90063|2022|PDM|7500.00|99|0.00|REPAIR BICEPS TENDON RUPTURE
20|FH_F136751_0_0|SrvcGrp|95559|2022|PDM|20500.00|99|0.00|HIP JOINT
20|FH_F136751_0_0|SrvcGrp|98266|2022|PDM|20500.00|99|0.00|REVISE KNEECAP
20|FH_F136751_0_0|SrvcGrp|98497|2022|PDM|16000.00|99|0.00|ARTHRODESIS POSTERIOR TECH
20|FH_F136751_0_0|SrvcGrp|99161|2022|PDM|20500.00|99|0.00|CPT 27138
20|FH_F136752_0_0|CSTM-ALL|CSTM-00|2020|PDM|408.00|99|0.00|AEG 1 (NO REV)
20|FH_F136756_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F136756_0_0|SrvcGrp|112862|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F136756_0_0|SrvcGrp|112978|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES
20|FH_F136756_0_0|SrvcGrp|73008|2022|PDM|266.20|99|0.00|AEG 10
20|FH_F136779_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F136779_0_0|CSTM-ALL|CSTM-00|2020|PDM|1094.00|99|0.00|AEG 4 (NO REV)
20|FH_F136779_0_0|SrvcGrp|106217|2022|PDM|2154.00|99|0.00|ARTHROSCOPY SHOULDER
20|FH_F136779_0_0|SrvcGrp|11043|2022|PDM|1140.00|99|0.00|CARPAL TUNNEL RELEASE
20|FH_F136779_0_0|SrvcGrp|112923|2022|PDM|2157.00|99|0.00|KNEE ARTHROSCOPY PROCEDURES
20|FH_F136779_0_0|SrvcGrp|112926|2022|PDM|2218.00|99|0.00|KNEE ARTHROSCOPY PROCEDURES
20|FH_F136779_0_0|SrvcGrp|19922|2022|PDM|3362.00|99|0.00|ARTHROSCOPY OF SHOULDER
20|FH_F136779_0_0|SrvcGrp|96939|2022|PDM|3463.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F136780_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F136787_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F136790_0_0|SrvcGrp|3405|2022|PDM|154.00|99|0.00|CPT 99212
20|FH_F136790_0_0|SrvcGrp|3406|2022|PDM|647.00|99|0.00|CPT 99214
20|FH_F136793_0_0|CSTM-ALL|CSTM-00|2020|PDM|392.00|99|0.00|AEG 1 (NO REV)
20|FH_F136793_0_0|CSTM-ALL|CSTM-00|2020|PDM|526.00|99|0.00|AEG 2 (NO REV)
20|FH_F136793_0_0|CSTM-ALL|CSTM-00|2020|PDM|829.00|99|0.00|AEG 5  (NO REV)
20|FH_F136806_0_0|CSTM-ALL|CSTM-00|2020|PDM|1062.00|99|0.00|AEG 4 (NO REV)
20|FH_F136806_0_0|SrvcGrp|106706|2022|PDM|2295.00|99|0.00|PAIN STIM SURGERY
20|FH_F136806_0_0|SrvcGrp|107441|2022|PDM|2575.00|99|0.00|AETNA CYSTOSCOPY PROSTATIC IMPLANTS
20|FH_F136806_0_0|SrvcGrp|112954|2022|PDM|7725.00|99|0.00|PACEMAKER
20|FH_F136806_0_0|SrvcGrp|11673|2022|PDM|2732.00|99|0.00|CPT 29888
20|FH_F136806_0_0|SrvcGrp|54943|2022|PDM|3463.00|99|0.00|REPAIR OF SLAP LESION
20|FH_F136818_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 9 (NO REV)
20|FH_F136818_0_0|CSTM-ALL|CSTM-00|2020|PDM|557.00|99|0.00|AEG 1 (NO REV)
20|FH_F136818_0_0|SrvcGrp|112936|2022|PDM|3000.00|99|0.00|SURGICAL SERVICES
20|FH_F136818_0_0|SrvcGrp|99073|2022|PDM|1.38|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F136832_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F136832_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F136843_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F136843_0_0|SrvcGrp|107748|2022|PDM|424.00|99|0.00|HEMODIALYSIS IN CENTER
20|FH_F136887_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F136887_0_0|CSTM-ALL|CSTM-00|2020|PDM|1610.00|99|0.00|AEG 1 (NO REV)
20|FH_F136887_0_0|CSTM-ALL|CSTM-00|2020|PDM|1704.00|99|0.00|AEG 2 (NO REV)
20|FH_F136887_0_0|CSTM-ALL|CSTM-00|2020|PDM|1886.00|99|0.00|AEG 3 (NO REV)
20|FH_F136887_0_0|CSTM-ALL|CSTM-00|2020|PDM|3161.00|99|0.00|AEG 9 (NO REV)
20|FH_F136887_0_0|SrvcGrp|112976|2022|PDM|6365.00|99|0.00|KNEE ARTHROSCOPY
20|FH_F136887_0_0|SrvcGrp|112977|2022|PDM|8755.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F136887_0_0|SrvcGrp|40002|2022|PDM|13648.00|99|0.00|TOTAL HIP
20|FH_F136887_0_0|SrvcGrp|40003|2022|PDM|14057.00|99|0.00|TOTAL KNEE
20|FH_F136947_0_0|SrvcGrp|13422|2022|PDM|400.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC
20|FH_F136947_0_0|SrvcGrp|2067|2022|PDM|800.00|99|0.00|SPECIALTY CARE TRANSPORT
20|FH_F136987_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F136987_0_0|SrvcGrp|30089|2022|PDM|404.00|99|0.00|HEMODIALYSIS SERVICES
20|FH_F136987_0_0|SrvcGrp|73559|2022|PDM|1818.00|99|0.00|AETNA INTENSIVE CARE
20|FH_F137057_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F137067_0_0|CSTM-ALL|CSTM-00|2020|PDM|1724.00|99|0.00|AEG 7 (NO REV)
20|FH_F137067_0_0|SrvcGrp|103236|2022|PDM|18900.00|99|0.00|AETNA INSJ STABLJ DEV
20|FH_F137067_0_0|SrvcGrp|111958|2022|PDM|2625.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F137067_0_0|SrvcGrp|112581|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F137067_0_0|SrvcGrp|112960|2022|PDM|21000.00|99|0.00|REVISION OF KNEE JOINT
20|FH_F137067_0_0|SrvcGrp|26278|2022|PDM|3491.00|99|0.00|CPT 29881
20|FH_F137067_0_0|SrvcGrp|27315|2022|PDM|6825.00|99|0.00|TENDON REPAIR
20|FH_F137067_0_0|SrvcGrp|33979|2022|PDM|21000.00|99|0.00|CPT 27440
20|FH_F137067_0_0|SrvcGrp|35668|2022|PDM|4305.00|99|0.00|CPT 29824
20|FH_F137067_0_0|SrvcGrp|35669|2022|PDM|6825.00|99|0.00|CPT 63650
20|FH_F137067_0_0|SrvcGrp|58993|2022|PDM|7350.00|99|0.00|DISKECTOMY
20|FH_F137067_0_0|SrvcGrp|70749|2022|PDM|3150.00|99|0.00|CPT 29823
20|FH_F137067_0_0|SrvcGrp|71666|2022|PDM|15750.00|99|0.00|CPT 63655
20|FH_F137067_0_0|SrvcGrp|78096|2022|PDM|5775.00|99|0.00|AETNA ARTHROSCOPY BICEPS
20|FH_F137067_0_0|SrvcGrp|80617|2022|PDM|19425.00|99|0.00|ARTHOPLASTY
20|FH_F137067_0_0|SrvcGrp|82113|2022|PDM|2625.00|99|0.00|KNEE ARTHROSCOPY SURGERY
20|FH_F137067_0_0|SrvcGrp|82720|2022|PDM|3491.00|99|0.00|WRIST ENDOSCOPY/SURGERY
20|FH_F137067_0_0|SrvcGrp|84318|2022|PDM|7350.00|99|0.00|SPINE INFUSION
20|FH_F137067_0_0|SrvcGrp|88157|2022|PDM|19425.00|99|0.00|TOTAL HIP ARTHROPLASTY
20|FH_F137067_0_0|SrvcGrp|88158|2022|PDM|5250.00|99|0.00|NECK SPINE DISK SURGERY
20|FH_F137067_0_0|SrvcGrp|88159|2022|PDM|5250.00|99|0.00|LOW BACK DISK SURGERY
20|FH_F137067_0_0|SrvcGrp|88164|2022|PDM|21000.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR
20|FH_F137067_0_0|SrvcGrp|88491|2022|PDM|5250.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR
20|FH_F137067_0_0|SrvcGrp|88597|2022|PDM|6300.00|99|0.00|INTERNAL FIX FOR FRACT/INSTA
20|FH_F137067_0_0|SrvcGrp|89404|2022|PDM|19425.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F137067_0_0|SrvcGrp|89861|2022|PDM|4515.00|99|0.00|LUMBAR LAMINOTOMY
20|FH_F137067_0_0|SrvcGrp|90063|2022|PDM|6825.00|99|0.00|REPAIR BICEPS TENDON RUPTURE
20|FH_F137067_0_0|SrvcGrp|92364|2022|PDM|22050.00|99|0.00|ARTHRODESIS SACROILIAC JOINT
20|FH_F137067_0_0|SrvcGrp|92412|2022|PDM|5250.00|99|0.00|SPINAL CRD DECOMP->2 CERVIC
20|FH_F137067_0_0|SrvcGrp|92414|2022|PDM|5250.00|99|0.00|SPINAL CRD DECOMP->2 LUMBAR
20|FH_F137067_0_0|SrvcGrp|92415|2022|PDM|7350.00|99|0.00|NECK SPINE DISK SURGERY
20|FH_F137067_0_0|SrvcGrp|93807|2022|PDM|4200.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY
20|FH_F137067_0_0|SrvcGrp|96839|2022|PDM|36750.00|99|0.00|REVISE SPINE ELTRD PLATE
20|FH_F137067_0_0|SrvcGrp|98497|2022|PDM|16800.00|99|0.00|ARTHRODESIS POSTERIOR TECH
20|FH_F137087_0_0|CSTM-ALL|CSTM-00|2020|PDM|3800.00|99|0.00|AEG 6 (NO REV)
20|FH_F137087_0_0|CSTM-ALL|CSTM-00|2020|PDM|3800.00|99|0.00|AEG 8 (NO REV)
20|FH_F137087_0_0|CSTM-ALL|CSTM-00|2020|PDM|3800.00|99|0.00|AEG 9 (NO REV)
20|FH_F137087_0_0|SrvcGrp|41335|2022|PDM|23000.00|99|0.00|TOTAL HIP
20|FH_F137087_0_0|SrvcGrp|80617|2022|PDM|21000.00|99|0.00|ARTHOPLASTY
20|FH_F137087_0_0|SrvcGrp|84939|2022|PDM|25000.00|99|0.00|SHOULDER JOINT
20|FH_F137239_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F137239_0_0|SrvcGrp|73842|2022|PDM|235.00|99|0.00|AETNA INTENSIVE OUTPATIENT
20|FH_F137243_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F137248_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F137248_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F137248_0_0|CSTM-ALL|CSTM-00|2020|PDM|2185.00|99|0.00|AEG 6 (NO REV)
20|FH_F137248_0_0|CSTM-ALL|CSTM-00|2020|PDM|3225.00|99|0.00|AEG 9 (NO REV)
20|FH_F137248_0_0|SrvcGrp|103569|2022|PDM|3978.00|99|0.00|REPAIR ANKLE FRACTURE
20|FH_F137248_0_0|SrvcGrp|113058|2022|PDM|3978.00|99|0.00|REMOVAL OF PILONIDAL LESION
20|FH_F137248_0_0|SrvcGrp|19922|2022|PDM|4058.00|99|0.00|ARTHROSCOPY OF SHOULDER
20|FH_F137248_0_0|SrvcGrp|96939|2022|PDM|4058.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F137248_0_0|SrvcGrp|98206|2022|PDM|4058.00|99|0.00|CORRECTION OF BUNION
20|FH_F137248_0_0|SrvcGrp|98360|2022|PDM|3978.00|99|0.00|AETNA LAMINECTOMY W/FACE-LUMBAR
20|FH_F137287_0_0|SrvcGrp|113070|2022|PDM|1050.00|99|0.00|IP DAY HOSPITAL
20|FH_F137287_0_0|SrvcGrp|113072|2022|PDM|300.00|99|0.00|HALF DAY OP THERAPY
20|FH_F137310_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F137310_0_0|SrvcGrp|108899|2022|PDM|1200.00|99|0.00|HOSPICE INPATIENT RESPITE CARE
20|FH_F137310_0_0|SrvcGrp|113310|2022|PDM|165.00|99|0.00|HOSPICE ROUTINE HOME CARE
20|FH_F137359_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F137359_0_0|SrvcGrp|82981|2022|PDM|90.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F137363_0_0|CSTM-ALL|CSTM-00|2020|PDM|515.00|99|0.00|AEG 2 (NO REV)
20|FH_F137363_0_0|CSTM-ALL|CSTM-00|2020|PDM|772.50|99|0.00|AEG 10 (NO REV)
20|FH_F137363_0_0|CSTM-ALL|CSTM-00|2020|PDM|824.00|99|0.00|AEG 5  (NO REV)
20|FH_F137363_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F137363_0_0|SrvcGrp|110358|2022|PDM|1854.00|99|0.00|ARTHROSCOPY
20|FH_F137447_0_0|SrvcGrp|106294|2022|PDM|270.41|99|0.00|AMBULANCE SERVICE EMERGENCY TRANSPORT LEVEL 1 (HFCA)
20|FH_F137530_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F137530_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|AMBULATORY SURGERY (DEFAULTSUR) W/O REMV TUNNLD CVC
20|FH_F137530_0_0|SrvcGrp|107792|2022|PDM|14301.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE
20|FH_F137530_0_0|SrvcGrp|107793|2022|PDM|23044.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE
20|FH_F137530_0_0|SrvcGrp|108194|2022|PDM|3117.00|99|0.00|INSERT TUN IP CATH PERC
20|FH_F137530_0_0|SrvcGrp|68546|2022|PDM|3035.00|99|0.00|CPT 36558
20|FH_F137567_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F137610_0_0|SrvcGrp|86723|2022|PDM|381.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)
20|FH_F137610_0_0|SrvcGrp|89149|2022|PDM|151.00|99|0.00|OP INTENSIVE
20|FH_F137638_0_0|SrvcGrp|100499|2022|PDM|1030.00|99|0.00|PARTIAL HOSPITALIZATION EATING DISORDERS
20|FH_F137639_0_0|SrvcGrp|27210|2022|PDM|1500.00|99|0.00|SKILLED NURSING LEVEL I
20|FH_F137798_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F137798_0_0|SrvcGrp|104228|2022|PDM|743.00|99|0.00|HOSPICE CARE (HCFA)
20|FH_F137798_0_0|SrvcGrp|29155|2022|PDM|743.00|99|0.00|HOSPICE SVCS
20|FH_F137798_0_0|SrvcGrp|80918|2022|PDM|140.00|99|0.00|RESPITE CARE
20|FH_F137799_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F137799_0_0|SrvcGrp|90707|2022|PDM|100.00|99|0.00|AETNA HOSPICE CARE
20|FH_F137847_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F137847_0_0|SrvcGrp|108484|2022|PDM|605.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY
20|FH_F137902_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F137902_0_0|SrvcGrp|73841|2022|PDM|269.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP
20|FH_F137902_0_0|SrvcGrp|90854|2022|PDM|713.00|99|0.00|AETNA IP DETOXIFICATION SERVICES
20|FH_F137906_0_0|SrvcGrp|104226|2022|PDM|100.00|99|0.00|HOSPICE CARE (HCFA)
20|FH_F137906_0_0|SrvcGrp|104228|2022|PDM|100.00|99|0.00|HOSPICE CARE (HCFA)
20|FH_F137933_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 1 (NO REV)
20|FH_F137933_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 2 (NO REV)
20|FH_F137933_0_0|CSTM-ALL|CSTM-00|2020|PDM|7500.00|99|0.00|AEG 7 (NO REV)
20|FH_F137933_0_0|SrvcGrp|112581|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F137933_0_0|SrvcGrp|113159|2022|PDM|3500.00|99|0.00|KIDNEY ENDOSCOPY & TREATMENT
20|FH_F137933_0_0|SrvcGrp|113164|2022|PDM|12900.00|99|0.00|INSERT PENILE PROSTH/NON-INF
20|FH_F137940_0_0|SrvcGrp|13681|2022|PDM|293.23|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT
20|FH_F137943_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F137943_0_0|SrvcGrp|68281|2022|PDM|1700.00|99|0.00|CPT 67041
20|FH_F137943_0_0|SrvcGrp|68282|2022|PDM|1700.00|99|0.00|CPT 67042
20|FH_F137943_0_0|SrvcGrp|85906|2022|PDM|1379.00|99|0.00|CPT 66710
20|FH_F137943_0_0|SrvcGrp|94902|2022|PDM|4240.00|99|0.00|INSERT ANT SEGMENT DRAIN EXT
20|FH_F137946_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F137946_0_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)
20|FH_F137946_0_0|SrvcGrp|113220|2022|PDM|416.78|99|0.00|COVID-19 NFCT DS 22 TRGT SARS-COV-2
20|FH_F137946_0_0|SrvcGrp|113224|2022|PDM|416.78|99|0.00|COVID-19 NFCT DS DNA&RNA 21 SARSCOV2
20|FH_F137946_0_0|SrvcGrp|113226|2022|PDM|42.28|99|0.00|COVID-19 SVNT SARSCOV2 ELISA PLSM SRM
20|FH_F137946_0_0|SrvcGrp|113230|2022|PDM|42.13|99|0.00|COVID-19 NEUTRLZG ANTB SARSCOV2 SCR
20|FH_F137946_0_0|SrvcGrp|113236|2022|PDM|41.38|99|0.00|COVID-19 SARS-COV-2 W/ OPTIC
20|FH_F137946_0_0|SrvcGrp|113241|2022|PDM|416.78|99|0.00|COVID-19 NFCT DS 22 TRGT SARS-COV-2 (HCFA)
20|FH_F137946_0_0|SrvcGrp|113242|2022|PDM|42.13|99|0.00|COVID-19 ANTIBODY SARS-COV-2 TITER(S) (HCFA)
20|FH_F137946_0_0|SrvcGrp|113250|2022|PDM|142.63|99|0.00|COVID-19 SARSCOV2&INF A&B&RSV AMP PRB (HCFA)
20|FH_F137946_0_0|SrvcGrp|82981|2022|PDM|140.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F137950_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 2 (NO REV)
20|FH_F137950_0_0|CSTM-ALL|CSTM-00|2020|PDM|1430.00|99|0.00|AEG 9 (NO REV)
20|FH_F137950_0_0|CSTM-ALL|CSTM-00|2020|PDM|1540.00|99|0.00|AEG 4 (NO REV)
20|FH_F137950_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|AEG 5  (NO REV)
20|FH_F137950_0_0|CSTM-ALL|CSTM-00|2020|PDM|1980.00|99|0.00|AEG 6 (NO REV)
20|FH_F137950_0_0|CSTM-ALL|CSTM-00|2020|PDM|2420.00|99|0.00|AEG 7 (NO REV)
20|FH_F137950_0_0|SrvcGrp|78403|2022|PDM|0.05|99|0.00|AETNA MED RECORD
20|FH_F137951_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F137951_0_0|CSTM-ALL|CSTM-00|2020|PDM|1025.00|99|0.00|AEG 4 (NO REV)
20|FH_F137951_0_0|CSTM-ALL|CSTM-00|2020|PDM|1150.00|99|0.00|AEG 5  (NO REV)
20|FH_F137951_0_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|AEG 6 (NO REV)
20|FH_F137951_0_0|CSTM-ALL|CSTM-00|2020|PDM|725.00|99|0.00|AEG 2 (NO REV)
20|FH_F137951_0_0|SrvcGrp|113114|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F137951_0_0|SrvcGrp|113169|2022|PDM|3130.00|99|0.00|REMOVAL OF KNEECAP
20|FH_F137951_0_0|SrvcGrp|11673|2022|PDM|4326.00|99|0.00|CPT 29888
20|FH_F137951_0_0|SrvcGrp|35669|2022|PDM|3000.00|99|0.00|CPT 63650
20|FH_F137951_0_0|SrvcGrp|63471|2022|PDM|3000.00|99|0.00|CPT 64590
20|FH_F137951_0_0|SrvcGrp|67065|2022|PDM|3000.00|99|0.00|CERVICAL SURGERY
20|FH_F137951_0_0|SrvcGrp|70749|2022|PDM|1478.00|99|0.00|CPT 29823
20|FH_F137951_0_0|SrvcGrp|79578|2022|PDM|1458.00|99|0.00|CPT 43246
20|FH_F137951_0_0|SrvcGrp|82109|2022|PDM|890.00|99|0.00|REVISE ULNAR NERVE ELBOW
20|FH_F137972_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F137972_0_0|CSTM-ALL|CSTM-00|2020|PDM|1197.00|99|0.00|AEG 6 (NO REV)
20|FH_F137972_0_0|CSTM-ALL|CSTM-00|2020|PDM|1942.00|99|0.00|AEG 9 (NO REV)
20|FH_F137972_0_0|SrvcGrp|90567|2022|PDM|957.00|99|0.00|CILIARY BODY DESTRUCTION
20|FH_F137984_0_0|CSTM-ALL|CSTM-00|2020|PCT|68.00|99|0.00|GENERAL ACUTE CARE
20|FH_F137986_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F137986_0_0|CSTM-ALL|CSTM-00|2020|PDM|1025.00|99|0.00|AEG 4 (NO REV)
20|FH_F137986_0_0|CSTM-ALL|CSTM-00|2020|PDM|1600.00|99|0.00|AEG 7 (NO REV)
20|FH_F137986_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|AEG 9 (NO REV)
20|FH_F137986_0_0|SrvcGrp|26278|2022|PDM|1436.00|99|0.00|CPT 29881
20|FH_F137986_0_0|SrvcGrp|33984|2022|PDM|1479.00|99|0.00|HAMMERTOE CORRECTION
20|FH_F137986_0_0|SrvcGrp|35668|2022|PDM|1436.00|99|0.00|CPT 29824
20|FH_F137986_0_0|SrvcGrp|35672|2022|PDM|3132.00|99|0.00|CPT 23412
20|FH_F137986_0_0|SrvcGrp|36591|2022|PDM|3000.00|99|0.00|CPT 63685
20|FH_F137986_0_0|SrvcGrp|54943|2022|PDM|3131.00|99|0.00|REPAIR OF SLAP LESION
20|FH_F137986_0_0|SrvcGrp|70749|2022|PDM|1478.00|99|0.00|CPT 29823
20|FH_F137986_0_0|SrvcGrp|82109|2022|PDM|890.00|99|0.00|REVISE ULNAR NERVE ELBOW
20|FH_F137986_0_0|SrvcGrp|85792|2022|PDM|4490.00|99|0.00|OPEN TREATMENT OF DISTAL
20|FH_F137986_0_0|SrvcGrp|88065|2022|PDM|3000.00|99|0.00|TOTAL DISC ARTHROPLASTY
20|FH_F137986_0_0|SrvcGrp|90365|2022|PDM|1436.00|99|0.00|REPAIR METACARPAL FRACTURE
20|FH_F137986_0_0|SrvcGrp|97484|2022|PDM|1458.00|99|0.00|ENDO CHOLANGIOPANCREATOGRAPH
20|FH_F138010_0_0|SrvcGrp|63297|2022|PDM|100.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F138010_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F138021_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F138021_0_0|CSTM-ALL|CSTM-00|2020|PDM|440.00|99|0.00|AEG 2 (NO REV)
20|FH_F138021_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 3 (NO REV)
20|FH_F138021_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|AEG 10 (NO REV)
20|FH_F138021_0_0|CSTM-ALL|CSTM-00|2020|PDM|835.00|99|0.00|AEG 6 (NO REV)
20|FH_F138021_0_0|SrvcGrp|112862|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F138021_0_0|SrvcGrp|113084|2022|PCT|0.00|99|0.00|CARDIAC CATH NOT REIMBURSED
20|FH_F138054_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F138054_0_0|SrvcGrp|11442|2022|PDM|881.00|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)
20|FH_F138054_0_0|SrvcGrp|22954|2022|PDM|240.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F138054_0_0|SrvcGrp|3327|2022|PDM|257.00|99|0.00|HOSPICE SERVICE - IP RESPITE
20|FH_F138054_0_0|SrvcGrp|42972|2022|PDM|66.63|99|0.00|HOME HEALTH AIDE
20|FH_F138054_0_0|SrvcGrp|57968|2022|PDM|58.22|99|0.00|CONTINUOUS HOMECARE
20|FH_F138054_0_0|SrvcGrp|66264|2022|PDM|146.00|99|0.00|PHYSICAL THERAPY SERVICES
20|FH_F138191_0_0|SrvcGrp|82981|2022|PDM|120.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F138196_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F138196_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F138196_0_0|CSTM-ALL|CSTM-00|2020|PDM|1028.00|99|0.00|AEG 6 (NO REV)
20|FH_F138196_0_0|CSTM-ALL|CSTM-00|2020|PDM|404.00|99|0.00|AEG 1 (NO REV)
20|FH_F138196_0_0|CSTM-ALL|CSTM-00|2020|PDM|544.00|99|0.00|AEG 2 (NO REV)
20|FH_F138196_0_0|SrvcGrp|76243|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F138197_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F138197_0_0|CSTM-ALL|CSTM-00|2020|PDM|1089.90|99|0.00|AEG 4 (NO REV)
20|FH_F138197_0_0|SrvcGrp|109220|2022|PDM|1720.95|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F138197_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F138216_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F138217_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F138217_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F138217_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F138218_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F138218_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F138219_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F138219_0_0|SrvcGrp|113090|2022|PDM|424.00|99|0.00|HEMODIALYSIS
20|FH_F138219_0_0|SrvcGrp|113091|2022|PDM|164.00|99|0.00|ACUTE KIDNEY INJURY
20|FH_F138236_0_0|SrvcGrp|73656|2022|PDM|550.00|99|0.00|AETNA HOSPICE SVCS
20|FH_F138236_0_0|SrvcGrp|80317|2022|PDM|105.00|99|0.00|RESPITE CARE
20|FH_F138283_0_0|SrvcGrp|14494|2022|PDM|24.50|99|0.00|CONTINUOUS HOMECARE
20|FH_F138283_0_0|SrvcGrp|29346|2022|PDM|25.00|99|0.00|SKILLED NURSING- LPN
20|FH_F138283_0_0|SrvcGrp|43567|2022|PDM|112.00|99|0.00|SKILLED NURSING - POSTNATAL
20|FH_F138283_0_0|SrvcGrp|43955|2022|PDM|112.00|99|0.00|NURSING CARE
20|FH_F138283_0_0|SrvcGrp|57650|2022|PDM|60.00|99|0.00|OCCUPATIONAL THERAPY SVCS MOD GO
20|FH_F138283_0_0|SrvcGrp|92501|2022|PDM|120.00|99|0.00|HOSPICE IP RESPITE CARE
20|FH_F138283_0_0|SrvcGrp|92502|2022|PDM|525.00|99|0.00|HOSPICE GENERAL IP CARE
20|FH_F138296_0_0|CSTM-ALL|CSTM-00|2020|PCT|50.00|99|0.00|PHARMACY SVCS
20|FH_F138350_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F138350_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 5  (NO REV)
20|FH_F138350_0_0|CSTM-ALL|CSTM-00|2020|PDM|965.00|99|0.00|AEG 4 (NO REV)
20|FH_F138350_0_0|SrvcGrp|113277|2022|PDM|2122.00|99|0.00|AETNA ARTHROSCOPY SURGERY
20|FH_F138350_0_0|SrvcGrp|27310|2022|PDM|2122.00|99|0.00|ENDOSCOPIC PLANTAR FASCIOTOMY
20|FH_F138353_0_0|CSTM-ALL|CSTM-00|2020|PDM|672.00|99|0.00|AEG 5  (NO REV)
20|FH_F138353_0_0|CSTM-ALL|CSTM-00|2020|PDM|672.00|99|0.00|AEG 7 (NO REV)
20|FH_F138353_0_0|CSTM-ALL|CSTM-00|2020|PDM|672.00|99|0.00|AEG 9 (NO REV)
20|FH_F138416_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F138416_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|RESPITE CARE
20|FH_F138417_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT
20|FH_F138420_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F138420_0_0|CSTM-ALL|CSTM-00|2020|PDM|2383.00|99|0.00|AEG 9 (NO REV)
20|FH_F138422_0_0|CSTM-ALL|CSTM-00|2020|PDM|562.00|99|0.00|AEG 3 (NO REV)
20|FH_F138422_0_0|CSTM-ALL|CSTM-00|2020|PDM|562.00|99|0.00|AEG 4 (NO REV)
20|FH_F138422_0_0|CSTM-ALL|CSTM-00|2020|PDM|562.00|99|0.00|AEG 8 (NO REV)
20|FH_F138450_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.93|99|0.00|GENERAL ACUTE CARE
20|FH_F138450_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.93|99|0.00|OP SVCS
20|FH_F138450_0_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC
20|FH_F138450_0_0|SrvcGrp|111928|2022|PDM|51.30|99|0.00|COVID-19 BARTONELLA
20|FH_F138450_0_0|SrvcGrp|112727|2022|PDM|45.23|99|0.00|COVID-19 IA NFCT AB SARS COV 2
20|FH_F138450_0_0|SrvcGrp|79699|2022|PCT|0.93|99|0.00|CARDIAC CATHETERIZATION INJECTIONS
20|FH_F138451_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F138452_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F138452_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|SUBACUTE CARE
20|FH_F138457_0_0|CSTM-ALL|CSTM-00|2020|PDM|573.00|99|0.00|AEG 1 (NO REV)
20|FH_F138460_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP PARTIAL HOSPITALIZATION
20|FH_F138478_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F138478_0_0|SrvcGrp|107792|2022|PDM|5622.94|99|0.00|DIALYSIS CIRCUIT PROCEDURE
20|FH_F138478_0_0|SrvcGrp|107878|2022|PDM|1905.93|99|0.00|INTRO CATH DIALYSIS CIRCUIT
20|FH_F138478_0_0|SrvcGrp|107879|2022|PDM|2558.53|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT
20|FH_F138478_0_0|SrvcGrp|108078|2022|PDM|1193.56|99|0.00|ARTERY-VEIN FUSION
20|FH_F138478_0_0|SrvcGrp|109496|2022|PDM|6732.64|99|0.00|UPGRADE OF IMPLANTED PACEMAK
20|FH_F138478_0_0|SrvcGrp|109498|2022|PDM|4867.04|99|0.00|INSERT 1 ELECTRODE PM-DEFIB
20|FH_F138478_0_0|SrvcGrp|109499|2022|PDM|5938.22|99|0.00|INSERT 2 ELECTRODE PM-DEFIB
20|FH_F138478_0_0|SrvcGrp|109510|2022|PDM|1736.59|99|0.00|REMOVE PACEMAKER ELECTRODE
20|FH_F138478_0_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F138478_0_0|SrvcGrp|77278|2022|PDM|1193.56|99|0.00|AETNA REPL TUNNLD CNTRL CVC W/O PORT/PUMP
20|FH_F138488_0_0|CSTM-ALL|CSTM-00|2020|PDM|581.11|99|0.00|AEG 4 (NO REV)
20|FH_F138488_0_0|CSTM-ALL|CSTM-00|2020|PDM|661.00|99|0.00|AEG 10 (NO REV)
20|FH_F138488_0_0|CSTM-ALL|CSTM-00|2020|PDM|661.00|99|0.00|AEG 2 (NO REV)
20|FH_F138488_0_0|CSTM-ALL|CSTM-00|2020|PDM|871.86|99|0.00|AEG 7 (NO REV)
20|FH_F138491_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F138491_0_0|SrvcGrp|95660|2022|PDM|400.00|99|0.00|HOSPICE SERVICES (HCFA)
20|FH_F138491_0_0|SrvcGrp|95661|2022|PDM|85.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F138532_0_0|SrvcGrp|113367|2022|PDM|182.00|99|0.00|CAPD/CCPD
20|FH_F138540_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F138540_0_0|CSTM-ALL|CSTM-00|2020|PCT|61.00|99|0.00|AEG 1 (NO REV)
20|FH_F138578_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F138588_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS
20|FH_F138611_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F138611_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F138611_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|AEG 10 (NO REV)
20|FH_F138611_0_0|SrvcGrp|80617|2022|PDM|14894.00|99|0.00|ARTHOPLASTY
20|FH_F138611_0_0|SrvcGrp|97741|2022|PDM|14894.00|99|0.00|REVISE KNEE
20|FH_F138611_0_0|SrvcGrp|97895|2022|PDM|14894.00|99|0.00|REVISE KNEE 2
20|FH_F138611_0_0|SrvcGrp|99161|2022|PDM|14894.00|99|0.00|CPT 27138
20|FH_F138647_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F138667_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE
20|FH_F138667_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS
20|FH_F138682_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F138682_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F138682_0_0|CSTM-ALL|CSTM-00|2020|PDM|483.00|99|0.00|AEG 1 (NO REV)
20|FH_F138682_0_0|CSTM-ALL|CSTM-00|2020|PDM|483.00|99|0.00|AEG 8 (NO REV)
20|FH_F138710_0_0|SrvcGrp|82981|2022|PDM|125.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F138751_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F138751_0_0|SrvcGrp|107746|2022|PCT|0.90|99|0.00|PARSABIV
20|FH_F138751_0_0|SrvcGrp|108042|2022|PDM|424.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD
20|FH_F138882_0_0|CSTM-ALL|CSTM-00|2020|PDM|3023.00|99|0.00|AEG 5  (NO REV)
20|FH_F138882_0_0|CSTM-ALL|CSTM-00|2020|PDM|3552.00|99|0.00|AEG 7 (NO REV)
20|FH_F138882_0_0|CSTM-ALL|CSTM-00|2020|PDM|3750.00|99|0.00|AEG 9 (NO REV)
20|FH_F138929_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F138929_0_0|CSTM-ALL|CSTM-00|2020|PDM|1760.00|99|0.00|AEG 7 (NO REV)
20|FH_F138929_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F138929_0_0|SrvcGrp|108260|2022|PDM|1320.00|99|0.00|AETNA FIXATION OF KNEE JOINT
20|FH_F138929_0_0|SrvcGrp|33986|2022|PDM|1595.00|99|0.00|CPT 26055
20|FH_F138929_0_0|SrvcGrp|34606|2022|PDM|4620.00|99|0.00|CPT 29827
20|FH_F138929_0_0|SrvcGrp|36591|2022|PDM|15400.00|99|0.00|CPT 63685
20|FH_F138929_0_0|SrvcGrp|41335|2022|PDM|17600.00|99|0.00|TOTAL HIP
20|FH_F138929_0_0|SrvcGrp|67065|2022|PDM|14850.00|99|0.00|CERVICAL SURGERY
20|FH_F138929_0_0|SrvcGrp|67066|2022|PDM|11000.00|99|0.00|CERVICAL SURGERY
20|FH_F138929_0_0|SrvcGrp|70749|2022|PDM|3520.00|99|0.00|CPT 29823
20|FH_F138929_0_0|SrvcGrp|82110|2022|PDM|3300.00|99|0.00|KNEE ARTHROSCOPY DIAGNOSTIC
20|FH_F138929_0_0|SrvcGrp|87677|2022|PDM|1457.50|99|0.00|CERVICAL OR THORACIC SURGERY
20|FH_F138929_0_0|SrvcGrp|88159|2022|PDM|6600.00|99|0.00|LOW BACK DISK SURGERY
20|FH_F138929_0_0|SrvcGrp|88163|2022|PDM|13750.00|99|0.00|LUMBAR SPINE FUSION
20|FH_F138929_0_0|SrvcGrp|89842|2022|PDM|13750.00|99|0.00|LUMBAR
20|FH_F138929_0_0|SrvcGrp|95559|2022|PDM|17600.00|99|0.00|HIP JOINT
20|FH_F138929_0_0|SrvcGrp|99166|2022|PDM|6600.00|99|0.00|CPT 63005
20|FH_F138932_0_0|CSTM-ALL|CSTM-00|2020|PCT|36500.00|99|0.00|TIMELY FILING
20|FH_F138932_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.50|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F138934_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F138934_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|AEG 2 (NO REV)
20|FH_F138934_0_0|SrvcGrp|79579|2022|PDM|675.00|99|0.00|CPT 43251
20|FH_F138963_0_0|SrvcGrp|16|2022|PDM|1031.00|99|0.00|ACUTE REHABILITATION
20|FH_F138987_0_0|SrvcGrp|83521|2022|PDM|130.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F138987_0_0|SrvcGrp|83857|2022|PDM|665.00|99|0.00|IP HOSPICE SVCS
20|FH_F138987_0_0|SrvcGrp|90707|2022|PDM|129.00|99|0.00|AETNA HOSPICE CARE
20|FH_F138995_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|AEG 7 (NO REV)
20|FH_F138995_0_0|CSTM-ALL|CSTM-00|2020|PDM|548.00|99|0.00|AEG 1 (NO REV)
20|FH_F138995_0_0|CSTM-ALL|CSTM-00|2020|PDM|775.00|99|0.00|AEG 2 (NO REV)
20|FH_F138995_0_0|CSTM-ALL|CSTM-00|2020|PDM|951.00|99|0.00|AEG 10 (NO REV)
20|FH_F138995_0_0|SrvcGrp|106265|2022|PDM|1900.00|99|0.00|NSL/SINS NDSC TOTAL
20|FH_F138995_0_0|SrvcGrp|113277|2022|PDM|1575.00|99|0.00|AETNA ARTHROSCOPY SURGERY
20|FH_F138995_0_0|SrvcGrp|36991|2022|PCT|0.00|99|0.00|IMPLANTS
20|FH_F138995_0_0|SrvcGrp|98402|2022|PDM|2150.00|99|0.00|RHINO INCL MJR SEPTAL RPR
20|FH_F139048_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F139048_0_0|CSTM-ALL|CSTM-00|2020|PDM|1045.00|99|0.00|AEG 4 (NO REV)
20|FH_F139048_0_0|CSTM-ALL|CSTM-00|2020|PDM|1233.00|99|0.00|AEG 6 (NO REV)
20|FH_F139048_0_0|CSTM-ALL|CSTM-00|2020|PDM|1452.00|99|0.00|AEG 8 (NO REV)
20|FH_F139048_0_0|CSTM-ALL|CSTM-00|2020|PDM|942.00|99|0.00|AEG 10 (NO REV)
20|FH_F139147_0_0|SrvcGrp|79593|2022|PDM|1804.00|99|0.00|CPT 45378
20|FH_F139147_0_0|SrvcGrp|88599|2022|PDM|5305.00|99|0.00|ENDOSCOPY MAXILLARY SINUS
20|FH_F139147_0_0|SrvcGrp|88823|2022|PDM|5150.00|99|0.00|REPAIR OF EARDRUM
20|FH_F139164_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F139169_0_0|CSTM-ALL|CSTM-00|2020|PDM|1416.00|99|0.00|AEG 6 (NO REV)
20|FH_F139169_0_0|CSTM-ALL|CSTM-00|2020|PDM|1672.56|99|0.00|AEG 7 (NO REV)
20|FH_F139169_0_0|CSTM-ALL|CSTM-00|2020|PDM|857.29|99|0.00|AEG 3 (NO REV)
20|FH_F139169_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F139169_0_0|SrvcGrp|35669|2022|PDM|5500.00|99|0.00|CPT 63650
20|FH_F139173_0_0|SrvcGrp|63297|2022|PDM|172.09|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F139173_0_0|SrvcGrp|65720|2022|PDM|172.09|99|0.00|RESPITE CARE
20|FH_F139173_0_0|SrvcGrp|73700|2022|PDM|176.00|99|0.00|AETNA - SKILLED NURSING
20|FH_F139173_0_0|SrvcGrp|89781|2022|PDM|172.09|99|0.00|RESPITE CARE (HCFA)
20|FH_F139177_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F139177_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F139177_0_0|CSTM-ALL|CSTM-00|2020|PDM|1112.00|99|0.00|AEG 10 (NO REV)
20|FH_F139177_0_0|CSTM-ALL|CSTM-00|2020|PDM|1313.00|99|0.00|AEG 6 (NO REV)
20|FH_F139177_0_0|CSTM-ALL|CSTM-00|2020|PDM|1529.00|99|0.00|AEG 7 (NO REV)
20|FH_F139177_0_0|CSTM-ALL|CSTM-00|2020|PDM|691.00|99|0.00|AEG 2 (NO REV)
20|FH_F139177_0_0|CSTM-ALL|CSTM-00|2020|PDM|973.00|99|0.00|AEG 4 (NO REV)
20|FH_F139177_0_0|SrvcGrp|11663|2022|PCT|0.32|99|0.00|IMPLANTS
20|FH_F139177_0_0|SrvcGrp|12491|2022|PCT|0.41|99|0.00|PACEMAKER
20|FH_F139236_0_0|CSTM-ALL|CSTM-00|2020|PDM|1131.00|99|0.00|AEG 10 (NO REV)
20|FH_F139236_0_0|CSTM-ALL|CSTM-00|2020|PDM|1556.00|99|0.00|AEG 7 (NO REV)
20|FH_F139236_0_0|CSTM-ALL|CSTM-00|2020|PDM|1922.00|99|0.00|AEG 9 (NO REV)
20|FH_F139236_0_0|CSTM-ALL|CSTM-00|2020|PDM|521.00|99|0.00|AEG 1 (NO REV)
20|FH_F139236_0_0|CSTM-ALL|CSTM-00|2020|PDM|704.00|99|0.00|AEG 2 (NO REV)
20|FH_F139236_0_0|CSTM-ALL|CSTM-00|2020|PDM|803.00|99|0.00|AEG 3 (NO REV)
20|FH_F139236_0_0|SrvcGrp|11259|2022|PCT|0.26|99|0.00|DRUGS
20|FH_F139236_0_0|SrvcGrp|12664|2022|PCT|0.75|99|0.00|IMPLANTS
20|FH_F139241_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F139241_0_0|CSTM-ALL|CSTM-00|2020|PDM|836.00|99|0.00|AEG 10 (NO REV)
20|FH_F139241_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F139241_0_0|SrvcGrp|113562|2022|PDM|1858.00|99|0.00|ARTHROSCOPY
20|FH_F139241_0_0|SrvcGrp|11673|2022|PDM|2022.00|99|0.00|CPT 29888
20|FH_F139241_0_0|SrvcGrp|26281|2022|PDM|1858.00|99|0.00|CPT 58353
20|FH_F139241_0_0|SrvcGrp|35667|2022|PDM|1311.00|99|0.00|CPT 20680
20|FH_F139241_0_0|SrvcGrp|58671|2022|PDM|1257.00|99|0.00|ASC CARVE OUT 64721
20|FH_F139241_0_0|SrvcGrp|59840|2022|PDM|1147.00|99|0.00|TYMPANOSTOMY
20|FH_F139241_0_0|SrvcGrp|77580|2022|PDM|1420.00|99|0.00|CPT 28296 - 28299
20|FH_F139241_0_0|SrvcGrp|77584|2022|PDM|765.00|99|0.00|DIAGNOSTIC COLONOSCOPY
20|FH_F139274_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F139274_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F139289_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F139289_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F139289_0_0|SrvcGrp|113492|2022|PDM|195.36|99|0.00|HOSPICE ROUTINE HOME CARE
20|FH_F139299_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F139299_0_0|SrvcGrp|73841|2022|PDM|435.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP
20|FH_F139299_0_0|SrvcGrp|86722|2022|PDM|230.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)
20|FH_F139309_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F139470_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F139470_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F139509_0_0|CSTM-ALL|CSTM-00|2020|PDM|495.00|99|0.00|AEG 3 (NO REV)
20|FH_F139515_0_0|CSTM-ALL|CSTM-00|2020|PDM|1030.00|99|0.00|AEG 4 (NO REV)
20|FH_F139515_0_0|CSTM-ALL|CSTM-00|2020|PDM|1854.00|99|0.00|AEG 9 (NO REV)
20|FH_F139515_0_0|CSTM-ALL|CSTM-00|2020|PDM|639.00|99|0.00|AEG 1 (NO REV)
20|FH_F139515_0_0|CSTM-ALL|CSTM-00|2020|PDM|721.00|99|0.00|AEG 2 (NO REV)
20|FH_F139515_0_0|SrvcGrp|105235|2022|PDM|3348.00|99|0.00|PARTIAL REMOVAL OF THYROID
20|FH_F139515_0_0|SrvcGrp|106265|2022|PDM|4352.00|99|0.00|NSL/SINS NDSC TOTAL
20|FH_F139515_0_0|SrvcGrp|106267|2022|PDM|2900.00|99|0.00|NSL/SINS NDSC SPHN TISS RMVL
20|FH_F139515_0_0|SrvcGrp|109957|2022|PDM|15862.00|99|0.00|REVISE CERV ARTIFIC DISC
20|FH_F139515_0_0|SrvcGrp|109966|2022|PDM|8549.00|99|0.00|DECOMPRESS SPINE CORD ADD-ON
20|FH_F139515_0_0|SrvcGrp|109967|2022|PDM|10653.00|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F139515_0_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS
20|FH_F139515_0_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F139515_0_0|SrvcGrp|11673|2022|PDM|3200.00|99|0.00|CPT 29888
20|FH_F139515_0_0|SrvcGrp|13187|2022|PCT|0.00|99|0.00|INTRAOCULAR LENSES
20|FH_F139515_0_0|SrvcGrp|14614|2022|PDM|4179.00|99|0.00|LITHOTRIPSY
20|FH_F139515_0_0|SrvcGrp|16732|2022|PDM|2150.00|99|0.00|HYSTEROSCOPY ABLATION
20|FH_F139515_0_0|SrvcGrp|27402|2022|PDM|2985.00|99|0.00|LASER PROCEDURES
20|FH_F139515_0_0|SrvcGrp|33985|2022|PDM|1250.00|99|0.00|CPT 19120
20|FH_F139515_0_0|SrvcGrp|37984|2022|PDM|1791.00|99|0.00|LUMBAR INJECTIONS PROCEDURE
20|FH_F139515_0_0|SrvcGrp|38364|2022|PDM|8549.00|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F139515_0_0|SrvcGrp|39604|2022|PDM|2632.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F139515_0_0|SrvcGrp|54962|2022|PDM|1910.00|99|0.00|RECONSTRUCTION OF SHOULDER CUFF (ROTATOR)
20|FH_F139515_0_0|SrvcGrp|59705|2022|PDM|2060.00|99|0.00|SEPTOPLASTY
20|FH_F139515_0_0|SrvcGrp|67119|2022|PDM|11840.00|99|0.00|ARTHODESIS
20|FH_F139515_0_0|SrvcGrp|74039|2022|PDM|8196.00|99|0.00|LAMINECTOMY
20|FH_F139515_0_0|SrvcGrp|75885|2022|PDM|2318.00|99|0.00|AETNA CPT 49560
20|FH_F139515_0_0|SrvcGrp|78283|2022|PDM|2395.00|99|0.00|CPT 49505
20|FH_F139515_0_0|SrvcGrp|82109|2022|PDM|1626.00|99|0.00|REVISE ULNAR NERVE ELBOW
20|FH_F139515_0_0|SrvcGrp|88158|2022|PDM|8549.00|99|0.00|NECK SPINE DISK SURGERY
20|FH_F139515_0_0|SrvcGrp|88163|2022|PDM|11473.00|99|0.00|LUMBAR SPINE FUSION
20|FH_F139515_0_0|SrvcGrp|89404|2022|PDM|10686.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F139515_0_0|SrvcGrp|90343|2022|PDM|8549.00|99|0.00|CERVICE CORPECTOMY 1 LEVEL
20|FH_F139515_0_0|SrvcGrp|90779|2022|PDM|2318.00|99|0.00|HERNIA PROCEDURES
20|FH_F139515_0_0|SrvcGrp|90799|2022|PDM|2250.00|99|0.00|REPAIR VENTRAL HERNIA INI BLOCK
20|FH_F139515_0_0|SrvcGrp|92413|2022|PDM|8549.00|99|0.00|SPINAL CRD DECOMP->2 THORAC
20|FH_F139515_0_0|SrvcGrp|93807|2022|PDM|8837.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY
20|FH_F139515_0_0|SrvcGrp|96839|2022|PDM|14072.00|99|0.00|REVISE SPINE ELTRD PLATE
20|FH_F139530_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F139551_0_0|CSTM-ALL|CSTM-00|2020|PDM|2280.00|99|0.00|AEG 3 (NO REV)
20|FH_F139551_0_0|CSTM-ALL|CSTM-00|2020|PDM|2322.00|99|0.00|AEG 8 (NO REV)
20|FH_F139551_0_0|CSTM-ALL|CSTM-00|2020|PDM|2620.00|99|0.00|AEG 5  (NO REV)
20|FH_F139551_0_0|CSTM-ALL|CSTM-00|2020|PDM|3140.00|99|0.00|AEG 9 (NO REV)
20|FH_F139551_0_0|SrvcGrp|110765|2022|PDM|1725.00|99|0.00|2ND LEVEL INJ PARAVERT F JNT C/T
20|FH_F139551_0_0|SrvcGrp|26432|2022|PDM|4400.00|99|0.00|OP SURGICAL SERVICES
20|FH_F139551_0_0|SrvcGrp|34606|2022|PDM|5000.00|99|0.00|CPT 29827
20|FH_F139551_0_0|SrvcGrp|54943|2022|PDM|3921.00|99|0.00|REPAIR OF SLAP LESION
20|FH_F139551_0_0|SrvcGrp|67065|2022|PDM|13234.00|99|0.00|CERVICAL SURGERY
20|FH_F139551_0_0|SrvcGrp|67066|2022|PDM|13897.00|99|0.00|CERVICAL SURGERY
20|FH_F139551_0_0|SrvcGrp|77461|2022|PDM|2650.00|99|0.00|CPT 52356
20|FH_F139551_0_0|SrvcGrp|78282|2022|PDM|4100.00|99|0.00|CPT 47563
20|FH_F139551_0_0|SrvcGrp|82298|2022|PDM|10764.00|99|0.00|AETNA LAP SLEEVE GASTRECTOMY
20|FH_F139551_0_0|SrvcGrp|87845|2022|PDM|1999.00|99|0.00|GASTRIC RESTRICTIVE PROCEDURE
20|FH_F139551_0_0|SrvcGrp|89861|2022|PDM|5769.00|99|0.00|LUMBAR LAMINOTOMY
20|FH_F139565_0_0|CSTM-ALL|CSTM-00|2020|PDM|1916.00|99|0.00|AEG 6 (NO REV)
20|FH_F139565_0_0|CSTM-ALL|CSTM-00|2020|PDM|2265.00|99|0.00|AEG 8 (NO REV)
20|FH_F139565_0_0|SrvcGrp|109348|2022|PDM|2869.00|99|0.00|EXCISION OF LESION OF EYELID
20|FH_F139565_0_0|SrvcGrp|109760|2022|PDM|6885.00|99|0.00|TRANSLUM DIL EYE CANAL
20|FH_F139565_0_0|SrvcGrp|109762|2022|PDM|4590.00|99|0.00|REMOVE EYELID LESION(S)
20|FH_F139565_0_0|SrvcGrp|42427|2022|PDM|6885.00|99|0.00|OP SURGERY CPT 65420
20|FH_F139565_0_0|SrvcGrp|77507|2022|PCT|1.00|99|0.00|AETNA CORNEAL TISSUE HANDLING
20|FH_F139565_0_0|SrvcGrp|78046|2022|PCT|1.00|99|0.00|AETNA AQUEOUS SHUNT
20|FH_F139565_0_0|SrvcGrp|84278|2022|PDM|9754.00|99|0.00|CORNEAL TRANSPLANT
20|FH_F139565_0_0|SrvcGrp|92549|2022|PDM|5738.00|99|0.00|REMOVAL OF EYE LESION
20|FH_F139566_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F139573_0_0|SrvcGrp|57967|2022|PDM|169.47|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F139576_0_0|CSTM-ALL|CSTM-00|2020|PDM|3732.00|99|0.00|AEG 9 (NO REV)
20|FH_F139576_0_0|SrvcGrp|113576|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F139576_0_0|SrvcGrp|13925|2022|PDM|3716.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F139576_0_0|SrvcGrp|16693|2022|PDM|2812.00|99|0.00|KNEE SCOPE, MENISCECTOMY
20|FH_F139576_0_0|SrvcGrp|19922|2022|PDM|2448.00|99|0.00|ARTHROSCOPY OF SHOULDER
20|FH_F139576_0_0|SrvcGrp|75725|2022|PDM|2174.00|99|0.00|LASER PROCEDURES
20|FH_F139576_0_0|SrvcGrp|96919|2022|PDM|2448.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F139576_0_0|SrvcGrp|96939|2022|PDM|2497.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F139580_0_0|SrvcGrp|107747|2022|PDM|318.00|99|0.00|HOME HEMODIALYSIS
20|FH_F139594_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 10 (NO REV)
20|FH_F139594_0_0|CSTM-ALL|CSTM-00|2020|PDM|1427.00|99|0.00|AEG 4 (NO REV)
20|FH_F139594_0_0|CSTM-ALL|CSTM-00|2020|PDM|1511.00|99|0.00|AEG 5  (NO REV)
20|FH_F139594_0_0|SrvcGrp|107441|2022|PDM|2754.00|99|0.00|AETNA CYSTOSCOPY PROSTATIC IMPLANTS
20|FH_F139594_0_0|SrvcGrp|38364|2022|PDM|4800.00|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F139607_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F139607_0_0|CSTM-ALL|CSTM-00|2020|PDM|1090.00|99|0.00|AEG 3 (NO REV)
20|FH_F139607_0_0|CSTM-ALL|CSTM-00|2020|PDM|1561.00|99|0.00|AEG 5  (NO REV)
20|FH_F139607_0_0|CSTM-ALL|CSTM-00|2020|PDM|2087.00|99|0.00|AEG 7 W/O SURG CARVEOUT (NO REV)
20|FH_F139607_0_0|CSTM-ALL|CSTM-00|2020|PDM|2184.00|99|0.00|AEG 8 (NO REV)
20|FH_F139607_0_0|CSTM-ALL|CSTM-00|2020|PDM|661.00|99|0.00|AEG 1 (NO REV)
20|FH_F139607_0_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F139607_0_0|SrvcGrp|11663|2022|PCT|0.30|99|0.00|IMPLANTS
20|FH_F139607_0_0|SrvcGrp|53703|2022|PDM|1122.00|99|0.00|REVISE AQUEOUS SHUNT TO EXTRAOCULAR RESIVOIR
20|FH_F139607_0_0|SrvcGrp|705|2022|PCT|0.30|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F139607_0_0|SrvcGrp|81571|2022|PDM|2335.00|99|0.00|NASAL ENDOSCOPY W/ SINUS OSTIA DILATION
20|FH_F139689_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F139689_0_0|SrvcGrp|107748|2022|PDM|541.00|99|0.00|HEMODIALYSIS IN CENTER
20|FH_F139690_0_0|SrvcGrp|108043|2022|PDM|214.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD
20|FH_F139703_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS
20|FH_F139715_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F139715_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.58|99|0.00|OP SVCS
20|FH_F139719_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F139719_0_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING
20|FH_F139750_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F139758_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F139779_0_0|CSTM-ALL|CSTM-00|2020|PCT|50.00|99|0.00|PHARMACY SVCS
20|FH_F139789_0_0|SrvcGrp|82981|2022|PDM|90.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F139825_0_0|CSTM-ALL|CSTM-00|2020|PDM|1473.00|99|0.00|AEG 10 (NO REV)
20|FH_F139825_0_0|CSTM-ALL|CSTM-00|2020|PDM|2338.00|99|0.00|AEG 7 (NO REV)
20|FH_F139825_0_0|SrvcGrp|106235|2022|PDM|6885.00|99|0.00|CYPASS
20|FH_F139825_0_0|SrvcGrp|109762|2022|PDM|4590.00|99|0.00|REMOVE EYELID LESION(S)
20|FH_F139825_0_0|SrvcGrp|109767|2022|PDM|2869.00|99|0.00|COVER EYE W/ MEMBRANE INCIDENTAL CODES
20|FH_F139825_0_0|SrvcGrp|114442|2022|PDM|11276.00|99|0.00|EXTRACAPSULAR CATARACT REMOVAL, INSERT LENS
20|FH_F139825_0_0|SrvcGrp|42429|2022|PDM|1721.00|99|0.00|OP SURGERY CPT 66761
20|FH_F139825_0_0|SrvcGrp|42550|2022|PDM|5738.00|99|0.00|OP SURGERY CPT 66984
20|FH_F139825_0_0|SrvcGrp|42551|2022|PDM|1721.00|99|0.00|OP SURGERY
20|FH_F139825_0_0|SrvcGrp|45583|2022|PDM|9754.00|99|0.00|CPT 65730
20|FH_F139825_0_0|SrvcGrp|46886|2022|PDM|4590.00|99|0.00|REMOVAL OF EYELID LESION
20|FH_F139825_0_0|SrvcGrp|46906|2022|PDM|9754.00|99|0.00|CORNEAL TISSUE
20|FH_F139825_0_0|SrvcGrp|77507|2022|PCT|1.00|99|0.00|AETNA CORNEAL TISSUE HANDLING
20|FH_F139825_0_0|SrvcGrp|84934|2022|PDM|6885.00|99|0.00|REMOVAL OF EYE LESION
20|FH_F139825_0_0|SrvcGrp|95819|2022|PDM|6885.00|99|0.00|GONIOTOMY
20|FH_F139873_0_0|CSTM-ALL|CSTM-00|2020|PDM|1752.00|99|0.00|AEG 6 (NO REV)
20|FH_F139873_0_0|CSTM-ALL|CSTM-00|2020|PDM|2063.00|99|0.00|AEG 8 (NO REV)
20|FH_F139873_0_0|CSTM-ALL|CSTM-00|2020|PDM|2831.00|99|0.00|AEG 9 (NO REV)
20|FH_F139873_0_0|SrvcGrp|11673|2022|PDM|2215.00|99|0.00|CPT 29888
20|FH_F139873_0_0|SrvcGrp|84279|2022|PDM|2992.00|99|0.00|CORNEAL TRANSPLANT
20|FH_F139887_0_0|CSTM-ALL|CSTM-00|2020|PDM|1197.00|99|0.00|AEG 6 (NO REV)
20|FH_F139887_0_0|CSTM-ALL|CSTM-00|2020|PDM|743.00|99|0.00|AEG 3 (NO REV)
20|FH_F139887_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 4 (NO REV)
20|FH_F139887_0_0|SrvcGrp|113591|2022|PDM|1007.00|99|0.00|REMOVAL OF TOE LESIONS
20|FH_F139916_0_0|SrvcGrp|73841|2022|PDM|453.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP
20|FH_F139916_0_0|SrvcGrp|90854|2022|PDM|855.00|99|0.00|AETNA IP DETOXIFICATION SERVICES
20|FH_F139927_0_0|SrvcGrp|10107|2022|PCT|0.60|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F139927_0_0|SrvcGrp|33165|2022|PDM|589.00|99|0.00|SKILLED NURSING - LEVEL II
20|FH_F139952_0_0|CSTM-ALL|CSTM-00|2020|PDM|691.00|99|0.00|AEG 1 (NO REV)
20|FH_F139952_0_0|CSTM-ALL|CSTM-00|2020|PDM|888.00|99|0.00|AEG 8 (NO REV)
20|FH_F140007_0_0|CSTM-ALL|CSTM-00|2020|PDM|1367.00|99|0.00|AEG 1 (NO REV)
20|FH_F140007_0_0|CSTM-ALL|CSTM-00|2020|PDM|2038.00|99|0.00|AEG 3 (NO REV)
20|FH_F140007_0_0|CSTM-ALL|CSTM-00|2020|PDM|2466.00|99|0.00|AEG 10 (NO REV)
20|FH_F140007_0_0|SrvcGrp|112026|2022|PDM|8045.00|99|0.00|TOTAL KNEE ARTHROPLASTY
20|FH_F140007_0_0|SrvcGrp|16692|2022|PDM|3470.00|99|0.00|KNEE SCOPE
20|FH_F140007_0_0|SrvcGrp|19991|2022|PDM|7887.00|99|0.00|NERVOUS SYSTEM SERVICES
20|FH_F140007_0_0|SrvcGrp|96349|2022|PDM|8045.00|99|0.00|NECK SPINE FUSE
20|FH_F140007_0_0|SrvcGrp|96353|2022|PDM|8045.00|99|0.00|RECONSTRUCT ANKLE JOINT
20|FH_F140007_0_0|SrvcGrp|96899|2022|PDM|8045.00|99|0.00|LUMBAR ARTIF DISCECTOMY
20|FH_F140007_0_0|SrvcGrp|96939|2022|PDM|4206.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F140007_0_0|SrvcGrp|97099|2022|PDM|8045.00|99|0.00|SPINAL DISK SURGERY ADD-ON
20|FH_F140007_0_0|SrvcGrp|97259|2022|PDM|8045.00|99|0.00|INCISE SPINAL COLUMN NERVES
20|FH_F140035_0_0|SrvcGrp|26160|2022|PDM|60.00|99|0.00|HOME HEALTH AIDE VISIT
20|FH_F140035_0_0|SrvcGrp|48385|2022|PDM|192.00|99|0.00|SPEECH THERAPY
20|FH_F140035_0_0|SrvcGrp|57968|2022|PDM|59.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F140035_0_0|SrvcGrp|72941|2022|PDM|257.00|99|0.00|HOSPICE CARE IN HOME
20|FH_F140102_0_0|SrvcGrp|82223|2022|PDM|105.00|99|0.00|HOSPICE CARE
20|FH_F140105_0_0|CSTM-ALL|CSTM-00|2020|PDM|1138.00|99|0.00|AEG 3 (NO REV)
20|FH_F140105_0_0|CSTM-ALL|CSTM-00|2020|PDM|677.00|99|0.00|AEG 1 (NO REV)
20|FH_F140105_0_0|CSTM-ALL|CSTM-00|2020|PDM|871.00|99|0.00|AEG 7 (NO REV)
20|FH_F140209_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 2 (NO REV)
20|FH_F140247_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F140295_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F140295_0_0|CSTM-ALL|CSTM-00|2020|PDM|1798.00|99|0.00|AEG 2 (NO REV)
20|FH_F140295_0_0|CSTM-ALL|CSTM-00|2020|PDM|2709.00|99|0.00|AEG 5  (NO REV)
20|FH_F140295_0_0|SrvcGrp|100043|2022|PDM|3899.00|99|0.00|FUSION OF FOOT BONES
20|FH_F140295_0_0|SrvcGrp|106680|2022|PDM|12875.00|99|0.00|REVISION OF ANKLE JOINT
20|FH_F140295_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F140295_0_0|SrvcGrp|26273|2022|PDM|3525.00|99|0.00|CPT 29880
20|FH_F140295_0_0|SrvcGrp|26278|2022|PDM|3193.00|99|0.00|CPT 29881
20|FH_F140295_0_0|SrvcGrp|33982|2022|PDM|3268.00|99|0.00|CPT 28296
20|FH_F140295_0_0|SrvcGrp|34606|2022|PDM|4352.00|99|0.00|CPT 29827
20|FH_F140295_0_0|SrvcGrp|35670|2022|PDM|6668.00|99|0.00|SPINAL NEUROSTIMULATORS PROCEDURE
20|FH_F140295_0_0|SrvcGrp|41335|2022|PDM|20085.00|99|0.00|TOTAL HIP
20|FH_F140295_0_0|SrvcGrp|58638|2022|PDM|3706.00|99|0.00|CPT 63688
20|FH_F140295_0_0|SrvcGrp|58993|2022|PDM|10603.00|99|0.00|DISKECTOMY
20|FH_F140295_0_0|SrvcGrp|67064|2022|PDM|1650.00|99|0.00|MUSCULOSKELETAL SYSTEM
20|FH_F140295_0_0|SrvcGrp|67066|2022|PDM|10300.00|99|0.00|CERVICAL SURGERY
20|FH_F140295_0_0|SrvcGrp|67072|2022|PDM|7282.00|99|0.00|CPT 22845
20|FH_F140295_0_0|SrvcGrp|67119|2022|PDM|5149.00|99|0.00|ARTHODESIS
20|FH_F140295_0_0|SrvcGrp|67279|2022|PDM|7720.00|99|0.00|CERVICAL SURGERY
20|FH_F140295_0_0|SrvcGrp|88340|2022|PDM|7874.00|99|0.00|SPINAL FUSION
20|FH_F140295_0_0|SrvcGrp|92819|2022|PDM|6212.00|99|0.00|HIP ARTHOSCOPY
20|FH_F140295_0_0|SrvcGrp|92820|2022|PDM|6474.00|99|0.00|HIP ARTHOSCOPY ACETABULOPLASTY
20|FH_F140295_0_0|SrvcGrp|96839|2022|PDM|4008.00|99|0.00|REVISE SPINE ELTRD PLATE
20|FH_F140340_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F140347_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE
20|FH_F140347_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS
20|FH_F140349_0_0|CSTM-ALL|CSTM-00|2020|PDM|428.00|99|0.00|AEG 5  (NO REV)
20|FH_F140373_0_0|CSTM-ALL|CSTM-00|2020|PDM|1291.00|99|0.00|AEG 6 (NO REV)
20|FH_F140373_0_0|CSTM-ALL|CSTM-00|2020|PDM|1590.00|99|0.00|AEG 7 (NO REV)
20|FH_F140373_0_0|CSTM-ALL|CSTM-00|2020|PDM|1922.00|99|0.00|AEG 9 (NO REV)
20|FH_F140373_0_0|CSTM-ALL|CSTM-00|2020|PDM|756.00|99|0.00|AEG 2 (NO REV)
20|FH_F140427_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F140427_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F140427_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 8 (NO REV)
20|FH_F140427_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 9 (NO REV)
20|FH_F140427_0_0|SrvcGrp|104921|2022|PDM|400.00|99|0.00|HEART FLOW RESERVE MEASURE-CONCUR
20|FH_F140427_0_0|SrvcGrp|104923|2022|PCT|1.00|99|0.00|CATHETER INTRAVASCULAR ULTRS
20|FH_F140427_0_0|SrvcGrp|104925|2022|PDM|5300.00|99|0.00|PRQ CARDIAC ANGIOPLAST 1 ART-CONCUR
20|FH_F140427_0_0|SrvcGrp|113114|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F140427_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F140427_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F140427_0_0|SrvcGrp|76023|2022|PDM|2500.00|99|0.00|OP AICD 33249
20|FH_F140472_0_0|SrvcGrp|15789|2022|PDM|80.00|99|0.00|SPEECH THERAPY
20|FH_F140472_0_0|SrvcGrp|16|2022|PDM|750.00|99|0.00|ACUTE REHABILITATION
20|FH_F140574_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F140575_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F140575_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F140576_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F140579_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|OP SVCS
20|FH_F140608_0_0|SrvcGrp|48398|2022|PDM|134.00|99|0.00|PT SERVICES
20|FH_F140629_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F140629_0_0|CSTM-ALL|CSTM-00|2020|PDM|1254.00|99|0.00|AEG 5  (NO REV)
20|FH_F140629_0_0|CSTM-ALL|CSTM-00|2020|PDM|1347.00|99|0.00|AEG 6 (NO REV)
20|FH_F140629_0_0|CSTM-ALL|CSTM-00|2020|PDM|1712.00|99|0.00|AEG 7 (NO REV)
20|FH_F140629_0_0|CSTM-ALL|CSTM-00|2020|PDM|1718.00|99|0.00|AEG 8 (NO REV)
20|FH_F140629_0_0|SrvcGrp|100661|2022|PDM|2497.00|99|0.00|AETNA OP SURGERY
20|FH_F140629_0_0|SrvcGrp|113481|2022|PDM|2497.00|99|0.00|LAPAROSCOPY
20|FH_F140629_0_0|SrvcGrp|113668|2022|PDM|2497.00|99|0.00|LYMPHATIC LAPAROSCOPY
20|FH_F140629_0_0|SrvcGrp|113670|2022|PDM|2497.00|99|0.00|LYMPH NODE BIOP LAPAROSCOPY
20|FH_F140629_0_0|SrvcGrp|113672|2022|PDM|2497.00|99|0.00|SPLENECTOMY LAPAROSCOPY
20|FH_F140629_0_0|SrvcGrp|113673|2022|PDM|2497.00|99|0.00|ENTEROLYSIS LAPAROSCOPY
20|FH_F140629_0_0|SrvcGrp|113676|2022|PDM|2497.00|99|0.00|LAPARO ABLATE LIVER CRYOSURG
20|FH_F140629_0_0|SrvcGrp|113677|2022|PDM|2497.00|99|0.00|UNLISTED LIVER LAPAROSCOPY
20|FH_F140629_0_0|SrvcGrp|113678|2022|PDM|2497.00|99|0.00|BILIARY LAPAROSCOPY
20|FH_F140629_0_0|SrvcGrp|113679|2022|PDM|2497.00|99|0.00|LAPARO DRAIN LYMPHOCELE
20|FH_F140629_0_0|SrvcGrp|113682|2022|PDM|2497.00|99|0.00|LAPARO URETHRAL SUSPENSION
20|FH_F140629_0_0|SrvcGrp|113684|2022|PDM|1302.00|99|0.00|RPR FEM HERNIA
20|FH_F140629_0_0|SrvcGrp|11663|2022|PCT|0.00|99|0.00|IMPLANTS
20|FH_F140629_0_0|SrvcGrp|27137|2022|PDM|2497.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F140629_0_0|SrvcGrp|27402|2022|PDM|3512.00|99|0.00|LASER PROCEDURES
20|FH_F140629_0_0|SrvcGrp|33967|2022|PDM|2497.00|99|0.00|CPT 47562
20|FH_F140629_0_0|SrvcGrp|63464|2022|PDM|1016.00|99|0.00|CPT 52276
20|FH_F140629_0_0|SrvcGrp|67989|2022|PDM|2497.00|99|0.00|CPT 49320
20|FH_F140629_0_0|SrvcGrp|78282|2022|PDM|2497.00|99|0.00|CPT 47563
20|FH_F140629_0_0|SrvcGrp|78283|2022|PDM|1302.00|99|0.00|CPT 49505
20|FH_F140629_0_0|SrvcGrp|82110|2022|PDM|2497.00|99|0.00|KNEE ARTHROSCOPY DIAGNOSTIC
20|FH_F140629_0_0|SrvcGrp|82112|2022|PDM|2497.00|99|0.00|KNEE ARTHROSCOPY SURGERY
20|FH_F140629_0_0|SrvcGrp|83648|2022|PDM|2497.00|99|0.00|CPT 47570
20|FH_F140629_0_0|SrvcGrp|86461|2022|PDM|1302.00|99|0.00|AREOLA RECONSTRUCTION
20|FH_F140629_0_0|SrvcGrp|88599|2022|PDM|1372.00|99|0.00|ENDOSCOPY MAXILLARY SINUS
20|FH_F140629_0_0|SrvcGrp|90822|2022|PDM|1372.00|99|0.00|NASAL/SINUS ENDOSCOPY SURGERY
20|FH_F140629_0_0|SrvcGrp|98526|2022|PDM|1016.00|99|0.00|CYSTOURETHROSCOPY
20|FH_F140651_0_0|CSTM-ALL|CSTM-00|2020|PDM|1056.00|99|0.00|AEG 2 (NO REV)
20|FH_F140689_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F140690_0_0|SrvcGrp|82981|2022|PDM|90.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F140762_0_0|CSTM-ALL|CSTM-00|2020|PDM|1019.00|99|0.00|AEG 5  (NO REV)
20|FH_F140762_0_0|CSTM-ALL|CSTM-00|2020|PDM|1193.00|99|0.00|AEG 6 (NO REV)
20|FH_F140762_0_0|CSTM-ALL|CSTM-00|2020|PDM|725.00|99|0.00|AEG 3 (NO REV)
20|FH_F140762_0_0|CSTM-ALL|CSTM-00|2020|PDM|894.00|99|0.00|AEG 10 (NO REV)
20|FH_F140762_0_0|CSTM-ALL|CSTM-00|2020|PDM|894.00|99|0.00|AEG 4 (NO REV)
20|FH_F140762_0_0|SrvcGrp|113694|2022|PDM|785.51|99|0.00|SURGERY OF EYE
20|FH_F140790_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F140790_0_0|CSTM-ALL|CSTM-00|2020|PDM|1021.00|99|0.00|AEG 6 (NO REV)
20|FH_F140790_0_0|CSTM-ALL|CSTM-00|2020|PDM|411.00|99|0.00|AEG 1 (NO REV)
20|FH_F140790_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|AEG 3 (NO REV)
20|FH_F140808_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F140808_0_0|CSTM-ALL|CSTM-00|2020|PDM|37.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F140827_0_0|CSTM-ALL|CSTM-00|2020|PDM|849.00|99|0.00|AEG 6 (NO REV)
20|FH_F140873_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F140873_0_0|SrvcGrp|80918|2022|PDM|145.00|99|0.00|RESPITE CARE
20|FH_F140987_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 1 (NO REV)
20|FH_F140987_0_0|CSTM-ALL|CSTM-00|2020|PDM|4750.00|99|0.00|AEG 8 (NO REV)
20|FH_F140987_0_0|CSTM-ALL|CSTM-00|2020|PDM|5000.00|99|0.00|AEG 9 (NO REV)
20|FH_F140987_0_0|CSTM-ALL|CSTM-00|2020|PDM|6500.00|99|0.00|AEG 7 (NO REV)
20|FH_F140987_0_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F140987_0_0|SrvcGrp|113576|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F140987_0_0|SrvcGrp|88157|2022|PDM|4000.00|99|0.00|TOTAL HIP ARTHROPLASTY
20|FH_F140987_0_0|SrvcGrp|93433|2022|PDM|4000.00|99|0.00|PARTIAL HIP REPLACEMENT
20|FH_F140987_0_0|SrvcGrp|99163|2022|PDM|3750.00|99|0.00|CPT 27703
20|FH_F140990_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F140990_0_0|SrvcGrp|108042|2022|PDM|584.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD
20|FH_F140990_0_0|SrvcGrp|108043|2022|PDM|250.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD
20|FH_F140990_0_0|SrvcGrp|113705|2022|PDM|250.00|99|0.00|CAPD/CCPD
20|FH_F141031_0_0|SrvcGrp|82981|2022|PDM|90.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F141034_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F141034_0_0|SrvcGrp|108443|2022|PDM|400.00|99|0.00|HEMODIALYSIS W/ TRAINING
20|FH_F141035_0_0|CSTM-ALL|CSTM-00|2020|PDM|2179.00|99|0.00|AEG 5  (NO REV)
20|FH_F141035_0_0|SrvcGrp|100081|2022|PDM|3309.00|99|0.00|EXC HAND TUM DEEP
20|FH_F141035_0_0|SrvcGrp|103563|2022|PDM|3932.00|99|0.00|REPAIR HAND TENDON
20|FH_F141035_0_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS
20|FH_F141035_0_0|SrvcGrp|113711|2022|PDM|6016.00|99|0.00|REMOVE MUSCLE FOREIGN BODY
20|FH_F141035_0_0|SrvcGrp|113713|2022|PDM|7008.00|99|0.00|REVISE WRIST JOINT
20|FH_F141035_0_0|SrvcGrp|113716|2022|PDM|2275.00|99|0.00|NJX AA / STR AXILLARY NERVE
20|FH_F141035_0_0|SrvcGrp|35667|2022|PDM|6016.00|99|0.00|CPT 20680
20|FH_F141035_0_0|SrvcGrp|58671|2022|PDM|4359.00|99|0.00|ASC CARVE OUT 64721
20|FH_F141129_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F141129_0_0|SrvcGrp|43891|2022|PDM|32.00|99|0.00|RN HOURLY PEDS
20|FH_F141129_0_0|SrvcGrp|72780|2022|PDM|19.50|99|0.00|HOME HEALTH AIDE - VISIT LEVEL
20|FH_F141167_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F141169_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F141169_0_0|CSTM-ALL|CSTM-00|2020|PDM|1075.00|99|0.00|AEG 8 (NO REV)
20|FH_F141169_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 7 (NO REV)
20|FH_F141169_0_0|CSTM-ALL|CSTM-00|2020|PDM|493.00|99|0.00|AEG 2 (NO REV)
20|FH_F38526_0_0|SrvcGrp|15762|2022|PCT|0.90|99|0.00|TRAUMA
20|FH_F38526_0_0|SrvcGrp|16|2022|PDM|1125.00|99|0.00|ACUTE REHABILITATION
20|FH_F38526_0_0|SrvcGrp|3037|2022|PDM|6115.00|99|0.00|LITHOTRIPSY
20|FH_F38526_0_0|SrvcGrp|359|2022|PDM|2100.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL I
20|FH_F38526_0_0|SrvcGrp|43|2022|PCT|0.65|99|0.00|IMPLANTS
20|FH_F38526_0_0|SrvcGrp|453|2022|PDM|520.00|99|0.00|PSYCH PARTIAL HOSP
20|FH_F38526_0_0|SrvcGrp|6|2022|PCT|0.79|99|0.00|OP SURGERY
20|FH_F38526_0_0|SrvcGrp|675|2022|PDM|1770.00|99|0.00|PEDIATRIC INPATIENT SVCS
20|FH_F38560_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|PEDIATRIC CV SURGERY (MS DRG)
20|FH_F38560_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|TRAUMA CARE
20|FH_F38560_0_0|SrvcGrp|29542|2022|PDM|15200.00|99|0.00|PEDIATRIC VALVE REPAIR/REPLACE (MS DRG)
20|FH_F38560_0_0|SrvcGrp|29555|2022|PDM|16500.00|99|0.00|ADULT AICD IMPLANT W/THORACOTOMY
20|FH_F38567_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|GENERAL ACUTE CARE
20|FH_F38567_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|OP SVCS
20|FH_F38584_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38584_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F38584_0_0|SrvcGrp|17075|2022|PDM|1334.00|99|0.00|ASPG VI
20|FH_F38584_0_0|SrvcGrp|23585|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F38591_0_0|CSTM-ALL|CSTM-00|2020|PDM|1831.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38591_0_0|SrvcGrp|10107|2022|PCT|0.70|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F38591_0_0|SrvcGrp|11663|2022|PCT|0.70|99|0.00|IMPLANTS
20|FH_F38591_0_0|SrvcGrp|12280|2022|PCT|0.70|99|0.00|IMPLANTS
20|FH_F38591_0_0|SrvcGrp|12491|2022|PCT|0.70|99|0.00|PACEMAKER
20|FH_F38591_0_0|SrvcGrp|12840|2022|PCT|0.70|99|0.00|PACEMAKER
20|FH_F38591_0_0|SrvcGrp|29817|2022|PDM|3979.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F38591_0_0|SrvcGrp|30623|2022|PDM|5570.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788
20|FH_F38591_0_0|SrvcGrp|360|2022|PDM|1831.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F38591_0_0|SrvcGrp|58|2022|PDM|8594.00|99|0.00|IP LITHOTRIPSY SVCS
20|FH_F38591_0_0|SrvcGrp|941|2022|PDM|3682.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F38601_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38607_0_0|SrvcGrp|35054|2022|PDM|1200.00|99|0.00|SKILLED NURSING - LEVEL 2
20|FH_F38673_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F38677_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F38677_0_0|SrvcGrp|21814|2022|PDM|135.00|99|0.00|CAPD/CCPD SUPPLEMENT
20|FH_F38677_0_0|SrvcGrp|21815|2022|PDM|135.00|99|0.00|CAPD/CCPD SUPPLEMENT
20|FH_F38691_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 221
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 223
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 233
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 247
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 249
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 250
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 286
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 287
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 417
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 419
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 467
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 490
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PDM|867.00|99|0.00|MS DRG 876, 880-887 ACUTE PSYCHIATRIC
20|FH_F38700_0_0|SrvcGrp|3029|2022|PDM|578.00|99|0.00|NEWBORN NURSERY
20|FH_F38700_0_0|SrvcGrp|361|2022|PDM|2311.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F38709_0_0|SrvcGrp|1267|2022|PCT|0.80|99|0.00|STEM CELL TRANSPLANT
20|FH_F38709_0_0|SrvcGrp|701|2022|PDM|1751.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F38771_0_0|CSTM-ALL|CSTM-00|2020|PCT|63.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38771_0_0|CSTM-ALL|CSTM-00|2020|PCT|63.00|99|0.00|OP SVCS
20|FH_F38790_0_0|SrvcGrp|1942|2022|PDM|1177.00|99|0.00|CORONARY & INTERMEDIATE UNIT CARE
20|FH_F38790_0_0|SrvcGrp|361|2022|PCT|0.77|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F38790_0_0|SrvcGrp|439|2022|PDM|1177.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F38804_0_0|CSTM-ALL|CSTM-00|2020|PCT|59.00|99|0.00|OP SVCS
20|FH_F38807_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|IMPLANTS
20|FH_F38807_0_0|SrvcGrp|17065|2022|PDM|333.00|99|0.00|ASPG I
20|FH_F38807_0_0|SrvcGrp|17071|2022|PDM|630.00|99|0.00|ASPG IV
20|FH_F38807_0_0|SrvcGrp|17077|2022|PDM|995.00|99|0.00|ASPG VII
20|FH_F38807_0_0|SrvcGrp|17079|2022|PDM|973.00|99|0.00|ASPG VIII
20|FH_F38808_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F38808_0_0|SrvcGrp|17065|2022|PDM|366.00|99|0.00|ASPG I
20|FH_F38808_0_0|SrvcGrp|17071|2022|PDM|693.00|99|0.00|ASPG IV
20|FH_F38808_0_0|SrvcGrp|17075|2022|PDM|826.00|99|0.00|ASPG VI
20|FH_F38808_0_0|SrvcGrp|17083|2022|PDM|561.00|99|0.00|ASPG X
20|FH_F38826_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|DRG 124-125 CARDIAC CATH
20|FH_F38826_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|ACUTE PSYCH
20|FH_F38826_0_0|SrvcGrp|12969|2022|PDM|325.00|99|0.00|NEWBORN NURSERY
20|FH_F38826_0_0|SrvcGrp|20012|2022|PCT|0.85|99|0.00|KIDNEY TRANSPLANT
20|FH_F38826_0_0|SrvcGrp|23342|2022|PCT|0.80|99|0.00|TRAUMA CARE
20|FH_F38826_0_0|SrvcGrp|360|2022|PCT|0.73|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F38838_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F38842_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F38842_0_0|SrvcGrp|11301|2022|PDM|900.00|99|0.00|MAGNETIC RESONANCE IMAGING
20|FH_F38843_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F38845_0_0|SrvcGrp|10639|2022|PDM|500.00|99|0.00|CT SCAN
20|FH_F38845_0_0|SrvcGrp|11301|2022|PDM|900.00|99|0.00|MAGNETIC RESONANCE IMAGING
20|FH_F38846_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F38847_0_0|SrvcGrp|72|2022|PDM|300.00|99|0.00|NEWBORN NURSERY
20|FH_F38848_0_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|ACUTE IP MED SVCS
20|FH_F38848_0_0|SrvcGrp|38|2022|PDM|2700.00|99|0.00|NORMAL DELIVERY
20|FH_F38860_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE
20|FH_F38860_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F38865_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|CHEMO DRUGS
20|FH_F38865_0_0|SrvcGrp|10|2022|PDM|5000.00|99|0.00|ANGIOPLASTY
20|FH_F38865_0_0|SrvcGrp|3259|2022|PDM|1035.00|99|0.00|ACUTE REHABILITATION
20|FH_F38865_0_0|SrvcGrp|38|2022|PDM|2845.00|99|0.00|NORMAL DELIVERY
20|FH_F38865_0_0|SrvcGrp|997|2022|PCT|0.75|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F38867_0_0|CSTM-ALL|CSTM-00|2020|PDM|182.50|99|0.00|CD PARTIAL HOSPITALIZATION
20|FH_F38883_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|OP SVCS
20|FH_F38900_0_0|SrvcGrp|16|2022|PDM|1240.00|99|0.00|ACUTE REHABILITATION
20|FH_F38900_0_0|SrvcGrp|2738|2022|PCT|0.70|99|0.00|IMPLANTS
20|FH_F38945_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F38948_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 216-227, 231-236 CV SURGERY
20|FH_F38948_0_0|CSTM-ALL|CSTM-00|2020|PDM|1899.00|99|0.00|SURGICAL ICU
20|FH_F38948_0_0|SrvcGrp|177|2022|PDM|2769.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F38949_0_0|CSTM-ALL|CSTM-00|2020|PDM|30294.00|99|0.00|MS DRG 216-221, 231-234 CV SURGERY
20|FH_F38949_0_0|SrvcGrp|115|2022|PDM|585.00|99|0.00|SKILLED NURSING CARE
20|FH_F38955_0_0|CSTM-ALL|CSTM-00|2020|PDM|2465.33|99|0.00|ACUTE IP MED SVCS
20|FH_F38976_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS
20|FH_F38982_0_0|CSTM-ALL|CSTM-00|2020|PDM|1573.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38982_0_0|SrvcGrp|360|2022|PDM|1573.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F38983_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38983_0_0|SrvcGrp|3418|2022|PDM|680.00|99|0.00|NEONATAL INTENSIVE CARE UNIT
20|FH_F38983_0_0|SrvcGrp|38|2022|PDM|2000.00|99|0.00|NORMAL DELIVERY
20|FH_F38986_0_0|SrvcGrp|19594|2022|PCT|0.65|99|0.00|IMPLANTS
20|FH_F38986_0_0|SrvcGrp|701|2022|PDM|1742.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F38986_0_0|SrvcGrp|97|2022|PDM|3643.00|99|0.00|C-SECTION
20|FH_F38999_0_0|CSTM-ALL|CSTM-00|2020|PDM|2484.00|99|0.00|NICU LEVEL V
20|FH_F39015_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F39015_0_0|CSTM-ALL|CSTM-00|2020|PDM|1258.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39018_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39022_0_0|CSTM-ALL|CSTM-00|2020|PDM|1950.00|99|0.00|ACUTE IP MED SVCS
20|FH_F39039_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS
20|FH_F39041_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F39041_0_0|CSTM-ALL|CSTM-00|2020|PDM|2054.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39051_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39051_0_0|SrvcGrp|11663|2022|PCT|0.55|99|0.00|IMPLANTS
20|FH_F39066_0_0|CSTM-ALL|CSTM-00|2020|PDM|25000.00|99|0.00|MS DRG 216-227, 231-236 CV SURGERY
20|FH_F39066_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F39066_0_0|SrvcGrp|3066|2022|PCT|0.50|99|0.00|HIGH-COST DRUGS
20|FH_F39066_0_0|SrvcGrp|97|2022|PDM|3500.00|99|0.00|C-SECTION
20|FH_F39071_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS
20|FH_F39075_0_0|CSTM-ALL|CSTM-00|2020|PCT|81.00|99|0.00|OP SVCS
20|FH_F39080_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|OP SVCS
20|FH_F39082_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.63|99|0.00|OP SVCS
20|FH_F39082_0_0|CSTM-ALL|CSTM-00|2020|PDM|17521.00|99|0.00|CARDIAC PACE DEV REPLACEMNT MS DRG 258-259
20|FH_F39082_0_0|CSTM-ALL|CSTM-00|2020|PDM|29201.00|99|0.00|MSDRG 235-236 CORONARY BYPASS
20|FH_F39082_0_0|SrvcGrp|131|2022|PCT|0.65|99|0.00|PACEMAKER DEVICE
20|FH_F39082_0_0|SrvcGrp|3493|2022|PCT|0.65|99|0.00|PHARMACY SVCS
20|FH_F39082_0_0|SrvcGrp|38|2022|PDM|4300.00|99|0.00|NORMAL DELIVERY
20|FH_F39082_0_0|SrvcGrp|97|2022|PDM|7740.00|99|0.00|C-SECTION
20|FH_F39082_0_0|SrvcGrp|997|2022|PCT|0.65|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F39085_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|ACUTE PSYCH
20|FH_F39085_0_0|SrvcGrp|115|2022|PDM|525.00|99|0.00|SKILLED NURSING CARE
20|FH_F39085_0_0|SrvcGrp|72|2022|PDM|400.00|99|0.00|NEWBORN NURSERY
20|FH_F39090_0_0|SrvcGrp|3826|2022|PCT|0.00|99|0.00|PRO FEES EXCLUDED ON UB-04
20|FH_F39098_0_0|CSTM-ALL|CSTM-00|2020|PDM|1234.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39101_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|OP SVCS
20|FH_F39138_0_0|CSTM-ALL|CSTM-00|2020|PDM|14374.00|99|0.00|MS DRG 248
20|FH_F39138_0_0|CSTM-ALL|CSTM-00|2020|PDM|1474.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39138_0_0|CSTM-ALL|CSTM-00|2020|PDM|15967.00|99|0.00|MS DRG 246
20|FH_F39138_0_0|CSTM-ALL|CSTM-00|2020|PDM|18945.00|99|0.00|MS DRG 242 PERMANENT CARDIAC PACEMAKER
20|FH_F39138_0_0|CSTM-ALL|CSTM-00|2020|PDM|21843.00|99|0.00|MS DRG 237
20|FH_F39138_0_0|CSTM-ALL|CSTM-00|2020|PDM|34672.00|99|0.00|MS DRG 222-223
20|FH_F39138_0_0|CSTM-ALL|CSTM-00|2020|PDM|38959.00|99|0.00|MSDRG 231-232 CORONARY BYPASS
20|FH_F39138_0_0|CSTM-ALL|CSTM-00|2020|PDM|765.00|99|0.00|MAGNETIC RESONANCE IMAGING (MRI)
20|FH_F39138_0_0|SrvcGrp|1121|2022|PDM|4915.00|99|0.00|OP PTCA ANGIOPLASTY
20|FH_F39138_0_0|SrvcGrp|24703|2022|PDM|355.00|99|0.00|NEWBORN NURSERY
20|FH_F39138_0_0|SrvcGrp|25346|2022|PDM|98.00|99|0.00|PT
20|FH_F39138_0_0|SrvcGrp|30092|2022|PDM|491.00|99|0.00|COMPUTED TOMOGRAPHY (CT)
20|FH_F39138_0_0|SrvcGrp|88|2022|PDM|4368.00|99|0.00|OP LITHOTRIPSY
20|FH_F39140_0_0|SrvcGrp|13631|2022|PDM|110.00|99|0.00|CPT 99213
20|FH_F39151_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|GENERAL ACUTE CARE
20|FH_F39162_0_0|SrvcGrp|17378|2022|PDM|135.00|99|0.00|CAPD TRAINING
20|FH_F39162_0_0|SrvcGrp|17379|2022|PDM|135.00|99|0.00|CCPD TRAINING
20|FH_F39162_0_0|SrvcGrp|21814|2022|PDM|135.00|99|0.00|CAPD/CCPD SUPPLEMENT
20|FH_F39162_0_0|SrvcGrp|24651|2022|PDM|135.00|99|0.00|HEMODIALYSIS - HOME TRAINING
20|FH_F39180_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F39180_0_0|SrvcGrp|12116|2022|PCT|0.50|99|0.00|DRUGS
20|FH_F39180_0_0|SrvcGrp|12280|2022|PCT|0.70|99|0.00|IMPLANTS
20|FH_F39180_0_0|SrvcGrp|24|2022|PDM|2819.00|99|0.00|CARDIAC CATH
20|FH_F39209_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS
20|FH_F39209_0_0|SrvcGrp|11258|2022|PCT|0.50|99|0.00|DRUGS
20|FH_F39209_0_0|SrvcGrp|29930|2022|PDM|400.00|99|0.00|DIALYSIS
20|FH_F39270_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39278_0_0|SrvcGrp|72781|2022|PDM|166.00|99|0.00|PT SVCS - VISIT LEVEL
20|FH_F39278_0_0|SrvcGrp|72782|2022|PDM|166.00|99|0.00|OT SVCS - VISIT LEVEL
20|FH_F39286_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F39286_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|OP SVCS
20|FH_F39287_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F39287_0_0|SrvcGrp|30267|2022|PDM|3764.00|99|0.00|HCPCS E0694 - MODEL 2400 6 OR 8 HO LAMP LIGHT SOURCE
20|FH_F39303_0_0|CSTM-ALL|CSTM-00|2020|PDM|1492.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39303_0_0|CSTM-ALL|CSTM-00|2020|PDM|854.00|99|0.00|ACUTE PSYCH
20|FH_F39303_0_0|SrvcGrp|16|2022|PDM|737.00|99|0.00|ACUTE REHABILITATION
20|FH_F39304_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39339_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F39339_0_0|SrvcGrp|3069|2022|PCT|0.55|99|0.00|IMPLANTS
20|FH_F39339_0_0|SrvcGrp|413|2022|PCT|0.75|99|0.00|TRANSPLANT SVCS
20|FH_F39339_0_0|SrvcGrp|941|2022|PDM|2245.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F39343_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39346_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F39346_0_0|SrvcGrp|19846|2022|PDM|12105.00|99|0.00|MS DRG 249 ONLY
20|FH_F39346_0_0|SrvcGrp|20075|2022|PDM|9056.00|99|0.00|MS DRG 286 ONLY
20|FH_F39346_0_0|SrvcGrp|20077|2022|PDM|32117.00|99|0.00|MS DRG 226-227 ONLY CARDIAC DEFIBRILLATOR
20|FH_F39346_0_0|SrvcGrp|20297|2022|PDM|30874.00|99|0.00|MS DRG 219-221 ONLY CARDIAC VALVE PROC
20|FH_F39346_0_0|SrvcGrp|20299|2022|PDM|36040.00|99|0.00|MS DRG 228-230 ONLY OTHER CARDIOTHORACIC PROC
20|FH_F39346_0_0|SrvcGrp|20900|2022|PDM|17682.00|99|0.00|MS DRG 248 ONLY
20|FH_F39346_0_0|SrvcGrp|21358|2022|PDM|9558.00|99|0.00|MS DRG 258-259 ONLY
20|FH_F39346_0_0|SrvcGrp|21798|2022|PDM|10293.00|99|0.00|MS DRG 252 ONLY
20|FH_F39346_0_0|SrvcGrp|27815|2022|PDM|6950.00|99|0.00|MS DRG 281 ONLY
20|FH_F39346_0_0|SrvcGrp|28002|2022|PDM|17077.00|99|0.00|MS DRG 253-254 ONLY
20|FH_F39346_0_0|SrvcGrp|29702|2022|PDM|7077.00|99|0.00|CV SURGERY MS DRG 260-262 ONLY
20|FH_F39346_0_0|SrvcGrp|439|2022|PDM|1500.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F39349_0_0|SrvcGrp|3029|2022|PDM|367.00|99|0.00|NEWBORN NURSERY
20|FH_F39349_0_0|SrvcGrp|453|2022|PDM|285.00|99|0.00|PSYCH PARTIAL HOSP
20|FH_F39351_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|OP SVCS
20|FH_F39352_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39355_0_0|SrvcGrp|12969|2022|PDM|350.00|99|0.00|NEWBORN NURSERY
20|FH_F39355_0_0|SrvcGrp|13990|2022|PCT|1.05|99|0.00|PACEMAKER
20|FH_F39355_0_0|SrvcGrp|6|2022|PCT|0.75|99|0.00|OP SURGERY
20|FH_F39360_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39360_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS
20|FH_F39393_0_0|SrvcGrp|17065|2022|PDM|475.00|99|0.00|ASPG I
20|FH_F39398_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|PEDIATRIC INTENSIVE CARE UNIT
20|FH_F39426_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F39426_0_0|SrvcGrp|472|2022|PDM|405.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F39426_0_0|SrvcGrp|474|2022|PDM|315.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F39450_0_0|CSTM-ALL|CSTM-00|2020|PDM|1190.00|99|0.00|ACUTE IP MED SVCS
20|FH_F39450_0_0|SrvcGrp|72|2022|PDM|259.00|99|0.00|NEWBORN NURSERY
20|FH_F39466_0_0|SrvcGrp|3934|2022|PDM|231.00|99|0.00|INTENSIVE ADULT DUAL DIAGNOSIS
20|FH_F39476_0_0|SrvcGrp|10939|2022|PDM|1701.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F39476_0_0|SrvcGrp|4109|2022|PDM|918.00|99|0.00|ACUTE PSYCH
20|FH_F39477_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39507_0_0|CSTM-ALL|CSTM-00|2020|PCT|71.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39507_0_0|CSTM-ALL|CSTM-00|2020|PCT|71.00|99|0.00|OP SVCS
20|FH_F39515_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F39516_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F39517_0_0|SrvcGrp|11336|2022|PCT|0.75|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F39531_0_0|CSTM-ALL|CSTM-00|2020|PDM|1900.00|99|0.00|ACUTE IP MED SVCS
20|FH_F39532_0_0|SrvcGrp|110|2022|PDM|340.00|99|0.00|CD - REHABILITATION
20|FH_F39535_0_0|SrvcGrp|72|2022|PDM|684.00|99|0.00|NEWBORN NURSERY
20|FH_F39538_0_0|CSTM-ALL|CSTM-00|2020|PDM|1243.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39538_0_0|CSTM-ALL|CSTM-00|2020|PDM|594.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F39538_0_0|SrvcGrp|701|2022|PDM|1676.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F39543_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39546_0_0|SrvcGrp|115|2022|PDM|700.00|99|0.00|SKILLED NURSING CARE
20|FH_F39546_0_0|SrvcGrp|13881|2022|PCT|1.05|99|0.00|PACEMAKER DEVICE
20|FH_F39546_0_0|SrvcGrp|6|2022|PCT|0.75|99|0.00|OP SURGERY
20|FH_F39551_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F39561_0_0|SrvcGrp|3327|2022|PDM|130.53|99|0.00|HOSPICE SERVICE - IP RESPITE
20|FH_F39567_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F39567_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F39567_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F39567_0_0|SrvcGrp|38|2022|PDM|1000.00|99|0.00|NORMAL DELIVERY
20|FH_F39567_0_0|SrvcGrp|6|2022|PCT|0.75|99|0.00|OP SURGERY
20|FH_F39567_0_0|SrvcGrp|91|2022|PCT|1.00|99|0.00|KIDNEY TRANSPLANT
20|FH_F39567_0_0|SrvcGrp|97|2022|PDM|1000.00|99|0.00|C-SECTION
20|FH_F39586_0_0|SrvcGrp|3810|2022|PDM|135.31|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F39604_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F39617_0_0|SrvcGrp|97|2022|PDM|4031.00|99|0.00|C-SECTION
20|FH_F39619_0_0|CSTM-ALL|CSTM-00|2020|PDM|1750.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39621_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39621_0_0|SrvcGrp|14412|2022|PDM|545.00|99|0.00|HOSPICE CARE
20|FH_F39621_0_0|SrvcGrp|22954|2022|PDM|115.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F39622_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.79|99|0.00|OP SVCS
20|FH_F39622_0_0|CSTM-ALL|CSTM-00|2020|PDM|1770.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F39622_0_0|SrvcGrp|38|2022|PDM|2100.00|99|0.00|NORMAL DELIVERY
20|FH_F39623_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39623_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F39623_0_0|CSTM-ALL|CSTM-00|2020|PDM|1600.00|99|0.00|OB GLOBAL
20|FH_F39627_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|OP SVCS
20|FH_F39627_0_0|SrvcGrp|30712|2022|PDM|12500.00|99|0.00|BRACHYTHERAPY SVCS
20|FH_F39633_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39633_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F39633_0_0|CSTM-ALL|CSTM-00|2020|PDM|947.00|99|0.00|DREYER AMB SURGERY - ASPG III
20|FH_F39659_0_0|CSTM-ALL|CSTM-00|2020|PDM|100.00|99|0.00|OP SVCS
20|FH_F39689_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39701_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39701_0_0|CSTM-ALL|CSTM-00|2020|PDM|1144.00|99|0.00|AEG 7 (NO REV)
20|FH_F39706_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|122.22|99|0.00|ASPG 122
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|1332.85|99|0.00|ASPG 7
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|1681.88|99|0.00|ASPG 901
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|186.20|99|0.00|ASPG 221
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|201.00|99|0.00|ASPG 220
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|316.70|99|0.00|ASPG 217
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|329.42|99|0.00|ASPG 107
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.85|99|0.00|ASPG 105
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|404.60|99|0.00|ASPG 104
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|499.57|99|0.00|ASPG 303
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|548.32|99|0.00|ASPG 204
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|560.59|99|0.00|ASPG 203
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|560.59|99|0.00|ASPG 403
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|597.44|99|0.00|ASPG 201
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|620.42|99|0.00|ASPG 2
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|621.75|99|0.00|ASPG 402
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|683.17|99|0.00|ASPG 301
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|89.64|99|0.00|ASPG 125
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|89.90|99|0.00|ASPG 227
20|FH_F39721_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F39727_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39727_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F39731_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39740_0_0|SrvcGrp|19671|2022|PDM|6857.00|99|0.00|MS DRG 286 ONLY CIRCULATORY DISORDERS W/CARD CATH COMPLEX DX
20|FH_F39740_0_0|SrvcGrp|20293|2022|PDM|20024.00|99|0.00|MS DRG 235-236 ONLY CV SURGERY
20|FH_F39740_0_0|SrvcGrp|20900|2022|PDM|13723.00|99|0.00|MS DRG 248 ONLY
20|FH_F39740_0_0|SrvcGrp|20902|2022|PDM|10964.00|99|0.00|MS DRG 249 ONLY
20|FH_F39740_0_0|SrvcGrp|20908|2022|PDM|12752.00|99|0.00|MS DRG 247 ONLY
20|FH_F39749_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39753_0_0|SrvcGrp|3273|2022|PCT|0.85|99|0.00|IMPLANTS
20|FH_F39753_0_0|SrvcGrp|701|2022|PDM|2494.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F39756_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F39756_0_0|CSTM-ALL|CSTM-00|2020|PDM|110.00|99|0.00|TOPICAL APPLICATION OF FLUORIDE (PROPHYLAXIS NOT INCLUDED)
20|FH_F39756_0_0|CSTM-ALL|CSTM-00|2020|PDM|1185.80|99|0.00|CUMBERLAND SURGERY CTR - ASPG VII
20|FH_F39756_0_0|CSTM-ALL|CSTM-00|2020|PDM|1628.55|99|0.00|CUMBERLAND SURGERY CTR - ASPG IX
20|FH_F39756_0_0|CSTM-ALL|CSTM-00|2020|PDM|683.76|99|0.00|CUMBERLAND SURGERY CTR - ASPG X
20|FH_F39756_0_0|CSTM-ALL|CSTM-00|2020|PDM|82.50|99|0.00|PROPHYLAXIS ADULT/CHILD - HCPCS D0110, D1120
20|FH_F39801_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39819_0_0|CSTM-ALL|CSTM-00|2020|PDM|3533.00|99|0.00|NY DRG 143 ONLY
20|FH_F39819_0_0|CSTM-ALL|CSTM-00|2020|PDM|4315.00|99|0.00|NY DRG 089 ONLY
20|FH_F39819_0_0|CSTM-ALL|CSTM-00|2020|PDM|4615.00|99|0.00|NY DRG 127 ONLY
20|FH_F39819_0_0|CSTM-ALL|CSTM-00|2020|PDM|5301.00|99|0.00|NY DRG 813 ONLY
20|FH_F39819_0_0|CSTM-ALL|CSTM-00|2020|PDM|6145.00|99|0.00|NY DRG 204 ONLY
20|FH_F39819_0_0|CSTM-ALL|CSTM-00|2020|PDM|7477.00|99|0.00|NY DRG 132 ONLY
20|FH_F39819_0_0|SrvcGrp|16|2022|PDM|900.00|99|0.00|ACUTE REHABILITATION
20|FH_F39819_0_0|SrvcGrp|9795|2022|PDM|400.00|99|0.00|SUBACUTE REHAB
20|FH_F39832_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F39838_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|OP SVCS
20|FH_F39839_0_0|SrvcGrp|65|2022|PDM|1635.00|99|0.00|OBSTETRICAL CARE
20|FH_F39839_0_0|SrvcGrp|701|2022|PDM|1390.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F39844_0_0|CSTM-ALL|CSTM-00|2020|PDM|29705.00|99|0.00|MSDRG 216-221, 231-236 CV SURGERY
20|FH_F39844_0_0|SrvcGrp|97|2022|PDM|3289.00|99|0.00|C-SECTION
20|FH_F39850_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F39855_0_0|SrvcGrp|360|2022|PDM|954.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F39855_0_0|SrvcGrp|997|2022|PCT|0.75|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F39857_0_0|SrvcGrp|360|2022|PDM|2080.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F39866_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP NUCLEAR MEDICINE
20|FH_F39866_0_0|SrvcGrp|6|2022|PDM|1825.00|99|0.00|OP SURGERY
20|FH_F39866_0_0|SrvcGrp|88|2022|PCT|0.75|99|0.00|OP LITHOTRIPSY
20|FH_F39869_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.00|99|0.00|OP SVCS
20|FH_F39886_0_0|SrvcGrp|16|2022|PDM|742.00|99|0.00|ACUTE REHABILITATION
20|FH_F39887_0_0|CSTM-ALL|CSTM-00|2020|PDM|336.00|99|0.00|NEWBORN NURSERY
20|FH_F39889_0_0|CSTM-ALL|CSTM-00|2020|PDM|998.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39889_0_0|SrvcGrp|6|2022|PCT|0.80|99|0.00|OP SURGERY
20|FH_F39892_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F39893_0_0|CSTM-ALL|CSTM-00|2020|PDM|1050.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39895_0_0|CSTM-ALL|CSTM-00|2020|PDM|1298.00|99|0.00|AMBULATORY SURGERY
20|FH_F39898_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F39898_0_0|SrvcGrp|12403|2022|PDM|45.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F39898_0_0|SrvcGrp|26001|2022|PDM|171.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F39910_0_0|CSTM-ALL|CSTM-00|2020|PDM|2440.00|99|0.00|MSDRG 216-221, 231-236 CV SURGERY
20|FH_F39910_0_0|SrvcGrp|97|2022|PDM|4668.00|99|0.00|C-SECTION
20|FH_F39912_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|ER SVCS
20|FH_F39912_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39917_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39917_0_0|CSTM-ALL|CSTM-00|2020|PDM|120.00|99|0.00|NEW PATIENT - SHORT VISIT
20|FH_F39917_0_0|SrvcGrp|13640|2022|PDM|120.00|99|0.00|CPT 99202
20|FH_F39917_0_0|SrvcGrp|3404|2022|PDM|120.00|99|0.00|CPT 99211
20|FH_F39917_0_0|SrvcGrp|3405|2022|PDM|120.00|99|0.00|CPT 99212
20|FH_F39917_0_0|SrvcGrp|3406|2022|PDM|120.00|99|0.00|CPT 99214
20|FH_F39919_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39919_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|LAPAROSCOPIC PROCEDURES
20|FH_F39919_0_0|CSTM-ALL|CSTM-00|2020|PDM|453.36|99|0.00|ASPG II
20|FH_F39919_0_0|CSTM-ALL|CSTM-00|2020|PDM|728.83|99|0.00|ASPG V
20|FH_F39920_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SURGERY
20|FH_F39920_0_0|CSTM-ALL|CSTM-00|2020|PDM|575.00|99|0.00|TRANSITIONAL CARE UNIT
20|FH_F39920_0_0|SrvcGrp|360|2022|PDM|800.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F39920_0_0|SrvcGrp|439|2022|PDM|1467.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F39939_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F39940_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F39941_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F39943_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.93|99|0.00|OP SVCS
20|FH_F39943_0_0|CSTM-ALL|CSTM-00|2020|PDM|1385.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39943_0_0|SrvcGrp|13551|2022|PDM|320.00|99|0.00|NEWBORN NURSERY
20|FH_F39943_0_0|SrvcGrp|16|2022|PDM|898.00|99|0.00|ACUTE REHABILITATION
20|FH_F39943_0_0|SrvcGrp|38|2022|PDM|2530.00|99|0.00|NORMAL DELIVERY
20|FH_F39943_0_0|SrvcGrp|526|2022|PDM|1850.00|99|0.00|CARDIAC CARE UNIT
20|FH_F39945_0_0|SrvcGrp|38|2022|PDM|2000.00|99|0.00|NORMAL DELIVERY
20|FH_F39955_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS
20|FH_F39956_0_0|CSTM-ALL|CSTM-00|2020|PDM|1004.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39956_0_0|SrvcGrp|38|2022|PDM|1751.00|99|0.00|NORMAL DELIVERY
20|FH_F39967_0_0|SrvcGrp|10107|2022|PCT|0.65|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F39973_0_0|CSTM-ALL|CSTM-00|2020|PCT|91.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39976_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F39992_0_0|SrvcGrp|12401|2022|PDM|85.50|99|0.00|RN VISIT
20|FH_F39992_0_0|SrvcGrp|22954|2022|PDM|93.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F39992_0_0|SrvcGrp|26001|2022|PDM|93.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F39992_0_0|SrvcGrp|3809|2022|PDM|474.00|99|0.00|HOSPICE CARE
20|FH_F39992_0_0|SrvcGrp|8962|2022|PDM|82.50|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F39992_0_0|SrvcGrp|9828|2022|PDM|36.00|99|0.00|HOME HEALTH AIDE
20|FH_F39995_0_0|SrvcGrp|115|2022|PDM|525.00|99|0.00|SKILLED NURSING CARE
20|FH_F39996_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F39996_0_0|SrvcGrp|24|2022|PDM|1400.00|99|0.00|CARDIAC CATH
20|FH_F40011_0_0|CSTM-ALL|CSTM-00|2020|PCT|76.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40026_0_0|SrvcGrp|31753|2022|PDM|975.00|99|0.00|SPINAL CORD CARE
20|FH_F40030_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|ACUTE PSYCH
20|FH_F40030_0_0|SrvcGrp|12342|2022|PCT|0.70|99|0.00|IMPLANTS
20|FH_F40032_0_0|SrvcGrp|110|2022|PDM|375.00|99|0.00|CD - REHABILITATION
20|FH_F40032_0_0|SrvcGrp|453|2022|PDM|200.00|99|0.00|PSYCH PARTIAL HOSP
20|FH_F40043_0_0|CSTM-ALL|CSTM-00|2020|PDM|1920.00|99|0.00|ACUTE IP SURG SVCS
20|FH_F40043_0_0|SrvcGrp|12772|2022|PDM|1395.00|99|0.00|ACUTE REHABILITATION
20|FH_F40043_0_0|SrvcGrp|31848|2022|PCT|0.76|99|0.00|MS DRG'S %BC SOUTHERN REGIOANL MED CTR
20|FH_F40043_0_0|SrvcGrp|361|2022|PDM|1920.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F40043_0_0|SrvcGrp|8|2022|PDM|2792.00|99|0.00|BURN INTENSIVE CARE
20|FH_F40043_0_0|SrvcGrp|9053|2022|PDM|13958.00|99|0.00|GASTRIC BYPASS
20|FH_F40043_0_0|SrvcGrp|9506|2022|PDM|2792.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F40046_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F40046_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.72|99|0.00|OP SVCS
20|FH_F40046_0_0|SrvcGrp|10540|2022|PDM|50.00|99|0.00|HOME HEALTH AIDE
20|FH_F40046_0_0|SrvcGrp|10541|2022|PDM|115.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F40046_0_0|SrvcGrp|15385|2022|PDM|105.00|99|0.00|SKILLED NURSING NON IV RELATED
20|FH_F40046_0_0|SrvcGrp|16|2022|PDM|1089.00|99|0.00|ACUTE REHABILITATION
20|FH_F40046_0_0|SrvcGrp|3066|2022|PCT|0.65|99|0.00|HIGH-COST DRUGS
20|FH_F40046_0_0|SrvcGrp|3069|2022|PCT|0.65|99|0.00|IMPLANTS
20|FH_F40049_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|OP SVCS
20|FH_F40055_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40056_0_0|SrvcGrp|30061|2022|PDM|6480.00|99|0.00|MULTI-BIRTH C-SECTION
20|FH_F40058_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F40060_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40066_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F40073_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F40073_0_0|SrvcGrp|17000|2022|PCT|0.70|99|0.00|OUTPATIENT SURGERY
20|FH_F40073_0_0|SrvcGrp|17071|2022|PCT|0.70|99|0.00|ASPG IV
20|FH_F40081_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|ADOLESCENT PSYCH PARTIAL HOSP
20|FH_F40081_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|PARTIAL HOSPITALIZATION
20|FH_F40081_0_0|SrvcGrp|3044|2022|PDM|900.00|99|0.00|TRANSITIONAL CARE UNIT
20|FH_F40088_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F40089_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F40089_0_0|SrvcGrp|27173|2022|PDM|50.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F40091_0_0|SrvcGrp|17075|2022|PCT|0.70|99|0.00|ASPG VI
20|FH_F40091_0_0|SrvcGrp|17077|2022|PCT|0.70|99|0.00|ASPG VII
20|FH_F40091_0_0|SrvcGrp|17083|2022|PCT|0.70|99|0.00|ASPG X
20|FH_F40092_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40092_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F40092_0_0|SrvcGrp|30733|2022|PDM|574.00|99|0.00|SKILLED NURSING CARE
20|FH_F40104_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F40104_0_0|SrvcGrp|9829|2022|PDM|107.71|99|0.00|PT SVCS
20|FH_F40110_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F40118_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|OP SVCS
20|FH_F40127_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F40127_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40134_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F40144_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|DURABLE MEDICAL EQUIPMENT
20|FH_F40144_0_0|CSTM-ALL|CSTM-00|2020|PDM|975.00|99|0.00|BRAIN INJURY SERVICES
20|FH_F40144_0_0|SrvcGrp|16|2022|PDM|891.00|99|0.00|ACUTE REHABILITATION
20|FH_F40144_0_0|SrvcGrp|3016|2022|PCT|0.73|99|0.00|HEMODIALYSIS
20|FH_F40149_0_0|CSTM-ALL|CSTM-00|2020|PDM|1406.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40149_0_0|SrvcGrp|38|2022|PDM|2530.00|99|0.00|NORMAL DELIVERY
20|FH_F40149_0_0|SrvcGrp|72|2022|PDM|506.00|99|0.00|NEWBORN NURSERY
20|FH_F40149_0_0|SrvcGrp|97|2022|PDM|3656.00|99|0.00|C-SECTION
20|FH_F40154_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F40154_0_0|SrvcGrp|10107|2022|PCT|0.80|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F40174_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40174_0_0|SrvcGrp|15403|2022|PDM|70.00|99|0.00|SPEECH THERAPY SVCS INITIAL EVAL
20|FH_F40174_0_0|SrvcGrp|16746|2022|PDM|70.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F40176_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F40176_0_0|CSTM-ALL|CSTM-00|2020|PDM|140.00|99|0.00|PT, OT ST
20|FH_F40176_0_0|CSTM-ALL|CSTM-00|2020|PDM|140.00|99|0.00|SKILLED NURSING VISIT
20|FH_F40189_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40191_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 216-237 CV SURGERY
20|FH_F40191_0_0|CSTM-ALL|CSTM-00|2020|PDM|3647.00|99|0.00|CPT CODE CARDIAC CATHETERIZATION
20|FH_F40191_0_0|SrvcGrp|11258|2022|PCT|0.46|99|0.00|DRUGS
20|FH_F40191_0_0|SrvcGrp|11336|2022|PCT|0.46|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F40191_0_0|SrvcGrp|3188|2022|PDM|562.00|99|0.00|NEWBORN NURSERY
20|FH_F40198_0_0|SrvcGrp|16|2022|PDM|461.00|99|0.00|ACUTE REHABILITATION
20|FH_F40203_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|BRAIN INJURY REHAB
20|FH_F40207_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP CATARACT SURGERY
20|FH_F40207_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F40213_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40230_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F40255_0_0|CSTM-ALL|CSTM-00|2020|PDM|1136.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40255_0_0|SrvcGrp|3259|2022|PDM|1136.00|99|0.00|ACUTE REHABILITATION
20|FH_F40260_0_0|CSTM-ALL|CSTM-00|2020|PDM|1275.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F40260_0_0|SrvcGrp|3029|2022|PDM|400.00|99|0.00|NEWBORN NURSERY
20|FH_F40272_0_0|CSTM-ALL|CSTM-00|2020|PDM|1450.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40272_0_0|SrvcGrp|13551|2022|PDM|400.00|99|0.00|NEWBORN NURSERY
20|FH_F40272_0_0|SrvcGrp|38|2022|PDM|2900.00|99|0.00|NORMAL DELIVERY
20|FH_F40272_0_0|SrvcGrp|701|2022|PDM|1750.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F40272_0_0|SrvcGrp|97|2022|PDM|3800.00|99|0.00|C-SECTION
20|FH_F40294_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|ACUTE PSYCH
20|FH_F40295_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|PHYSICIANS SERVICES (CMS 1500)
20|FH_F40295_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F40297_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SURGERY
20|FH_F40302_0_0|SrvcGrp|72|2022|PDM|291.00|99|0.00|NEWBORN NURSERY
20|FH_F40302_0_0|SrvcGrp|97|2022|PDM|4229.00|99|0.00|C-SECTION
20|FH_F40304_0_0|SrvcGrp|19615|2022|PDM|375.00|99|0.00|COMPUTED TOMOGRAPHY (CT SCAN)
20|FH_F40331_0_0|CSTM-ALL|CSTM-00|2020|PDM|1811.00|99|0.00|HEMATOLOGY/ONCOLOGY UNIT
20|FH_F40332_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40332_0_0|SrvcGrp|14187|2022|PDM|750.00|99|0.00|MRI
20|FH_F40332_0_0|SrvcGrp|16|2022|PDM|750.00|99|0.00|ACUTE REHABILITATION
20|FH_F40332_0_0|SrvcGrp|19973|2022|PCT|0.70|99|0.00|CAT SCAN
20|FH_F40333_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F40333_0_0|SrvcGrp|16|2022|PDM|850.00|99|0.00|ACUTE REHABILITATION
20|FH_F40334_0_0|SrvcGrp|3029|2022|PDM|556.00|99|0.00|NEWBORN NURSERY
20|FH_F40340_0_0|CSTM-ALL|CSTM-00|2020|PDM|927.00|99|0.00|ADULT / PEDIATRIC BRAIN SURGERY
20|FH_F40345_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F40345_0_0|SrvcGrp|115|2022|PDM|515.00|99|0.00|SKILLED NURSING CARE
20|FH_F40345_0_0|SrvcGrp|16|2022|PDM|725.00|99|0.00|ACUTE REHABILITATION
20|FH_F40346_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F40346_0_0|CSTM-ALL|CSTM-00|2020|PDM|1050.00|99|0.00|ASPG II
20|FH_F40346_0_0|CSTM-ALL|CSTM-00|2020|PDM|1203.00|99|0.00|ASPG X
20|FH_F40346_0_0|CSTM-ALL|CSTM-00|2020|PDM|1841.00|99|0.00|ASPG VII
20|FH_F40346_0_0|SrvcGrp|14187|2022|PCT|0.75|99|0.00|MRI
20|FH_F40346_0_0|SrvcGrp|19973|2022|PCT|0.75|99|0.00|CAT SCAN
20|FH_F40346_0_0|SrvcGrp|3029|2022|PDM|350.00|99|0.00|NEWBORN NURSERY
20|FH_F40347_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40358_0_0|CSTM-ALL|CSTM-00|2020|PDM|1450.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F40358_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|MS DRG 765-766 C-SECTION
20|FH_F40358_0_0|SrvcGrp|16|2022|PDM|850.00|99|0.00|ACUTE REHABILITATION
20|FH_F40358_0_0|SrvcGrp|9795|2022|PDM|975.00|99|0.00|SUBACUTE REHAB
20|FH_F40370_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE
20|FH_F40370_0_0|SrvcGrp|109|2022|PDM|695.00|99|0.00|CD - DETOX
20|FH_F40372_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F40374_0_0|CSTM-ALL|CSTM-00|2020|PCT|57.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40388_0_0|CSTM-ALL|CSTM-00|2020|PDM|878.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40391_0_0|CSTM-ALL|CSTM-00|2020|PCT|57.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40402_0_0|SrvcGrp|38|2022|PDM|1273.00|99|0.00|NORMAL DELIVERY
20|FH_F40403_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40412_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40415_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F40416_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F40416_0_0|SrvcGrp|97|2022|PDM|3662.00|99|0.00|C-SECTION
20|FH_F40417_0_0|SrvcGrp|439|2022|PDM|1800.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F40418_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|ACUTE IP MED SVCS
20|FH_F40418_0_0|SrvcGrp|6|2022|PCT|0.85|99|0.00|OP SURGERY
20|FH_F40423_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F40423_0_0|CSTM-ALL|CSTM-00|2020|PDM|985.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40423_0_0|SrvcGrp|32551|2022|PDM|5500.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F40423_0_0|SrvcGrp|6|2022|PCT|0.85|99|0.00|OP SURGERY
20|FH_F40427_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F40427_0_0|CSTM-ALL|CSTM-00|2020|PDM|1008.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40427_0_0|SrvcGrp|3029|2022|PDM|337.00|99|0.00|NEWBORN NURSERY
20|FH_F40427_0_0|SrvcGrp|701|2022|PDM|1623.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F40438_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F40438_0_0|CSTM-ALL|CSTM-00|2020|PDM|1175.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40438_0_0|SrvcGrp|13849|2022|PCT|0.65|99|0.00|LITHOTRIPSY
20|FH_F40442_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE
20|FH_F40446_0_0|SrvcGrp|30941|2022|PDM|350.00|99|0.00|NEWBORN NURSERY
20|FH_F40446_0_0|SrvcGrp|3418|2022|PDM|1300.00|99|0.00|NEONATAL INTENSIVE CARE UNIT
20|FH_F40448_0_0|CSTM-ALL|CSTM-00|2020|PDM|1081.00|99|0.00|HEAD INJURY REHABILITATION
20|FH_F40448_0_0|CSTM-ALL|CSTM-00|2020|PDM|1081.00|99|0.00|PEDIATRIC REHABILITATION
20|FH_F40453_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40454_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40457_0_0|CSTM-ALL|CSTM-00|2020|PDM|1591.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40465_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|DRG 115 PERM CARDIAC PACE IMP (551)
20|FH_F40465_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|DRG 121 CIRCULATORY DISORDERS
20|FH_F40465_0_0|CSTM-ALL|CSTM-00|2020|PDM|1245.00|99|0.00|ACUTE IP MED SVCS
20|FH_F40465_0_0|CSTM-ALL|CSTM-00|2020|PDM|27000.00|99|0.00|DRG 515 ONLY CARDIAC DEF IMP W/O CARD CATH
20|FH_F40465_0_0|CSTM-ALL|CSTM-00|2020|PDM|29000.00|99|0.00|DRG 105 ONLY CARDIAC VLV PROC W/O CA CAT
20|FH_F40465_0_0|CSTM-ALL|CSTM-00|2020|PDM|35000.00|99|0.00|DRG 104 ONLY CARDIAC VALVE PROCEDURE W/CARDIAC CATH
20|FH_F40465_0_0|CSTM-ALL|CSTM-00|2020|PDM|589.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F40465_0_0|SrvcGrp|10059|2022|PDM|7000.00|99|0.00|DRG 124 ONLY CIRCULATORY DISORDERS W/CARDIAC CATH COMPLEX DX
20|FH_F40465_0_0|SrvcGrp|10061|2022|PDM|6000.00|99|0.00|DRG 125 ONLY CIRC DISORD W/CA CATH W/O
20|FH_F40465_0_0|SrvcGrp|177|2022|PDM|2288.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F40465_0_0|SrvcGrp|65|2022|PDM|1560.00|99|0.00|OBSTETRICAL CARE
20|FH_F40465_0_0|SrvcGrp|8|2022|PCT|0.75|99|0.00|BURN INTENSIVE CARE
20|FH_F40465_0_0|SrvcGrp|9863|2022|PDM|2439.00|99|0.00|INTENSIVE CARE/CORONARY CARE UNIT
20|FH_F40471_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F40472_0_0|CSTM-ALL|CSTM-00|2020|PDM|60.00|99|0.00|SPEECH THERAPY SVCS
20|FH_F40472_0_0|SrvcGrp|15403|2022|PDM|70.00|99|0.00|SPEECH THERAPY SVCS INITIAL EVAL
20|FH_F40495_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE
20|FH_F40501_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F40501_0_0|CSTM-ALL|CSTM-00|2020|PDM|131.00|99|0.00|IP PSYCHIATRIC TREATMENT (4-7 HRS)
20|FH_F40501_0_0|CSTM-ALL|CSTM-00|2020|PDM|263.00|99|0.00|IP PSYCHIATRIC TREATMENT (8-12 HRS)
20|FH_F40501_0_0|SrvcGrp|3449|2022|PDM|600.00|99|0.00|ELECTRO CONVULSIVE THERAPY
20|FH_F40515_0_0|CSTM-ALL|CSTM-00|2020|PDM|988.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40517_0_0|SrvcGrp|3809|2022|PDM|729.81|99|0.00|HOSPICE CARE
20|FH_F40521_0_0|CSTM-ALL|CSTM-00|2020|PDM|870.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40521_0_0|SrvcGrp|38|2022|PDM|2900.00|99|0.00|NORMAL DELIVERY
20|FH_F40521_0_0|SrvcGrp|97|2022|PDM|4100.00|99|0.00|C-SECTION
20|FH_F40535_0_0|CSTM-ALL|CSTM-00|2020|PDM|955.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|IMPLANTS/PROSTHETICS
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|100.27|99|0.00|DELAWARE VALLEY- ASC 122
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|103.42|99|0.00|DELAWARE VALLEY- ASC 121
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|103.42|99|0.00|DELAWARE VALLEY- ASC 221
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|103.42|99|0.00|DELAWARE VALLEY- ASC 309
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|149.05|99|0.00|DELAWARE VALLEY- ASC 117
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|157.55|99|0.00|DELAWARE VALLEY- ASC 217
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|170.84|99|0.00|DELAWARE VALLEY- ASC 216
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|252.51|99|0.00|DELAWARE VALLEY- ASC 109
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|267.97|99|0.00|DELAWARE VALLEY- ASC 214
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|285.09|99|0.00|DELAWARE VALLEY- ASC 305
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|377.44|99|0.00|DELAWARE VALLEY- ASC 1
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|380.17|99|0.00|DELAWARE VALLEY- ASC 208
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|422.71|99|0.00|DELAWARE VALLEY- ASC 302
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|422.71|99|0.00|DELAWARE VALLEY- ASC 404
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|578.07|99|0.00|DELAWARE VALLEY- ASC 3
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|75.85|99|0.00|DELAWARE VALLEY- ASC 124
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|82.15|99|0.00|DELAWARE VALLEY- ASC 123
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|931.22|99|0.00|DELAWARE VALLEY- ASC 6
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|1085.00|99|0.00|HAPA EPA ASC 54
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|109.00|99|0.00|HAPA EPA ASC 18
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|1361.00|99|0.00|HAPA EPA ASC 56
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|158.00|99|0.00|HAPA EPA ASC 26
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|165.00|99|0.00|HAPA EPA ASC 27
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|268.00|99|0.00|HAPA EPA ASC 36
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|330.00|99|0.00|HAPA EPA ASC 39
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|407.00|99|0.00|HAPA EPA ASC 46
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|507.00|99|0.00|HAPA EPA ASC 53
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|74.00|99|0.00|HAPA EPA ASC 13
20|FH_F40541_0_0|SrvcGrp|27536|2022|PDM|605.00|99|0.00|HAPA EPA ASC 57 UNGROUPED
20|FH_F40546_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40546_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F40549_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40549_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F40550_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F40554_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|ACUTE IP MED SVCS
20|FH_F40554_0_0|SrvcGrp|30941|2022|PDM|280.00|99|0.00|NEWBORN NURSERY
20|FH_F40554_0_0|SrvcGrp|38|2022|PDM|1200.00|99|0.00|NORMAL DELIVERY
20|FH_F40554_0_0|SrvcGrp|439|2022|PDM|1400.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F40560_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F40560_0_0|CSTM-ALL|CSTM-00|2020|PDM|810.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40564_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F40564_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AIDS CARE
20|FH_F40564_0_0|SrvcGrp|16|2022|PDM|625.00|99|0.00|ACUTE REHABILITATION
20|FH_F40564_0_0|SrvcGrp|65|2022|PDM|2000.00|99|0.00|OBSTETRICAL CARE
20|FH_F40567_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F40571_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F40571_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40579_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40579_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|OP SVCS
20|FH_F40590_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F40591_0_0|CSTM-ALL|CSTM-00|2020|PDM|5971.00|99|0.00|CV SURGERY MS DRGS 215-238, 242-244, 258-262
20|FH_F40591_0_0|SrvcGrp|9510|2022|PDM|1194.00|99|0.00|SKILLED NURSING CARE
20|FH_F40593_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40598_0_0|SrvcGrp|3029|2022|PDM|300.00|99|0.00|NEWBORN NURSERY
20|FH_F40598_0_0|SrvcGrp|32595|2022|PCT|0.85|99|0.00|IP SURGERY
20|FH_F40599_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|CV SURGERY OTLR (MS DRG 216-223, 226-227, 231-236, 248-251)
20|FH_F40599_0_0|SrvcGrp|10927|2022|PDM|360.00|99|0.00|COMPUTED TOMOGRAPHY (CT)
20|FH_F40599_0_0|SrvcGrp|180|2022|PDM|1751.00|99|0.00|INTENSIVE CARE SERVICES
20|FH_F40599_0_0|SrvcGrp|24|2022|PDM|3852.00|99|0.00|CARDIAC CATH
20|FH_F40599_0_0|SrvcGrp|27776|2022|PDM|515.00|99|0.00|OP MRI
20|FH_F40599_0_0|SrvcGrp|58|2022|PDM|5150.00|99|0.00|IP LITHOTRIPSY SVCS
20|FH_F40600_0_0|CSTM-ALL|CSTM-00|2020|PDM|1631.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40600_0_0|SrvcGrp|109|2022|PDM|916.00|99|0.00|CD - DETOX
20|FH_F40600_0_0|SrvcGrp|110|2022|PDM|601.00|99|0.00|CD - REHABILITATION
20|FH_F40600_0_0|SrvcGrp|12491|2022|PCT|0.70|99|0.00|PACEMAKER
20|FH_F40603_0_0|SrvcGrp|13630|2022|PDM|200.00|99|0.00|CPT 99204
20|FH_F40603_0_0|SrvcGrp|3405|2022|PDM|90.00|99|0.00|CPT 99212
20|FH_F40603_0_0|SrvcGrp|3406|2022|PDM|200.00|99|0.00|CPT 99214
20|FH_F40607_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F40607_0_0|SrvcGrp|16746|2022|PDM|45.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F40607_0_0|SrvcGrp|27173|2022|PDM|45.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F40615_0_0|SrvcGrp|97|2022|PDM|4369.00|99|0.00|C-SECTION
20|FH_F40624_0_0|CSTM-ALL|CSTM-00|2020|PDM|1657.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F40624_0_0|SrvcGrp|11336|2022|PCT|0.60|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F40624_0_0|SrvcGrp|20272|2022|PDM|36409.00|99|0.00|MS DRG 219-221 ONLY CARDIAC VLV PROC W/O CA CAT
20|FH_F40624_0_0|SrvcGrp|20293|2022|PDM|36409.00|99|0.00|MS DRG 235-236 ONLY CV SURGERY
20|FH_F40624_0_0|SrvcGrp|23477|2022|PDM|8810.00|99|0.00|MSDRG 286-287 ONLY CARDIAC CATH
20|FH_F40624_0_0|SrvcGrp|3178|2022|PDM|766.00|99|0.00|ACUTE PSYCH
20|FH_F40624_0_0|SrvcGrp|360|2022|PDM|675.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F40624_0_0|SrvcGrp|941|2022|PDM|2800.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F40627_0_0|CSTM-ALL|CSTM-00|2020|PDM|5520.00|99|0.00|CV SURGERY MS DRGS 215-238, 242-244, 258-262
20|FH_F40627_0_0|SrvcGrp|8968|2022|PDM|3335.00|99|0.00|NICU LEVEL III & IV
20|FH_F40634_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|TISSUE PLASMINOGEN ACTIVATOR
20|FH_F40635_0_0|SrvcGrp|3029|2022|PDM|345.00|99|0.00|NEWBORN NURSERY
20|FH_F40635_0_0|SrvcGrp|38|2022|PDM|2600.00|99|0.00|NORMAL DELIVERY
20|FH_F40635_0_0|SrvcGrp|439|2022|PDM|1700.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F40643_0_0|SrvcGrp|10107|2022|PCT|0.60|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F40643_0_0|SrvcGrp|115|2022|PDM|355.00|99|0.00|SKILLED NURSING CARE
20|FH_F40643_0_0|SrvcGrp|11663|2022|PCT|0.60|99|0.00|IMPLANTS
20|FH_F40644_0_0|CSTM-ALL|CSTM-00|2020|PDM|1423.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40644_0_0|SrvcGrp|115|2022|PDM|453.00|99|0.00|SKILLED NURSING CARE
20|FH_F40644_0_0|SrvcGrp|33081|2022|PCT|0.50|99|0.00|OP CHEMOTHERAPY DRUGS
20|FH_F40644_0_0|SrvcGrp|471|2022|PDM|832.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F40644_0_0|SrvcGrp|6|2022|PDM|1940.00|99|0.00|OP SURGERY
20|FH_F40645_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F40645_0_0|CSTM-ALL|CSTM-00|2020|PDM|1060.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F40647_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F40649_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.83|99|0.00|OP SVCS
20|FH_F40649_0_0|SrvcGrp|6|2022|PCT|0.83|99|0.00|OP SURGERY
20|FH_F40652_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40653_0_0|CSTM-ALL|CSTM-00|2020|PDM|720.00|99|0.00|ACUTE PSYCH
20|FH_F40659_0_0|SrvcGrp|33165|2022|PDM|400.00|99|0.00|SKILLED NURSING - LEVEL II
20|FH_F40661_0_0|CSTM-ALL|CSTM-00|2020|PDM|1164.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40661_0_0|CSTM-ALL|CSTM-00|2020|PDM|541.00|99|0.00|ADULT PSYCHIATRIC
20|FH_F40661_0_0|SrvcGrp|588|2022|PDM|1786.00|99|0.00|CORONARY CARE UNIT
20|FH_F40667_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|OP SVCS
20|FH_F40684_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40690_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|IMPLANTS
20|FH_F40690_0_0|SrvcGrp|12031|2022|PCT|0.80|99|0.00|DURABLE MEDICAL EQUIPMENT (DME)
20|FH_F40690_0_0|SrvcGrp|188|2022|PCT|0.80|99|0.00|AZT (ZIDOVUDINE)
20|FH_F40690_0_0|SrvcGrp|6|2022|PCT|0.92|99|0.00|OP SURGERY
20|FH_F40698_0_0|SrvcGrp|13631|2022|PDM|90.00|99|0.00|CPT 99213
20|FH_F40698_0_0|SrvcGrp|3406|2022|PDM|100.00|99|0.00|CPT 99214
20|FH_F40710_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS
20|FH_F40715_0_0|SrvcGrp|177|2022|PDM|1815.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F40715_0_0|SrvcGrp|6|2022|PCT|0.83|99|0.00|OP SURGERY
20|FH_F40719_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F40719_0_0|CSTM-ALL|CSTM-00|2020|PDM|947.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40725_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40734_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40734_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F40738_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|SPINAL CORD REHAB
20|FH_F40738_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40738_0_0|SrvcGrp|16|2022|PDM|750.00|99|0.00|ACUTE REHABILITATION
20|FH_F40762_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40762_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS
20|FH_F40765_0_0|SrvcGrp|109|2022|PDM|648.00|99|0.00|CD - DETOX
20|FH_F40780_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F40799_0_0|CSTM-ALL|CSTM-00|2020|PDM|2250.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40800_0_0|SrvcGrp|3029|2022|PDM|250.00|99|0.00|NEWBORN NURSERY
20|FH_F40812_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F40834_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|CV SURGERY (MS DRG)
20|FH_F40834_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F40834_0_0|CSTM-ALL|CSTM-00|2020|PDM|1517.00|99|0.00|ACUTE IP MED SVCS
20|FH_F40834_0_0|SrvcGrp|33313|2022|PDM|393.00|99|0.00|MULTIPLE BIRTH
20|FH_F40834_0_0|SrvcGrp|33366|2022|PDM|787.00|99|0.00|MULTIPLE BIRTH - NICU LEVEL I
20|FH_F40834_0_0|SrvcGrp|33368|2022|PDM|2146.00|99|0.00|MULTIPLE BIRTH - NICU LEVEL II
20|FH_F40834_0_0|SrvcGrp|33370|2022|PDM|2146.00|99|0.00|MULTIPLE BIRTH - NICU LEVEL III
20|FH_F40834_0_0|SrvcGrp|38|2022|PDM|3820.00|99|0.00|NORMAL DELIVERY
20|FH_F40834_0_0|SrvcGrp|675|2022|PDM|1517.00|99|0.00|PEDIATRIC INPATIENT SVCS
20|FH_F40834_0_0|SrvcGrp|997|2022|PCT|0.85|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F40838_0_0|CSTM-ALL|CSTM-00|2020|PDM|1150.00|99|0.00|ACUTE IP MED SVCS
20|FH_F40838_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|ACUTE IP SURGICAL SERVICES
20|FH_F40840_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.00|99|0.00|OP SVCS
20|FH_F40853_0_0|CSTM-ALL|CSTM-00|2020|PDM|1060.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40855_0_0|SrvcGrp|13551|2022|PDM|322.00|99|0.00|NEWBORN NURSERY
20|FH_F40855_0_0|SrvcGrp|97|2022|PDM|3467.00|99|0.00|C-SECTION
20|FH_F40885_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|CPT 95808 MOD TC
20|FH_F40903_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F40904_0_0|SrvcGrp|701|2022|PDM|1875.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F40906_0_0|SrvcGrp|13422|2022|PDM|209.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC
20|FH_F40906_0_0|SrvcGrp|13681|2022|PDM|278.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT
20|FH_F40906_0_0|SrvcGrp|18071|2022|PDM|55.00|99|0.00|AMBULANCE RESPONSE/TREATMENT - NO TRANSPORT
20|FH_F40943_0_0|SrvcGrp|12496|2022|PDM|753.00|99|0.00|ACUTE REHABILITATION
20|FH_F40943_0_0|SrvcGrp|43285|2022|PDM|71.00|99|0.00|SPEECH THERAPY
20|FH_F40957_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40972_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40972_0_0|SrvcGrp|16|2022|PDM|750.00|99|0.00|ACUTE REHABILITATION
20|FH_F40972_0_0|SrvcGrp|469|2022|PDM|1300.00|99|0.00|VENTILATOR REHABILITATION
20|FH_F40975_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|GENERAL ACUTE CARE
20|FH_F40975_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|OP SVCS
20|FH_F40975_0_0|SrvcGrp|6|2022|PCT|0.78|99|0.00|OP SURGERY
20|FH_F40977_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F40980_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F40980_0_0|CSTM-ALL|CSTM-00|2020|PDM|11601.00|99|0.00|MS DRG 286
20|FH_F40980_0_0|CSTM-ALL|CSTM-00|2020|PDM|20625.00|99|0.00|MS DRG 246
20|FH_F40980_0_0|CSTM-ALL|CSTM-00|2020|PDM|64454.00|99|0.00|MSDRG 219-221 CARDIAC VLV PX+OTR MJR CARDIOTHORACIC PX W/CC
20|FH_F40980_0_0|CSTM-ALL|CSTM-00|2020|PDM|77346.00|99|0.00|MSDRG 216-218 CARDIAC VALVE PROCEDURE W/ CARDIAC CATH
20|FH_F40980_0_0|SrvcGrp|13811|2022|PDM|512.00|99|0.00|PSYCH PARTIAL HOSP
20|FH_F40980_0_0|SrvcGrp|15|2022|PDM|5826.00|99|0.00|PEDIATRIC INTENSIVE CARE UNIT
20|FH_F40980_0_0|SrvcGrp|20162|2022|PDM|28018.00|99|0.00|BARIATRIC SERVICES
20|FH_F40980_0_0|SrvcGrp|361|2022|PDM|5826.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F40980_0_0|SrvcGrp|6|2022|PCT|0.80|99|0.00|OP SURGERY
20|FH_F40980_0_0|SrvcGrp|8|2022|PDM|6898.00|99|0.00|BURN INTENSIVE CARE
20|FH_F40983_0_0|CSTM-ALL|CSTM-00|2020|PDM|338.50|99|0.00|ASPG I
20|FH_F40983_0_0|CSTM-ALL|CSTM-00|2020|PDM|640.40|99|0.00|ASPG X
20|FH_F40983_0_0|CSTM-ALL|CSTM-00|2020|PDM|728.83|99|0.00|ASPG V
20|FH_F40994_0_0|CSTM-ALL|CSTM-00|2020|PDM|875.00|99|0.00|ACUTE IP MED SVCS
20|FH_F41015_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PHARMACY SVCS
20|FH_F41015_0_0|SrvcGrp|474|2022|PDM|200.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F41021_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F41021_0_0|SrvcGrp|11000|2022|PCT|0.55|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F41021_0_0|SrvcGrp|17067|2022|PDM|2416.00|99|0.00|ASPG II
20|FH_F41021_0_0|SrvcGrp|17071|2022|PDM|3412.00|99|0.00|ASPG IV
20|FH_F41021_0_0|SrvcGrp|17073|2022|PDM|3884.00|99|0.00|ASPG V
20|FH_F41021_0_0|SrvcGrp|17081|2022|PDM|6589.00|99|0.00|ASPG IX
20|FH_F41033_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41033_0_0|SrvcGrp|17069|2022|PDM|561.00|99|0.00|ASPG III
20|FH_F41033_0_0|SrvcGrp|17081|2022|PDM|1473.00|99|0.00|ASPG IX
20|FH_F41035_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41035_0_0|SrvcGrp|72998|2022|PDM|788.00|99|0.00|AEG 5
20|FH_F41053_0_0|CSTM-ALL|CSTM-00|2020|PDM|562.00|99|0.00|ACUTE PSYCH
20|FH_F41059_0_0|CSTM-ALL|CSTM-00|2020|PDM|230.00|99|0.00|ADOLOESCENT PARTIAL HOSPITALIZATION
20|FH_F41059_0_0|CSTM-ALL|CSTM-00|2020|PDM|230.00|99|0.00|CHILD PARTIAL HOSPITALIZATION
20|FH_F41059_0_0|CSTM-ALL|CSTM-00|2020|PDM|536.00|99|0.00|ADOLESCENT PSYCHIATRIC
20|FH_F41059_0_0|CSTM-ALL|CSTM-00|2020|PDM|536.00|99|0.00|CHILD PSYCHIATRIC
20|FH_F41059_0_0|CSTM-ALL|CSTM-00|2020|PDM|536.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41112_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F41133_0_0|SrvcGrp|1306|2022|PDM|311.00|99|0.00|OP PSYCH PARTIAL HOSP
20|FH_F41133_0_0|SrvcGrp|13811|2022|PDM|311.00|99|0.00|PSYCH PARTIAL HOSP
20|FH_F41135_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41135_0_0|SrvcGrp|17067|2022|PDM|430.85|99|0.00|ASPG II
20|FH_F41135_0_0|SrvcGrp|17079|2022|PDM|944.29|99|0.00|ASPG VIII
20|FH_F41142_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F41142_0_0|CSTM-ALL|CSTM-00|2020|PDM|168.00|99|0.00|ADOLESCENT PSYCH HALF DAY (4-7 HRS)
20|FH_F41142_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|ADULT PSYCHIATRIC
20|FH_F41142_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|CHEMICAL DEPENDENCY - ADOLESCENT
20|FH_F41155_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|TPA
20|FH_F41155_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F41155_0_0|CSTM-ALL|CSTM-00|2020|PDM|962.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F41155_0_0|SrvcGrp|10107|2022|PCT|0.70|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F41155_0_0|SrvcGrp|3029|2022|PDM|239.00|99|0.00|NEWBORN NURSERY
20|FH_F41155_0_0|SrvcGrp|38|2022|PDM|2081.00|99|0.00|NORMAL DELIVERY
20|FH_F41155_0_0|SrvcGrp|701|2022|PDM|1717.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F41155_0_0|SrvcGrp|705|2022|PCT|0.70|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F41158_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41158_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS
20|FH_F41161_0_0|CSTM-ALL|CSTM-00|2020|PDM|548.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41161_0_0|CSTM-ALL|CSTM-00|2020|PDM|658.00|99|0.00|ELECTROCONVULSIVE THERAPY
20|FH_F41166_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41167_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F41167_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|ACUTE PSYCH
20|FH_F41167_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F41171_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41171_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F41173_0_0|CSTM-ALL|CSTM-00|2020|PDM|364.00|99|0.00|CHILD PSYCH RESIDENTIAL TREAT
20|FH_F41173_0_0|CSTM-ALL|CSTM-00|2020|PDM|655.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41173_0_0|SrvcGrp|109|2022|PDM|598.00|99|0.00|CD - DETOX
20|FH_F41178_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F41178_0_0|CSTM-ALL|CSTM-00|2020|PDM|421.00|99|0.00|CD RESIDENTIAL TREATMENT
20|FH_F41178_0_0|CSTM-ALL|CSTM-00|2020|PDM|451.00|99|0.00|PSYCHIATRIC RESIDENTIAL TREATMENT
20|FH_F41178_0_0|CSTM-ALL|CSTM-00|2020|PDM|646.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41178_0_0|SrvcGrp|109|2022|PDM|710.00|99|0.00|CD - DETOX
20|FH_F41181_0_0|CSTM-ALL|CSTM-00|2020|PDM|728.00|99|0.00|ACUTE PSYCH
20|FH_F41181_0_0|SrvcGrp|38|2022|PDM|3432.00|99|0.00|NORMAL DELIVERY
20|FH_F41181_0_0|SrvcGrp|97|2022|PDM|4056.00|99|0.00|C-SECTION
20|FH_F41200_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41201_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|MSDRG 286-287 CARDIAC CATH
20|FH_F41201_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|ANGIOPLASTY
20|FH_F41201_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 927-929, 933-935 BURN SVCS
20|FH_F41201_0_0|SrvcGrp|10013|2022|PDM|325.00|99|0.00|NEWBORN NURSERY
20|FH_F41201_0_0|SrvcGrp|359|2022|PCT|0.73|99|0.00|NEONATAL INTENSIVE CARE LEVEL I
20|FH_F41201_0_0|SrvcGrp|360|2022|PCT|0.73|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F41201_0_0|SrvcGrp|941|2022|PCT|0.73|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F41202_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.93|99|0.00|OP SVCS
20|FH_F41229_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|SPINAL CORD REHABILITATION
20|FH_F41254_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|BLOOD AND BLOOD PRODUCTS
20|FH_F41261_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS
20|FH_F41273_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F41275_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F41275_0_0|CSTM-ALL|CSTM-00|2020|PDM|130.00|99|0.00|OP ADULT PARTIAL HOSPITALIZATION FULL DAY (8-12 HOURS)
20|FH_F41275_0_0|CSTM-ALL|CSTM-00|2020|PDM|140.00|99|0.00|OP ADOLESCENT PARTIAL HOSPITALIZATION HALF DAY (4-7 HOURS)
20|FH_F41275_0_0|CSTM-ALL|CSTM-00|2020|PDM|250.00|99|0.00|OP PARTIAL HOSPITALIZATION (8-12 HOURS)
20|FH_F41275_0_0|CSTM-ALL|CSTM-00|2020|PDM|290.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F41275_0_0|CSTM-ALL|CSTM-00|2020|PDM|625.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41279_0_0|CSTM-ALL|CSTM-00|2020|PDM|372.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41279_0_0|SrvcGrp|1306|2022|PDM|266.00|99|0.00|OP PSYCH PARTIAL HOSP
20|FH_F41281_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41314_0_0|SrvcGrp|30941|2022|PDM|564.00|99|0.00|NEWBORN NURSERY
20|FH_F41317_0_0|SrvcGrp|3029|2022|PDM|265.00|99|0.00|NEWBORN NURSERY
20|FH_F41320_0_0|CSTM-ALL|CSTM-00|2020|PDM|865.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41348_0_0|CSTM-ALL|CSTM-00|2020|PDM|213.00|99|0.00|OP ADOLESCENT PARTIAL HOSPITALIZATION (CD)
20|FH_F41348_0_0|CSTM-ALL|CSTM-00|2020|PDM|410.00|99|0.00|CD - ADULT
20|FH_F41348_0_0|CSTM-ALL|CSTM-00|2020|PDM|410.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41348_0_0|CSTM-ALL|CSTM-00|2020|PDM|425.00|99|0.00|CHEMICAL DEPENDENCY - ADOLESCENT
20|FH_F41374_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|CD - ADULT
20|FH_F41377_0_0|SrvcGrp|177|2022|PDM|950.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F41405_0_0|CSTM-ALL|CSTM-00|2020|PDM|65.00|99|0.00|OP SVCS
20|FH_F41429_0_0|SrvcGrp|13811|2022|PDM|263.00|99|0.00|PSYCH PARTIAL HOSP
20|FH_F41438_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F41441_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F41452_0_0|CSTM-ALL|CSTM-00|2020|PDM|782.10|99|0.00|ASPG 5- PROGRESSIVE SURG
20|FH_F41456_0_0|SrvcGrp|11442|2022|PDM|623.00|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)
20|FH_F41457_0_0|CSTM-ALL|CSTM-00|2020|PDM|37.00|99|0.00|AMBULANCE WAITING TIME
20|FH_F41457_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|HOSPICE SVCS
20|FH_F41457_0_0|SrvcGrp|13085|2022|PDM|1100.00|99|0.00|OBSERVATION SVCS
20|FH_F41457_0_0|SrvcGrp|13592|2022|PDM|2750.00|99|0.00|OP LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F41457_0_0|SrvcGrp|34346|2022|PDM|2750.00|99|0.00|OP SURGERY
20|FH_F41458_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F41461_0_0|SrvcGrp|30941|2022|PDM|200.00|99|0.00|NEWBORN NURSERY
20|FH_F41461_0_0|SrvcGrp|439|2022|PDM|1350.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F41481_0_0|SrvcGrp|17069|2022|PDM|560.00|99|0.00|ASPG III
20|FH_F41481_0_0|SrvcGrp|17071|2022|PDM|692.00|99|0.00|ASPG IV
20|FH_F41481_0_0|SrvcGrp|17075|2022|PDM|914.00|99|0.00|ASPG VI
20|FH_F41481_0_0|SrvcGrp|17083|2022|PDM|366.00|99|0.00|ASPG X
20|FH_F41484_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F41484_0_0|CSTM-ALL|CSTM-00|2020|PDM|492.54|99|0.00|ASPG IX
20|FH_F41484_0_0|CSTM-ALL|CSTM-00|2020|PDM|802.00|99|0.00|ASPG VI
20|FH_F41484_0_0|CSTM-ALL|CSTM-00|2020|PDM|966.14|99|0.00|ASPG VII
20|FH_F41489_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41494_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F41494_0_0|SrvcGrp|6|2022|PCT|0.75|99|0.00|OP SURGERY
20|FH_F41494_0_0|SrvcGrp|97|2022|PDM|4685.00|99|0.00|C-SECTION
20|FH_F41516_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41516_0_0|CSTM-ALL|CSTM-00|2020|PDM|275.00|99|0.00|NEUROREHABILITATION IP SVCS
20|FH_F41516_0_0|SrvcGrp|32550|2022|PDM|300.00|99|0.00|NEWBORN NURSERY
20|FH_F41516_0_0|SrvcGrp|34549|2022|PCT|0.95|99|0.00|CAT SCAN
20|FH_F41535_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F41535_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|ACUTE PSYCH
20|FH_F41535_0_0|CSTM-ALL|CSTM-00|2020|PDM|875.00|99|0.00|ACUTE IP MED SVCS
20|FH_F41539_0_0|SrvcGrp|33825|2022|PDM|482.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG 3
20|FH_F41539_0_0|SrvcGrp|33828|2022|PDM|780.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG 6
20|FH_F41539_0_0|SrvcGrp|33829|2022|PDM|941.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG 7
20|FH_F41539_0_0|SrvcGrp|33830|2022|PDM|888.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG 8
20|FH_F41540_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41540_0_0|SrvcGrp|104295|2022|PDM|1152.00|99|0.00|UNGROUPED
20|FH_F41540_0_0|SrvcGrp|33823|2022|PDM|688.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG I
20|FH_F41540_0_0|SrvcGrp|33825|2022|PDM|966.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG 3
20|FH_F41540_0_0|SrvcGrp|33827|2022|PDM|1290.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG 5
20|FH_F41540_0_0|SrvcGrp|33829|2022|PDM|1776.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG 7
20|FH_F41540_0_0|SrvcGrp|33831|2022|PDM|1840.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG 9
20|FH_F41594_0_0|CSTM-ALL|CSTM-00|2020|PDM|106.19|99|0.00|CPT 92526
20|FH_F41594_0_0|SrvcGrp|10431|2022|PDM|78.00|99|0.00|SPEECH THERAPY
20|FH_F41602_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.66|99|0.00|OP SVCS
20|FH_F41608_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F41611_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F41611_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41652_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F41652_0_0|CSTM-ALL|CSTM-00|2020|PDM|144.00|99|0.00|CD PARTIAL HOSP (<= 4 HOURS)
20|FH_F41652_0_0|CSTM-ALL|CSTM-00|2020|PDM|324.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41660_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41661_0_0|SrvcGrp|16|2022|PDM|630.00|99|0.00|ACUTE REHABILITATION
20|FH_F41672_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41675_0_0|SrvcGrp|14651|2022|PDM|1575.00|99|0.00|LITHOTRIPSY SVCS
20|FH_F41675_0_0|SrvcGrp|18076|2022|PDM|760.00|99|0.00|MRI
20|FH_F41675_0_0|SrvcGrp|27776|2022|PDM|760.00|99|0.00|OP MRI
20|FH_F41675_0_0|SrvcGrp|30661|2022|PDM|1575.00|99|0.00|LITHOTRIPSY SVCS
20|FH_F41678_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F41678_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41692_0_0|CSTM-ALL|CSTM-00|2020|PCT|67.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41695_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41696_0_0|CSTM-ALL|CSTM-00|2020|PDM|268.00|99|0.00|CD DAY TREATMENT
20|FH_F41696_0_0|SrvcGrp|110|2022|PDM|504.00|99|0.00|CD - REHABILITATION
20|FH_F41699_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F41738_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F41738_0_0|CSTM-ALL|CSTM-00|2020|PDM|1565.00|99|0.00|COVENTRY ENHANCED GROUPER 9
20|FH_F41738_0_0|CSTM-ALL|CSTM-00|2020|PDM|330.00|99|0.00|COVENTRY ENHANCED GROUPER 10
20|FH_F41738_0_0|CSTM-ALL|CSTM-00|2020|PDM|596.00|99|0.00|COVENTRY ENHANCED GROUPER 3
20|FH_F41738_0_0|SrvcGrp|21342|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F41739_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.79|99|0.00|DRG 545 ONLY
20|FH_F41739_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F41739_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ORGAN ACQUISITION
20|FH_F41739_0_0|CSTM-ALL|CSTM-00|2020|PDM|33063.00|99|0.00|DRG 531/532 ONLY
20|FH_F41739_0_0|SrvcGrp|11000|2022|PCT|0.70|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F41739_0_0|SrvcGrp|34765|2022|PCT|1.00|99|0.00|BLOOD AND BLOOD PRODUCTS
20|FH_F41739_0_0|SrvcGrp|38|2022|PDM|5724.00|99|0.00|NORMAL DELIVERY
20|FH_F41749_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|EATING DISORDER PARTIAL DAY - ADOLESCENT
20|FH_F41749_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41749_0_0|SrvcGrp|3390|2022|PDM|275.00|99|0.00|CPT 90801
20|FH_F41773_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41795_0_0|CSTM-ALL|CSTM-00|2020|PDM|60.00|99|0.00|SPEECH THERAPY SVCS
20|FH_F41796_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F41798_0_0|CSTM-ALL|CSTM-00|2020|PDM|218.00|99|0.00|PSYCH PARTIAL HOSPITALIZATION
20|FH_F41801_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE
20|FH_F41801_0_0|SrvcGrp|109|2022|PDM|555.00|99|0.00|CD - DETOX
20|FH_F41803_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41803_0_0|SrvcGrp|34875|2022|PCT|0.50|99|0.00|COCHLEAR IMPLANT
20|FH_F41808_0_0|SrvcGrp|12403|2022|PDM|788.55|99|0.00|CONTINUOUS HOMECARE
20|FH_F41809_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41809_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|ACUTE PSYCH
20|FH_F41809_0_0|SrvcGrp|38|2022|PDM|1600.00|99|0.00|NORMAL DELIVERY
20|FH_F41809_0_0|SrvcGrp|97|2022|PDM|2400.00|99|0.00|C-SECTION
20|FH_F41814_0_0|SrvcGrp|9501|2022|PDM|1196.00|99|0.00|ACUTE IP MED/SURG SVCS
20|FH_F41814_0_0|SrvcGrp|997|2022|PCT|0.45|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F41818_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|OP SVCS
20|FH_F41835_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F41835_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41835_0_0|SrvcGrp|16|2022|PDM|630.00|99|0.00|ACUTE REHABILITATION
20|FH_F41845_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.93|99|0.00|OP SVCS
20|FH_F41845_0_0|SrvcGrp|110|2022|PDM|475.00|99|0.00|CD - REHABILITATION
20|FH_F41874_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F41885_0_0|CSTM-ALL|CSTM-00|2020|PDM|875.00|99|0.00|ACUTE IP MED SVCS
20|FH_F41887_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41887_0_0|SrvcGrp|13640|2022|PDM|110.00|99|0.00|CPT 99202
20|FH_F41934_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|ASPG II - CPD 1281588
20|FH_F41934_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|ASPG III - CPD 1281588
20|FH_F41962_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41962_0_0|SrvcGrp|38|2022|PDM|850.00|99|0.00|NORMAL DELIVERY
20|FH_F41962_0_0|SrvcGrp|97|2022|PDM|850.00|99|0.00|C-SECTION
20|FH_F41979_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS
20|FH_F41988_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F41989_0_0|CSTM-ALL|CSTM-00|2020|PDM|179.00|99|0.00|OP SVCS
20|FH_F41989_0_0|SrvcGrp|109|2022|PDM|630.00|99|0.00|CD - DETOX
20|FH_F41992_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42005_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|GASTRO ASSOC OF  ORANGEBURG GI PROCEDURES 500
20|FH_F42018_0_0|CSTM-ALL|CSTM-00|2020|PCT|62.79|99|0.00|OP SVCS
20|FH_F42019_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|ACUTE PSYCH
20|FH_F42024_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.79|99|0.00|OP SVCS
20|FH_F42024_0_0|SrvcGrp|16867|2022|PCT|1.00|99|0.00|PACEMAKER IMPLANT W/O ACUTE INFARCTION
20|FH_F42024_0_0|SrvcGrp|35556|2022|PCT|1.00|99|0.00|BLOOD AND BLOOD PRODUCTS - IP
20|FH_F42024_0_0|SrvcGrp|9936|2022|PDM|125.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F42024_0_0|SrvcGrp|9937|2022|PDM|125.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F42024_0_0|SrvcGrp|9938|2022|PDM|125.00|99|0.00|SPEECH THERAPY
20|FH_F42026_0_0|CSTM-ALL|CSTM-00|2020|PDM|183.00|99|0.00|CD DAY TREATMENT
20|FH_F42042_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42098_0_0|SrvcGrp|11072|2022|PDM|50.00|99|0.00|SPEECH THERAPY SVCS
20|FH_F42098_0_0|SrvcGrp|11073|2022|PDM|55.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F42098_0_0|SrvcGrp|28284|2022|PDM|50.00|99|0.00|SUBSEQUENT  SPECIALTY NURSING S9123 MOD TF
20|FH_F42105_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F42117_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|UNLISTED PROCEDURE, MATERNITY CARE AND DELIVERY
20|FH_F42138_0_0|SrvcGrp|13722|2022|PDM|116.00|99|0.00|HOSPICE SERVICE - ROUTINE HOME CARE
20|FH_F42138_0_0|SrvcGrp|3810|2022|PDM|116.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|1070.00|99|0.00|HAPA EPA ASC 8
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|1082.00|99|0.00|HAPA EPA ASC 54
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|113.00|99|0.00|HAPA EPA ASC 19
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|195.00|99|0.00|HAPA EPA ASC 29
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|264.00|99|0.00|HAPA EPA ASC 35
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|329.00|99|0.00|HAPA EPA ASC 39
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|340.00|99|0.00|HAPA EPA ASC 40
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|352.00|99|0.00|HAPA EPA ASC 42
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|377.00|99|0.00|HAPA EPA ASC 44
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|384.00|99|0.00|HAPA EPA ASC 45
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|457.00|99|0.00|HAPA EPA ASC 51
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|688.00|99|0.00|HAPA EPA ASC 4
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|74.00|99|0.00|HAPA EPA ASC 13
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|911.00|99|0.00|HAPA EPA ASC 6
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|95.00|99|0.00|HAPA EPA ASC 15
20|FH_F42140_0_0|SrvcGrp|27536|2022|PDM|495.00|99|0.00|HAPA EPA ASC 57 UNGROUPED
20|FH_F42142_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42142_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F42153_0_0|SrvcGrp|11336|2022|PCT|0.65|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F42153_0_0|SrvcGrp|180|2022|PDM|3195.00|99|0.00|INTENSIVE CARE SERVICES
20|FH_F42153_0_0|SrvcGrp|3029|2022|PDM|578.00|99|0.00|NEWBORN NURSERY
20|FH_F42153_0_0|SrvcGrp|65|2022|PDM|2427.00|99|0.00|OBSTETRICAL CARE
20|FH_F42156_0_0|CSTM-ALL|CSTM-00|2020|PDM|1273.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42156_0_0|SrvcGrp|97|2022|PDM|2546.00|99|0.00|C-SECTION
20|FH_F42159_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|GENERAL ACUTE CARE
20|FH_F42159_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|OP SVCS
20|FH_F42159_0_0|SrvcGrp|22461|2022|PCT|0.95|99|0.00|INPATIENT HOSPICE SVCS
20|FH_F42159_0_0|SrvcGrp|29817|2022|PDM|2300.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F42161_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|GENERAL ACUTE CARE
20|FH_F42161_0_0|SrvcGrp|12146|2022|PDM|1700.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F42161_0_0|SrvcGrp|20801|2022|PCT|0.88|99|0.00|HOME HEALTH
20|FH_F42163_0_0|CSTM-ALL|CSTM-00|2020|PDM|60.00|99|0.00|OP SVCS
20|FH_F42165_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F42165_0_0|SrvcGrp|12146|2022|PDM|1700.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F42168_0_0|SrvcGrp|12118|2022|PDM|600.00|99|0.00|COMPUTED TOMOGRAPHY (CT)
20|FH_F42169_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F42169_0_0|SrvcGrp|20801|2022|PCT|0.85|99|0.00|HOME HEALTH
20|FH_F42176_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|GENERAL ACUTE CARE
20|FH_F42176_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|MS DRG 765-766 ONLY C-SECTION
20|FH_F42176_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|PEDIATRIC IP SVCS
20|FH_F42176_0_0|SrvcGrp|177|2022|PDM|1100.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F42176_0_0|SrvcGrp|20801|2022|PCT|0.88|99|0.00|HOME HEALTH
20|FH_F42177_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|MS DRG 795 ONLY & REV CODES 170-171 NRML NEWBORN OTLR
20|FH_F42177_0_0|SrvcGrp|177|2022|PDM|1250.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F42177_0_0|SrvcGrp|20801|2022|PCT|0.85|99|0.00|HOME HEALTH
20|FH_F42195_0_0|CSTM-ALL|CSTM-00|2020|PCT|68.80|99|0.00|GENERAL ACUTE CARE
20|FH_F42244_0_0|CSTM-ALL|CSTM-00|2020|PDM|468.00|99|0.00|ACUTE PSYCH
20|FH_F42244_0_0|SrvcGrp|115|2022|PDM|468.00|99|0.00|SKILLED NURSING CARE
20|FH_F42244_0_0|SrvcGrp|13292|2022|PCT|0.70|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F42244_0_0|SrvcGrp|24703|2022|PDM|260.00|99|0.00|NEWBORN NURSERY
20|FH_F42244_0_0|SrvcGrp|360|2022|PCT|0.75|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F42250_0_0|CSTM-ALL|CSTM-00|2020|PCT|74.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42255_0_0|CSTM-ALL|CSTM-00|2020|PDM|966.14|99|0.00|ASPG VII
20|FH_F42258_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F42258_0_0|SrvcGrp|3409|2022|PDM|350.00|99|0.00|NEWBORN NURSERY
20|FH_F42258_0_0|SrvcGrp|439|2022|PDM|1400.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F42260_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42260_0_0|CSTM-ALL|CSTM-00|2020|PDM|1004.00|99|0.00|COVENTRY ENHANCED GROUPER 5
20|FH_F42260_0_0|CSTM-ALL|CSTM-00|2020|PDM|1156.00|99|0.00|COVENTRY ENHANCED GROUPER 6
20|FH_F42260_0_0|CSTM-ALL|CSTM-00|2020|PDM|1362.00|99|0.00|COVENTRY ENHANCED GROUPER 8
20|FH_F42260_0_0|CSTM-ALL|CSTM-00|2020|PDM|1362.00|99|0.00|COVENTRY ENHANCED GROUPER 8 MOD 50
20|FH_F42260_0_0|CSTM-ALL|CSTM-00|2020|PDM|714.00|99|0.00|COVENTRY ENHANCED GROUPER 3 MOD 50
20|FH_F42260_0_0|CSTM-ALL|CSTM-00|2020|PDM|882.00|99|0.00|COVENTRY ENHANCED GROUPER 4
20|FH_F42272_0_0|CSTM-ALL|CSTM-00|2020|PDM|459.00|99|0.00|ASPG X
20|FH_F42272_0_0|SrvcGrp|28818|2022|PCT|0.45|99|0.00|SUPPLIES AND DEVICES
20|FH_F42282_0_0|SrvcGrp|110|2022|PDM|470.00|99|0.00|CD - REHABILITATION
20|FH_F42294_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42295_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS
20|FH_F42312_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|AZT ZIDOVUDINE
20|FH_F42312_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|DDI VIDEX
20|FH_F42332_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F42333_0_0|CSTM-ALL|CSTM-00|2020|PDM|330.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42342_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F42352_0_0|CSTM-ALL|CSTM-00|2020|PDM|1216.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42352_0_0|SrvcGrp|269|2022|PCT|0.65|99|0.00|OP LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F42355_0_0|SrvcGrp|110|2022|PDM|350.00|99|0.00|CD - REHABILITATION
20|FH_F42363_0_0|CSTM-ALL|CSTM-00|2020|PDM|120.00|99|0.00|CD INTENSIVE OUTPATIENT SVCS
20|FH_F42363_0_0|CSTM-ALL|CSTM-00|2020|PDM|200.00|99|0.00|CD PARTIAL HOSPITALIZATION
20|FH_F42363_0_0|CSTM-ALL|CSTM-00|2020|PDM|275.00|99|0.00|CD REHABILITATION
20|FH_F42366_0_0|CSTM-ALL|CSTM-00|2020|PCT|58.00|99|0.00|OP SVCS
20|FH_F42366_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|EMERGENCY ROOM
20|FH_F42367_0_0|CSTM-ALL|CSTM-00|2020|PCT|58.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42367_0_0|CSTM-ALL|CSTM-00|2020|PCT|58.00|99|0.00|OP SVCS
20|FH_F42367_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|EMERGENCY ROOM
20|FH_F42396_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F42397_0_0|CSTM-ALL|CSTM-00|2020|PDM|1288.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42402_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|ECHOCARDIOGRAM
20|FH_F42402_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|SONOGRAM
20|FH_F42402_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42402_0_0|SrvcGrp|177|2022|PCT|0.90|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F42423_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F42423_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|COVENTRY ENHANCED GROUPER 7
20|FH_F42423_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|COVENTRY ENHANCED GROUPER 2
20|FH_F42423_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|COVENTRY ENHANCED GROUPER 3
20|FH_F42423_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|COVENTRY ENHANCED GROUPER 10
20|FH_F42423_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|COVENTRY ENHANCED GROUPER 4
20|FH_F42423_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|COVENTRY ENHANCED GROUPER 9
20|FH_F42423_0_0|CSTM-ALL|CSTM-00|2020|PDM|975.00|99|0.00|COVENTRY ENHANCED GROUPER 8
20|FH_F42426_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F42426_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42426_0_0|SrvcGrp|109|2022|PDM|450.00|99|0.00|CD - DETOX
20|FH_F42433_0_0|SrvcGrp|471|2022|PDM|520.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F42433_0_0|SrvcGrp|474|2022|PDM|220.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F42438_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42438_0_0|CSTM-ALL|CSTM-00|2020|PDM|1508.00|99|0.00|COVENTRY ENHANCED GROUPER 8
20|FH_F42438_0_0|CSTM-ALL|CSTM-00|2020|PDM|2075.00|99|0.00|COVENTRY ENHANCED GROUPER 9
20|FH_F42438_0_0|SrvcGrp|23585|2022|PCT|1.05|99|0.00|IMPLANTS
20|FH_F42444_0_0|CSTM-ALL|CSTM-00|2020|PDM|936.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42453_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F42453_0_0|CSTM-ALL|CSTM-00|2020|PDM|459.00|99|0.00|CHEMICAL DEPENDENCY - ADOLESCENT
20|FH_F42464_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS
20|FH_F42464_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|BURN OUTPATIENT SERVICES
20|FH_F42466_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F42466_0_0|CSTM-ALL|CSTM-00|2020|PDM|477.00|99|0.00|SKILLED NURSING
20|FH_F42466_0_0|SrvcGrp|38|2022|PDM|2016.00|99|0.00|NORMAL DELIVERY
20|FH_F42467_0_0|SrvcGrp|3029|2022|PDM|220.00|99|0.00|NEWBORN NURSERY
20|FH_F42467_0_0|SrvcGrp|38|2022|PDM|1600.00|99|0.00|NORMAL DELIVERY
20|FH_F42500_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F42500_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42500_0_0|SrvcGrp|439|2022|PDM|1150.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F42539_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F42539_0_0|SrvcGrp|12403|2022|PDM|42.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F42539_0_0|SrvcGrp|3809|2022|PDM|602.00|99|0.00|HOSPICE CARE
20|FH_F42551_0_0|CSTM-ALL|CSTM-00|2020|PDM|205.00|99|0.00|CD (ADULT) - DAY TREATMENT
20|FH_F42554_0_0|CSTM-ALL|CSTM-00|2020|PCT|76.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42554_0_0|CSTM-ALL|CSTM-00|2020|PCT|76.00|99|0.00|OP SVCS
20|FH_F42557_0_0|CSTM-ALL|CSTM-00|2020|PDM|135.00|99|0.00|OP SVCS
20|FH_F42557_0_0|CSTM-ALL|CSTM-00|2020|PDM|330.00|99|0.00|CD - ADULT PARTIAL HOSPITAL
20|FH_F42557_0_0|CSTM-ALL|CSTM-00|2020|PDM|430.00|99|0.00|ACUTE REHABILITATION
20|FH_F42557_0_0|SrvcGrp|3087|2022|PDM|586.00|99|0.00|CD - DETOX
20|FH_F42573_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42577_0_0|CSTM-ALL|CSTM-00|2020|PDM|199.00|99|0.00|PSYCH PARTIAL HOSPITALIZATION
20|FH_F42577_0_0|CSTM-ALL|CSTM-00|2020|PDM|337.00|99|0.00|PSYCHIATRIC RESIDENTIAL TREATMENT
20|FH_F42577_0_0|CSTM-ALL|CSTM-00|2020|PDM|607.00|99|0.00|ACUTE PSYCH
20|FH_F42581_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F42581_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F42626_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TRANSPORTATION SERVICES
20|FH_F42626_0_0|SrvcGrp|3029|2022|PDM|244.00|99|0.00|NEWBORN NURSERY
20|FH_F42633_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|C-SECTION
20|FH_F42633_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F42633_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|NORMAL DELIVERY
20|FH_F42646_0_0|SrvcGrp|177|2022|PDM|950.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F42646_0_0|SrvcGrp|3029|2022|PDM|220.00|99|0.00|NEWBORN NURSERY
20|FH_F42646_0_0|SrvcGrp|3418|2022|PDM|1000.00|99|0.00|NEONATAL INTENSIVE CARE UNIT
20|FH_F42655_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42688_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42690_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F42706_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS
20|FH_F42706_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|BLOOD / BLOOD PRODUCTS
20|FH_F42706_0_0|CSTM-ALL|CSTM-00|2020|PDM|443.02|99|0.00|ASPG II
20|FH_F42706_0_0|CSTM-ALL|CSTM-00|2020|PDM|712.21|99|0.00|ASPG V
20|FH_F42706_0_0|SrvcGrp|17739|2022|PDM|1400.00|99|0.00|ICU/CCU
20|FH_F42706_0_0|SrvcGrp|18006|2022|PDM|100.00|99|0.00|PHYSICAL THERAPY
20|FH_F42706_0_0|SrvcGrp|36413|2022|PDM|100.00|99|0.00|SPEECH  THERAPY
20|FH_F42706_0_0|SrvcGrp|36415|2022|PDM|140.00|99|0.00|PT/OT/ST (INITIAL EVAL)
20|FH_F42706_0_0|SrvcGrp|471|2022|PDM|839.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F42706_0_0|SrvcGrp|472|2022|PDM|766.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F42706_0_0|SrvcGrp|473|2022|PDM|470.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F42706_0_0|SrvcGrp|474|2022|PDM|375.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F42706_0_0|SrvcGrp|70939|2022|PCT|0.27|99|0.00|DRUGS
20|FH_F42706_0_0|SrvcGrp|8950|2022|PDM|1300.00|99|0.00|INTERMEDIATE ICU/CCU
20|FH_F42706_0_0|SrvcGrp|9228|2022|PDM|100.00|99|0.00|RESPIRATORY THERAPY SVCS
20|FH_F42708_0_0|CSTM-ALL|CSTM-00|2020|PDM|684.00|99|0.00|ACUTE PSYCH
20|FH_F42715_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS
20|FH_F42715_0_0|SrvcGrp|472|2022|PDM|423.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F42719_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.60|99|0.00|GENERAL ACUTE CARE
20|FH_F42736_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42744_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42744_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F42754_0_0|CSTM-ALL|CSTM-00|2020|PDM|143.00|99|0.00|CD DAY TREATMENT
20|FH_F42755_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F42797_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42799_0_0|CSTM-ALL|CSTM-00|2020|PDM|70.00|99|0.00|OP SVCS
20|FH_F42803_0_0|CSTM-ALL|CSTM-00|2020|PDM|475.00|99|0.00|TRANSITIONAL CARE UNIT
20|FH_F42803_0_0|SrvcGrp|13551|2022|PDM|300.00|99|0.00|NEWBORN NURSERY
20|FH_F42807_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|DURABLE MEDICAL EQUIPMENT
20|FH_F42807_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|NUCLEAR MEDICINE / PROSTATE SEED IMPLANTS
20|FH_F42807_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F42807_0_0|SrvcGrp|1021|2022|PCT|0.75|99|0.00|VENTILATOR EQUIPMENT
20|FH_F42807_0_0|SrvcGrp|109|2022|PDM|780.00|99|0.00|CD - DETOX
20|FH_F42807_0_0|SrvcGrp|11258|2022|PCT|0.75|99|0.00|DRUGS
20|FH_F42807_0_0|SrvcGrp|115|2022|PDM|468.00|99|0.00|SKILLED NURSING CARE
20|FH_F42807_0_0|SrvcGrp|12280|2022|PCT|0.75|99|0.00|IMPLANTS
20|FH_F42807_0_0|SrvcGrp|38|2022|PDM|4472.00|99|0.00|NORMAL DELIVERY
20|FH_F42807_0_0|SrvcGrp|705|2022|PCT|0.75|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F42822_0_0|CSTM-ALL|CSTM-00|2020|PDM|225.00|99|0.00|ADOLESCENT PARTIAL HOSPITALIZATION
20|FH_F42822_0_0|SrvcGrp|33252|2022|PDM|567.00|99|0.00|CD (CHILD) - DETOX
20|FH_F42897_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42902_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42905_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42906_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42913_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42917_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F42917_0_0|SrvcGrp|36727|2022|PDM|400.00|99|0.00|PSYCH- PARTIAL HOSP
20|FH_F42921_0_0|CSTM-ALL|CSTM-00|2020|PCT|71.60|99|0.00|OP SVCS
20|FH_F42932_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42933_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F42938_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F42939_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42939_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F42945_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F42946_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42948_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F42951_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.50|99|0.00|GENERAL ACUTE CARE
20|FH_F42979_0_0|CSTM-ALL|CSTM-00|2020|PDM|96.00|99|0.00|CPT 90809
20|FH_F42979_0_0|CSTM-ALL|CSTM-00|2020|PDM|96.00|99|0.00|CPT 90887
20|FH_F42979_0_0|SrvcGrp|3378|2022|PDM|372.00|99|0.00|OBSERVATION SVCS
20|FH_F42979_0_0|SrvcGrp|3397|2022|PDM|42.00|99|0.00|CPT 90849
20|FH_F42980_0_0|SrvcGrp|50202|2022|PDM|125.00|99|0.00|OP OFFICE VISIT
20|FH_F42984_0_0|CSTM-ALL|CSTM-00|2020|PDM|373.00|99|0.00|ADOLESCENT RESIDENTIAL TREATMENT
20|FH_F42984_0_0|SrvcGrp|109|2022|PDM|584.00|99|0.00|CD - DETOX
20|FH_F42992_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS
20|FH_F42992_0_0|CSTM-ALL|CSTM-00|2020|PDM|2365.00|99|0.00|MS DRG 765-766 C-SECTION
20|FH_F42992_0_0|SrvcGrp|31931|2022|PDM|1336.00|99|0.00|SKILLED NURSING CARE
20|FH_F43000_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43000_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F43000_0_0|CSTM-ALL|CSTM-00|2020|PDM|75.00|99|0.00|OT SERVICES
20|FH_F43008_0_0|CSTM-ALL|CSTM-00|2020|PDM|2334.00|99|0.00|MS DRG 765-766 C-SECTION
20|FH_F43008_0_0|SrvcGrp|18932|2022|PDM|1500.00|99|0.00|MS DRG 774 REPLACEMENT MS DRG 805-806
20|FH_F43008_0_0|SrvcGrp|40820|2022|PDM|1280.00|99|0.00|ICU/CCU
20|FH_F43014_0_0|CSTM-ALL|CSTM-00|2020|PDM|75.00|99|0.00|OP SVCS
20|FH_F43018_0_0|SrvcGrp|13709|2022|PDM|3010.00|99|0.00|ACUTE IP MEDICAL SVCS
20|FH_F43018_0_0|SrvcGrp|13811|2022|PDM|304.00|99|0.00|PSYCH PARTIAL HOSP
20|FH_F43018_0_0|SrvcGrp|16|2022|PDM|1550.00|99|0.00|ACUTE REHABILITATION
20|FH_F43018_0_0|SrvcGrp|16033|2022|PCT|0.60|99|0.00|HIGH COST DRUGS
20|FH_F43018_0_0|SrvcGrp|16034|2022|PDM|489.00|99|0.00|RESIDENTIAL TREATMENT
20|FH_F43018_0_0|SrvcGrp|35164|2022|PCT|0.75|99|0.00|NICU LEVEL II OR III
20|FH_F43018_0_0|SrvcGrp|8950|2022|PDM|3530.00|99|0.00|INTERMEDIATE ICU/CCU
20|FH_F43027_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43076_0_0|SrvcGrp|27726|2022|PCT|0.75|99|0.00|OP SURGERY
20|FH_F43078_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43078_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F43078_0_0|SrvcGrp|12403|2022|PDM|140.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F43081_0_0|CSTM-ALL|CSTM-00|2020|PDM|144.00|99|0.00|PSYCHIATRIC RESIDENTIAL TREATMENT
20|FH_F43113_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F43113_0_0|SrvcGrp|17766|2022|PDM|77.00|99|0.00|HOME HEALTH - PT/OT/ST
20|FH_F43135_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F43135_0_0|CSTM-ALL|CSTM-00|2020|PDM|710.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43135_0_0|SrvcGrp|958|2022|PDM|820.00|99|0.00|VENTILATOR SERVICES
20|FH_F43147_0_0|SrvcGrp|110|2022|PDM|460.00|99|0.00|CD - REHABILITATION
20|FH_F43154_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43167_0_0|CSTM-ALL|CSTM-00|2020|PDM|475.00|99|0.00|ACUTE PSYCH
20|FH_F43167_0_0|CSTM-ALL|CSTM-00|2020|PDM|475.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43167_0_0|SrvcGrp|80|2022|PDM|925.00|99|0.00|ACUTE PSYCH
20|FH_F43169_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43171_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F43171_0_0|CSTM-ALL|CSTM-00|2020|PDM|360.00|99|0.00|ADULT PSYCH DAY TREATMENT
20|FH_F43172_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F43196_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43199_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43199_0_0|SrvcGrp|12263|2022|PDM|26.25|99|0.00|HOME HEALTH AIDE- HOURLY
20|FH_F43199_0_0|SrvcGrp|12702|2022|PDM|68.25|99|0.00|RN, INTERMITTENT VISIT
20|FH_F43199_0_0|SrvcGrp|8962|2022|PDM|131.25|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F43199_0_0|SrvcGrp|9829|2022|PDM|131.25|99|0.00|PT SVCS
20|FH_F43199_0_0|SrvcGrp|9830|2022|PDM|131.25|99|0.00|OT SVCS
20|FH_F43210_0_0|CSTM-ALL|CSTM-00|2020|PDM|847.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43236_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F43236_0_0|SrvcGrp|13643|2022|PDM|1500.00|99|0.00|DRG 372 NORMAL DELIVERY (MOTHER ONLY)
20|FH_F43236_0_0|SrvcGrp|37018|2022|PDM|225.00|99|0.00|BOARDER BABY
20|FH_F43237_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.76|99|0.00|OP SVCS
20|FH_F43237_0_0|SrvcGrp|6|2022|PCT|0.80|99|0.00|OP SURGERY
20|FH_F43241_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F43244_0_0|SrvcGrp|15150|2022|PCT|0.80|99|0.00|DRUGS
20|FH_F43244_0_0|SrvcGrp|31134|2022|PDM|1100.00|99|0.00|SURGICAL - ADULT/PEDIATRIC
20|FH_F43244_0_0|SrvcGrp|40820|2022|PDM|1200.00|99|0.00|ICU/CCU
20|FH_F43245_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43245_0_0|SrvcGrp|31134|2022|PDM|750.00|99|0.00|SURGICAL - ADULT/PEDIATRIC
20|FH_F43249_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.54|99|0.00|OP SVCS
20|FH_F43249_0_0|SrvcGrp|24|2022|PDM|5828.00|99|0.00|CARDIAC CATH
20|FH_F43249_0_0|SrvcGrp|360|2022|PDM|2590.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F43249_0_0|SrvcGrp|40820|2022|PDM|2590.00|99|0.00|ICU/CCU
20|FH_F43260_0_0|CSTM-ALL|CSTM-00|2020|PDM|250.00|99|0.00|CD PARTIAL HOSPITALIZATION
20|FH_F43260_0_0|CSTM-ALL|CSTM-00|2020|PDM|385.00|99|0.00|TRANSITIONAL CARE UNIT
20|FH_F43260_0_0|CSTM-ALL|CSTM-00|2020|PDM|525.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F43260_0_0|SrvcGrp|1306|2022|PDM|250.00|99|0.00|OP PSYCH PARTIAL HOSP
20|FH_F43293_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F43293_0_0|SrvcGrp|3165|2022|PCT|0.85|99|0.00|EMERGENCY ROOM
20|FH_F43294_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F43294_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43295_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|CV SERVICES (MS DRG)
20|FH_F43295_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F43295_0_0|CSTM-ALL|CSTM-00|2020|PDM|929.00|99|0.00|ADULT CD OUTPATIENT SVCS
20|FH_F43295_0_0|SrvcGrp|18932|2022|PDM|2442.00|99|0.00|MS DRG 774 REPLACEMENT MS DRG 805-806
20|FH_F43295_0_0|SrvcGrp|31134|2022|PDM|1221.00|99|0.00|SURGICAL - ADULT/PEDIATRIC
20|FH_F43295_0_0|SrvcGrp|37018|2022|PDM|432.00|99|0.00|BOARDER BABY
20|FH_F43296_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F43296_0_0|CSTM-ALL|CSTM-00|2020|PDM|300.00|99|0.00|CD SVCS (ADULT)
20|FH_F43296_0_0|SrvcGrp|18932|2022|PDM|1370.00|99|0.00|MS DRG 774 REPLACEMENT MS DRG 805-806
20|FH_F43296_0_0|SrvcGrp|3178|2022|PDM|1045.00|99|0.00|ACUTE PSYCH
20|FH_F43296_0_0|SrvcGrp|43871|2022|PDM|473.00|99|0.00|NEWBORN NURSERY
20|FH_F43330_0_0|CSTM-ALL|CSTM-00|2020|PDM|30.00|99|0.00|HOME HEALTH MOD TD
20|FH_F43330_0_0|SrvcGrp|11068|2022|PDM|90.00|99|0.00|PT SVCS
20|FH_F43330_0_0|SrvcGrp|11080|2022|PDM|80.00|99|0.00|NURSING CARE
20|FH_F43332_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43332_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS
20|FH_F43333_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|OP SVCS
20|FH_F43333_0_0|SrvcGrp|350|2022|PDM|875.00|99|0.00|SURGICAL CARE
20|FH_F43333_0_0|SrvcGrp|38|2022|PDM|1600.00|99|0.00|NORMAL DELIVERY
20|FH_F43352_0_0|CSTM-ALL|CSTM-00|2020|PDM|1146.00|99|0.00|WELLPATH PROPIETARY ASC V
20|FH_F43352_0_0|CSTM-ALL|CSTM-00|2020|PDM|531.00|99|0.00|WELLPATH PROPIETARY ASC I
20|FH_F43411_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|AETNA OP CT SCANS (CTSCAN)
20|FH_F43411_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|CV SERVICES (MS DRG)
20|FH_F43411_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43411_0_0|SrvcGrp|16|2022|PDM|1270.00|99|0.00|ACUTE REHABILITATION
20|FH_F43411_0_0|SrvcGrp|43871|2022|PDM|450.00|99|0.00|NEWBORN NURSERY
20|FH_F43412_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43412_0_0|SrvcGrp|109|2022|PDM|700.00|99|0.00|CD - DETOX
20|FH_F43412_0_0|SrvcGrp|37266|2022|PDM|600.00|99|0.00|ADULT REHABILITATION FULL DAY
20|FH_F43417_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F43417_0_0|CSTM-ALL|CSTM-00|2020|PDM|2334.00|99|0.00|MS DRG 765-766 C-SECTION
20|FH_F43417_0_0|SrvcGrp|18932|2022|PDM|1500.00|99|0.00|MS DRG 774 REPLACEMENT MS DRG 805-806
20|FH_F43417_0_0|SrvcGrp|37018|2022|PDM|250.00|99|0.00|BOARDER BABY
20|FH_F43417_0_0|SrvcGrp|9539|2022|PDM|300.00|99|0.00|SUBACUTE CARE
20|FH_F43418_0_0|SrvcGrp|37018|2022|PDM|250.00|99|0.00|BOARDER BABY
20|FH_F43421_0_0|CSTM-ALL|CSTM-00|2020|PDM|489.00|99|0.00|CD ADULT REHAB
20|FH_F43421_0_0|CSTM-ALL|CSTM-00|2020|PDM|66.00|99|0.00|CD SVCS (ADULT)
20|FH_F43421_0_0|SrvcGrp|12290|2022|PDM|524.00|99|0.00|DETOXIFICATION
20|FH_F43421_0_0|SrvcGrp|37015|2022|PDM|524.00|99|0.00|CHILD & ADOLESCENT PSYCH
20|FH_F43436_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|AMBULANCE SVCS
20|FH_F43443_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|ACUTE PSYCH
20|FH_F43443_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43450_0_0|CSTM-ALL|CSTM-00|2020|PDM|536.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43486_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.64|99|0.00|OP SVCS
20|FH_F43486_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE
20|FH_F43503_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|MSDRG 246-251 ANGIOPLASTY
20|FH_F43503_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|MSDRG 286-287 CARDIAC CATH
20|FH_F43513_0_0|CSTM-ALL|CSTM-00|2020|PCT|86.60|99|0.00|OP SVCS
20|FH_F43536_0_0|SrvcGrp|38|2022|PDM|4354.00|99|0.00|NORMAL DELIVERY
20|FH_F43536_0_0|SrvcGrp|97|2022|PDM|1959.00|99|0.00|C-SECTION
20|FH_F43575_0_0|CSTM-ALL|CSTM-00|2020|PDM|973.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43612_0_0|CSTM-ALL|CSTM-00|2020|PDM|670.00|99|0.00|ADOLESCENT PSYCHIATRIC
20|FH_F43613_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F43653_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F43663_0_0|CSTM-ALL|CSTM-00|2020|PDM|729.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43663_0_0|SrvcGrp|52|2022|PCT|0.65|99|0.00|RESIDENTIAL TREATMENT SVCS
20|FH_F43665_0_0|CSTM-ALL|CSTM-00|2020|PDM|892.00|99|0.00|SPINAL CORD REHABILITATION
20|FH_F43665_0_0|SrvcGrp|16|2022|PDM|761.00|99|0.00|ACUTE REHABILITATION
20|FH_F43693_0_0|CSTM-ALL|CSTM-00|2020|PDM|257.00|99|0.00|CD PARTIAL HOSPITALIZATION
20|FH_F43693_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43696_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE
20|FH_F43696_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F43719_0_0|CSTM-ALL|CSTM-00|2020|PDM|515.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F43719_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43720_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43720_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F43774_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43779_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|BURN SVCS
20|FH_F43779_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|CV SURGERY
20|FH_F43779_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|TRAUMA CARE
20|FH_F43779_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|FACTOR VIII
20|FH_F43779_0_0|CSTM-ALL|CSTM-00|2020|PDM|1689.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43779_0_0|CSTM-ALL|CSTM-00|2020|PDM|890.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F43779_0_0|SrvcGrp|13292|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F43779_0_0|SrvcGrp|359|2022|PDM|1128.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL I
20|FH_F43779_0_0|SrvcGrp|97|2022|PDM|6537.00|99|0.00|C-SECTION
20|FH_F43793_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F43800_0_0|CSTM-ALL|CSTM-00|2020|PDM|847.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43800_0_0|CSTM-ALL|CSTM-00|2020|PDM|961.00|99|0.00|HEAD INJURY REHABILITATION
20|FH_F43800_0_0|SrvcGrp|16|2022|PDM|847.00|99|0.00|ACUTE REHABILITATION
20|FH_F43801_0_0|CSTM-ALL|CSTM-00|2020|PDM|847.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43801_0_0|SrvcGrp|16|2022|PDM|847.00|99|0.00|ACUTE REHABILITATION
20|FH_F43832_0_0|SrvcGrp|17766|2022|PDM|152.00|99|0.00|HOME HEALTH - PT/OT/ST
20|FH_F43858_0_0|SrvcGrp|30961|2022|PDM|12.50|99|0.00|HOME HEALTH AIDE
20|FH_F43858_0_0|SrvcGrp|37403|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE
20|FH_F43858_0_0|SrvcGrp|37406|2022|PDM|90.00|99|0.00|SPEECH THERAPY SVCS
20|FH_F43859_0_0|SrvcGrp|30958|2022|PDM|65.00|99|0.00|SKILLED LPN VISIT
20|FH_F43859_0_0|SrvcGrp|30961|2022|PDM|12.50|99|0.00|HOME HEALTH AIDE
20|FH_F43859_0_0|SrvcGrp|37405|2022|PDM|90.00|99|0.00|OT SVCS
20|FH_F43860_0_0|SrvcGrp|30955|2022|PDM|115.00|99|0.00|SKILLED RN VISIT
20|FH_F43860_0_0|SrvcGrp|30961|2022|PDM|12.50|99|0.00|HOME HEALTH AIDE
20|FH_F43860_0_0|SrvcGrp|37406|2022|PDM|90.00|99|0.00|SPEECH THERAPY SVCS
20|FH_F43861_0_0|CSTM-ALL|CSTM-00|2020|PDM|25.00|99|0.00|SKILLED LPN HOURLY
20|FH_F43861_0_0|SrvcGrp|35468|2022|PDM|75.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F43861_0_0|SrvcGrp|37406|2022|PDM|90.00|99|0.00|SPEECH THERAPY SVCS
20|FH_F43863_0_0|SrvcGrp|30955|2022|PDM|115.00|99|0.00|SKILLED RN VISIT
20|FH_F43863_0_0|SrvcGrp|30958|2022|PDM|65.00|99|0.00|SKILLED LPN VISIT
20|FH_F43863_0_0|SrvcGrp|37405|2022|PDM|90.00|99|0.00|OT SVCS
20|FH_F43865_0_0|SrvcGrp|30955|2022|PDM|115.00|99|0.00|SKILLED RN VISIT
20|FH_F43865_0_0|SrvcGrp|37403|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE
20|FH_F43865_0_0|SrvcGrp|37404|2022|PDM|90.00|99|0.00|PT SVCS
20|FH_F43865_0_0|SrvcGrp|37406|2022|PDM|90.00|99|0.00|SPEECH THERAPY SVCS
20|FH_F43867_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F43867_0_0|SrvcGrp|30955|2022|PDM|115.00|99|0.00|SKILLED RN VISIT
20|FH_F43867_0_0|SrvcGrp|30961|2022|PDM|12.50|99|0.00|HOME HEALTH AIDE
20|FH_F43867_0_0|SrvcGrp|35468|2022|PDM|75.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F43872_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43872_0_0|SrvcGrp|471|2022|PDM|579.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F43895_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F43895_0_0|CSTM-ALL|CSTM-00|2020|PDM|1105.00|99|0.00|ACUTE REHABILITATION
20|FH_F43895_0_0|SrvcGrp|45882|2022|PDM|125.00|99|0.00|PT
20|FH_F43895_0_0|SrvcGrp|45884|2022|PDM|125.00|99|0.00|ST
20|FH_F43913_0_0|SrvcGrp|32550|2022|PDM|350.00|99|0.00|NEWBORN NURSERY
20|FH_F43913_0_0|SrvcGrp|37873|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F43919_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43919_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F43934_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43953_0_0|CSTM-ALL|CSTM-00|2020|PDM|2521.00|99|0.00|MS DRG 765-768, 774-775 C-SECTION & NORMAL DELIVERY
20|FH_F43953_0_0|CSTM-ALL|CSTM-00|2020|PDM|3106.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43953_0_0|SrvcGrp|26595|2022|PDM|1343.00|99|0.00|ACUTE PSYCHIATRIC
20|FH_F43953_0_0|SrvcGrp|38421|2022|PCT|0.70|99|0.00|INTERLUKEN II & DRUGS (IP)
20|FH_F43953_0_0|SrvcGrp|941|2022|PDM|4201.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F44023_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.71|99|0.00|OP SVCS
20|FH_F44023_0_0|CSTM-ALL|CSTM-00|2020|PDM|2236.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44023_0_0|SrvcGrp|38002|2022|PDM|3505.00|99|0.00|SURGICAL DAY CARE
20|FH_F44023_0_0|SrvcGrp|9875|2022|PDM|2236.00|99|0.00|ACUTE IP MEDICAL SERVICES
20|FH_F44025_0_0|CSTM-ALL|CSTM-00|2020|PDM|374.00|99|0.00|CD PARTIAL HOSPITALIZATION
20|FH_F44042_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F44048_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS
20|FH_F44048_0_0|CSTM-ALL|CSTM-00|2020|PDM|609.00|99|0.00|ADOLESCENT PSYCHIATRIC
20|FH_F44072_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44075_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F44075_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|ASPG IX
20|FH_F44075_0_0|CSTM-ALL|CSTM-00|2020|PDM|517.00|99|0.00|ASPG II
20|FH_F44093_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|ACUTE PSYCH
20|FH_F44113_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|PEDIATRIC IP SVCS
20|FH_F44113_0_0|SrvcGrp|16|2022|PDM|700.00|99|0.00|ACUTE REHABILITATION
20|FH_F44113_0_0|SrvcGrp|29817|2022|PDM|3000.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F44113_0_0|SrvcGrp|31007|2022|PDM|225.00|99|0.00|MS DRG 795 ONLY & REV CODES 170-171 NORMAL NEWBORN
20|FH_F44113_0_0|SrvcGrp|3349|2022|PDM|3000.00|99|0.00|LITHOTRIPSY SVCS
20|FH_F44114_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F44134_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F44134_0_0|CSTM-ALL|CSTM-00|2020|PDM|1366.41|99|0.00|COVENTRY ENHANCED GROUPER 7
20|FH_F44134_0_0|SrvcGrp|41333|2022|PDM|4862.00|99|0.00|LITHO MOD 51
20|FH_F44172_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F44172_0_0|SrvcGrp|25934|2022|PDM|1400.00|99|0.00|SKILLED NURSING
20|FH_F44177_0_0|SrvcGrp|23477|2022|PDM|2333.00|99|0.00|MSDRG 286-287 ONLY CARDIAC CATH
20|FH_F44177_0_0|SrvcGrp|30133|2022|PDM|6634.00|99|0.00|LASER SURGERY
20|FH_F44177_0_0|SrvcGrp|30135|2022|PDM|6634.00|99|0.00|LAP SURGERY
20|FH_F44177_0_0|SrvcGrp|9774|2022|PDM|2030.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F44198_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44198_0_0|SrvcGrp|13597|2022|PDM|190.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT
20|FH_F44218_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F44218_0_0|SrvcGrp|10951|2022|PDM|350.00|99|0.00|PARTIAL HOSPITALIZATION PSYCH/CD
20|FH_F44218_0_0|SrvcGrp|33813|2022|PDM|650.00|99|0.00|CD - DETOX
20|FH_F44218_0_0|SrvcGrp|37542|2022|PDM|500.00|99|0.00|RESIDENTIAL TREATMENT
20|FH_F44225_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|HOME HEALTH SERVICES
20|FH_F44225_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F44225_0_0|SrvcGrp|22461|2022|PCT|0.90|99|0.00|INPATIENT HOSPICE SVCS
20|FH_F44241_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F44241_0_0|CSTM-ALL|CSTM-00|2020|PDM|1396.00|99|0.00|ASPG II
20|FH_F44241_0_0|CSTM-ALL|CSTM-00|2020|PDM|2390.00|99|0.00|ASPG VI
20|FH_F44241_0_0|CSTM-ALL|CSTM-00|2020|PDM|2815.00|99|0.00|ASPG VIII
20|FH_F44241_0_0|CSTM-ALL|CSTM-00|2020|PDM|4641.00|99|0.00|ARTHROSCOPY
20|FH_F44241_0_0|SrvcGrp|35669|2022|PDM|4641.00|99|0.00|CPT 63650
20|FH_F44241_0_0|SrvcGrp|38352|2022|PDM|3875.00|99|0.00|FOOT MUSCLOSKELETAL PROCEDURE
20|FH_F44255_0_0|SrvcGrp|109|2022|PDM|583.00|99|0.00|CD - DETOX
20|FH_F44257_0_0|CSTM-ALL|CSTM-00|2020|PDM|291.00|99|0.00|PARTIAL HOSPITAL
20|FH_F44258_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F44278_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F44278_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|IMPLANTS
20|FH_F44278_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|MS DRG 765-766 ONLY C-SECTION
20|FH_F44278_0_0|SrvcGrp|12146|2022|PDM|2700.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F44278_0_0|SrvcGrp|20801|2022|PCT|0.85|99|0.00|HOME HEALTH
20|FH_F44278_0_0|SrvcGrp|22461|2022|PCT|0.85|99|0.00|INPATIENT HOSPICE SVCS
20|FH_F44278_0_0|SrvcGrp|36144|2022|PCT|0.85|99|0.00|OP SURGERY
20|FH_F44299_0_0|SrvcGrp|10540|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE
20|FH_F44299_0_0|SrvcGrp|10541|2022|PDM|65.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F44299_0_0|SrvcGrp|10545|2022|PDM|65.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F44299_0_0|SrvcGrp|15385|2022|PDM|75.00|99|0.00|SKILLED NURSING NON IV RELATED
20|FH_F44312_0_0|CSTM-ALL|CSTM-00|2020|PDM|275.00|99|0.00|PSYCH PARTIAL HOSPITALIZATION
20|FH_F44312_0_0|CSTM-ALL|CSTM-00|2020|PDM|555.00|99|0.00|ADULT PSYCHIATRIC
20|FH_F44312_0_0|SrvcGrp|110|2022|PDM|490.00|99|0.00|CD - REHABILITATION
20|FH_F44314_0_0|SrvcGrp|26775|2022|PDM|46.00|99|0.00|OT
20|FH_F44334_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44334_0_0|SrvcGrp|12044|2022|PDM|772.30|99|0.00|SLEEP STUDIES
20|FH_F44334_0_0|SrvcGrp|13620|2022|PDM|802.59|99|0.00|SLEEP STUDIES
20|FH_F44334_0_0|SrvcGrp|13621|2022|PDM|470.99|99|0.00|SLEEP STUDIES
20|FH_F44334_0_0|SrvcGrp|13626|2022|PDM|476.66|99|0.00|SLEEP STUDIES
20|FH_F44336_0_0|CSTM-ALL|CSTM-00|2020|PDM|354.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44336_0_0|SrvcGrp|167|2022|PDM|354.00|99|0.00|CD (ADULT) - REHABILITATION
20|FH_F44336_0_0|SrvcGrp|196|2022|PDM|411.00|99|0.00|CD (ADOLESCENT) - DETOX
20|FH_F44342_0_0|CSTM-ALL|CSTM-00|2020|PDM|680.00|99|0.00|CHILD PSYCHIATRIC
20|FH_F44350_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F44350_0_0|SrvcGrp|13811|2022|PDM|300.00|99|0.00|PSYCH PARTIAL HOSP
20|FH_F44354_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44356_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44358_0_0|CSTM-ALL|CSTM-00|2020|PDM|233.00|99|0.00|CD PARTIAL HOSPITALIZATION
20|FH_F44358_0_0|CSTM-ALL|CSTM-00|2020|PDM|597.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44394_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OP SVCS
20|FH_F44394_0_0|CSTM-ALL|CSTM-00|2020|PDM|83.00|99|0.00|TRANSITIONAL CARE UNIT
20|FH_F44435_0_0|CSTM-ALL|CSTM-00|2020|PDM|1020.00|99|0.00|OP SURGERY (CPT 52332)
20|FH_F44435_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|AEG 3 (NO REV)
20|FH_F44435_0_0|SrvcGrp|25518|2022|PDM|3925.00|99|0.00|LAPAROSCOPY SURGICAL CHOLECYSTECTOMY
20|FH_F44435_0_0|SrvcGrp|27345|2022|PDM|2950.00|99|0.00|OP SURGERY (CPT 49650)
20|FH_F44438_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|DIALYSIS SERVICES
20|FH_F44438_0_0|SrvcGrp|11199|2022|PCT|0.70|99|0.00|HYPERBARIC CHAMBER
20|FH_F44455_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F44459_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F44459_0_0|SrvcGrp|38676|2022|PDM|45.00|99|0.00|SPEECH THERAPY
20|FH_F44495_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F44495_0_0|CSTM-ALL|CSTM-00|2020|PDM|128.00|99|0.00|PT / OT / ST
20|FH_F44582_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|ASPG I
20|FH_F44582_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|ASPG II
20|FH_F44582_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|ASPG VI
20|FH_F44582_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F44582_0_0|SrvcGrp|13880|2022|PCT|0.65|99|0.00|IMPLANTS
20|FH_F44582_0_0|SrvcGrp|16065|2022|PCT|1.00|99|0.00|BLOOD AND BLOOD PRODUCTS
20|FH_F44582_0_0|SrvcGrp|21826|2022|PDM|7000.00|99|0.00|PTCA (MS DRG ONLY)
20|FH_F44582_0_0|SrvcGrp|23206|2022|PCT|0.70|99|0.00|PTCA
20|FH_F44582_0_0|SrvcGrp|9838|2022|PDM|2800.00|99|0.00|TRANSITIONAL CARE UNIT
20|FH_F44601_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|PROFESSIONAL FEES ON CMS1500
20|FH_F44612_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|IMPLANTS
20|FH_F44612_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44638_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F44638_0_0|CSTM-ALL|CSTM-00|2020|PDM|200.00|99|0.00|PSYCHIATRIC PARTIAL HOSPITALIZATION (IP) - ADULT
20|FH_F44638_0_0|CSTM-ALL|CSTM-00|2020|PDM|200.00|99|0.00|PSYCHIATRIC PARTIAL HOSPITALIZATION (OP) - ADOLESCENT
20|FH_F44638_0_0|CSTM-ALL|CSTM-00|2020|PDM|595.00|99|0.00|ADOLESCENT PSYCHIATRIC
20|FH_F44646_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44646_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F44660_0_0|SrvcGrp|10400|2022|PDM|1750.00|99|0.00|IP SURGERY
20|FH_F44660_0_0|SrvcGrp|3029|2022|PDM|325.00|99|0.00|NEWBORN NURSERY
20|FH_F44701_0_0|CSTM-ALL|CSTM-00|2020|PDM|1410.00|99|0.00|ASPG VIII
20|FH_F44701_0_0|CSTM-ALL|CSTM-00|2020|PDM|1942.00|99|0.00|ASPG IX
20|FH_F44701_0_0|CSTM-ALL|CSTM-00|2020|PDM|50.00|99|0.00|INTRAOCULAR LENS
20|FH_F44701_0_0|CSTM-ALL|CSTM-00|2020|PDM|602.00|99|0.00|ASPG II
20|FH_F44701_0_0|CSTM-ALL|CSTM-00|2020|PDM|689.00|99|0.00|ASPG III
20|FH_F44701_0_0|SrvcGrp|38909|2022|PDM|1410.00|99|0.00|CPT 67036 - VITRECTOMY, MECHANICAL
20|FH_F44724_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44724_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F44724_0_0|SrvcGrp|33165|2022|PDM|360.00|99|0.00|SKILLED NURSING - LEVEL II
20|FH_F44754_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44754_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F44754_0_0|SrvcGrp|10540|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE
20|FH_F44755_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.60|99|0.00|OP SVCS
20|FH_F44772_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F44813_0_0|CSTM-ALL|CSTM-00|2020|PDM|205.00|99|0.00|PSYCHIATRIC DAY TREATMENT PROGRAM
20|FH_F44813_0_0|CSTM-ALL|CSTM-00|2020|PDM|430.00|99|0.00|CHILD PSYCHIATRIC
20|FH_F44952_0_0|SrvcGrp|26001|2022|PDM|139.76|99|0.00|HOSPICE RESPITE SVCS
20|FH_F44992_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|BLOOD AND BLOOD PRODUCTS
20|FH_F45120_0_0|CSTM-ALL|CSTM-00|2020|PDM|1145.00|99|0.00|COVENTRY ENHANCED GROUPER 6
20|FH_F45120_0_0|CSTM-ALL|CSTM-00|2020|PDM|865.00|99|0.00|COVENTRY ENHANCED GROUPER 4
20|FH_F45120_0_0|SrvcGrp|13880|2022|PCT|0.21|99|0.00|IMPLANTS
20|FH_F45120_0_0|SrvcGrp|29988|2022|PCT|0.21|99|0.00|INTRAOCULAR LENSES
20|FH_F45120_0_0|SrvcGrp|30457|2022|PCT|0.21|99|0.00|DRUGS
20|FH_F45121_0_0|CSTM-ALL|CSTM-00|2020|PDM|25.00|99|0.00|CD RESIDENTIAL TREATMENT
20|FH_F45169_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F45169_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F45175_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F45176_0_0|CSTM-ALL|CSTM-00|2020|PDM|1464.00|99|0.00|ASPG V
20|FH_F45176_0_0|CSTM-ALL|CSTM-00|2020|PDM|2800.00|99|0.00|KNEE ARTHROSCOPY
20|FH_F45176_0_0|CSTM-ALL|CSTM-00|2020|PDM|912.00|99|0.00|ASPG II
20|FH_F45220_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS
20|FH_F45303_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F45312_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE
20|FH_F45312_0_0|SrvcGrp|15663|2022|PCT|0.88|99|0.00|TRAUMA CARE
20|FH_F45324_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F45372_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F45372_0_0|SrvcGrp|30941|2022|PDM|306.00|99|0.00|NEWBORN NURSERY
20|FH_F45435_0_0|SrvcGrp|12401|2022|PDM|105.00|99|0.00|RN VISIT
20|FH_F45436_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F45436_0_0|SrvcGrp|12401|2022|PDM|130.00|99|0.00|RN VISIT
20|FH_F45436_0_0|SrvcGrp|26798|2022|PDM|70.00|99|0.00|LICENSED PRACTICAL NURSE
20|FH_F45436_0_0|SrvcGrp|8962|2022|PDM|170.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F45513_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F45513_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F45513_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.37|99|0.00|COVENTRY ENHANCED DEFAULT 10021-69990
20|FH_F45513_0_0|CSTM-ALL|CSTM-00|2020|PDM|865.16|99|0.00|COVENTRY ENHANCED GROUPER 4
20|FH_F45513_0_0|SrvcGrp|14614|2022|PDM|3800.00|99|0.00|LITHOTRIPSY
20|FH_F45513_0_0|SrvcGrp|26216|2022|PDM|1750.00|99|0.00|ARTHROSCOPY
20|FH_F45513_0_0|SrvcGrp|41336|2022|PDM|3300.00|99|0.00|VAGINAL HYSTERECTOMY
20|FH_F45519_0_0|CSTM-ALL|CSTM-00|2020|PCT|86.00|99|0.00|OP SVCS
20|FH_F45535_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F45535_0_0|CSTM-ALL|CSTM-00|2020|PDM|373.00|99|0.00|ASPG I - GNADEN HUETTEN
20|FH_F45535_0_0|CSTM-ALL|CSTM-00|2020|PDM|803.00|99|0.00|ASPG V - GNADEN HUETTEN
20|FH_F45653_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F45752_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F45752_0_0|CSTM-ALL|CSTM-00|2020|PDM|1205.00|99|0.00|ASPG V
20|FH_F45752_0_0|SrvcGrp|23936|2022|PCT|1.10|99|0.00|CORNEAL TISSUE SVCS
20|FH_F45795_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F45798_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F45798_0_0|CSTM-ALL|CSTM-00|2020|PDM|16600.00|99|0.00|DRG 216 BIOPSIES MUSCU & CON TISSUE
20|FH_F45798_0_0|CSTM-ALL|CSTM-00|2020|PDM|17600.00|99|0.00|DRG 544 MAJOR JOINT REPLACEMENT/REATTACHMENT OF LWR EXTRMTY
20|FH_F45798_0_0|CSTM-ALL|CSTM-00|2020|PDM|56600.00|99|0.00|DRG 496 COMB ANTI/POST SPINAL FUSION
20|FH_F45798_0_0|SrvcGrp|360|2022|PDM|2160.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F45798_0_0|SrvcGrp|9518|2022|PDM|1090.00|99|0.00|EMERGENCY ROOM
20|FH_F45873_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F45915_0_0|SrvcGrp|33166|2022|PDM|650.00|99|0.00|SKILLED NURSING - LEVEL III
20|FH_F46113_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|GENERAL ACUTE CARE
20|FH_F46158_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE
20|FH_F46158_0_0|SrvcGrp|17065|2022|PCT|0.65|99|0.00|ASPG I
20|FH_F46158_0_0|SrvcGrp|17073|2022|PCT|0.65|99|0.00|ASPG V
20|FH_F46158_0_0|SrvcGrp|17077|2022|PCT|0.65|99|0.00|ASPG VII
20|FH_F46173_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F46192_0_0|CSTM-ALL|CSTM-00|2020|PDM|3010.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F46192_0_0|SrvcGrp|29817|2022|PDM|2083.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F46197_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F46197_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F46197_0_0|SrvcGrp|17000|2022|PCT|0.83|99|0.00|OUTPATIENT SURGERY
20|FH_F46257_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F46273_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F46284_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F46284_0_0|CSTM-ALL|CSTM-00|2020|PDM|158.00|99|0.00|SKILLED NURSING CARE
20|FH_F46284_0_0|CSTM-ALL|CSTM-00|2020|PDM|158.00|99|0.00|SOCIAL WORKER
20|FH_F46284_0_0|SrvcGrp|26742|2022|PDM|147.00|99|0.00|PT
20|FH_F46288_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F46333_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|HIGH-COST DRUGS
20|FH_F46352_0_0|SrvcGrp|10410|2022|PDM|79.00|99|0.00|SKILLED NURSING CARE
20|FH_F46352_0_0|SrvcGrp|22954|2022|PDM|295.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F46354_0_0|CSTM-ALL|CSTM-00|2020|PDM|1394.96|99|0.00|COVENTRY ENHANCED GROUPER 9
20|FH_F46354_0_0|CSTM-ALL|CSTM-00|2020|PDM|464.64|99|0.00|COVENTRY ENHANCED GROUPER 2
20|FH_F46357_0_0|CSTM-ALL|CSTM-00|2020|PDM|1986.24|99|0.00|COVENTRY ENHANCED GROUPER 9
20|FH_F46357_0_0|CSTM-ALL|CSTM-00|2020|PDM|982.14|99|0.00|COVENTRY ENHANCED GROUPER 4
20|FH_F46357_0_0|SrvcGrp|38925|2022|PCT|1.10|99|0.00|HCPC IMPLANTS
20|FH_F46357_0_0|SrvcGrp|41333|2022|PDM|4200.00|99|0.00|LITHO MOD 51
20|FH_F46357_0_0|SrvcGrp|41334|2022|PDM|3400.00|99|0.00|TOTAL KNEE
20|FH_F46359_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F46359_0_0|SrvcGrp|26742|2022|PDM|147.00|99|0.00|PT
20|FH_F46372_0_0|SrvcGrp|3066|2022|PCT|0.65|99|0.00|HIGH-COST DRUGS
20|FH_F46373_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.84|99|0.00|GENERAL ACUTE CARE
20|FH_F46473_0_0|CSTM-ALL|CSTM-00|2020|PDM|2460.00|99|0.00|ASPG IX
20|FH_F46473_0_0|SrvcGrp|11151|2022|PDM|2771.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F46492_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|ASPG X
20|FH_F46492_0_0|SrvcGrp|10391|2022|PDM|2145.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F46492_0_0|SrvcGrp|11151|2022|PDM|2771.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F46612_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F46612_0_0|SrvcGrp|3809|2022|PDM|1391.00|99|0.00|HOSPICE CARE
20|FH_F46672_0_0|CSTM-ALL|CSTM-00|2020|PDM|20.00|99|0.00|HOME HEALTH AIDE (ADDITIONAL HOURS)
20|FH_F46672_0_0|SrvcGrp|12401|2022|PDM|90.00|99|0.00|RN VISIT
20|FH_F46732_0_0|SrvcGrp|12264|2022|PDM|80.00|99|0.00|DIETICIAN OR LPN SERVICES
20|FH_F46732_0_0|SrvcGrp|12403|2022|PDM|34.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F46732_0_0|SrvcGrp|3809|2022|PDM|619.00|99|0.00|HOSPICE CARE
20|FH_F46732_0_0|SrvcGrp|39524|2022|PDM|240.00|99|0.00|BILIRUBIN TEST
20|FH_F46732_0_0|SrvcGrp|91722|2022|PDM|148.00|99|0.00|ENTEROSTOMAL VISIT F/U VISIT
20|FH_F141169_0_0|CSTM-ALL|CSTM-00|2020|PDM|563.00|99|0.00|AEG 10 (NO REV)
20|FH_F141169_0_0|CSTM-ALL|CSTM-00|2020|PDM|792.00|99|0.00|AEG 5  (NO REV)
20|FH_F141169_0_0|SrvcGrp|113733|2022|PDM|362.00|99|0.00|COLPOSCOPY
20|FH_F141169_0_0|SrvcGrp|113734|2022|PDM|136.00|99|0.00|EXAM OF VAGINA
20|FH_F141169_0_0|SrvcGrp|73610|2022|PCT|0.00|99|0.00|AETNA IMPLANTS
20|FH_F141170_0_0|CSTM-ALL|CSTM-00|2020|PDM|1370.00|99|0.00|AEG 6 (NO REV)
20|FH_F141170_0_0|CSTM-ALL|CSTM-00|2020|PDM|577.50|99|0.00|AEG 1 (NO REV)
20|FH_F141170_0_0|SrvcGrp|103588|2022|PDM|6000.00|99|0.00|CAROTID/INOM ART
20|FH_F141170_0_0|SrvcGrp|103591|2022|PDM|6000.00|99|0.00|SUBCLAVIAN ART
20|FH_F141170_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F141170_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F141170_0_0|SrvcGrp|58636|2022|PDM|15015.00|99|0.00|CPT 62362
20|FH_F141170_0_0|SrvcGrp|88065|2022|PDM|13500.00|99|0.00|TOTAL DISC ARTHROPLASTY
20|FH_F141170_0_0|SrvcGrp|92364|2022|PDM|13000.00|99|0.00|ARTHRODESIS SACROILIAC JOINT
20|FH_F141170_0_0|SrvcGrp|92365|2022|PDM|10500.00|99|0.00|FUSION OF SACROILIAC JOINT
20|FH_F141170_0_0|SrvcGrp|92408|2022|PDM|4880.00|99|0.00|PERQ VERTEBRAL AUGMENTATION
20|FH_F141170_0_0|SrvcGrp|99073|2022|PDM|1.38|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F141207_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F141207_0_0|SrvcGrp|63297|2022|PDM|185.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F141207_0_0|SrvcGrp|80918|2022|PDM|485.00|99|0.00|RESPITE CARE
20|FH_F141207_0_0|SrvcGrp|90707|2022|PDM|205.00|99|0.00|AETNA HOSPICE CARE
20|FH_F141207_0_0|SrvcGrp|95660|2022|PDM|995.00|99|0.00|HOSPICE SERVICES (HCFA)
20|FH_F141210_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F141210_0_0|CSTM-ALL|CSTM-00|2020|PDM|1645.00|99|0.00|AEG 2 (NO REV)
20|FH_F141210_0_0|CSTM-ALL|CSTM-00|2020|PDM|2112.00|99|0.00|AEG 4 (NO REV)
20|FH_F141210_0_0|SrvcGrp|109016|2022|PDM|5305.00|99|0.00|REMOVAL OF ADENOIDS
20|FH_F141210_0_0|SrvcGrp|113115|2022|PDM|4751.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F141210_0_0|SrvcGrp|65625|2022|PDM|5305.00|99|0.00|CPT 30520
20|FH_F141210_0_0|SrvcGrp|88823|2022|PDM|5305.00|99|0.00|REPAIR OF EARDRUM
20|FH_F141211_0_0|CSTM-ALL|CSTM-00|2020|PDM|1490.00|99|0.00|AEG 2 (NO REV)
20|FH_F141211_0_0|CSTM-ALL|CSTM-00|2020|PDM|2687.00|99|0.00|AEG 5  (NO REV)
20|FH_F141211_0_0|CSTM-ALL|CSTM-00|2020|PDM|2920.00|99|0.00|AEG 6 (NO REV)
20|FH_F141211_0_0|CSTM-ALL|CSTM-00|2020|PDM|3025.00|99|0.00|AEG 7 (NO REV)
20|FH_F141212_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F141212_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F141217_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F141217_0_0|CSTM-ALL|CSTM-00|2020|PDM|1114.00|99|0.00|AEG 3 (NO REV)
20|FH_F141217_0_0|CSTM-ALL|CSTM-00|2020|PDM|1415.00|99|0.00|AEG 4 (NO REV)
20|FH_F141217_0_0|CSTM-ALL|CSTM-00|2020|PDM|1666.00|99|0.00|AEG 5  (NO REV)
20|FH_F141217_0_0|CSTM-ALL|CSTM-00|2020|PDM|1727.00|99|0.00|AEG 9 (NO REV)
20|FH_F141217_0_0|CSTM-ALL|CSTM-00|2020|PDM|1910.00|99|0.00|AEG 8 (NO REV)
20|FH_F141217_0_0|CSTM-ALL|CSTM-00|2020|PDM|603.00|99|0.00|AEG 1 (NO REV)
20|FH_F141217_0_0|SrvcGrp|93433|2022|PDM|9500.00|99|0.00|PARTIAL HIP REPLACEMENT
20|FH_F141248_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F141248_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F141267_0_0|SrvcGrp|113619|2022|PDM|550.00|99|0.00|HOSPICE CARE (HCFA)
20|FH_F141267_0_0|SrvcGrp|83857|2022|PDM|939.00|99|0.00|IP HOSPICE SVCS
20|FH_F141411_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 4 (NO REV)
20|FH_F141411_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 5  (NO REV)
20|FH_F141411_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|AEG 7 (NO REV)
20|FH_F141411_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|AEG 8 (NO REV)
20|FH_F141411_0_0|SrvcGrp|104950|2022|PDM|12500.00|99|0.00|REMOVAL OF IMPLANT MATERIAL
20|FH_F141411_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F141411_0_0|SrvcGrp|113759|2022|PDM|1500.00|99|0.00|REMOVAL OF SKIN LESION
20|FH_F141411_0_0|SrvcGrp|78403|2022|PDM|0.25|99|0.00|AETNA MED RECORD
20|FH_F141411_0_0|SrvcGrp|82115|2022|PDM|4750.00|99|0.00|REPAIR UMBIL HERNIA
20|FH_F141411_0_0|SrvcGrp|83837|2022|PDM|17500.00|99|0.00|EXCISION EXCESSIVE SKIN
20|FH_F141447_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F141447_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F141447_0_0|CSTM-ALL|CSTM-00|2020|PDM|1452.00|99|0.00|AEG 6 (NO REV)
20|FH_F141447_0_0|SrvcGrp|106880|2022|PDM|924.00|99|0.00|PARAVERTEBRAL FACET JOINT NERVE DESTRUCTION
20|FH_F141447_0_0|SrvcGrp|12664|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F141471_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F141471_0_0|CSTM-ALL|CSTM-00|2020|PDM|1751.00|99|0.00|AEG 9 (NO REV)
20|FH_F141471_0_0|SrvcGrp|107792|2022|PDM|5842.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE
20|FH_F141471_0_0|SrvcGrp|107793|2022|PDM|9661.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE
20|FH_F141471_0_0|SrvcGrp|107878|2022|PDM|2549.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT
20|FH_F141471_0_0|SrvcGrp|109488|2022|PDM|5760.00|99|0.00|VASC EMBOLIZE/OCCLUDE ARTERY
20|FH_F141471_0_0|SrvcGrp|113576|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F141507_0_0|CSTM-ALL|CSTM-00|2020|PDM|1793.00|99|0.00|AEG 7 (NO REV)
20|FH_F141507_0_0|CSTM-ALL|CSTM-00|2020|PDM|599.00|99|0.00|AEG 1 (NO REV)
20|FH_F141507_0_0|SrvcGrp|109760|2022|PDM|3150.00|99|0.00|TRANSLUM DIL EYE CANAL
20|FH_F141507_0_0|SrvcGrp|84931|2022|PDM|3000.00|99|0.00|KERATOPLASTY
20|FH_F141507_0_0|SrvcGrp|95107|2022|PDM|1056.00|99|0.00|INTRAOCULAR LENS PROSTHESIS
20|FH_F141511_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F141511_0_0|SrvcGrp|110579|2022|PDM|1550.00|99|0.00|INTERMEDIATE ICU/CCU
20|FH_F141511_0_0|SrvcGrp|73559|2022|PDM|1585.00|99|0.00|AETNA INTENSIVE CARE
20|FH_F141511_0_0|SrvcGrp|78579|2022|PDM|1400.00|99|0.00|AETNA ACUTE IP MEDICAL SVCS
20|FH_F141651_0_0|CSTM-ALL|CSTM-00|2020|PDM|1763.00|99|0.00|AEG 9 (NO REV)
20|FH_F141651_0_0|SrvcGrp|106265|2022|PDM|2200.00|99|0.00|NSL/SINS NDSC TOTAL
20|FH_F141651_0_0|SrvcGrp|107058|2022|PDM|3575.00|99|0.00|PARTIAL REMOVAL OF TONGUE
20|FH_F141651_0_0|SrvcGrp|107167|2022|PDM|3850.00|99|0.00|RHINOPLASTY
20|FH_F141651_0_0|SrvcGrp|113813|2022|PDM|2200.00|99|0.00|REMOVAL OF NOSE POLYPS
20|FH_F141651_0_0|SrvcGrp|113815|2022|PDM|154.00|99|0.00|VENTILATOR TUBE REMOVAL
20|FH_F141651_0_0|SrvcGrp|12664|2022|PCT|0.00|99|0.00|IMPLANTS
20|FH_F141651_0_0|SrvcGrp|65404|2022|PDM|1540.00|99|0.00|CPT 69421
20|FH_F141651_0_0|SrvcGrp|78093|2022|PDM|2200.00|99|0.00|AETNA NASAL ENDOSCOPY SURG
20|FH_F141651_0_0|SrvcGrp|88599|2022|PDM|2200.00|99|0.00|ENDOSCOPY MAXILLARY SINUS
20|FH_F141651_0_0|SrvcGrp|88823|2022|PDM|1540.00|99|0.00|REPAIR OF EARDRUM
20|FH_F141651_0_0|SrvcGrp|90822|2022|PDM|2200.00|99|0.00|NASAL/SINUS ENDOSCOPY SURGERY
20|FH_F141651_0_0|SrvcGrp|91420|2022|PDM|2200.00|99|0.00|REMOVAL OF ADENOIDS
20|FH_F141651_0_0|SrvcGrp|91880|2022|PDM|4400.00|99|0.00|OSSEOINTEGRATED IMPLANT
20|FH_F141651_0_0|SrvcGrp|91941|2022|PDM|3850.00|99|0.00|NASAL/SINUS ENDOSCOPY WITH DILATION
20|FH_F141707_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 3 (NO REV)
20|FH_F141707_0_0|CSTM-ALL|CSTM-00|2020|PDM|2100.00|99|0.00|AEG 5  (NO REV)
20|FH_F141707_0_0|CSTM-ALL|CSTM-00|2020|PDM|2400.00|99|0.00|AEG 6 (NO REV)
20|FH_F141707_0_0|CSTM-ALL|CSTM-00|2020|PDM|2750.00|99|0.00|AEG 7 (NO REV)
20|FH_F141707_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 1 (NO REV)
20|FH_F141707_0_0|SrvcGrp|112581|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F141707_0_0|SrvcGrp|112862|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F141829_0_0|SrvcGrp|106317|2022|PDM|508.09|99|0.00|SPECIALTY CARE TRANSPORT (HCFA)
20|FH_F141829_0_0|SrvcGrp|107353|2022|PDM|370.57|99|0.00|AMB SRVC NEONAT TRNSPRT BS RATE EMERG 1 WAY (HCFA)
20|FH_F141837_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F141837_0_0|SrvcGrp|106317|2022|PDM|1275.00|99|0.00|SPECIALTY CARE TRANSPORT (HCFA)
20|FH_F141861_0_0|CSTM-ALL|CSTM-00|2020|PDM|1103.00|99|0.00|AEG 10 (NO REV)
20|FH_F141861_0_0|CSTM-ALL|CSTM-00|2020|PDM|1121.00|99|0.00|AEG 8 (NO REV)
20|FH_F141861_0_0|CSTM-ALL|CSTM-00|2020|PDM|1156.00|99|0.00|AEG 7 (NO REV)
20|FH_F141861_0_0|CSTM-ALL|CSTM-00|2020|PDM|1556.00|99|0.00|AEG 9 (NO REV)
20|FH_F141861_0_0|CSTM-ALL|CSTM-00|2020|PDM|387.00|99|0.00|AEG 1 (NO REV)
20|FH_F141861_0_0|CSTM-ALL|CSTM-00|2020|PDM|834.00|99|0.00|AEG 5  (NO REV)
20|FH_F141877_0_0|SrvcGrp|83885|2022|PDM|564.00|99|0.00|CARDIAC CATH
20|FH_F141901_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F141901_0_0|CSTM-ALL|CSTM-00|2020|PDM|1194.57|99|0.00|ASPG VII
20|FH_F141901_0_0|SrvcGrp|100983|2022|PCT|1.10|99|0.00|IMPLANTS/PROSTHETICS
20|FH_F142070_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F142070_0_0|SrvcGrp|107749|2022|PDM|300.00|99|0.00|CAPD/CCPD
20|FH_F142070_0_0|SrvcGrp|107750|2022|PDM|25.00|99|0.00|TRAINING INCL A TREATMENT
20|FH_F142073_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F142073_0_0|CSTM-ALL|CSTM-00|2020|PDM|1360.00|99|0.00|AEG 5  (NO REV)
20|FH_F142073_0_0|CSTM-ALL|CSTM-00|2020|PDM|2600.00|99|0.00|AEG 9 (NO REV)
20|FH_F142073_0_0|CSTM-ALL|CSTM-00|2020|PDM|980.00|99|0.00|AEG 3 (NO REV)
20|FH_F142073_0_0|SrvcGrp|101114|2022|PDM|11900.00|99|0.00|ARTHOPLASTY
20|FH_F142073_0_0|SrvcGrp|101282|2022|PDM|11900.00|99|0.00|REVISE HIP JOINT COMPONENT
20|FH_F142073_0_0|SrvcGrp|108269|2022|PDM|11900.00|99|0.00|REVISE HIP JOINT COMPONENT
20|FH_F142073_0_0|SrvcGrp|115762|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F142073_0_0|SrvcGrp|33984|2022|PDM|1000.00|99|0.00|HAMMERTOE CORRECTION
20|FH_F142073_0_0|SrvcGrp|35668|2022|PDM|2300.00|99|0.00|CPT 29824
20|FH_F142073_0_0|SrvcGrp|40003|2022|PDM|11900.00|99|0.00|TOTAL KNEE
20|FH_F142073_0_0|SrvcGrp|41334|2022|PDM|11900.00|99|0.00|TOTAL KNEE
20|FH_F142073_0_0|SrvcGrp|67279|2022|PDM|11900.00|99|0.00|CERVICAL SURGERY
20|FH_F142073_0_0|SrvcGrp|77485|2022|PDM|1060.00|99|0.00|AETNA REMOVAL OF IMPLANT
20|FH_F142073_0_0|SrvcGrp|89860|2022|PDM|5980.00|99|0.00|SPINAL DISK SURGERY ADD-ON
20|FH_F142073_0_0|SrvcGrp|89861|2022|PDM|5980.00|99|0.00|LUMBAR LAMINOTOMY
20|FH_F142073_0_0|SrvcGrp|92412|2022|PDM|5980.00|99|0.00|SPINAL CRD DECOMP->2 CERVIC
20|FH_F142073_0_0|SrvcGrp|92415|2022|PDM|5980.00|99|0.00|NECK SPINE DISK SURGERY
20|FH_F142073_0_0|SrvcGrp|97019|2022|PDM|2400.00|99|0.00|ARTHROSCOPY BICEPS TENODESIS
20|FH_F142073_0_0|SrvcGrp|97159|2022|PDM|5980.00|99|0.00|TRANSPEDICULAR, 1 SEG, LUMBAR
20|FH_F142073_0_0|SrvcGrp|97199|2022|PDM|5980.00|99|0.00|THORAX SPINE DISK SURGERY
20|FH_F142073_0_0|SrvcGrp|97730|2022|PDM|11900.00|99|0.00|REVERSE HIP JOINT
20|FH_F142073_0_0|SrvcGrp|98360|2022|PDM|5980.00|99|0.00|AETNA LAMINECTOMY W/FACE-LUMBAR
20|FH_F142073_0_0|SrvcGrp|98597|2022|PDM|5980.00|99|0.00|CERVICAL LAMINOTOMY
20|FH_F142073_0_0|SrvcGrp|98598|2022|PDM|5980.00|99|0.00|LUMBAR LAMINOTOMY
20|FH_F142073_0_0|SrvcGrp|98599|2022|PDM|5980.00|99|0.00|LAMINECTOMY W/FACE-THORACIC
20|FH_F142087_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.50|99|0.00|HSS ASC
20|FH_F142087_0_0|SrvcGrp|88157|2022|PDM|15500.00|99|0.00|TOTAL HIP ARTHROPLASTY
20|FH_F142087_0_0|SrvcGrp|88164|2022|PDM|15000.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR
20|FH_F142087_0_0|SrvcGrp|89404|2022|PDM|15500.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F142087_0_0|SrvcGrp|93063|2022|PDM|15000.00|99|0.00|LUMBAR ARTIF DISKECTOMY
20|FH_F142087_0_0|SrvcGrp|93065|2022|PDM|10000.00|99|0.00|LUMB ARTIF DISKECTOMY ADDL
20|FH_F142087_0_0|SrvcGrp|93432|2022|PDM|15000.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT
20|FH_F142229_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.10|99|0.00|GENERAL ACUTE CARE
20|FH_F142252_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F142327_0_0|SrvcGrp|113924|2022|PDM|1000.00|99|0.00|OCCUPATIONAL MULTIFOCAL LENS
20|FH_F142327_0_0|SrvcGrp|85966|2022|PDM|2500.00|99|0.00|EXTRACAPSULAR CATARACT
20|FH_F142332_0_0|SrvcGrp|23683|2022|PDM|74.00|99|0.00|SKILLED NURSING RN
20|FH_F142332_0_0|SrvcGrp|27969|2022|PDM|40.00|99|0.00|HOME HEALTH AIDE
20|FH_F142332_0_0|SrvcGrp|53145|2022|PDM|70.00|99|0.00|SOCIAL WORKER
20|FH_F142332_0_0|SrvcGrp|88621|2022|PDM|118.00|99|0.00|SKILLED NURSING LPN
20|FH_F142370_0_0|SrvcGrp|113176|2022|PDM|28.39|99|0.00|COVID-19 IMMUN ADMIN 2ND DOSE - MODERNA
20|FH_F46856_0_0|CSTM-ALL|CSTM-00|2020|PCT|68.00|99|0.00|GENERAL ACUTE CARE
20|FH_F46874_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F46874_0_0|CSTM-ALL|CSTM-00|2020|PDM|1110.00|99|0.00|ASPG IV
20|FH_F46874_0_0|CSTM-ALL|CSTM-00|2020|PDM|1480.00|99|0.00|ASPG VI
20|FH_F46874_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|ASPG III
20|FH_F46914_0_0|CSTM-ALL|CSTM-00|2020|PDM|158.00|99|0.00|SOCIAL WORKER
20|FH_F46914_0_0|SrvcGrp|9828|2022|PDM|63.00|99|0.00|HOME HEALTH AIDE
20|FH_F46918_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F46938_0_0|SrvcGrp|10528|2022|PDM|45.00|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F46941_0_0|SrvcGrp|10527|2022|PDM|100.00|99|0.00|HOSPICE SVCS
20|FH_F46972_0_0|SrvcGrp|10527|2022|PDM|100.00|99|0.00|HOSPICE SVCS
20|FH_F46972_0_0|SrvcGrp|32189|2022|PDM|35.00|99|0.00|RESPITE CARE
20|FH_F47037_0_0|CSTM-ALL|CSTM-00|2020|PDM|10.00|99|0.00|TELEMANAGEMENT SERVICES
20|FH_F47037_0_0|SrvcGrp|10527|2022|PDM|103.00|99|0.00|HOSPICE SVCS
20|FH_F47037_0_0|SrvcGrp|10538|2022|PDM|25.00|99|0.00|NURSING CARE
20|FH_F47037_0_0|SrvcGrp|10542|2022|PDM|92.00|99|0.00|OCCUPATIONAL THERAPY SVCS
20|FH_F47037_0_0|SrvcGrp|12403|2022|PDM|24.50|99|0.00|CONTINUOUS HOMECARE
20|FH_F47037_0_0|SrvcGrp|14081|2022|PDM|92.00|99|0.00|HOME VISIT - POSTNATAL
20|FH_F47037_0_0|SrvcGrp|26001|2022|PDM|110.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F47097_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F47113_0_0|CSTM-ALL|CSTM-00|2020|PDM|1281.00|99|0.00|AEG 8 (NO REV)
20|FH_F47113_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|AEG 4 (NO REV)
20|FH_F47113_0_0|CSTM-ALL|CSTM-00|2020|PDM|939.00|99|0.00|AEG 5  (NO REV)
20|FH_F47128_0_0|SrvcGrp|3982|2022|PDM|2121.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F47140_0_0|CSTM-ALL|CSTM-00|2020|PDM|478.10|99|0.00|SLEEP STUDIES CPT 95805 W/MODIFIER TC
20|FH_F47140_0_0|CSTM-ALL|CSTM-00|2020|PDM|615.10|99|0.00|SLEEP STUDIES CPT 95811 W/MODIFIER TC
20|FH_F47140_0_0|CSTM-ALL|CSTM-00|2020|PDM|75.38|99|0.00|SLEEP STUDIES CPT 95807 W/MODIFIER 26
20|FH_F47152_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.69|99|0.00|GENERAL ACUTE CARE
20|FH_F47152_0_0|SrvcGrp|39544|2022|PDM|145000.00|99|0.00|MS DRG 005-006 LIVER TRANSPLANT - CADAVER DONOR
20|FH_F47173_0_0|SrvcGrp|977|2022|PCT|0.85|99|0.00|RADIOLOGY SVCS
20|FH_F47233_0_0|CSTM-ALL|CSTM-00|2020|PDM|1980.00|99|0.00|WELLPATH PROPRIETARY ASC IX
20|FH_F47233_0_0|CSTM-ALL|CSTM-00|2020|PDM|387.00|99|0.00|WELLPATH PROPIETARY ASC I
20|FH_F47233_0_0|CSTM-ALL|CSTM-00|2020|PDM|612.00|99|0.00|WELLPATH PROPIETARY ASC III
20|FH_F47233_0_0|CSTM-ALL|CSTM-00|2020|PDM|693.00|99|0.00|WELLPATH PROPIETARY ASC IV
20|FH_F47234_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F47248_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F47319_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F47341_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F47345_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.90|99|0.00|GENERAL ACUTE CARE
20|FH_F47345_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.90|99|0.00|OP SVCS
20|FH_F47421_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F47421_0_0|CSTM-ALL|CSTM-00|2020|PDM|780.00|99|0.00|ASPG III
20|FH_F47421_0_0|CSTM-ALL|CSTM-00|2020|PDM|780.00|99|0.00|ASPG X
20|FH_F47424_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F47424_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F47424_0_0|SrvcGrp|42784|2022|PDM|75.00|99|0.00|OCCUPATIONAL THERAPY  SRVCS
20|FH_F47424_0_0|SrvcGrp|42785|2022|PDM|75.00|99|0.00|SPEECH THERAPY  SRVCS
20|FH_F47462_0_0|SrvcGrp|15478|2022|PDM|130.00|99|0.00|OCCUPATIONAL THERAPY SVCS INITIAL EVAL
20|FH_F47473_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|OP SVCS
20|FH_F47495_0_0|SrvcGrp|30041|2022|PCT|0.50|99|0.00|SURGICAL INVASIVE PROC W/ANESTHESIA
20|FH_F47495_0_0|SrvcGrp|35054|2022|PDM|1450.00|99|0.00|SKILLED NURSING - LEVEL 2
20|FH_F47499_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F47552_0_0|CSTM-ALL|CSTM-00|2020|PDM|1222.00|99|0.00|ASPG IV
20|FH_F47552_0_0|CSTM-ALL|CSTM-00|2020|PDM|1888.00|99|0.00|ASPG X
20|FH_F47552_0_0|CSTM-ALL|CSTM-00|2020|PDM|1929.00|99|0.00|ASPG VII
20|FH_F47552_0_0|CSTM-ALL|CSTM-00|2020|PDM|646.00|99|0.00|ASPG I
20|FH_F47552_0_0|CSTM-ALL|CSTM-00|2020|PDM|646.00|99|0.00|OP SURGERY CARVE OUTS
20|FH_F47573_0_0|SrvcGrp|12079|2022|PCT|1.00|99|0.00|MED SURG SUPPLIES
20|FH_F47573_0_0|SrvcGrp|42825|2022|PDM|65.00|99|0.00|HOME HEALTH AIDE VISIT
20|FH_F47573_0_0|SrvcGrp|42826|2022|PDM|158.00|99|0.00|PHYSICAL THERAPY VISIT
20|FH_F47575_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F47605_0_0|SrvcGrp|22077|2022|PDM|710.00|99|0.00|RESIDENTIAL TREATMENT SVCS
20|FH_F47636_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F47641_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|GENERAL ACUTE CARE
20|FH_F47656_0_0|CSTM-ALL|CSTM-00|2020|PDM|2275.00|99|0.00|OBSTETRICAL CARE (DRGS 370-374)
20|FH_F47656_0_0|SrvcGrp|16|2022|PCT|0.80|99|0.00|ACUTE REHABILITATION
20|FH_F47659_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE
20|FH_F47659_0_0|SrvcGrp|3029|2022|PDM|740.00|99|0.00|NEWBORN NURSERY
20|FH_F47659_0_0|SrvcGrp|361|2022|PCT|0.80|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|111.00|99|0.00|GA RETINA SURG CTR ASC 2
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|1487.00|99|0.00|GA RETINA SURG CTR ASC 31
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|1583.00|99|0.00|GA RETINA SURG CTR ASC 34
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|1761.00|99|0.00|GA RETINA SURG CTR ASC 35
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|189.00|99|0.00|GA RETINA SURG CTR ASC 4
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|217.00|99|0.00|GA RETINA SURG CTR ASC 6
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|258.00|99|0.00|GA RETINA SURG CTR ASC 9
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|654.00|99|0.00|GA RETINA SURG CTR ASC 15
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|GA RETINA SURG CTR ASC 18
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|873.00|99|0.00|GA RETINA SURG CTR ASC 19
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|GA RETINA SURG CTR ASC 23
20|FH_F47694_0_0|SrvcGrp|23587|2022|PDM|1295.00|99|0.00|RESIDENTIAL TREATMENT - PSYCH
20|FH_F142370_0_0|SrvcGrp|113178|2022|PDM|28.39|99|0.00|COVID-19 IMMUN ADMIN 2ND DOSE - ASTRAZENECA
20|FH_F142370_0_0|SrvcGrp|113541|2022|PDM|51.31|99|0.00|COVID-19 AMP PRB
20|FH_F142370_0_0|SrvcGrp|113548|2022|PDM|142.63|99|0.00|COVID-19 NFCT DS VIR RESP RNA 4 TRGT
20|FH_F142370_0_0|SrvcGrp|14048|2022|PDM|1450.00|99|0.00|EXTRA CORPOREAL MEMBRANE OXYGEN
20|FH_F142376_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F142376_0_0|CSTM-ALL|CSTM-00|2020|PDM|1795.00|99|0.00|AEG 6 (NO REV)
20|FH_F142376_0_0|CSTM-ALL|CSTM-00|2020|PDM|814.00|99|0.00|AEG 1 (NO REV)
20|FH_F142376_0_0|SrvcGrp|101281|2022|PDM|7405.00|99|0.00|SPINE FUSION EXTRA SEGMENT
20|FH_F142376_0_0|SrvcGrp|105524|2022|PDM|3254.00|99|0.00|INSJ BIOMECHANICAL DEVICE
20|FH_F142376_0_0|SrvcGrp|107374|2022|PDM|9383.00|99|0.00|AETNA ARTHRODESIS INTERSPC
20|FH_F142376_0_0|SrvcGrp|108265|2022|PDM|2310.00|99|0.00|AETNA INSJ BIOMECHANICAL DEVICE
20|FH_F142376_0_0|SrvcGrp|112511|2022|PDM|2805.00|99|0.00|SP BONE ALGRFT STRUCT ADD-ON
20|FH_F142376_0_0|SrvcGrp|113966|2022|PDM|4221.00|99|0.00|PERQ LAMOT/LAM CRV/THRC
20|FH_F142376_0_0|SrvcGrp|113968|2022|PDM|1459.00|99|0.00|INSJ STABLJ DEV W/ DCMPRN
20|FH_F142376_0_0|SrvcGrp|113977|2022|PDM|4221.00|99|0.00|NDSC DCMPRN 1 NTRSPC LUMBAR
20|FH_F142376_0_0|SrvcGrp|47544|2022|PDM|6590.00|99|0.00|PERCUTANEOUS IMPLANT OF NEUROSTIMULATOR ELECTRODES
20|FH_F142376_0_0|SrvcGrp|87120|2022|PDM|7822.00|99|0.00|PERQ VERTEBRAL AUGMENTATION
20|FH_F142376_0_0|SrvcGrp|87124|2022|PDM|268.00|99|0.00|INJ PERIPHERAL NERVE
20|FH_F142376_0_0|SrvcGrp|97319|2022|PDM|13055.00|99|0.00|REVISE SPINE ELTRD PLATE
20|FH_F142376_0_0|SrvcGrp|98564|2022|PDM|17545.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR
20|FH_F142376_0_0|SrvcGrp|98569|2022|PDM|7405.00|99|0.00|POSTERIOR NON-SEGMENTAL INST
20|FH_F142376_0_0|SrvcGrp|98584|2022|PDM|14466.00|99|0.00|TOTAL DISC ARTHROPLASTY
20|FH_F142376_0_0|SrvcGrp|98588|2022|PDM|3511.00|99|0.00|REMOVE SPINE INFUSION DEVI16
20|FH_F142376_0_0|SrvcGrp|98609|2022|PDM|7405.00|99|0.00|POSTERIOR SEGMENTAL INSTRU
20|FH_F142454_0_0|CSTM-ALL|CSTM-00|2020|PDM|1196.00|99|0.00|AEG 8 (NO REV)
20|FH_F142454_0_0|CSTM-ALL|CSTM-00|2020|PDM|490.00|99|0.00|AEG 2 (NO REV)
20|FH_F142454_0_0|SrvcGrp|42550|2022|PDM|1400.00|99|0.00|OP SURGERY CPT 66984
20|FH_F142454_0_0|SrvcGrp|92551|2022|PDM|832.00|99|0.00|TREATMENT OF RETINA
20|FH_F142454_0_0|SrvcGrp|95819|2022|PDM|6200.00|99|0.00|GONIOTOMY
20|FH_F142587_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F142587_0_0|SrvcGrp|14494|2022|PDM|1278.30|99|0.00|CONTINUOUS HOMECARE
20|FH_F142611_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F142611_0_0|SrvcGrp|82981|2022|PDM|155.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F142673_0_0|CSTM-ALL|CSTM-00|2020|PDM|1017.00|99|0.00|AEG 1 (NO REV)
20|FH_F142694_0_0|SrvcGrp|82981|2022|PDM|250.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F142710_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F142710_0_0|SrvcGrp|82223|2022|PDM|105.00|99|0.00|HOSPICE CARE
20|FH_F142710_0_0|SrvcGrp|84185|2022|PDM|105.00|99|0.00|RESPITE CARE
20|FH_F142785_0_0|SrvcGrp|87077|2022|PDM|125.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F142894_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F142894_0_0|SrvcGrp|113620|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F142894_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F142894_0_0|SrvcGrp|80920|2022|PDM|100.00|99|0.00|HOSPICE SERVICES
20|FH_F142930_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F142930_0_0|SrvcGrp|83857|2022|PDM|475.00|99|0.00|IP HOSPICE SVCS
20|FH_F142992_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F143050_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F143067_0_0|SrvcGrp|107634|2022|PDM|285.00|99|0.00|PERITONEAL TREATMENTS W/ PATIENT TRAINGING
20|FH_F143201_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING
20|FH_F143297_0_0|CSTM-ALL|CSTM-00|2020|PDM|1540.00|99|0.00|AEG 6 (NO REV)
20|FH_F143297_0_0|CSTM-ALL|CSTM-00|2020|PDM|2031.00|99|0.00|AEG 8 (NO REV)
20|FH_F143297_0_0|CSTM-ALL|CSTM-00|2020|PDM|2516.00|99|0.00|DEVICE INSERTION
20|FH_F143297_0_0|SrvcGrp|113576|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F143297_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F143335_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F143335_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|HSS ASC
20|FH_F143388_0_0|SrvcGrp|33722|2022|PDM|25.00|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F143388_0_0|SrvcGrp|84185|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F143450_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F143450_0_0|CSTM-ALL|CSTM-00|2020|PDM|1599.00|99|0.00|AEG 9 (NO REV)
20|FH_F143450_0_0|CSTM-ALL|CSTM-00|2020|PDM|792.00|99|0.00|AEG 4 (NO REV)
20|FH_F143450_0_0|CSTM-ALL|CSTM-00|2020|PDM|876.00|99|0.00|AEG 5  (NO REV)
20|FH_F143450_0_0|SrvcGrp|108935|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F143450_0_0|SrvcGrp|113568|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F143450_0_0|SrvcGrp|92703|2022|PDM|1751.00|99|0.00|ENDOSCOPIC RETRO CHOLANGIOPANCREATOGRAPHY
20|FH_F143457_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F143467_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F143467_0_0|CSTM-ALL|CSTM-00|2020|PDM|990.00|99|0.00|AEG 2 (NO REV)
20|FH_F143467_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F143467_0_0|SrvcGrp|114050|2022|PDM|1424.00|99|0.00|REPAIR OF TOE FRACTURE
20|FH_F143467_0_0|SrvcGrp|33980|2022|PDM|4067.00|99|0.00|CPT 28298
20|FH_F143467_0_0|SrvcGrp|33982|2022|PDM|1424.00|99|0.00|CPT 28296
20|FH_F143467_0_0|SrvcGrp|41327|2022|PDM|1424.00|99|0.00|OP SURGERY CPT 28308
20|FH_F143528_0_0|CSTM-ALL|CSTM-00|2020|PDM|1942.50|99|0.00|AEG 3 (NO REV) W/O SURGERY
20|FH_F143528_0_0|SrvcGrp|100067|2022|PDM|2625.00|99|0.00|ANKLE ARTHROSCOPY SURGERY
20|FH_F143528_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F143528_0_0|SrvcGrp|107121|2022|PDM|1914.15|99|0.00|RECONSTRUCTION TONGUE FOLD
20|FH_F143528_0_0|SrvcGrp|109965|2022|PDM|5250.00|99|0.00|THORAX SPINE DISK SURGERY
20|FH_F143528_0_0|SrvcGrp|114085|2022|PDM|5250.00|99|0.00|TRANSPEDICULAR
20|FH_F47717_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.54|99|0.00|OP SVCS
20|FH_F47727_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS
20|FH_F47736_0_0|SrvcGrp|3809|2022|PDM|535.00|99|0.00|HOSPICE CARE
20|FH_F47773_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F47812_0_0|CSTM-ALL|CSTM-00|2020|PDM|560.00|99|0.00|SKILLED NURSING
20|FH_F47812_0_0|SrvcGrp|42869|2022|PDM|40.12|99|0.00|PHYSICAL THERAPY VISIT
20|FH_F47818_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F47819_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F47836_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F47836_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|ENT SURG CTR -CVTY ENHANCED GROUP 6
20|FH_F47836_0_0|CSTM-ALL|CSTM-00|2020|PDM|1900.00|99|0.00|ENT SURG CTR -CVTY ENHANCED GROUP 8
20|FH_F47836_0_0|CSTM-ALL|CSTM-00|2020|PDM|2600.00|99|0.00|ENT SURG CTR -CVTY ENHANCED GROUP 9
20|FH_F47836_0_0|SrvcGrp|44322|2022|PDM|1450.00|99|0.00|SUBMUCOUS RESECTION
20|FH_F47836_0_0|SrvcGrp|56242|2022|PDM|5000.00|99|0.00|NASAL/SINUS ENDOSCOPY
20|FH_F47837_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F47837_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F47857_0_0|SrvcGrp|166|2022|PDM|340.00|99|0.00|CD (ADULT) - DETOXIFICATION
20|FH_F47884_0_0|CSTM-ALL|CSTM-00|2020|PDM|1474.00|99|0.00|GENERAL ACUTE CARE
20|FH_F47884_0_0|CSTM-ALL|CSTM-00|2020|PDM|741.00|99|0.00|ACUTE PSYCH
20|FH_F47952_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|HOSPICE CARE
20|FH_F47952_0_0|SrvcGrp|10528|2022|PDM|45.00|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F47952_0_0|SrvcGrp|36066|2022|PDM|27.50|99|0.00|NURSING CARE
20|FH_F47952_0_0|SrvcGrp|42974|2022|PDM|95.00|99|0.00|OCCUPATIONAL THERAPIST
20|FH_F47952_0_0|SrvcGrp|43956|2022|PDM|55.00|99|0.00|NURSING CARE
20|FH_F47952_0_0|SrvcGrp|44284|2022|PDM|125.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F47969_0_0|SrvcGrp|22954|2022|PDM|120.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F47969_0_0|SrvcGrp|26001|2022|PDM|90.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F47970_0_0|SrvcGrp|97711|2022|PDM|750.00|99|0.00|COLONOSCOPY
20|FH_F47996_0_0|CSTM-ALL|CSTM-00|2020|PCT|59.50|99|0.00|GENERAL ACUTE CARE
20|FH_F47999_0_0|SrvcGrp|42827|2022|PDM|104.50|99|0.00|OCCUPATIONAL THERAPY VISIT
20|FH_F48034_0_0|CSTM-ALL|CSTM-00|2020|PDM|150.00|99|0.00|INTENSIVE OUTPATIENT - ADULT/ADOLESCENT
20|FH_F48034_0_0|CSTM-ALL|CSTM-00|2020|PDM|150.00|99|0.00|SUBSTANCE ABUSE INTENSIVE OUTPATIENT - ADULT/ADOLESCENT
20|FH_F48092_0_0|SrvcGrp|14110|2022|PDM|28.75|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F48092_0_0|SrvcGrp|3259|2022|PDM|1200.00|99|0.00|ACUTE REHABILITATION
20|FH_F48092_0_0|SrvcGrp|33166|2022|PDM|1000.00|99|0.00|SKILLED NURSING - LEVEL III
20|FH_F48133_0_0|CSTM-ALL|CSTM-00|2020|PDM|560.00|99|0.00|SKILLED NURSING
20|FH_F48192_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F48192_0_0|SrvcGrp|44123|2022|PCT|1.00|99|0.00|HIGH COST DRUGS (REV CODES 250-259, 631-637)
20|FH_F48215_0_0|SrvcGrp|10410|2022|PDM|42.25|99|0.00|SKILLED NURSING CARE
20|FH_F48215_0_0|SrvcGrp|12401|2022|PDM|85.50|99|0.00|RN VISIT
20|FH_F48215_0_0|SrvcGrp|8962|2022|PDM|82.50|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F48215_0_0|SrvcGrp|9830|2022|PDM|85.50|99|0.00|OT SVCS
20|FH_F48215_0_0|SrvcGrp|9832|2022|PDM|84.50|99|0.00|ST SVCS
20|FH_F48230_0_0|CSTM-ALL|CSTM-00|2020|PCT|66.00|99|0.00|GENERAL ACUTE CARE
20|FH_F48254_0_0|SrvcGrp|44326|2022|PDM|60.00|99|0.00|PT & OT (VISIT LVL) OT MOD GO
20|FH_F48258_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F48292_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F48292_0_0|SrvcGrp|44242|2022|PDM|446.00|99|0.00|HEMO/HOME DIALYSIS SVCS
20|FH_F48292_0_0|SrvcGrp|44243|2022|PDM|446.00|99|0.00|HOME HEMO TRAINING
20|FH_F48292_0_0|SrvcGrp|44245|2022|PDM|165.00|99|0.00|CAPD/CCPD SUPPLEMENT
20|FH_F48292_0_0|SrvcGrp|44246|2022|PDM|192.00|99|0.00|CAPD TRAINING
20|FH_F48292_0_0|SrvcGrp|44248|2022|PDM|165.00|99|0.00|CAPD/CCPD SUPPLEMENT
20|FH_F48295_0_0|SrvcGrp|36066|2022|PDM|26.00|99|0.00|NURSING CARE
20|FH_F48295_0_0|SrvcGrp|44424|2022|PDM|100.00|99|0.00|MEDICAL SOCIAL WORKER (VISIT LVL)
20|FH_F48295_0_0|SrvcGrp|44429|2022|PDM|90.00|99|0.00|ENTEROSTOMAL THERAPY SERVICES (VISIT LVL)
20|FH_F48313_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F48313_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F48315_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.83|99|0.00|OP SVCS
20|FH_F48353_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F48353_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F48396_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F48418_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F48459_0_0|SrvcGrp|44326|2022|PDM|60.00|99|0.00|PT & OT (VISIT LVL) OT MOD GO
20|FH_F48473_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F48473_0_0|SrvcGrp|8962|2022|PDM|93.50|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F48475_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F48476_0_0|SrvcGrp|10528|2022|PDM|45.00|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F48476_0_0|SrvcGrp|32189|2022|PDM|35.00|99|0.00|RESPITE CARE
20|FH_F48476_0_0|SrvcGrp|42975|2022|PDM|90.00|99|0.00|PHYSICAL THERAPIST
20|FH_F48476_0_0|SrvcGrp|43955|2022|PDM|85.00|99|0.00|NURSING CARE
20|FH_F48581_0_0|CSTM-ALL|CSTM-00|2020|PDM|1600.00|99|0.00|MS DRG 774-775, 767-768 NORMAL DELIVERY (MS DRG ONLY)
20|FH_F48588_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F48588_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F48695_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F48754_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F48754_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F48834_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE
20|FH_F48834_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS
20|FH_F48915_0_0|CSTM-ALL|CSTM-00|2020|PDM|60.00|99|0.00|PHYSICAL THERAPY
20|FH_F48927_0_0|SrvcGrp|8968|2022|PDM|2400.00|99|0.00|NICU LEVEL III & IV
20|FH_F48929_0_0|SrvcGrp|12403|2022|PDM|936.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F48929_0_0|SrvcGrp|42784|2022|PDM|60.00|99|0.00|OCCUPATIONAL THERAPY  SRVCS
20|FH_F143528_0_0|SrvcGrp|15473|2022|PDM|4076.10|99|0.00|CPT CODE 42820
20|FH_F143528_0_0|SrvcGrp|58638|2022|PDM|2296.35|99|0.00|CPT 63688
20|FH_F143528_0_0|SrvcGrp|80617|2022|PDM|12600.00|99|0.00|ARTHOPLASTY
20|FH_F143528_0_0|SrvcGrp|82113|2022|PDM|2625.00|99|0.00|KNEE ARTHROSCOPY SURGERY
20|FH_F143528_0_0|SrvcGrp|83641|2022|PDM|8865.15|99|0.00|CPT 29889
20|FH_F143528_0_0|SrvcGrp|86463|2022|PDM|1914.15|99|0.00|FRACTURE NASAL INFERIOR
20|FH_F143528_0_0|SrvcGrp|88065|2022|PDM|9208.50|99|0.00|TOTAL DISC ARTHROPLASTY
20|FH_F143528_0_0|SrvcGrp|88157|2022|PDM|14700.00|99|0.00|TOTAL HIP ARTHROPLASTY
20|FH_F143528_0_0|SrvcGrp|88163|2022|PDM|10500.00|99|0.00|LUMBAR SPINE FUSION
20|FH_F143528_0_0|SrvcGrp|88164|2022|PDM|10500.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR
20|FH_F143528_0_0|SrvcGrp|88596|2022|PDM|2625.00|99|0.00|EXC OF TRIANG FIBROCARTILAGE
20|FH_F143528_0_0|SrvcGrp|88600|2022|PDM|2625.00|99|0.00|WRIST ARTHROS DIAG W/WO BIO
20|FH_F143528_0_0|SrvcGrp|89857|2022|PDM|5250.00|99|0.00|REMOVAL OF SPINAL LAMINA
20|FH_F143528_0_0|SrvcGrp|90802|2022|PDM|4464.60|99|0.00|LAP INC HERNIA REPAIR
20|FH_F143528_0_0|SrvcGrp|93641|2022|PDM|3491.25|99|0.00|KNEE ARTHROSCOPIC SURGERY
20|FH_F143528_0_0|SrvcGrp|93807|2022|PDM|5490.45|99|0.00|REVISE SPINE ELTRD PERQ ARAY
20|FH_F143528_0_0|SrvcGrp|99174|2022|PDM|1914.15|99|0.00|CPT 30140
20|FH_F143530_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F143539_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F143539_0_0|CSTM-ALL|CSTM-00|2020|PDM|1156.00|99|0.00|AEG 3 (NO REV)
20|FH_F143539_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F143542_0_0|CSTM-ALL|CSTM-00|2020|PDM|1078.00|99|0.00|AEG 2 (NO REV)
20|FH_F143542_0_0|CSTM-ALL|CSTM-00|2020|PDM|2952.00|99|0.00|AEG 9 (NO REV)
20|FH_F143542_0_0|SrvcGrp|109348|2022|PDM|2869.00|99|0.00|EXCISION OF LESION OF EYELID
20|FH_F143542_0_0|SrvcGrp|109760|2022|PDM|6885.00|99|0.00|TRANSLUM DIL EYE CANAL
20|FH_F143542_0_0|SrvcGrp|109761|2022|PDM|4590.00|99|0.00|REMOVE EYELID LESIONS
20|FH_F143542_0_0|SrvcGrp|109764|2022|PDM|4590.00|99|0.00|REPAIR EYELID DEFECT
20|FH_F143542_0_0|SrvcGrp|109769|2022|PDM|2433.00|99|0.00|COVER EYE W/ MEMBRANE SUTURE INCIDENTAL CODES
20|FH_F143542_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F143542_0_0|SrvcGrp|114442|2022|PDM|12049.00|99|0.00|EXTRACAPSULAR CATARACT REMOVAL, INSERT LENS
20|FH_F143542_0_0|SrvcGrp|84279|2022|PDM|9754.00|99|0.00|CORNEAL TRANSPLANT
20|FH_F143542_0_0|SrvcGrp|84280|2022|PDM|9754.00|99|0.00|CORNEAL TRANSPLANT
20|FH_F143542_0_0|SrvcGrp|95819|2022|PDM|6885.00|99|0.00|GONIOTOMY
20|FH_F143564_0_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|AEG 10 (NO REV)
20|FH_F143564_0_0|CSTM-ALL|CSTM-00|2020|PDM|1775.00|99|0.00|AEG 7 (NO REV)
20|FH_F143564_0_0|CSTM-ALL|CSTM-00|2020|PDM|525.00|99|0.00|AEG 1 (NO REV)
20|FH_F143564_0_0|SrvcGrp|107757|2022|PDM|2900.00|99|0.00|LAP PARAESOPH HER RPR W/ MESH
20|FH_F143564_0_0|SrvcGrp|115352|2022|PCT|0.55|99|0.00|STOMACH PROCEDURE
20|FH_F143564_0_0|SrvcGrp|81904|2022|PDM|3315.00|99|0.00|LAP PARASOPHAG HERNIA REPAIR
20|FH_F143564_0_0|SrvcGrp|82298|2022|PDM|23083.00|99|0.00|AETNA LAP SLEEVE GASTRECTOMY
20|FH_F143564_0_0|SrvcGrp|87845|2022|PDM|1850.00|99|0.00|GASTRIC RESTRICTIVE PROCEDURE
20|FH_F143564_0_0|SrvcGrp|90802|2022|PDM|2658.00|99|0.00|LAP INC HERNIA REPAIR
20|FH_F143564_0_0|SrvcGrp|92418|2022|PDM|2998.00|99|0.00|LAPAROSCOPY
20|FH_F143564_0_0|SrvcGrp|92419|2022|PDM|3850.00|99|0.00|LAPAROSCOPY
20|FH_F143571_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F143571_0_0|SrvcGrp|63297|2022|PDM|153.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F143571_0_0|SrvcGrp|73656|2022|PDM|661.00|99|0.00|AETNA HOSPICE SVCS
20|FH_F143577_0_0|SrvcGrp|87077|2022|PDM|133.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F143580_0_0|SrvcGrp|13262|2022|PDM|5.25|99|0.00|GROUND MILEAGE, PER STATUTE MILE
20|FH_F143580_0_0|SrvcGrp|13597|2022|PDM|245.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT
20|FH_F143648_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 1 (NO REV)
20|FH_F143648_0_0|SrvcGrp|103516|2022|PDM|2784.00|99|0.00|INSERT INTRAUTERINE DEVICE
20|FH_F143648_0_0|SrvcGrp|114092|2022|PDM|1960.00|99|0.00|DRAINAGE OF VULVA ABSCESS
20|FH_F143648_0_0|SrvcGrp|27347|2022|PDM|6000.00|99|0.00|CPT 58558
20|FH_F143648_0_0|SrvcGrp|89867|2022|PDM|2800.00|99|0.00|AETNA EXAM OF VAGINA
20|FH_F143650_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F143650_0_0|SrvcGrp|109973|2022|PDM|1800.00|99|0.00|ARTHROSCOPY / SURGERY
20|FH_F143650_0_0|SrvcGrp|109974|2022|PDM|1800.00|99|0.00|ELBOW ARTHROSCOPY / SURGERY
20|FH_F143650_0_0|SrvcGrp|109975|2022|PCT|0.00|99|0.00|TOTAL JOINT REPLACEMENTS
20|FH_F143650_0_0|SrvcGrp|11673|2022|PDM|2900.00|99|0.00|CPT 29888
20|FH_F143650_0_0|SrvcGrp|34603|2022|PDM|2800.00|99|0.00|CPT 24341
20|FH_F143650_0_0|SrvcGrp|42472|2022|PDM|2600.00|99|0.00|CPT 58670
20|FH_F143650_0_0|SrvcGrp|72121|2022|PDM|2800.00|99|0.00|ARTHOSCOPY
20|FH_F143650_0_0|SrvcGrp|72996|2022|PDM|2200.00|99|0.00|AEG 4
20|FH_F143650_0_0|SrvcGrp|73000|2022|PDM|2900.00|99|0.00|AEG 6
20|FH_F143650_0_0|SrvcGrp|73004|2022|PDM|2190.00|99|0.00|AEG 8
20|FH_F143650_0_0|SrvcGrp|75002|2022|PDM|3900.00|99|0.00|ARTHOSCOPY
20|FH_F143650_0_0|SrvcGrp|78096|2022|PDM|2800.00|99|0.00|AETNA ARTHROSCOPY BICEPS
20|FH_F143650_0_0|SrvcGrp|78285|2022|PDM|2600.00|99|0.00|CPT 58671
20|FH_F143650_0_0|SrvcGrp|80617|2022|PDM|4100.00|99|0.00|ARTHOPLASTY
20|FH_F143650_0_0|SrvcGrp|85792|2022|PDM|3900.00|99|0.00|OPEN TREATMENT OF DISTAL
20|FH_F143650_0_0|SrvcGrp|90360|2022|PDM|2800.00|99|0.00|REPAIR FRACTURE OF ULNA
20|FH_F143668_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F143668_0_0|SrvcGrp|114060|2022|PDM|3300.00|99|0.00|PNEUMATIC COMPRESSOR (MOD NU)
20|FH_F143668_0_0|SrvcGrp|114061|2022|PDM|37.00|99|0.00|SEGMENTAL PNEUMATIC TRUNK (MOD RR)
20|FH_F143668_0_0|SrvcGrp|114068|2022|PDM|280.00|99|0.00|SEGMENTAL PNEUMATIC (MOD NU)
20|FH_F143668_0_0|SrvcGrp|115715|2022|PDM|210.00|99|0.00|SEGMENTAL PNEUMATIC (MOD UE)
20|FH_F143684_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F143684_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F48935_0_0|SrvcGrp|471|2022|PDM|660.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F48937_0_0|SrvcGrp|10518|2022|PDM|65.00|99|0.00|ENTEROSTOMAL VISIT F/U VISIT
20|FH_F48937_0_0|SrvcGrp|10623|2022|PDM|65.00|99|0.00|SPEECH THERAPY SERVICES
20|FH_F48937_0_0|SrvcGrp|26160|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE VISIT
20|FH_F48994_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F48994_0_0|CSTM-ALL|CSTM-00|2020|PDM|1518.00|99|0.00|ASPG VIII
20|FH_F48994_0_0|CSTM-ALL|CSTM-00|2020|PDM|2089.00|99|0.00|ASPG IX- MOD 50
20|FH_F48994_0_0|CSTM-ALL|CSTM-00|2020|PDM|520.00|99|0.00|ASPG I
20|FH_F48994_0_0|CSTM-ALL|CSTM-00|2020|PDM|520.00|99|0.00|ASPG I- MOD 50
20|FH_F48994_0_0|CSTM-ALL|CSTM-00|2020|PDM|983.00|99|0.00|ASPG IV- MOD 50
20|FH_F48997_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F48998_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F48998_0_0|SrvcGrp|43893|2022|PDM|18.00|99|0.00|OCCUPATIONAL THERAPY VISIT
20|FH_F49005_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F49005_0_0|CSTM-ALL|CSTM-00|2020|PDM|125.00|99|0.00|MEDICAL SOCIAL WORKER VISIT - IP
20|FH_F49005_0_0|SrvcGrp|45334|2022|PDM|50.00|99|0.00|HOME HEALTH AIDE
20|FH_F49016_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|GENERAL ACUTE CARE
20|FH_F49016_0_0|CSTM-ALL|CSTM-00|2020|PDM|975.00|99|0.00|SUBACUTE CARE
20|FH_F49016_0_0|SrvcGrp|10904|2022|PDM|550.00|99|0.00|EMERGENCY ROOM LEVEL II
20|FH_F49016_0_0|SrvcGrp|14187|2022|PDM|650.00|99|0.00|MRI
20|FH_F49016_0_0|SrvcGrp|19973|2022|PDM|575.00|99|0.00|CAT SCAN
20|FH_F49016_0_0|SrvcGrp|42824|2022|PDM|60.00|99|0.00|SKILLED NURSING VISIT
20|FH_F49016_0_0|SrvcGrp|9774|2022|PDM|1650.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F49026_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F49027_0_0|SrvcGrp|43785|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY SERVICES
20|FH_F49027_0_0|SrvcGrp|44860|2022|PDM|600.00|99|0.00|SKILLED NURSING, BARIATRIC
20|FH_F49027_0_0|SrvcGrp|45148|2022|PDM|90.00|99|0.00|SPEECH THERAPY
20|FH_F49027_0_0|SrvcGrp|45150|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY
20|FH_F49029_0_0|SrvcGrp|21594|2022|PDM|335.00|99|0.00|SKILLED NURSING
20|FH_F49031_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.10|99|0.00|GENERAL ACUTE CARE
20|FH_F49033_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F49033_0_0|SrvcGrp|44860|2022|PDM|600.00|99|0.00|SKILLED NURSING, BARIATRIC
20|FH_F49035_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F49035_0_0|SrvcGrp|45150|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY
20|FH_F49037_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F49037_0_0|SrvcGrp|21594|2022|PDM|335.00|99|0.00|SKILLED NURSING
20|FH_F49039_0_0|SrvcGrp|44860|2022|PDM|600.00|99|0.00|SKILLED NURSING, BARIATRIC
20|FH_F49042_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F49042_0_0|SrvcGrp|44860|2022|PDM|600.00|99|0.00|SKILLED NURSING, BARIATRIC
20|FH_F49044_0_0|SrvcGrp|21594|2022|PDM|335.00|99|0.00|SKILLED NURSING
20|FH_F49046_0_0|SrvcGrp|21594|2022|PDM|335.00|99|0.00|SKILLED NURSING
20|FH_F49046_0_0|SrvcGrp|44860|2022|PDM|600.00|99|0.00|SKILLED NURSING, BARIATRIC
20|FH_F49046_0_0|SrvcGrp|45148|2022|PDM|90.00|99|0.00|SPEECH THERAPY
20|FH_F49046_0_0|SrvcGrp|45150|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY
20|FH_F49049_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F49049_0_0|SrvcGrp|21594|2022|PDM|335.00|99|0.00|SKILLED NURSING
20|FH_F49051_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F49051_0_0|SrvcGrp|21594|2022|PDM|335.00|99|0.00|SKILLED NURSING
20|FH_F49054_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F49054_0_0|SrvcGrp|21594|2022|PDM|335.00|99|0.00|SKILLED NURSING
20|FH_F49054_0_0|SrvcGrp|43785|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY SERVICES
20|FH_F49054_0_0|SrvcGrp|45150|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY
20|FH_F49279_0_0|CSTM-ALL|CSTM-00|2020|PDM|1105.00|99|0.00|ASPG V
20|FH_F49279_0_0|CSTM-ALL|CSTM-00|2020|PDM|1597.00|99|0.00|ASPG VIII
20|FH_F49279_0_0|CSTM-ALL|CSTM-00|2020|PDM|2407.00|99|0.00|ASPG IX
20|FH_F49280_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS
20|FH_F49299_0_0|SrvcGrp|473|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F49300_0_0|SrvcGrp|10528|2022|PDM|45.00|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F49300_0_0|SrvcGrp|36066|2022|PDM|26.00|99|0.00|NURSING CARE
20|FH_F49300_0_0|SrvcGrp|36068|2022|PDM|45.00|99|0.00|SKILLED NURSING NON IV RELATED
20|FH_F49329_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F49329_0_0|CSTM-ALL|CSTM-00|2020|PDM|140.00|99|0.00|DIETICIAN VISIT - OP
20|FH_F49329_0_0|CSTM-ALL|CSTM-00|2020|PDM|179.00|99|0.00|MEDICAL SOCIAL WORKER VISIT - IP
20|FH_F49459_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F49476_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS
20|FH_F49478_0_0|CSTM-ALL|CSTM-00|2020|PDM|696.00|99|0.00|COVENTRY ENHANCED GROUPER 4
20|FH_F49489_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F49489_0_0|CSTM-ALL|CSTM-00|2020|PDM|1532.94|99|0.00|ASPG IV
20|FH_F49489_0_0|CSTM-ALL|CSTM-00|2020|PDM|1673.63|99|0.00|ASPG V
20|FH_F49489_0_0|CSTM-ALL|CSTM-00|2020|PDM|2756.36|99|0.00|ASPG X
20|FH_F49535_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F49543_0_0|CSTM-ALL|CSTM-00|2020|PCT|76.00|99|0.00|GENERAL ACUTE CARE
20|FH_F49572_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE
20|FH_F49572_0_0|SrvcGrp|15132|2022|PDM|1250.00|99|0.00|ACUTE IP MEDICAL SVCS
20|FH_F49572_0_0|SrvcGrp|29817|2022|PDM|1900.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F49572_0_0|SrvcGrp|43502|2022|PDM|300.00|99|0.00|NEWBORN NURSERY WITH MS DRG 795
20|FH_F49573_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F49575_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F49598_0_0|CSTM-ALL|CSTM-00|2020|PDM|2234.00|99|0.00|MS DRG 774-775, 767-768 NORMAL DELIVERY (MS DRG ONLY)
20|FH_F49598_0_0|SrvcGrp|30623|2022|PDM|3183.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788
20|FH_F49598_0_0|SrvcGrp|9774|2022|PDM|1697.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F49669_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F143684_0_0|CSTM-ALL|CSTM-00|2020|PDM|1340.00|99|0.00|AEG 4 (NO REV)
20|FH_F143684_0_0|SrvcGrp|103329|2022|PDM|9833.00|99|0.00|INSJ STABLJ DEV W/ DCMPRN
20|FH_F143684_0_0|SrvcGrp|35670|2022|PDM|31212.00|99|0.00|SPINAL NEUROSTIMULATORS PROCEDURE
20|FH_F143684_0_0|SrvcGrp|88487|2022|PDM|8323.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION
20|FH_F143684_0_0|SrvcGrp|92408|2022|PDM|8323.00|99|0.00|PERQ VERTEBRAL AUGMENTATION
20|FH_F143771_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F143783_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F143783_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F143783_0_0|SrvcGrp|113613|2022|PDM|105.00|99|0.00|HOSPICE CARE (HCFA)
20|FH_F143783_0_0|SrvcGrp|63297|2022|PDM|105.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F143783_0_0|SrvcGrp|83521|2022|PDM|105.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F143783_0_0|SrvcGrp|89781|2022|PDM|105.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F143783_0_0|SrvcGrp|93098|2022|PDM|105.00|99|0.00|HOSPICE CARE
20|FH_F143783_0_0|SrvcGrp|94781|2022|PDM|105.00|99|0.00|HOSPICE IN LTCH (HCFA)
20|FH_F143832_0_0|SrvcGrp|114106|2022|PDM|3102.72|99|0.00|AVF BY TISSUE W THERMAL E
20|FH_F143848_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F143850_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F143850_0_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F143898_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F143898_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F143898_0_0|SrvcGrp|104229|2022|PDM|100.00|99|0.00|HOSPICE IN HOME (HCFA)
20|FH_F143898_0_0|SrvcGrp|29155|2022|PDM|100.00|99|0.00|HOSPICE SVCS
20|FH_F143898_0_0|SrvcGrp|57967|2022|PDM|160.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F143898_0_0|SrvcGrp|57968|2022|PDM|28.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F143898_0_0|SrvcGrp|84185|2022|PDM|160.00|99|0.00|RESPITE CARE
20|FH_F143898_0_0|SrvcGrp|95661|2022|PDM|160.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F143988_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F143988_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F143988_0_0|CSTM-ALL|CSTM-00|2020|PCT|2.10|99|0.00|HSS ASC INVOICE
20|FH_F144021_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F144029_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F144029_0_0|SrvcGrp|107750|2022|PDM|25.00|99|0.00|TRAINING INCL A TREATMENT
20|FH_F144039_0_0|CSTM-ALL|CSTM-00|2020|PDM|1499.00|99|0.00|AEG 5  (NO REV)
20|FH_F144039_0_0|CSTM-ALL|CSTM-00|2020|PDM|1916.00|99|0.00|AEG 6 (NO REV)
20|FH_F144039_0_0|CSTM-ALL|CSTM-00|2020|PDM|2265.00|99|0.00|AEG 8 (NO REV)
20|FH_F144039_0_0|CSTM-ALL|CSTM-00|2020|PDM|2952.00|99|0.00|AEG 9 (NO REV)
20|FH_F144039_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F144039_0_0|SrvcGrp|106235|2022|PDM|6885.00|99|0.00|CYPASS
20|FH_F144039_0_0|SrvcGrp|109346|2022|PDM|4590.00|99|0.00|EXCISION OF CHALAZION DIFFERENT LIDS
20|FH_F144039_0_0|SrvcGrp|109761|2022|PDM|4590.00|99|0.00|REMOVE EYELID LESIONS
20|FH_F144039_0_0|SrvcGrp|109764|2022|PDM|4590.00|99|0.00|REPAIR EYELID DEFECT
20|FH_F144039_0_0|SrvcGrp|42427|2022|PDM|6885.00|99|0.00|OP SURGERY CPT 65420
20|FH_F144039_0_0|SrvcGrp|42428|2022|PDM|1721.00|99|0.00|OP SURGERY CPT 65855
20|FH_F144039_0_0|SrvcGrp|84278|2022|PDM|9754.00|99|0.00|CORNEAL TRANSPLANT
20|FH_F144039_0_0|SrvcGrp|84934|2022|PDM|6885.00|99|0.00|REMOVAL OF EYE LESION
20|FH_F144039_0_0|SrvcGrp|85966|2022|PDM|7459.00|99|0.00|EXTRACAPSULAR CATARACT
20|FH_F144039_0_0|SrvcGrp|92549|2022|PDM|5378.00|99|0.00|REMOVAL OF EYE LESION
20|FH_F144039_0_0|SrvcGrp|95819|2022|PDM|6885.00|99|0.00|GONIOTOMY
20|FH_F144191_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F144191_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|AEG 10 (NO REV)
20|FH_F144191_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 5  (NO REV)
20|FH_F144191_0_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|AEG 7 (NO REV)
20|FH_F144191_0_0|SrvcGrp|80617|2022|PDM|9875.00|99|0.00|ARTHOPLASTY
20|FH_F144191_0_0|SrvcGrp|89404|2022|PDM|9875.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F144191_0_0|SrvcGrp|90063|2022|PDM|2600.00|99|0.00|REPAIR BICEPS TENDON RUPTURE
20|FH_F144191_0_0|SrvcGrp|90363|2022|PDM|3700.00|99|0.00|REVISE/IMPLANT FINGER JOINT
20|FH_F144228_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F144228_0_0|CSTM-ALL|CSTM-00|2020|PDM|2435.00|99|0.00|AEG 3 (NO REV)
20|FH_F144228_0_0|SrvcGrp|101118|2022|PDM|13985.00|99|0.00|ARTHROSCOPY REPAIR
20|FH_F144228_0_0|SrvcGrp|103574|2022|PDM|7132.00|99|0.00|ANKLE ARTHROSCOPY
20|FH_F144228_0_0|SrvcGrp|114147|2022|PDM|1078.00|99|0.00|WINDPIPE INCISION
20|FH_F144228_0_0|SrvcGrp|114149|2022|PDM|1142.00|99|0.00|ESOPH ENDOSCOPY DILATION
20|FH_F144228_0_0|SrvcGrp|16668|2022|PDM|5543.00|99|0.00|OPEN TX OF BIMALLIOLAR ANKLE FX W/FIX
20|FH_F144228_0_0|SrvcGrp|64737|2022|PDM|894.00|99|0.00|CPT 43202
20|FH_F144228_0_0|SrvcGrp|85198|2022|PDM|8072.00|99|0.00|AETNA KNEE ARTHROSCOPY
20|FH_F144248_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F144248_0_0|CSTM-ALL|CSTM-00|2020|PDM|1473.00|99|0.00|AEG 4 (NO REV)
20|FH_F144248_0_0|CSTM-ALL|CSTM-00|2020|PDM|1916.00|99|0.00|AEG 6 (NO REV)
20|FH_F144248_0_0|CSTM-ALL|CSTM-00|2020|PDM|2265.00|99|0.00|AEG 8 (NO REV)
20|FH_F144248_0_0|CSTM-ALL|CSTM-00|2020|PDM|6885.00|99|0.00|DEVICE INSERTION
20|FH_F144248_0_0|SrvcGrp|109758|2022|PDM|11475.00|99|0.00|COLLAGEN CROSSLINKING CORNEA
20|FH_F144248_0_0|SrvcGrp|109762|2022|PDM|4590.00|99|0.00|REMOVE EYELID LESION(S)
20|FH_F144248_0_0|SrvcGrp|109763|2022|PDM|2869.00|99|0.00|TREAT EYELID LESION
20|FH_F144248_0_0|SrvcGrp|109764|2022|PDM|4590.00|99|0.00|REPAIR EYELID DEFECT
20|FH_F144248_0_0|SrvcGrp|109767|2022|PDM|2869.00|99|0.00|COVER EYE W/ MEMBRANE INCIDENTAL CODES
20|FH_F144248_0_0|SrvcGrp|109769|2022|PDM|2433.00|99|0.00|COVER EYE W/ MEMBRANE SUTURE INCIDENTAL CODES
20|FH_F144248_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F144248_0_0|SrvcGrp|114443|2022|PDM|10328.00|99|0.00|EXTRACAPSULAR CATARACT REMOVAL, INSERT LENS
20|FH_F144248_0_0|SrvcGrp|42427|2022|PDM|6885.00|99|0.00|OP SURGERY CPT 65420
20|FH_F144248_0_0|SrvcGrp|42550|2022|PDM|5738.00|99|0.00|OP SURGERY CPT 66984
20|FH_F144248_0_0|SrvcGrp|42551|2022|PDM|1721.00|99|0.00|OP SURGERY
20|FH_F144291_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F144291_0_0|SrvcGrp|107749|2022|PDM|182.00|99|0.00|CAPD/CCPD
20|FH_F144291_0_0|SrvcGrp|111468|2022|PDM|150.00|99|0.00|DIALYSIS PATIENT TRAINING
20|FH_F144648_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F144648_0_0|SrvcGrp|108042|2022|PDM|424.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD
20|FH_F144651_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.11|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE
20|FH_F144651_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.53|99|0.00|HSS ASC
20|FH_F144651_0_0|SrvcGrp|101280|2022|PDM|15500.00|99|0.00|TOTAL HIP ARTHROPLASTY
20|FH_F144651_0_0|SrvcGrp|113840|2022|PDM|15500.00|99|0.00|REVISE HIP ARTHROPLASTY
20|FH_F144651_0_0|SrvcGrp|114176|2022|PDM|6000.00|99|0.00|SPINE PROCEDURES
20|FH_F144651_0_0|SrvcGrp|96353|2022|PDM|16400.00|99|0.00|RECONSTRUCT ANKLE JOINT
20|FH_F144651_0_0|SrvcGrp|98561|2022|PDM|12000.00|99|0.00|ARTHRODESIS POSTERIOR TECH
20|FH_F144651_0_0|SrvcGrp|98564|2022|PDM|15000.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR
20|FH_F144769_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F144769_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.53|99|0.00|CARDIAC CATH
20|FH_F144769_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.67|99|0.00|OP SVCS
20|FH_F144769_0_0|CSTM-ALL|CSTM-00|2020|PDM|76999.00|99|0.00|CV SURGERY
20|FH_F144769_0_0|SrvcGrp|11000|2022|PCT|0.21|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F144808_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F144808_0_0|CSTM-ALL|CSTM-00|2020|PDM|2096.00|99|0.00|AEG 3 (NO REV)
20|FH_F144808_0_0|SrvcGrp|34606|2022|PDM|2888.00|99|0.00|CPT 29827
20|FH_F144808_0_0|SrvcGrp|58993|2022|PDM|7215.00|99|0.00|DISKECTOMY
20|FH_F144808_0_0|SrvcGrp|67279|2022|PDM|7699.00|99|0.00|CERVICAL SURGERY
20|FH_F144808_0_0|SrvcGrp|88157|2022|PDM|7215.00|99|0.00|TOTAL HIP ARTHROPLASTY
20|FH_F144808_0_0|SrvcGrp|88158|2022|PDM|7215.00|99|0.00|NECK SPINE DISK SURGERY
20|FH_F144808_0_0|SrvcGrp|88160|2022|PDM|7215.00|99|0.00|LAMINECTOMY W/FACETECTOMY
20|FH_F144808_0_0|SrvcGrp|88163|2022|PDM|7699.00|99|0.00|LUMBAR SPINE FUSION
20|FH_F144808_0_0|SrvcGrp|98498|2022|PDM|7215.00|99|0.00|TRANSPEDICULAR 1 SEG THORACIC
20|FH_F144828_0_0|CSTM-ALL|CSTM-00|2020|PDM|1870.00|99|0.00|AEG 4 (NO REV)
20|FH_F144828_0_0|CSTM-ALL|CSTM-00|2020|PDM|2310.00|99|0.00|AEG 7 (NO REV)
20|FH_F144828_0_0|CSTM-ALL|CSTM-00|2020|PDM|2440.00|99|0.00|AEG 9 (NO REV)
20|FH_F144828_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AEG 1 (NO REV)
20|FH_F144828_0_0|CSTM-ALL|CSTM-00|2020|PDM|880.00|99|0.00|AEG 10 (NO REV)
20|FH_F144828_0_0|SrvcGrp|101842|2022|PDM|4290.00|99|0.00|REVISE BREAST RECONSTRUCTION
20|FH_F144828_0_0|SrvcGrp|114194|2022|PDM|2200.00|99|0.00|SKIN FULL GRAFT PROCEDURE
20|FH_F144828_0_0|SrvcGrp|28557|2022|PDM|3850.00|99|0.00|CPT 19318
20|FH_F144848_0_0|CSTM-ALL|CSTM-00|2020|PDM|1057.00|99|0.00|AEG 7 (NO REV)
20|FH_F144848_0_0|CSTM-ALL|CSTM-00|2020|PDM|1433.00|99|0.00|AEG 9 (NO REV)
20|FH_F144848_0_0|CSTM-ALL|CSTM-00|2020|PDM|415.00|99|0.00|AEG 1 (NO REV)
20|FH_F144848_0_0|CSTM-ALL|CSTM-00|2020|PDM|761.00|99|0.00|AEG 10 (NO REV)
20|FH_F144848_0_0|CSTM-ALL|CSTM-00|2020|PDM|761.00|99|0.00|AEG 5  (NO REV)
20|FH_F144848_0_0|CSTM-ALL|CSTM-00|2020|PDM|905.00|99|0.00|AEG 6 (NO REV)
20|FH_F144848_0_0|SrvcGrp|113988|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F144848_0_0|SrvcGrp|64761|2022|PDM|3700.00|99|0.00|DISCECTOMY
20|FH_F144848_0_0|SrvcGrp|80139|2022|PDM|20928.00|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F144848_0_0|SrvcGrp|93740|2022|PDM|2437.00|99|0.00|REVISE/REMOVE NEURO RECEIVER
20|FH_F144848_0_0|SrvcGrp|97139|2022|PDM|3700.00|99|0.00|LAMINECTOMY W/FACETECTOMY
20|FH_F144848_0_0|SrvcGrp|97279|2022|PDM|1119.00|99|0.00|REMOVE SPINE ELTRD PERQ ARAY
20|FH_F144848_0_0|SrvcGrp|97299|2022|PDM|2437.00|99|0.00|REMOVE SPINE ELTRD PLATE
20|FH_F144848_0_0|SrvcGrp|97319|2022|PDM|18043.00|99|0.00|REVISE SPINE ELTRD PLATE
20|FH_F144988_0_0|SrvcGrp|87077|2022|PDM|130.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F145188_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F145188_0_0|CSTM-ALL|CSTM-00|2020|PDM|150.00|99|0.00|AEG 10 (NO REV)
20|FH_F145188_0_0|CSTM-ALL|CSTM-00|2020|PDM|566.00|99|0.00|AEG 3 (NO REV)
20|FH_F145188_0_0|CSTM-ALL|CSTM-00|2020|PDM|916.00|99|0.00|AEG 6 (NO REV)
20|FH_F145268_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS
20|FH_F145268_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F145348_0_0|CSTM-ALL|CSTM-00|2020|PDM|2619.00|99|0.00|GENERAL ACUTE CARE
20|FH_F145448_0_0|CSTM-ALL|CSTM-00|2020|PDM|1339.00|99|0.00|AEG 9 (NO REV)
20|FH_F145448_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|AEG 4 (NO REV)
20|FH_F145448_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|AEG 6 (NO REV)
20|FH_F145508_0_0|SrvcGrp|104229|2022|PDM|181.21|99|0.00|HOSPICE IN HOME (HCFA)
20|FH_F145508_0_0|SrvcGrp|95660|2022|PDM|956.15|99|0.00|HOSPICE SERVICES (HCFA)
20|FH_F145543_0_0|CSTM-ALL|CSTM-00|2020|PDM|1026.00|99|0.00|AEG 8 (NO REV)
20|FH_F145543_0_0|CSTM-ALL|CSTM-00|2020|PDM|311.00|99|0.00|AEG 1 (NO REV)
20|FH_F145543_0_0|CSTM-ALL|CSTM-00|2020|PDM|770.00|99|0.00|AEG 5  (NO REV)
20|FH_F145543_0_0|CSTM-ALL|CSTM-00|2020|PDM|782.00|99|0.00|AEG 6 (NO REV)
20|FH_F145543_0_0|SrvcGrp|104721|2022|PDM|770.00|99|0.00|REVISE EYELID W/ EXCESS SKIN
20|FH_F145543_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS
20|FH_F145563_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|OP SVCS
20|FH_F145567_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|HSS ASC
20|FH_F145568_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F145568_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F145568_0_0|SrvcGrp|108484|2022|PDM|660.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY
20|FH_F145587_0_0|CSTM-ALL|CSTM-00|2020|PDM|605.27|99|0.00|AEG 2 (NO REV)
20|FH_F145587_0_0|SrvcGrp|109068|2022|PDM|1262.70|99|0.00|PARTIAL REMOVAL OF FOOT BONE
20|FH_F145587_0_0|SrvcGrp|109788|2022|PDM|1262.70|99|0.00|REVISION OF HAMMERTOE
20|FH_F145587_0_0|SrvcGrp|26273|2022|PDM|1262.70|99|0.00|CPT 29880
20|FH_F145587_0_0|SrvcGrp|26274|2022|PDM|1262.70|99|0.00|CPT 29877
20|FH_F145587_0_0|SrvcGrp|26277|2022|PDM|1262.70|99|0.00|CPT 29874
20|FH_F145587_0_0|SrvcGrp|88154|2022|PDM|1779.93|99|0.00|LASER TREATMENT OLD RETINA
20|FH_F145587_0_0|SrvcGrp|89988|2022|PDM|1262.70|99|0.00|REPAIR HALLUX RIGIDUS
20|FH_F145599_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F145674_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.62|99|0.00|GENERAL ACUTE CARE
20|FH_F145689_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F145721_0_0|SrvcGrp|80920|2022|PDM|925.00|99|0.00|HOSPICE SERVICES
20|FH_F145739_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F145739_0_0|CSTM-ALL|CSTM-00|2020|PDM|576.00|99|0.00|AEG 3 (NO REV)
20|FH_F145739_0_0|CSTM-ALL|CSTM-00|2020|PDM|935.00|99|0.00|AEG 6 (NO REV)
20|FH_F145752_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F145762_0_0|CSTM-ALL|CSTM-00|2020|PDM|430.00|99|0.00|AEG 1 (NO REV)
20|FH_F145781_0_0|SrvcGrp|110860|2022|PDM|1500.00|99|0.00|CONJUNCTIVORHINOSTOMY
20|FH_F145781_0_0|SrvcGrp|113988|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F145781_0_0|SrvcGrp|114305|2022|PDM|2000.00|99|0.00|OSTEOCHONDRAL ALLOGRAFT KNEE
20|FH_F145781_0_0|SrvcGrp|114308|2022|PDM|1300.00|99|0.00|PARTIAL REMVL OF EYE FLUID
20|FH_F145781_0_0|SrvcGrp|27261|2022|PDM|10500.00|99|0.00|CPT 27446
20|FH_F145781_0_0|SrvcGrp|90061|2022|PDM|11000.00|99|0.00|AETNA RECONSTRUCT SHOULDER JOINT
20|FH_F145784_0_0|CSTM-ALL|CSTM-00|2020|PDM|2123.00|99|0.00|AEG 10 (NO REV)
20|FH_F145784_0_0|CSTM-ALL|CSTM-00|2020|PDM|910.00|99|0.00|AEG 2 (NO REV)
20|FH_F145784_0_0|SrvcGrp|104249|2022|PDM|2750.00|99|0.00|FULL GRAFT PROCEDURE
20|FH_F145863_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.00|99|0.00|OP SVCS
20|FH_F145870_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F145870_0_0|CSTM-ALL|CSTM-00|2020|PDM|1083.00|99|0.00|AEG 5  (NO REV)
20|FH_F145870_0_0|CSTM-ALL|CSTM-00|2020|PDM|2024.00|99|0.00|AEG 9 (NO REV)
20|FH_F145870_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F145877_0_0|SrvcGrp|33659|2022|PDM|400.00|99|0.00|DIALYSIS SERVICES
20|FH_F145885_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F145920_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F145920_0_0|CSTM-ALL|CSTM-00|2020|PDM|2958.00|99|0.00|AEG 7 (NO REV)
20|FH_F145920_0_0|SrvcGrp|113988|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F145920_0_0|SrvcGrp|79594|2022|PDM|1970.00|99|0.00|CPT 45380
20|FH_F145959_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.35|99|0.00|HSS ASC
20|FH_F146011_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.20|99|0.00|GENERAL ACUTE CARE
20|FH_F146011_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.20|99|0.00|OP SVCS
20|FH_F146012_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F146040_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F146040_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F146040_0_0|SrvcGrp|82981|2022|PDM|185.09|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F146043_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F146043_0_0|CSTM-ALL|CSTM-00|2020|PDM|1240.00|99|0.00|AEG 1 (NO REV)
20|FH_F146043_0_0|CSTM-ALL|CSTM-00|2020|PDM|1407.00|99|0.00|AEG 2 (NO REV)
20|FH_F146112_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|GENERAL ACUTE CARE
20|FH_F146117_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F146122_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|OP SVCS
20|FH_F146125_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 4 (NO REV)
20|FH_F146125_0_0|SrvcGrp|101520|2022|PDM|3245.00|99|0.00|T1H W/T/O (<250G)
20|FH_F146125_0_0|SrvcGrp|113988|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F146125_0_0|SrvcGrp|27348|2022|PDM|3245.00|99|0.00|OP SURGERY (CPT 58662)
20|FH_F146125_0_0|SrvcGrp|64517|2022|PDM|2000.00|99|0.00|REDUCE MANMMAPLASTY
20|FH_F146125_0_0|SrvcGrp|88147|2022|PDM|3197.00|99|0.00|LAPAROSCOPY REMOVE ADNEXA
20|FH_F146204_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AEG 1 (NO REV)
20|FH_F146204_0_0|CSTM-ALL|CSTM-00|2020|PDM|693.00|99|0.00|AEG 2 (NO REV)
20|FH_F146204_0_0|SrvcGrp|113890|2022|PDM|1500.00|99|0.00|REMOVE VAGINA LESION
20|FH_F146204_0_0|SrvcGrp|24543|2022|PDM|1500.00|99|0.00|REMOVE VAGINA GLAND LESION
20|FH_F146204_0_0|SrvcGrp|27348|2022|PDM|2376.00|99|0.00|OP SURGERY (CPT 58662)
20|FH_F146204_0_0|SrvcGrp|33987|2022|PDM|1500.00|99|0.00|CPT 57522
20|FH_F146204_0_0|SrvcGrp|67989|2022|PDM|2376.00|99|0.00|CPT 49320
20|FH_F146204_0_0|SrvcGrp|67994|2022|PDM|1500.00|99|0.00|CPT 58120
20|FH_F146204_0_0|SrvcGrp|88147|2022|PDM|2376.00|99|0.00|LAPAROSCOPY REMOVE ADNEXA
20|FH_F146217_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F146217_0_0|SrvcGrp|84185|2022|PDM|141.22|99|0.00|RESPITE CARE
20|FH_F146217_0_0|SrvcGrp|95661|2022|PDM|423.55|99|0.00|RESPITE CARE (HCFA)
20|FH_F146239_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F146255_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.90|99|0.00|OP SVCS
20|FH_F146256_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|GENERAL ACUTE CARE
20|FH_F146260_0_0|CSTM-ALL|CSTM-00|2020|PCT|63.20|99|0.00|OP SVCS
20|FH_F146261_0_0|CSTM-ALL|CSTM-00|2020|PCT|71.80|99|0.00|GENERAL ACUTE CARE
20|FH_F146262_0_0|CSTM-ALL|CSTM-00|2020|PCT|91.00|99|0.00|GENERAL ACUTE CARE
20|FH_F146262_0_0|CSTM-ALL|CSTM-00|2020|PCT|91.00|99|0.00|OP SVCS
20|FH_F146266_0_0|CSTM-ALL|CSTM-00|2020|PDM|1560.00|99|0.00|AEG 10 (NO REV)
20|FH_F146266_0_0|CSTM-ALL|CSTM-00|2020|PDM|2300.00|99|0.00|AEG 4 (NO REV)
20|FH_F146266_0_0|CSTM-ALL|CSTM-00|2020|PDM|2365.00|99|0.00|AEG 5  (NO REV)
20|FH_F146266_0_0|CSTM-ALL|CSTM-00|2020|PDM|2900.00|99|0.00|AEG 7 (NO REV)
20|FH_F146266_0_0|CSTM-ALL|CSTM-00|2020|PDM|3101.00|99|0.00|AEG 8 (NO REV)
20|FH_F146266_0_0|CSTM-ALL|CSTM-00|2020|PDM|4558.00|99|0.00|AEG 9 (NO REV)
20|FH_F146266_0_0|SrvcGrp|100017|2022|PDM|12752.00|99|0.00|FUSION OF FOOT BONES
20|FH_F146266_0_0|SrvcGrp|100044|2022|PDM|3000.00|99|0.00|INCISION OF HEEL BONE
20|FH_F146266_0_0|SrvcGrp|103586|2022|PDM|5559.00|99|0.00|REMOVE SPINE INFUSION
20|FH_F146266_0_0|SrvcGrp|111588|2022|PDM|6699.00|99|0.00|REPAIR OF THIGH MUSCLE
20|FH_F146266_0_0|SrvcGrp|112168|2022|PDM|7945.00|99|0.00|REMOVE WRIST JOINT IMPLANT
20|FH_F146266_0_0|SrvcGrp|114328|2022|PDM|8661.00|99|0.00|REVISE ELBOW JOINT
20|FH_F146266_0_0|SrvcGrp|114329|2022|PDM|3174.00|99|0.00|BIOPSY FINGER JOINT LINING
20|FH_F146266_0_0|SrvcGrp|34606|2022|PDM|5000.00|99|0.00|CPT 29827
20|FH_F146266_0_0|SrvcGrp|35670|2022|PDM|1450.00|99|0.00|SPINAL NEUROSTIMULATORS PROCEDURE
20|FH_F146266_0_0|SrvcGrp|35671|2022|PDM|2775.00|99|0.00|TRANSPLANT FOREARM TENDON
20|FH_F146266_0_0|SrvcGrp|67065|2022|PDM|16795.00|99|0.00|CERVICAL SURGERY
20|FH_F146266_0_0|SrvcGrp|67069|2022|PDM|6848.00|99|0.00|CPT 22634
20|FH_F146266_0_0|SrvcGrp|67072|2022|PDM|6188.00|99|0.00|CPT 22845
20|FH_F146266_0_0|SrvcGrp|75002|2022|PDM|3770.00|99|0.00|ARTHOSCOPY
20|FH_F146266_0_0|SrvcGrp|80617|2022|PDM|20107.00|99|0.00|ARTHOPLASTY
20|FH_F146266_0_0|SrvcGrp|85778|2022|PDM|3950.00|99|0.00|REPAIR OF ANKLE FRACTURE
20|FH_F146266_0_0|SrvcGrp|88156|2022|PDM|10928.00|99|0.00|REVISION OF KNEE JOINT
20|FH_F146266_0_0|SrvcGrp|88162|2022|PDM|5911.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON
20|FH_F146266_0_0|SrvcGrp|88596|2022|PDM|1945.00|99|0.00|EXC OF TRIANG FIBROCARTILAGE
20|FH_F146266_0_0|SrvcGrp|92364|2022|PDM|15038.00|99|0.00|ARTHRODESIS SACROILIAC JOINT
20|FH_F146266_0_0|SrvcGrp|93069|2022|PDM|9084.00|99|0.00|POSTERIOR NON-SEGMENTAL INST
20|FH_F146266_0_0|SrvcGrp|93807|2022|PDM|7772.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY
20|FH_F146266_0_0|SrvcGrp|94904|2022|PDM|3865.00|99|0.00|REPAIR/REVISE WRIST JOINT
20|FH_F146266_0_0|SrvcGrp|98003|2022|PDM|2365.00|99|0.00|BIMALLEOLAR ANKLE FRACTURE
20|FH_F146266_0_0|SrvcGrp|98497|2022|PDM|15190.00|99|0.00|ARTHRODESIS POSTERIOR TECH
20|FH_F146266_0_0|SrvcGrp|99167|2022|PDM|7030.00|99|0.00|CPT 63057
20|FH_F146283_0_0|CSTM-ALL|CSTM-00|2020|PDM|2419.00|99|0.00|GENERAL ACUTE CARE
20|FH_F146293_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|OP SVCS
20|FH_F146399_0_0|SrvcGrp|108042|2022|PDM|424.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD
20|FH_F146569_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F146569_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F146569_0_0|SrvcGrp|80920|2022|PDM|475.00|99|0.00|HOSPICE SERVICES
20|FH_F146620_0_0|CSTM-ALL|CSTM-00|2020|PCT|38.70|99|0.00|GENERAL ACUTE CARE
20|FH_F146620_0_0|CSTM-ALL|CSTM-00|2020|PCT|38.70|99|0.00|OP SVCS
20|FH_F146642_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F146644_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F146760_0_0|SrvcGrp|108043|2022|PDM|182.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD
20|FH_F146760_0_0|SrvcGrp|108082|2022|PDM|25.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER
20|FH_F146765_0_0|SrvcGrp|80920|2022|PDM|100.00|99|0.00|HOSPICE SERVICES
20|FH_F146765_0_0|SrvcGrp|82222|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F146765_0_0|SrvcGrp|84185|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F146790_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|AEG 6 (NO REV)
20|FH_F146790_0_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F146792_0_0|CSTM-ALL|CSTM-00|2020|PDM|1287.00|99|0.00|AEG 1 (NO REV)
20|FH_F146792_0_0|CSTM-ALL|CSTM-00|2020|PDM|1724.00|99|0.00|AEG 2 (NO REV)
20|FH_F146792_0_0|CSTM-ALL|CSTM-00|2020|PDM|2770.00|99|0.00|AEG 5  (NO REV)
20|FH_F146792_0_0|CSTM-ALL|CSTM-00|2020|PDM|3763.00|99|0.00|AEG 8 (NO REV)
20|FH_F146803_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 2 (NO REV)
20|FH_F146803_0_0|CSTM-ALL|CSTM-00|2020|PDM|1900.00|99|0.00|AEG 4 (NO REV)
20|FH_F146803_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|AEG 6 (NO REV)
20|FH_F146803_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|AEG 8 (NO REV)
20|FH_F146803_0_0|SrvcGrp|113114|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F146807_28655_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F146859_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F146859_0_0|CSTM-ALL|CSTM-00|2020|PDM|1433.00|99|0.00|AEG 5  (NO REV)
20|FH_F146859_0_0|CSTM-ALL|CSTM-00|2020|PDM|794.00|99|0.00|AEG 2 (NO REV)
20|FH_F146859_0_0|SrvcGrp|103574|2022|PDM|5019.00|99|0.00|ANKLE ARTHROSCOPY
20|FH_F146859_0_0|SrvcGrp|104163|2022|PDM|4511.00|99|0.00|KYPHOPLASTY
20|FH_F146859_0_0|SrvcGrp|106166|2022|PDM|3345.00|99|0.00|REPAIR WRIST JOINT(S)
20|FH_F146859_0_0|SrvcGrp|106167|2022|PDM|1791.00|99|0.00|REMOVE TENDON SHEATH LESION
20|FH_F146859_0_0|SrvcGrp|107385|2022|PDM|5367.00|99|0.00|REMOVE CERV ARTIF DISC
20|FH_F146859_0_0|SrvcGrp|108292|2022|PDM|3531.00|99|0.00|AETNA ANKLE ARTHROSCOPY
20|FH_F146859_0_0|SrvcGrp|108298|2022|PDM|1465.00|99|0.00|AETNA REPAIR CLAVICLE DISLOCATION
20|FH_F146859_0_0|SrvcGrp|108316|2022|PDM|565.00|99|0.00|AETNA FIXATION OF KNEE JOINT
20|FH_F146859_0_0|SrvcGrp|114839|2022|PDM|2087.00|99|0.00|FOOT CONTRACTURE
20|FH_F146859_0_0|SrvcGrp|114844|2022|PDM|1394.00|99|0.00|FINGER FRACTURE REPAIR
20|FH_F146859_0_0|SrvcGrp|114845|2022|PDM|1757.00|99|0.00|FINGER TENDON REPAIR
20|FH_F146859_0_0|SrvcGrp|114850|2022|PDM|1096.00|99|0.00|NERVOUS SYSTEM PROCEDURE
20|FH_F146859_0_0|SrvcGrp|114851|2022|PDM|3810.00|99|0.00|SPINE ELTRD PERQ ARAY REMOVE
20|FH_F146859_0_0|SrvcGrp|114852|2022|PDM|620.00|99|0.00|INJECT SPINE L/S CD
20|FH_F146859_0_0|SrvcGrp|114858|2022|PDM|1530.00|99|0.00|WRIST ARTHROS
20|FH_F146859_0_0|SrvcGrp|114859|2022|PDM|3608.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F146859_0_0|SrvcGrp|114901|2022|PDM|2320.00|99|0.00|TRANSPLANT HAND TENDON
20|FH_F146859_0_0|SrvcGrp|44460|2022|PDM|3704.00|99|0.00|IMPLANTATION OF NEUROSTIMULATOR ELECTRODES
20|FH_F146859_0_0|SrvcGrp|94561|2022|PDM|2789.00|99|0.00|HIP ARTHRO W/ FEMOROPLASTY
20|FH_F146859_0_0|SrvcGrp|94563|2022|PDM|2789.00|99|0.00|HIP ARTHRO W/ LABRAL REPAIR
20|FH_F146859_0_0|SrvcGrp|99073|2022|PDM|1.38|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F146885_0_0|SrvcGrp|89337|2022|PDM|980.00|99|0.00|DETOXIFICATION
20|FH_F146904_0_0|SrvcGrp|87077|2022|PDM|114.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F146933_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F146986_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F146986_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F147009_0_0|CSTM-ALL|CSTM-00|2020|PDM|1339.00|99|0.00|AEG 9 (NO REV)
20|FH_F147009_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 1 (NO REV)
20|FH_F147009_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 10 (NO REV)
20|FH_F147009_0_0|CSTM-ALL|CSTM-00|2020|PDM|446.00|99|0.00|AEG 2 (NO REV)
20|FH_F147009_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|AEG 7 (NO REV)
20|FH_F147211_0_0|SrvcGrp|109118|2022|PDM|1266.00|99|0.00|SUBACUTE REHAB LEVEL 5
20|FH_F147340_0_0|SrvcGrp|29428|2022|PDM|1519.00|99|0.00|HOME/CHRONIC HEMODIALYSIS TREATMENT
20|FH_F147340_0_0|SrvcGrp|68641|2022|PDM|1141.00|99|0.00|HOME HEMODIALYSIS
20|FH_F147363_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F147372_0_0|SrvcGrp|46903|2022|PDM|825.00|99|0.00|RESIDENTIAL TREATMENT
20|FH_F147418_0_0|CSTM-ALL|CSTM-00|2020|PDM|1990.00|99|0.00|AEG 10 (NO REV)
20|FH_F147418_0_0|CSTM-ALL|CSTM-00|2020|PDM|2350.00|99|0.00|AEG 4 (NO REV)
20|FH_F147418_0_0|CSTM-ALL|CSTM-00|2020|PDM|3740.00|99|0.00|AEG 8 (NO REV)
20|FH_F147418_0_0|SrvcGrp|11000|2022|PCT|0.00|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F147418_0_0|SrvcGrp|115022|2022|PDM|7000.00|99|0.00|CARDIOLOGY
20|FH_F147502_0_0|SrvcGrp|29346|2022|PDM|85.00|99|0.00|SKILLED NURSING- LPN
20|FH_F147502_0_0|SrvcGrp|48396|2022|PDM|85.00|99|0.00|OT SERVICES
20|FH_F147502_0_0|SrvcGrp|82222|2022|PDM|150.00|99|0.00|HOSPICE CARE
20|FH_F147502_0_0|SrvcGrp|95660|2022|PDM|575.00|99|0.00|HOSPICE SERVICES (HCFA)
20|FH_F147502_0_0|SrvcGrp|95661|2022|PDM|150.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F147532_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F147532_0_0|SrvcGrp|29353|2022|PDM|717.20|99|0.00|HOSPICE SVCS
20|FH_F147532_0_0|SrvcGrp|80317|2022|PDM|144.84|99|0.00|RESPITE CARE
20|FH_F147532_0_0|SrvcGrp|87798|2022|PDM|144.84|99|0.00|HOSPICE CARE (ALL OTHER)(HCFA)
20|FH_F147532_0_0|SrvcGrp|89783|2022|PDM|717.20|99|0.00|RESPITE CARE (HCFA)
20|FH_F147532_0_0|SrvcGrp|90478|2022|PDM|144.84|99|0.00|HOSPICE
20|FH_F147661_0_0|CSTM-ALL|CSTM-00|2020|PDM|1015.00|99|0.00|AEG 5  (NO REV)
20|FH_F147661_0_0|CSTM-ALL|CSTM-00|2020|PDM|798.00|99|0.00|AEG 9 (NO REV)
20|FH_F147800_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F147800_0_0|CSTM-ALL|CSTM-00|2020|PDM|1075.00|99|0.00|AEG 8 (NO REV)
20|FH_F147800_0_0|CSTM-ALL|CSTM-00|2020|PDM|563.00|99|0.00|AEG 9 (NO REV)
20|FH_F147800_0_0|CSTM-ALL|CSTM-00|2020|PDM|912.00|99|0.00|AEG 6 (NO REV)
20|FH_F147800_0_0|SrvcGrp|100923|2022|PDM|990.00|99|0.00|DRUGS
20|FH_F147800_0_0|SrvcGrp|103236|2022|PDM|16390.00|99|0.00|AETNA INSJ STABLJ DEV
20|FH_F147800_0_0|SrvcGrp|110571|2022|PDM|880.00|99|0.00|NERVE BLOCK INJECTION 8
20|FH_F147800_0_0|SrvcGrp|110767|2022|PDM|458.00|99|0.00|2ND LEVEL INJ PARAVERT F JNT L/S
20|FH_F147800_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F147800_0_0|SrvcGrp|113716|2022|PDM|880.00|99|0.00|NJX AA / STR AXILLARY NERVE
20|FH_F147800_0_0|SrvcGrp|36591|2022|PDM|48400.00|99|0.00|CPT 63685
20|FH_F147800_0_0|SrvcGrp|45063|2022|PDM|880.00|99|0.00|CPT 64493  INJECTION CARVE OUT
20|FH_F147800_0_0|SrvcGrp|53065|2022|PDM|1210.00|99|0.00|INJECTION(S), LUMBAR OR SACRAL, SINGLE LEVEL
20|FH_F147800_0_0|SrvcGrp|87677|2022|PDM|1650.00|99|0.00|CERVICAL OR THORACIC SURGERY
20|FH_F147800_0_0|SrvcGrp|87679|2022|PDM|1650.00|99|0.00|LUMBAR OR SACRAL SURGERY
20|FH_F147899_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F147899_0_0|SrvcGrp|115221|2022|PDM|1790.00|99|0.00|UPPR GI OPTICL ENDOMICRSCOPY (HCFA)
20|FH_F147919_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F147919_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F147980_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F147980_0_0|SrvcGrp|104230|2022|PDM|95.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F147980_0_0|SrvcGrp|29155|2022|PDM|95.00|99|0.00|HOSPICE SVCS
20|FH_F148008_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F148008_0_0|SrvcGrp|471|2022|PDM|603.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F148166_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F148181_0_0|SrvcGrp|65720|2022|PDM|155.00|99|0.00|RESPITE CARE
20|FH_F148181_0_0|SrvcGrp|94780|2022|PDM|155.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)
20|FH_F148181_0_0|SrvcGrp|95661|2022|PDM|837.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F148186_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F148186_0_0|SrvcGrp|106314|2022|PDM|675.00|99|0.00|ADVANCED LIFE SUPPORT LEVEL 2 (ALS2) (HCFA)
20|FH_F148186_0_0|SrvcGrp|106317|2022|PDM|823.00|99|0.00|SPECIALTY CARE TRANSPORT (HCFA)
20|FH_F148186_0_0|SrvcGrp|2067|2022|PDM|823.00|99|0.00|SPECIALTY CARE TRANSPORT
20|FH_F148243_0_0|CSTM-ALL|CSTM-00|2020|PDM|1133.00|99|0.00|AEG 7 (NO REV)
20|FH_F148243_0_0|CSTM-ALL|CSTM-00|2020|PDM|957.00|99|0.00|AEG 6 (NO REV)
20|FH_F148243_0_0|SrvcGrp|105632|2022|PDM|1450.00|99|0.00|AMPUTATION OF TOE
20|FH_F148243_0_0|SrvcGrp|107988|2022|PDM|585.00|99|0.00|PARTIAL REMOVAL OF TOE
20|FH_F148243_0_0|SrvcGrp|114924|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F148243_0_0|SrvcGrp|114926|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES
20|FH_F148243_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F148243_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F148243_0_0|SrvcGrp|79588|2022|PDM|650.00|99|0.00|CPT 43235
20|FH_F148243_0_0|SrvcGrp|84971|2022|PDM|879.00|99|0.00|CPT 43245
20|FH_F148243_0_0|SrvcGrp|84972|2022|PDM|550.00|99|0.00|CPT 43247
20|FH_F148243_0_0|SrvcGrp|84974|2022|PDM|879.00|99|0.00|CPT 43255
20|FH_F148243_0_0|SrvcGrp|87677|2022|PDM|957.00|99|0.00|CERVICAL OR THORACIC SURGERY
20|FH_F148243_0_0|SrvcGrp|87679|2022|PDM|957.00|99|0.00|LUMBAR OR SACRAL SURGERY
20|FH_F148243_0_0|SrvcGrp|98466|2022|PDM|1450.00|99|0.00|PARTIAL REMOVAL OF FOOT BONE
20|FH_F148260_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F148260_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F148260_0_0|SrvcGrp|104753|2022|PDM|3048.00|99|0.00|PELVIC EXAMINATION
20|FH_F148260_0_0|SrvcGrp|104754|2022|PDM|1671.00|99|0.00|CYSTOMETROGRAM W/ VP&UP
20|FH_F148260_0_0|SrvcGrp|104755|2022|PDM|550.00|99|0.00|ANAL/URINARY MUSCLE STUDY
20|FH_F148260_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F148260_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F148260_0_0|SrvcGrp|115341|2022|PDM|10009.00|99|0.00|LYSIS LAPAROSCOPY
20|FH_F148260_0_0|SrvcGrp|33965|2022|PDM|13643.00|99|0.00|CPT 58552
20|FH_F148260_0_0|SrvcGrp|41547|2022|PDM|15259.00|99|0.00|OP LAPAROSCOPIC HYSTERECTOMY
20|FH_F148325_0_0|SrvcGrp|57968|2022|PDM|37.74|99|0.00|CONTINUOUS HOMECARE
20|FH_F148325_0_0|SrvcGrp|92501|2022|PDM|151.98|99|0.00|HOSPICE IP RESPITE CARE
20|FH_F148325_0_0|SrvcGrp|92502|2022|PDM|654.59|99|0.00|HOSPICE GENERAL IP CARE
20|FH_F148326_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F148326_0_0|CSTM-ALL|CSTM-00|2020|PDM|1734.00|99|0.00|AEG 3 (NO REV)
20|FH_F148326_0_0|CSTM-ALL|CSTM-00|2020|PDM|3451.00|99|0.00|AEG 7 (NO REV)
20|FH_F148326_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F148326_0_0|SrvcGrp|90383|2022|PDM|8000.00|99|0.00|RECONSTRUCT SHOULDER JOINT
20|FH_F148326_0_0|SrvcGrp|90436|2022|PDM|8160.00|99|0.00|TOTAL HIP ARTHROPLASTY
20|FH_F148344_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F148344_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F148345_0_0|CSTM-ALL|CSTM-00|2020|PDM|1216.00|99|0.00|AEG 5  (NO REV)
20|FH_F148345_0_0|CSTM-ALL|CSTM-00|2020|PDM|1471.00|99|0.00|AEG 6 (NO REV)
20|FH_F148346_0_0|SrvcGrp|46903|2022|PDM|1191.00|99|0.00|RESIDENTIAL TREATMENT
20|FH_F148346_0_0|SrvcGrp|74668|2022|PDM|281.00|99|0.00|AETNA INTENSIVE OUTPATIENT
20|FH_F148347_0_0|CSTM-ALL|CSTM-00|2020|PDM|1410.00|99|0.00|AEG 8 (NO REV)
20|FH_F148347_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 4 (NO REV)
20|FH_F148347_0_0|SrvcGrp|109800|2022|PDM|2378.00|99|0.00|REPAIR ANAL FISTULA
20|FH_F148347_0_0|SrvcGrp|109801|2022|PDM|1932.00|99|0.00|ANOSCOPY AND BIOPSY
20|FH_F148347_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F148347_0_0|SrvcGrp|33967|2022|PDM|5144.00|99|0.00|CPT 47562
20|FH_F148347_0_0|SrvcGrp|35664|2022|PDM|3422.65|99|0.00|VNUS CLOSURE
20|FH_F148347_0_0|SrvcGrp|82118|2022|PDM|4603.00|99|0.00|LAPAROSCOPY ESOPHAGUS
20|FH_F148429_0_0|SrvcGrp|11577|2022|PDM|495.00|99|0.00|DIALYSIS
20|FH_F148439_0_0|SrvcGrp|87537|2022|PCT|0.00|99|0.00|MED REHAB DAY PROGRAM (FULL)
20|FH_F148488_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F148489_0_0|SrvcGrp|46903|2022|PDM|600.00|99|0.00|RESIDENTIAL TREATMENT
20|FH_F148494_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F148494_0_0|SrvcGrp|101280|2022|PDM|15500.00|99|0.00|TOTAL HIP ARTHROPLASTY
20|FH_F148494_0_0|SrvcGrp|113843|2022|PDM|15500.00|99|0.00|REVISE KNEE
20|FH_F148494_0_0|SrvcGrp|40003|2022|PDM|15000.00|99|0.00|TOTAL KNEE
20|FH_F148494_0_0|SrvcGrp|96899|2022|PDM|15000.00|99|0.00|LUMBAR ARTIF DISCECTOMY
20|FH_F148494_0_0|SrvcGrp|98565|2022|PDM|15000.00|99|0.00|LUMBAR SPINE FUSION COMBINED
20|FH_F148494_0_0|SrvcGrp|98566|2022|PDM|15000.00|99|0.00|ARTHRDSIS LAT MINI DISKECT
20|FH_F148521_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F148541_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.60|99|0.00|HSS ASC
20|FH_F148546_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F148555_0_0|CSTM-ALL|CSTM-00|2020|PDM|577.00|99|0.00|AEG 3 (NO REV)
20|FH_F148555_0_0|SrvcGrp|109219|2022|PDM|3709.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F148555_0_0|SrvcGrp|115437|2022|PDM|3605.00|99|0.00|INSERT HEART PM ATRIAL & VENT
20|FH_F148555_0_0|SrvcGrp|115499|2022|PDM|3914.00|99|0.00|MAP TACHYCARDIA, ADD-ON
20|FH_F148555_0_0|SrvcGrp|21781|2022|PDM|5871.00|99|0.00|OP AICD 33249
20|FH_F148555_0_0|SrvcGrp|28399|2022|PDM|3090.00|99|0.00|CPT CODE 93620
20|FH_F148601_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.49|99|0.00|OP SVCS
20|FH_F148639_0_0|SrvcGrp|35668|2022|PDM|2412.00|99|0.00|CPT 29824
20|FH_F148639_0_0|SrvcGrp|35669|2022|PDM|3400.00|99|0.00|CPT 63650
20|FH_F148639_0_0|SrvcGrp|38364|2022|PDM|3400.00|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F148639_0_0|SrvcGrp|63472|2022|PDM|3495.00|99|0.00|CPT 64581
20|FH_F148639_0_0|SrvcGrp|72121|2022|PDM|3084.00|99|0.00|ARTHOSCOPY
20|FH_F148639_0_0|SrvcGrp|76604|2022|PDM|1850.00|99|0.00|CPT 25447
20|FH_F148639_0_0|SrvcGrp|87677|2022|PDM|1675.00|99|0.00|CERVICAL OR THORACIC SURGERY
20|FH_F148639_0_0|SrvcGrp|87679|2022|PDM|1675.00|99|0.00|LUMBAR OR SACRAL SURGERY
20|FH_F148639_0_0|SrvcGrp|90063|2022|PDM|2833.00|99|0.00|REPAIR BICEPS TENDON RUPTURE
20|FH_F148639_0_0|SrvcGrp|93807|2022|PDM|3400.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY
20|FH_F148645_0_0|CSTM-ALL|CSTM-00|2020|PDM|3733.94|99|0.00|AEG 8 (NO REV)
20|FH_F148645_0_0|CSTM-ALL|CSTM-00|2020|PDM|4355.19|99|0.00|AEG 7 (NO REV)
20|FH_F148667_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F148667_0_0|CSTM-ALL|CSTM-00|2020|PDM|1495.00|99|0.00|AEG 6 (NO REV)
20|FH_F148667_0_0|CSTM-ALL|CSTM-00|2020|PDM|1687.00|99|0.00|AEG 8 (NO REV)
20|FH_F148667_0_0|SrvcGrp|100061|2022|PDM|2856.00|99|0.00|REPAIR THUMB FRACTURE
20|FH_F148667_0_0|SrvcGrp|100063|2022|PDM|2856.00|99|0.00|REPAIR FOOT DISLOCATION
20|FH_F148667_0_0|SrvcGrp|100066|2022|PDM|2856.00|99|0.00|REPAIR RADIUS FRACTURE
20|FH_F148667_0_0|SrvcGrp|115492|2022|PDM|2052.00|99|0.00|PALM CONTRACTURE RELEASE
20|FH_F148667_0_0|SrvcGrp|11663|2022|PCT|0.00|99|0.00|IMPLANTS
20|FH_F148667_0_0|SrvcGrp|13187|2022|PCT|0.00|99|0.00|INTRAOCULAR LENSES
20|FH_F148667_0_0|SrvcGrp|26273|2022|PDM|2856.00|99|0.00|CPT 29880
20|FH_F148667_0_0|SrvcGrp|26275|2022|PDM|2856.00|99|0.00|CPT 29826
20|FH_F148667_0_0|SrvcGrp|35667|2022|PDM|2052.00|99|0.00|CPT 20680
20|FH_F148667_0_0|SrvcGrp|41334|2022|PDM|11000.00|99|0.00|TOTAL KNEE
20|FH_F148667_0_0|SrvcGrp|67065|2022|PDM|7918.00|99|0.00|CERVICAL SURGERY
20|FH_F148667_0_0|SrvcGrp|76604|2022|PDM|2856.00|99|0.00|CPT 25447
20|FH_F148667_0_0|SrvcGrp|85792|2022|PDM|2856.00|99|0.00|OPEN TREATMENT OF DISTAL
20|FH_F148667_0_0|SrvcGrp|86233|2022|PDM|11000.00|99|0.00|AETNA RECONSTRUCT ANKLE JOINT
20|FH_F148667_0_0|SrvcGrp|89980|2022|PDM|2727.00|99|0.00|OPEN TREATMENT OF DISTAL
20|FH_F148667_0_0|SrvcGrp|90365|2022|PDM|2856.00|99|0.00|REPAIR METACARPAL FRACTURE
20|FH_F148667_0_0|SrvcGrp|90420|2022|PDM|2791.00|99|0.00|REPAIR CLAVICLE FRACTURE
20|FH_F148667_0_0|SrvcGrp|90975|2022|PDM|1207.00|99|0.00|INJECTION OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE
20|FH_F49739_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F49776_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE
20|FH_F49776_0_0|SrvcGrp|10410|2022|PDM|47.00|99|0.00|SKILLED NURSING CARE
20|FH_F49776_0_0|SrvcGrp|26001|2022|PDM|90.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F49776_0_0|SrvcGrp|42830|2022|PDM|102.00|99|0.00|MEDICAL SOCIAL WORKER VISIT
20|FH_F49832_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F49832_0_0|SrvcGrp|42824|2022|PDM|90.00|99|0.00|SKILLED NURSING VISIT
20|FH_F49853_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F49853_0_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F49853_0_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F49913_0_0|SrvcGrp|43785|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY SERVICES
20|FH_F49913_0_0|SrvcGrp|44860|2022|PDM|600.00|99|0.00|SKILLED NURSING, BARIATRIC
20|FH_F49913_0_0|SrvcGrp|45148|2022|PDM|90.00|99|0.00|SPEECH THERAPY
20|FH_F49914_0_0|SrvcGrp|21594|2022|PDM|335.00|99|0.00|SKILLED NURSING
20|FH_F49914_0_0|SrvcGrp|43785|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY SERVICES
20|FH_F49920_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F49920_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F49932_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|GENERAL ACUTE CARE
20|FH_F49937_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F49937_0_0|SrvcGrp|45148|2022|PDM|90.00|99|0.00|SPEECH THERAPY
20|FH_F49943_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F49943_0_0|SrvcGrp|42974|2022|PDM|140.00|99|0.00|OCCUPATIONAL THERAPIST
20|FH_F49943_0_0|SrvcGrp|45924|2022|PDM|36.00|99|0.00|HOME HEALTH AIDE
20|FH_F49954_0_0|SrvcGrp|43785|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY SERVICES
20|FH_F49996_0_0|CSTM-ALL|CSTM-00|2020|PDM|1518.00|99|0.00|ASPG VIII
20|FH_F49996_0_0|SrvcGrp|30076|2022|PCT|1.00|99|0.00|IMPLANTS, PROSTHETICS, OR SUPPLIES
20|FH_F50013_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F50074_0_0|CSTM-ALL|CSTM-00|2020|PCT|74.00|99|0.00|GENERAL ACUTE CARE
20|FH_F50100_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE
20|FH_F50100_0_0|SrvcGrp|12403|2022|PDM|43.67|99|0.00|CONTINUOUS HOMECARE
20|FH_F50100_0_0|SrvcGrp|46110|2022|PDM|58.08|99|0.00|HI-TECH NURSING (ADDITIONAL HOUR)
20|FH_F50100_0_0|SrvcGrp|46111|2022|PDM|103.73|99|0.00|MATERNAL/CHILD HEALTH
20|FH_F50137_0_0|CSTM-ALL|CSTM-00|2020|PDM|115.00|99|0.00|SPEECH THERAPY SERVICES
20|FH_F50137_0_0|CSTM-ALL|CSTM-00|2020|PDM|120.00|99|0.00|HOME VISIT MECHANICAL VENTILATION CARE
20|FH_F50137_0_0|CSTM-ALL|CSTM-00|2020|PDM|120.00|99|0.00|HOME VISIT STOMA/COLOSTOMY/CYSTOSTOMY CARE
20|FH_F50137_0_0|SrvcGrp|15070|2022|PDM|120.00|99|0.00|HOME HEALTH (NEWBORN CARE)
20|FH_F50137_0_0|SrvcGrp|46234|2022|PDM|55.00|99|0.00|SKILLED NURSING
20|FH_F50137_0_0|SrvcGrp|46249|2022|PDM|120.00|99|0.00|HOME VISIT STOMA/COLOSTOMY/CYSTOSTOMY CARE
20|FH_F50137_0_0|SrvcGrp|46250|2022|PDM|120.00|99|0.00|HOME VISIT CATHETER CARE
20|FH_F50163_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F50214_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F50218_0_0|CSTM-ALL|CSTM-00|2020|PDM|120.00|99|0.00|HOME VISIT MECHANICAL VENTILATION CARE
20|FH_F50218_0_0|CSTM-ALL|CSTM-00|2020|PDM|120.00|99|0.00|SKILLED NURSING SERVICES (15 MINS)
20|FH_F50218_0_0|SrvcGrp|24345|2022|PDM|120.00|99|0.00|RESPIRATORY THERAPY VISIT
20|FH_F50218_0_0|SrvcGrp|45944|2022|PDM|32.00|99|0.00|HOME HEALTH AIDE SVCS
20|FH_F50218_0_0|SrvcGrp|46234|2022|PDM|60.00|99|0.00|SKILLED NURSING
20|FH_F50237_0_0|SrvcGrp|16|2022|PDM|850.00|99|0.00|ACUTE REHABILITATION
20|FH_F50237_0_0|SrvcGrp|22106|2022|PDM|575.00|99|0.00|CAT SCAN
20|FH_F50237_0_0|SrvcGrp|9774|2022|PDM|1550.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F50237_0_0|SrvcGrp|9978|2022|PDM|1150.00|99|0.00|ACUTE INPATIENT MEDICAL SVCS
20|FH_F50240_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F50334_0_0|SrvcGrp|43892|2022|PDM|123.00|99|0.00|PHYSICAL THERAPY VISIT
20|FH_F50336_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F50372_0_0|CSTM-ALL|CSTM-00|2020|PDM|50.00|99|0.00|CPT 99201
20|FH_F50372_0_0|SrvcGrp|46583|2022|PDM|80.00|99|0.00|CPT 99202
20|FH_F50372_0_0|SrvcGrp|46585|2022|PDM|190.00|99|0.00|CPT 99204
20|FH_F50372_0_0|SrvcGrp|46586|2022|PDM|225.00|99|0.00|CPT 99205
20|FH_F50372_0_0|SrvcGrp|46588|2022|PDM|80.00|99|0.00|CPT 99212
20|FH_F50432_0_0|CSTM-ALL|CSTM-00|2020|PDM|1017.00|99|0.00|COVENTRY ENHANCED GROUPER 4 MOD 50
20|FH_F50432_0_0|CSTM-ALL|CSTM-00|2020|PDM|1158.00|99|0.00|COVENTRY ENHANCED GROUPER 5
20|FH_F50432_0_0|CSTM-ALL|CSTM-00|2020|PDM|1334.00|99|0.00|COVENTRY ENHANCED GROUPER 6 MOD 50
20|FH_F50432_0_0|CSTM-ALL|CSTM-00|2020|PDM|1607.00|99|0.00|COVENTRY ENHANCED GROUPER 7
20|FH_F50432_0_0|CSTM-ALL|CSTM-00|2020|PDM|2162.00|99|0.00|COVENTRY ENHANCED GROUPER 9 MOD 50
20|FH_F50432_0_0|CSTM-ALL|CSTM-00|2020|PDM|538.00|99|0.00|COVENTRY ENHANCED GROUPER 1 MOD 50
20|FH_F50432_0_0|CSTM-ALL|CSTM-00|2020|PDM|720.00|99|0.00|COVENTRY ENHANCED GROUPER 2 MOD 50
20|FH_F50432_0_0|CSTM-ALL|CSTM-00|2020|PDM|988.00|99|0.00|COVENTRY ENHANCED GROUPER 3
20|FH_F50459_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F50459_0_0|SrvcGrp|33165|2022|PDM|405.00|99|0.00|SKILLED NURSING - LEVEL II
20|FH_F50462_0_0|SrvcGrp|23683|2022|PDM|105.00|99|0.00|SKILLED NURSING RN
20|FH_F50462_0_0|SrvcGrp|27968|2022|PDM|90.00|99|0.00|SKILLED NURSING LPN
20|FH_F50462_0_0|SrvcGrp|45949|2022|PDM|140.00|99|0.00|OCCUPATIONAL THERAPY SVCS
20|FH_F50462_0_0|SrvcGrp|45950|2022|PDM|140.00|99|0.00|SPEECH THERAPY
20|FH_F50462_0_0|SrvcGrp|46693|2022|PDM|90.00|99|0.00|LPN NURSING SERVICES
20|FH_F50474_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F50475_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F50475_0_0|CSTM-ALL|CSTM-00|2020|PDM|895.00|99|0.00|ASPG III - FH SW CUSTOM GROUPERS
20|FH_F50477_0_0|SrvcGrp|29402|2022|PDM|135.00|99|0.00|HOME HEALTH THERAPY VISITS OP
20|FH_F50485_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F50494_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.00|99|0.00|GENERAL ACUTE CARE
20|FH_F50496_0_0|CSTM-ALL|CSTM-00|2020|PCT|74.00|99|0.00|OP SVCS
20|FH_F148667_0_0|SrvcGrp|92014|2022|PDM|2052.00|99|0.00|PHALANGEAL SHAFT FRACTURE
20|FH_F148720_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F148720_0_0|SrvcGrp|103552|2022|PDM|75.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER
20|FH_F148720_0_0|SrvcGrp|105357|2022|PDM|325.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD
20|FH_F148779_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F148839_0_0|CSTM-ALL|CSTM-00|2020|PDM|1081.00|99|0.00|AEG 9 (NO REV)
20|FH_F148839_0_0|SrvcGrp|114442|2022|PDM|3246.00|99|0.00|EXTRACAPSULAR CATARACT REMOVAL, INSERT LENS
20|FH_F148859_0_0|SrvcGrp|107498|2022|PDM|728.00|99|0.00|AETNA VASECTOMY, UNILAT OR BILAT
20|FH_F148859_0_0|SrvcGrp|115512|2022|PDM|2081.00|99|0.00|CYSTOURETHRO
20|FH_F148859_0_0|SrvcGrp|115526|2022|PDM|780.00|99|0.00|CIRCUMCISION
20|FH_F148859_0_0|SrvcGrp|28512|2022|PDM|2683.00|99|0.00|REPAIR BLADDER DEFECT
20|FH_F148859_0_0|SrvcGrp|47545|2022|PDM|18865.00|99|0.00|INSERTION/REPLACEMENT OF PERIPHERAL/GASTRIC NEUROSTIMULATOR
20|FH_F148859_0_0|SrvcGrp|68048|2022|PDM|6791.00|99|0.00|CPT 64581
20|FH_F148859_0_0|SrvcGrp|75725|2022|PDM|2185.00|99|0.00|LASER PROCEDURES
20|FH_F148859_0_0|SrvcGrp|80523|2022|PDM|14566.00|99|0.00|PENILE PROSTHESIS IMPLANTATION
20|FH_F148859_0_0|SrvcGrp|80524|2022|PDM|13525.00|99|0.00|INFLATABLE PENILE PROSTHESIS
20|FH_F148859_0_0|SrvcGrp|89576|2022|PDM|373.00|99|0.00|APPLY INTERSTIT RADIAT COMPLEX
20|FH_F148859_0_0|SrvcGrp|89657|2022|PDM|23.46|99|0.00|RADIATION TREATMENT DEVICES
20|FH_F148860_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F148860_0_0|SrvcGrp|115535|2022|PDM|5900.00|99|0.00|CYSTOURETHROSCOPY
20|FH_F148865_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F148865_0_0|SrvcGrp|82222|2022|PDM|140.00|99|0.00|HOSPICE CARE
20|FH_F148865_0_0|SrvcGrp|82223|2022|PDM|140.00|99|0.00|HOSPICE CARE
20|FH_F148884_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F148892_0_0|CSTM-ALL|CSTM-00|2020|PDM|1185.47|99|0.00|AEG 6 (NO REV)
20|FH_F148892_0_0|CSTM-ALL|CSTM-00|2020|PDM|477.62|99|0.00|AEG 1 (NO REV)
20|FH_F148892_0_0|CSTM-ALL|CSTM-00|2020|PDM|732.16|99|0.00|AEG 10 (NO REV)
20|FH_F148892_0_0|SrvcGrp|110571|2022|PDM|668.00|99|0.00|NERVE BLOCK INJECTION 8
20|FH_F148892_0_0|SrvcGrp|115145|2022|PDM|668.00|99|0.00|NJX AA&/STRD PUDENDAL NERVE
20|FH_F148892_0_0|SrvcGrp|36591|2022|PDM|38367.00|99|0.00|CPT 63685
20|FH_F148892_0_0|SrvcGrp|87677|2022|PDM|1293.00|99|0.00|CERVICAL OR THORACIC SURGERY
20|FH_F148892_0_0|SrvcGrp|88487|2022|PDM|4704.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION
20|FH_F148900_0_0|CSTM-ALL|CSTM-00|2020|PDM|1029.60|99|0.00|AEG 5  (NO REV)
20|FH_F148900_0_0|CSTM-ALL|CSTM-00|2020|PDM|1185.47|99|0.00|AEG 6 (NO REV)
20|FH_F148900_0_0|CSTM-ALL|CSTM-00|2020|PDM|1397.11|99|0.00|AEG 8 (NO REV)
20|FH_F148900_0_0|CSTM-ALL|CSTM-00|2020|PDM|732.16|99|0.00|AEG 10 (NO REV)
20|FH_F148900_0_0|SrvcGrp|45063|2022|PDM|668.00|99|0.00|CPT 64493  INJECTION CARVE OUT
20|FH_F148900_0_0|SrvcGrp|92364|2022|PDM|16453.00|99|0.00|ARTHRODESIS SACROILIAC JOINT
20|FH_F148900_0_0|SrvcGrp|92408|2022|PDM|4704.00|99|0.00|PERQ VERTEBRAL AUGMENTATION
20|FH_F148927_0_0|CSTM-ALL|CSTM-00|2020|PDM|1854.00|99|0.00|AEG 10 (NO REV)
20|FH_F148927_0_0|CSTM-ALL|CSTM-00|2020|PDM|2884.00|99|0.00|AEG 8 (NO REV)
20|FH_F148927_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|AEG 9 (NO REV)
20|FH_F148927_0_0|CSTM-ALL|CSTM-00|2020|PDM|955.00|99|0.00|AEG 1 (NO REV)
20|FH_F148927_0_0|SrvcGrp|114924|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F148927_0_0|SrvcGrp|16719|2022|PCT|0.47|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F148981_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|AEG 4 (NO REV)
20|FH_F149024_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F149024_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F149028_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F149029_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F149060_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.50|99|0.00|GENERAL ACUTE CARE
20|FH_F149086_0_0|SrvcGrp|80918|2022|PDM|169.00|99|0.00|RESPITE CARE
20|FH_F149086_0_0|SrvcGrp|84185|2022|PDM|169.00|99|0.00|RESPITE CARE
20|FH_F149120_0_0|SrvcGrp|87077|2022|PDM|145.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F149179_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F149179_0_0|CSTM-ALL|CSTM-00|2020|PDM|2600.00|99|0.00|AEG 5  (NO REV)
20|FH_F149179_0_0|SrvcGrp|10986|2022|PDM|5098.00|99|0.00|ARTHROSCOPIC KNEE REPAIR
20|FH_F149179_0_0|SrvcGrp|115609|2022|PDM|3450.00|99|0.00|ANKLE FRACTURE REPAIR
20|FH_F149179_0_0|SrvcGrp|115610|2022|PDM|4400.00|99|0.00|VENTRAL HERN INIT REPAIR
20|FH_F149179_0_0|SrvcGrp|115614|2022|PDM|3978.00|99|0.00|LAMINOTOMY/LAMINECTOMY
20|FH_F149179_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F149240_0_0|SrvcGrp|103911|2022|PDM|384.52|99|0.00|HOSPICE CARE PROVIDED IN INPATIENT HOSPICE FACILITY
20|FH_F149240_0_0|SrvcGrp|113620|2022|PDM|87.23|99|0.00|HOSPICE CARE
20|FH_F149240_0_0|SrvcGrp|82222|2022|PDM|144.84|99|0.00|HOSPICE CARE
20|FH_F149263_0_0|CSTM-ALL|CSTM-00|2020|PDM|3060.00|99|0.00|AEG 9 (NO REV)
20|FH_F149263_0_0|CSTM-ALL|CSTM-00|2020|PDM|3200.00|99|0.00|AEG 8 (NO REV)
20|FH_F149263_0_0|CSTM-ALL|CSTM-00|2020|PDM|3264.00|99|0.00|AEG 7 (NO REV)
20|FH_F149263_0_0|SrvcGrp|115359|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F149263_0_0|SrvcGrp|115606|2022|PDM|4900.00|99|0.00|REVISE CERV ARTIFIC DISC
20|FH_F149263_0_0|SrvcGrp|27343|2022|PDM|3500.00|99|0.00|OP SURGERY (CPT 25607 - 25609)
20|FH_F149263_0_0|SrvcGrp|88030|2022|PDM|6500.00|99|0.00|REVISION OF KNEE JOINT
20|FH_F149267_0_0|CSTM-ALL|CSTM-00|2020|PDM|2503.00|99|0.00|AEG 6 (NO REV)
20|FH_F149267_0_0|CSTM-ALL|CSTM-00|2020|PDM|2956.00|99|0.00|AEG 8 (NO REV)
20|FH_F149267_0_0|CSTM-ALL|CSTM-00|2020|PDM|676.00|99|0.00|AEG 1 (NO REV)
20|FH_F149267_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F149273_0_0|CSTM-ALL|CSTM-00|2020|PDM|1836.00|99|0.00|AEG 2 (NO REV)
20|FH_F149273_0_0|CSTM-ALL|CSTM-00|2020|PDM|2081.00|99|0.00|AEG 3 (NO REV)
20|FH_F149273_0_0|CSTM-ALL|CSTM-00|2020|PDM|2652.00|99|0.00|AEG 6 (NO REV)
20|FH_F149273_0_0|SrvcGrp|115606|2022|PDM|4998.00|99|0.00|REVISE CERV ARTIFIC DISC
20|FH_F149273_0_0|SrvcGrp|27343|2022|PDM|3570.00|99|0.00|OP SURGERY (CPT 25607 - 25609)
20|FH_F149273_0_0|SrvcGrp|75182|2022|PCT|1.00|99|0.00|AETNA IMPLANTS
20|FH_F149273_0_0|SrvcGrp|88030|2022|PDM|6630.00|99|0.00|REVISION OF KNEE JOINT
20|FH_F149273_0_0|SrvcGrp|89404|2022|PDM|6800.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F149273_0_0|SrvcGrp|93641|2022|PDM|3450.00|99|0.00|KNEE ARTHROSCOPIC SURGERY
20|FH_F149344_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F149344_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F149344_0_0|SrvcGrp|13597|2022|PDM|166.11|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT
20|FH_F149344_0_0|SrvcGrp|2067|2022|PDM|1118.17|99|0.00|SPECIALTY CARE TRANSPORT
20|FH_F149404_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F149439_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F149479_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F149479_0_0|SrvcGrp|105819|2022|PDM|1375.00|99|0.00|AETNA RESIDENTIAL TREATMNT-EATING DISORDERS
20|FH_F149479_0_0|SrvcGrp|109036|2022|PDM|700.00|99|0.00|PARTIAL HOSPITALIZATION
20|FH_F149513_0_0|SrvcGrp|3327|2022|PDM|442.19|99|0.00|HOSPICE SERVICE - IP RESPITE
20|FH_F149517_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F149517_0_0|SrvcGrp|104226|2022|PDM|190.00|99|0.00|HOSPICE CARE (HCFA)
20|FH_F149517_0_0|SrvcGrp|104228|2022|PDM|190.00|99|0.00|HOSPICE CARE (HCFA)
20|FH_F149517_0_0|SrvcGrp|80918|2022|PDM|706.00|99|0.00|RESPITE CARE
20|FH_F149517_0_0|SrvcGrp|80920|2022|PDM|678.00|99|0.00|HOSPICE SERVICES
20|FH_F149517_0_0|SrvcGrp|95660|2022|PDM|692.00|99|0.00|HOSPICE SERVICES (HCFA)
20|FH_F149523_0_0|SrvcGrp|101114|2022|PDM|15000.00|99|0.00|ARTHOPLASTY
20|FH_F149523_0_0|SrvcGrp|113843|2022|PDM|15500.00|99|0.00|REVISE KNEE
20|FH_F149523_0_0|SrvcGrp|114173|2022|PDM|3000.00|99|0.00|CARDIAC CATHERIZATION INCL INJECTIONS
20|FH_F149523_0_0|SrvcGrp|114175|2022|PDM|6000.00|99|0.00|SPINE PROCEDURES
20|FH_F149523_0_0|SrvcGrp|114176|2022|PDM|6000.00|99|0.00|SPINE PROCEDURES
20|FH_F149523_0_0|SrvcGrp|40002|2022|PDM|15500.00|99|0.00|TOTAL HIP
20|FH_F149523_0_0|SrvcGrp|98561|2022|PDM|12000.00|99|0.00|ARTHRODESIS POSTERIOR TECH
20|FH_F149543_0_0|SrvcGrp|107748|2022|PDM|424.00|99|0.00|HEMODIALYSIS IN CENTER
20|FH_F149543_0_0|SrvcGrp|108042|2022|PDM|424.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD
20|FH_F149581_0_0|SrvcGrp|80258|2022|PCT|0.00|99|0.00|AETNA SKILLED CARE
20|FH_F149581_0_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE
20|FH_F149603_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE
20|FH_F149605_0_0|SrvcGrp|103846|2022|PDM|87.23|99|0.00|HOSPICE CARE
20|FH_F149605_0_0|SrvcGrp|113451|2022|PDM|87.23|99|0.00|HOSPICE CARE
20|FH_F149605_0_0|SrvcGrp|65720|2022|PDM|153.00|99|0.00|RESPITE CARE
20|FH_F149660_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F149660_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F149660_0_0|SrvcGrp|13681|2022|PDM|173.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT
20|FH_F149660_0_0|SrvcGrp|34625|2022|PDM|25.00|99|0.00|NON EMERGENCY TRANSPORT
20|FH_F149661_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F149679_0_0|SrvcGrp|106294|2022|PDM|198.55|99|0.00|AMBULANCE SERVICE EMERGENCY TRANSPORT LEVEL 1 (HFCA)
20|FH_F149679_0_0|SrvcGrp|106317|2022|PDM|1118.17|99|0.00|SPECIALTY CARE TRANSPORT (HCFA)
20|FH_F149679_0_0|SrvcGrp|107353|2022|PDM|248.94|99|0.00|AMB SRVC NEONAT TRNSPRT BS RATE EMERG 1 WAY (HCFA)
20|FH_F149679_0_0|SrvcGrp|13262|2022|PDM|3.68|99|0.00|GROUND MILEAGE, PER STATUTE MILE
20|FH_F149679_0_0|SrvcGrp|13422|2022|PDM|188.89|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC
20|FH_F149679_0_0|SrvcGrp|13683|2022|PDM|594.21|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2
20|FH_F149679_0_0|SrvcGrp|2067|2022|PDM|1118.17|99|0.00|SPECIALTY CARE TRANSPORT
20|FH_F149699_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F149701_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F149701_0_0|SrvcGrp|73483|2022|PDM|486.00|99|0.00|AETNA SUBACUTE III
20|FH_F149701_0_0|SrvcGrp|79720|2022|PDM|972.00|99|0.00|ACUTE REHAB II
20|FH_F149719_0_0|SrvcGrp|108043|2022|PDM|236.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD
20|FH_F149719_0_0|SrvcGrp|108180|2022|PDM|550.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD
20|FH_F149719_0_0|SrvcGrp|108546|2022|PDM|236.00|99|0.00|PERITONEAL TREATMENTS W/ PATIENT TRAINING
20|FH_F149719_0_0|SrvcGrp|113580|2022|PDM|150.00|99|0.00|DIALYSIS PATIENT TRAINING
20|FH_F149779_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 10 (NO REV)
20|FH_F149779_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|AEG 5  (NO REV)
20|FH_F149779_0_0|CSTM-ALL|CSTM-00|2020|PDM|3126.00|99|0.00|AEG 7 (NO REV)
20|FH_F149868_0_0|SrvcGrp|29353|2022|PDM|190.00|99|0.00|HOSPICE SVCS
20|FH_F149868_0_0|SrvcGrp|63297|2022|PDM|194.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F149868_0_0|SrvcGrp|74546|2022|PDM|678.00|99|0.00|HOSPICE SERVICES
20|FH_F149868_0_0|SrvcGrp|89822|2022|PDM|194.00|99|0.00|HOSPICE ROUTINE HOME CARE
20|FH_F149868_0_0|SrvcGrp|90478|2022|PDM|190.00|99|0.00|HOSPICE
20|FH_F149882_0_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F149899_0_0|CSTM-ALL|CSTM-00|2020|PDM|540.00|99|0.00|AEG 1 (NO REV)
20|FH_F149899_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|AETNA SURGERY DEFAULT WITHOUT GROUPER 1 & 2
20|FH_F149959_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F149959_0_0|SrvcGrp|46903|2022|PDM|750.00|99|0.00|RESIDENTIAL TREATMENT
20|FH_F149980_0_0|CSTM-ALL|CSTM-00|2020|PDM|1440.00|99|0.00|AEG 6 (NO REV)
20|FH_F149980_0_0|CSTM-ALL|CSTM-00|2020|PDM|1884.00|99|0.00|AEG 9 (NO REV)
20|FH_F149980_0_0|CSTM-ALL|CSTM-00|2020|PDM|624.00|99|0.00|AEG 2 (NO REV)
20|FH_F149980_0_0|SrvcGrp|115788|2022|PDM|3480.00|99|0.00|IMPLANT EYE SHUNT
20|FH_F149980_0_0|SrvcGrp|115790|2022|PDM|3300.00|99|0.00|EXTRACAPSULAR CATARACT REMOVAL INSERT LENS
20|FH_F149980_0_0|SrvcGrp|115796|2022|PDM|696.00|99|0.00|SURGICAL COLONOSCOPY
20|FH_F149980_0_0|SrvcGrp|115798|2022|PDM|1000.00|99|0.00|TREATMENT OF RETINA
20|FH_F150025_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F150025_0_0|SrvcGrp|80920|2022|PDM|475.00|99|0.00|HOSPICE SERVICES
20|FH_F50498_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE
20|FH_F50519_0_0|SrvcGrp|46765|2022|PDM|85.00|99|0.00|CPT CODE 90801 PER VISIT
20|FH_F50519_0_0|SrvcGrp|46767|2022|PDM|80.00|99|0.00|CPT CODE 90806 PER VISIT
20|FH_F50535_0_0|CSTM-ALL|CSTM-00|2020|PDM|615.00|99|0.00|COVENTRY ENHANCED GROUPER 3
20|FH_F50535_0_0|CSTM-ALL|CSTM-00|2020|PDM|864.00|99|0.00|COVENTRY ENHANCED GROUPER 10
20|FH_F50535_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|COVENTRY ENHANCED GROUPER 6
20|FH_F50583_0_0|SrvcGrp|473|2022|PDM|800.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F50612_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F50612_0_0|CSTM-ALL|CSTM-00|2020|PDM|572.00|99|0.00|SKILLED NURSING
20|FH_F50615_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F50615_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F50615_0_0|SrvcGrp|44860|2022|PDM|600.00|99|0.00|SKILLED NURSING, BARIATRIC
20|FH_F50615_0_0|SrvcGrp|45148|2022|PDM|90.00|99|0.00|SPEECH THERAPY
20|FH_F50615_0_0|SrvcGrp|45150|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY
20|FH_F50622_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE
20|FH_F50635_0_0|SrvcGrp|16173|2022|PDM|365.00|99|0.00|PARTIAL HOSPITALIZATION
20|FH_F50652_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|GENERAL ACUTE CARE
20|FH_F50654_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|ASPG IV
20|FH_F50654_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|ASPG IX
20|FH_F50654_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F50654_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DRAINAGE OF EYE
20|FH_F50654_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REPAIR OF EYELID DEFECT
20|FH_F50654_0_0|SrvcGrp|28551|2022|PCT|1.00|99|0.00|REPAIR OF COMPLEX RETINAL DETACHMENT
20|FH_F50654_0_0|SrvcGrp|46887|2022|PCT|1.00|99|0.00|REPAIR DETACHED RETINA
20|FH_F50694_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F50715_0_0|SrvcGrp|26001|2022|PDM|140.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F50715_0_0|SrvcGrp|3809|2022|PDM|600.00|99|0.00|HOSPICE CARE
20|FH_F50832_0_0|CSTM-ALL|CSTM-00|2020|PCT|66.30|99|0.00|OP SVCS
20|FH_F50873_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F50873_0_0|CSTM-ALL|CSTM-00|2020|PDM|35.00|99|0.00|HOME HEALTH AIDE
20|FH_F50873_0_0|SrvcGrp|42828|2022|PDM|75.00|99|0.00|SPEECH THERAPY VISIT
20|FH_F50879_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.20|99|0.00|OP SVCS
20|FH_F50958_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS
20|FH_F51016_0_0|SrvcGrp|11258|2022|PCT|0.60|99|0.00|DRUGS
20|FH_F51016_0_0|SrvcGrp|33166|2022|PDM|550.00|99|0.00|SKILLED NURSING - LEVEL III
20|FH_F51016_0_0|SrvcGrp|43893|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY VISIT
20|FH_F51115_0_0|SrvcGrp|12403|2022|PDM|32.56|99|0.00|CONTINUOUS HOMECARE
20|FH_F51115_0_0|SrvcGrp|3809|2022|PDM|594.59|99|0.00|HOSPICE CARE
20|FH_F51115_0_0|SrvcGrp|42826|2022|PDM|108.24|99|0.00|PHYSICAL THERAPY VISIT
20|FH_F51120_0_0|SrvcGrp|12403|2022|PDM|39.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F51121_0_0|SrvcGrp|26001|2022|PDM|152.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F51121_0_0|SrvcGrp|3809|2022|PDM|657.00|99|0.00|HOSPICE CARE
20|FH_F51123_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE
20|FH_F51123_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F51123_0_0|SrvcGrp|12403|2022|PDM|40.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F51123_0_0|SrvcGrp|3809|2022|PDM|675.00|99|0.00|HOSPICE CARE
20|FH_F51124_0_0|SrvcGrp|26160|2022|PDM|38.00|99|0.00|HOME HEALTH AIDE VISIT
20|FH_F51124_0_0|SrvcGrp|40582|2022|PDM|250.00|99|0.00|HOSPICE SVCS
20|FH_F51129_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F51129_0_0|CSTM-ALL|CSTM-00|2020|PDM|6000.00|99|0.00|ONCOLOGY
20|FH_F51129_0_0|SrvcGrp|11919|2022|PCT|0.75|99|0.00|ORGAN TRANSPLANT SVCS
20|FH_F51129_0_0|SrvcGrp|3178|2022|PDM|1100.00|99|0.00|ACUTE PSYCH
20|FH_F51129_0_0|SrvcGrp|361|2022|PCT|0.75|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F51129_0_0|SrvcGrp|38704|2022|PCT|0.85|99|0.00|PTE EVALUATION
20|FH_F51129_0_0|SrvcGrp|4020|2022|PCT|0.92|99|0.00|TRAUMA CARE
20|FH_F51129_0_0|SrvcGrp|941|2022|PCT|0.75|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F51135_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|GENERAL ACUTE CARE
20|FH_F51135_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|OP SVCS
20|FH_F51135_0_0|SrvcGrp|26001|2022|PDM|152.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F51135_0_0|SrvcGrp|3809|2022|PDM|657.00|99|0.00|HOSPICE CARE
20|FH_F51138_0_0|SrvcGrp|12403|2022|PDM|39.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F51192_0_0|SrvcGrp|33166|2022|PDM|550.00|99|0.00|SKILLED NURSING - LEVEL III
20|FH_F51192_0_0|SrvcGrp|44105|2022|PDM|55.00|99|0.00|PHYSICAL THERAPY
20|FH_F51192_0_0|SrvcGrp|44106|2022|PDM|55.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F51232_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F51258_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F51258_0_0|SrvcGrp|12496|2022|PDM|753.00|99|0.00|ACUTE REHABILITATION
20|FH_F51258_0_0|SrvcGrp|474|2022|PDM|260.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F51272_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|HOME HEALTH SERVICES
20|FH_F51272_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|HOSPICE SERVICES
20|FH_F51272_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MENTAL HEALTH SERVICES
20|FH_F51272_0_0|CSTM-ALL|CSTM-00|2020|PDM|7000.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F51272_0_0|SrvcGrp|10944|2022|PCT|0.75|99|0.00|EMERGENCY ROOM
20|FH_F51272_0_0|SrvcGrp|16|2022|PDM|2800.00|99|0.00|ACUTE REHABILITATION
20|FH_F51272_0_0|SrvcGrp|3029|2022|PDM|650.00|99|0.00|NEWBORN NURSERY
20|FH_F51272_0_0|SrvcGrp|3378|2022|PCT|0.65|99|0.00|OBSERVATION SVCS
20|FH_F51318_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F51318_0_0|CSTM-ALL|CSTM-00|2020|PCT|9000.00|99|0.00|TIMELY FILING
20|FH_F51358_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F51358_0_0|SrvcGrp|46234|2022|PDM|130.00|99|0.00|SKILLED NURSING
20|FH_F51358_0_0|SrvcGrp|46248|2022|PDM|130.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F51359_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|OP SVCS
20|FH_F51364_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.00|99|0.00|GENERAL ACUTE CARE
20|FH_F51374_0_0|CSTM-ALL|CSTM-00|2020|PCT|69.00|99|0.00|GENERAL ACUTE CARE
20|FH_F150025_0_0|SrvcGrp|90707|2022|PDM|100.00|99|0.00|AETNA HOSPICE CARE
20|FH_F150026_0_0|SrvcGrp|30609|2022|PDM|25.00|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F150026_0_0|SrvcGrp|65720|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F150026_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F150026_0_0|SrvcGrp|80920|2022|PDM|475.00|99|0.00|HOSPICE SERVICES
20|FH_F150026_0_0|SrvcGrp|93098|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F150102_0_0|CSTM-ALL|CSTM-00|2020|PDM|2047.00|99|0.00|AEG 1 (NO REV)
20|FH_F150102_0_0|CSTM-ALL|CSTM-00|2020|PDM|2286.00|99|0.00|AEG 5  (NO REV)
20|FH_F150102_0_0|CSTM-ALL|CSTM-00|2020|PDM|2528.00|99|0.00|AEG 6 (NO REV)
20|FH_F150102_0_0|CSTM-ALL|CSTM-00|2020|PDM|2647.00|99|0.00|AEG 8 (NO REV)
20|FH_F150102_0_0|SrvcGrp|114930|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F150102_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F150164_0_0|SrvcGrp|30609|2022|PDM|25.00|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F150164_0_0|SrvcGrp|65720|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F150164_0_0|SrvcGrp|80920|2022|PDM|475.00|99|0.00|HOSPICE SERVICES
20|FH_F150164_0_0|SrvcGrp|93098|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F150200_0_0|CSTM-ALL|CSTM-00|2020|PDM|1.00|99|0.00|AEG 6 (NO REV)
20|FH_F150200_0_0|CSTM-ALL|CSTM-00|2020|PDM|1.02|99|0.00|AEG 9 (NO REV)
20|FH_F150200_0_0|CSTM-ALL|CSTM-00|2020|PDM|2071.00|99|0.00|AEG 5  (NO REV)
20|FH_F150200_0_0|CSTM-ALL|CSTM-00|2020|PDM|935.00|99|0.00|AEG 1 (NO REV)
20|FH_F150200_0_0|SrvcGrp|14614|2022|PDM|4682.00|99|0.00|LITHOTRIPSY
20|FH_F150200_0_0|SrvcGrp|36591|2022|PDM|4776.00|99|0.00|CPT 63685
20|FH_F150200_0_0|SrvcGrp|77021|2022|PDM|4590.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY
20|FH_F150220_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F150224_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F150224_0_0|SrvcGrp|57967|2022|PDM|179.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F150226_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F150226_0_0|SrvcGrp|13595|2022|PDM|198.55|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC
20|FH_F150226_0_0|SrvcGrp|2067|2022|PDM|1118.17|99|0.00|SPECIALTY CARE TRANSPORT
20|FH_F150280_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F150280_0_0|SrvcGrp|78067|2022|PCT|0.60|99|0.00|SUBACUTE CARE
20|FH_F150280_0_0|SrvcGrp|87537|2022|PDM|809.00|99|0.00|MED REHAB DAY PROGRAM (FULL)
20|FH_F150521_0_0|CSTM-ALL|CSTM-00|2020|PDM|565.00|99|0.00|AEG 1 (NO REV)
20|FH_F150521_0_0|CSTM-ALL|CSTM-00|2020|PDM|795.00|99|0.00|AEG 2 (NO REV)
20|FH_F150542_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F150542_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F150619_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F150619_0_0|SrvcGrp|13187|2022|PCT|0.00|99|0.00|INTRAOCULAR LENSES
20|FH_F150660_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F150663_0_0|SrvcGrp|108484|2022|PDM|700.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY
20|FH_F150663_0_0|SrvcGrp|74668|2022|PDM|227.00|99|0.00|AETNA INTENSIVE OUTPATIENT
20|FH_F150663_0_0|SrvcGrp|90854|2022|PDM|876.00|99|0.00|AETNA IP DETOXIFICATION SERVICES
20|FH_F150699_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F150699_0_0|SrvcGrp|108518|2022|PDM|9450.00|99|0.00|IMPLANT PAT ACTIVE HT RECORD
20|FH_F150699_0_0|SrvcGrp|109495|2022|PDM|12296.00|99|0.00|INSERT PULSE GEN DUAL LEADS
20|FH_F150699_0_0|SrvcGrp|109496|2022|PDM|12296.00|99|0.00|UPGRADE OF IMPLANTED PACEMAK
20|FH_F150699_0_0|SrvcGrp|109501|2022|PDM|4068.00|99|0.00|REPAIR LEAD PACE-DEFIB DUAL
20|FH_F150699_0_0|SrvcGrp|109504|2022|PDM|12055.00|99|0.00|REMV & REPLC PM GEN DUAL LEAD
20|FH_F150699_0_0|SrvcGrp|112881|2022|PDM|4068.00|99|0.00|REMOVE PACEMAKER SYSTEM
20|FH_F150699_0_0|SrvcGrp|115839|2022|PDM|1988.00|99|0.00|REVISE POCKET PACEMAKER
20|FH_F150699_0_0|SrvcGrp|95339|2022|PDM|12296.00|99|0.00|INSERT PACING LEAD & CONNECT
20|FH_F150759_0_0|CSTM-ALL|CSTM-00|2020|PDM|446.00|99|0.00|AEG 2 (NO REV)
20|FH_F150763_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F150763_0_0|CSTM-ALL|CSTM-00|2020|PDM|1407.00|99|0.00|AEG 1 (NO REV)
20|FH_F150763_0_0|CSTM-ALL|CSTM-00|2020|PDM|1923.00|99|0.00|AEG 3 (NO REV)
20|FH_F150763_0_0|CSTM-ALL|CSTM-00|2020|PDM|3698.00|99|0.00|AEG 10 (NO REV)
20|FH_F150763_0_0|CSTM-ALL|CSTM-00|2020|PDM|3751.00|99|0.00|AEG 7 (NO REV)
20|FH_F150763_0_0|SrvcGrp|107744|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F150763_0_0|SrvcGrp|13807|2022|PDM|511.00|99|0.00|OBSERVATION SVCS
20|FH_F150819_0_0|CSTM-ALL|CSTM-00|2020|PCT|91.00|99|0.00|GENERAL ACUTE CARE
20|FH_F150906_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F150910_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.11|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE
20|FH_F150910_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.40|99|0.00|HSS ASC
20|FH_F150910_0_0|SrvcGrp|108093|2022|PDM|10950.00|99|0.00|REVISE HIP ARTHROPLASTY
20|FH_F150910_0_0|SrvcGrp|113853|2022|PDM|3000.00|99|0.00|CARDIAC CATHERIZATION INCL INJECTIONS
20|FH_F150910_0_0|SrvcGrp|41334|2022|PDM|10500.00|99|0.00|TOTAL KNEE
20|FH_F150910_0_0|SrvcGrp|93431|2022|PDM|10500.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT
20|FH_F150936_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F150939_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F150939_0_0|SrvcGrp|100242|2022|PCT|0.00|99|0.00|ANTIBODY
20|FH_F150939_0_0|SrvcGrp|100255|2022|PDM|110.00|99|0.00|REPAIR SUPERFICIAL WOUND(S) (OVER 30.0 CM)
20|FH_F150939_0_0|SrvcGrp|100257|2022|PDM|58.00|99|0.00|REPAIR SUPERFICIAL WOUND(S) (5.1 -7.5 CM)
20|FH_F150939_0_0|SrvcGrp|100259|2022|PDM|110.00|99|0.00|REPAIR SUPERFICIAL WOUND(S) (20.1 - 30.0 CM)
20|FH_F150939_0_0|SrvcGrp|100271|2022|PDM|14.10|99|0.00|IIV3 VACC NO PRSV 0.5 ML IM
20|FH_F150939_0_0|SrvcGrp|101411|2022|PDM|58.00|99|0.00|NEW PATIENT OFFICE VISIT
20|FH_F150939_0_0|SrvcGrp|104055|2022|PDM|13.47|99|0.00|INFLUENZA VACCINE
20|FH_F150939_0_0|SrvcGrp|105342|2022|PDM|5.38|99|0.00|METHILPREDNISO ACET 80MG/2MX
20|FH_F150939_0_0|SrvcGrp|115658|2022|PDM|66.43|99|0.00|INFLUENZA VACCINE AIIV4
20|FH_F150939_0_0|SrvcGrp|22380|2022|PDM|41.00|99|0.00|CPT CODE 94060
20|FH_F150939_0_0|SrvcGrp|36669|2022|PDM|10.00|99|0.00|IMMUNIZATION ADMIN
20|FH_F150939_0_0|SrvcGrp|68241|2022|PDM|1.70|99|0.00|DESTRUCTION WARTS - 2ND - 4TH LESIONS
20|FH_F150939_0_0|SrvcGrp|82746|2022|PDM|8.00|99|0.00|CULT BACT BLD AEROIC ISOLA
20|FH_F150939_0_0|SrvcGrp|90489|2022|PDM|82.51|99|0.00|PNEUMOCOCCAL VACCINE
20|FH_F150939_0_0|SrvcGrp|90643|2022|PDM|17.01|99|0.00|AETNA MEDICATION ASSISTED TREATMENT MAINTENANCE INJECTION
20|FH_F150939_0_0|SrvcGrp|94423|2022|PDM|10.00|99|0.00|IMMUNIZATIONS
20|FH_F150939_0_0|SrvcGrp|97972|2022|PDM|7.80|99|0.00|TYMPANOMETRY IMPEDANCE TEST
20|FH_F150948_0_0|SrvcGrp|113852|2022|PDM|1125.00|99|0.00|STENT PACEMT ANTE COROTID
20|FH_F150948_0_0|SrvcGrp|98497|2022|PDM|10800.00|99|0.00|ARTHRODESIS POSTERIOR TECH
20|FH_F150949_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F150949_0_0|SrvcGrp|67068|2022|PDM|10500.00|99|0.00|LUMBAR SPINE FUSION COMBINED
20|FH_F150949_0_0|SrvcGrp|84939|2022|PDM|10500.00|99|0.00|SHOULDER JOINT
20|FH_F150949_0_0|SrvcGrp|93065|2022|PDM|9000.00|99|0.00|LUMB ARTIF DISKECTOMY ADDL
20|FH_F150949_0_0|SrvcGrp|98497|2022|PDM|10800.00|99|0.00|ARTHRODESIS POSTERIOR TECH
20|FH_F150959_0_0|CSTM-ALL|CSTM-00|2020|PDM|1430.00|99|0.00|AEG 6 (NO REV)
20|FH_F150959_0_0|CSTM-ALL|CSTM-00|2020|PDM|1540.00|99|0.00|AEG 3 (NO REV)
20|FH_F150959_0_0|CSTM-ALL|CSTM-00|2020|PDM|2310.00|99|0.00|AEG 7 (NO REV)
20|FH_F150959_0_0|CSTM-ALL|CSTM-00|2020|PDM|770.00|99|0.00|AEG 1 (NO REV)
20|FH_F150959_0_0|CSTM-ALL|CSTM-00|2020|PDM|880.00|99|0.00|AEG 10 (NO REV)
20|FH_F150980_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.50|99|0.00|HSS ASC
20|FH_F150982_0_0|CSTM-ALL|CSTM-00|2020|PDM|1652.00|99|0.00|AEG 6 (NO REV)
20|FH_F150982_0_0|CSTM-ALL|CSTM-00|2020|PDM|1927.00|99|0.00|AEG 8 W/O 66982, 66984
20|FH_F150982_0_0|CSTM-ALL|CSTM-00|2020|PDM|716.00|99|0.00|AEG 1 (NO REV)
20|FH_F150982_0_0|CSTM-ALL|CSTM-00|2020|PDM|936.00|99|0.00|AEG 2 (NO REV)
20|FH_F150982_0_0|SrvcGrp|100039|2022|PDM|5200.00|99|0.00|REPAIR OF HEEL FRACTURE
20|FH_F150982_0_0|SrvcGrp|101522|2022|PDM|2759.00|99|0.00|T1H W/T/O UTERUS (>250G)
20|FH_F150982_0_0|SrvcGrp|104257|2022|PDM|1382.00|99|0.00|SKIN TISSUE REARRANGEMENT
20|FH_F150982_0_0|SrvcGrp|104751|2022|PDM|3303.00|99|0.00|REPAIR RECTUM & VAGINA
20|FH_F150982_0_0|SrvcGrp|109132|2022|PDM|2202.00|99|0.00|ARTHROSCOPIC FRACTURE TX
20|FH_F150982_0_0|SrvcGrp|111187|2022|PDM|3178.00|99|0.00|REMOVAL OF OVARIAN CYST(S)
20|FH_F150982_0_0|SrvcGrp|111804|2022|PDM|1377.00|99|0.00|CYSTOSCOPY & REVISE URETHRA
20|FH_F150982_0_0|SrvcGrp|112583|2022|PDM|3664.00|99|0.00|LAPAROSCOPY
20|FH_F150982_0_0|SrvcGrp|114442|2022|PDM|2808.00|99|0.00|EXTRACAPSULAR CATARACT REMOVAL, INSERT LENS
20|FH_F150982_0_0|SrvcGrp|114518|2022|PDM|2808.00|99|0.00|INSERTION DRAINAGE DEVICE
20|FH_F150982_0_0|SrvcGrp|114926|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES
20|FH_F150982_0_0|SrvcGrp|15473|2022|PDM|3028.00|99|0.00|CPT CODE 42820
20|FH_F150982_0_0|SrvcGrp|26274|2022|PDM|2202.00|99|0.00|CPT 29877
20|FH_F150982_0_0|SrvcGrp|26277|2022|PDM|2202.00|99|0.00|CPT 29874
20|FH_F150982_0_0|SrvcGrp|26279|2022|PDM|2202.00|99|0.00|CPT 29884
20|FH_F150982_0_0|SrvcGrp|28551|2022|PDM|2392.00|99|0.00|REPAIR OF COMPLEX RETINAL DETACHMENT
20|FH_F150982_0_0|SrvcGrp|3378|2022|PDM|1652.00|99|0.00|OBSERVATION SVCS
20|FH_F150982_0_0|SrvcGrp|33982|2022|PDM|1976.00|99|0.00|CPT 28296
20|FH_F150982_0_0|SrvcGrp|38709|2022|PDM|3182.00|99|0.00|HYSTEROSCOPY
20|FH_F150982_0_0|SrvcGrp|42550|2022|PDM|1382.00|99|0.00|OP SURGERY CPT 66984
20|FH_F150982_0_0|SrvcGrp|46890|2022|PDM|2808.00|99|0.00|IMPLANT EYE SHUNT
20|FH_F150982_0_0|SrvcGrp|46906|2022|PDM|2392.00|99|0.00|CORNEAL TISSUE
20|FH_F150982_0_0|SrvcGrp|47142|2022|PDM|4404.00|99|0.00|CPT 49650
20|FH_F150982_0_0|SrvcGrp|53065|2022|PDM|1040.00|99|0.00|INJECTION(S), LUMBAR OR SACRAL, SINGLE LEVEL
20|FH_F150982_0_0|SrvcGrp|63463|2022|PDM|1652.00|99|0.00|CPT 52204
20|FH_F150982_0_0|SrvcGrp|63468|2022|PDM|1652.00|99|0.00|CPT 52281
20|FH_F150982_0_0|SrvcGrp|64517|2022|PDM|6606.00|99|0.00|REDUCE MANMMAPLASTY
20|FH_F150982_0_0|SrvcGrp|67994|2022|PDM|2202.00|99|0.00|CPT 58120
20|FH_F150982_0_0|SrvcGrp|70749|2022|PDM|3303.00|99|0.00|CPT 29823
20|FH_F150982_0_0|SrvcGrp|72121|2022|PDM|3303.00|99|0.00|ARTHOSCOPY
20|FH_F150982_0_0|SrvcGrp|75885|2022|PDM|2643.00|99|0.00|AETNA CPT 49560
20|FH_F150982_0_0|SrvcGrp|76604|2022|PDM|1976.00|99|0.00|CPT 25447
20|FH_F150982_0_0|SrvcGrp|77021|2022|PDM|5726.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY
20|FH_F150982_0_0|SrvcGrp|78282|2022|PDM|4368.00|99|0.00|CPT 47563
20|FH_F150982_0_0|SrvcGrp|79583|2022|PDM|1382.00|99|0.00|CPT 45381
20|FH_F150982_0_0|SrvcGrp|79594|2022|PDM|1382.00|99|0.00|CPT 45380
20|FH_F150982_0_0|SrvcGrp|82109|2022|PDM|1101.00|99|0.00|REVISE ULNAR NERVE ELBOW
20|FH_F150982_0_0|SrvcGrp|82110|2022|PDM|2202.00|99|0.00|KNEE ARTHROSCOPY DIAGNOSTIC
20|FH_F150982_0_0|SrvcGrp|83640|2022|PDM|2202.00|99|0.00|CPT 29887
20|FH_F150982_0_0|SrvcGrp|83835|2022|PDM|5506.00|99|0.00|REPLACE TISSUE EXPANDER
20|FH_F150982_0_0|SrvcGrp|83837|2022|PDM|6606.00|99|0.00|EXCISION EXCESSIVE SKIN
20|FH_F150982_0_0|SrvcGrp|84939|2022|PDM|26425.00|99|0.00|SHOULDER JOINT
20|FH_F150982_0_0|SrvcGrp|85000|2022|PDM|1382.00|99|0.00|CPT 45384
20|FH_F150982_0_0|SrvcGrp|85785|2022|PDM|2202.00|99|0.00|ARTHROSCOPY
20|FH_F150982_0_0|SrvcGrp|87677|2022|PDM|2080.00|99|0.00|CERVICAL OR THORACIC SURGERY
20|FH_F150982_0_0|SrvcGrp|87679|2022|PDM|2080.00|99|0.00|LUMBAR OR SACRAL SURGERY
20|FH_F150982_0_0|SrvcGrp|88148|2022|PDM|2527.00|99|0.00|LAPAROSCOPY SALPINGOSTOMY
20|FH_F150982_0_0|SrvcGrp|88157|2022|PDM|24223.00|99|0.00|TOTAL HIP ARTHROPLASTY
20|FH_F150982_0_0|SrvcGrp|88163|2022|PDM|13213.00|99|0.00|LUMBAR SPINE FUSION
20|FH_F150982_0_0|SrvcGrp|88493|2022|PDM|5284.00|99|0.00|AETNA VERTEBROPLASTY ADDL INJECT
20|FH_F150982_0_0|SrvcGrp|88494|2022|PDM|4886.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION
20|FH_F150982_0_0|SrvcGrp|88596|2022|PDM|1976.00|99|0.00|EXC OF TRIANG FIBROCARTILAGE
20|FH_F150982_0_0|SrvcGrp|89848|2022|PDM|9909.00|99|0.00|SPINE FUSION EXTRA SEGMENT
20|FH_F150982_0_0|SrvcGrp|92010|2022|PDM|1382.00|99|0.00|LESION OF TENDON SHEATH OR JOINT CAPSULE
20|FH_F150982_0_0|SrvcGrp|92410|2022|PDM|4404.00|99|0.00|SPINE FUSION EXTRA SEGMENT
20|FH_F150982_0_0|SrvcGrp|92821|2022|PDM|16516.00|99|0.00|HIP ARTHROSCOPY W/ LABRAL REPAIR
20|FH_F150982_0_0|SrvcGrp|93637|2022|PDM|3971.00|99|0.00|LAPAROSCOPY SURGICAL
20|FH_F151002_0_0|SrvcGrp|13990|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F151045_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F151084_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F151084_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.93|99|0.00|HSS ASC
20|FH_F151139_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F151139_0_0|SrvcGrp|100960|2022|PDM|79.00|99|0.00|FIXED WING AIR MILEAGE
20|FH_F151139_0_0|SrvcGrp|12869|2022|PDM|155.00|99|0.00|AIR AMBULANCE
20|FH_F151143_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F151143_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F151143_0_0|SrvcGrp|115963|2022|PDM|12.00|99|0.00|NON-EMERGENT FIXED WING AIR MILEAGE (MOD NE)
20|FH_F151143_0_0|SrvcGrp|12869|2022|PDM|155.00|99|0.00|AIR AMBULANCE
20|FH_F151156_0_0|CSTM-ALL|CSTM-00|2020|PDM|35.00|99|0.00|AEG 4 (NO REV)
20|FH_F151156_0_0|CSTM-ALL|CSTM-00|2020|PDM|35.00|99|0.00|AEG 5  (NO REV)
20|FH_F151156_0_0|CSTM-ALL|CSTM-00|2020|PDM|35.00|99|0.00|AEG 8 (NO REV)
20|FH_F151156_0_0|CSTM-ALL|CSTM-00|2020|PDM|36.00|99|0.00|AEG 9 (NO REV)
20|FH_F151156_0_0|CSTM-ALL|CSTM-00|2020|PDM|621.00|99|0.00|AEG 1 (NO REV)
20|FH_F151157_0_0|CSTM-ALL|CSTM-00|2020|PDM|665.00|99|0.00|AEG 1 (NO REV)
20|FH_F151157_0_0|CSTM-ALL|CSTM-00|2020|PDM|665.00|99|0.00|AEG 1 (NO REV) W/ GASTROESOPHOGEAL
20|FH_F151157_0_0|CSTM-ALL|CSTM-00|2020|PDM|961.00|99|0.00|AEG 2 (NO REV)
20|FH_F151158_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE
20|FH_F151202_0_0|SrvcGrp|74668|2022|PDM|190.00|99|0.00|AETNA INTENSIVE OUTPATIENT
20|FH_F151202_0_0|SrvcGrp|75419|2022|PDM|350.00|99|0.00|OP PARTIAL HOSPITALIZATION
20|FH_F151202_0_0|SrvcGrp|90854|2022|PDM|1000.00|99|0.00|AETNA IP DETOXIFICATION SERVICES
20|FH_F151225_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F151225_0_0|SrvcGrp|80317|2022|PDM|704.00|99|0.00|RESPITE CARE
20|FH_F151399_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F151399_0_0|SrvcGrp|107351|2022|PDM|11273.00|99|0.00|AMB SRVC CONVNTION AIR TRANSPORT 1 WAY (HCFA)
20|FH_F151399_0_0|SrvcGrp|113574|2022|PDM|13589.00|99|0.00|AMBULANCE AIR TRANSPORT (HCFA)
20|FH_F151399_0_0|SrvcGrp|12868|2022|PDM|13589.00|99|0.00|AIR AMBULANCE
20|FH_F151400_0_0|CSTM-ALL|CSTM-00|2020|PDM|2921.00|99|0.00|AEG 10 (NO REV)
20|FH_F151400_0_0|SrvcGrp|87119|2022|PDM|4600.00|99|0.00|PERQ VERTEBRAL AUGMENTATION
20|FH_F151400_0_0|SrvcGrp|93741|2022|PDM|3181.00|99|0.00|REVISE SPINE ELECTRODE PERCUTANEOUS ARRAY
20|FH_F151400_0_0|SrvcGrp|98603|2022|PDM|4600.00|99|0.00|PERQ VERTEBRAL AUGMENTATION
20|FH_F151407_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F151407_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|GENERAL ACUTE CARE
20|FH_F151424_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F151500_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F151517_0_0|SrvcGrp|75419|2022|PDM|367.00|99|0.00|OP PARTIAL HOSPITALIZATION
20|FH_F151559_0_0|SrvcGrp|55677|2022|PDM|2000.00|99|0.00|VAGINAL DELIVERY ONLY
20|FH_F151607_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|GENERAL ACUTE CARE
20|FH_F151751_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F151751_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F151751_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|AEG 3 (NO REV)
20|FH_F151751_0_0|CSTM-ALL|CSTM-00|2020|PDM|1364.00|99|0.00|AEG 7 (NO REV)
20|FH_F151751_0_0|SrvcGrp|115169|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F151780_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F31049_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31049_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F31056_0_0|SrvcGrp|3069|2022|PCT|0.65|99|0.00|IMPLANTS
20|FH_F31056_0_0|SrvcGrp|360|2022|PDM|1387.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F31056_0_0|SrvcGrp|3673|2022|PDM|867.00|99|0.00|ACUTE PSYCHIATRIC
20|FH_F31087_0_0|SrvcGrp|10521|2022|PDM|110.00|99|0.00|PHYSICAL THERAPY
20|FH_F31087_0_0|SrvcGrp|10522|2022|PDM|218.00|99|0.00|PICC LINE INSERT
20|FH_F31087_0_0|SrvcGrp|1168|2022|PDM|33.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F31087_0_0|SrvcGrp|3810|2022|PDM|132.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F31087_0_0|SrvcGrp|473|2022|PDM|324.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F31087_0_0|SrvcGrp|474|2022|PDM|234.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F31096_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE
20|FH_F31107_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31107_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|OP SVCS
20|FH_F31111_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|OP SVCS
20|FH_F31139_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31178_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F31181_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F31184_0_0|CSTM-ALL|CSTM-00|2020|PDM|13000.00|99|0.00|MS DRG 253-254 CV SURGERY
20|FH_F31184_0_0|CSTM-ALL|CSTM-00|2020|PDM|29100.00|99|0.00|MSDRG 233-234 CORONARY BYPASS
20|FH_F31184_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|MS DRG 767-768, 774-775 NORMAL DELIVERY
20|FH_F31184_0_0|CSTM-ALL|CSTM-00|2020|PDM|7900.00|99|0.00|MSDRG 286-287 CARDIAC CATH
20|FH_F31184_0_0|SrvcGrp|3982|2022|PDM|2700.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F31204_0_0|CSTM-ALL|CSTM-00|2020|PDM|692.00|99|0.00|ACUTE PSYCH
20|FH_F31204_0_0|CSTM-ALL|CSTM-00|2020|PDM|692.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31204_0_0|SrvcGrp|3338|2022|PDM|210.00|99|0.00|OP PSYCH HOSP - ADULT
20|FH_F31220_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS
20|FH_F31227_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31227_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F31248_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31253_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F31319_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.00|99|0.00|OP SVCS
20|FH_F31369_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31375_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F31398_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS
20|FH_F31433_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|DRUGS
20|FH_F31433_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F31446_0_0|CSTM-ALL|CSTM-00|2020|PDM|575.00|99|0.00|CD - ADULT
20|FH_F31446_0_0|CSTM-ALL|CSTM-00|2020|PDM|575.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31519_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31524_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31525_0_0|SrvcGrp|3029|2022|PDM|562.00|99|0.00|NEWBORN NURSERY
20|FH_F31525_0_0|SrvcGrp|360|2022|PDM|616.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F31537_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F31542_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F31542_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F31542_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|ASPG III
20|FH_F31542_0_0|CSTM-ALL|CSTM-00|2020|PDM|1484.00|99|0.00|ASPG IV
20|FH_F31542_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|MS DRG 767-768, 774-775 NORMAL DELIVERY
20|FH_F31542_0_0|CSTM-ALL|CSTM-00|2020|PDM|2314.00|99|0.00|ASPG VI
20|FH_F31542_0_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|ASPG X
20|FH_F31542_0_0|SrvcGrp|11259|2022|PCT|0.60|99|0.00|DRUGS
20|FH_F31542_0_0|SrvcGrp|12212|2022|PDM|800.00|99|0.00|MAGNETIC RESONANCE IMAGING (MRI)
20|FH_F31542_0_0|SrvcGrp|13123|2022|PDM|450.00|99|0.00|COMPUTED TOMOGRAPHY (CT)
20|FH_F31542_0_0|SrvcGrp|9808|2022|PDM|5000.00|99|0.00|PTCA WITH STENT
20|FH_F31542_0_0|SrvcGrp|9911|2022|PDM|500.00|99|0.00|EMERGENCY ROOM SVCS
20|FH_F31579_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31594_0_0|CSTM-ALL|CSTM-00|2020|PDM|1450.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31594_0_0|SrvcGrp|24|2022|PDM|1400.00|99|0.00|CARDIAC CATH
20|FH_F31594_0_0|SrvcGrp|72|2022|PDM|200.00|99|0.00|NEWBORN NURSERY
20|FH_F31595_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.93|99|0.00|OP SVCS
20|FH_F31595_0_0|SrvcGrp|12855|2022|PCT|0.93|99|0.00|OP SURGERY
20|FH_F31595_0_0|SrvcGrp|12856|2022|PDM|92.00|99|0.00|NURSING CARE
20|FH_F31595_0_0|SrvcGrp|8962|2022|PDM|85.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F31595_0_0|SrvcGrp|9829|2022|PDM|85.00|99|0.00|PT SVCS
20|FH_F31595_0_0|SrvcGrp|9830|2022|PDM|85.00|99|0.00|OT SVCS
20|FH_F31597_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F31643_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31688_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F31783_0_0|CSTM-ALL|CSTM-00|2020|PDM|13230.00|99|0.00|MS DRG 253-254 CV SURGERY
20|FH_F31783_0_0|CSTM-ALL|CSTM-00|2020|PDM|18270.00|99|0.00|MS DRG 242
20|FH_F31783_0_0|CSTM-ALL|CSTM-00|2020|PDM|20475.00|99|0.00|MS DRG 237
20|FH_F31783_0_0|CSTM-ALL|CSTM-00|2020|PDM|20475.00|99|0.00|MSDRG 235-236 CORONARY BYPASS
20|FH_F31783_0_0|CSTM-ALL|CSTM-00|2020|PDM|27300.00|99|0.00|MSDRG 219-221 CARDIAC VLV PX+OTR MJR CARDIOTHORACIC PX W/CC
20|FH_F31798_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|CV SURGERY
20|FH_F31798_0_0|SrvcGrp|13295|2022|PDM|1890.00|99|0.00|PET SCAN
20|FH_F31798_0_0|SrvcGrp|24|2022|PCT|0.75|99|0.00|CARDIAC CATH
20|FH_F31798_0_0|SrvcGrp|3069|2022|PCT|1.15|99|0.00|IMPLANTS
20|FH_F31798_0_0|SrvcGrp|360|2022|PCT|0.85|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F31798_0_0|SrvcGrp|58|2022|PCT|0.85|99|0.00|IP LITHOTRIPSY SVCS
20|FH_F31819_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS
20|FH_F31822_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31822_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F31824_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|IMPLANTS
20|FH_F31824_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|OP SVCS
20|FH_F31824_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F31824_0_0|CSTM-ALL|CSTM-00|2020|PDM|275.00|99|0.00|BOARDER BABY SVCS
20|FH_F31824_0_0|SrvcGrp|439|2022|PDM|1000.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F31825_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31829_0_0|CSTM-ALL|CSTM-00|2020|PCT|91.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31829_0_0|CSTM-ALL|CSTM-00|2020|PCT|91.00|99|0.00|OP SVCS
20|FH_F31836_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F31840_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31842_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F31842_0_0|CSTM-ALL|CSTM-00|2020|PDM|670.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31843_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31871_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F31881_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS
20|FH_F31908_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F31912_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31912_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.00|99|0.00|OP SVCS
20|FH_F31916_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31921_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS
20|FH_F31927_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE
20|FH_F31928_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SURG
20|FH_F31928_0_0|SrvcGrp|10419|2022|PDM|790.00|99|0.00|SKILLED NURSING CARE
20|FH_F31944_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.97|99|0.00|OP SVCS
20|FH_F31944_0_0|CSTM-ALL|CSTM-00|2020|PDM|35.00|99|0.00|HOME HEALTH AIDE
20|FH_F31944_0_0|CSTM-ALL|CSTM-00|2020|PDM|75.00|99|0.00|PHYSICAL THERAPY
20|FH_F31968_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS
20|FH_F31970_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS
20|FH_F31982_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F31985_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|GENERAL ACUTE CARE
20|FH_F31996_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32001_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32002_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32010_0_0|CSTM-ALL|CSTM-00|2020|PCT|86.00|99|0.00|OP SVCS
20|FH_F32014_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F32056_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS
20|FH_F32060_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32066_0_0|SrvcGrp|30426|2022|PCT|0.68|99|0.00|CARVE OUT MS DRG PROCEDURES
20|FH_F32073_0_0|CSTM-ALL|CSTM-00|2020|PDM|1103.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32073_0_0|CSTM-ALL|CSTM-00|2020|PDM|1295.00|99|0.00|AMPUTATION
20|FH_F32073_0_0|CSTM-ALL|CSTM-00|2020|PDM|1516.00|99|0.00|SPINAL CORD REHABILITATION
20|FH_F32090_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F32097_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32118_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS
20|FH_F32123_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|OP SVCS
20|FH_F32127_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS
20|FH_F32135_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F32142_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32142_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|OP SVCS
20|FH_F32150_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32151_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32154_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32156_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F32165_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F32190_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32190_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F32201_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32212_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32227_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32283_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS
20|FH_F32285_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F32287_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32287_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS
20|FH_F32288_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS
20|FH_F32293_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F32305_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE
20|FH_F32316_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F32327_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32336_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.50|99|0.00|OP SVCS
20|FH_F32360_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32360_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F32364_0_0|CSTM-ALL|CSTM-00|2020|PCT|99.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32364_0_0|CSTM-ALL|CSTM-00|2020|PCT|99.00|99|0.00|OP SVCS
20|FH_F32374_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32375_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS
20|FH_F32388_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F32390_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32390_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F32393_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F32402_0_0|CSTM-ALL|CSTM-00|2020|PCT|42.00|99|0.00|OP SVCS
20|FH_F32402_0_0|CSTM-ALL|CSTM-00|2020|PCT|58.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32405_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32427_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32461_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32471_0_0|CSTM-ALL|CSTM-00|2020|PCT|91.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32482_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS
20|FH_F32486_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32487_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F32501_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32502_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32509_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F32509_0_0|SrvcGrp|12438|2022|PDM|16970.00|99|0.00|PTCA WITH STENT
20|FH_F32509_0_0|SrvcGrp|88|2022|PDM|12663.00|99|0.00|OP LITHOTRIPSY
20|FH_F32509_0_0|SrvcGrp|9511|2022|PDM|5350.00|99|0.00|OBSERVATION SVCS
20|FH_F32512_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32513_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32521_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32523_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS
20|FH_F32530_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32532_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F32534_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32589_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS
20|FH_F32594_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|ACUTE IP MED SVCS
20|FH_F32594_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|OP SVCS
20|FH_F32604_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.96|99|0.00|GENERAL ACUTE CARE
20|FH_F32612_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32617_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32618_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F32621_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F32627_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32628_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32657_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32675_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32675_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F32703_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32704_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F32708_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32708_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F32709_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32709_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F32718_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32720_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS
20|FH_F32729_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS
20|FH_F32732_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|GENERAL ACUTE CARE
20|FH_F51482_0_0|CSTM-ALL|CSTM-00|2020|PCT|68.00|99|0.00|GENERAL ACUTE CARE
20|FH_F51492_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F51492_0_0|SrvcGrp|43893|2022|PDM|75.00|99|0.00|OCCUPATIONAL THERAPY VISIT
20|FH_F51541_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|GENERAL ACUTE CARE
20|FH_F51545_0_0|SrvcGrp|42825|2022|PDM|65.00|99|0.00|HOME HEALTH AIDE VISIT
20|FH_F51545_0_0|SrvcGrp|43894|2022|PDM|150.00|99|0.00|SPEECH THERAPY VISIT
20|FH_F51545_0_0|SrvcGrp|45783|2022|PDM|145.00|99|0.00|SKILLED NURSING VISIT
20|FH_F51548_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F51548_0_0|SrvcGrp|15850|2022|PDM|120.00|99|0.00|HOSPICE SVCS
20|FH_F51557_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F51658_0_0|SrvcGrp|44428|2022|PDM|105.00|99|0.00|OCCUPATIONAL THERAPY SVCS (VISIT LVL)
20|FH_F51658_0_0|SrvcGrp|45924|2022|PDM|46.00|99|0.00|HOME HEALTH AIDE
20|FH_F51658_0_0|SrvcGrp|45944|2022|PDM|46.00|99|0.00|HOME HEALTH AIDE SVCS
20|FH_F51658_0_0|SrvcGrp|45949|2022|PDM|105.00|99|0.00|OCCUPATIONAL THERAPY SVCS
20|FH_F51674_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS
20|FH_F51733_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F51733_0_0|SrvcGrp|44428|2022|PDM|105.00|99|0.00|OCCUPATIONAL THERAPY SVCS (VISIT LVL)
20|FH_F51733_0_0|SrvcGrp|45950|2022|PDM|105.00|99|0.00|SPEECH THERAPY
20|FH_F51733_0_0|SrvcGrp|46234|2022|PDM|90.00|99|0.00|SKILLED NURSING
20|FH_F51855_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE
20|FH_F51859_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F51934_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F51934_0_0|SrvcGrp|46350|2022|PDM|100.00|99|0.00|HI TECH SKILLED NURSING SERVICES
20|FH_F51934_0_0|SrvcGrp|46604|2022|PDM|120.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES
20|FH_F51934_0_0|SrvcGrp|48399|2022|PDM|110.00|99|0.00|SPEECH THERAPY
20|FH_F52112_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F52152_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F52335_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F52393_0_0|SrvcGrp|49109|2022|PDM|1800.00|99|0.00|HEARING AID
20|FH_F52516_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F52516_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F52516_0_0|SrvcGrp|3810|2022|PDM|135.11|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F52534_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F52617_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F52713_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|GENERAL ACUTE CARE
20|FH_F52713_0_0|SrvcGrp|29702|2022|PDM|17942.00|99|0.00|CV SURGERY MS DRG 260-262 ONLY
20|FH_F52713_0_0|SrvcGrp|29817|2022|PDM|6725.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F52713_0_0|SrvcGrp|3029|2022|PDM|1025.00|99|0.00|NEWBORN NURSERY
20|FH_F52713_0_0|SrvcGrp|36768|2022|PCT|0.60|99|0.00|OTHER DIAGNOSTIC TESTING
20|FH_F52713_0_0|SrvcGrp|42784|2022|PDM|240.00|99|0.00|OCCUPATIONAL THERAPY  SRVCS
20|FH_F52713_0_0|SrvcGrp|9774|2022|PDM|5000.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F52733_0_0|SrvcGrp|43567|2022|PDM|85.00|99|0.00|SKILLED NURSING - POSTNATAL
20|FH_F52753_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F52753_0_0|CSTM-ALL|CSTM-00|2020|PDM|1115.00|99|0.00|ASPG VI
20|FH_F52753_0_0|CSTM-ALL|CSTM-00|2020|PDM|1480.00|99|0.00|ASPG VIII
20|FH_F52753_0_0|CSTM-ALL|CSTM-00|2020|PDM|50.00|99|0.00|INTRAOCULAR LENS
20|FH_F52753_0_0|CSTM-ALL|CSTM-00|2020|PDM|945.00|99|0.00|ASPG III
20|FH_F52753_0_0|CSTM-ALL|CSTM-00|2020|PDM|970.00|99|0.00|ASPG V
20|FH_F52754_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F52754_0_0|CSTM-ALL|CSTM-00|2020|PDM|95.00|99|0.00|OCCUPATIONAL THERAPY VISIT
20|FH_F52754_0_0|SrvcGrp|12512|2022|PDM|1260.00|99|0.00|ACUTE REHABILITATION
20|FH_F52754_0_0|SrvcGrp|3259|2022|PDM|970.00|99|0.00|ACUTE REHABILITATION
20|FH_F52754_0_0|SrvcGrp|9460|2022|PDM|850.00|99|0.00|ACUTE REHABILITATION
20|FH_F52772_0_0|SrvcGrp|472|2022|PDM|660.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F52772_0_0|SrvcGrp|474|2022|PDM|385.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F52872_0_0|CSTM-ALL|CSTM-00|2020|PDM|593.00|99|0.00|WILLS COMM SURG SVC ASC 1
20|FH_F52872_0_0|CSTM-ALL|CSTM-00|2020|PDM|799.00|99|0.00|WILLS COMM SURG SVC ASC 2
20|FH_F52956_0_0|SrvcGrp|36770|2022|PDM|151.82|99|0.00|PERITONEAL/CAPD/CCPD
20|FH_F52956_0_0|SrvcGrp|49603|2022|PDM|339.90|99|0.00|ULTRAFILTRATION
20|FH_F52992_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F53032_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE
20|FH_F53373_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F53373_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F53373_0_0|CSTM-ALL|CSTM-00|2020|PDM|1742.00|99|0.00|ASPG IX
20|FH_F53373_0_0|CSTM-ALL|CSTM-00|2020|PDM|720.00|99|0.00|ASPG X
20|FH_F53373_0_0|CSTM-ALL|CSTM-00|2020|PDM|875.00|99|0.00|ASPG IV
20|FH_F53373_0_0|SrvcGrp|36991|2022|PCT|1.10|99|0.00|IMPLANTS
20|FH_F53418_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F53418_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F53573_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F53573_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F54056_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F54056_0_0|SrvcGrp|22954|2022|PDM|135.11|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F54172_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|ZERO ALLOWABLE - OUTPATIENT SERVICES
20|FH_F54172_0_0|SrvcGrp|9529|2022|PDM|643.00|99|0.00|HOSPICE SVCS
20|FH_F54272_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F54272_0_0|CSTM-ALL|CSTM-00|2020|PDM|1430.00|99|0.00|ASPG III
20|FH_F54272_0_0|CSTM-ALL|CSTM-00|2020|PDM|1660.00|99|0.00|ASPG IV
20|FH_F54272_0_0|CSTM-ALL|CSTM-00|2020|PDM|1709.00|99|0.00|GENERAL ACUTE CARE
20|FH_F54272_0_0|CSTM-ALL|CSTM-00|2020|PDM|1795.00|99|0.00|ASPG V
20|FH_F54272_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|ASPG IX
20|FH_F54272_0_0|SrvcGrp|1135|2022|PDM|139.00|99|0.00|CLINIC VISIT
20|FH_F54272_0_0|SrvcGrp|51783|2022|PCT|0.45|99|0.00|IP PHARMACY
20|FH_F32732_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|OP SVCS
20|FH_F32739_0_0|CSTM-ALL|CSTM-00|2020|PCT|50.00|99|0.00|LABORATORY
20|FH_F32739_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F32771_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F32772_0_0|SrvcGrp|79699|2022|PCT|0.95|99|0.00|CARDIAC CATHETERIZATION INJECTIONS
20|FH_F32777_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32779_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F32779_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|GENERAL ACUTE CARE
20|FH_F32779_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OP SVCS
20|FH_F32781_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32781_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F32783_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32799_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32803_0_0|CSTM-ALL|CSTM-00|2020|PDM|30341.00|99|0.00|CV SURGERY
20|FH_F32803_0_0|SrvcGrp|1121|2022|PCT|0.65|99|0.00|OP PTCA ANGIOPLASTY
20|FH_F32803_0_0|SrvcGrp|411|2022|PCT|0.65|99|0.00|OP CARDIAC CATH
20|FH_F32804_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS
20|FH_F32825_0_0|CSTM-ALL|CSTM-00|2020|PDM|10058.00|99|0.00|MS DRG 249
20|FH_F32825_0_0|CSTM-ALL|CSTM-00|2020|PDM|30516.00|99|0.00|MS DRG 216-227, 231-236 CV SURGERY
20|FH_F32825_0_0|SrvcGrp|11259|2022|PCT|0.60|99|0.00|DRUGS
20|FH_F32825_0_0|SrvcGrp|268|2022|PCT|0.70|99|0.00|HYPERBARIC CHAMBER
20|FH_F32825_0_0|SrvcGrp|8950|2022|PDM|1316.00|99|0.00|INTERMEDIATE ICU/CCU
20|FH_F32826_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS
20|FH_F32861_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.50|99|0.00|GENERAL ACUTE CARE
20|FH_F32861_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.50|99|0.00|OP SVCS
20|FH_F32869_0_0|CSTM-ALL|CSTM-00|2020|PDM|20000.00|99|0.00|MSDRG 235-236 CORONARY BYPASS
20|FH_F32869_0_0|CSTM-ALL|CSTM-00|2020|PDM|25000.00|99|0.00|MSDRG 231-232 CORONARY BYPASS
20|FH_F32869_0_0|CSTM-ALL|CSTM-00|2020|PDM|8000.00|99|0.00|MS DRGS 248, 250-251 (PTCA W/O STENT)
20|FH_F32869_0_0|SrvcGrp|11919|2022|PCT|0.40|99|0.00|ORGAN TRANSPLANT SVCS
20|FH_F32869_0_0|SrvcGrp|12435|2022|PDM|6000.00|99|0.00|PTCA W/ CARDIAC ABLATION
20|FH_F32869_0_0|SrvcGrp|6|2022|PDM|2800.00|99|0.00|OP SURGERY
20|FH_F32869_0_0|SrvcGrp|9774|2022|PDM|1500.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F32870_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS
20|FH_F32877_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32881_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32885_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F32886_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32888_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F32902_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS
20|FH_F32906_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F32911_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32914_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F32927_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32929_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS
20|FH_F32933_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32935_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|DIALYSIS SVCS
20|FH_F32935_0_0|SrvcGrp|14492|2022|PCT|0.35|99|0.00|DURABLE MEDICAL EQUIPMENT (DME)
20|FH_F32938_0_0|SrvcGrp|12342|2022|PCT|1.10|99|0.00|IMPLANTS
20|FH_F32953_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32957_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32957_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS
20|FH_F32963_0_0|CSTM-ALL|CSTM-00|2020|PCT|76.00|99|0.00|OP SVCS
20|FH_F32965_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32965_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F32970_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32970_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F32972_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32980_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32984_0_0|CSTM-ALL|CSTM-00|2020|PCT|86.40|99|0.00|OP SVCS
20|FH_F32986_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32987_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32994_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OBSERVATION SERVICES
20|FH_F32994_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OBSERVATION SVCS
20|FH_F32994_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F32995_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F32995_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|ASPG III
20|FH_F32995_0_0|CSTM-ALL|CSTM-00|2020|PDM|1688.00|99|0.00|ASPG V
20|FH_F32995_0_0|CSTM-ALL|CSTM-00|2020|PDM|2313.00|99|0.00|ASPG VI
20|FH_F32995_0_0|CSTM-ALL|CSTM-00|2020|PDM|785.00|99|0.00|ASPG I
20|FH_F32996_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|TRAUMA CARE
20|FH_F32996_0_0|CSTM-ALL|CSTM-00|2020|PDM|1728.00|99|0.00|GENERAL ACUTE CARE
20|FH_F32996_0_0|CSTM-ALL|CSTM-00|2020|PDM|3240.00|99|0.00|CORONARY CARE UNIT
20|FH_F32996_0_0|CSTM-ALL|CSTM-00|2020|PDM|540.00|99|0.00|NEWBORN NURSERY - LEVEL I
20|FH_F32996_0_0|SrvcGrp|941|2022|PDM|3240.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F32998_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS
20|FH_F33039_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33039_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F33063_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33070_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33088_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33096_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33103_0_0|CSTM-ALL|CSTM-00|2020|PCT|99.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33113_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33126_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F33163_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS
20|FH_F33165_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33165_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F33181_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE
20|FH_F33182_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|ACUTE PSYCH
20|FH_F33183_0_0|SrvcGrp|14547|2022|PDM|1200.00|99|0.00|HERNIA REPAIR
20|FH_F33220_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33233_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F33233_0_0|SrvcGrp|2161|2022|PDM|20.79|99|0.00|THERAPEUTIC
20|FH_F33241_0_0|CSTM-ALL|CSTM-00|2020|PDM|1484.00|99|0.00|ASPG IV
20|FH_F33241_0_0|CSTM-ALL|CSTM-00|2020|PDM|2314.00|99|0.00|ASPG VI
20|FH_F33241_0_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|OP SVCS
20|FH_F33241_0_0|SrvcGrp|9511|2022|PDM|42.00|99|0.00|OBSERVATION SVCS
20|FH_F33241_0_0|SrvcGrp|9808|2022|PDM|5000.00|99|0.00|PTCA WITH STENT
20|FH_F33241_0_0|SrvcGrp|9936|2022|PDM|90.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F33246_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.50|99|0.00|GENERAL ACUTE CARE
20|FH_F33255_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F33269_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F33271_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F33282_0_0|CSTM-ALL|CSTM-00|2020|PCT|86.00|99|0.00|OP SVCS
20|FH_F33319_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33322_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|BURN SERVICES
20|FH_F33322_0_0|SrvcGrp|10427|2022|PCT|0.90|99|0.00|TRAUMA CARE
20|FH_F33331_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|OP SVCS
20|FH_F33335_0_0|CSTM-ALL|CSTM-00|2020|PCT|68.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33381_0_0|CSTM-ALL|CSTM-00|2020|PDM|1004.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F33381_0_0|CSTM-ALL|CSTM-00|2020|PDM|31231.00|99|0.00|MSDRG 226-227 CV SURG CARDIAC DEFIBRILLATOR
20|FH_F33381_0_0|CSTM-ALL|CSTM-00|2020|PDM|37565.00|99|0.00|MS DRG 236
20|FH_F33381_0_0|CSTM-ALL|CSTM-00|2020|PDM|4368.00|99|0.00|MS DRG 767-768, 774-775 NORMAL DELIVERY
20|FH_F33381_0_0|CSTM-ALL|CSTM-00|2020|PDM|8299.00|99|0.00|MS DRG 286
20|FH_F33381_0_0|SrvcGrp|15055|2022|PCT|0.65|99|0.00|IMPLANTS/PROSTHETICS/STENTS/BLOOD PRODUCTS
20|FH_F33381_0_0|SrvcGrp|3029|2022|PDM|831.00|99|0.00|NEWBORN NURSERY
20|FH_F33381_0_0|SrvcGrp|3224|2022|PCT|0.78|99|0.00|EMERGENCY ROOM SVCS
20|FH_F33381_0_0|SrvcGrp|9774|2022|PDM|3494.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F33381_0_0|SrvcGrp|9795|2022|PDM|862.00|99|0.00|SUBACUTE REHAB
20|FH_F33390_0_0|SrvcGrp|16|2022|PDM|1064.00|99|0.00|ACUTE REHABILITATION
20|FH_F33411_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33421_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.10|99|0.00|GENERAL ACUTE CARE
20|FH_F33435_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS
20|FH_F33456_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33456_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS
20|FH_F33471_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE
20|FH_F33471_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F33471_0_0|SrvcGrp|13476|2022|PCT|0.90|99|0.00|TRAUMA CARE
20|FH_F33472_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS
20|FH_F33496_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|OP SVCS
20|FH_F33497_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS
20|FH_F33504_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33517_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F33521_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33530_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|BURN SERVICES
20|FH_F33530_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|TRAUMA SERVICES
20|FH_F33532_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F33554_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33558_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F33559_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F33566_0_0|SrvcGrp|2738|2022|PCT|0.75|99|0.00|IMPLANTS
20|FH_F33581_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|TRAUMA CARE
20|FH_F33581_0_0|CSTM-ALL|CSTM-00|2020|PDM|1728.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33581_0_0|CSTM-ALL|CSTM-00|2020|PDM|540.00|99|0.00|NEWBORN NURSERY - LEVEL I
20|FH_F33581_0_0|SrvcGrp|1943|2022|PDM|3240.00|99|0.00|NEONATAL INTENSVE CARE II & III
20|FH_F33581_0_0|SrvcGrp|24|2022|PCT|0.75|99|0.00|CARDIAC CATH
20|FH_F33624_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33624_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS
20|FH_F33630_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33635_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS
20|FH_F33642_0_0|CSTM-ALL|CSTM-00|2020|PDM|1550.00|99|0.00|ASPG III
20|FH_F33642_0_0|CSTM-ALL|CSTM-00|2020|PDM|2975.00|99|0.00|MS DRG 767-768, 774-775 NORMAL DELIVERY
20|FH_F33642_0_0|CSTM-ALL|CSTM-00|2020|PDM|3400.00|99|0.00|ASPG VIII
20|FH_F33642_0_0|SrvcGrp|10964|2022|PDM|1500.00|99|0.00|ACUTE IP MED/SURG SVCS
20|FH_F33642_0_0|SrvcGrp|13362|2022|PCT|0.75|99|0.00|EMERGENCY ROOM SVCS LEVEL IV
20|FH_F33642_0_0|SrvcGrp|13363|2022|PCT|0.75|99|0.00|EMERGENCY ROOM SVCS LEVEL V
20|FH_F33642_0_0|SrvcGrp|13692|2022|PDM|6000.00|99|0.00|OP CARDIAC CATH
20|FH_F33642_0_0|SrvcGrp|14609|2022|PCT|0.75|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F33642_0_0|SrvcGrp|15355|2022|PCT|0.60|99|0.00|MAGNETIC RESONANCE IMAGING (MRI)
20|FH_F33642_0_0|SrvcGrp|15370|2022|PCT|0.60|99|0.00|OTHER DIAGNOSTIC
20|FH_F33642_0_0|SrvcGrp|16|2022|PDM|800.00|99|0.00|ACUTE REHABILITATION
20|FH_F33642_0_0|SrvcGrp|18197|2022|PCT|0.75|99|0.00|MS DRG 025
20|FH_F33642_0_0|SrvcGrp|3932|2022|PDM|5250.00|99|0.00|LITHOTRIPSY
20|FH_F33642_0_0|SrvcGrp|941|2022|PDM|1300.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F33649_0_0|CSTM-ALL|CSTM-00|2020|PDM|675.00|99|0.00|ADULT PSYCHIATRIC
20|FH_F33649_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|CHILD PSYCHIATRIC
20|FH_F33659_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|GENERAL ACUTE CARE
20|FH_F33660_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33660_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F33664_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.91|99|0.00|GENERAL ACUTE CARE
20|FH_F54272_0_0|SrvcGrp|51785|2022|PCT|0.45|99|0.00|OP BLOOD PRODUCTS
20|FH_F54272_0_0|SrvcGrp|51786|2022|PCT|0.45|99|0.00|IP BLOOD PRODUCTS
20|FH_F54272_0_0|SrvcGrp|8960|2022|PDM|125.00|99|0.00|SPEECH THERAPY
20|FH_F54512_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE
20|FH_F54513_0_0|SrvcGrp|10527|2022|PDM|110.00|99|0.00|HOSPICE SVCS
20|FH_F54513_0_0|SrvcGrp|10534|2022|PDM|110.00|99|0.00|NURSING CARE
20|FH_F54513_0_0|SrvcGrp|10543|2022|PDM|110.00|99|0.00|SPEECH THERAPY SVCS
20|FH_F54513_0_0|SrvcGrp|10544|2022|PDM|110.00|99|0.00|ENTEROSTOMAL THERAPY SERVICES
20|FH_F54513_0_0|SrvcGrp|11442|2022|PDM|475.00|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)
20|FH_F54532_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE
20|FH_F54532_0_0|SrvcGrp|22985|2022|PDM|1130.00|99|0.00|GERIATRIC PSYCH SERVICES
20|FH_F54572_0_0|SrvcGrp|29930|2022|PDM|400.00|99|0.00|DIALYSIS
20|FH_F54614_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F54614_0_0|SrvcGrp|50907|2022|PDM|75.00|99|0.00|SPEECH THERAPY
20|FH_F54614_0_0|SrvcGrp|90559|2022|PDM|75.00|99|0.00|RN VISIT
20|FH_F54652_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F54652_0_0|CSTM-ALL|CSTM-00|2020|PDM|536.71|99|0.00|ASPG III
20|FH_F54732_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE
20|FH_F54732_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS
20|FH_F54752_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F54752_0_0|CSTM-ALL|CSTM-00|2020|PDM|1339.00|99|0.00|ASPG IX
20|FH_F54752_0_0|SrvcGrp|23585|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F54793_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F54952_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F55032_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F55054_0_0|CSTM-ALL|CSTM-00|2020|PDM|1430.00|99|0.00|GENERAL ACUTE CARE
20|FH_F55054_0_0|CSTM-ALL|CSTM-00|2020|PDM|4415.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F55054_0_0|SrvcGrp|10400|2022|PDM|1430.00|99|0.00|IP SURGERY
20|FH_F55054_0_0|SrvcGrp|20752|2022|PDM|25750.00|99|0.00|MSDRG 619-621 ONLY BARIATRIC SURGERY
20|FH_F55054_0_0|SrvcGrp|29949|2022|PCT|0.70|99|0.00|TRAUMA
20|FH_F55054_0_0|SrvcGrp|3069|2022|PCT|0.60|99|0.00|IMPLANTS
20|FH_F55054_0_0|SrvcGrp|51267|2022|PDM|32460.00|99|0.00|CARDIOVASCULAR SURGERY
20|FH_F55054_0_0|SrvcGrp|51271|2022|PDM|160.00|99|0.00|OP INTENSIVE PSYCH
20|FH_F55054_0_0|SrvcGrp|51274|2022|PDM|455.00|99|0.00|PSYCH PARTIAL HOSPITALIZATION
20|FH_F55054_0_0|SrvcGrp|53542|2022|PDM|845.00|99|0.00|CHEMICAL DEPENDENCY UNIT - DETOX
20|FH_F55054_0_0|SrvcGrp|9939|2022|PDM|1430.00|99|0.00|ACUTE MEDICAL SVCS
20|FH_F55113_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F55113_0_0|CSTM-ALL|CSTM-00|2020|PDM|4635.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F55113_0_0|SrvcGrp|23477|2022|PDM|4635.00|99|0.00|MSDRG 286-287 ONLY CARDIAC CATH
20|FH_F55113_0_0|SrvcGrp|29949|2022|PCT|0.70|99|0.00|TRAUMA
20|FH_F55113_0_0|SrvcGrp|31074|2022|PDM|475.00|99|0.00|MS DRG 795 ONLY
20|FH_F55212_0_0|SrvcGrp|46905|2022|PDM|73.00|99|0.00|OBSERVATION SVCS
20|FH_F55212_0_0|SrvcGrp|51064|2022|PDM|173.00|99|0.00|SUBSEQUENT HOSPITAL CARE
20|FH_F55212_0_0|SrvcGrp|80|2022|PDM|655.00|99|0.00|ACUTE PSYCH
20|FH_F55532_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F55532_0_0|SrvcGrp|12030|2022|PDM|1100.00|99|0.00|PEDIATRIC INTENSIVE CARE UNIT
20|FH_F55532_0_0|SrvcGrp|471|2022|PDM|825.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F55532_0_0|SrvcGrp|473|2022|PDM|725.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F55532_0_0|SrvcGrp|53602|2022|PCT|1.00|99|0.00|DRUGS
20|FH_F55532_0_0|SrvcGrp|592|2022|PDM|825.00|99|0.00|SUB-ACUTE CARE
20|FH_F55574_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.86|99|0.00|OP SVCS
20|FH_F55574_0_0|SrvcGrp|51543|2022|PCT|0.86|99|0.00|AMBULATORY SURGERY
20|FH_F55673_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F55693_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F55694_0_0|CSTM-ALL|CSTM-00|2020|PDM|1827.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F55694_0_0|SrvcGrp|11000|2022|PCT|0.59|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F55694_0_0|SrvcGrp|19661|2022|PDM|51792.00|99|0.00|MS DRG 216-218 ONLY CARDIAC VALVE PROCEDURE W/CARDIAC CATH
20|FH_F55694_0_0|SrvcGrp|30546|2022|PDM|20847.00|99|0.00|MS DRG 246-247 ONLY
20|FH_F55694_0_0|SrvcGrp|39245|2022|PCT|0.59|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS (CARDIAC)
20|FH_F55812_0_0|SrvcGrp|10541|2022|PDM|70.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F55812_0_0|SrvcGrp|10543|2022|PDM|70.00|99|0.00|SPEECH THERAPY SVCS
20|FH_F55812_0_0|SrvcGrp|14254|2022|PDM|45.00|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F55874_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F56054_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F56092_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.74|99|0.00|GENERAL ACUTE CARE
20|FH_F56112_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|OP SVCS
20|FH_F56136_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.98|99|0.00|OP SVCS
20|FH_F56136_0_0|CSTM-ALL|CSTM-00|2020|PDM|2073.00|99|0.00|GENERAL ACUTE CARE
20|FH_F56136_0_0|SrvcGrp|13131|2022|PDM|2073.00|99|0.00|OBSERVATION SVCS
20|FH_F56136_0_0|SrvcGrp|16|2022|PDM|1070.00|99|0.00|ACUTE REHABILITATION
20|FH_F56136_0_0|SrvcGrp|16362|2022|PCT|0.92|99|0.00|CCPD TRAINING
20|FH_F56136_0_0|SrvcGrp|19961|2022|PCT|0.85|99|0.00|MS DRG 231-232 ONLY CORONARY BYPASS W/ PTCA
20|FH_F56136_0_0|SrvcGrp|20077|2022|PCT|0.85|99|0.00|MS DRG 226-227 ONLY CARDIAC DEFIBRILLATOR
20|FH_F56136_0_0|SrvcGrp|20299|2022|PCT|0.85|99|0.00|MS DRG 228-230 ONLY OTHER CARDIOTHORACIC PROC
20|FH_F56136_0_0|SrvcGrp|21813|2022|PCT|0.92|99|0.00|ARENESP
20|FH_F56136_0_0|SrvcGrp|22811|2022|PCT|0.92|99|0.00|TRAUMA CARE
20|FH_F56136_0_0|SrvcGrp|22817|2022|PCT|0.92|99|0.00|ARTHROSCOPIC  SURGERY
20|FH_F56136_0_0|SrvcGrp|29817|2022|PDM|1905.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F56136_0_0|SrvcGrp|31099|2022|PDM|683.00|99|0.00|NORMAL NEWBORN VIA C-SECTION
20|FH_F56136_0_0|SrvcGrp|43939|2022|PCT|0.92|99|0.00|SLEEP STUDIES
20|FH_F56136_0_0|SrvcGrp|8950|2022|PDM|2810.00|99|0.00|INTERMEDIATE ICU/CCU
20|FH_F56137_0_0|SrvcGrp|15132|2022|PDM|1000.00|99|0.00|ACUTE IP MEDICAL SVCS
20|FH_F33672_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS
20|FH_F33685_0_0|SrvcGrp|6|2022|PCT|0.70|99|0.00|OP SURGERY
20|FH_F33688_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F33712_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|CPT CODES 70000-79999 (RAD)
20|FH_F33712_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 417-419
20|FH_F33712_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 691-692 URINARY STONES
20|FH_F33712_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MSDRG 242-244, 258-262 PACEMAKER INSERTION/REVISION
20|FH_F33712_0_0|CSTM-ALL|CSTM-00|2020|PDM|1550.00|99|0.00|ASPG III
20|FH_F33712_0_0|CSTM-ALL|CSTM-00|2020|PDM|1900.00|99|0.00|ASPG IV
20|FH_F33712_0_0|CSTM-ALL|CSTM-00|2020|PDM|2900.00|99|0.00|ASPG VII
20|FH_F33712_0_0|CSTM-ALL|CSTM-00|2020|PDM|2975.00|99|0.00|MS DRG 767-768, 774-775 NORMAL DELIVERY
20|FH_F33712_0_0|CSTM-ALL|CSTM-00|2020|PDM|3975.00|99|0.00|MS DRG 765-766 C-SECTION
20|FH_F33712_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|ASPG IX
20|FH_F33712_0_0|SrvcGrp|10905|2022|PCT|0.75|99|0.00|EMERGENCY ROOM LEVEL III
20|FH_F33712_0_0|SrvcGrp|10946|2022|PCT|0.75|99|0.00|EMERGENCY ROOM
20|FH_F33712_0_0|SrvcGrp|10947|2022|PCT|0.75|99|0.00|EMERGENCY ROOM
20|FH_F33712_0_0|SrvcGrp|12146|2022|PDM|1800.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F33712_0_0|SrvcGrp|13065|2022|PCT|0.75|99|0.00|EMERGENCY ROOM
20|FH_F33712_0_0|SrvcGrp|13692|2022|PDM|6000.00|99|0.00|OP CARDIAC CATH
20|FH_F33712_0_0|SrvcGrp|15351|2022|PDM|6500.00|99|0.00|PTCA ANGIOPLASTY
20|FH_F33712_0_0|SrvcGrp|15363|2022|PCT|0.60|99|0.00|DME/ORTHOTICS/PROSTHETICS/IMPLANTS
20|FH_F33712_0_0|SrvcGrp|15370|2022|PCT|0.60|99|0.00|OTHER DIAGNOSTIC
20|FH_F33712_0_0|SrvcGrp|16|2022|PDM|800.00|99|0.00|ACUTE REHABILITATION
20|FH_F33712_0_0|SrvcGrp|18791|2022|PCT|0.75|99|0.00|MS DRG 215
20|FH_F33712_0_0|SrvcGrp|361|2022|PDM|900.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F33712_0_0|SrvcGrp|941|2022|PDM|1300.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F33719_0_0|CSTM-ALL|CSTM-00|2020|PDM|3351.00|99|0.00|MS DRG 222-227, 246-249 ANGIOPLASTY
20|FH_F33719_0_0|CSTM-ALL|CSTM-00|2020|PDM|344.00|99|0.00|PSYCHIATRIC RESIDENTIAL TREATMENT
20|FH_F33719_0_0|CSTM-ALL|CSTM-00|2020|PDM|535.00|99|0.00|ACUTE PSYCH
20|FH_F33719_0_0|SrvcGrp|110|2022|PDM|500.00|99|0.00|CD - REHABILITATION
20|FH_F33719_0_0|SrvcGrp|11083|2022|PDM|1117.00|99|0.00|NORMAL DELIVERY (MOTHER ONLY)
20|FH_F33719_0_0|SrvcGrp|11086|2022|PDM|1178.00|99|0.00|CSECT (MOTHER ONLY)
20|FH_F33719_0_0|SrvcGrp|14414|2022|PDM|467.00|99|0.00|NEWBORN NURSERY
20|FH_F33719_0_0|SrvcGrp|512|2022|PCT|0.70|99|0.00|PANCREAS TRANSPLANT
20|FH_F33725_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.97|99|0.00|GENERAL ACUTE CARE
20|FH_F33725_0_0|CSTM-ALL|CSTM-00|2020|PDM|75.00|99|0.00|PHYSICAL THERAPY
20|FH_F33725_0_0|SrvcGrp|13380|2022|PDM|75.00|99|0.00|RN VISIT
20|FH_F33728_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F33744_0_0|SrvcGrp|16150|2022|PDM|14840.00|99|0.00|CARDIAC BRACHYTHERAPY SVCS
20|FH_F33744_0_0|SrvcGrp|72|2022|PDM|435.00|99|0.00|NEWBORN NURSERY
20|FH_F33744_0_0|SrvcGrp|903|2022|PDM|5300.00|99|0.00|PTC ANGIOPLASTY
20|FH_F33782_0_0|SrvcGrp|14110|2022|PDM|75.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F33785_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F33785_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 216-221, 231-234 CV SURGERY
20|FH_F33785_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|VENTILATOR
20|FH_F33785_0_0|SrvcGrp|13133|2022|PCT|0.70|99|0.00|PT/OT/ST
20|FH_F33785_0_0|SrvcGrp|14453|2022|PDM|5200.00|99|0.00|LITHOTRIPSY SVCS
20|FH_F33785_0_0|SrvcGrp|147|2022|PCT|0.50|99|0.00|HOME HEALTH CARE
20|FH_F33785_0_0|SrvcGrp|24|2022|PDM|2800.00|99|0.00|CARDIAC CATH
20|FH_F33785_0_0|SrvcGrp|3138|2022|PDM|750.00|99|0.00|COMPUTED TOMOGRAPHY (CT)
20|FH_F33785_0_0|SrvcGrp|3409|2022|PDM|300.00|99|0.00|NEWBORN NURSERY
20|FH_F33785_0_0|SrvcGrp|361|2022|PDM|1500.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F33785_0_0|SrvcGrp|897|2022|PDM|950.00|99|0.00|ACUTE REHAB W/ VENTILATOR
20|FH_F33788_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F33789_0_0|SrvcGrp|45626|2022|PCT|0.70|99|0.00|OP SURGERY BILATERAL
20|FH_F33789_0_0|SrvcGrp|6|2022|PCT|0.78|99|0.00|OP SURGERY
20|FH_F33791_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|ACUTE IP MED SVCS
20|FH_F33791_0_0|SrvcGrp|11108|2022|PDM|300.00|99|0.00|NEWBORN NURSERY
20|FH_F33791_0_0|SrvcGrp|111925|2022|PDM|1200.00|99|0.00|VAGINAL DELIVERY INCLUDES NEWBORN
20|FH_F33829_0_0|CSTM-ALL|CSTM-00|2020|PCT|53.60|99|0.00|GENERAL ACUTE CARE
20|FH_F33829_0_0|CSTM-ALL|CSTM-00|2020|PCT|53.60|99|0.00|OP SVCS
20|FH_F33845_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F33851_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33856_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33856_0_0|SrvcGrp|12118|2022|PCT|0.85|99|0.00|COMPUTED TOMOGRAPHY (CT)
20|FH_F33856_0_0|SrvcGrp|147|2022|PCT|0.85|99|0.00|HOME HEALTH CARE
20|FH_F33856_0_0|SrvcGrp|675|2022|PDM|700.00|99|0.00|PEDIATRIC INPATIENT SVCS
20|FH_F33856_0_0|SrvcGrp|72|2022|PDM|210.00|99|0.00|NEWBORN NURSERY
20|FH_F33896_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F33896_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|OP SVCS
20|FH_F33908_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.90|99|0.00|GENERAL ACUTE CARE
20|FH_F33930_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34005_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS
20|FH_F34020_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F34022_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F34024_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|OP SVCS
20|FH_F34048_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.77|99|0.00|OP SVCS
20|FH_F34100_0_0|SrvcGrp|16116|2022|PDM|90.00|99|0.00|PT/OT/ST
20|FH_F34100_0_0|SrvcGrp|9861|2022|PDM|875.00|99|0.00|ACUTE REHABILITATION
20|FH_F34104_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34112_0_0|CSTM-ALL|CSTM-00|2020|PDM|27105.00|99|0.00|MS DRG 216-227, 231-236 CV SURGERY
20|FH_F34112_0_0|SrvcGrp|115|2022|PDM|680.00|99|0.00|SKILLED NURSING CARE
20|FH_F34112_0_0|SrvcGrp|12342|2022|PCT|0.50|99|0.00|IMPLANTS
20|FH_F34112_0_0|SrvcGrp|16|2022|PDM|975.00|99|0.00|ACUTE REHABILITATION
20|FH_F34112_0_0|SrvcGrp|16097|2022|PDM|5550.00|99|0.00|LAPAROSCOPIC HYSTERECTOMY
20|FH_F34138_0_0|SrvcGrp|22954|2022|PDM|127.23|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F34138_0_0|SrvcGrp|3809|2022|PDM|567.07|99|0.00|HOSPICE CARE
20|FH_F34145_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F34148_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34155_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F34161_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34177_0_0|CSTM-ALL|CSTM-00|2020|PCT|74.30|99|0.00|OP SVCS
20|FH_F34182_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|MS DRG 253
20|FH_F34182_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|MS DRG 254
20|FH_F34182_0_0|CSTM-ALL|CSTM-00|2020|PDM|13128.00|99|0.00|MS DRG 280
20|FH_F34182_0_0|CSTM-ALL|CSTM-00|2020|PDM|16823.00|99|0.00|MS DRG 466-468
20|FH_F34182_0_0|CSTM-ALL|CSTM-00|2020|PDM|20737.00|99|0.00|MS DRG 665 ONLY
20|FH_F34182_0_0|CSTM-ALL|CSTM-00|2020|PDM|22932.00|99|0.00|MS DRGS 038-039 EXTRACRANIAL VASCULAR PROCEDURES W/O CC
20|FH_F34182_0_0|CSTM-ALL|CSTM-00|2020|PDM|2729.00|99|0.00|MSDRG 231-232 CORONARY BYPASS
20|FH_F34182_0_0|CSTM-ALL|CSTM-00|2020|PDM|927.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F34182_0_0|SrvcGrp|12118|2022|PDM|736.00|99|0.00|COMPUTED TOMOGRAPHY (CT)
20|FH_F34182_0_0|SrvcGrp|12840|2022|PCT|0.78|99|0.00|PACEMAKER
20|FH_F34182_0_0|SrvcGrp|13055|2022|PCT|0.78|99|0.00|BLOOD AND BLOOD PRODUCTS
20|FH_F34182_0_0|SrvcGrp|13397|2022|PCT|0.78|99|0.00|IMPLANTS
20|FH_F34182_0_0|SrvcGrp|19661|2022|PDM|2729.00|99|0.00|MS DRG 216-218 ONLY CARDIAC VALVE PROCEDURE W/CARDIAC CATH
20|FH_F34182_0_0|SrvcGrp|20906|2022|PDM|10805.00|99|0.00|MS DRG 243-244 ONLY CARDIAC PACEMAKER
20|FH_F34188_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34189_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34240_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F34241_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34241_0_0|SrvcGrp|3259|2022|PDM|850.00|99|0.00|ACUTE REHABILITATION
20|FH_F34246_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.10|99|0.00|OP SVCS
20|FH_F34253_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34258_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34263_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F34273_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|OP SVCS
20|FH_F34303_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F34303_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34317_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34328_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34336_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34336_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS
20|FH_F34371_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34371_0_0|SrvcGrp|10534|2022|PDM|85.00|99|0.00|NURSING CARE
20|FH_F34399_0_0|CSTM-ALL|CSTM-00|2020|PCT|69.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34403_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F34413_0_0|SrvcGrp|11336|2022|PCT|0.65|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F34413_0_0|SrvcGrp|3277|2022|PDM|200.00|99|0.00|SKILLED NURSING CARE
20|FH_F34413_0_0|SrvcGrp|9838|2022|PDM|1000.00|99|0.00|TRANSITIONAL CARE UNIT
20|FH_F34438_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34454_0_0|SrvcGrp|12263|2022|PDM|17.50|99|0.00|HOME HEALTH AIDE- HOURLY
20|FH_F34454_0_0|SrvcGrp|12264|2022|PDM|60.75|99|0.00|DIETICIAN OR LPN SERVICES
20|FH_F34454_0_0|SrvcGrp|12403|2022|PDM|26.25|99|0.00|CONTINUOUS HOMECARE
20|FH_F34454_0_0|SrvcGrp|9830|2022|PDM|85.50|99|0.00|OT SVCS
20|FH_F34480_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F34491_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS
20|FH_F34503_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34532_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34535_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS
20|FH_F34546_0_0|SrvcGrp|11108|2022|PDM|200.00|99|0.00|NEWBORN NURSERY
20|FH_F34546_0_0|SrvcGrp|14230|2022|PDM|400.00|99|0.00|SKILLED NURSING CARE
20|FH_F34550_0_0|CSTM-ALL|CSTM-00|2020|PDM|27251.00|99|0.00|MSDRG 216-238 CV SURGERY
20|FH_F34550_0_0|SrvcGrp|11258|2022|PCT|0.50|99|0.00|DRUGS
20|FH_F34550_0_0|SrvcGrp|11283|2022|PCT|0.70|99|0.00|HYPERBARIC CHAMBER
20|FH_F34550_0_0|SrvcGrp|361|2022|PDM|1019.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F34550_0_0|SrvcGrp|701|2022|PDM|1533.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F34603_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.55|99|0.00|OP SVCS
20|FH_F34604_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34641_0_0|CSTM-ALL|CSTM-00|2020|PDM|415.00|99|0.00|CD PARTIAL HOSPITALIZATION
20|FH_F34641_0_0|CSTM-ALL|CSTM-00|2020|PDM|465.00|99|0.00|CD PARTIAL HOSPITALIZATION
20|FH_F34641_0_0|CSTM-ALL|CSTM-00|2020|PDM|925.00|99|0.00|ADULT PSYCHIATRIC
20|FH_F34641_0_0|CSTM-ALL|CSTM-00|2020|PDM|975.00|99|0.00|CHILD PSYCH
20|FH_F34652_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F34652_0_0|CSTM-ALL|CSTM-00|2020|PDM|1843.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34652_0_0|SrvcGrp|97|2022|PDM|5440.00|99|0.00|C-SECTION
20|FH_F34658_0_0|CSTM-ALL|CSTM-00|2020|PCT|63.00|99|0.00|OP SVCS
20|FH_F34672_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|OP SVCS
20|FH_F34678_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|OP SVCS
20|FH_F34685_0_0|CSTM-ALL|CSTM-00|2020|PCT|67.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34686_0_0|CSTM-ALL|CSTM-00|2020|PCT|68.00|99|0.00|OP SVCS
20|FH_F34688_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F34691_0_0|SrvcGrp|13127|2022|PCT|0.70|99|0.00|DIALYSIS
20|FH_F34691_0_0|SrvcGrp|17146|2022|PDM|1081.00|99|0.00|MRI
20|FH_F34696_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F34709_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING
20|FH_F34747_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F34747_0_0|CSTM-ALL|CSTM-00|2020|PDM|943.60|99|0.00|ASPG V
20|FH_F34777_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|DRUGS
20|FH_F34777_0_0|CSTM-ALL|CSTM-00|2020|PDM|34546.00|99|0.00|MS DRG 216-227, 231-236 CV SURGERY
20|FH_F34777_0_0|SrvcGrp|13217|2022|PCT|0.60|99|0.00|ORTHOTICS/PROSTHETICS/IMPLANTS
20|FH_F34777_0_0|SrvcGrp|17350|2022|PDM|6995.00|99|0.00|CARDIAC ABLATION
20|FH_F34777_0_0|SrvcGrp|2045|2022|PDM|17500.00|99|0.00|ANEURYSM REPAIR
20|FH_F34783_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34792_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F34831_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F34843_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS
20|FH_F34852_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F34852_0_0|SrvcGrp|38|2022|PDM|2600.00|99|0.00|NORMAL DELIVERY
20|FH_F34852_0_0|SrvcGrp|9852|2022|PCT|0.70|99|0.00|LABORATORY
20|FH_F34894_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34899_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE
20|FH_F34918_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.79|99|0.00|OP SVCS
20|FH_F34918_0_0|SrvcGrp|360|2022|PDM|1547.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F34924_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F34924_0_0|SrvcGrp|360|2022|PDM|1250.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F34924_0_0|SrvcGrp|97|2022|PDM|4500.00|99|0.00|C-SECTION
20|FH_F34938_0_0|SrvcGrp|17624|2022|PCT|0.75|99|0.00|IMPLANTS
20|FH_F34963_0_0|SrvcGrp|12074|2022|PDM|130.00|99|0.00|RESIDENTIAL HOSPICE SERVICES
20|FH_F34971_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE
20|FH_F34975_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F34983_0_0|SrvcGrp|38|2022|PDM|1377.00|99|0.00|NORMAL DELIVERY
20|FH_F34983_0_0|SrvcGrp|72|2022|PDM|408.00|99|0.00|NEWBORN NURSERY
20|FH_F34984_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F34998_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F34998_0_0|CSTM-ALL|CSTM-00|2020|PDM|575.00|99|0.00|TRANSITIONAL CARE UNIT
20|FH_F34998_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|ACUTE PSYCH
20|FH_F34998_0_0|SrvcGrp|439|2022|PDM|1467.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F34998_0_0|SrvcGrp|72|2022|PDM|450.00|99|0.00|NEWBORN NURSERY
20|FH_F34999_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F35042_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F35042_0_0|SrvcGrp|941|2022|PDM|2506.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F35056_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|OP SVCS
20|FH_F35056_0_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|ASPG I
20|FH_F35056_0_0|SrvcGrp|14657|2022|PDM|663.00|99|0.00|MENTAL HEALTH / DETOX
20|FH_F35056_0_0|SrvcGrp|15411|2022|PDM|1500.00|99|0.00|SURGICAL SVCS
20|FH_F35069_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|GENERAL ACUTE CARE
20|FH_F35080_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F35088_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.44|99|0.00|OP SVCS
20|FH_F35088_0_0|CSTM-ALL|CSTM-00|2020|PDM|3407.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35088_0_0|SrvcGrp|115|2022|PDM|1041.00|99|0.00|SKILLED NURSING CARE
20|FH_F35088_0_0|SrvcGrp|12543|2022|PCT|0.70|99|0.00|LAPAROSCOPIC HYSTERECTOMY
20|FH_F35088_0_0|SrvcGrp|24|2022|PCT|0.65|99|0.00|CARDIAC CATH
20|FH_F35088_0_0|SrvcGrp|268|2022|PCT|0.70|99|0.00|HYPERBARIC CHAMBER
20|FH_F35088_0_0|SrvcGrp|290|2022|PCT|0.65|99|0.00|IP LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F35088_0_0|SrvcGrp|413|2022|PCT|0.75|99|0.00|TRANSPLANT SVCS
20|FH_F35088_0_0|SrvcGrp|56342|2022|PCT|0.65|99|0.00|PTC ANGIOPLASTY
20|FH_F35088_0_0|SrvcGrp|65|2022|PDM|2838.00|99|0.00|OBSTETRICAL CARE
20|FH_F35128_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F35133_0_0|CSTM-ALL|CSTM-00|2020|PDM|1900.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35133_0_0|SrvcGrp|16|2022|PDM|1100.00|99|0.00|ACUTE REHABILITATION
20|FH_F35133_0_0|SrvcGrp|3029|2022|PDM|400.00|99|0.00|NEWBORN NURSERY
20|FH_F35158_0_0|CSTM-ALL|CSTM-00|2020|PCT|63.20|99|0.00|GENERAL ACUTE CARE
20|FH_F35158_0_0|CSTM-ALL|CSTM-00|2020|PCT|63.20|99|0.00|OP SVCS
20|FH_F35166_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35167_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|MSDRG 242-244, 258-262 PACEMAKER INSERTION/REVISION
20|FH_F35167_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.66|99|0.00|OP SVCS
20|FH_F35167_0_0|SrvcGrp|12543|2022|PCT|0.70|99|0.00|LAPAROSCOPIC HYSTERECTOMY
20|FH_F35167_0_0|SrvcGrp|24|2022|PCT|0.65|99|0.00|CARDIAC CATH
20|FH_F35167_0_0|SrvcGrp|290|2022|PDM|8993.00|99|0.00|IP LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F35167_0_0|SrvcGrp|3102|2022|PCT|0.55|99|0.00|IMPLANTS
20|FH_F35167_0_0|SrvcGrp|411|2022|PCT|0.63|99|0.00|OP CARDIAC CATH
20|FH_F35167_0_0|SrvcGrp|903|2022|PCT|0.65|99|0.00|PTC ANGIOPLASTY
20|FH_F35167_0_0|SrvcGrp|997|2022|PCT|0.55|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F35174_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 238 ONLY
20|FH_F35174_0_0|SrvcGrp|20744|2022|PCT|0.75|99|0.00|MS DRG 242 ONLY
20|FH_F35174_0_0|SrvcGrp|21354|2022|PCT|0.75|99|0.00|MS DRG 250-251 ONLY
20|FH_F35176_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F35176_0_0|SrvcGrp|26001|2022|PDM|94.50|99|0.00|HOSPICE RESPITE SVCS
20|FH_F35176_0_0|SrvcGrp|8962|2022|PDM|82.50|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F35202_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35202_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F35202_0_0|SrvcGrp|3327|2022|PDM|94.50|99|0.00|HOSPICE SERVICE - IP RESPITE
20|FH_F35202_0_0|SrvcGrp|9828|2022|PDM|35.70|99|0.00|HOME HEALTH AIDE
20|FH_F35202_0_0|SrvcGrp|9830|2022|PDM|84.00|99|0.00|OT SVCS
20|FH_F35210_0_0|CSTM-ALL|CSTM-00|2020|PDM|3785.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35210_0_0|SrvcGrp|33793|2022|PCT|0.65|99|0.00|MSDRG 246-251 ONLY ANGIOPLASTY
20|FH_F35210_0_0|SrvcGrp|47252|2022|PCT|0.65|99|0.00|MS DRG 216-237 ONLY
20|FH_F35212_0_0|SrvcGrp|12403|2022|PDM|26.25|99|0.00|CONTINUOUS HOMECARE
20|FH_F35212_0_0|SrvcGrp|9830|2022|PDM|85.50|99|0.00|OT SVCS
20|FH_F35216_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|PT/OT
20|FH_F35216_0_0|CSTM-ALL|CSTM-00|2020|PDM|3750.00|99|0.00|MS DRG 490
20|FH_F35216_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|ASPG I
20|FH_F35216_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|ASPG II
20|FH_F35216_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|ASPG IX
20|FH_F35216_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|ASPG VI
20|FH_F35216_0_0|CSTM-ALL|CSTM-00|2020|PDM|5750.00|99|0.00|MS DRG 490 ONLY
20|FH_F35216_0_0|CSTM-ALL|CSTM-00|2020|PDM|7000.00|99|0.00|MS DRG 495
20|FH_F35216_0_0|CSTM-ALL|CSTM-00|2020|PDM|7350.00|99|0.00|MS DRG 473 CERVICAL SPINAL FUSION W/O CC
20|FH_F35216_0_0|SrvcGrp|10944|2022|PCT|0.75|99|0.00|EMERGENCY ROOM
20|FH_F35216_0_0|SrvcGrp|11258|2022|PCT|0.60|99|0.00|DRUGS
20|FH_F35216_0_0|SrvcGrp|13123|2022|PDM|650.00|99|0.00|COMPUTED TOMOGRAPHY (CT)
20|FH_F35217_0_0|CSTM-ALL|CSTM-00|2020|PDM|1678.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35221_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35221_0_0|SrvcGrp|97|2022|PDM|3900.00|99|0.00|C-SECTION
20|FH_F35245_0_0|SrvcGrp|9936|2022|PDM|70.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F35259_0_0|SrvcGrp|23348|2022|PDM|70265.00|99|0.00|CV SURGERY MS DRG'S ONLY 216-221, 231-236
20|FH_F35259_0_0|SrvcGrp|3499|2022|PCT|0.68|99|0.00|IMPLANTS
20|FH_F35262_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35271_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE
20|FH_F35271_0_0|SrvcGrp|9774|2022|PDM|1300.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F35278_0_0|CSTM-ALL|CSTM-00|2020|PDM|70.00|99|0.00|SPEECH THERAPY
20|FH_F35287_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35344_0_0|SrvcGrp|944|2022|PDM|12320.00|99|0.00|BARIATRIC SVCS
20|FH_F35344_0_0|SrvcGrp|9487|2022|PDM|6644.00|99|0.00|OP LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F35345_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35346_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F35357_0_0|CSTM-ALL|CSTM-00|2020|PDM|770.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F35366_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE
20|FH_F35368_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|HIGH COST PHARMACEUTICALS
20|FH_F35368_0_0|CSTM-ALL|CSTM-00|2020|PDM|1290.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F35368_0_0|SrvcGrp|1014|2022|PDM|6879.00|99|0.00|STENT PLACEMENT
20|FH_F35368_0_0|SrvcGrp|12211|2022|PDM|1110.00|99|0.00|ACUTE PHYSICAL REHAB
20|FH_F35368_0_0|SrvcGrp|12219|2022|PDM|6416.00|99|0.00|PACEMAKER IMPLANT
20|FH_F35368_0_0|SrvcGrp|97|2022|PDM|2750.00|99|0.00|C-SECTION
20|FH_F35369_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|CV SURGERY
20|FH_F35369_0_0|CSTM-ALL|CSTM-00|2020|PDM|770.00|99|0.00|ACUTE PSYCH
20|FH_F35369_0_0|CSTM-ALL|CSTM-00|2020|PDM|770.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F35369_0_0|SrvcGrp|12713|2022|PDM|13000.00|99|0.00|BRACHIOTHERAPY
20|FH_F35369_0_0|SrvcGrp|13004|2022|PCT|0.65|99|0.00|OP SURGERY
20|FH_F35369_0_0|SrvcGrp|16|2022|PDM|1100.00|99|0.00|ACUTE REHABILITATION
20|FH_F35369_0_0|SrvcGrp|16109|2022|PCT|1.15|99|0.00|IMPLANTS
20|FH_F35369_0_0|SrvcGrp|24|2022|PDM|3500.00|99|0.00|CARDIAC CATH
20|FH_F35369_0_0|SrvcGrp|413|2022|PCT|0.80|99|0.00|TRANSPLANT SVCS
20|FH_F35381_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|BURN SERVICES
20|FH_F35381_0_0|CSTM-ALL|CSTM-00|2020|PDM|2627.00|99|0.00|MS DRG 216-227, 231-236 CV SURGERY
20|FH_F35381_0_0|SrvcGrp|14495|2022|PCT|0.95|99|0.00|TRAUMA
20|FH_F35381_0_0|SrvcGrp|16777|2022|PCT|1.00|99|0.00|ORGAN ACQUISITION
20|FH_F35381_0_0|SrvcGrp|3066|2022|PCT|0.75|99|0.00|HIGH-COST DRUGS
20|FH_F35381_0_0|SrvcGrp|413|2022|PCT|0.70|99|0.00|TRANSPLANT SVCS
20|FH_F35381_0_0|SrvcGrp|941|2022|PDM|2100.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F35384_0_0|CSTM-ALL|CSTM-00|2020|PDM|1830.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35384_0_0|SrvcGrp|11086|2022|PDM|1178.00|99|0.00|CSECT (MOTHER ONLY)
20|FH_F35384_0_0|SrvcGrp|15361|2022|PDM|3351.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F35384_0_0|SrvcGrp|6|2022|PCT|0.70|99|0.00|OP SURGERY
20|FH_F35387_0_0|SrvcGrp|14414|2022|PDM|467.00|99|0.00|NEWBORN NURSERY
20|FH_F35387_0_0|SrvcGrp|15361|2022|PDM|3351.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F35387_0_0|SrvcGrp|6|2022|PCT|0.70|99|0.00|OP SURGERY
20|FH_F35388_0_0|CSTM-ALL|CSTM-00|2020|PDM|4200.00|99|0.00|MS DRG 765-766 C-SECTION
20|FH_F35388_0_0|SrvcGrp|10639|2022|PDM|1000.00|99|0.00|CT SCAN
20|FH_F35388_0_0|SrvcGrp|14320|2022|PCT|0.50|99|0.00|OP IMPLANTS/PROSTHETICS/DEVICES
20|FH_F35404_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|GENERAL ACUTE CARE
20|FH_F35404_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|MS DRG 767-768, 774-775 NORMAL DELIVERY
20|FH_F35404_0_0|SrvcGrp|12179|2022|PCT|0.55|99|0.00|CPT CODES 70000-79999 (RAD)
20|FH_F35404_0_0|SrvcGrp|3950|2022|PDM|5200.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F35404_0_0|SrvcGrp|66239|2022|PDM|5200.00|99|0.00|LITHOTRIPSY
20|FH_F35404_0_0|SrvcGrp|66240|2022|PDM|6982.00|99|0.00|PTCA
20|FH_F35408_0_0|CSTM-ALL|CSTM-00|2020|PDM|0.83|99|0.00|ADDITIONAL MILEAGE - WHEELCHAIR VAN
20|FH_F35408_0_0|CSTM-ALL|CSTM-00|2020|PDM|5.35|99|0.00|ADDITIONAL MILEAGE
20|FH_F35408_0_0|SrvcGrp|16896|2022|PDM|475.00|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2
20|FH_F35408_0_0|SrvcGrp|16900|2022|PDM|262.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT
20|FH_F35408_0_0|SrvcGrp|19609|2022|PDM|39.00|99|0.00|NONEMERGENCY TRANSPORTATION, WHEELCHAIR VAN
20|FH_F35411_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F35411_0_0|SrvcGrp|11036|2022|PCT|0.65|99|0.00|PHARMACY SVCS
20|FH_F35411_0_0|SrvcGrp|13152|2022|PDM|8050.00|99|0.00|RADIO FREQUENCY ABLATION
20|FH_F35411_0_0|SrvcGrp|13169|2022|PCT|0.65|99|0.00|RADIATION THERAPY SVCS
20|FH_F35411_0_0|SrvcGrp|360|2022|PDM|2080.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F35411_0_0|SrvcGrp|8968|2022|PDM|2512.00|99|0.00|NICU LEVEL III & IV
20|FH_F35411_0_0|SrvcGrp|913|2022|PDM|539.00|99|0.00|ELECTROSHOCK TREATMENT
20|FH_F35411_0_0|SrvcGrp|9263|2022|PDM|875.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F35411_0_0|SrvcGrp|9911|2022|PDM|4928.00|99|0.00|EMERGENCY ROOM SVCS
20|FH_F35416_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|DME/IMPLANTS/PROSTHETICS/PACEMAKERS/CARDIAC DEFIB
20|FH_F35416_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|DME/IMPLANTS/PROSTHETICS/PACEMAKERS/CARDIAC DEFIB
20|FH_F35416_0_0|SrvcGrp|11049|2022|PCT|0.80|99|0.00|OP LITHOTRIPSY
20|FH_F35416_0_0|SrvcGrp|16|2022|PDM|1386.00|99|0.00|ACUTE REHABILITATION
20|FH_F35416_0_0|SrvcGrp|29817|2022|PDM|4200.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F35416_0_0|SrvcGrp|35010|2022|PDM|6900.00|99|0.00|MS DRG 242-251 ONLY
20|FH_F35432_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|OP SVCS
20|FH_F35432_0_0|CSTM-ALL|CSTM-00|2020|PDM|3937.00|99|0.00|MS DRG 767-768, 774-775 NORMAL DELIVERY
20|FH_F35432_0_0|SrvcGrp|12394|2022|PCT|0.74|99|0.00|PROSTHETICS/IMPLANTS/DEVICES
20|FH_F35432_0_0|SrvcGrp|16870|2022|PDM|2081.00|99|0.00|ICU
20|FH_F35432_0_0|SrvcGrp|3029|2022|PDM|450.00|99|0.00|NEWBORN NURSERY
20|FH_F35442_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35446_0_0|CSTM-ALL|CSTM-00|2020|PDM|612.00|99|0.00|REHABILITATION DAY PROGRAM
20|FH_F35446_0_0|CSTM-ALL|CSTM-00|2020|PDM|690.00|99|0.00|ACUTE PSYCH
20|FH_F35446_0_0|SrvcGrp|12627|2022|PCT|0.70|99|0.00|DRUGS
20|FH_F35446_0_0|SrvcGrp|361|2022|PDM|2076.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F35448_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35448_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|PROFESSIONAL SVCS
20|FH_F35448_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|TRANSPLANT SVCS
20|FH_F35453_0_0|SrvcGrp|701|2022|PDM|1840.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F35453_0_0|SrvcGrp|72|2022|PDM|403.00|99|0.00|NEWBORN NURSERY
20|FH_F35453_0_0|SrvcGrp|97|2022|PDM|4025.00|99|0.00|C-SECTION
20|FH_F35458_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|ASPG II
20|FH_F35458_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|ASPG III
20|FH_F35458_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|ASPG IX
20|FH_F35458_0_0|SrvcGrp|3378|2022|PDM|2625.00|99|0.00|OBSERVATION SVCS
20|FH_F35458_0_0|SrvcGrp|360|2022|PDM|550.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F35458_0_0|SrvcGrp|58929|2022|PDM|5600.00|99|0.00|ORTHO SURGERY
20|FH_F35458_0_0|SrvcGrp|8968|2022|PDM|2300.00|99|0.00|NICU LEVEL III & IV
20|FH_F35476_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.84|99|0.00|OP SVCS
20|FH_F35476_0_0|CSTM-ALL|CSTM-00|2020|PDM|20000.00|99|0.00|MS DRG 243-244
20|FH_F35476_0_0|CSTM-ALL|CSTM-00|2020|PDM|21714.00|99|0.00|MS DRG 242
20|FH_F35476_0_0|CSTM-ALL|CSTM-00|2020|PDM|33926.00|99|0.00|MS DRG 233-234 CORONARY BYPASS
20|FH_F35476_0_0|CSTM-ALL|CSTM-00|2020|PDM|3737.00|99|0.00|MS DRG 775
20|FH_F35476_0_0|SrvcGrp|12393|2022|PCT|0.95|99|0.00|AMBULANCE SVCS
20|FH_F35476_0_0|SrvcGrp|19661|2022|PDM|41307.00|99|0.00|MS DRG 216-218 ONLY CARDIAC VALVE PROCEDURE W/CARDIAC CATH
20|FH_F35476_0_0|SrvcGrp|19961|2022|PDM|40124.00|99|0.00|MS DRG 231-232 ONLY CORONARY BYPASS W/ PTCA
20|FH_F35476_0_0|SrvcGrp|20272|2022|PDM|35580.00|99|0.00|MS DRG 219-221 ONLY CARDIAC VLV PROC W/O CA CAT
20|FH_F35476_0_0|SrvcGrp|997|2022|PCT|0.83|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F35499_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F35509_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35513_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.97|99|0.00|OP SVCS
20|FH_F35513_0_0|CSTM-ALL|CSTM-00|2020|PDM|75.00|99|0.00|SOCIAL WORKER (MEDICAL)
20|FH_F35513_0_0|SrvcGrp|16496|2022|PDM|900.00|99|0.00|POLYSOMNOGRAPHY - CPAP
20|FH_F35527_0_0|SrvcGrp|16496|2022|PDM|900.00|99|0.00|POLYSOMNOGRAPHY - CPAP
20|FH_F35567_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.83|99|0.00|GENERAL ACUTE CARE
20|FH_F35567_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.83|99|0.00|OP SVCS
20|FH_F35599_0_0|CSTM-ALL|CSTM-00|2020|PDM|825.00|99|0.00|ABORTION 15 WEEKS
20|FH_F35599_0_0|SrvcGrp|20848|2022|PDM|625.00|99|0.00|ABORTION UP TO 11 WEEKS
20|FH_F35622_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F35678_0_0|CSTM-ALL|CSTM-00|2020|PDM|1024.00|99|0.00|ACUTE PSYCH
20|FH_F35678_0_0|CSTM-ALL|CSTM-00|2020|PDM|11300.00|99|0.00|MS DRG 246
20|FH_F35678_0_0|CSTM-ALL|CSTM-00|2020|PDM|11300.00|99|0.00|MS DRG 247
20|FH_F35678_0_0|CSTM-ALL|CSTM-00|2020|PDM|1270.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35678_0_0|CSTM-ALL|CSTM-00|2020|PDM|16952.00|99|0.00|MS DRG 024
20|FH_F35678_0_0|CSTM-ALL|CSTM-00|2020|PDM|35315.00|99|0.00|CV SURGERY
20|FH_F35678_0_0|CSTM-ALL|CSTM-00|2020|PDM|3533.00|99|0.00|MS DRG 767-768, 774-775 NORMAL DELIVERY
20|FH_F35678_0_0|CSTM-ALL|CSTM-00|2020|PDM|8476.00|99|0.00|CIRCULATORY DSRDR W/ACUTE MYCRDL INFRCTN MS DRG 281-282
20|FH_F35678_0_0|CSTM-ALL|CSTM-00|2020|PDM|8476.00|99|0.00|MS DRG 030
20|FH_F35678_0_0|CSTM-ALL|CSTM-00|2020|PDM|8476.00|99|0.00|MS DRG 039
20|FH_F35678_0_0|SrvcGrp|13470|2022|PDM|1837.00|99|0.00|ACUTE SURGICAL SVCS
20|FH_F35678_0_0|SrvcGrp|16|2022|PDM|1024.00|99|0.00|ACUTE REHABILITATION
20|FH_F35678_0_0|SrvcGrp|1943|2022|PDM|1412.00|99|0.00|NEONATAL INTENSVE CARE II & III
20|FH_F35716_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35716_0_0|SrvcGrp|26001|2022|PDM|94.50|99|0.00|HOSPICE RESPITE SVCS
20|FH_F35716_0_0|SrvcGrp|3809|2022|PDM|483.00|99|0.00|HOSPICE CARE
20|FH_F35727_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F35730_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F35730_0_0|CSTM-ALL|CSTM-00|2020|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F35730_0_0|CSTM-ALL|CSTM-00|2020|PDM|90.00|99|0.00|SOCIAL WORKER (MEDICAL)
20|FH_F35730_0_0|CSTM-ALL|CSTM-00|2020|PDM|90.00|99|0.00|SPEECH THERAPY
20|FH_F35783_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35796_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.50|99|0.00|GENERAL ACUTE CARE
20|FH_F35798_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35804_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35805_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35847_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.63|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F35847_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.66|99|0.00|OP SVCS
20|FH_F35847_0_0|SrvcGrp|12047|2022|PCT|0.66|99|0.00|CPT CODES 80000-89999, 36415 (LAB)
20|FH_F35847_0_0|SrvcGrp|12596|2022|PCT|0.66|99|0.00|OP RADIOLOGY
20|FH_F35847_0_0|SrvcGrp|3066|2022|PCT|0.66|99|0.00|HIGH-COST DRUGS
20|FH_F35857_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35857_0_0|CSTM-ALL|CSTM-00|2020|PDM|1030.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F35857_0_0|CSTM-ALL|CSTM-00|2020|PDM|705.00|99|0.00|AEG 1 (NO REV)
20|FH_F35875_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35898_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F35926_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35926_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F35928_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS
20|FH_F35941_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE
20|FH_F35941_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS
20|FH_F35966_0_0|SrvcGrp|16899|2022|PDM|275.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT
20|FH_F35966_0_0|SrvcGrp|16900|2022|PDM|325.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT
20|FH_F35982_0_0|CSTM-ALL|CSTM-00|2020|PDM|1980.00|99|0.00|ASPG IX
20|FH_F35982_0_0|CSTM-ALL|CSTM-00|2020|PDM|612.00|99|0.00|ASPG III
20|FH_F35987_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F35987_0_0|SrvcGrp|115|2022|PDM|908.00|99|0.00|SKILLED NURSING CARE
20|FH_F35987_0_0|SrvcGrp|16|2022|PDM|1265.00|99|0.00|ACUTE REHABILITATION
20|FH_F35987_0_0|SrvcGrp|33793|2022|PDM|6087.00|99|0.00|MSDRG 246-251 ONLY ANGIOPLASTY
20|FH_F35987_0_0|SrvcGrp|360|2022|PDM|1461.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F35990_0_0|CSTM-ALL|CSTM-00|2020|PDM|1718.00|99|0.00|ACUTE IP MED SVCS
20|FH_F35990_0_0|SrvcGrp|115|2022|PDM|908.00|99|0.00|SKILLED NURSING CARE
20|FH_F35990_0_0|SrvcGrp|16|2022|PDM|1265.00|99|0.00|ACUTE REHABILITATION
20|FH_F35990_0_0|SrvcGrp|72|2022|PDM|601.00|99|0.00|NEWBORN NURSERY
20|FH_F36036_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36036_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F36036_0_0|CSTM-ALL|CSTM-00|2020|PDM|205.00|99|0.00|CPT CODE 93012
20|FH_F36036_0_0|SrvcGrp|10775|2022|PDM|205.00|99|0.00|CPT CODE 93271
20|FH_F36045_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36047_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36049_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36049_0_0|CSTM-ALL|CSTM-00|2020|PDM|435.00|99|0.00|MRI
20|FH_F36052_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F36107_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F36107_0_0|SrvcGrp|3810|2022|PDM|105.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F36118_0_0|SrvcGrp|1168|2022|PDM|25.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F36118_0_0|SrvcGrp|12264|2022|PDM|80.00|99|0.00|DIETICIAN OR LPN SERVICES
20|FH_F36118_0_0|SrvcGrp|14306|2022|PDM|53.00|99|0.00|WELL MOM/WELL BABY VISIT
20|FH_F36118_0_0|SrvcGrp|8962|2022|PDM|102.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F36118_0_0|SrvcGrp|9829|2022|PDM|102.00|99|0.00|PT SVCS
20|FH_F36127_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F36135_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36135_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F36137_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F36146_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|OP SVCS
20|FH_F36150_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F36154_0_0|SrvcGrp|38|2022|PDM|2500.00|99|0.00|NORMAL DELIVERY
20|FH_F36154_0_0|SrvcGrp|97|2022|PDM|4025.00|99|0.00|C-SECTION
20|FH_F36155_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OP SVCS
20|FH_F36170_0_0|SrvcGrp|12290|2022|PDM|618.00|99|0.00|DETOXIFICATION
20|FH_F36171_0_0|SrvcGrp|13298|2022|PCT|0.95|99|0.00|LABORATORY
20|FH_F36202_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|MSDRG 619-621 BARIATRIC SERVICES
20|FH_F36202_0_0|SrvcGrp|14937|2022|PDM|2999.00|99|0.00|ICU/CCU
20|FH_F36202_0_0|SrvcGrp|3066|2022|PCT|0.77|99|0.00|HIGH-COST DRUGS
20|FH_F36202_0_0|SrvcGrp|997|2022|PCT|0.75|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F36207_0_0|SrvcGrp|19607|2022|PDM|750.00|99|0.00|SPECIALTY CARE TRANSPORT
20|FH_F36217_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F36217_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.74|99|0.00|GENERAL ACUTE CARE
20|FH_F36217_0_0|SrvcGrp|15122|2022|PCT|0.70|99|0.00|CARDIAC CATH LAB SVCS
20|FH_F36222_0_0|CSTM-ALL|CSTM-00|2020|PDM|979.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36222_0_0|SrvcGrp|115|2022|PDM|412.00|99|0.00|SKILLED NURSING CARE
20|FH_F36237_0_0|CSTM-ALL|CSTM-00|2020|PCT|99.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36237_0_0|CSTM-ALL|CSTM-00|2020|PCT|99.00|99|0.00|OP SVCS
20|FH_F36263_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|OP SVCS
20|FH_F36263_0_0|SrvcGrp|13298|2022|PCT|0.83|99|0.00|LABORATORY
20|FH_F36274_0_0|SrvcGrp|12264|2022|PDM|70.00|99|0.00|DIETICIAN OR LPN SERVICES
20|FH_F36274_0_0|SrvcGrp|13703|2022|PDM|35.00|99|0.00|LICENSED PRACTICAL NURSE- HOURLY
20|FH_F36274_0_0|SrvcGrp|8962|2022|PDM|100.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F36274_0_0|SrvcGrp|9829|2022|PDM|90.00|99|0.00|PT SVCS
20|FH_F36274_0_0|SrvcGrp|9830|2022|PDM|90.00|99|0.00|OT SVCS
20|FH_F36286_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F36286_0_0|SrvcGrp|11606|2022|PDM|646.00|99|0.00|ACUTE CARE (MEDICAL & SURGICAL)
20|FH_F36299_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP IV THERAPY SERVICES
20|FH_F36299_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|OP SVCS
20|FH_F36299_0_0|SrvcGrp|24|2022|PCT|0.80|99|0.00|CARDIAC CATH
20|FH_F36328_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F36328_0_0|SrvcGrp|115|2022|PDM|468.00|99|0.00|SKILLED NURSING CARE
20|FH_F36328_0_0|SrvcGrp|72|2022|PDM|260.00|99|0.00|NEWBORN NURSERY
20|FH_F36338_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F36341_0_0|CSTM-ALL|CSTM-00|2020|PDM|1080.00|99|0.00|ASPG III
20|FH_F36341_0_0|CSTM-ALL|CSTM-00|2020|PDM|2838.00|99|0.00|ASPG IX
20|FH_F36341_0_0|CSTM-ALL|CSTM-00|2020|PDM|588.00|99|0.00|ACUTE PSYCH
20|FH_F36341_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36341_0_0|SrvcGrp|16|2022|PDM|893.00|99|0.00|ACUTE REHABILITATION
20|FH_F36350_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F36350_0_0|CSTM-ALL|CSTM-00|2020|PDM|1326.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36350_0_0|CSTM-ALL|CSTM-00|2020|PDM|424.00|99|0.00|MS DRG 789-794 SICK BABY
20|FH_F36350_0_0|SrvcGrp|29817|2022|PDM|3183.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F36350_0_0|SrvcGrp|3066|2022|PCT|0.65|99|0.00|HIGH-COST DRUGS
20|FH_F36350_0_0|SrvcGrp|72|2022|PDM|384.00|99|0.00|NEWBORN NURSERY
20|FH_F36363_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36366_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F36366_0_0|CSTM-ALL|CSTM-00|2020|PDM|632.00|99|0.00|CPT 95808 MOD TC
20|FH_F36366_0_0|SrvcGrp|13626|2022|PDM|648.00|99|0.00|SLEEP STUDIES
20|FH_F36385_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F36386_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F36386_0_0|SrvcGrp|3327|2022|PDM|90.00|99|0.00|HOSPICE SERVICE - IP RESPITE
20|FH_F36401_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.90|99|0.00|OP SVCS
20|FH_F36403_0_0|CSTM-ALL|CSTM-00|2020|PDM|575.00|99|0.00|R&B OTHER
20|FH_F36403_0_0|SrvcGrp|9861|2022|PDM|360.00|99|0.00|ACUTE REHABILITATION
20|FH_F36418_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36420_0_0|SrvcGrp|177|2022|PDM|1600.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F36429_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36431_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F36431_0_0|CSTM-ALL|CSTM-00|2020|PDM|1419.84|99|0.00|ASPG V
20|FH_F36431_0_0|CSTM-ALL|CSTM-00|2020|PDM|1836.00|99|0.00|ASPG IX
20|FH_F36431_0_0|CSTM-ALL|CSTM-00|2020|PDM|591.60|99|0.00|ASPG I
20|FH_F36431_0_0|CSTM-ALL|CSTM-00|2020|PDM|946.56|99|0.00|ASPG IV
20|FH_F36433_0_0|CSTM-ALL|CSTM-00|2020|PDM|1406.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36433_0_0|CSTM-ALL|CSTM-00|2020|PDM|29741.00|99|0.00|MS DRG 216-221, 228-236
20|FH_F36433_0_0|CSTM-ALL|CSTM-00|2020|PDM|486.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F36439_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F36439_0_0|SrvcGrp|23000|2022|PDM|1300.00|99|0.00|V5261
20|FH_F36439_0_0|SrvcGrp|23003|2022|PDM|1600.00|99|0.00|V5258
20|FH_F36439_0_0|SrvcGrp|23013|2022|PDM|650.00|99|0.00|V5246
20|FH_F36450_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|103.00|99|0.00|SALLY BALIN,999182,ASC 123
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|103.00|99|0.00|SALLY BALIN,999182,ASC 311
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|120.65|99|0.00|SALLY BALIN,999182,ASC 223
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|124.31|99|0.00|SALLY BALIN,999182,ASC 120
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|1450.64|99|0.00|SALLY BALIN,999182,ASC 903
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|148.34|99|0.00|SALLY BALIN,999182,ASC 222
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|153.12|99|0.00|SALLY BALIN,999182,ASC 118
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|161.85|99|0.00|SALLY BALIN,999182,ASC 221
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|191.45|99|0.00|SALLY BALIN,999182,ASC 219
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|259.40|99|0.00|SALLY BALIN,999182,ASC 218
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|292.86|99|0.00|SALLY BALIN,999182,ASC 106
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|292.86|99|0.00|SALLY BALIN,999182,ASC 306
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|351.69|99|0.00|SALLY BALIN,999182,ASC 104
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|402.68|99|0.00|SALLY BALIN,999182,ASC 209
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|409.77|99|0.00|SALLY BALIN,999182,ASC 208
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|434.24|99|0.00|SALLY BALIN,999182,ASC 303
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|487.28|99|0.00|SALLY BALIN,999182,ASC 203
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|492.65|99|0.00|SALLY BALIN,999182,ASC 202
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|540.44|99|0.00|SALLY BALIN,999182,ASC 302
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|733.56|99|0.00|SALLY BALIN,999182,ASC 401
20|FH_F36454_0_0|SrvcGrp|16719|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F36462_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36464_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS
20|FH_F36472_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|MS DRG 215-227, 231-234 CV SURGERY
20|FH_F36476_0_0|CSTM-ALL|CSTM-00|2020|PDM|1050.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36476_0_0|SrvcGrp|16|2022|PDM|800.00|99|0.00|ACUTE REHABILITATION
20|FH_F36479_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F36479_0_0|CSTM-ALL|CSTM-00|2020|PDM|2295.00|99|0.00|CV SURGERY
20|FH_F36479_0_0|SrvcGrp|115|2022|PDM|519.00|99|0.00|SKILLED NURSING CARE
20|FH_F36479_0_0|SrvcGrp|361|2022|PDM|1748.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F36479_0_0|SrvcGrp|413|2022|PCT|0.75|99|0.00|TRANSPLANT SVCS
20|FH_F36479_0_0|SrvcGrp|97|2022|PDM|1476.00|99|0.00|C-SECTION
20|FH_F36492_0_0|SrvcGrp|73008|2022|PDM|1080.00|99|0.00|AEG 10
20|FH_F36500_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36521_0_0|SrvcGrp|72|2022|PDM|220.00|99|0.00|NEWBORN NURSERY
20|FH_F36524_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36533_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36534_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36534_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS
20|FH_F36552_0_0|CSTM-ALL|CSTM-00|2020|PDM|10410.00|99|0.00|MS DRG 264
20|FH_F36552_0_0|CSTM-ALL|CSTM-00|2020|PDM|11515.00|99|0.00|MS DRG 238
20|FH_F36552_0_0|CSTM-ALL|CSTM-00|2020|PDM|20890.00|99|0.00|MS DRG 235
20|FH_F36552_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|ACUTE PSYCH
20|FH_F36552_0_0|CSTM-ALL|CSTM-00|2020|PDM|7845.00|99|0.00|MS DRG 285
20|FH_F36552_0_0|CSTM-ALL|CSTM-00|2020|PDM|9940.00|99|0.00|MS DRG 249
20|FH_F36555_0_0|SrvcGrp|472|2022|PDM|468.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F36576_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|MSDRG 216-238, 242-244, 246-251, 258, 261, 286-287 CV SURG
20|FH_F36576_0_0|SrvcGrp|147|2022|PCT|0.90|99|0.00|HOME HEALTH CARE
20|FH_F36576_0_0|SrvcGrp|72|2022|PDM|321.00|99|0.00|NEWBORN NURSERY
20|FH_F36590_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F36590_0_0|SrvcGrp|701|2022|PDM|1926.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F36590_0_0|SrvcGrp|72|2022|PDM|589.00|99|0.00|NEWBORN NURSERY
20|FH_F36594_0_0|SrvcGrp|12263|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE- HOURLY
20|FH_F36594_0_0|SrvcGrp|12264|2022|PDM|80.00|99|0.00|DIETICIAN OR LPN SERVICES
20|FH_F36594_0_0|SrvcGrp|13703|2022|PDM|40.00|99|0.00|LICENSED PRACTICAL NURSE- HOURLY
20|FH_F36594_0_0|SrvcGrp|3810|2022|PDM|120.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F36634_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F36634_0_0|CSTM-ALL|CSTM-00|2020|PDM|1430.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36634_0_0|SrvcGrp|16|2022|PDM|1084.00|99|0.00|ACUTE REHABILITATION
20|FH_F36646_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F36646_0_0|SrvcGrp|473|2022|PDM|375.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F36667_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36669_0_0|SrvcGrp|12403|2022|PDM|31.94|99|0.00|CONTINUOUS HOMECARE
20|FH_F36669_0_0|SrvcGrp|3810|2022|PDM|131.37|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F36681_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36681_0_0|CSTM-ALL|CSTM-00|2020|PDM|1808.00|99|0.00|ASPG IX
20|FH_F36681_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|ASPG I
20|FH_F36681_0_0|CSTM-ALL|CSTM-00|2020|PDM|968.00|99|0.00|ASPG V
20|FH_F36681_0_0|SrvcGrp|15472|2022|PDM|450.00|99|0.00|CPT CODE 62284
20|FH_F36681_0_0|SrvcGrp|15473|2022|PDM|968.00|99|0.00|CPT CODE 42820
20|FH_F36683_0_0|CSTM-ALL|CSTM-00|2020|PDM|11149.00|99|0.00|MS DRG 248
20|FH_F36683_0_0|CSTM-ALL|CSTM-00|2020|PDM|11149.00|99|0.00|MS DRG 249
20|FH_F36683_0_0|CSTM-ALL|CSTM-00|2020|PDM|11149.00|99|0.00|MS DRG 250
20|FH_F36683_0_0|CSTM-ALL|CSTM-00|2020|PDM|11149.00|99|0.00|MS DRG 251
20|FH_F36683_0_0|CSTM-ALL|CSTM-00|2020|PDM|5017.00|99|0.00|MS DRG 286
20|FH_F36683_0_0|SrvcGrp|6|2022|PDM|1968.00|99|0.00|OP SURGERY
20|FH_F36704_0_0|CSTM-ALL|CSTM-00|2020|PDM|2700.00|99|0.00|MSDRG 231-232 CORONARY BYPASS
20|FH_F36704_0_0|CSTM-ALL|CSTM-00|2020|PDM|2700.00|99|0.00|MSDRG 233-234 CORONARY BYPASS
20|FH_F36704_0_0|CSTM-ALL|CSTM-00|2020|PDM|619.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F36704_0_0|SrvcGrp|15|2022|PDM|1750.00|99|0.00|PEDIATRIC INTENSIVE CARE UNIT
20|FH_F36704_0_0|SrvcGrp|588|2022|PDM|1675.00|99|0.00|CORONARY CARE UNIT
20|FH_F36704_0_0|SrvcGrp|941|2022|PDM|1800.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F36710_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36715_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ORGAN ACQUISITION
20|FH_F36715_0_0|SrvcGrp|15122|2022|PCT|0.80|99|0.00|CARDIAC CATH LAB SVCS
20|FH_F36715_0_0|SrvcGrp|177|2022|PDM|1631.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F36719_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36732_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36734_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F36743_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|POST INTENSIVE CARE UNIT
20|FH_F36743_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.79|99|0.00|OP SVCS
20|FH_F36743_0_0|CSTM-ALL|CSTM-00|2020|PDM|2040.00|99|0.00|POST INTENSIVE CARE UNIT
20|FH_F36743_0_0|CSTM-ALL|CSTM-00|2020|PDM|7800.00|99|0.00|MSDRG 246-251 ANGIOPLASTY
20|FH_F36743_0_0|SrvcGrp|10013|2022|PDM|619.00|99|0.00|NEWBORN NURSERY
20|FH_F36743_0_0|SrvcGrp|16|2022|PDM|1125.00|99|0.00|ACUTE REHABILITATION
20|FH_F36743_0_0|SrvcGrp|23928|2022|PDM|5900.00|99|0.00|ABDOMINAL LAPAROSCOPIC PROCEDURES
20|FH_F36743_0_0|SrvcGrp|3037|2022|PDM|6115.00|99|0.00|LITHOTRIPSY
20|FH_F36743_0_0|SrvcGrp|997|2022|PCT|0.65|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F36749_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS
20|FH_F36750_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36761_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36788_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36803_0_0|CSTM-ALL|CSTM-00|2020|PDM|1553.00|99|0.00|GENERAL ACUTE CARE
20|FH_F36822_0_0|CSTM-ALL|CSTM-00|2020|PDM|11814.00|99|0.00|MS DRG 245
20|FH_F36822_0_0|CSTM-ALL|CSTM-00|2020|PDM|26136.00|99|0.00|MS DRG 216-227, 231-236 CV SURGERY
20|FH_F36822_0_0|SrvcGrp|72|2022|PDM|791.00|99|0.00|NEWBORN NURSERY
20|FH_F36830_0_0|CSTM-ALL|CSTM-00|2020|PCT|59.40|99|0.00|OP SVCS
20|FH_F36852_0_0|CSTM-ALL|CSTM-00|2020|PCT|63.80|99|0.00|GENERAL ACUTE CARE
20|FH_F36854_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F36854_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|PROSTHETICS/IMPLANTS
20|FH_F36854_0_0|CSTM-ALL|CSTM-00|2020|PDM|4050.00|99|0.00|CV SURGERY (MS DRG)
20|FH_F36854_0_0|SrvcGrp|361|2022|PDM|2225.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F36854_0_0|SrvcGrp|413|2022|PCT|0.75|99|0.00|TRANSPLANT SVCS
20|FH_F36854_0_0|SrvcGrp|72|2022|PDM|570.00|99|0.00|NEWBORN NURSERY
20|FH_F36883_0_0|SrvcGrp|52953|2022|PDM|260.00|99|0.00|PSYCHIATRIC CPT 90853
20|FH_F36883_0_0|SrvcGrp|73653|2022|PDM|260.00|99|0.00|AETNA INTENSIVE OUTPATIENT
20|FH_F36883_0_0|SrvcGrp|79699|2022|PCT|0.52|99|0.00|CARDIAC CATHETERIZATION INJECTIONS
20|FH_F36906_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F36917_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F36917_0_0|SrvcGrp|3259|2022|PDM|725.00|99|0.00|ACUTE REHABILITATION
20|FH_F36917_0_0|SrvcGrp|9811|2022|PDM|325.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F36955_0_0|CSTM-ALL|CSTM-00|2020|PDM|672.00|99|0.00|CD - RESIDENTIAL TREATMENT
20|FH_F37045_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F37075_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|OP SVCS
20|FH_F37077_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F37078_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE
20|FH_F37078_0_0|SrvcGrp|12496|2022|PDM|676.00|99|0.00|ACUTE REHABILITATION
20|FH_F37081_0_0|CSTM-ALL|CSTM-00|2020|PDM|13000.00|99|0.00|MS DRG 472-473
20|FH_F37081_0_0|CSTM-ALL|CSTM-00|2020|PDM|17669.00|99|0.00|MS DRG 460
20|FH_F37081_0_0|CSTM-ALL|CSTM-00|2020|PDM|18900.00|99|0.00|MS DRG 483
20|FH_F37081_0_0|CSTM-ALL|CSTM-00|2020|PDM|18900.00|99|0.00|MS DRG 484
20|FH_F37081_0_0|CSTM-ALL|CSTM-00|2020|PDM|25400.00|99|0.00|MS DRG 471
20|FH_F37081_0_0|CSTM-ALL|CSTM-00|2020|PDM|29771.00|99|0.00|MSDRG 235-236 CORONARY BYPASS
20|FH_F37081_0_0|CSTM-ALL|CSTM-00|2020|PDM|52864.00|99|0.00|MS DRG 225
20|FH_F37081_0_0|CSTM-ALL|CSTM-00|2020|PDM|6950.00|99|0.00|MS DRG 287
20|FH_F37081_0_0|CSTM-ALL|CSTM-00|2020|PDM|8150.00|99|0.00|MS DRG 490
20|FH_F37081_0_0|SrvcGrp|360|2022|PDM|2848.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F37081_0_0|SrvcGrp|38|2022|PDM|4500.00|99|0.00|NORMAL DELIVERY
20|FH_F37081_0_0|SrvcGrp|97|2022|PDM|5375.00|99|0.00|C-SECTION
20|FH_F37100_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F37104_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37104_0_0|CSTM-ALL|CSTM-00|2020|PDM|1162.00|99|0.00|ASPG VII
20|FH_F37104_0_0|CSTM-ALL|CSTM-00|2020|PDM|736.00|99|0.00|ASPG IV
20|FH_F37104_0_0|CSTM-ALL|CSTM-00|2020|PDM|965.00|99|0.00|ASPG VI
20|FH_F37152_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37152_0_0|SrvcGrp|11232|2022|PDM|550.00|99|0.00|PARTIAL HOSPITALIZATION
20|FH_F37171_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37181_0_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37188_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37188_0_0|CSTM-ALL|CSTM-00|2020|PDM|40.00|99|0.00|OP SVCS
20|FH_F37189_0_0|CSTM-ALL|CSTM-00|2020|PDM|45.00|99|0.00|OP SVCS
20|FH_F37190_0_0|CSTM-ALL|CSTM-00|2020|PDM|54.00|99|0.00|OP SVCS
20|FH_F37198_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE
20|FH_F37198_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F37198_0_0|SrvcGrp|36991|2022|PCT|0.40|99|0.00|IMPLANTS
20|FH_F37209_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE
20|FH_F37209_0_0|SrvcGrp|6|2022|PCT|0.90|99|0.00|OP SURGERY
20|FH_F37227_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F37227_0_0|CSTM-ALL|CSTM-00|2020|PDM|1123.00|99|0.00|ASPG VIII
20|FH_F37227_0_0|CSTM-ALL|CSTM-00|2020|PDM|1547.00|99|0.00|ASPG IX
20|FH_F37227_0_0|CSTM-ALL|CSTM-00|2020|PDM|589.00|99|0.00|ASPG III
20|FH_F37227_0_0|CSTM-ALL|CSTM-00|2020|PDM|728.00|99|0.00|ASPG IV
20|FH_F37227_0_0|CSTM-ALL|CSTM-00|2020|PDM|953.00|99|0.00|ASPG VI
20|FH_F37244_0_0|CSTM-ALL|CSTM-00|2020|PDM|170.00|99|0.00|OP SVCS
20|FH_F37257_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F37257_0_0|SrvcGrp|12158|2022|PCT|0.80|99|0.00|PT/OT/ST
20|FH_F37257_0_0|SrvcGrp|13749|2022|PDM|650.00|99|0.00|OP MRI
20|FH_F37257_0_0|SrvcGrp|147|2022|PCT|0.70|99|0.00|HOME HEALTH CARE
20|FH_F37267_0_0|SrvcGrp|12264|2022|PDM|60.75|99|0.00|DIETICIAN OR LPN SERVICES
20|FH_F37267_0_0|SrvcGrp|13703|2022|PDM|26.75|99|0.00|LICENSED PRACTICAL NURSE- HOURLY
20|FH_F37267_0_0|SrvcGrp|22954|2022|PDM|483.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F37267_0_0|SrvcGrp|3809|2022|PDM|483.00|99|0.00|HOSPICE CARE
20|FH_F37285_0_0|CSTM-ALL|CSTM-00|2020|PDM|1269.00|99|0.00|AEG 6 (NO REV)
20|FH_F37292_0_0|SrvcGrp|9460|2022|PDM|1434.00|99|0.00|ACUTE REHABILITATION
20|FH_F37292_0_0|SrvcGrp|9861|2022|PDM|1861.00|99|0.00|ACUTE REHABILITATION
20|FH_F37346_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37361_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37361_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F37361_0_0|SrvcGrp|12401|2022|PDM|88.00|99|0.00|RN VISIT
20|FH_F37361_0_0|SrvcGrp|9832|2022|PDM|82.50|99|0.00|ST SVCS
20|FH_F37364_0_0|SrvcGrp|11258|2022|PCT|0.70|99|0.00|DRUGS
20|FH_F37364_0_0|SrvcGrp|131|2022|PCT|0.70|99|0.00|PACEMAKER DEVICE
20|FH_F37364_0_0|SrvcGrp|2738|2022|PCT|0.70|99|0.00|IMPLANTS
20|FH_F37364_0_0|SrvcGrp|361|2022|PDM|1800.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F37364_0_0|SrvcGrp|72|2022|PDM|700.00|99|0.00|NEWBORN NURSERY
20|FH_F37385_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.97|99|0.00|GENERAL ACUTE CARE
20|FH_F37394_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE
20|FH_F37394_0_0|SrvcGrp|474|2022|PDM|600.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F37422_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F37422_0_0|SrvcGrp|473|2022|PDM|300.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F37440_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|IMPLANTS
20|FH_F37443_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|CARDIAC CATH LAB SVCS
20|FH_F37443_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|PROSTH/ORTHO/PACEMKR/INTRA LENS/IMPLNT/ROBOTIC SYS/SUPPLIES
20|FH_F37443_0_0|SrvcGrp|9774|2022|PDM|2100.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F37444_0_0|SrvcGrp|16615|2022|PCT|0.72|99|0.00|RN VISIT
20|FH_F37444_0_0|SrvcGrp|16617|2022|PCT|0.72|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F37444_0_0|SrvcGrp|16620|2022|PCT|0.72|99|0.00|PT SVCS
20|FH_F37478_0_0|SrvcGrp|15|2022|PDM|3638.00|99|0.00|PEDIATRIC INTENSIVE CARE UNIT
20|FH_F37478_0_0|SrvcGrp|6|2022|PCT|0.80|99|0.00|OP SURGERY
20|FH_F37478_0_0|SrvcGrp|8968|2022|PCT|0.80|99|0.00|NICU LEVEL III & IV
20|FH_F37487_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37487_0_0|SrvcGrp|15145|2022|PCT|0.70|99|0.00|DIALYSIS
20|FH_F37487_0_0|SrvcGrp|16615|2022|PDM|74.00|99|0.00|RN VISIT
20|FH_F37487_0_0|SrvcGrp|16619|2022|PDM|80.00|99|0.00|OT SVCS
20|FH_F37487_0_0|SrvcGrp|3259|2022|PDM|900.00|99|0.00|ACUTE REHABILITATION
20|FH_F37487_0_0|SrvcGrp|3611|2022|PCT|0.70|99|0.00|DURABLE MEDICAL EQUIPMENT
20|FH_F37490_0_0|CSTM-ALL|CSTM-00|2020|PDM|1041.55|99|0.00|ASPG V
20|FH_F37490_0_0|CSTM-ALL|CSTM-00|2020|PDM|1198.67|99|0.00|ASPG VI
20|FH_F37490_0_0|SrvcGrp|26278|2022|PDM|914.75|99|0.00|CPT 29881
20|FH_F37490_0_0|SrvcGrp|26421|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F37490_0_0|SrvcGrp|26475|2022|PDM|1750.00|99|0.00|OP SURGICAL SERVICES
20|FH_F37491_0_0|SrvcGrp|12525|2022|PDM|83.00|99|0.00|NEUROPSYCHOLOGY ASSESMENT
20|FH_F37491_0_0|SrvcGrp|12591|2022|PDM|135.00|99|0.00|CD FULL DAY
20|FH_F37491_0_0|SrvcGrp|23992|2022|PDM|37.00|99|0.00|PSYCH PARTIAL HOSP EXTENDED DAY
20|FH_F37491_0_0|SrvcGrp|3259|2022|PDM|370.00|99|0.00|ACUTE REHABILITATION
20|FH_F37493_0_0|SrvcGrp|16|2022|PDM|1254.00|99|0.00|ACUTE REHABILITATION
20|FH_F37493_0_0|SrvcGrp|413|2022|PCT|0.75|99|0.00|TRANSPLANT SVCS
20|FH_F37493_0_0|SrvcGrp|72|2022|PDM|649.00|99|0.00|NEWBORN NURSERY
20|FH_F37494_0_0|CSTM-ALL|CSTM-00|2020|PDM|1202.36|99|0.00|ASPG IV
20|FH_F37494_0_0|CSTM-ALL|CSTM-00|2020|PDM|1855.71|99|0.00|ASPG VIII
20|FH_F37545_0_0|CSTM-ALL|CSTM-00|2020|PDM|70.00|99|0.00|OP SVCS
20|FH_F37546_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F37546_0_0|SrvcGrp|10431|2022|PDM|91.00|99|0.00|SPEECH THERAPY
20|FH_F37546_0_0|SrvcGrp|15403|2022|PDM|191.75|99|0.00|SPEECH THERAPY SVCS INITIAL EVAL
20|FH_F56137_0_0|SrvcGrp|45882|2022|PDM|95.00|99|0.00|PT
20|FH_F56252_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F56252_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F56276_0_0|SrvcGrp|26778|2022|PDM|72.00|99|0.00|CPT 90816
20|FH_F56276_0_0|SrvcGrp|52943|2022|PDM|137.00|99|0.00|PSYCHIATRIC INITIAL EVALUATION CPT 90801
20|FH_F56276_0_0|SrvcGrp|52947|2022|PDM|94.00|99|0.00|PSYCHIATRIC CPT 90808
20|FH_F56276_0_0|SrvcGrp|52951|2022|PDM|106.00|99|0.00|PSYCHIATRIC CPT 90846
20|FH_F56276_0_0|SrvcGrp|52953|2022|PDM|63.00|99|0.00|PSYCHIATRIC CPT 90853
20|FH_F56293_0_0|SrvcGrp|52842|2022|PDM|380.00|99|0.00|GI PROCEDURE GROUP A
20|FH_F56332_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F56472_0_0|SrvcGrp|29347|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE
20|FH_F56573_0_0|SrvcGrp|13621|2022|PCT|0.00|99|0.00|SLEEP STUDIES
20|FH_F56672_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F56676_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F56678_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F56683_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE
20|FH_F56712_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F56772_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F56772_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F56813_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F56813_0_0|SrvcGrp|16|2022|PDM|2197.00|99|0.00|ACUTE REHABILITATION
20|FH_F56832_0_0|SrvcGrp|177|2022|PDM|1700.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F56832_0_0|SrvcGrp|43|2022|PCT|0.60|99|0.00|IMPLANTS
20|FH_F56952_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS
20|FH_F56972_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F56972_0_0|SrvcGrp|473|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F57032_0_0|SrvcGrp|53486|2022|PDM|11.00|99|0.00|LANCET
20|FH_F57073_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MSDRG CV SURGERY
20|FH_F57073_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F57073_0_0|CSTM-ALL|CSTM-00|2020|PDM|1393.00|99|0.00|SPECIALTY REHABILITATION
20|FH_F57073_0_0|SrvcGrp|944|2022|PDM|12480.00|99|0.00|BARIATRIC SVCS
20|FH_F57093_0_0|SrvcGrp|11232|2022|PDM|272.00|99|0.00|PARTIAL HOSPITALIZATION
20|FH_F57093_0_0|SrvcGrp|17808|2022|PDM|550.00|99|0.00|ELECTRO CONVULSIVE THERAPY
20|FH_F57093_0_0|SrvcGrp|3259|2022|PDM|652.00|99|0.00|ACUTE REHABILITATION
20|FH_F57114_0_0|CSTM-ALL|CSTM-00|2020|PCT|99.00|99|0.00|OP SVCS
20|FH_F57372_0_0|SrvcGrp|17100|2022|PDM|546.00|99|0.00|SKILLED NURSING
20|FH_F57372_0_0|SrvcGrp|45883|2022|PDM|110.00|99|0.00|OT
20|FH_F57396_0_0|SrvcGrp|46583|2022|PDM|80.00|99|0.00|CPT 99202
20|FH_F57553_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|CTR FOR DIGEST DIS $450  MOD SU
20|FH_F57592_0_0|CSTM-ALL|CSTM-00|2020|PDM|2900.00|99|0.00|GENERAL ACUTE CARE
20|FH_F57592_0_0|SrvcGrp|21102|2022|PDM|65000.00|99|0.00|MS DRG 219 ONLY
20|FH_F57592_0_0|SrvcGrp|28120|2022|PDM|22000.00|99|0.00|MS DRG 467 ONLY
20|FH_F57592_0_0|SrvcGrp|29280|2022|PDM|10000.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F57592_0_0|SrvcGrp|29606|2022|PDM|28500.00|99|0.00|MS DRG 218 ONLY
20|FH_F57592_0_0|SrvcGrp|29817|2022|PDM|5200.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F57912_0_0|CSTM-ALL|CSTM-00|2020|PDM|120.00|99|0.00|OP SVCS
20|FH_F58013_0_0|CSTM-ALL|CSTM-00|2020|PDM|110.00|99|0.00|OP SVCS
20|FH_F58096_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE
20|FH_F58153_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE
20|FH_F58153_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F58252_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE
20|FH_F58252_0_0|SrvcGrp|48385|2022|PDM|31.25|99|0.00|SPEECH THERAPY
20|FH_F58252_0_0|SrvcGrp|48393|2022|PDM|8.50|99|0.00|SKILLED NURSING SERVICES (PER HOUR)
20|FH_F58252_0_0|SrvcGrp|48395|2022|PDM|31.25|99|0.00|OT SERVICES
20|FH_F58252_0_0|SrvcGrp|48398|2022|PDM|31.25|99|0.00|PT SERVICES
20|FH_F58252_0_0|SrvcGrp|48399|2022|PDM|31.25|99|0.00|SPEECH THERAPY
20|FH_F58494_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F58494_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F58514_0_0|SrvcGrp|44326|2022|PDM|60.00|99|0.00|PT & OT (VISIT LVL) OT MOD GO
20|FH_F58514_0_0|SrvcGrp|76207|2022|PDM|60.00|99|0.00|SPEECH THERAPY (VISIT LVL) MOD GN
20|FH_F58574_0_0|SrvcGrp|76207|2022|PDM|60.00|99|0.00|SPEECH THERAPY (VISIT LVL) MOD GN
20|FH_F58592_0_0|CSTM-ALL|CSTM-00|2020|PDM|525.00|99|0.00|OP SURGERY (MOD SG)
20|FH_F58615_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F58713_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F58713_0_0|CSTM-ALL|CSTM-00|2020|PDM|1029.00|99|0.00|ASPG IV
20|FH_F58713_0_0|CSTM-ALL|CSTM-00|2020|PDM|1624.00|99|0.00|ASPG VII
20|FH_F58856_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS
20|FH_F58856_0_0|SrvcGrp|20898|2022|PDM|19500.00|99|0.00|MS DRG 246 ONLY
20|FH_F58856_0_0|SrvcGrp|20900|2022|PDM|22850.00|99|0.00|MS DRG 248 ONLY
20|FH_F58856_0_0|SrvcGrp|20910|2022|PDM|34600.00|99|0.00|MS DRG 234 ONLY
20|FH_F58856_0_0|SrvcGrp|20914|2022|PDM|36875.00|99|0.00|MS DRG 233 ONLY
20|FH_F58856_0_0|SrvcGrp|20926|2022|PDM|30625.00|99|0.00|MS DRG 235 ONLY
20|FH_F58856_0_0|SrvcGrp|21102|2022|PDM|36875.00|99|0.00|MS DRG 219 ONLY
20|FH_F58856_0_0|SrvcGrp|22406|2022|PDM|3350.00|99|0.00|ASPG VI (REV CODE + CPT)
20|FH_F58856_0_0|SrvcGrp|22408|2022|PDM|3875.00|99|0.00|ASPG VIII (REV CODE + CPT)
20|FH_F58856_0_0|SrvcGrp|28165|2022|PDM|32500.00|99|0.00|MS DRG 228 ONLY
20|FH_F58856_0_0|SrvcGrp|28167|2022|PDM|40000.00|99|0.00|MS DRG 231 ONLY
20|FH_F58856_0_0|SrvcGrp|29607|2022|PDM|34600.00|99|0.00|MS DRG 221 ONLY
20|FH_F58856_0_0|SrvcGrp|30623|2022|PDM|5150.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788
20|FH_F58856_0_0|SrvcGrp|31074|2022|PDM|950.00|99|0.00|MS DRG 795 ONLY
20|FH_F58856_0_0|SrvcGrp|50169|2022|PDM|32300.00|99|0.00|MSDRG 227 ONLY
20|FH_F58856_0_0|SrvcGrp|54973|2022|PDM|41600.00|99|0.00|MS DRG 225 ONLY
20|FH_F58973_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F58973_0_0|CSTM-ALL|CSTM-00|2020|PDM|1262.00|99|0.00|COVENTRY ENHANCED GROUPER 5
20|FH_F58973_0_0|CSTM-ALL|CSTM-00|2020|PDM|2355.00|99|0.00|COVENTRY ENHANCED GROUPER 10
20|FH_F58973_0_0|CSTM-ALL|CSTM-00|2020|PDM|585.00|99|0.00|COVENTRY ENHANCED GROUPER 1
20|FH_F58974_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS
20|FH_F59093_0_0|SrvcGrp|42973|2022|PDM|85.00|99|0.00|SPEECH  THERAPIST
20|FH_F59093_0_0|SrvcGrp|42974|2022|PDM|85.00|99|0.00|OCCUPATIONAL THERAPIST
20|FH_F59093_0_0|SrvcGrp|42975|2022|PDM|85.00|99|0.00|PHYSICAL THERAPIST
20|FH_F59093_0_0|SrvcGrp|88620|2022|PDM|85.00|99|0.00|SKILLED NURSING RN
20|FH_F59274_0_0|SrvcGrp|17140|2022|PDM|140.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F59274_0_0|SrvcGrp|46424|2022|PDM|32.00|99|0.00|HI TECH SKILLED NURSING SERVICES
20|FH_F59274_0_0|SrvcGrp|48399|2022|PDM|34.00|99|0.00|SPEECH THERAPY
20|FH_F59333_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F59333_0_0|SrvcGrp|26001|2022|PDM|139.76|99|0.00|HOSPICE RESPITE SVCS
20|FH_F59652_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE
20|FH_F59992_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F60019_0_0|SrvcGrp|26036|2022|PCT|0.75|99|0.00|DRUGS
20|FH_F60019_0_0|SrvcGrp|3259|2022|PDM|1342.00|99|0.00|ACUTE REHABILITATION
20|FH_F60019_0_0|SrvcGrp|34086|2022|PCT|0.75|99|0.00|PT/OT/ST
20|FH_F60072_0_0|CSTM-ALL|CSTM-00|2020|PDM|26200.00|99|0.00|MS DRG 456-482, 490-494
20|FH_F60072_0_0|SrvcGrp|14414|2022|PDM|515.00|99|0.00|NEWBORN NURSERY
20|FH_F60072_0_0|SrvcGrp|9444|2022|PCT|1.00|99|0.00|AMBULANCE SERVICES
20|FH_F60073_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F60095_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|OP SVCS
20|FH_F60232_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F60252_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F60273_0_0|CSTM-ALL|CSTM-00|2020|PDM|1249.30|99|0.00|ASPG VIII
20|FH_F60273_0_0|CSTM-ALL|CSTM-00|2020|PDM|1874.25|99|0.00|ASPG IX
20|FH_F60273_0_0|CSTM-ALL|CSTM-00|2020|PDM|651.63|99|0.00|ASPG III
20|FH_F60273_0_0|CSTM-ALL|CSTM-00|2020|PDM|805.65|99|0.00|ASPG IV
20|FH_F60273_0_0|SrvcGrp|29830|2022|PDM|7276.50|99|0.00|PERCUT NEEDLE INSERTION
20|FH_F60275_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F60276_0_0|CSTM-ALL|CSTM-00|2020|PDM|482.00|99|0.00|ASPG III
20|FH_F60276_0_0|CSTM-ALL|CSTM-00|2020|PDM|482.00|99|0.00|ASPG X
20|FH_F60276_0_0|CSTM-ALL|CSTM-00|2020|PDM|678.00|99|0.00|ASPG V
20|FH_F60276_0_0|SrvcGrp|56453|2022|PDM|750.00|99|0.00|VITRECTOMY
20|FH_F60292_0_0|SrvcGrp|32652|2022|PDM|500.00|99|0.00|SKILLED NURSING CARE
20|FH_F60296_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|MS DRG 927-929, 933-935 BURN SERVICES
20|FH_F60317_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F60317_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F60356_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F60356_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F60365_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|OP SVCS
20|FH_F60812_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|GENERAL ACUTE CARE
20|FH_F60812_0_0|SrvcGrp|10533|2022|PCT|0.75|99|0.00|SUBACUTE ANTEPARTUM SVCS
20|FH_F60812_0_0|SrvcGrp|3044|2022|PCT|0.75|99|0.00|TRANSITIONAL CARE UNIT
20|FH_F60812_0_0|SrvcGrp|44012|2022|PDM|3751.00|99|0.00|RESIDENTIAL REHABILITATION
20|FH_F60836_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F60836_0_0|CSTM-ALL|CSTM-00|2020|PDM|2660.00|99|0.00|ASPG X
20|FH_F60836_0_0|CSTM-ALL|CSTM-00|2020|PDM|878.72|99|0.00|ASPG IV
20|FH_F61072_0_0|SrvcGrp|42830|2022|PDM|75.00|99|0.00|MEDICAL SOCIAL WORKER VISIT
20|FH_F61292_0_0|CSTM-ALL|CSTM-00|2020|PDM|2112.00|99|0.00|ASPG IV - FH SW CUSTOM GROUPERS
20|FH_F61292_0_0|CSTM-ALL|CSTM-00|2020|PDM|2401.00|99|0.00|ASPG V - FH SW CUSTOM GROUPERS
20|FH_F61292_0_0|CSTM-ALL|CSTM-00|2020|PDM|3762.00|99|0.00|ASPG VIII - FH SW CUSTOM GROUPERS
20|FH_F61292_0_0|SrvcGrp|108|2022|PCT|0.63|99|0.00|EXTRA CORPOREAL MEMBRANE OXYGEN
20|FH_F61292_0_0|SrvcGrp|11920|2022|PCT|0.49|99|0.00|PHARMACY SVCS
20|FH_F61292_0_0|SrvcGrp|12413|2022|PDM|8720.00|99|0.00|PTCA
20|FH_F61292_0_0|SrvcGrp|12590|2022|PDM|523.00|99|0.00|PSYCH PARTIAL HOSP - FULL DAY
20|FH_F61292_0_0|SrvcGrp|12597|2022|PCT|0.49|99|0.00|DIALYSIS
20|FH_F61292_0_0|SrvcGrp|45882|2022|PDM|105.00|99|0.00|PT
20|FH_F61292_0_0|SrvcGrp|47260|2022|PCT|0.44|99|0.00|IMPLANTS 274-276, 278  LINE LEVEL
20|FH_F61292_0_0|SrvcGrp|57202|2022|PDM|2499.00|99|0.00|SPINE SURGERY
20|FH_F61292_0_0|SrvcGrp|57204|2022|PDM|23802.00|99|0.00|CYBER KNIFE RADIOSURGERY
20|FH_F61292_0_0|SrvcGrp|941|2022|PDM|3140.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F61292_0_0|SrvcGrp|99068|2022|PDM|31051.00|99|0.00|MS DRG 228-229 ONLY OTHER CARDIOTHORACIC PROC
20|FH_F61292_0_0|SrvcGrp|9978|2022|PDM|2168.00|99|0.00|ACUTE INPATIENT MEDICAL SVCS
20|FH_F61312_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F61332_0_0|CSTM-ALL|CSTM-00|2020|PDM|1150.00|99|0.00|GENERAL ACUTE CARE
20|FH_F61332_0_0|SrvcGrp|13268|2022|PCT|0.65|99|0.00|OCCUPATIONAL THERAPY
20|FH_F61332_0_0|SrvcGrp|16718|2022|PCT|1.05|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F61332_0_0|SrvcGrp|40222|2022|PCT|0.65|99|0.00|OP SVCS
20|FH_F61673_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F61773_0_0|CSTM-ALL|CSTM-00|2020|PCT|86.00|99|0.00|GENERAL ACUTE CARE
20|FH_F61813_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F62175_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F62175_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F62252_0_0|SrvcGrp|12496|2022|PDM|680.00|99|0.00|ACUTE REHABILITATION
20|FH_F62252_0_0|SrvcGrp|471|2022|PDM|550.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F62352_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F62394_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS
20|FH_F62513_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F62513_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F62513_0_0|CSTM-ALL|CSTM-00|2020|PDM|1212.60|99|0.00|ASPG II
20|FH_F62513_0_0|CSTM-ALL|CSTM-00|2020|PDM|1385.61|99|0.00|ASPG III
20|FH_F62513_0_0|CSTM-ALL|CSTM-00|2020|PDM|1709.53|99|0.00|ASPG IV
20|FH_F62513_0_0|SrvcGrp|36663|2022|PCT|1.00|99|0.00|IMPLANTS/PROSTHETICS/DEVICES/SUPPLIES
20|FH_F62577_0_0|SrvcGrp|13297|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F62577_0_0|SrvcGrp|58454|2022|PDM|652.00|99|0.00|ASPG I
20|FH_F62577_0_0|SrvcGrp|58463|2022|PDM|1074.00|99|0.00|ASPG X
20|FH_F62600_0_0|CSTM-ALL|CSTM-00|2020|PDM|1322.00|99|0.00|ASPG VI
20|FH_F62600_0_0|CSTM-ALL|CSTM-00|2020|PDM|1592.00|99|0.00|ASPG VII
20|FH_F62600_0_0|CSTM-ALL|CSTM-00|2020|PDM|2142.00|99|0.00|ASPG IX
20|FH_F62601_0_0|SrvcGrp|46605|2022|PDM|31.25|99|0.00|CLINICAL SOCIAL WORKER SERVICES
20|FH_F62601_0_0|SrvcGrp|48394|2022|PDM|7.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F62609_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F62614_0_0|SrvcGrp|48385|2022|PDM|30.00|99|0.00|SPEECH THERAPY
20|FH_F62614_0_0|SrvcGrp|48398|2022|PDM|30.00|99|0.00|PT SERVICES
20|FH_F62624_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F62624_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F62624_0_0|SrvcGrp|30623|2022|PDM|5000.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788
20|FH_F62624_0_0|SrvcGrp|58516|2022|PDM|5445.00|99|0.00|OP CARDIAC CATH
20|FH_F62624_0_0|SrvcGrp|58518|2022|PDM|6500.00|99|0.00|MS DRG 691 - 694 ONLY - LITHROTRIPSY
20|FH_F62624_0_0|SrvcGrp|9838|2022|PDM|2300.00|99|0.00|TRANSITIONAL CARE UNIT
20|FH_F62627_0_0|CSTM-ALL|CSTM-00|2020|PCT|36500.00|99|0.00|TIMELY FILING
20|FH_F62627_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F62681_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F62694_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F62695_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS
20|FH_F62702_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F62702_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F62713_0_0|SrvcGrp|22954|2022|PDM|135.11|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F62719_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F62719_0_0|SrvcGrp|44712|2022|PDM|108.00|99|0.00|OT SVCS
20|FH_F62719_0_0|SrvcGrp|59292|2022|PDM|50.67|99|0.00|SUBSEQUENT MATERNAL/CHILD HEALTH
20|FH_F62732_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F62750_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE
20|FH_F62754_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE
20|FH_F62754_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS
20|FH_F62773_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE
20|FH_F62797_0_0|CSTM-ALL|CSTM-00|2020|PCT|42.00|99|0.00|GENERAL ACUTE CARE
20|FH_F62799_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F62802_0_0|CSTM-ALL|CSTM-00|2020|PDM|1270.00|99|0.00|ASPG VI
20|FH_F62802_0_0|CSTM-ALL|CSTM-00|2020|PDM|1395.00|99|0.00|ASPG VIII
20|FH_F62802_0_0|CSTM-ALL|CSTM-00|2020|PDM|720.00|99|0.00|ASPG II
20|FH_F62802_0_0|CSTM-ALL|CSTM-00|2020|PDM|830.00|99|0.00|ASPG III
20|FH_F62816_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F62864_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F62867_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|OP SVCS
20|FH_F62867_0_0|SrvcGrp|1306|2022|PDM|300.00|99|0.00|OP PSYCH PARTIAL HOSP
20|FH_F62867_0_0|SrvcGrp|25686|2022|PDM|745.00|99|0.00|ACUTE PSYCH IP SVCS
20|FH_F62892_0_0|SrvcGrp|14254|2022|PDM|45.00|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F62892_0_0|SrvcGrp|53747|2022|PDM|35.00|99|0.00|RESPITE CARE
20|FH_F62917_0_0|CSTM-ALL|CSTM-00|2020|PCT|40.00|99|0.00|GENERAL ACUTE CARE
20|FH_F62922_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F62922_0_0|SrvcGrp|13778|2022|PDM|850.00|99|0.00|PSYCH/CD
20|FH_F62924_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|GENERAL ACUTE CARE
20|FH_F62924_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|OP SVCS
20|FH_F62974_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F62974_0_0|SrvcGrp|17140|2022|PDM|98.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F62977_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F62977_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|ASPG IX
20|FH_F62977_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|ASPG IV
20|FH_F62977_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|ASPG V
20|FH_F62978_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F62978_0_0|CSTM-ALL|CSTM-00|2020|PDM|535.00|99|0.00|ASPG II
20|FH_F62978_0_0|CSTM-ALL|CSTM-00|2020|PDM|612.00|99|0.00|ASPG III
20|FH_F63018_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63054_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63054_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F63081_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63081_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS
20|FH_F63095_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F63095_0_0|CSTM-ALL|CSTM-00|2020|PDM|4310.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63095_0_0|SrvcGrp|16536|2022|PCT|1.00|99|0.00|HIGH COST DRUGS
20|FH_F63095_0_0|SrvcGrp|27781|2022|PCT|0.65|99|0.00|CARDIAC CATH
20|FH_F63095_0_0|SrvcGrp|537|2022|PCT|0.65|99|0.00|OBSERVATION SERVICES
20|FH_F63101_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|OP SVCS
20|FH_F63101_0_0|CSTM-ALL|CSTM-00|2020|PDM|2960.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63114_0_0|SrvcGrp|46424|2022|PDM|25.00|99|0.00|HI TECH SKILLED NURSING SERVICES
20|FH_F63114_0_0|SrvcGrp|48385|2022|PDM|30.00|99|0.00|SPEECH THERAPY
20|FH_F63114_0_0|SrvcGrp|48393|2022|PDM|7.50|99|0.00|SKILLED NURSING SERVICES (PER HOUR)
20|FH_F63114_0_0|SrvcGrp|48394|2022|PDM|7.50|99|0.00|SKILLED NURSING SERVICES
20|FH_F63114_0_0|SrvcGrp|48398|2022|PDM|30.00|99|0.00|PT SERVICES
20|FH_F63114_0_0|SrvcGrp|48399|2022|PDM|30.00|99|0.00|SPEECH THERAPY
20|FH_F63124_0_0|SrvcGrp|46234|2022|PDM|135.00|99|0.00|SKILLED NURSING
20|FH_F63129_0_0|SrvcGrp|46350|2022|PDM|25.00|99|0.00|HI TECH SKILLED NURSING SERVICES
20|FH_F63129_0_0|SrvcGrp|48396|2022|PDM|30.00|99|0.00|OT SERVICES
20|FH_F63141_0_0|SrvcGrp|3259|2022|PDM|1300.00|99|0.00|ACUTE REHABILITATION
20|FH_F63141_0_0|SrvcGrp|33812|2022|PDM|370.00|99|0.00|IOP / MENTAL HEALTH / SUBSTANCE ABUSE
20|FH_F63141_0_0|SrvcGrp|38223|2022|PDM|1300.00|99|0.00|ADULT DETOX
20|FH_F63141_0_0|SrvcGrp|80|2022|PDM|1300.00|99|0.00|ACUTE PSYCH
20|FH_F63145_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F63145_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F63178_0_0|CSTM-ALL|CSTM-00|2020|PDM|401.00|99|0.00|COVENTRY ENHANCED GROUPER 1
20|FH_F63178_0_0|CSTM-ALL|CSTM-00|2020|PDM|538.00|99|0.00|COVENTRY ENHANCED GROUPER 2
20|FH_F63178_0_0|CSTM-ALL|CSTM-00|2020|PDM|864.00|99|0.00|COVENTRY ENHANCED GROUPER 10
20|FH_F63182_0_0|CSTM-ALL|CSTM-00|2020|PDM|1038.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F63185_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE
20|FH_F63185_0_0|SrvcGrp|46604|2022|PDM|35.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES
20|FH_F63185_0_0|SrvcGrp|46605|2022|PDM|35.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES
20|FH_F63185_0_0|SrvcGrp|48385|2022|PDM|30.00|99|0.00|SPEECH THERAPY
20|FH_F63185_0_0|SrvcGrp|48396|2022|PDM|30.00|99|0.00|OT SERVICES
20|FH_F63185_0_0|SrvcGrp|48398|2022|PDM|30.00|99|0.00|PT SERVICES
20|FH_F63186_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F63196_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F63229_0_0|SrvcGrp|43534|2022|PDM|365.00|99|0.00|HOME HEMODIALYSIS
20|FH_F63229_0_0|SrvcGrp|44244|2022|PDM|385.00|99|0.00|HEMODIALYSIS - HOME TRAINING
20|FH_F63229_0_0|SrvcGrp|44245|2022|PDM|160.00|99|0.00|CAPD/CCPD SUPPLEMENT
20|FH_F63235_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F63235_0_0|SrvcGrp|72990|2022|PDM|931.00|99|0.00|AEG 1
20|FH_F63235_0_0|SrvcGrp|72996|2022|PDM|2499.00|99|0.00|AEG 4
20|FH_F63235_0_0|SrvcGrp|72998|2022|PDM|2005.00|99|0.00|AEG 5
20|FH_F63244_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F63249_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F63249_0_0|SrvcGrp|23683|2022|PDM|30.00|99|0.00|SKILLED NURSING RN
20|FH_F63249_0_0|SrvcGrp|27969|2022|PDM|40.00|99|0.00|HOME HEALTH AIDE
20|FH_F63249_0_0|SrvcGrp|42973|2022|PDM|95.00|99|0.00|SPEECH  THERAPIST
20|FH_F63249_0_0|SrvcGrp|46118|2022|PDM|65.00|99|0.00|NUTRITNAL CNSLNG/DIABETES EDU
20|FH_F63249_0_0|SrvcGrp|57650|2022|PDM|70.00|99|0.00|OCCUPATIONAL THERAPY SVCS MOD GO
20|FH_F63249_0_0|SrvcGrp|59414|2022|PDM|95.00|99|0.00|PHYSICAL THERAPY SVCS EXCLD MOD GP
20|FH_F63258_0_0|CSTM-ALL|CSTM-00|2020|PCT|74.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63275_0_0|SrvcGrp|12403|2022|PDM|31.76|99|0.00|CONTINUOUS HOMECARE
20|FH_F63275_0_0|SrvcGrp|26001|2022|PDM|138.62|99|0.00|HOSPICE RESPITE SVCS
20|FH_F63276_0_0|SrvcGrp|42826|2022|PDM|140.00|99|0.00|PHYSICAL THERAPY VISIT
20|FH_F63276_0_0|SrvcGrp|42828|2022|PDM|140.00|99|0.00|SPEECH THERAPY VISIT
20|FH_F63281_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F63297_0_0|SrvcGrp|59424|2022|PDM|75.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F63297_0_0|SrvcGrp|59426|2022|PDM|75.00|99|0.00|PT
20|FH_F63297_0_0|SrvcGrp|59427|2022|PDM|75.00|99|0.00|OT
20|FH_F63312_0_0|CSTM-ALL|CSTM-00|2020|PDM|10.00|99|0.00|TELEMANAGEMENT SERVICES
20|FH_F63312_0_0|SrvcGrp|10518|2022|PDM|85.00|99|0.00|ENTEROSTOMAL VISIT F/U VISIT
20|FH_F63312_0_0|SrvcGrp|10541|2022|PDM|79.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F63312_0_0|SrvcGrp|10542|2022|PDM|79.00|99|0.00|OCCUPATIONAL THERAPY SVCS
20|FH_F63312_0_0|SrvcGrp|14080|2022|PDM|85.00|99|0.00|HOME VISIT - PRENATAL
20|FH_F63312_0_0|SrvcGrp|18024|2022|PDM|65.00|99|0.00|NUTRITNAL CNSLNG/DIABETES EDU
20|FH_F63312_0_0|SrvcGrp|22387|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F63312_0_0|SrvcGrp|26001|2022|PDM|110.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F63317_0_0|SrvcGrp|27249|2022|PDM|60.00|99|0.00|PT
20|FH_F63385_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63385_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F63385_0_0|CSTM-ALL|CSTM-00|2020|PDM|1794.00|99|0.00|ASPG VII
20|FH_F63385_0_0|CSTM-ALL|CSTM-00|2020|PDM|806.00|99|0.00|ASPG II
20|FH_F63396_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63398_0_0|SrvcGrp|1306|2022|PDM|300.00|99|0.00|OP PSYCH PARTIAL HOSP
20|FH_F63398_0_0|SrvcGrp|3259|2022|PDM|575.00|99|0.00|ACUTE REHABILITATION
20|FH_F63419_0_0|SrvcGrp|11232|2022|PDM|285.00|99|0.00|PARTIAL HOSPITALIZATION
20|FH_F63422_0_0|SrvcGrp|12496|2022|PDM|428.00|99|0.00|ACUTE REHABILITATION
20|FH_F63432_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.76|99|0.00|GENERAL ACUTE CARE
20|FH_F63432_0_0|SrvcGrp|4109|2022|PCT|0.76|99|0.00|ACUTE PSYCH
20|FH_F63436_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63438_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63444_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F63456_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F63462_0_0|CSTM-ALL|CSTM-00|2020|PDM|1845.00|99|0.00|ASPG VII
20|FH_F63462_0_0|CSTM-ALL|CSTM-00|2020|PDM|1903.00|99|0.00|ASPG IX
20|FH_F63462_0_0|SrvcGrp|11000|2022|PCT|0.50|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F63481_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.76|99|0.00|GENERAL ACUTE CARE
20|FH_F63481_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.76|99|0.00|OP SVCS
20|FH_F63481_0_0|SrvcGrp|26234|2022|PDM|850.00|99|0.00|SLEEP STUDIES
20|FH_F63494_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F63514_0_0|SrvcGrp|1168|2022|PDM|32.96|99|0.00|CONTINUOUS HOMECARE
20|FH_F63514_0_0|SrvcGrp|17140|2022|PDM|139.52|99|0.00|HOSPICE RESPITE SVCS
20|FH_F63552_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63552_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F63556_0_0|SrvcGrp|10400|2022|PDM|4000.00|99|0.00|IP SURGERY
20|FH_F63618_0_0|SrvcGrp|11258|2022|PCT|0.65|99|0.00|DRUGS
20|FH_F63618_0_0|SrvcGrp|16|2022|PDM|3000.00|99|0.00|ACUTE REHABILITATION
20|FH_F63625_0_0|SrvcGrp|12394|2022|PCT|0.60|99|0.00|PROSTHETICS/IMPLANTS/DEVICES
20|FH_F63625_0_0|SrvcGrp|32539|2022|PDM|11576.00|99|0.00|MS DRG 222-227 ONLY
20|FH_F63625_0_0|SrvcGrp|47103|2022|PCT|0.80|99|0.00|UNGROUPED OUTPATIENT SURGERY
20|FH_F63625_0_0|SrvcGrp|9511|2022|PDM|966.00|99|0.00|OBSERVATION SVCS
20|FH_F63759_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F63759_0_0|SrvcGrp|3205|2022|PDM|1225.00|99|0.00|ACUTE REHAB
20|FH_F63899_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS
20|FH_F64160_0_0|SrvcGrp|22954|2022|PDM|177.45|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F64160_0_0|SrvcGrp|60461|2022|PDM|179.96|99|0.00|RESIDENTIAL HOSPICE
20|FH_F64180_0_0|SrvcGrp|11442|2022|PDM|643.00|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)
20|FH_F64180_0_0|SrvcGrp|12023|2022|PDM|147.00|99|0.00|HOSPICE RESPITE SERVICES
20|FH_F64180_0_0|SrvcGrp|3327|2022|PDM|155.00|99|0.00|HOSPICE SERVICE - IP RESPITE
20|FH_F64180_0_0|SrvcGrp|37016|2022|PDM|68.00|99|0.00|PT/OT/ST
20|FH_F64180_0_0|SrvcGrp|3810|2022|PDM|147.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F64440_0_0|SrvcGrp|111603|2022|PDM|839.00|99|0.00|CT W/ & W/O CONTRAST
20|FH_F64440_0_0|SrvcGrp|61896|2022|PDM|110.00|99|0.00|OP PT/OT
20|FH_F64441_0_0|SrvcGrp|42784|2022|PDM|68.00|99|0.00|OCCUPATIONAL THERAPY  SRVCS
20|FH_F64659_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE
20|FH_F64659_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS
20|FH_F64659_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|EMERGENCY ROOM
20|FH_F64779_0_0|SrvcGrp|42827|2022|PDM|163.00|99|0.00|OCCUPATIONAL THERAPY VISIT
20|FH_F64779_0_0|SrvcGrp|42830|2022|PDM|163.00|99|0.00|MEDICAL SOCIAL WORKER VISIT
20|FH_F64839_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F64839_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F64940_0_0|SrvcGrp|1168|2022|PDM|38.25|99|0.00|CONTINUOUS HOMECARE
20|FH_F64940_0_0|SrvcGrp|12157|2022|PDM|93.50|99|0.00|RN VISIT
20|FH_F64940_0_0|SrvcGrp|17139|2022|PDM|605.00|99|0.00|HOSPICE CARE
20|FH_F64943_0_0|CSTM-ALL|CSTM-00|2020|PDM|598.00|99|0.00|ADULT PARTIAL HOSPITALIZATION
20|FH_F64943_0_0|SrvcGrp|17274|2022|PDM|697.00|99|0.00|CHEMICAL DEPENDENCY - ADULT
20|FH_F64943_0_0|SrvcGrp|61041|2022|PCT|0.80|99|0.00|TRANSCRANIAL MAGNETIC STIMULATION (TMS)
20|FH_F65100_0_0|SrvcGrp|44302|2022|PDM|60.00|99|0.00|PT & OT (VISIT LVL) PT MOD GP
20|FH_F65103_0_0|SrvcGrp|44302|2022|PDM|60.00|99|0.00|PT & OT (VISIT LVL) PT MOD GP
20|FH_F65103_0_0|SrvcGrp|44326|2022|PDM|60.00|99|0.00|PT & OT (VISIT LVL) OT MOD GO
20|FH_F65200_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F65239_0_0|CSTM-ALL|CSTM-00|2020|PDM|1181.00|99|0.00|AEG 6 (NO REV)
20|FH_F65239_0_0|SrvcGrp|36591|2022|PDM|984.00|99|0.00|CPT 63685
20|FH_F65239_0_0|SrvcGrp|61356|2022|PDM|984.00|99|0.00|SURGICAL CARVEOUTS (1)
20|FH_F65359_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F65359_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SURGERY
20|FH_F65440_0_0|CSTM-ALL|CSTM-00|2020|PDM|1718.00|99|0.00|COVENTRY ENHANCED GROUPER 8
20|FH_F65440_0_0|CSTM-ALL|CSTM-00|2020|PDM|2368.00|99|0.00|COVENTRY ENHANCED GROUPER 9
20|FH_F65440_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|COVENTRY ENHANCED GROUPER 3
20|FH_F65440_0_0|SrvcGrp|29830|2022|PDM|2571.00|99|0.00|PERCUT NEEDLE INSERTION
20|FH_F65444_0_0|SrvcGrp|76207|2022|PDM|75.00|99|0.00|SPEECH THERAPY (VISIT LVL) MOD GN
20|FH_F65680_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE
20|FH_F65681_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OUTPATIENT (THERAPIES)
20|FH_F65681_0_0|SrvcGrp|472|2022|PDM|460.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F65719_0_0|CSTM-ALL|CSTM-00|2020|PDM|1304.00|99|0.00|AEG 7 (NO REV)
20|FH_F65719_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 2 (NO REV)
20|FH_F65719_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|AEG 4 (NO REV)
20|FH_F65719_0_0|CSTM-ALL|CSTM-00|2020|PDM|939.00|99|0.00|AEG 5  (NO REV)
20|FH_F65979_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F65979_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|COVENTRY ENHANCED GROUPER 2
20|FH_F65979_0_0|CSTM-ALL|CSTM-00|2020|PDM|1320.00|99|0.00|COVENTRY ENHANCED GROUPER 3
20|FH_F65979_0_0|CSTM-ALL|CSTM-00|2020|PDM|1925.00|99|0.00|COVENTRY ENHANCED GROUPER 5
20|FH_F65979_0_0|SrvcGrp|61557|2022|PDM|1815.00|99|0.00|MUSCULOSKELETAL SURGERY
20|FH_F66059_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F66388_0_0|SrvcGrp|44105|2022|PDM|48.00|99|0.00|PHYSICAL THERAPY
20|FH_F66388_0_0|SrvcGrp|44107|2022|PDM|48.00|99|0.00|SPEECH THERAPY
20|FH_F66403_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F66404_0_0|SrvcGrp|471|2022|PDM|625.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F66405_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F66405_0_0|SrvcGrp|33165|2022|PDM|425.00|99|0.00|SKILLED NURSING - LEVEL II
20|FH_F66405_0_0|SrvcGrp|471|2022|PDM|625.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F66408_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F66408_0_0|SrvcGrp|33166|2022|PDM|500.00|99|0.00|SKILLED NURSING - LEVEL III
20|FH_F66408_0_0|SrvcGrp|471|2022|PDM|625.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F66409_0_0|SrvcGrp|33164|2022|PDM|350.00|99|0.00|SKILLED NURSING - LEVEL I
20|FH_F66409_0_0|SrvcGrp|33166|2022|PDM|500.00|99|0.00|SKILLED NURSING - LEVEL III
20|FH_F66410_0_0|SrvcGrp|33165|2022|PDM|425.00|99|0.00|SKILLED NURSING - LEVEL II
20|FH_F66410_0_0|SrvcGrp|33166|2022|PDM|500.00|99|0.00|SKILLED NURSING - LEVEL III
20|FH_F66412_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F66412_0_0|SrvcGrp|33165|2022|PDM|425.00|99|0.00|SKILLED NURSING - LEVEL II
20|FH_F66412_0_0|SrvcGrp|33166|2022|PDM|500.00|99|0.00|SKILLED NURSING - LEVEL III
20|FH_F66420_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F66420_0_0|SrvcGrp|33165|2022|PDM|425.00|99|0.00|SKILLED NURSING - LEVEL II
20|FH_F66420_0_0|SrvcGrp|471|2022|PDM|625.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F66422_0_0|SrvcGrp|44105|2022|PDM|48.00|99|0.00|PHYSICAL THERAPY
20|FH_F66422_0_0|SrvcGrp|473|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F66439_0_0|CSTM-ALL|CSTM-00|2020|PCT|36500.00|99|0.00|TIMELY FILING
20|FH_F66469_0_0|CSTM-ALL|CSTM-00|2020|PDM|1540.00|99|0.00|2006 MEDICARE ASPG IX
20|FH_F66469_0_0|CSTM-ALL|CSTM-00|2020|PDM|513.00|99|0.00|2006 MEDICARE ASPG II
20|FH_F66469_0_0|CSTM-ALL|CSTM-00|2020|PDM|587.00|99|0.00|2006 MEDICARE ASPG III
20|FH_F66469_0_0|CSTM-ALL|CSTM-00|2020|PDM|587.00|99|0.00|2006 MEDICARE ASPG X
20|FH_F66469_0_0|CSTM-ALL|CSTM-00|2020|PDM|725.00|99|0.00|2006 MEDICARE ASPG IV
20|FH_F66469_0_0|SrvcGrp|29718|2022|PCT|0.45|99|0.00|SUPPLIES/DEVICES/IMPLANTABLES
20|FH_F66480_0_0|SrvcGrp|14306|2022|PDM|247.00|99|0.00|WELL MOM/WELL BABY VISIT
20|FH_F66480_0_0|SrvcGrp|17621|2022|PDM|168.00|99|0.00|HOME HEALTH SVCS
20|FH_F66480_0_0|SrvcGrp|39524|2022|PDM|25.00|99|0.00|BILIRUBIN TEST
20|FH_F66481_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F66541_0_0|CSTM-ALL|CSTM-00|2020|PCT|13500.00|99|0.00|PERITONEAL DIALYSIS
20|FH_F66545_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F66545_0_0|SrvcGrp|61817|2022|PDM|110.00|99|0.00|PT SVCS
20|FH_F66545_0_0|SrvcGrp|61818|2022|PDM|110.00|99|0.00|OT SERVICES
20|FH_F66569_0_0|SrvcGrp|62260|2022|PDM|85.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F66569_0_0|SrvcGrp|62261|2022|PDM|85.00|99|0.00|SPEECH THERAPY
20|FH_F66642_0_0|CSTM-ALL|CSTM-00|2020|PCT|50.30|99|0.00|GENERAL ACUTE CARE
20|FH_F66687_0_0|CSTM-ALL|CSTM-00|2020|PDM|11452.00|99|0.00|CARDIAC CATH
20|FH_F66687_0_0|SrvcGrp|20744|2022|PCT|0.85|99|0.00|MS DRG 242 ONLY
20|FH_F66687_0_0|SrvcGrp|20910|2022|PDM|73092.00|99|0.00|MS DRG 234 ONLY
20|FH_F66687_0_0|SrvcGrp|20926|2022|PDM|77368.00|99|0.00|MS DRG 235 ONLY
20|FH_F66687_0_0|SrvcGrp|21106|2022|PDM|35205.00|99|0.00|MS DRG 250 ONLY
20|FH_F66687_0_0|SrvcGrp|21108|2022|PDM|44886.00|99|0.00|MS DRG 243 ONLY
20|FH_F66687_0_0|SrvcGrp|29757|2022|PDM|26191.00|99|0.00|MS DRG 251 ONLY
20|FH_F66687_0_0|SrvcGrp|39136|2022|PCT|0.85|99|0.00|MSDRG 226-227 ONLY CARDIAC
20|FH_F66687_0_0|SrvcGrp|62294|2022|PDM|31557.00|99|0.00|TRANSLUMINAL STENT PLACEMENT
20|FH_F66687_0_0|SrvcGrp|69923|2022|PDM|51051.00|99|0.00|PTCA W/ STENT
20|FH_F66687_0_0|SrvcGrp|69924|2022|PDM|24486.00|99|0.00|PTCA W/O STENT
20|FH_F66687_0_0|SrvcGrp|69926|2022|PDM|2312.00|99|0.00|ELECTROPHSIOLOGY
20|FH_F66705_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE
20|FH_F66705_0_0|SrvcGrp|42763|2022|PDM|85.00|99|0.00|SKILLED NURSING CARE VISIT
20|FH_F66705_0_0|SrvcGrp|62537|2022|PDM|70.00|99|0.00|SPEECH THERAPY
20|FH_F66705_0_0|SrvcGrp|62539|2022|PDM|70.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F66711_0_0|SrvcGrp|60057|2022|PDM|90.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F66760_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F66760_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F66760_0_0|SrvcGrp|63456|2022|PDM|2000.00|99|0.00|GLOBAL FEE FACILITY FEE (EXCLUDING DELIVERY)
20|FH_F66765_0_0|SrvcGrp|3810|2022|PDM|148.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F66765_0_0|SrvcGrp|42763|2022|PDM|100.00|99|0.00|SKILLED NURSING CARE VISIT
20|FH_F66765_0_0|SrvcGrp|44392|2022|PDM|40.00|99|0.00|HOME HEALTH AIDE
20|FH_F66765_0_0|SrvcGrp|62538|2022|PDM|100.00|99|0.00|PHYSICAL THERAPY
20|FH_F66835_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|GENERAL ACUTE CARE
20|FH_F66835_0_0|SrvcGrp|12591|2022|PDM|245.00|99|0.00|CD FULL DAY
20|FH_F66835_0_0|SrvcGrp|35966|2022|PDM|745.00|99|0.00|ECT
20|FH_F66879_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F66900_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F66961_0_0|SrvcGrp|76207|2022|PDM|60.00|99|0.00|SPEECH THERAPY (VISIT LVL) MOD GN
20|FH_F66970_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F66970_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|ASPG X
20|FH_F66970_0_0|CSTM-ALL|CSTM-00|2020|PDM|1050.00|99|0.00|ASPG V
20|FH_F66970_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|ASPG IX
20|FH_F67025_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|ASPG IV
20|FH_F67063_0_0|CSTM-ALL|CSTM-00|2020|PDM|1330.00|99|0.00|WELLPATH ASC VI
20|FH_F67086_0_0|SrvcGrp|17140|2022|PDM|139.76|99|0.00|HOSPICE RESPITE SVCS
20|FH_F67101_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE
20|FH_F67121_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE
20|FH_F67121_0_0|SrvcGrp|44883|2022|PDM|18.00|99|0.00|RT/PT/ST/OT
20|FH_F67121_0_0|SrvcGrp|474|2022|PDM|360.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F67132_0_0|CSTM-ALL|CSTM-00|2020|PCT|37.80|99|0.00|GENERAL ACUTE CARE
20|FH_F67136_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|BURN SERVICES
20|FH_F67136_0_0|SrvcGrp|16|2022|PDM|5056.00|99|0.00|ACUTE REHABILITATION
20|FH_F67136_0_0|SrvcGrp|31009|2022|PCT|0.65|99|0.00|OP SURGERY
20|FH_F67136_0_0|SrvcGrp|4109|2022|PDM|3371.00|99|0.00|ACUTE PSYCH
20|FH_F67136_0_0|SrvcGrp|8968|2022|PDM|10674.00|99|0.00|NICU LEVEL III & IV
20|FH_F67150_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F67169_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.00|99|0.00|OP SVCS
20|FH_F67173_0_0|CSTM-ALL|CSTM-00|2020|PDM|1415.00|99|0.00|ASPG VII - FH SW CUSTOM GROUPERS
20|FH_F67173_0_0|CSTM-ALL|CSTM-00|2020|PDM|5000.00|99|0.00|OP SVCS
20|FH_F67173_0_0|CSTM-ALL|CSTM-00|2020|PDM|720.00|99|0.00|ASPG II - FH SW CUSTOM GROUPERS
20|FH_F67173_0_0|CSTM-ALL|CSTM-00|2020|PDM|945.00|99|0.00|ASPG IV - FH SW CUSTOM GROUPERS
20|FH_F67173_0_0|SrvcGrp|63058|2022|PDM|945.00|99|0.00|UNLISTED CODES OP SURGERY
20|FH_F67180_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F67191_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|GENERAL ACUTE CARE
20|FH_F67195_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F67195_0_0|CSTM-ALL|CSTM-00|2020|PDM|1004.00|99|0.00|COVENTRY ENHANCED GROUPER 5
20|FH_F67195_0_0|CSTM-ALL|CSTM-00|2020|PDM|1875.00|99|0.00|COVENTRY ENHANCED GROUPER 9
20|FH_F67195_0_0|CSTM-ALL|CSTM-00|2020|PDM|466.00|99|0.00|COVENTRY ENHANCED GROUPER 1
20|FH_F67195_0_0|CSTM-ALL|CSTM-00|2020|PDM|624.00|99|0.00|COVENTRY ENHANCED GROUPER 2
20|FH_F67195_0_0|CSTM-ALL|CSTM-00|2020|PDM|882.00|99|0.00|COVENTRY ENHANCED GROUPER 4
20|FH_F67204_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F67265_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|PEDIATRIC PSYCHIATRIC SERVICES
20|FH_F67288_0_0|CSTM-ALL|CSTM-00|2020|PCT|9000.00|99|0.00|TIMELY FILING
20|FH_F67300_0_0|SrvcGrp|9518|2022|PCT|0.75|99|0.00|EMERGENCY ROOM
20|FH_F67302_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F67302_0_0|SrvcGrp|9518|2022|PCT|0.75|99|0.00|EMERGENCY ROOM
20|FH_F67303_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F67306_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F67309_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|GENERAL ACUTE CARE
20|FH_F67309_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|OP SVCS
20|FH_F67319_0_0|SrvcGrp|23683|2022|PDM|47.00|99|0.00|SKILLED NURSING RN
20|FH_F67319_0_0|SrvcGrp|27969|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE
20|FH_F67319_0_0|SrvcGrp|63536|2022|PDM|105.00|99|0.00|HOSPICE CARE/ IN HOME S9126 VISIT LEVEL
20|FH_F67339_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F67339_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F67339_0_0|SrvcGrp|474|2022|PDM|1100.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F67339_0_0|SrvcGrp|9936|2022|PDM|65.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F67379_0_0|SrvcGrp|11920|2022|PCT|0.74|99|0.00|PHARMACY SVCS
20|FH_F67379_0_0|SrvcGrp|16|2022|PDM|1024.00|99|0.00|ACUTE REHABILITATION
20|FH_F67379_0_0|SrvcGrp|44564|2022|PDM|423.00|99|0.00|NEWBORN NURSERY
20|FH_F67424_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS
20|FH_F67425_0_0|SrvcGrp|30031|2022|PDM|3400.00|99|0.00|PTCA + CATH
20|FH_F67425_0_0|SrvcGrp|30133|2022|PDM|7165.00|99|0.00|LASER SURGERY
20|FH_F67425_0_0|SrvcGrp|30623|2022|PDM|2200.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788
20|FH_F67425_0_0|SrvcGrp|4109|2022|PDM|1620.00|99|0.00|ACUTE PSYCH
20|FH_F67425_0_0|SrvcGrp|8968|2022|PDM|2730.00|99|0.00|NICU LEVEL III & IV
20|FH_F67425_0_0|SrvcGrp|9774|2022|PDM|2569.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F67502_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|GENERAL ACUTE CARE
20|FH_F67560_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.83|99|0.00|OP SVCS
20|FH_F67560_0_0|SrvcGrp|17077|2022|PCT|0.83|99|0.00|ASPG VII
20|FH_F67560_0_0|SrvcGrp|17081|2022|PCT|0.83|99|0.00|ASPG IX
20|FH_F67581_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F67639_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F67639_0_0|CSTM-ALL|CSTM-00|2020|PDM|492.54|99|0.00|ASPG III
20|FH_F67639_0_0|SrvcGrp|63460|2022|PDM|1100.00|99|0.00|CPT 55040
20|FH_F67639_0_0|SrvcGrp|63461|2022|PDM|1025.00|99|0.00|CPT 52235
20|FH_F67639_0_0|SrvcGrp|63468|2022|PDM|650.00|99|0.00|CPT 52281
20|FH_F67639_0_0|SrvcGrp|63471|2022|PDM|12562.00|99|0.00|CPT 64590
20|FH_F67639_0_0|SrvcGrp|63472|2022|PDM|4750.00|99|0.00|CPT 64581
20|FH_F67680_0_0|CSTM-ALL|CSTM-00|2020|PDM|135.00|99|0.00|OP SVCS
20|FH_F67683_0_0|SrvcGrp|3259|2022|PDM|652.00|99|0.00|ACUTE REHABILITATION
20|FH_F67683_0_0|SrvcGrp|80|2022|PDM|652.00|99|0.00|ACUTE PSYCH
20|FH_F67741_0_0|CSTM-ALL|CSTM-00|2020|PCT|45.00|99|0.00|OP SVCS
20|FH_F67763_0_0|SrvcGrp|44245|2022|PDM|150.00|99|0.00|CAPD/CCPD SUPPLEMENT
20|FH_F67763_0_0|SrvcGrp|64297|2022|PDM|280.00|99|0.00|CAPD
20|FH_F67861_0_0|SrvcGrp|3099|2022|PCT|0.75|99|0.00|OP SURGERY
20|FH_F67861_0_0|SrvcGrp|46028|2022|PDM|95.00|99|0.00|URGENT CARE/PROMPT CARE CLINIC
20|FH_F67861_0_0|SrvcGrp|46030|2022|PDM|19800.00|99|0.00|GASTRIC REDUCTION - DUODENAL SWITCH
20|FH_F67861_0_0|SrvcGrp|9774|2022|PDM|3300.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F67887_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F67887_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F67887_0_0|SrvcGrp|12157|2022|PDM|114.00|99|0.00|RN VISIT
20|FH_F67887_0_0|SrvcGrp|13703|2022|PDM|31.00|99|0.00|LICENSED PRACTICAL NURSE- HOURLY
20|FH_F67887_0_0|SrvcGrp|42826|2022|PDM|100.00|99|0.00|PHYSICAL THERAPY VISIT
20|FH_F67888_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F67888_0_0|SrvcGrp|26001|2022|PDM|142.05|99|0.00|HOSPICE RESPITE SVCS
20|FH_F67920_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE
20|FH_F67920_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS
20|FH_F67924_0_0|SrvcGrp|29137|2022|PDM|23.00|99|0.00|HOME HEALTH AIDE
20|FH_F67924_0_0|SrvcGrp|44949|2022|PDM|44.00|99|0.00|RESPIRATORY THERAPY SVCS
20|FH_F67924_0_0|SrvcGrp|45783|2022|PDM|115.00|99|0.00|SKILLED NURSING VISIT
20|FH_F67963_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|PHYSICIANS SERVICES (CMS 1500)
20|FH_F67963_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|GENERAL ACUTE CARE
20|FH_F67963_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|OP SVCS
20|FH_F67984_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F67984_0_0|SrvcGrp|17139|2022|PDM|540.00|99|0.00|HOSPICE CARE
20|FH_F67986_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F68043_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|EMERGENCY ROOM SVCS
20|FH_F68043_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F68121_0_0|SrvcGrp|64322|2022|PDM|100.00|99|0.00|SPEECH THERAPY
20|FH_F68121_0_0|SrvcGrp|64324|2022|PDM|100.00|99|0.00|BIOFEEDBACK
20|FH_F68121_0_0|SrvcGrp|64377|2022|PDM|100.00|99|0.00|SPEECH THERAPY EVAL/RE-EVAL
20|FH_F68161_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F68161_0_0|CSTM-ALL|CSTM-00|2020|PDM|1068.00|99|0.00|COVENTRY ENHANCED GROUPER 1
20|FH_F68161_0_0|CSTM-ALL|CSTM-00|2020|PDM|2755.00|99|0.00|COVENTRY ENHANCED GROUPER 6
20|FH_F68161_0_0|CSTM-ALL|CSTM-00|2020|PDM|2790.00|99|0.00|COVENTRY ENHANCED GROUPER 8
20|FH_F68161_0_0|CSTM-ALL|CSTM-00|2020|PDM|2855.00|99|0.00|COVENTRY ENHANCED GROUPER 7
20|FH_F68251_0_0|SrvcGrp|33166|2022|PDM|475.00|99|0.00|SKILLED NURSING - LEVEL III
20|FH_F68251_0_0|SrvcGrp|43893|2022|PDM|80.00|99|0.00|OCCUPATIONAL THERAPY VISIT
20|FH_F68309_0_0|CSTM-ALL|CSTM-00|2020|PDM|994.00|99|0.00|AEG 6 (NO REV)
20|FH_F68322_0_0|SrvcGrp|17067|2022|PDM|785.00|99|0.00|ASPG II
20|FH_F68343_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F68363_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F68363_0_0|SrvcGrp|12043|2022|PDM|210.00|99|0.00|CPT 99205
20|FH_F68363_0_0|SrvcGrp|3404|2022|PDM|55.00|99|0.00|CPT 99211
20|FH_F68363_0_0|SrvcGrp|3406|2022|PDM|190.00|99|0.00|CPT 99214
20|FH_F68365_0_0|CSTM-ALL|CSTM-00|2020|PDM|668.00|99|0.00|COVENTRY ENHANCED GROUPER 3
20|FH_F68365_0_0|CSTM-ALL|CSTM-00|2020|PDM|939.00|99|0.00|COVENTRY ENHANCED GROUPER 5
20|FH_F68441_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE
20|FH_F68441_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS
20|FH_F68460_0_0|SrvcGrp|75522|2022|PDM|517.00|99|0.00|RESIDENTIAL TREATMENT PSYCHIATIC OR CD
20|FH_F68460_0_0|SrvcGrp|89337|2022|PDM|813.00|99|0.00|DETOXIFICATION
20|FH_F68481_0_0|CSTM-ALL|CSTM-00|2020|PDM|1110.00|99|0.00|ASPG IV
20|FH_F68481_0_0|CSTM-ALL|CSTM-00|2020|PDM|1480.00|99|0.00|ASPG VI
20|FH_F68481_0_0|CSTM-ALL|CSTM-00|2020|PDM|1750.00|99|0.00|ASPG VII
20|FH_F68481_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|ASPG III
20|FH_F68481_0_0|SrvcGrp|64776|2022|PCT|1.00|99|0.00|CORNEAL TISSUE IMPLANTS/PROSTHETICS/ORTHO
20|FH_F68622_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F68622_0_0|SrvcGrp|10708|2022|PCT|0.80|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F68622_0_0|SrvcGrp|8960|2022|PCT|0.80|99|0.00|SPEECH THERAPY
20|FH_F68622_0_0|SrvcGrp|9541|2022|PCT|0.80|99|0.00|OCCUPATIONAL THERAPY
20|FH_F68622_0_0|SrvcGrp|9861|2022|PDM|1138.00|99|0.00|ACUTE REHABILITATION
20|FH_F68626_0_0|SrvcGrp|33659|2022|PDM|400.00|99|0.00|DIALYSIS SERVICES
20|FH_F68660_0_0|SrvcGrp|14096|2022|PCT|0.65|99|0.00|EMERGENCY ROOM SVCS
20|FH_F68660_0_0|SrvcGrp|3378|2022|PCT|0.65|99|0.00|OBSERVATION SVCS
20|FH_F68699_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|GENERAL ACUTE CARE
20|FH_F68719_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F68828_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F68831_0_0|SrvcGrp|3809|2022|PDM|605.00|99|0.00|HOSPICE CARE
20|FH_F68831_0_0|SrvcGrp|9829|2022|PDM|99.00|99|0.00|PT SVCS
20|FH_F68837_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F68837_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F68837_0_0|SrvcGrp|38024|2022|PDM|1011.00|99|0.00|DIALYSIS/PLASMAPHRESIS
20|FH_F68841_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F68843_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F68843_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS
20|FH_F68844_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|ACUTE IP MEDICAL SVCS
20|FH_F68844_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE
20|FH_F68844_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|TRANSPLANT MSDRG ONLY
20|FH_F68844_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|TRAUMA CARE
20|FH_F68850_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F68853_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F68856_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F68865_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F68866_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE
20|FH_F68868_0_0|SrvcGrp|1943|2022|PDM|2605.00|99|0.00|NEONATAL INTENSVE CARE II & III
20|FH_F68868_0_0|SrvcGrp|941|2022|PDM|3126.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F68887_0_0|SrvcGrp|44105|2022|PDM|48.00|99|0.00|PHYSICAL THERAPY
20|FH_F68887_0_0|SrvcGrp|44106|2022|PDM|48.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F68887_0_0|SrvcGrp|472|2022|PDM|460.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F68887_0_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F68887_0_0|SrvcGrp|474|2022|PDM|250.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F68888_0_0|SrvcGrp|44105|2022|PDM|48.00|99|0.00|PHYSICAL THERAPY
20|FH_F68909_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|OP SVCS
20|FH_F68944_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F68944_0_0|SrvcGrp|43986|2022|PDM|4422.00|99|0.00|CARDIAC PACEMAKER (MS DRG 242-244, 258-262 ONLY)
20|FH_F68944_0_0|SrvcGrp|44008|2022|PCT|0.70|99|0.00|EMERGENCY ROOM SERVICES
20|FH_F68944_0_0|SrvcGrp|60|2022|PDM|2870.00|99|0.00|NEWBORN NURSERY - LEVEL II
20|FH_F68944_0_0|SrvcGrp|8968|2022|PDM|3500.00|99|0.00|NICU LEVEL III & IV
20|FH_F68947_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F68947_0_0|CSTM-ALL|CSTM-00|2020|PDM|1850.00|99|0.00|COVENTRY ENHANCED GROUPER 4
20|FH_F68947_0_0|SrvcGrp|59705|2022|PDM|5367.60|99|0.00|SEPTOPLASTY
20|FH_F68950_0_0|CSTM-ALL|CSTM-00|2020|PDM|1009.45|99|0.00|ASPG II
20|FH_F68950_0_0|CSTM-ALL|CSTM-00|2020|PDM|1623.00|99|0.00|ASPG V
20|FH_F68950_0_0|SrvcGrp|27751|2022|PDM|2894.06|99|0.00|OP ARTHROSCOPY
20|FH_F68950_0_0|SrvcGrp|40944|2022|PDM|2662.54|99|0.00|BIOPSY OF BREAST
20|FH_F68964_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|OP SVCS
20|FH_F68966_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|GENERAL ACUTE CARE
20|FH_F68968_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|OP SVCS
20|FH_F68974_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|GENERAL ACUTE CARE
20|FH_F68974_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|OP SVCS
20|FH_F69023_0_0|CSTM-ALL|CSTM-00|2020|PDM|134.00|99|0.00|OP SVCS
20|FH_F69063_0_0|SrvcGrp|30609|2022|PDM|45.00|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F69063_0_0|SrvcGrp|42973|2022|PDM|95.00|99|0.00|SPEECH  THERAPIST
20|FH_F69063_0_0|SrvcGrp|43955|2022|PDM|90.00|99|0.00|NURSING CARE
20|FH_F69063_0_0|SrvcGrp|43957|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE
20|FH_F69071_0_0|SrvcGrp|13262|2022|PDM|11.91|99|0.00|GROUND MILEAGE, PER STATUTE MILE
20|FH_F69071_0_0|SrvcGrp|13683|2022|PDM|864.00|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2
20|FH_F69084_0_0|CSTM-ALL|CSTM-00|2020|PDM|1515.00|99|0.00|AEG 9 (NO REV)
20|FH_F69084_0_0|CSTM-ALL|CSTM-00|2020|PDM|431.00|99|0.00|AEG 1 (NO REV)
20|FH_F69084_0_0|CSTM-ALL|CSTM-00|2020|PDM|576.00|99|0.00|AEG 2 (NO REV)
20|FH_F69122_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F69122_0_0|SrvcGrp|32555|2022|PDM|512.50|99|0.00|IV HYDRATION FOR HYPEREMESIS
20|FH_F69202_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F69202_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.90|99|0.00|ASPG VIII
20|FH_F69202_0_0|SrvcGrp|115740|2022|PDM|3500.00|99|0.00|ASPG AMBULATORY SURGERY UNGROUPABLE
20|FH_F69202_0_0|SrvcGrp|16|2022|PDM|1800.00|99|0.00|ACUTE REHABILITATION
20|FH_F69202_0_0|SrvcGrp|20096|2022|PDM|42500.00|99|0.00|MS DRG 222-223 ONLY
20|FH_F69202_0_0|SrvcGrp|20297|2022|PDM|31900.00|99|0.00|MS DRG 219-221 ONLY CARDIAC VALVE PROC
20|FH_F69202_0_0|SrvcGrp|26690|2022|PDM|62600.00|99|0.00|MS DRG 215 ONLY
20|FH_F69202_0_0|SrvcGrp|30623|2022|PDM|4300.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788
20|FH_F69202_0_0|SrvcGrp|31778|2022|PDM|16400.00|99|0.00|MS DRG 246-247, 249 ONLY  PTCA W/STENT
20|FH_F69202_0_0|SrvcGrp|31782|2022|PDM|9300.00|99|0.00|MSDRG 258-262 ONLY PACEMAKER REVISION OR REPLACEMENT
20|FH_F69202_0_0|SrvcGrp|361|2022|PDM|1100.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F69202_0_0|SrvcGrp|40403|2022|PDM|750.00|99|0.00|EMERGENCY ROOM SVCS
20|FH_F69202_0_0|SrvcGrp|72|2022|PDM|400.00|99|0.00|NEWBORN NURSERY
20|FH_F69202_0_0|SrvcGrp|9501|2022|PDM|2400.00|99|0.00|ACUTE IP MED/SURG SVCS
20|FH_F69202_0_0|SrvcGrp|9510|2022|PDM|900.00|99|0.00|SKILLED NURSING CARE
20|FH_F69202_0_0|SrvcGrp|9936|2022|PDM|125.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F69202_0_0|SrvcGrp|9937|2022|PDM|125.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F69205_0_0|SrvcGrp|10517|2022|PDM|74.04|99|0.00|HOME HEALTH AIDE VISIT
20|FH_F69242_0_0|SrvcGrp|27968|2022|PDM|27.50|99|0.00|SKILLED NURSING LPN
20|FH_F69242_0_0|SrvcGrp|30609|2022|PDM|45.00|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F69249_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|GENERAL ACUTE CARE
20|FH_F69249_0_0|SrvcGrp|11258|2022|PCT|0.50|99|0.00|DRUGS
20|FH_F69284_0_0|CSTM-ALL|CSTM-00|2020|PCT|71.70|99|0.00|GENERAL ACUTE CARE
20|FH_F69322_0_0|CSTM-ALL|CSTM-00|2020|PDM|321.00|99|0.00|CD ADULT PARTIAL HOSPITALIZATION
20|FH_F69322_0_0|CSTM-ALL|CSTM-00|2020|PDM|680.00|99|0.00|DUAL DIAGNOSIS
20|FH_F69322_0_0|CSTM-ALL|CSTM-00|2020|PDM|881.00|99|0.00|ADULT PSYCHIATRIC
20|FH_F69322_0_0|SrvcGrp|196|2022|PDM|881.00|99|0.00|CD (ADOLESCENT) - DETOX
20|FH_F69324_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F69423_0_0|CSTM-ALL|CSTM-00|2020|PDM|1280.00|99|0.00|AEG 6 (NO REV)
20|FH_F69423_0_0|CSTM-ALL|CSTM-00|2020|PDM|2055.00|99|0.00|AEG 9 (NO REV)
20|FH_F69423_0_0|CSTM-ALL|CSTM-00|2020|PDM|512.00|99|0.00|AEG 1 (NO REV)
20|FH_F69423_0_0|CSTM-ALL|CSTM-00|2020|PDM|968.00|99|0.00|AEG 10 (NO REV)
20|FH_F69423_0_0|SrvcGrp|35734|2022|PDM|1665.00|99|0.00|CPT 29874 29877 29880-29881 29884 29888
20|FH_F69423_0_0|SrvcGrp|36991|2022|PCT|0.84|99|0.00|IMPLANTS
20|FH_F69423_0_0|SrvcGrp|65625|2022|PDM|1200.00|99|0.00|CPT 30520
20|FH_F69504_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F69504_0_0|CSTM-ALL|CSTM-00|2020|PDM|27.00|99|0.00|SKILLED NURSING HCPC
20|FH_F69504_0_0|SrvcGrp|46605|2022|PDM|11.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES
20|FH_F69504_0_0|SrvcGrp|48385|2022|PDM|23.00|99|0.00|SPEECH THERAPY
20|FH_F69583_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F69604_0_0|CSTM-ALL|CSTM-00|2020|PDM|110.00|99|0.00|OP SVCS
20|FH_F69647_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F69647_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F69647_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS
20|FH_F69647_0_0|SrvcGrp|17067|2022|PDM|785.00|99|0.00|ASPG II
20|FH_F69648_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F69648_0_0|CSTM-ALL|CSTM-00|2020|PDM|10.00|99|0.00|SKILLED NURSING HCPC
20|FH_F69651_0_0|SrvcGrp|10534|2022|PDM|90.00|99|0.00|NURSING CARE
20|FH_F69651_0_0|SrvcGrp|10541|2022|PDM|95.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F69651_0_0|SrvcGrp|10544|2022|PDM|73.00|99|0.00|ENTEROSTOMAL THERAPY SERVICES
20|FH_F69651_0_0|SrvcGrp|14254|2022|PDM|45.00|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F69683_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|OP SVCS
20|FH_F69703_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|COVENTRY ENHANCED GROUPER 10
20|FH_F69703_0_0|CSTM-ALL|CSTM-00|2020|PDM|1150.00|99|0.00|COVENTRY ENHANCED GROUPER 6
20|FH_F69703_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|COVENTRY ENHANCED GROUPER 9
20|FH_F69703_0_0|CSTM-ALL|CSTM-00|2020|PDM|735.00|99|0.00|COVENTRY ENHANCED GROUPER 2
20|FH_F69712_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F69727_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F69749_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE
20|FH_F69749_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|OP SVCS
20|FH_F69785_0_0|SrvcGrp|42973|2022|PDM|83.00|99|0.00|SPEECH  THERAPIST
20|FH_F69785_0_0|SrvcGrp|42974|2022|PDM|83.00|99|0.00|OCCUPATIONAL THERAPIST
20|FH_F69785_0_0|SrvcGrp|42975|2022|PDM|83.00|99|0.00|PHYSICAL THERAPIST
20|FH_F69785_0_0|SrvcGrp|45924|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE
20|FH_F69787_0_0|SrvcGrp|66343|2022|PDM|5000.00|99|0.00|CYBERKNIFE
20|FH_F69806_0_0|CSTM-ALL|CSTM-00|2020|PCT|81.18|99|0.00|OP SVCS
20|FH_F69846_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F69862_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE
20|FH_F69944_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F69944_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F69965_0_0|SrvcGrp|66482|2022|PDM|25.00|99|0.00|HOME HEALTH AID
20|FH_F69971_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AEG 10 DUBUQUE ENDOSCOPY CENTER (NO REV)
20|FH_F69971_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AEG 3 DUBUQUE ENDOSCOPY CENTER (NO REV)
20|FH_F69971_0_0|CSTM-ALL|CSTM-00|2020|PDM|1984.00|99|0.00|AEG 2 DUBUQUE ENDOSCOPY CENTER (NO REV)
20|FH_F69971_0_0|SrvcGrp|36722|2022|PDM|108.00|99|0.00|SIGMOIDOSCOPY
20|FH_F70005_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F70005_0_0|CSTM-ALL|CSTM-00|2020|PDM|1562.00|99|0.00|AEG 5  (NO REV)
20|FH_F70005_0_0|CSTM-ALL|CSTM-00|2020|PDM|1816.00|99|0.00|AEG 9 (NO REV)
20|FH_F70005_0_0|CSTM-ALL|CSTM-00|2020|PDM|2166.00|99|0.00|AEG 7 (NO REV)
20|FH_F70005_0_0|SrvcGrp|13990|2022|PCT|0.55|99|0.00|PACEMAKER
20|FH_F70005_0_0|SrvcGrp|23585|2022|PCT|0.55|99|0.00|IMPLANTS
20|FH_F70026_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F70090_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|TRAUMA CARE
20|FH_F70104_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F70104_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.35|99|0.00|OP SVCS
20|FH_F70104_0_0|SrvcGrp|10540|2022|PDM|28.00|99|0.00|HOME HEALTH AIDE
20|FH_F70104_0_0|SrvcGrp|10542|2022|PDM|48.00|99|0.00|OCCUPATIONAL THERAPY SVCS
20|FH_F70104_0_0|SrvcGrp|42973|2022|PDM|48.00|99|0.00|SPEECH  THERAPIST
20|FH_F70104_0_0|SrvcGrp|42976|2022|PDM|48.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F70104_0_0|SrvcGrp|44427|2022|PDM|48.00|99|0.00|PHYSICAL THERAPY SVCS (VISIT LVL)
20|FH_F70104_0_0|SrvcGrp|46424|2022|PDM|12.00|99|0.00|HI TECH SKILLED NURSING SERVICES
20|FH_F70104_0_0|SrvcGrp|46605|2022|PDM|12.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES
20|FH_F70162_0_0|CSTM-ALL|CSTM-00|2020|PDM|1990.00|99|0.00|GENERAL ACUTE CARE
20|FH_F70182_0_0|SrvcGrp|29898|2022|PDM|110.00|99|0.00|RN VISIT
20|FH_F70205_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE
20|FH_F70205_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F70205_0_0|SrvcGrp|44883|2022|PDM|18.00|99|0.00|RT/PT/ST/OT
20|FH_F70205_0_0|SrvcGrp|473|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F70303_0_0|SrvcGrp|13722|2022|PDM|218.00|99|0.00|HOSPICE SERVICE - ROUTINE HOME CARE
20|FH_F70303_0_0|SrvcGrp|14494|2022|PDM|53.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F70303_0_0|SrvcGrp|17139|2022|PDM|948.00|99|0.00|HOSPICE CARE
20|FH_F70303_0_0|SrvcGrp|17140|2022|PDM|211.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F70331_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F70343_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS
20|FH_F70444_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F70510_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F70510_0_0|SrvcGrp|14494|2022|PDM|32.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F70546_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F70605_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE
20|FH_F70605_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F70606_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F70606_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F70606_0_0|SrvcGrp|473|2022|PDM|550.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F70645_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE
20|FH_F70645_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F70645_0_0|SrvcGrp|9938|2022|PDM|90.00|99|0.00|SPEECH THERAPY
20|FH_F70964_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F71042_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F71042_0_0|SrvcGrp|13268|2022|PCT|0.70|99|0.00|OCCUPATIONAL THERAPY
20|FH_F71042_0_0|SrvcGrp|14610|2022|PCT|0.70|99|0.00|SPEECH PATHOLOGY VISIT
20|FH_F71043_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS
20|FH_F71049_0_0|SrvcGrp|20072|2022|PDM|1345.00|99|0.00|MS DRG 880-887, 894-897
20|FH_F71049_0_0|SrvcGrp|38607|2022|PDM|636.00|99|0.00|SKILLED NURSING
20|FH_F71068_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F71069_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F71070_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F71070_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F71070_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|COVENTRY ENHANCED GROUPER 2
20|FH_F71070_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|COVENTRY ENHANCED GROUPER 9
20|FH_F71070_0_0|SrvcGrp|47532|2022|PDM|2200.00|99|0.00|TRANSURETHRAL ELECTROSURGICAL RESECTION OF PROSTATE
20|FH_F71070_0_0|SrvcGrp|47544|2022|PDM|2600.00|99|0.00|PERCUTANEOUS IMPLANT OF NEUROSTIMULATOR ELECTRODES
20|FH_F71070_0_0|SrvcGrp|68055|2022|PDM|3000.00|99|0.00|CPT 52649
20|FH_F71070_0_0|SrvcGrp|68102|2022|PCT|1.05|99|0.00|IMPLANTS W/ SURGERIES
20|FH_F71103_0_0|SrvcGrp|42785|2022|PDM|90.00|99|0.00|SPEECH THERAPY  SRVCS
20|FH_F71103_0_0|SrvcGrp|44391|2022|PDM|110.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F71103_0_0|SrvcGrp|68139|2022|PDM|110.00|99|0.00|RN VISIT
20|FH_F71145_0_0|SrvcGrp|44248|2022|PDM|145.00|99|0.00|CAPD/CCPD SUPPLEMENT
20|FH_F71229_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE
20|FH_F71268_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F71268_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE
20|FH_F71268_0_0|SrvcGrp|29817|2022|PDM|4500.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F71268_0_0|SrvcGrp|31505|2022|PCT|0.80|99|0.00|TRAUMA CARE
20|FH_F71268_0_0|SrvcGrp|3409|2022|PDM|800.00|99|0.00|NEWBORN NURSERY
20|FH_F71268_0_0|SrvcGrp|60|2022|PDM|3200.00|99|0.00|NEWBORN NURSERY - LEVEL II
20|FH_F71268_0_0|SrvcGrp|68287|2022|PCT|0.80|99|0.00|TRAUMA
20|FH_F71271_0_0|SrvcGrp|48394|2022|PDM|7.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F71271_0_0|SrvcGrp|66264|2022|PDM|8.00|99|0.00|PHYSICAL THERAPY SERVICES
20|FH_F71282_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS
20|FH_F71342_0_0|CSTM-ALL|CSTM-00|2020|PDM|1801.00|99|0.00|AEG 5  (NO REV)
20|FH_F71342_0_0|CSTM-ALL|CSTM-00|2020|PDM|2444.00|99|0.00|AEG 8 (NO REV)
20|FH_F71342_0_0|CSTM-ALL|CSTM-00|2020|PDM|3365.00|99|0.00|AEG 9 (NO REV)
20|FH_F71345_0_0|SrvcGrp|26001|2022|PDM|163.81|99|0.00|HOSPICE RESPITE SVCS
20|FH_F71345_0_0|SrvcGrp|9832|2022|PDM|105.37|99|0.00|ST SVCS
20|FH_F71346_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F71362_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F71365_0_0|SrvcGrp|59427|2022|PDM|90.00|99|0.00|OT
20|FH_F71443_0_0|CSTM-ALL|CSTM-00|2020|PDM|12.00|99|0.00|SKILLED NURSING
20|FH_F71443_0_0|SrvcGrp|10517|2022|PDM|7.00|99|0.00|HOME HEALTH AIDE VISIT
20|FH_F71443_0_0|SrvcGrp|68640|2022|PDM|4.00|99|0.00|THERAPY
20|FH_F71590_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F71590_0_0|CSTM-ALL|CSTM-00|2020|PDM|2750.00|99|0.00|GENERAL ACUTE CARE
20|FH_F71628_0_0|SrvcGrp|42971|2022|PDM|120.00|99|0.00|SKN RN
20|FH_F71628_0_0|SrvcGrp|48394|2022|PDM|7.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F71633_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE
20|FH_F71633_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS
20|FH_F71634_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|GENERAL ACUTE CARE
20|FH_F71647_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F71647_0_0|SrvcGrp|474|2022|PDM|225.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F71686_0_0|SrvcGrp|12146|2022|PDM|2300.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F71686_0_0|SrvcGrp|229|2022|PDM|600.00|99|0.00|COMPUTED TOMOGRAPHY (CT SCAN)
20|FH_F71686_0_0|SrvcGrp|29817|2022|PDM|3200.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F71686_0_0|SrvcGrp|47583|2022|PCT|0.85|99|0.00|HOSPICE SVCS
20|FH_F71702_0_0|CSTM-ALL|CSTM-00|2020|PDM|692.55|99|0.00|ASPG V
20|FH_F71702_0_0|CSTM-ALL|CSTM-00|2020|PDM|802.00|99|0.00|ASPG VI
20|FH_F71747_0_0|CSTM-ALL|CSTM-00|2020|PDM|988.00|99|0.00|GENERAL ACUTE CARE
20|FH_F71829_0_0|SrvcGrp|26001|2022|PDM|160.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F71848_0_0|SrvcGrp|68780|2022|PDM|108.15|99|0.00|SPECIAL STAINS GROUP 2
20|FH_F71863_0_0|SrvcGrp|9829|2022|PDM|104.50|99|0.00|PT SVCS
20|FH_F71863_0_0|SrvcGrp|9830|2022|PDM|104.50|99|0.00|OT SVCS
20|FH_F71863_0_0|SrvcGrp|9832|2022|PDM|105.50|99|0.00|ST SVCS
20|FH_F71866_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F71866_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F71905_0_0|SrvcGrp|66481|2022|PDM|75.00|99|0.00|SOCIAL WORKER
20|FH_F71923_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F71923_0_0|SrvcGrp|68899|2022|PDM|212.18|99|0.00|DIALYSIS TRAINING
20|FH_F72024_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F72024_0_0|SrvcGrp|3810|2022|PDM|147.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F72047_0_0|CSTM-ALL|CSTM-00|2020|PCT|9000.00|99|0.00|TIMELY FILING
20|FH_F72051_0_0|SrvcGrp|59427|2022|PDM|75.00|99|0.00|OT
20|FH_F72051_0_0|SrvcGrp|66482|2022|PDM|35.00|99|0.00|HOME HEALTH AID
20|FH_F72065_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72065_0_0|SrvcGrp|1168|2022|PDM|47.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F72085_0_0|SrvcGrp|64297|2022|PDM|314.00|99|0.00|CAPD
20|FH_F72086_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72090_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F72090_0_0|SrvcGrp|17140|2022|PDM|160.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F72102_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F72143_0_0|CSTM-ALL|CSTM-00|2020|PDM|1475.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72143_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|ACUTE PSYCH
20|FH_F72143_0_0|SrvcGrp|40820|2022|PDM|2800.00|99|0.00|ICU/CCU
20|FH_F72222_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS
20|FH_F72262_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F72262_0_0|SrvcGrp|30089|2022|PDM|400.00|99|0.00|HEMODIALYSIS SERVICES
20|FH_F72302_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F72302_0_0|CSTM-ALL|CSTM-00|2020|PDM|1131.00|99|0.00|AEG 7 (NO REV)
20|FH_F72302_0_0|CSTM-ALL|CSTM-00|2020|PDM|601.00|99|0.00|AEG 10 (NO REV)
20|FH_F72302_0_0|CSTM-ALL|CSTM-00|2020|PDM|601.00|99|0.00|AEG 3 (NO REV)
20|FH_F72302_0_0|CSTM-ALL|CSTM-00|2020|PDM|741.00|99|0.00|AEG 4 (NO REV)
20|FH_F72302_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|AEG 5  (NO REV)
20|FH_F72302_0_0|SrvcGrp|16732|2022|PDM|1706.00|99|0.00|HYSTEROSCOPY ABLATION
20|FH_F72302_0_0|SrvcGrp|27347|2022|PDM|852.00|99|0.00|CPT 58558
20|FH_F72306_0_0|SrvcGrp|21342|2022|PCT|1.10|99|0.00|IMPLANTS
20|FH_F72387_0_0|SrvcGrp|9811|2022|PDM|550.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F72390_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F72390_0_0|CSTM-ALL|CSTM-00|2020|PDM|3553.00|99|0.00|ASPG V
20|FH_F72390_0_0|SrvcGrp|27155|2022|PCT|1.00|99|0.00|DME/ORTHOTICS/PROSTHETICS/IMPLANTS
20|FH_F72404_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72404_0_0|CSTM-ALL|CSTM-00|2020|PDM|1365.00|99|0.00|AEG 5  (NO REV)
20|FH_F72404_0_0|CSTM-ALL|CSTM-00|2020|PDM|1572.00|99|0.00|AEG 6 (NO REV)
20|FH_F72404_0_0|CSTM-ALL|CSTM-00|2020|PDM|1851.00|99|0.00|AEG 8 (NO REV)
20|FH_F72407_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F72416_0_0|SrvcGrp|45883|2022|PDM|80.00|99|0.00|OT
20|FH_F72484_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F72523_0_0|SrvcGrp|26001|2022|PDM|173.90|99|0.00|HOSPICE RESPITE SVCS
20|FH_F72523_0_0|SrvcGrp|3809|2022|PDM|755.55|99|0.00|HOSPICE CARE
20|FH_F72542_0_0|SrvcGrp|12918|2022|PDM|950.00|99|0.00|GYNECOLOGICAL MED/SURG
20|FH_F72543_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F72543_0_0|SrvcGrp|46110|2022|PDM|56.70|99|0.00|HI-TECH NURSING (ADDITIONAL HOUR)
20|FH_F72543_0_0|SrvcGrp|68986|2022|PDM|108.00|99|0.00|PT VISIT
20|FH_F72543_0_0|SrvcGrp|69021|2022|PDM|108.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F72584_0_0|SrvcGrp|10410|2022|PDM|60.00|99|0.00|SKILLED NURSING CARE
20|FH_F72584_0_0|SrvcGrp|42824|2022|PDM|120.00|99|0.00|SKILLED NURSING VISIT
20|FH_F72584_0_0|SrvcGrp|44131|2022|PDM|140.00|99|0.00|SPEECH THERAPY VISIT
20|FH_F72589_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F72606_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F72606_0_0|SrvcGrp|15158|2022|PDM|700.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT
20|FH_F72606_0_0|SrvcGrp|30623|2022|PDM|4600.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788
20|FH_F72606_0_0|SrvcGrp|30661|2022|PDM|9525.00|99|0.00|LITHOTRIPSY SVCS
20|FH_F72606_0_0|SrvcGrp|3259|2022|PDM|4300.00|99|0.00|ACUTE REHABILITATION
20|FH_F72606_0_0|SrvcGrp|43986|2022|PDM|9525.00|99|0.00|CARDIAC PACEMAKER (MS DRG 242-244, 258-262 ONLY)
20|FH_F72606_0_0|SrvcGrp|50362|2022|PDM|2500.00|99|0.00|ACUTE PSYCH
20|FH_F72648_0_0|SrvcGrp|44250|2022|PDM|280.00|99|0.00|CCPD TRAINING
20|FH_F72648_0_0|SrvcGrp|68642|2022|PDM|570.00|99|0.00|URGENT PERITONEAL DIALYSIS
20|FH_F72662_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F72662_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72662_0_0|SrvcGrp|29978|2022|PDM|157.00|99|0.00|WOUND THERAPY ELEC PUMP
20|FH_F72664_0_0|SrvcGrp|68380|2022|PDM|75.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F72666_0_0|SrvcGrp|16|2022|PDM|1122.00|99|0.00|ACUTE REHABILITATION
20|FH_F72666_0_0|SrvcGrp|23477|2022|PDM|4614.00|99|0.00|MSDRG 286-287 ONLY CARDIAC CATH
20|FH_F72666_0_0|SrvcGrp|24703|2022|PDM|417.00|99|0.00|NEWBORN NURSERY
20|FH_F72666_0_0|SrvcGrp|69689|2022|PCT|0.75|99|0.00|OP GAMMA KNIFE
20|FH_F72666_0_0|SrvcGrp|69700|2022|PDM|26372.00|99|0.00|IP DEEP BRAIN STIMULATION
20|FH_F72702_0_0|CSTM-ALL|CSTM-00|2020|PDM|649.00|99|0.00|AEG 2 (NO REV)
20|FH_F72704_0_0|SrvcGrp|43892|2022|PDM|80.00|99|0.00|PHYSICAL THERAPY VISIT
20|FH_F72742_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F72746_0_0|SrvcGrp|12403|2022|PDM|39.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F72746_0_0|SrvcGrp|3809|2022|PDM|698.00|99|0.00|HOSPICE CARE
20|FH_F72764_0_0|SrvcGrp|12118|2022|PDM|350.00|99|0.00|COMPUTED TOMOGRAPHY (CT)
20|FH_F72764_0_0|SrvcGrp|32703|2022|PDM|1900.00|99|0.00|ICU
20|FH_F72765_0_0|SrvcGrp|12118|2022|PDM|350.00|99|0.00|COMPUTED TOMOGRAPHY (CT)
20|FH_F72784_0_0|SrvcGrp|10391|2022|PDM|2249.73|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F72784_0_0|SrvcGrp|11258|2022|PCT|0.65|99|0.00|DRUGS
20|FH_F72784_0_0|SrvcGrp|3418|2022|PDM|3262.11|99|0.00|NEONATAL INTENSIVE CARE UNIT
20|FH_F72788_0_0|SrvcGrp|3029|2022|PDM|755.00|99|0.00|NEWBORN NURSERY
20|FH_F72788_0_0|SrvcGrp|3271|2022|PDM|5018.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F72823_0_0|SrvcGrp|33164|2022|PDM|350.00|99|0.00|SKILLED NURSING - LEVEL I
20|FH_F72830_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS
20|FH_F72830_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|PSYCH AND ER
20|FH_F72830_0_0|SrvcGrp|10425|2022|PDM|370.00|99|0.00|NEWBORN NURSERY
20|FH_F72830_0_0|SrvcGrp|11259|2022|PCT|0.40|99|0.00|DRUGS
20|FH_F72830_0_0|SrvcGrp|15323|2022|PDM|150.00|99|0.00|ER LEVEL I
20|FH_F72830_0_0|SrvcGrp|15324|2022|PDM|300.00|99|0.00|ER LEVEL II
20|FH_F72830_0_0|SrvcGrp|15326|2022|PDM|900.00|99|0.00|ER LEVEL IV
20|FH_F72830_0_0|SrvcGrp|37015|2022|PDM|1150.00|99|0.00|CHILD & ADOLESCENT PSYCH
20|FH_F72830_0_0|SrvcGrp|70046|2022|PDM|2900.00|99|0.00|CVTY ENHANCED + REV CODE ASPG 6
20|FH_F72830_0_0|SrvcGrp|70048|2022|PDM|2900.00|99|0.00|CVTY ENHANCED + REV CODE ASPG 8
20|FH_F72830_0_0|SrvcGrp|941|2022|PDM|1808.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F72842_0_0|CSTM-ALL|CSTM-00|2020|PDM|3411.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72842_0_0|SrvcGrp|3458|2022|PCT|0.68|99|0.00|NEONATAL INTENSIVE CARE UNIT
20|FH_F72845_0_0|CSTM-ALL|CSTM-00|2020|PDM|1475.00|99|0.00|ACUTE PSYCH
20|FH_F72845_0_0|CSTM-ALL|CSTM-00|2020|PDM|3246.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72850_0_0|SrvcGrp|29817|2022|PDM|5157.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F72850_0_0|SrvcGrp|30623|2022|PDM|11179.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788
20|FH_F72850_0_0|SrvcGrp|3271|2022|PDM|5018.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F72859_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.91|99|0.00|GENERAL ACUTE CARE
20|FH_F72859_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.91|99|0.00|OP SVCS
20|FH_F72859_0_0|CSTM-ALL|CSTM-00|2020|PDM|10.07|99|0.00|TOTAL PARENTERAL NUTRITION
20|FH_F72859_0_0|CSTM-ALL|CSTM-00|2020|PDM|21.19|99|0.00|TOTAL PARENTERAL NUTRITION
20|FH_F72859_0_0|CSTM-ALL|CSTM-00|2020|PDM|270.67|99|0.00|TOTAL PARENTERAL NUTRITION
20|FH_F72859_0_0|CSTM-ALL|CSTM-00|2020|PDM|90.23|99|0.00|TOTAL PARENTERAL NUTRITION
20|FH_F72859_0_0|SrvcGrp|10543|2022|PDM|96.54|99|0.00|SPEECH THERAPY SVCS
20|FH_F72859_0_0|SrvcGrp|10564|2022|PDM|170.00|99|0.00|HOME INFUSION
20|FH_F72859_0_0|SrvcGrp|10570|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY
20|FH_F72859_0_0|SrvcGrp|11442|2022|PDM|509.86|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)
20|FH_F72859_0_0|SrvcGrp|11788|2022|PDM|70.00|99|0.00|HOME INFUSION THERAPY
20|FH_F72859_0_0|SrvcGrp|11802|2022|PDM|160.00|99|0.00|HOME INFUSION
20|FH_F72859_0_0|SrvcGrp|3810|2022|PDM|114.08|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F72859_0_0|SrvcGrp|471|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F72887_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F72889_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.69|99|0.00|OP SVCS
20|FH_F72907_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F72928_0_0|CSTM-ALL|CSTM-00|2020|PCT|67.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72936_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72936_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F72939_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE
20|FH_F72945_0_0|CSTM-ALL|CSTM-00|2020|PCT|66.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72971_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE
20|FH_F72971_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F72972_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F72973_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72980_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F73011_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F73025_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F73025_0_0|SrvcGrp|48396|2022|PDM|30.00|99|0.00|OT SERVICES
20|FH_F73084_0_0|SrvcGrp|46117|2022|PDM|24.00|99|0.00|HOME HEALTH AIDE (PER HOUR)
20|FH_F73084_0_0|SrvcGrp|68988|2022|PDM|72.00|99|0.00|ST VISIT
20|FH_F73125_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F73125_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F73125_0_0|SrvcGrp|48394|2022|PDM|7.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F73126_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F73142_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F73204_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F73204_0_0|SrvcGrp|3809|2022|PDM|644.00|99|0.00|HOSPICE CARE
20|FH_F73210_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F73228_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F73228_0_0|SrvcGrp|17067|2022|PDM|3074.00|99|0.00|ASPG II
20|FH_F73228_0_0|SrvcGrp|17081|2022|PDM|8384.00|99|0.00|ASPG IX
20|FH_F73342_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F73342_0_0|CSTM-ALL|CSTM-00|2020|PDM|1575.00|99|0.00|ASPG 3 PIEDMONT OUTPATIENT SURGERY CENTER
20|FH_F73342_0_0|CSTM-ALL|CSTM-00|2020|PDM|200.00|99|0.00|ASPG 10 PIEDMONT OUTPATIENT SURGERY CENTER
20|FH_F73342_0_0|CSTM-ALL|CSTM-00|2020|PDM|2475.00|99|0.00|ASPG 6 PIEDMONT OUTPATIENT SURGERY CENTER
20|FH_F73342_0_0|CSTM-ALL|CSTM-00|2020|PDM|665.00|99|0.00|ASPG 1 PIEDMONT OUTPATIENT SURGERY CENTER
20|FH_F73402_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE
20|FH_F73403_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F73403_0_0|SrvcGrp|43428|2022|PDM|60.00|99|0.00|RN HOURLY
20|FH_F73403_0_0|SrvcGrp|45965|2022|PDM|120.00|99|0.00|SKILLED NURSING VISIT
20|FH_F73403_0_0|SrvcGrp|45967|2022|PDM|45.00|99|0.00|HOME HEALTH AIDE
20|FH_F73403_0_0|SrvcGrp|62537|2022|PDM|130.00|99|0.00|SPEECH THERAPY
20|FH_F73485_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F73485_0_0|SrvcGrp|46424|2022|PDM|15.00|99|0.00|HI TECH SKILLED NURSING SERVICES
20|FH_F73485_0_0|SrvcGrp|48394|2022|PDM|7.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F73502_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F73502_0_0|SrvcGrp|22954|2022|PDM|100.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F73643_0_0|SrvcGrp|26001|2022|PDM|140.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F73643_0_0|SrvcGrp|57968|2022|PDM|32.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F73662_0_0|CSTM-ALL|CSTM-00|2020|PDM|1039.00|99|0.00|ASPG X
20|FH_F73662_0_0|CSTM-ALL|CSTM-00|2020|PDM|735.00|99|0.00|ASPG II
20|FH_F73662_0_0|SrvcGrp|14320|2022|PCT|0.50|99|0.00|OP IMPLANTS/PROSTHETICS/DEVICES
20|FH_F73662_0_0|SrvcGrp|15472|2022|PDM|549.00|99|0.00|CPT CODE 62284
20|FH_F73684_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F73684_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F73684_0_0|SrvcGrp|3087|2022|PDM|790.00|99|0.00|CD - DETOX
20|FH_F73684_0_0|SrvcGrp|3259|2022|PDM|600.00|99|0.00|ACUTE REHABILITATION
20|FH_F73684_0_0|SrvcGrp|70947|2022|PDM|75.00|99|0.00|ROOM AND BOARD DAY OF DISCHARGE
20|FH_F73684_0_0|SrvcGrp|9811|2022|PDM|600.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F73705_0_0|CSTM-ALL|CSTM-00|2020|PDM|175.00|99|0.00|ASPG I
20|FH_F73705_0_0|CSTM-ALL|CSTM-00|2020|PDM|175.00|99|0.00|ASPG X
20|FH_F73705_0_0|CSTM-ALL|CSTM-00|2020|PDM|300.00|99|0.00|ASPG III
20|FH_F73705_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|ASPG IX
20|FH_F73705_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|ASPG VII
20|FH_F73705_0_0|CSTM-ALL|CSTM-00|2020|PDM|75.00|99|0.00|OP SVCS
20|FH_F73705_0_0|SrvcGrp|42869|2022|PDM|75.00|99|0.00|PHYSICAL THERAPY VISIT
20|FH_F73727_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F73728_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F73728_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F73729_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F73730_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F73764_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F73864_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F73864_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F73864_0_0|SrvcGrp|48385|2022|PDM|12.00|99|0.00|SPEECH THERAPY
20|FH_F73864_0_0|SrvcGrp|48394|2022|PDM|7.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F73923_0_0|CSTM-ALL|CSTM-00|2020|PDM|1121.00|99|0.00|AEG 8 (NO REV)
20|FH_F73923_0_0|CSTM-ALL|CSTM-00|2020|PDM|1540.00|99|0.00|AEG 9 (NO REV)
20|FH_F73923_0_0|CSTM-ALL|CSTM-00|2020|PDM|383.00|99|0.00|AEG 1 (NO REV)
20|FH_F73923_0_0|CSTM-ALL|CSTM-00|2020|PDM|587.00|99|0.00|AEG 10 (NO REV)
20|FH_F73923_0_0|CSTM-ALL|CSTM-00|2020|PDM|724.00|99|0.00|AEG 4 (NO REV)
20|FH_F73967_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F73967_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F73967_0_0|SrvcGrp|12403|2022|PDM|640.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F73967_0_0|SrvcGrp|22954|2022|PDM|147.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F73967_0_0|SrvcGrp|26001|2022|PDM|155.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F73967_0_0|SrvcGrp|42782|2022|PDM|68.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F74102_0_0|SrvcGrp|22954|2022|PDM|164.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F74102_0_0|SrvcGrp|3809|2022|PDM|715.00|99|0.00|HOSPICE CARE
20|FH_F74227_0_0|SrvcGrp|16700|2022|PDM|3000.00|99|0.00|PROFESSIONAL FEES ON UB04
20|FH_F74263_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F74263_0_0|CSTM-ALL|CSTM-00|2020|PDM|2246.00|99|0.00|SURGICAL SPECIALTY CENTER  ASC GROUPER 10
20|FH_F74263_0_0|CSTM-ALL|CSTM-00|2020|PDM|2246.00|99|0.00|SURGICAL SPECIALTY CENTER  ASC GROUPER 9
20|FH_F74263_0_0|CSTM-ALL|CSTM-00|2020|PDM|857.00|99|0.00|SURGICAL SPECIALTY CENTER  ASC GROUPER 11
20|FH_F74283_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F74283_0_0|SrvcGrp|42782|2022|PDM|75.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F74305_0_0|CSTM-ALL|CSTM-00|2020|PDM|1095.00|99|0.00|ASPG VII
20|FH_F74305_0_0|CSTM-ALL|CSTM-00|2020|PDM|491.00|99|0.00|ASPG II
20|FH_F74305_0_0|CSTM-ALL|CSTM-00|2020|PDM|693.00|99|0.00|ASPG X
20|FH_F74305_0_0|CSTM-ALL|CSTM-00|2020|PDM|909.00|99|0.00|ASPG VI
20|FH_F74363_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F74363_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F74424_0_0|SrvcGrp|48005|2022|PDM|231.00|99|0.00|HOME HEALTH AIDE
20|FH_F74463_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F74463_0_0|CSTM-ALL|CSTM-00|2020|PDM|1900.00|99|0.00|COVENTRY ENHANCED GROUPER 9
20|FH_F74463_0_0|SrvcGrp|71666|2022|PDM|4700.00|99|0.00|CPT 63655
20|FH_F74463_0_0|SrvcGrp|71667|2022|PDM|1100.00|99|0.00|SURGERY
20|FH_F74507_0_0|SrvcGrp|72161|2022|PDM|1790.00|99|0.00|SKILLED NURSING LEVEL 2 REV CODE 206
20|FH_F74509_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|OP SVCS
20|FH_F74562_0_0|SrvcGrp|109|2022|PDM|535.00|99|0.00|CD - DETOX
20|FH_F74562_0_0|SrvcGrp|115|2022|PDM|750.00|99|0.00|SKILLED NURSING CARE
20|FH_F74583_0_0|SrvcGrp|42974|2022|PDM|56.00|99|0.00|OCCUPATIONAL THERAPIST
20|FH_F74583_0_0|SrvcGrp|42975|2022|PDM|56.00|99|0.00|PHYSICAL THERAPIST
20|FH_F74583_0_0|SrvcGrp|45924|2022|PDM|32.00|99|0.00|HOME HEALTH AIDE
20|FH_F74583_0_0|SrvcGrp|66005|2022|PDM|14.00|99|0.00|SKILLED NURSING HCPC
20|FH_F74622_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F74622_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|COVENTRY ENHANCED GROUPER 10
20|FH_F74622_0_0|CSTM-ALL|CSTM-00|2020|PDM|1221.00|99|0.00|COVENTRY ENHANCED GROUPER 8
20|FH_F74622_0_0|CSTM-ALL|CSTM-00|2020|PDM|1249.00|99|0.00|COVENTRY ENHANCED GROUPER 7
20|FH_F74653_0_0|CSTM-ALL|CSTM-00|2020|PCT|66.00|99|0.00|GENERAL ACUTE CARE
20|FH_F74670_0_0|SrvcGrp|28919|2022|PDM|31.00|99|0.00|CPT 97750
20|FH_F74670_0_0|SrvcGrp|46724|2022|PDM|95.00|99|0.00|WORK HARDENING
20|FH_F74670_0_0|SrvcGrp|72379|2022|PDM|90.00|99|0.00|SPEECH THERAPY
20|FH_F74763_0_0|CSTM-ALL|CSTM-00|2020|PCT|59.80|99|0.00|OP SVCS
20|FH_F74765_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F74765_0_0|CSTM-ALL|CSTM-00|2020|PDM|1199.00|99|0.00|COVENTRY ENHANCED GROUPER 7
20|FH_F74765_0_0|CSTM-ALL|CSTM-00|2020|PDM|1243.00|99|0.00|COVENTRY ENHANCED GROUPER 8
20|FH_F74765_0_0|CSTM-ALL|CSTM-00|2020|PDM|1614.00|99|0.00|COVENTRY ENHANCED GROUPER 9
20|FH_F74765_0_0|CSTM-ALL|CSTM-00|2020|PDM|806.00|99|0.00|COVENTRY ENHANCED GROUPER 4
20|FH_F74825_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F74825_0_0|SrvcGrp|473|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F74844_0_0|CSTM-ALL|CSTM-00|2020|PDM|560.00|99|0.00|SKILLED NURSING
20|FH_F74844_0_0|SrvcGrp|42869|2022|PDM|60.00|99|0.00|PHYSICAL THERAPY VISIT
20|FH_F37565_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37566_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F37590_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F37590_0_0|SrvcGrp|12264|2022|PDM|59.85|99|0.00|DIETICIAN OR LPN SERVICES
20|FH_F37590_0_0|SrvcGrp|9832|2022|PDM|84.00|99|0.00|ST SVCS
20|FH_F37639_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37639_0_0|CSTM-ALL|CSTM-00|2020|PDM|1213.38|99|0.00|ASPG VIII
20|FH_F37639_0_0|CSTM-ALL|CSTM-00|2020|PDM|1669.08|99|0.00|ASPG IX
20|FH_F37639_0_0|CSTM-ALL|CSTM-00|2020|PDM|555.95|99|0.00|ASPG II
20|FH_F37639_0_0|CSTM-ALL|CSTM-00|2020|PDM|635.73|99|0.00|ASPG III
20|FH_F37639_0_0|CSTM-ALL|CSTM-00|2020|PDM|635.73|99|0.00|ASPG X
20|FH_F37639_0_0|CSTM-ALL|CSTM-00|2020|PDM|785.30|99|0.00|ASPG IV
20|FH_F37644_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37644_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|PT EVALS
20|FH_F37644_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|PT SERVICES
20|FH_F37650_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37659_0_0|CSTM-ALL|CSTM-00|2020|PDM|274.00|99|0.00|CD SVCS
20|FH_F37659_0_0|SrvcGrp|13551|2022|PDM|549.00|99|0.00|NEWBORN NURSERY
20|FH_F37659_0_0|SrvcGrp|26985|2022|PDM|79058.00|99|0.00|BMT RELATED ALLOGENEIC
20|FH_F37659_0_0|SrvcGrp|26989|2022|PDM|120783.00|99|0.00|LUNG-DOUBLE TRANSPLANT
20|FH_F37659_0_0|SrvcGrp|27381|2022|PDM|65881.00|99|0.00|MS DRG 001-002 & REV CODE & PROC CODES HEART TRANSPLANT
20|FH_F37659_0_0|SrvcGrp|4109|2022|PDM|700.00|99|0.00|ACUTE PSYCH
20|FH_F37659_0_0|SrvcGrp|91|2022|PDM|43921.00|99|0.00|KIDNEY TRANSPLANT
20|FH_F37667_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS
20|FH_F37679_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE
20|FH_F37679_0_0|SrvcGrp|10578|2022|PDM|33.50|99|0.00|HYDRATION THERAPY - 1 LITER
20|FH_F37679_0_0|SrvcGrp|10580|2022|PDM|37.50|99|0.00|HYDRATION THERAPY - 3 LITERS
20|FH_F37679_0_0|SrvcGrp|14945|2022|PDM|8.50|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN
20|FH_F37679_0_0|SrvcGrp|17005|2022|PDM|61.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 8HRS
20|FH_F37679_0_0|SrvcGrp|17014|2022|PDM|61.00|99|0.00|HOME INFUSION THERAPY
20|FH_F37679_0_0|SrvcGrp|21711|2022|PDM|110.00|99|0.00|TOTAL PARENTERAL NUTRITION; LESS THAN 2 LITERS
20|FH_F37679_0_0|SrvcGrp|22594|2022|PDM|61.00|99|0.00|IMIGLUCERASE
20|FH_F37679_0_0|SrvcGrp|24747|2022|PDM|61.00|99|0.00|HOME INFUSION THERAPY
20|FH_F37679_0_0|SrvcGrp|24758|2022|PDM|15.00|99|0.00|HOME INJECTABLE THERAPY
20|FH_F37679_0_0|SrvcGrp|26845|2022|PDM|30.50|99|0.00|IMMUNOTHERAPY (MOD SH)
20|FH_F37679_0_0|SrvcGrp|26849|2022|PDM|30.50|99|0.00|HOME INFUSION THERAPY (MOD SH)
20|FH_F37679_0_0|SrvcGrp|26853|2022|PDM|30.50|99|0.00|CHELATION THERAPY (MOD SH)
20|FH_F37679_0_0|SrvcGrp|26861|2022|PDM|30.50|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC (MOD SH)
20|FH_F37679_0_0|SrvcGrp|26862|2022|PDM|15.25|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC (MOD SJ)
20|FH_F37679_0_0|SrvcGrp|26869|2022|PDM|61.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC
20|FH_F37679_0_0|SrvcGrp|26871|2022|PDM|61.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 3 HRS
20|FH_F37679_0_0|SrvcGrp|27035|2022|PDM|27.50|99|0.00|TOTAL PARENTERAL NUTRITION;ONE LITER PER DAY (MOD SJ)
20|FH_F37679_0_0|SrvcGrp|27038|2022|PDM|55.00|99|0.00|TOTAL PARENTERAL NUTRITION; LESS THAN 3 LITERS (MOD SH)
20|FH_F37679_0_0|SrvcGrp|27043|2022|PDM|15.25|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 24HRS (MOD SJ)
20|FH_F37679_0_0|SrvcGrp|27044|2022|PDM|30.50|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 12HRS (MOD SH)
20|FH_F37679_0_0|SrvcGrp|27046|2022|PDM|30.50|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 8HRS (MOD SH)
20|FH_F37679_0_0|SrvcGrp|27048|2022|PDM|30.50|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 6HRS(MOD SH)
20|FH_F37679_0_0|SrvcGrp|27049|2022|PDM|15.25|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 6HRS (MOD SJ)
20|FH_F37679_0_0|SrvcGrp|27055|2022|PDM|8.38|99|0.00|HYDRATION THERAPY - 1 LITER (MOD SJ)
20|FH_F37679_0_0|SrvcGrp|27057|2022|PDM|8.75|99|0.00|HYDRATION THERAPY - 2 LITERS (MOD SJ)
20|FH_F37679_0_0|SrvcGrp|27064|2022|PDM|30.50|99|0.00|CHEMOTHERAPY (MOD SH)
20|FH_F37679_0_0|SrvcGrp|27066|2022|PDM|30.50|99|0.00|HOME INFUSION THERAPY, PAIN MGMT (MOD SH)
20|FH_F37679_0_0|SrvcGrp|27068|2022|PDM|30.50|99|0.00|PAIN MANAGAMENT - INTERMITTENT (MOD SH)
20|FH_F37679_0_0|SrvcGrp|27070|2022|PDM|3.25|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN (MOD SH)
20|FH_F37679_0_0|SrvcGrp|27075|2022|PDM|20.00|99|0.00|HOME INFUSION THERAPY (MOD SJ)
20|FH_F37679_0_0|SrvcGrp|27129|2022|PDM|3.75|99|0.00|INTERMITTENT ANTICOAGULANT THERAPY (MOD SJ)
20|FH_F37679_0_0|SrvcGrp|27138|2022|PDM|7.50|99|0.00|INTERFERON INJECTION THERAPY (MOD SH)
20|FH_F37679_0_0|SrvcGrp|27152|2022|PDM|30.50|99|0.00|HOME INFUSION THERAPY (MOD SH)
20|FH_F37679_0_0|SrvcGrp|89787|2022|PCT|0.50|99|0.00|HCPCS CODES
20|FH_F37698_0_0|SrvcGrp|20801|2022|PCT|0.85|99|0.00|HOME HEALTH
20|FH_F37703_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F37703_0_0|SrvcGrp|15873|2022|PDM|31.00|99|0.00|HOSPICE SERVICE - CONTINUOUS HOME CARE
20|FH_F37733_0_0|SrvcGrp|27210|2022|PDM|140.00|99|0.00|SKILLED NURSING LEVEL I
20|FH_F37734_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37738_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37771_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F37777_0_0|CSTM-ALL|CSTM-00|2020|PDM|475.00|99|0.00|TRAUMA, SPINAL CORD & BRAIN DAY TREATMENT
20|FH_F37777_0_0|SrvcGrp|25346|2022|PDM|30.00|99|0.00|PT
20|FH_F37777_0_0|SrvcGrp|26180|2022|PDM|30.00|99|0.00|ST
20|FH_F37778_0_0|CSTM-ALL|CSTM-00|2020|PDM|1749.00|99|0.00|LAPAROSCOPY (49650, 58660-58673)
20|FH_F37778_0_0|CSTM-ALL|CSTM-00|2020|PDM|1884.00|99|0.00|ASPG VIII
20|FH_F37778_0_0|CSTM-ALL|CSTM-00|2020|PDM|1884.00|99|0.00|LAPAROSCOPIC PROCEDURES
20|FH_F37778_0_0|CSTM-ALL|CSTM-00|2020|PDM|585.00|99|0.00|ASPG I
20|FH_F37778_0_0|CSTM-ALL|CSTM-00|2020|PDM|783.00|99|0.00|ASPG II
20|FH_F37778_0_0|SrvcGrp|14614|2022|PDM|3100.00|99|0.00|LITHOTRIPSY
20|FH_F37809_0_0|CSTM-ALL|CSTM-00|2020|PDM|1670.00|99|0.00|ASPG II
20|FH_F37809_0_0|CSTM-ALL|CSTM-00|2020|PDM|954.00|99|0.00|ASPG I
20|FH_F37812_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING
20|FH_F37812_0_0|CSTM-ALL|CSTM-00|2020|PCT|22500.00|99|0.00|OT SERVICES
20|FH_F37812_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37812_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|TRAUMA CARE
20|FH_F37847_0_0|SrvcGrp|9828|2022|PDM|44.00|99|0.00|HOME HEALTH AIDE
20|FH_F37847_0_0|SrvcGrp|9832|2022|PDM|88.00|99|0.00|ST SVCS
20|FH_F37850_0_0|CSTM-ALL|CSTM-00|2020|PDM|1622.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37850_0_0|SrvcGrp|131|2022|PCT|0.65|99|0.00|PACEMAKER DEVICE
20|FH_F37850_0_0|SrvcGrp|220|2022|PCT|0.65|99|0.00|INTRAOCULAR LENSES
20|FH_F37850_0_0|SrvcGrp|2738|2022|PCT|0.65|99|0.00|IMPLANTS
20|FH_F37850_0_0|SrvcGrp|2741|2022|PCT|0.65|99|0.00|DRUGS
20|FH_F37850_0_0|SrvcGrp|27566|2022|PCT|0.68|99|0.00|CV SURGERY
20|FH_F37850_0_0|SrvcGrp|6|2022|PDM|3245.00|99|0.00|OP SURGERY
20|FH_F37850_0_0|SrvcGrp|65|2022|PCT|0.73|99|0.00|OBSTETRICAL CARE
20|FH_F37850_0_0|SrvcGrp|941|2022|PDM|2163.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F37875_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F37901_0_0|CSTM-ALL|CSTM-00|2020|PDM|45.00|99|0.00|SPEECH THERAPY SVCS
20|FH_F37909_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37909_0_0|CSTM-ALL|CSTM-00|2020|PDM|60.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F37909_0_0|CSTM-ALL|CSTM-00|2020|PDM|70.00|99|0.00|PHYSICAL THERAPY SVCS RE-EVAL
20|FH_F37909_0_0|SrvcGrp|15477|2022|PDM|70.00|99|0.00|PHYSICAL THERAPY SVCS INITIAL EVAL
20|FH_F37910_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F37910_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|MS DRG 765-768, 774-775 C-SECTION & NORMAL DELIVERY
20|FH_F37910_0_0|SrvcGrp|27761|2022|PCT|0.85|99|0.00|ICU/CCU
20|FH_F37937_0_0|SrvcGrp|11069|2022|PDM|100.00|99|0.00|OT SVCS
20|FH_F37937_0_0|SrvcGrp|27725|2022|PDM|45.00|99|0.00|SKILLED RN HOURLY
20|FH_F37943_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F37960_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F37960_0_0|CSTM-ALL|CSTM-00|2020|PDM|1010.00|99|0.00|MS DRG 767-768, 774-775 NORMAL DELIVERY
20|FH_F37960_0_0|SrvcGrp|359|2022|PDM|1010.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL I
20|FH_F37987_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F37987_0_0|CSTM-ALL|CSTM-00|2020|PDM|1070.00|99|0.00|ASPG VIII
20|FH_F37987_0_0|CSTM-ALL|CSTM-00|2020|PDM|1473.00|99|0.00|ASPG IX
20|FH_F37987_0_0|CSTM-ALL|CSTM-00|2020|PDM|491.00|99|0.00|ASPG II
20|FH_F37996_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38004_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|GENERAL ACUTE CARE
20|FH_F38004_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|OP SVCS
20|FH_F38007_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F38007_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|PEDIATRIC IP SERVICES
20|FH_F38007_0_0|SrvcGrp|27887|2022|PCT|0.88|99|0.00|BONE MARROW TRANSPLANT
20|FH_F38007_0_0|SrvcGrp|8950|2022|PDM|3385.00|99|0.00|INTERMEDIATE ICU/CCU
20|FH_F38007_0_0|SrvcGrp|941|2022|PDM|3195.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F38016_0_0|CSTM-ALL|CSTM-00|2020|PDM|3245.00|99|0.00|CV SURGERY (MS DRG ONLY)
20|FH_F38016_0_0|CSTM-ALL|CSTM-00|2020|PDM|3245.00|99|0.00|MS DRG 247
20|FH_F38016_0_0|SrvcGrp|23477|2022|PDM|6490.00|99|0.00|MSDRG 286-287 ONLY CARDIAC CATH
20|FH_F38016_0_0|SrvcGrp|38|2022|PDM|2380.00|99|0.00|NORMAL DELIVERY
20|FH_F38016_0_0|SrvcGrp|43|2022|PCT|0.60|99|0.00|IMPLANTS
20|FH_F38016_0_0|SrvcGrp|701|2022|PDM|1731.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F38023_0_0|SrvcGrp|15850|2022|PDM|105.00|99|0.00|HOSPICE SVCS
20|FH_F38034_0_0|CSTM-ALL|CSTM-00|2020|PDM|2264.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F38034_0_0|SrvcGrp|11283|2022|PCT|0.70|99|0.00|HYPERBARIC CHAMBER
20|FH_F38034_0_0|SrvcGrp|115|2022|PDM|862.00|99|0.00|SKILLED NURSING CARE
20|FH_F38034_0_0|SrvcGrp|26793|2022|PDM|852.00|99|0.00|NEWBORN NURSERY
20|FH_F38034_0_0|SrvcGrp|27881|2022|PDM|4171.00|99|0.00|ANGIOPLASTY
20|FH_F38034_0_0|SrvcGrp|3188|2022|PDM|852.00|99|0.00|NEWBORN NURSERY
20|FH_F38034_0_0|SrvcGrp|43395|2022|PCT|0.85|99|0.00|LITHOTRIPSY SVCS
20|FH_F38037_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F38037_0_0|SrvcGrp|12401|2022|PDM|88.00|99|0.00|RN VISIT
20|FH_F38039_0_0|SrvcGrp|12401|2022|PDM|82.50|99|0.00|RN VISIT
20|FH_F38039_0_0|SrvcGrp|9832|2022|PDM|77.00|99|0.00|ST SVCS
20|FH_F38047_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F38051_0_0|SrvcGrp|110|2022|PDM|300.00|99|0.00|CD - REHABILITATION
20|FH_F38069_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.87|99|0.00|GENERAL ACUTE CARE
20|FH_F38069_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.87|99|0.00|OP SVCS
20|FH_F38081_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F38081_0_0|SrvcGrp|474|2022|PDM|300.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F38088_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38089_0_0|CSTM-ALL|CSTM-00|2020|PDM|32604.00|99|0.00|CORONARY BYPASS SURGERY
20|FH_F38089_0_0|CSTM-ALL|CSTM-00|2020|PDM|709.00|99|0.00|ADULT PSYCHIATRIC
20|FH_F38089_0_0|SrvcGrp|16|2022|PDM|1134.00|99|0.00|ACUTE REHABILITATION
20|FH_F38089_0_0|SrvcGrp|24537|2022|PDM|496.00|99|0.00|DIALYSIS
20|FH_F38089_0_0|SrvcGrp|38|2022|PDM|2835.00|99|0.00|NORMAL DELIVERY
20|FH_F38089_0_0|SrvcGrp|701|2022|PDM|1985.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F38089_0_0|SrvcGrp|72|2022|PDM|354.00|99|0.00|NEWBORN NURSERY
20|FH_F38090_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F38090_0_0|CSTM-ALL|CSTM-00|2020|PDM|1435.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38090_0_0|CSTM-ALL|CSTM-00|2020|PDM|624.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F38090_0_0|SrvcGrp|43|2022|PCT|0.50|99|0.00|IMPLANTS
20|FH_F38090_0_0|SrvcGrp|7|2022|PDM|2055.00|99|0.00|NEONATAL INTENSIVE
20|FH_F38090_0_0|SrvcGrp|97|2022|PDM|4636.00|99|0.00|C-SECTION
20|FH_F38135_0_0|SrvcGrp|28227|2022|PCT|0.75|99|0.00|ANGIOPLASTY
20|FH_F38151_0_0|CSTM-ALL|CSTM-00|2020|PDM|637.00|99|0.00|ACUTE PSYCH
20|FH_F38151_0_0|SrvcGrp|131|2022|PCT|0.85|99|0.00|PACEMAKER DEVICE
20|FH_F38151_0_0|SrvcGrp|28279|2022|PCT|0.85|99|0.00|CARDIAC CATHETERIZATION
20|FH_F74844_0_0|SrvcGrp|42871|2022|PDM|60.00|99|0.00|SPEECH THERAPY VISIT
20|FH_F74845_0_0|SrvcGrp|14177|2022|PDM|19495.00|99|0.00|BARIATRIC SVCS
20|FH_F74845_0_0|SrvcGrp|16|2022|PDM|1234.00|99|0.00|ACUTE REHABILITATION
20|FH_F74845_0_0|SrvcGrp|24|2022|PCT|0.75|99|0.00|CARDIAC CATH
20|FH_F74845_0_0|SrvcGrp|3029|2022|PDM|524.00|99|0.00|NEWBORN NURSERY
20|FH_F74845_0_0|SrvcGrp|59837|2022|PCT|1.15|99|0.00|RADIOACTIVE SEEDS
20|FH_F74883_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F74947_0_0|SrvcGrp|33165|2022|PDM|550.00|99|0.00|SKILLED NURSING - LEVEL II
20|FH_F75087_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F75087_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|COVENTRY ENHANCED GROUPER 10
20|FH_F75087_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|COVENTRY ENHANCED GROUPER 6
20|FH_F75087_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|COVENTRY ENHANCED GROUPER 8
20|FH_F75087_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|COVENTRY ENHANCED GROUPER 1
20|FH_F75087_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|COVENTRY ENHANCED GROUPER 2
20|FH_F75087_0_0|SrvcGrp|14614|2022|PDM|4000.00|99|0.00|LITHOTRIPSY
20|FH_F75087_0_0|SrvcGrp|63459|2022|PDM|2350.00|99|0.00|CPT 52601
20|FH_F75087_0_0|SrvcGrp|63469|2022|PDM|900.00|99|0.00|CPT 55700
20|FH_F75105_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F75105_0_0|CSTM-ALL|CSTM-00|2020|PDM|60.00|99|0.00|OP SVCS
20|FH_F75184_0_0|CSTM-ALL|CSTM-00|2020|PDM|865.60|99|0.00|DIALYSIS
20|FH_F75185_0_0|SrvcGrp|472|2022|PDM|460.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F75205_0_0|SrvcGrp|43428|2022|PDM|60.00|99|0.00|RN HOURLY
20|FH_F75205_0_0|SrvcGrp|43432|2022|PDM|17.00|99|0.00|HOME HEALTH AIDE HOURLY
20|FH_F75205_0_0|SrvcGrp|45965|2022|PDM|120.00|99|0.00|SKILLED NURSING VISIT
20|FH_F75205_0_0|SrvcGrp|62537|2022|PDM|130.00|99|0.00|SPEECH THERAPY
20|FH_F75205_0_0|SrvcGrp|62538|2022|PDM|130.00|99|0.00|PHYSICAL THERAPY
20|FH_F75207_0_0|SrvcGrp|59353|2022|PDM|325.00|99|0.00|HEMODIALYSIS - HOME TRAINING
20|FH_F75207_0_0|SrvcGrp|59357|2022|PDM|140.00|99|0.00|CAPD TRAINING
20|FH_F75207_0_0|SrvcGrp|59358|2022|PDM|140.00|99|0.00|CCPD TRAINING
20|FH_F75243_0_0|SrvcGrp|10951|2022|PDM|273.00|99|0.00|PARTIAL HOSPITALIZATION PSYCH/CD
20|FH_F75243_0_0|SrvcGrp|12290|2022|PDM|418.00|99|0.00|DETOXIFICATION
20|FH_F75245_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.80|99|0.00|GENERAL ACUTE CARE
20|FH_F75307_0_0|SrvcGrp|26001|2022|PDM|159.74|99|0.00|HOSPICE RESPITE SVCS
20|FH_F75307_0_0|SrvcGrp|27968|2022|PDM|28.00|99|0.00|SKILLED NURSING LPN
20|FH_F75307_0_0|SrvcGrp|42976|2022|PDM|105.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F75307_0_0|SrvcGrp|46118|2022|PDM|72.00|99|0.00|NUTRITNAL CNSLNG/DIABETES EDU
20|FH_F75307_0_0|SrvcGrp|57649|2022|PDM|77.00|99|0.00|PHYSICAL THERAPY SVCS MOD GP
20|FH_F75307_0_0|SrvcGrp|59415|2022|PDM|105.00|99|0.00|OCCUPATIONAL THERAPY SVCS EXCLD MOD GO
20|FH_F75342_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F75344_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F75483_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F75542_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F75542_0_0|SrvcGrp|17140|2022|PDM|148.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F75595_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F75606_0_0|CSTM-ALL|CSTM-00|2020|PDM|2460.00|99|0.00|GENERAL ACUTE CARE
20|FH_F75606_0_0|SrvcGrp|12299|2022|PCT|0.68|99|0.00|PROSTHETICS/IMPLANTS/DEVICES
20|FH_F75606_0_0|SrvcGrp|1943|2022|PDM|2605.00|99|0.00|NEONATAL INTENSVE CARE II & III
20|FH_F75606_0_0|SrvcGrp|941|2022|PDM|3126.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F75643_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F75722_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS
20|FH_F75786_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F75786_0_0|CSTM-ALL|CSTM-00|2020|PDM|1308.00|99|0.00|COVENTRY ENHANCED GROUPER 9
20|FH_F75786_0_0|CSTM-ALL|CSTM-00|2020|PDM|425.00|99|0.00|COVENTRY ENHANCED GROUPER 1
20|FH_F75786_0_0|CSTM-ALL|CSTM-00|2020|PDM|615.00|99|0.00|COVENTRY ENHANCED DEFAULT 10021-69990
20|FH_F75786_0_0|CSTM-ALL|CSTM-00|2020|PDM|972.00|99|0.00|COVENTRY ENHANCED GROUPER 7
20|FH_F75788_0_0|CSTM-ALL|CSTM-00|2020|PCT|64.90|99|0.00|OP SVCS
20|FH_F75793_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE
20|FH_F75803_0_0|CSTM-ALL|CSTM-00|2020|PDM|1897.00|99|0.00|GENERAL ACUTE CARE
20|FH_F75803_0_0|SrvcGrp|11000|2022|PCT|0.70|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F75803_0_0|SrvcGrp|29817|2022|PDM|2529.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F75804_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|PROFESSIONAL FEES ON CMS1500
20|FH_F75806_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F75806_0_0|SrvcGrp|100948|2022|PDM|216.00|99|0.00|HOME HEALTH LPN SERVICE
20|FH_F75806_0_0|SrvcGrp|10540|2022|PDM|143.00|99|0.00|HOME HEALTH AIDE
20|FH_F75826_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F75862_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F75862_0_0|SrvcGrp|22954|2022|PDM|154.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F75862_0_0|SrvcGrp|26001|2022|PDM|156.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F75944_0_0|SrvcGrp|34342|2022|PCT|0.50|99|0.00|IMPLANTS
20|FH_F75944_0_0|SrvcGrp|68185|2022|PDM|642.00|99|0.00|CVTY ENHANCED + REV CODES ASPG 1
20|FH_F75944_0_0|SrvcGrp|68186|2022|PDM|860.00|99|0.00|CVTY ENHANCED + REV CODES ASPG 2
20|FH_F75944_0_0|SrvcGrp|68190|2022|PDM|1591.00|99|0.00|CVTY ENHANCED + REV CODES ASPG 6
20|FH_F75944_0_0|SrvcGrp|68193|2022|PDM|2461.00|99|0.00|CVTY ENHANCED + REV CODES ASPG 9
20|FH_F75963_0_0|SrvcGrp|46424|2022|PDM|18.00|99|0.00|HI TECH SKILLED NURSING SERVICES
20|FH_F75963_0_0|SrvcGrp|46605|2022|PDM|18.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES
20|FH_F75963_0_0|SrvcGrp|66265|2022|PDM|8.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F75963_0_0|SrvcGrp|73139|2022|PDM|18.00|99|0.00|PHYSICAL THERAPY SERVICES
20|FH_F76022_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE
20|FH_F76022_0_0|SrvcGrp|73283|2022|PCT|0.85|99|0.00|OP GAMMA KNIFE
20|FH_F76028_0_0|SrvcGrp|45965|2022|PDM|120.00|99|0.00|SKILLED NURSING VISIT
20|FH_F38151_0_0|SrvcGrp|701|2022|PDM|2113.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F38151_0_0|SrvcGrp|72|2022|PDM|423.00|99|0.00|NEWBORN NURSERY
20|FH_F38151_0_0|SrvcGrp|997|2022|PCT|0.85|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F38153_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.40|99|0.00|OP SVCS
20|FH_F38159_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F38159_0_0|CSTM-ALL|CSTM-00|2020|PDM|547.97|99|0.00|YORK END CTR HAPA EAST ASPG III
20|FH_F38159_0_0|CSTM-ALL|CSTM-00|2020|PDM|651.20|99|0.00|YORK END CTR HAPA EAST ASPG X
20|FH_F38172_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|GA STANDARD CT CODES
20|FH_F38227_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38227_0_0|SrvcGrp|47994|2022|PDM|80.00|99|0.00|PHYSICAL THERAPY VISIT
20|FH_F38242_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|IMPLANTS
20|FH_F38242_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS
20|FH_F38249_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|MS DRG 003
20|FH_F38249_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AMBULANCE SVCS
20|FH_F38250_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F38277_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F38288_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|ASPG X
20|FH_F38288_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|ASPG VI
20|FH_F38289_0_0|SrvcGrp|28705|2022|PDM|1057.23|99|0.00|CENTER FOR SPINE CARE DISCOGRAM
20|FH_F38332_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F38332_0_0|CSTM-ALL|CSTM-00|2020|PDM|42216.00|99|0.00|MS DRG 233
20|FH_F38332_0_0|CSTM-ALL|CSTM-00|2020|PDM|42216.00|99|0.00|MS DRG 235
20|FH_F38332_0_0|CSTM-ALL|CSTM-00|2020|PDM|42216.00|99|0.00|MS DRG 236
20|FH_F38332_0_0|SrvcGrp|997|2022|PCT|0.50|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F38364_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38373_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38380_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38383_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|AUTOLOGUS BONE MARROW HARVEST
20|FH_F38383_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|TRANSPLANT ACQUISITION
20|FH_F38387_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F38389_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F38396_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|GENERAL ACUTE CARE
20|FH_F38396_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|OP SVCS
20|FH_F38396_0_0|SrvcGrp|72|2022|PDM|200.00|99|0.00|NEWBORN NURSERY
20|FH_F38410_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38410_0_0|SrvcGrp|10540|2022|PDM|22.00|99|0.00|HOME HEALTH AIDE
20|FH_F38410_0_0|SrvcGrp|10541|2022|PDM|110.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F38410_0_0|SrvcGrp|10543|2022|PDM|110.00|99|0.00|SPEECH THERAPY SVCS
20|FH_F38410_0_0|SrvcGrp|15846|2022|PDM|47.00|99|0.00|HOME VISIT
20|FH_F38411_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 461
20|FH_F38411_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 484
20|FH_F38411_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 652
20|FH_F38411_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 808
20|FH_F38411_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 810
20|FH_F38411_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 886
20|FH_F38411_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 917
20|FH_F38411_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F38411_0_0|CSTM-ALL|CSTM-00|2020|PDM|4800.00|99|0.00|MS DRG 765-766 C-SECTION
20|FH_F38411_0_0|SrvcGrp|13715|2022|PCT|0.80|99|0.00|DME/ORTHOTICS/PROSTHETICS/IMPLANTS
20|FH_F38411_0_0|SrvcGrp|19886|2022|PCT|0.80|99|0.00|MS DRG 466-468 ONLY
20|FH_F38411_0_0|SrvcGrp|21354|2022|PCT|0.80|99|0.00|MS DRG 250-251 ONLY
20|FH_F38411_0_0|SrvcGrp|28990|2022|PCT|0.80|99|0.00|TRAUMA SERVICES
20|FH_F38411_0_0|SrvcGrp|3208|2022|PDM|600.00|99|0.00|SUBACUTE CARE
20|FH_F38411_0_0|SrvcGrp|361|2022|PDM|1500.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F38417_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38417_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F38417_0_0|CSTM-ALL|CSTM-00|2020|PDM|1070.00|99|0.00|ASPG VIII
20|FH_F38417_0_0|CSTM-ALL|CSTM-00|2020|PDM|1095.00|99|0.00|ASPG VII
20|FH_F38417_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|ASPG X
20|FH_F38417_0_0|CSTM-ALL|CSTM-00|2020|PDM|789.00|99|0.00|ASPG V
20|FH_F38433_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38436_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38436_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS
20|FH_F38438_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38450_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F38450_0_0|CSTM-ALL|CSTM-00|2020|PDM|85.00|99|0.00|PT / OT / ST
20|FH_F38473_0_0|CSTM-ALL|CSTM-00|2020|PDM|45.00|99|0.00|LPN HI TECH - HOURLY
20|FH_F38473_0_0|CSTM-ALL|CSTM-00|2020|PDM|73.00|99|0.00|LPN VISIT
20|FH_F38473_0_0|SrvcGrp|10541|2022|PDM|110.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F38473_0_0|SrvcGrp|10543|2022|PDM|110.00|99|0.00|SPEECH THERAPY SVCS
20|FH_F38475_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F38475_0_0|CSTM-ALL|CSTM-00|2020|PDM|73.00|99|0.00|LPN VISIT
20|FH_F38475_0_0|SrvcGrp|10407|2022|PDM|55.00|99|0.00|HOME INFUSION
20|FH_F38475_0_0|SrvcGrp|10541|2022|PDM|110.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F38476_0_0|SrvcGrp|10540|2022|PDM|22.00|99|0.00|HOME HEALTH AIDE
20|FH_F38476_0_0|SrvcGrp|15846|2022|PDM|47.00|99|0.00|HOME VISIT
20|FH_F38476_0_0|SrvcGrp|27968|2022|PDM|41.00|99|0.00|SKILLED NURSING LPN
20|FH_F38496_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.50|99|0.00|GENERAL ACUTE CARE
20|FH_F38526_0_0|CSTM-ALL|CSTM-00|2020|PDM|3900.00|99|0.00|MS DRG 242-244 PACEMAKER IMPLANT W/ACUTE INFARCTION
20|FH_F38526_0_0|CSTM-ALL|CSTM-00|2020|PDM|5500.00|99|0.00|MSDRG 286-287 CARDIAC CATH
20|FH_F38526_0_0|CSTM-ALL|CSTM-00|2020|PDM|7800.00|99|0.00|MSDRG 246-251 ANGIOPLASTY
20|FH_F38526_0_0|SrvcGrp|23928|2022|PDM|5900.00|99|0.00|ABDOMINAL LAPAROSCOPIC PROCEDURES
20|FH_F38526_0_0|SrvcGrp|360|2022|PDM|2200.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F38526_0_0|SrvcGrp|361|2022|PDM|2300.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F76063_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F76063_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F76124_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F76124_0_0|SrvcGrp|3259|2022|PDM|750.00|99|0.00|ACUTE REHABILITATION
20|FH_F76124_0_0|SrvcGrp|33166|2022|PDM|377.00|99|0.00|SKILLED NURSING - LEVEL III
20|FH_F76146_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F76146_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS
20|FH_F76146_0_0|SrvcGrp|68186|2022|PDM|781.00|99|0.00|CVTY ENHANCED + REV CODES ASPG 2
20|FH_F76146_0_0|SrvcGrp|68188|2022|PDM|1103.00|99|0.00|CVTY ENHANCED + REV CODES ASPG 4
20|FH_F76163_0_0|SrvcGrp|26001|2022|PDM|150.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F76163_0_0|SrvcGrp|57968|2022|PDM|30.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F76171_0_0|CSTM-ALL|CSTM-00|2020|PDM|10.00|99|0.00|LVN HOURLY
20|FH_F76171_0_0|SrvcGrp|26160|2022|PDM|60.00|99|0.00|HOME HEALTH AIDE VISIT
20|FH_F76171_0_0|SrvcGrp|48645|2022|PDM|126.00|99|0.00|OP SKILLED NURSING
20|FH_F76171_0_0|SrvcGrp|73301|2022|PDM|73.00|99|0.00|PHYSICAL THERAPY HOURLY
20|FH_F76171_0_0|SrvcGrp|73302|2022|PDM|225.00|99|0.00|SPEECH THERAPY RE-EVALUATION
20|FH_F76222_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|OP SVCS
20|FH_F76222_0_0|SrvcGrp|30623|2022|PDM|8038.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788
20|FH_F76262_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|COLONOSCOPY
20|FH_F76284_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F76284_0_0|SrvcGrp|3809|2022|PDM|737.00|99|0.00|HOSPICE CARE
20|FH_F76285_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F76285_0_0|SrvcGrp|44885|2022|PDM|154.00|99|0.00|PHYSICAL THERAPY SVCS RE-EVAL PER VISIT
20|FH_F76285_0_0|SrvcGrp|48631|2022|PDM|154.00|99|0.00|OCCUPATIONAL THERAPY SVCS RE-EVAL
20|FH_F76303_0_0|SrvcGrp|42974|2022|PDM|150.00|99|0.00|OCCUPATIONAL THERAPIST
20|FH_F76303_0_0|SrvcGrp|53145|2022|PDM|18.00|99|0.00|SOCIAL WORKER
20|FH_F76382_0_0|SrvcGrp|14997|2022|PCT|0.50|99|0.00|DRUGS
20|FH_F76382_0_0|SrvcGrp|43892|2022|PDM|110.00|99|0.00|PHYSICAL THERAPY VISIT
20|FH_F76382_0_0|SrvcGrp|44131|2022|PDM|110.00|99|0.00|SPEECH THERAPY VISIT
20|FH_F76382_0_0|SrvcGrp|471|2022|PDM|625.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F76382_0_0|SrvcGrp|472|2022|PDM|550.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F76382_0_0|SrvcGrp|473|2022|PDM|475.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F76402_0_0|CSTM-ALL|CSTM-00|2020|PCT|24411.00|99|0.00|CAPD/CCPD SUPPLEMENT
20|FH_F76402_0_0|CSTM-ALL|CSTM-00|2020|PCT|36500.00|99|0.00|TIMELY FILING
20|FH_F76402_0_0|CSTM-ALL|CSTM-00|2020|PCT|56650.00|99|0.00|HOME HEMO TRAINING
20|FH_F76502_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS
20|FH_F76522_0_0|SrvcGrp|16719|2022|PCT|0.45|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F76522_0_0|SrvcGrp|23585|2022|PCT|0.45|99|0.00|IMPLANTS
20|FH_F76588_0_0|SrvcGrp|26160|2022|PDM|8.00|99|0.00|HOME HEALTH AIDE VISIT
20|FH_F76588_0_0|SrvcGrp|73523|2022|PDM|18.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F76588_0_0|SrvcGrp|73524|2022|PDM|18.00|99|0.00|PHYSICAL THERAPY
20|FH_F76624_0_0|CSTM-ALL|CSTM-00|2020|PDM|1051.00|99|0.00|ASPG III - IOWA
20|FH_F76624_0_0|CSTM-ALL|CSTM-00|2020|PDM|2049.00|99|0.00|ASPG VII - IOWA
20|FH_F76624_0_0|CSTM-ALL|CSTM-00|2020|PDM|2779.00|99|0.00|ASPG IX - IOWA
20|FH_F76624_0_0|SrvcGrp|14006|2022|PCT|0.38|99|0.00|IMPLANTS
20|FH_F76662_0_0|SrvcGrp|11442|2022|PDM|737.00|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)
20|FH_F76662_0_0|SrvcGrp|59426|2022|PDM|85.00|99|0.00|PT
20|FH_F76662_0_0|SrvcGrp|59428|2022|PDM|85.00|99|0.00|ST
20|FH_F76782_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F76782_0_0|SrvcGrp|22954|2022|PDM|159.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F76864_0_0|SrvcGrp|73948|2022|PDM|325.00|99|0.00|SKILLED NURSING
20|FH_F76887_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F77025_0_0|SrvcGrp|34342|2022|PCT|1.10|99|0.00|IMPLANTS
20|FH_F77042_0_0|SrvcGrp|74381|2022|PDM|18.00|99|0.00|PHYSICAL THERAPY
20|FH_F77042_0_0|SrvcGrp|74384|2022|PDM|18.00|99|0.00|RESPIRATORY THERAPY
20|FH_F77082_0_0|CSTM-ALL|CSTM-00|2020|PDM|10593.00|99|0.00|2007 MEDICARE ASPG VIII
20|FH_F77082_0_0|SrvcGrp|32560|2022|PCT|0.95|99|0.00|BURN SERVICES (MS DRG)
20|FH_F77082_0_0|SrvcGrp|3378|2022|PCT|0.75|99|0.00|OBSERVATION SVCS
20|FH_F77082_0_0|SrvcGrp|33793|2022|PDM|20740.00|99|0.00|MSDRG 246-251 ONLY ANGIOPLASTY
20|FH_F77082_0_0|SrvcGrp|47250|2022|PDM|2160.00|99|0.00|MS DRG 876, 880-887 ONLY
20|FH_F77184_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F77184_0_0|SrvcGrp|46605|2022|PDM|18.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES
20|FH_F77184_0_0|SrvcGrp|48385|2022|PDM|18.00|99|0.00|SPEECH THERAPY
20|FH_F77184_0_0|SrvcGrp|48394|2022|PDM|8.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F77234_0_0|SrvcGrp|17071|2022|PDM|1822.00|99|0.00|ASPG IV
20|FH_F77234_0_0|SrvcGrp|17079|2022|PDM|2803.00|99|0.00|ASPG VIII
20|FH_F77404_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F77404_0_0|SrvcGrp|26001|2022|PDM|142.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F77404_0_0|SrvcGrp|3809|2022|PDM|615.00|99|0.00|HOSPICE CARE
20|FH_F77448_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F77448_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F77462_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F77462_0_0|SrvcGrp|30609|2022|PDM|45.00|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F77462_0_0|SrvcGrp|42973|2022|PDM|110.00|99|0.00|SPEECH  THERAPIST
20|FH_F77462_0_0|SrvcGrp|42976|2022|PDM|135.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F77462_0_0|SrvcGrp|43955|2022|PDM|100.00|99|0.00|NURSING CARE
20|FH_F77504_0_0|SrvcGrp|10014|2022|PDM|1275.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F77504_0_0|SrvcGrp|29557|2022|PCT|1.00|99|0.00|TISSUE PLASMINOGEN ACTIVATOR
20|FH_F77504_0_0|SrvcGrp|33230|2022|PDM|1275.00|99|0.00|AIDS UNIT
20|FH_F77504_0_0|SrvcGrp|33235|2022|PCT|1.00|99|0.00|ORTHOTICS/PROSTHETICS/IMPLANTS
20|FH_F77504_0_0|SrvcGrp|592|2022|PDM|400.00|99|0.00|SUB-ACUTE CARE
20|FH_F77544_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F38526_0_0|SrvcGrp|49|2022|PDM|12500.00|99|0.00|HIP REPLACEMENT
20|FH_F38528_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS
20|FH_F38560_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F38560_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|LEVEL 1 IP REHAB
20|FH_F38560_0_0|CSTM-ALL|CSTM-00|2020|PDM|3550.00|99|0.00|ADULT ANGIO W/O CARDIAC CATH
20|FH_F38560_0_0|CSTM-ALL|CSTM-00|2020|PDM|385.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F38560_0_0|SrvcGrp|29514|2022|PDM|15000.00|99|0.00|ADULT ABLATION/ELECTROPHYSIOLOGY
20|FH_F38560_0_0|SrvcGrp|29516|2022|PDM|7000.00|99|0.00|ADULT ELECTROPHYSIOLOGY
20|FH_F38560_0_0|SrvcGrp|38|2022|PDM|1750.00|99|0.00|NORMAL DELIVERY
20|FH_F38560_0_0|SrvcGrp|413|2022|PCT|0.70|99|0.00|TRANSPLANT SVCS
20|FH_F38560_0_0|SrvcGrp|97|2022|PDM|3900.00|99|0.00|C-SECTION
20|FH_F38567_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|ACUTE PSYCH
20|FH_F38568_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38584_0_0|SrvcGrp|17071|2022|PDM|1012.00|99|0.00|ASPG IV
20|FH_F38584_0_0|SrvcGrp|17079|2022|PDM|1564.00|99|0.00|ASPG VIII
20|FH_F38591_0_0|SrvcGrp|11853|2022|PCT|0.70|99|0.00|DRUGS
20|FH_F38591_0_0|SrvcGrp|72|2022|PDM|534.00|99|0.00|NEWBORN NURSERY
20|FH_F38607_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F38676_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE
20|FH_F38677_0_0|SrvcGrp|24651|2022|PDM|135.00|99|0.00|HEMODIALYSIS - HOME TRAINING
20|FH_F38686_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|OP SVCS
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 224
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 225
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 226
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 227
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 231
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 248
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 466
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 468
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 469
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 620
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 621
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PDM|867.00|99|0.00|MSDRG 894-897 CHEMICAL DEPENDENCY
20|FH_F38700_0_0|SrvcGrp|3271|2022|PDM|3195.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F38709_0_0|CSTM-ALL|CSTM-00|2020|PDM|1273.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38709_0_0|SrvcGrp|8950|2022|PDM|1751.00|99|0.00|INTERMEDIATE ICU/CCU
20|FH_F38730_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38730_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F38732_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38790_0_0|SrvcGrp|411|2022|PCT|0.77|99|0.00|OP CARDIAC CATH
20|FH_F38790_0_0|SrvcGrp|69560|2022|PCT|0.77|99|0.00|MS DRG 216-232,237- 238 ONLY CARDIOVASCULAR
20|FH_F38805_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|DELIVERY
20|FH_F38805_0_0|CSTM-ALL|CSTM-00|2020|PDM|975.00|99|0.00|LABOR ROOM/DELIVERY 4 OR MORE HRS/TRANSFERRED
20|FH_F38807_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F38807_0_0|SrvcGrp|17067|2022|PDM|446.00|99|0.00|ASPG II
20|FH_F38807_0_0|SrvcGrp|17069|2022|PDM|510.00|99|0.00|ASPG III
20|FH_F38807_0_0|SrvcGrp|17075|2022|PDM|826.00|99|0.00|ASPG VI
20|FH_F38808_0_0|SrvcGrp|17073|2022|PDM|789.00|99|0.00|ASPG V
20|FH_F38808_0_0|SrvcGrp|17077|2022|PDM|1095.00|99|0.00|ASPG VII
20|FH_F38826_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|ACUTE IP MED SVCS
20|FH_F38826_0_0|SrvcGrp|17365|2022|PDM|5125.00|99|0.00|AIR AMBULANCE SVCS
20|FH_F38826_0_0|SrvcGrp|177|2022|PDM|2200.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F38826_0_0|SrvcGrp|65|2022|PCT|0.73|99|0.00|OBSTETRICAL CARE
20|FH_F38826_0_0|SrvcGrp|701|2022|PDM|2600.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F38842_0_0|SrvcGrp|10639|2022|PDM|500.00|99|0.00|CT SCAN
20|FH_F38845_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F38846_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38846_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|NEWBORN NURSERY
20|FH_F38847_0_0|SrvcGrp|38|2022|PDM|2400.00|99|0.00|NORMAL DELIVERY
20|FH_F38847_0_0|SrvcGrp|411|2022|PCT|0.70|99|0.00|OP CARDIAC CATH
20|FH_F38848_0_0|SrvcGrp|10111|2022|PCT|0.70|99|0.00|IMPLANTS
20|FH_F38848_0_0|SrvcGrp|72|2022|PDM|600.00|99|0.00|NEWBORN NURSERY
20|FH_F38855_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38865_0_0|CSTM-ALL|CSTM-00|2020|PDM|680.00|99|0.00|ACUTE PSYCH
20|FH_F38865_0_0|SrvcGrp|109|2022|PDM|700.00|99|0.00|CD - DETOX
20|FH_F38867_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|GENERAL ACUTE CARE
20|FH_F38867_0_0|CSTM-ALL|CSTM-00|2020|PDM|535.00|99|0.00|ACUTE PSYCH
20|FH_F38867_0_0|SrvcGrp|72|2022|PCT|0.92|99|0.00|NEWBORN NURSERY
20|FH_F38889_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F38910_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS
20|FH_F38939_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|OP SVCS
20|FH_F38948_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 286-287
20|FH_F38948_0_0|SrvcGrp|16|2022|PDM|1108.00|99|0.00|ACUTE REHABILITATION
20|FH_F38948_0_0|SrvcGrp|24703|2022|PDM|506.00|99|0.00|NEWBORN NURSERY
20|FH_F38949_0_0|SrvcGrp|10107|2022|PCT|0.60|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F38949_0_0|SrvcGrp|12674|2022|PCT|0.60|99|0.00|IMPLANTS
20|FH_F38952_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.84|99|0.00|GENERAL ACUTE CARE
20|FH_F38955_0_0|CSTM-ALL|CSTM-00|2020|PDM|1036.41|99|0.00|CHEMICAL DEPENDENCY
20|FH_F38955_0_0|SrvcGrp|1137|2022|PDM|603.71|99|0.00|ELECTRO CONVULSIVE THERAPY
20|FH_F38955_0_0|SrvcGrp|97|2022|PDM|3423.44|99|0.00|C-SECTION
20|FH_F38961_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38961_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F38961_0_0|SrvcGrp|473|2022|PDM|325.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F38966_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F38967_0_0|SrvcGrp|29971|2022|PDM|700.00|99|0.00|DIALYSIS
20|FH_F38976_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38977_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F38982_0_0|SrvcGrp|115|2022|PDM|566.00|99|0.00|SKILLED NURSING CARE
20|FH_F38982_0_0|SrvcGrp|16|2022|PDM|881.00|99|0.00|ACUTE REHABILITATION
20|FH_F38982_0_0|SrvcGrp|23348|2022|PDM|3146.00|99|0.00|CV SURGERY MS DRG'S ONLY 216-221, 231-236
20|FH_F38986_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F38986_0_0|SrvcGrp|38|2022|PDM|2535.00|99|0.00|NORMAL DELIVERY
20|FH_F38999_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F38999_0_0|CSTM-ALL|CSTM-00|2020|PDM|1573.00|99|0.00|GENERAL ACUTE CARE
20|FH_F38999_0_0|SrvcGrp|15|2022|PDM|3441.00|99|0.00|PEDIATRIC INTENSIVE CARE UNIT
20|FH_F39015_0_0|SrvcGrp|1306|2022|PDM|350.00|99|0.00|OP PSYCH PARTIAL HOSP
20|FH_F39015_0_0|SrvcGrp|13551|2022|PDM|442.00|99|0.00|NEWBORN NURSERY
20|FH_F39015_0_0|SrvcGrp|13811|2022|PDM|350.00|99|0.00|PSYCH PARTIAL HOSP
20|FH_F39018_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F39022_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|CV SURGERY
20|FH_F39022_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F39022_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|SKILLED NURSING
20|FH_F39022_0_0|SrvcGrp|16|2022|PDM|1330.00|99|0.00|ACUTE REHABILITATION
20|FH_F39022_0_0|SrvcGrp|97|2022|PDM|2610.00|99|0.00|C-SECTION
20|FH_F39041_0_0|CSTM-ALL|CSTM-00|2020|PDM|6085.00|99|0.00|MS DRG 765-766 C-SECTION
20|FH_F39041_0_0|CSTM-ALL|CSTM-00|2020|PDM|797.00|99|0.00|ACUTE PSYCH
20|FH_F39051_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F39051_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|OP SURGERY
20|FH_F39057_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39066_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F39066_0_0|SrvcGrp|13811|2022|PDM|200.00|99|0.00|PSYCH PARTIAL HOSP
20|FH_F39066_0_0|SrvcGrp|16|2022|PDM|800.00|99|0.00|ACUTE REHABILITATION
20|FH_F39066_0_0|SrvcGrp|24|2022|PDM|5000.00|99|0.00|CARDIAC CATH
20|FH_F39066_0_0|SrvcGrp|29780|2022|PDM|7000.00|99|0.00|ANGIOPLASTY
20|FH_F39066_0_0|SrvcGrp|3029|2022|PDM|400.00|99|0.00|NEWBORN NURSERY
20|FH_F39066_0_0|SrvcGrp|38|2022|PDM|2650.00|99|0.00|NORMAL DELIVERY
20|FH_F39066_0_0|SrvcGrp|701|2022|PDM|1800.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F39066_0_0|SrvcGrp|8950|2022|PDM|1800.00|99|0.00|INTERMEDIATE ICU/CCU
20|FH_F39071_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39075_0_0|CSTM-ALL|CSTM-00|2020|PCT|81.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39080_0_0|SrvcGrp|30060|2022|PDM|5400.00|99|0.00|NORMAL DELIVERY
20|FH_F39080_0_0|SrvcGrp|30062|2022|PDM|4320.00|99|0.00|MULTIPLE BIRTH NORMAL DELIVERY
20|FH_F39080_0_0|SrvcGrp|38|2022|PDM|3600.00|99|0.00|NORMAL DELIVERY
20|FH_F39082_0_0|CSTM-ALL|CSTM-00|2020|PDM|14310.00|99|0.00|ORTHOPEDIC SURGERY (MS DRG 453-455, 459, 466-470)
20|FH_F39082_0_0|CSTM-ALL|CSTM-00|2020|PDM|16062.00|99|0.00|MS DRG 238
20|FH_F39082_0_0|CSTM-ALL|CSTM-00|2020|PDM|16792.00|99|0.00|MS DRG 490
20|FH_F39082_0_0|CSTM-ALL|CSTM-00|2020|PDM|2147.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F39082_0_0|CSTM-ALL|CSTM-00|2020|PDM|32123.00|99|0.00|MS DRG 233-234 CORONARY BYPASS
20|FH_F39082_0_0|SrvcGrp|2738|2022|PCT|0.65|99|0.00|IMPLANTS
20|FH_F39082_0_0|SrvcGrp|361|2022|PDM|2452.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F39082_0_0|SrvcGrp|941|2022|PDM|2452.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F39098_0_0|SrvcGrp|28098|2022|PCT|0.75|99|0.00|OP ANGIOPLASTY
20|FH_F39098_0_0|SrvcGrp|3029|2022|PDM|457.00|99|0.00|NEWBORN NURSERY
20|FH_F39101_0_0|CSTM-ALL|CSTM-00|2020|PDM|49800.00|99|0.00|MSDRG 231-232 CORONARY BYPASS
20|FH_F39101_0_0|SrvcGrp|20272|2022|PDM|43800.00|99|0.00|MS DRG 219-221 ONLY CARDIAC VLV PROC W/O CA CAT
20|FH_F39138_0_0|CSTM-ALL|CSTM-00|2020|PDM|11537.00|99|0.00|MS DRG 249
20|FH_F39138_0_0|CSTM-ALL|CSTM-00|2020|PDM|13245.00|99|0.00|MS DRG 238
20|FH_F39138_0_0|CSTM-ALL|CSTM-00|2020|PDM|42386.00|99|0.00|MSDRG 216-218 CARDIAC VALVE PROCEDURE W/ CARDIAC CATH
20|FH_F39138_0_0|CSTM-ALL|CSTM-00|2020|PDM|5848.00|99|0.00|MS DRG 287
20|FH_F39138_0_0|SrvcGrp|26893|2022|PCT|0.60|99|0.00|PROSTHETICS/ORTHOTICS/IMPLANTS
20|FH_F39138_0_0|SrvcGrp|360|2022|PDM|765.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F39140_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F39151_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|IMPLANTS (HEART TRANSPLANT)
20|FH_F39162_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39162_0_0|CSTM-ALL|CSTM-00|2020|PDM|300.00|99|0.00|ULTRAFILTRATION
20|FH_F39162_0_0|SrvcGrp|21815|2022|PDM|135.00|99|0.00|CAPD/CCPD SUPPLEMENT
20|FH_F39176_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|BONE MARROW TRANSPLANT
20|FH_F39176_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS
20|FH_F39178_0_0|SrvcGrp|439|2022|PDM|2247.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F39180_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|DME
20|FH_F39180_0_0|SrvcGrp|12155|2022|PCT|0.50|99|0.00|DRUGS
20|FH_F39180_0_0|SrvcGrp|360|2022|PDM|1783.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F39180_0_0|SrvcGrp|701|2022|PDM|1783.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F39180_0_0|SrvcGrp|72|2022|PDM|292.00|99|0.00|NEWBORN NURSERY
20|FH_F39209_0_0|SrvcGrp|471|2022|PDM|1250.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F39209_0_0|SrvcGrp|472|2022|PDM|1100.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F39268_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|BLOOD AND BLOOD PRODUCTS
20|FH_F39268_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|OP SVCS
20|FH_F39269_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F39274_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39274_0_0|SrvcGrp|57968|2022|PDM|71.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F39278_0_0|SrvcGrp|8962|2022|PDM|166.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F39279_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F39279_0_0|SrvcGrp|30275|2022|PCT|0.55|99|0.00|PROSTHETICS/IMPLANTS/ORTHOTICS/SUPPLIES
20|FH_F39279_0_0|SrvcGrp|9840|2022|PDM|1850.00|99|0.00|ICU UNIT
20|FH_F39303_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OP SVCS
20|FH_F39303_0_0|SrvcGrp|115|2022|PDM|464.00|99|0.00|SKILLED NURSING CARE
20|FH_F39303_0_0|SrvcGrp|19108|2022|PDM|17745.00|99|0.00|MS DRG 619
20|FH_F39304_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS
20|FH_F39339_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F39339_0_0|CSTM-ALL|CSTM-00|2020|PDM|1605.00|99|0.00|C-SECTION
20|FH_F39339_0_0|SrvcGrp|3409|2022|PDM|405.00|99|0.00|NEWBORN NURSERY
20|FH_F39346_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F39346_0_0|SrvcGrp|115|2022|PDM|558.00|99|0.00|SKILLED NURSING CARE
20|FH_F39346_0_0|SrvcGrp|147|2022|PCT|0.68|99|0.00|HOME HEALTH CARE
20|FH_F39346_0_0|SrvcGrp|20744|2022|PDM|18945.00|99|0.00|MS DRG 242 ONLY
20|FH_F39346_0_0|SrvcGrp|20914|2022|PDM|30441.00|99|0.00|MS DRG 233 ONLY
20|FH_F39346_0_0|SrvcGrp|21350|2022|PDM|6697.00|99|0.00|MS DRG 287 ONLY
20|FH_F39346_0_0|SrvcGrp|27813|2022|PDM|10160.00|99|0.00|MS DRG 280 ONLY
20|FH_F39346_0_0|SrvcGrp|29600|2022|PDM|7737.00|99|0.00|MS DRG 263 ONLY
20|FH_F39346_0_0|SrvcGrp|30546|2022|PDM|21518.00|99|0.00|MS DRG 246-247 ONLY
20|FH_F39346_0_0|SrvcGrp|38|2022|PDM|1350.00|99|0.00|NORMAL DELIVERY
20|FH_F39349_0_0|CSTM-ALL|CSTM-00|2020|PDM|1359.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39349_0_0|SrvcGrp|115|2022|PDM|568.00|99|0.00|SKILLED NURSING CARE
20|FH_F39349_0_0|SrvcGrp|269|2022|PDM|2978.00|99|0.00|OP LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F39352_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F39355_0_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|CD SVCS
20|FH_F39355_0_0|SrvcGrp|110|2022|PDM|475.00|99|0.00|CD - REHABILITATION
20|FH_F39355_0_0|SrvcGrp|16141|2022|PCT|1.05|99|0.00|PACEMAKER
20|FH_F39355_0_0|SrvcGrp|16719|2022|PCT|1.05|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F39355_0_0|SrvcGrp|411|2022|PDM|3200.00|99|0.00|OP CARDIAC CATH
20|FH_F39355_0_0|SrvcGrp|7|2022|PDM|1400.00|99|0.00|NEONATAL INTENSIVE
20|FH_F39366_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|BLOOD AND BLOOD PRODUCTS
20|FH_F39391_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS
20|FH_F39393_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F39398_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SURGERY
20|FH_F39398_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F39418_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|BLOOD AND BLOOD PRODUCTS
20|FH_F39418_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39426_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39426_0_0|SrvcGrp|12496|2022|PDM|680.00|99|0.00|ACUTE REHABILITATION
20|FH_F39426_0_0|SrvcGrp|471|2022|PDM|550.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F39428_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39433_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39450_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F39450_0_0|SrvcGrp|177|2022|PDM|1268.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F39466_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE
20|FH_F39466_0_0|SrvcGrp|4109|2022|PDM|735.00|99|0.00|ACUTE PSYCH
20|FH_F39476_0_0|CSTM-ALL|CSTM-00|2020|PDM|1361.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F39476_0_0|SrvcGrp|41404|2022|PDM|2700.00|99|0.00|ANGIOPLASTY / PTCA W/ ICD 9
20|FH_F39476_0_0|SrvcGrp|43|2022|PCT|0.45|99|0.00|IMPLANTS
20|FH_F39477_0_0|SrvcGrp|22954|2022|PDM|115.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F39504_0_0|CSTM-ALL|CSTM-00|2020|PDM|55.00|99|0.00|PT/OT/ST
20|FH_F39517_0_0|CSTM-ALL|CSTM-00|2020|PDM|6100.00|99|0.00|CV SURGERY (MS DRG)
20|FH_F39517_0_0|SrvcGrp|16|2022|PCT|0.80|99|0.00|ACUTE REHABILITATION
20|FH_F39517_0_0|SrvcGrp|360|2022|PCT|0.80|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F39517_0_0|SrvcGrp|941|2022|PCT|0.80|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F39535_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|OP SVCS
20|FH_F39535_0_0|SrvcGrp|65|2022|PDM|3160.00|99|0.00|OBSTETRICAL CARE
20|FH_F39537_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39537_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F39538_0_0|SrvcGrp|65|2022|PDM|1406.00|99|0.00|OBSTETRICAL CARE
20|FH_F39540_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F39545_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39546_0_0|SrvcGrp|13292|2022|PCT|1.05|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F39546_0_0|SrvcGrp|30806|2022|PCT|1.05|99|0.00|SKIN GRAFT
20|FH_F39549_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39549_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|NEWBORN NURSERY
20|FH_F39551_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39558_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39558_0_0|SrvcGrp|17065|2022|PDM|389.00|99|0.00|ASPG I
20|FH_F39558_0_0|SrvcGrp|17069|2022|PDM|595.00|99|0.00|ASPG III
20|FH_F39558_0_0|SrvcGrp|17073|2022|PDM|836.00|99|0.00|ASPG V
20|FH_F39558_0_0|SrvcGrp|17075|2022|PDM|969.00|99|0.00|ASPG VI
20|FH_F39558_0_0|SrvcGrp|17077|2022|PDM|1162.00|99|0.00|ASPG VII
20|FH_F39558_0_0|SrvcGrp|17079|2022|PDM|1141.00|99|0.00|ASPG VIII
20|FH_F39561_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F39561_0_0|SrvcGrp|1168|2022|PDM|29.78|99|0.00|CONTINUOUS HOMECARE
20|FH_F39567_0_0|CSTM-ALL|CSTM-00|2020|PDM|10800.00|99|0.00|MS DRG 216-227, 231-236 CV SURGERY
20|FH_F39567_0_0|SrvcGrp|10|2022|PDM|4050.00|99|0.00|ANGIOPLASTY
20|FH_F39567_0_0|SrvcGrp|16|2022|PDM|800.00|99|0.00|ACUTE REHABILITATION
20|FH_F39567_0_0|SrvcGrp|24|2022|PDM|3000.00|99|0.00|CARDIAC CATH
20|FH_F39604_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39604_0_0|SrvcGrp|16325|2022|PDM|571.00|99|0.00|HEMODIALYSIS SVCS
20|FH_F39604_0_0|SrvcGrp|16526|2022|PDM|177.00|99|0.00|DIALYSIS
20|FH_F39617_0_0|SrvcGrp|997|2022|PCT|0.80|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F39621_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F39622_0_0|SrvcGrp|23958|2022|PCT|0.65|99|0.00|PHARMACY
20|FH_F39622_0_0|SrvcGrp|2741|2022|PCT|0.65|99|0.00|DRUGS
20|FH_F39622_0_0|SrvcGrp|290|2022|PDM|5900.00|99|0.00|IP LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F39627_0_0|SrvcGrp|10111|2022|PCT|0.85|99|0.00|IMPLANTS
20|FH_F39627_0_0|SrvcGrp|177|2022|PDM|1500.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F39627_0_0|SrvcGrp|439|2022|PDM|2500.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F39633_0_0|SrvcGrp|17065|2022|PDM|619.00|99|0.00|ASPG I
20|FH_F39633_0_0|SrvcGrp|17067|2022|PDM|828.00|99|0.00|ASPG II
20|FH_F39662_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39664_0_0|CSTM-ALL|CSTM-00|2020|PDM|115.00|99|0.00|OP SVCS
20|FH_F39695_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F39701_0_0|CSTM-ALL|CSTM-00|2020|PDM|1121.00|99|0.00|AEG 8 (NO REV)
20|FH_F39701_0_0|CSTM-ALL|CSTM-00|2020|PDM|513.00|99|0.00|AEG 2 (NO REV)
20|FH_F39701_0_0|CSTM-ALL|CSTM-00|2020|PDM|587.00|99|0.00|AEG 10 (NO REV)
20|FH_F39701_0_0|CSTM-ALL|CSTM-00|2020|PDM|725.00|99|0.00|AEG 4 (NO REV)
20|FH_F39701_0_0|CSTM-ALL|CSTM-00|2020|PDM|825.00|99|0.00|AEG 5  (NO REV)
20|FH_F39704_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39704_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS
20|FH_F39714_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.53|99|0.00|ASPG 6
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|118.00|99|0.00|ASPG 123
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|118.50|99|0.00|ASPG 312
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|1297.45|99|0.00|ASPG 801
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|133.73|99|0.00|ASPG 224
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|1688.87|99|0.00|ASPG 902
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|170.34|99|0.00|ASPG 119
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|201.00|99|0.00|ASPG 114
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|298.42|99|0.00|ASPG 218
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|316.70|99|0.00|ASPG 109
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|321.49|99|0.00|ASPG 216
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|336.92|99|0.00|ASPG 106
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|349.88|99|0.00|ASPG 306
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|433.05|99|0.00|ASPG 305
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|446.07|99|0.00|ASPG 101
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|449.30|99|0.00|ASPG 210
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|463.25|99|0.00|ASPG 209
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|471.41|99|0.00|ASPG 304
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|499.57|99|0.00|ASPG 405
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|50.25|99|0.00|ASPG 228
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|534.80|99|0.00|ASPG 404
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|960.45|99|0.00|ASPG 501
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|997.39|99|0.00|ASPG 5
20|FH_F39716_0_0|SrvcGrp|16684|2022|PCT|1.00|99|0.00|DRUGS
20|FH_F39721_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39721_0_0|SrvcGrp|17378|2022|PDM|210.00|99|0.00|CAPD TRAINING
20|FH_F39740_0_0|SrvcGrp|20272|2022|PDM|29216.00|99|0.00|MS DRG 219-221 ONLY CARDIAC VLV PROC W/O CA CAT
20|FH_F39740_0_0|SrvcGrp|21350|2022|PDM|5158.00|99|0.00|MS DRG 287 ONLY
20|FH_F39740_0_0|SrvcGrp|21359|2022|PDM|13014.00|99|0.00|MS DRG 460 ONLY
20|FH_F39740_0_0|SrvcGrp|31038|2022|PDM|27096.00|99|0.00|MS DRG 233-234 ONLY
20|FH_F39749_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F39753_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|OP SVCS
20|FH_F39756_0_0|CSTM-ALL|CSTM-00|2020|PDM|220.00|99|0.00|DENTAL PROCEDURES - CHILD
20|FH_F39756_0_0|CSTM-ALL|CSTM-00|2020|PDM|275.00|99|0.00|DENTAL PROCEDURES - CHILD
20|FH_F39756_0_0|CSTM-ALL|CSTM-00|2020|PDM|531.30|99|0.00|CUMBERLAND SURGERY CTR-ASPG II
20|FH_F39756_0_0|CSTM-ALL|CSTM-00|2020|PDM|607.20|99|0.00|CUMBERLAND SURGERY CTR-ASPG III
20|FH_F39756_0_0|CSTM-ALL|CSTM-00|2020|PDM|751.30|99|0.00|CUMBERLAND SURGERY CTR - ASPG IV
20|FH_F39756_0_0|CSTM-ALL|CSTM-00|2020|PDM|924.00|99|0.00|DENTAL PROCEDURES - CHILD
20|FH_F39819_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F39819_0_0|CSTM-ALL|CSTM-00|2020|PDM|1465.00|99|0.00|NY DRG 629 ONLY
20|FH_F39819_0_0|CSTM-ALL|CSTM-00|2020|PDM|4409.00|99|0.00|NY DRG 142 ONLY
20|FH_F39819_0_0|CSTM-ALL|CSTM-00|2020|PDM|4706.00|99|0.00|NY DRG 426 ONLY
20|FH_F39819_0_0|CSTM-ALL|CSTM-00|2020|PDM|6264.00|99|0.00|NY DRG 141 ONLY
20|FH_F39819_0_0|CSTM-ALL|CSTM-00|2020|PDM|6406.00|99|0.00|NY DRG 370 ONLY
20|FH_F39825_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|ANCILLARY SERVICES
20|FH_F39825_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39832_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39839_0_0|CSTM-ALL|CSTM-00|2020|PDM|2842.00|99|0.00|MSDRG 216-221, 231-236 CV SURGERY
20|FH_F39844_0_0|CSTM-ALL|CSTM-00|2020|PDM|690.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F39844_0_0|CSTM-ALL|CSTM-00|2020|PDM|7426.00|99|0.00|MS DRG 248-251 PTCA
20|FH_F39844_0_0|SrvcGrp|11000|2022|PCT|0.70|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F39844_0_0|SrvcGrp|58|2022|PDM|3978.00|99|0.00|IP LITHOTRIPSY SVCS
20|FH_F39849_0_0|CSTM-ALL|CSTM-00|2020|PCT|74.00|99|0.00|OP SVCS
20|FH_F39850_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39855_0_0|CSTM-ALL|CSTM-00|2020|PDM|646.00|99|0.00|ACUTE PSYCH
20|FH_F39855_0_0|SrvcGrp|24703|2022|PDM|424.00|99|0.00|NEWBORN NURSERY
20|FH_F39855_0_0|SrvcGrp|65|2022|PDM|1829.00|99|0.00|OBSTETRICAL CARE
20|FH_F39857_0_0|CSTM-ALL|CSTM-00|2020|PDM|1664.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39857_0_0|SrvcGrp|110|2022|PDM|728.00|99|0.00|CD - REHABILITATION
20|FH_F39857_0_0|SrvcGrp|11336|2022|PCT|0.75|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F39857_0_0|SrvcGrp|38|2022|PDM|4472.00|99|0.00|NORMAL DELIVERY
20|FH_F39857_0_0|SrvcGrp|97|2022|PDM|5616.00|99|0.00|C-SECTION
20|FH_F39863_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.21|99|0.00|OP SVCS
20|FH_F39866_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39866_0_0|SrvcGrp|8950|2022|PDM|1800.00|99|0.00|INTERMEDIATE ICU/CCU
20|FH_F39886_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F39886_0_0|SrvcGrp|115|2022|PDM|478.00|99|0.00|SKILLED NURSING CARE
20|FH_F39886_0_0|SrvcGrp|72|2022|PDM|265.00|99|0.00|NEWBORN NURSERY
20|FH_F39887_0_0|CSTM-ALL|CSTM-00|2020|PDM|1600.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39889_0_0|SrvcGrp|12906|2022|PCT|0.85|99|0.00|IP LITHOTRIPSY
20|FH_F39889_0_0|SrvcGrp|3409|2022|PDM|295.00|99|0.00|NEWBORN NURSERY
20|FH_F39893_0_0|SrvcGrp|360|2022|PDM|600.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F39895_0_0|CSTM-ALL|CSTM-00|2020|PDM|1027.00|99|0.00|ACUTE IP MED SVCS
20|FH_F39895_0_0|SrvcGrp|1306|2022|PDM|270.00|99|0.00|OP PSYCH PARTIAL HOSP
20|FH_F39895_0_0|SrvcGrp|16|2022|PDM|811.00|99|0.00|ACUTE REHABILITATION
20|FH_F39898_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39898_0_0|SrvcGrp|22954|2022|PDM|170.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F39898_0_0|SrvcGrp|3809|2022|PDM|716.00|99|0.00|HOSPICE CARE
20|FH_F39910_0_0|CSTM-ALL|CSTM-00|2020|PDM|2068.00|99|0.00|OP SVCS
20|FH_F39910_0_0|SrvcGrp|360|2022|PDM|870.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F39917_0_0|SrvcGrp|13630|2022|PDM|120.00|99|0.00|CPT 99204
20|FH_F39919_0_0|CSTM-ALL|CSTM-00|2020|PDM|1011.42|99|0.00|ASPG VII
20|FH_F39919_0_0|CSTM-ALL|CSTM-00|2020|PDM|1361.00|99|0.00|ASPG IX
20|FH_F39919_0_0|CSTM-ALL|CSTM-00|2020|PDM|518.42|99|0.00|ASPG III
20|FH_F39919_0_0|CSTM-ALL|CSTM-00|2020|PDM|640.40|99|0.00|ASPG IV
20|FH_F39925_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|ACUTE PSYCH
20|FH_F39939_0_0|CSTM-ALL|CSTM-00|2020|PDM|1020.00|99|0.00|ACUTE PSYCH / CHEMICAL DEPENDENCY
20|FH_F39939_0_0|SrvcGrp|10111|2022|PCT|0.83|99|0.00|IMPLANTS
20|FH_F39939_0_0|SrvcGrp|8968|2022|PDM|1280.00|99|0.00|NICU LEVEL III & IV
20|FH_F39943_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|ACUTE PSYCH
20|FH_F39943_0_0|SrvcGrp|115|2022|PDM|400.00|99|0.00|SKILLED NURSING CARE
20|FH_F39944_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39944_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F39945_0_0|SrvcGrp|3409|2022|PDM|365.00|99|0.00|NEWBORN NURSERY
20|FH_F39945_0_0|SrvcGrp|350|2022|PDM|1400.00|99|0.00|SURGICAL CARE
20|FH_F39945_0_0|SrvcGrp|439|2022|PDM|1700.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F39956_0_0|SrvcGrp|3029|2022|PDM|237.00|99|0.00|NEWBORN NURSERY
20|FH_F39967_0_0|CSTM-ALL|CSTM-00|2020|PDM|1460.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39967_0_0|SrvcGrp|701|2022|PDM|1785.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F39969_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS
20|FH_F39973_0_0|CSTM-ALL|CSTM-00|2020|PCT|91.00|99|0.00|OP SVCS
20|FH_F39977_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|OP SVCS
20|FH_F39988_0_0|SrvcGrp|16|2022|PDM|933.00|99|0.00|ACUTE REHABILITATION
20|FH_F39992_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F39992_0_0|CSTM-ALL|CSTM-00|2020|PDM|42.25|99|0.00|RN HOURLY HOME CARE
20|FH_F39992_0_0|SrvcGrp|12403|2022|PDM|26.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F39995_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|ACUTE IP MED SVCS
20|FH_F39995_0_0|SrvcGrp|16|2022|PDM|850.00|99|0.00|ACUTE REHABILITATION
20|FH_F39995_0_0|SrvcGrp|177|2022|PDM|1100.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F39995_0_0|SrvcGrp|701|2022|PDM|1550.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F39996_0_0|CSTM-ALL|CSTM-00|2020|PDM|1450.00|99|0.00|GENERAL ACUTE CARE
20|FH_F39996_0_0|SrvcGrp|12184|2022|PCT|1.10|99|0.00|IMPLANTS
20|FH_F39996_0_0|SrvcGrp|3029|2022|PDM|200.00|99|0.00|NEWBORN NURSERY
20|FH_F40008_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40011_0_0|CSTM-ALL|CSTM-00|2020|PCT|74.00|99|0.00|OP SVCS
20|FH_F40026_0_0|SrvcGrp|16|2022|PDM|891.00|99|0.00|ACUTE REHABILITATION
20|FH_F40026_0_0|SrvcGrp|3016|2022|PCT|0.73|99|0.00|HEMODIALYSIS
20|FH_F40026_0_0|SrvcGrp|997|2022|PCT|0.73|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F40030_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F40030_0_0|SrvcGrp|13293|2022|PCT|0.70|99|0.00|HIGH-COST DRUGS
20|FH_F40032_0_0|SrvcGrp|109|2022|PDM|425.00|99|0.00|CD - DETOX
20|FH_F40043_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.76|99|0.00|LAPAROSCOPY F/S
20|FH_F40043_0_0|CSTM-ALL|CSTM-00|2020|PDM|5351.00|99|0.00|MS DRG 765-766 C-SECTION
20|FH_F40043_0_0|CSTM-ALL|CSTM-00|2020|PDM|5990.00|99|0.00|MS DRG 283
20|FH_F40043_0_0|CSTM-ALL|CSTM-00|2020|PDM|6164.00|99|0.00|CARDIAC CATH
20|FH_F40043_0_0|SrvcGrp|13000|2022|PCT|0.76|99|0.00|OBSERVATION SVCS
20|FH_F40043_0_0|SrvcGrp|30654|2022|PCT|0.76|99|0.00|OP LITHOTRIPSY
20|FH_F40043_0_0|SrvcGrp|33267|2022|PCT|0.76|99|0.00|GA ASPG VII
20|FH_F40043_0_0|SrvcGrp|33270|2022|PCT|0.76|99|0.00|GA ASPG X
20|FH_F40046_0_0|SrvcGrp|10542|2022|PDM|115.00|99|0.00|OCCUPATIONAL THERAPY SVCS
20|FH_F40046_0_0|SrvcGrp|14492|2022|PCT|0.65|99|0.00|DURABLE MEDICAL EQUIPMENT (DME)
20|FH_F40049_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40056_0_0|SrvcGrp|97|2022|PDM|5400.00|99|0.00|C-SECTION
20|FH_F40058_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40059_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40059_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|OP SVCS
20|FH_F40073_0_0|SrvcGrp|17073|2022|PCT|0.70|99|0.00|ASPG V
20|FH_F40073_0_0|SrvcGrp|17075|2022|PCT|0.70|99|0.00|ASPG VI
20|FH_F40073_0_0|SrvcGrp|17079|2022|PCT|0.70|99|0.00|ASPG VIII
20|FH_F40081_0_0|CSTM-ALL|CSTM-00|2020|PDM|300.00|99|0.00|CRISIS EVALUATION
20|FH_F40081_0_0|SrvcGrp|11975|2022|PDM|600.00|99|0.00|ELECTRO CONVULSIVE THERAPY
20|FH_F40081_0_0|SrvcGrp|3087|2022|PDM|735.00|99|0.00|CD - DETOX
20|FH_F40081_0_0|SrvcGrp|3378|2022|PDM|735.00|99|0.00|OBSERVATION SVCS
20|FH_F40081_0_0|SrvcGrp|80|2022|PDM|735.00|99|0.00|ACUTE PSYCH
20|FH_F40082_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F40084_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OP SVCS
20|FH_F40088_0_0|CSTM-ALL|CSTM-00|2020|PDM|955.00|99|0.00|ACUTE IP MED SVCS
20|FH_F40091_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40091_0_0|SrvcGrp|17000|2022|PCT|0.70|99|0.00|OUTPATIENT SURGERY
20|FH_F40091_0_0|SrvcGrp|17065|2022|PDM|1053.00|99|0.00|ASPG I
20|FH_F40091_0_0|SrvcGrp|17067|2022|PDM|1419.00|99|0.00|ASPG II
20|FH_F40091_0_0|SrvcGrp|17071|2022|PCT|0.70|99|0.00|ASPG IV
20|FH_F40091_0_0|SrvcGrp|17073|2022|PCT|0.70|99|0.00|ASPG V
20|FH_F40091_0_0|SrvcGrp|17079|2022|PCT|0.70|99|0.00|ASPG VIII
20|FH_F40091_0_0|SrvcGrp|17081|2022|PCT|0.70|99|0.00|ASPG IX
20|FH_F40104_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40104_0_0|SrvcGrp|12401|2022|PDM|121.29|99|0.00|RN VISIT
20|FH_F40104_0_0|SrvcGrp|9830|2022|PDM|107.71|99|0.00|OT SVCS
20|FH_F40110_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40115_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F40144_0_0|SrvcGrp|3055|2022|PCT|0.73|99|0.00|MAGNETIC RESONANCE IMAGING
20|FH_F40144_0_0|SrvcGrp|958|2022|PDM|1114.00|99|0.00|VENTILATOR SERVICES
20|FH_F40154_0_0|CSTM-ALL|CSTM-00|2020|PDM|2056.00|99|0.00|OBSTETRICAL SERVICES
20|FH_F40154_0_0|SrvcGrp|13248|2022|PCT|0.80|99|0.00|OP SURGERY
20|FH_F40154_0_0|SrvcGrp|72|2022|PDM|614.00|99|0.00|NEWBORN NURSERY
20|FH_F40174_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F40174_0_0|CSTM-ALL|CSTM-00|2020|PDM|60.00|99|0.00|PT & OT
20|FH_F40176_0_0|CSTM-ALL|CSTM-00|2020|PDM|45.00|99|0.00|NURSING VISIT
20|FH_F40189_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS
20|FH_F40191_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F40191_0_0|SrvcGrp|177|2022|PDM|2036.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F40191_0_0|SrvcGrp|3157|2022|PDM|893.00|99|0.00|ACUTE REHABILITATION
20|FH_F40191_0_0|SrvcGrp|361|2022|PDM|2667.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F40191_0_0|SrvcGrp|6|2022|PCT|0.70|99|0.00|OP SURGERY
20|FH_F40191_0_0|SrvcGrp|9889|2022|PDM|2036.00|99|0.00|NICU LEVEL I & II
20|FH_F40198_0_0|SrvcGrp|115|2022|PDM|233.00|99|0.00|SKILLED NURSING CARE
20|FH_F40198_0_0|SrvcGrp|3029|2022|PDM|514.00|99|0.00|NEWBORN NURSERY
20|FH_F40213_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F40230_0_0|CSTM-ALL|CSTM-00|2020|PDM|1014.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40236_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F40252_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|PHYSICIANS SERVICES (CMS 1500)
20|FH_F40252_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F40255_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F40255_0_0|SrvcGrp|1259|2022|PDM|1298.00|99|0.00|INTERMEDIATE INTENSIVE CARE UNIT
20|FH_F40256_0_0|CSTM-ALL|CSTM-00|2020|PDM|490.00|99|0.00|ACUTE PSYCH
20|FH_F40260_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F40270_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F40270_0_0|SrvcGrp|6|2022|PCT|0.90|99|0.00|OP SURGERY
20|FH_F40272_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F40272_0_0|SrvcGrp|6|2022|PCT|0.80|99|0.00|OP SURGERY
20|FH_F40289_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F40289_0_0|CSTM-ALL|CSTM-00|2020|PDM|1061.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F40289_0_0|SrvcGrp|3029|2022|PDM|398.00|99|0.00|NEWBORN NURSERY
20|FH_F40294_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.93|99|0.00|GENERAL ACUTE CARE
20|FH_F40296_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|PHYSICIANS SERVICES (CMS 1500)
20|FH_F40296_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F40302_0_0|CSTM-ALL|CSTM-00|2020|PDM|645.00|99|0.00|ACUTE PSYCH
20|FH_F40304_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.77|99|0.00|OP SVCS
20|FH_F40304_0_0|SrvcGrp|115|2022|PDM|636.00|99|0.00|SKILLED NURSING CARE
20|FH_F40304_0_0|SrvcGrp|17100|2022|PCT|0.81|99|0.00|SKILLED NURSING
20|FH_F40304_0_0|SrvcGrp|3660|2022|PDM|575.00|99|0.00|MAGNETIC RESONANCE IMAGING (MRI)
20|FH_F40321_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F40321_0_0|CSTM-ALL|CSTM-00|2020|PDM|1428.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40321_0_0|SrvcGrp|701|2022|PDM|2856.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F40321_0_0|SrvcGrp|97|2022|PDM|4845.00|99|0.00|C-SECTION
20|FH_F40331_0_0|SrvcGrp|361|2022|PDM|2484.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F40332_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F40332_0_0|SrvcGrp|11258|2022|PCT|0.65|99|0.00|DRUGS
20|FH_F40332_0_0|SrvcGrp|11259|2022|PCT|0.65|99|0.00|DRUGS
20|FH_F40332_0_0|SrvcGrp|12791|2022|PCT|0.65|99|0.00|PROSTHETICS/IMPLANTS/DEVICES
20|FH_F40332_0_0|SrvcGrp|9795|2022|PDM|825.00|99|0.00|SUBACUTE REHAB
20|FH_F40333_0_0|CSTM-ALL|CSTM-00|2020|PDM|2800.00|99|0.00|MS DRG 767-768, 774-775  NORMAL DELIVERY
20|FH_F40333_0_0|SrvcGrp|9795|2022|PDM|975.00|99|0.00|SUBACUTE REHAB
20|FH_F40334_0_0|CSTM-ALL|CSTM-00|2020|PDM|1591.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40334_0_0|SrvcGrp|350|2022|PDM|2333.00|99|0.00|SURGICAL CARE
20|FH_F40334_0_0|SrvcGrp|65|2022|PDM|2333.00|99|0.00|OBSTETRICAL CARE
20|FH_F40340_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F40345_0_0|SrvcGrp|30941|2022|PDM|309.00|99|0.00|NEWBORN NURSERY
20|FH_F40345_0_0|SrvcGrp|439|2022|PDM|1545.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F40346_0_0|CSTM-ALL|CSTM-00|2020|PDM|683.00|99|0.00|ASPG I
20|FH_F40346_0_0|SrvcGrp|13692|2022|PCT|0.75|99|0.00|OP CARDIAC CATH
20|FH_F40347_0_0|SrvcGrp|3029|2022|PDM|350.00|99|0.00|NEWBORN NURSERY
20|FH_F40350_0_0|SrvcGrp|14187|2022|PDM|750.00|99|0.00|MRI
20|FH_F40350_0_0|SrvcGrp|16|2022|PDM|850.00|99|0.00|ACUTE REHABILITATION
20|FH_F40350_0_0|SrvcGrp|9774|2022|PDM|2000.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F40358_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F40370_0_0|SrvcGrp|13811|2022|PDM|406.00|99|0.00|PSYCH PARTIAL HOSP
20|FH_F40372_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40388_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OP SVCS
20|FH_F40388_0_0|CSTM-ALL|CSTM-00|2020|PDM|407.00|99|0.00|ACUTE PSYCH
20|FH_F40393_0_0|CSTM-ALL|CSTM-00|2020|PDM|1313.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40393_0_0|SrvcGrp|38|2022|PDM|1313.00|99|0.00|NORMAL DELIVERY
20|FH_F40402_0_0|CSTM-ALL|CSTM-00|2020|PDM|1167.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40410_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40412_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.00|99|0.00|OP SVCS
20|FH_F40417_0_0|SrvcGrp|65|2022|PDM|2300.00|99|0.00|OBSTETRICAL CARE
20|FH_F40418_0_0|SrvcGrp|177|2022|PDM|1900.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F40418_0_0|SrvcGrp|38|2022|PDM|1230.00|99|0.00|NORMAL DELIVERY
20|FH_F40418_0_0|SrvcGrp|97|2022|PDM|1950.00|99|0.00|C-SECTION
20|FH_F40421_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|AMBULATORY SURGERY
20|FH_F40421_0_0|SrvcGrp|997|2022|PCT|0.80|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F40423_0_0|CSTM-ALL|CSTM-00|2020|PDM|480.00|99|0.00|SKILLED NURSING CARE
20|FH_F40431_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F40431_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|NEUROREHABILITATION IP SVCS
20|FH_F40431_0_0|SrvcGrp|3140|2022|PCT|0.50|99|0.00|PHARMACY SERVICES
20|FH_F40438_0_0|SrvcGrp|2741|2022|PCT|0.60|99|0.00|DRUGS
20|FH_F40438_0_0|SrvcGrp|350|2022|PDM|1366.00|99|0.00|SURGICAL CARE
20|FH_F40442_0_0|SrvcGrp|38|2022|PDM|2500.00|99|0.00|NORMAL DELIVERY
20|FH_F40442_0_0|SrvcGrp|97|2022|PDM|3885.00|99|0.00|C-SECTION
20|FH_F40448_0_0|CSTM-ALL|CSTM-00|2020|PDM|1081.00|99|0.00|SPINAL CORD REHABILITATION
20|FH_F40453_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|TRAUMA CARE
20|FH_F40453_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS
20|FH_F40457_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F40465_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|DRG 118 CARDIAC PACE DEV REPLACEMNT
20|FH_F40465_0_0|CSTM-ALL|CSTM-00|2020|PDM|15000.00|99|0.00|DRG 516 ONLY - PERCUTANEOUS CARDIO PROC W/ ACUTE MYO
20|FH_F40465_0_0|CSTM-ALL|CSTM-00|2020|PDM|27000.00|99|0.00|DRG 107 ONLY CRNRY BYPASS (DRG 547-548)
20|FH_F40465_0_0|CSTM-ALL|CSTM-00|2020|PDM|33000.00|99|0.00|DRG 514 (535-536)
20|FH_F40465_0_0|CSTM-ALL|CSTM-00|2020|PDM|9250.00|99|0.00|DRG 518 ONLY PERC CARDIO W/O AC W/O CORO
20|FH_F40465_0_0|SrvcGrp|32607|2022|PCT|0.75|99|0.00|JOINT REPLACEMENT PROCEDURES
20|FH_F40495_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F40501_0_0|CSTM-ALL|CSTM-00|2020|PDM|325.00|99|0.00|PSYCHIATRIC RESIDENTIAL TREATMENT
20|FH_F40502_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40502_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F40507_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40517_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40517_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F40517_0_0|SrvcGrp|13722|2022|PDM|165.20|99|0.00|HOSPICE SERVICE - ROUTINE HOME CARE
20|FH_F40517_0_0|SrvcGrp|15873|2022|PDM|40.17|99|0.00|HOSPICE SERVICE - CONTINUOUS HOME CARE
20|FH_F40521_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F40521_0_0|SrvcGrp|24|2022|PDM|4100.00|99|0.00|CARDIAC CATH
20|FH_F40521_0_0|SrvcGrp|32550|2022|PDM|250.00|99|0.00|NEWBORN NURSERY
20|FH_F40526_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F40526_0_0|CSTM-ALL|CSTM-00|2020|PDM|1335.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40527_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|SPINAL CORD REHABILITATION
20|FH_F40527_0_0|SrvcGrp|16|2022|PDM|850.00|99|0.00|ACUTE REHABILITATION
20|FH_F40527_0_0|SrvcGrp|20071|2022|PDM|950.00|99|0.00|MS DRG 945-946
20|FH_F40530_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F40530_0_0|CSTM-ALL|CSTM-00|2020|PDM|1309.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40530_0_0|SrvcGrp|1171|2022|PCT|0.70|99|0.00|IMPLANTS
20|FH_F40535_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|ACUTE PSYCH
20|FH_F40535_0_0|SrvcGrp|9518|2022|PDM|300.00|99|0.00|EMERGENCY ROOM
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|1127.79|99|0.00|DELAWARE VALLEY- ASC 7
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|117.45|99|0.00|DELAWARE VALLEY- ASC 219
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|1412.12|99|0.00|DELAWARE VALLEY- ASC 902
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|1423.13|99|0.00|DELAWARE VALLEY- ASC 901
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|149.46|99|0.00|DELAWARE VALLEY- ASC 116
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|157.55|99|0.00|DELAWARE VALLEY- ASC 115
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|164.33|99|0.00|DELAWARE VALLEY- ASC 114
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|170.84|99|0.00|DELAWARE VALLEY- ASC 113
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|170.84|99|0.00|DELAWARE VALLEY- ASC 307
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|201.81|99|0.00|DELAWARE VALLEY- ASC 112
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|208.36|99|0.00|DELAWARE VALLEY- ASC 306
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|252.51|99|0.00|DELAWARE VALLEY- ASC 215
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|272.03|99|0.00|DELAWARE VALLEY- ASC 213
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|278.74|99|0.00|DELAWARE VALLEY- ASC 106
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|342.35|99|0.00|DELAWARE VALLEY- ASC 103
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|366.43|99|0.00|DELAWARE VALLEY- ASC 101
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|398.89|99|0.00|DELAWARE VALLEY- ASC 303
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|443.13|99|0.00|DELAWARE VALLEY- ASC 205
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|448.59|99|0.00|DELAWARE VALLEY- ASC 204
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|463.96|99|0.00|DELAWARE VALLEY- ASC 202
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|53.64|99|0.00|DELAWARE VALLEY- ASC 125
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|714.08|99|0.00|DELAWARE VALLEY- ASC 4
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|97.92|99|0.00|DELAWARE VALLEY- ASC 222
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|100.00|99|0.00|HAPA EPA ASC 17
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|1071.00|99|0.00|HAPA EPA ASC 8
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|139.00|99|0.00|HAPA EPA ASC 22
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|152.00|99|0.00|HAPA EPA ASC 25
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|243.00|99|0.00|HAPA EPA ASC 32
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|264.00|99|0.00|HAPA EPA ASC 35
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|275.00|99|0.00|HAPA EPA ASC 37
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|377.00|99|0.00|HAPA EPA ASC 44
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|384.00|99|0.00|HAPA EPA ASC 45
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|41.00|99|0.00|HAPA EPA ASC 10
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|447.00|99|0.00|HAPA EPA ASC 50
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|52.00|99|0.00|HAPA EPA ASC 11
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|688.00|99|0.00|HAPA EPA ASC 4
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|73.00|99|0.00|HAPA EPA ASC 12
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|79.00|99|0.00|HAPA EPA ASC 14
20|FH_F40561_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40561_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS
20|FH_F40564_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|ACUTE PSYCH
20|FH_F40575_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40575_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS
20|FH_F40589_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40589_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|OP SVCS
20|FH_F40590_0_0|CSTM-ALL|CSTM-00|2020|PDM|1081.00|99|0.00|HEAD INJURY REHAB
20|FH_F40590_0_0|CSTM-ALL|CSTM-00|2020|PDM|1081.00|99|0.00|PEDIATRIC REHABILITATION
20|FH_F40591_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F40591_0_0|CSTM-ALL|CSTM-00|2020|PDM|17250.00|99|0.00|SPINAL SURGERY MS DRGS 028-030, 453-460, 471-473, 490-491
20|FH_F40591_0_0|CSTM-ALL|CSTM-00|2020|PDM|2700.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F40591_0_0|CSTM-ALL|CSTM-00|2020|PDM|3278.00|99|0.00|MS DRG 767-768, 774-775 NORMAL DELIVERY
20|FH_F40591_0_0|CSTM-ALL|CSTM-00|2020|PDM|5175.00|99|0.00|MSDRG 286-287 CARDIAC CATH
20|FH_F40591_0_0|SrvcGrp|11920|2022|PCT|0.70|99|0.00|PHARMACY SVCS
20|FH_F40591_0_0|SrvcGrp|12359|2022|PDM|2944.00|99|0.00|TELEMETRY SVCS
20|FH_F40591_0_0|SrvcGrp|12670|2022|PCT|0.60|99|0.00|IMPLANTS/PROSTHETICS/DEVICES
20|FH_F40591_0_0|SrvcGrp|3409|2022|PDM|928.00|99|0.00|NEWBORN NURSERY
20|FH_F40591_0_0|SrvcGrp|360|2022|PDM|2739.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F40591_0_0|SrvcGrp|8968|2022|PDM|4025.00|99|0.00|NICU LEVEL III & IV
20|FH_F40593_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F40593_0_0|SrvcGrp|472|2022|PDM|375.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F40598_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F40598_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40598_0_0|SrvcGrp|6|2022|PCT|0.85|99|0.00|OP SURGERY
20|FH_F40598_0_0|SrvcGrp|701|2022|PDM|1450.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F40599_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F40599_0_0|SrvcGrp|12118|2022|PDM|360.00|99|0.00|COMPUTED TOMOGRAPHY (CT)
20|FH_F40599_0_0|SrvcGrp|17773|2022|PDM|2884.00|99|0.00|PET SCAN
20|FH_F40599_0_0|SrvcGrp|26916|2022|PCT|0.60|99|0.00|IMPLANTS/PROSHETICS/ORTHOTICS
20|FH_F40599_0_0|SrvcGrp|528|2022|PDM|1391.00|99|0.00|TELEMETRY UNIT
20|FH_F40600_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|DRUGS
20|FH_F40600_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F40600_0_0|SrvcGrp|6|2022|PDM|2633.00|99|0.00|OP SURGERY
20|FH_F40600_0_0|SrvcGrp|97|2022|PDM|5719.00|99|0.00|C-SECTION
20|FH_F40603_0_0|CSTM-ALL|CSTM-00|2020|PDM|65.00|99|0.00|NEW PATIENT - SHORT VISIT
20|FH_F40603_0_0|SrvcGrp|12043|2022|PDM|220.00|99|0.00|CPT 99205
20|FH_F40603_0_0|SrvcGrp|13632|2022|PDM|220.00|99|0.00|CPT 99215
20|FH_F40603_0_0|SrvcGrp|13640|2022|PDM|90.00|99|0.00|CPT 99202
20|FH_F40605_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|HEAD INJURY REHABILITATION
20|FH_F40605_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|SPINAL CORD REHABILITATION
20|FH_F40605_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40605_0_0|SrvcGrp|16|2022|PDM|750.00|99|0.00|ACUTE REHABILITATION
20|FH_F40607_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40615_0_0|SrvcGrp|38|2022|PDM|1690.00|99|0.00|NORMAL DELIVERY
20|FH_F40622_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE
20|FH_F40622_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F40622_0_0|CSTM-ALL|CSTM-00|2020|PDM|742.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F40624_0_0|CSTM-ALL|CSTM-00|2020|PDM|4465.00|99|0.00|MS DRG 767-768, 774-775 NORMAL DELIVERY
20|FH_F40624_0_0|SrvcGrp|12290|2022|PDM|1657.00|99|0.00|DETOXIFICATION
20|FH_F40624_0_0|SrvcGrp|25934|2022|PDM|649.00|99|0.00|SKILLED NURSING
20|FH_F40624_0_0|SrvcGrp|27726|2022|PCT|0.55|99|0.00|OP SURGERY
20|FH_F40624_0_0|SrvcGrp|28170|2022|PDM|3173.00|99|0.00|ICU/CCU
20|FH_F40624_0_0|SrvcGrp|31773|2022|PDM|3500.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F40624_0_0|SrvcGrp|361|2022|PDM|875.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F40624_0_0|SrvcGrp|39245|2022|PCT|0.60|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS (CARDIAC)
20|FH_F40627_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F40627_0_0|CSTM-ALL|CSTM-00|2020|PDM|5715.00|99|0.00|MS DRG 417-419
20|FH_F40627_0_0|CSTM-ALL|CSTM-00|2020|PDM|926.00|99|0.00|MULTIPLE BIRTH
20|FH_F40627_0_0|SrvcGrp|9774|2022|PDM|3780.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F40634_0_0|CSTM-ALL|CSTM-00|2020|PDM|1061.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40634_0_0|SrvcGrp|115|2022|PDM|530.00|99|0.00|SKILLED NURSING CARE
20|FH_F40634_0_0|SrvcGrp|97|2022|PDM|2917.00|99|0.00|C-SECTION
20|FH_F40635_0_0|CSTM-ALL|CSTM-00|2020|PDM|1060.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F40635_0_0|CSTM-ALL|CSTM-00|2020|PDM|505.00|99|0.00|SKILLED NURSING
20|FH_F40644_0_0|SrvcGrp|11199|2022|PCT|0.80|99|0.00|HYPERBARIC CHAMBER
20|FH_F40644_0_0|SrvcGrp|11663|2022|PCT|0.80|99|0.00|IMPLANTS
20|FH_F40644_0_0|SrvcGrp|3095|2022|PDM|1164.00|99|0.00|ROOM AND BOARD PRIVATE
20|FH_F40645_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|EATING DISORDER
20|FH_F40645_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|PSYCHIATRIC EATING DISORDERS
20|FH_F40645_0_0|CSTM-ALL|CSTM-00|2020|PDM|1060.00|99|0.00|ACUTE PSYCH
20|FH_F40645_0_0|SrvcGrp|1306|2022|PDM|546.00|99|0.00|OP PSYCH PARTIAL HOSP
20|FH_F40645_0_0|SrvcGrp|15634|2022|PDM|245.00|99|0.00|OP PARTIAL PSYCH
20|FH_F40649_0_0|CSTM-ALL|CSTM-00|2020|PDM|1378.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40652_0_0|CSTM-ALL|CSTM-00|2020|PDM|150.00|99|0.00|OP SVCS
20|FH_F40653_0_0|CSTM-ALL|CSTM-00|2020|PDM|720.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F40653_0_0|SrvcGrp|33151|2022|PCT|0.90|99|0.00|BONE MARROW TRANSPLANT
20|FH_F40653_0_0|SrvcGrp|33152|2022|PCT|0.90|99|0.00|STEREOTACTIC RADIOSURGERY
20|FH_F40653_0_0|SrvcGrp|38|2022|PDM|4020.00|99|0.00|NORMAL DELIVERY
20|FH_F40657_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F40657_0_0|CSTM-ALL|CSTM-00|2020|PDM|1379.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40659_0_0|SrvcGrp|27856|2022|PDM|46.00|99|0.00|THERAPY
20|FH_F40661_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F40661_0_0|CSTM-ALL|CSTM-00|2020|PDM|245.00|99|0.00|PSYCH PARTIAL HOSPITALIZATION
20|FH_F40661_0_0|CSTM-ALL|CSTM-00|2020|PDM|487.00|99|0.00|SKILLED NURSING
20|FH_F40661_0_0|CSTM-ALL|CSTM-00|2020|PDM|569.00|99|0.00|CHILD PSYCHIATRIC
20|FH_F40685_0_0|SrvcGrp|115|2022|PDM|468.00|99|0.00|SKILLED NURSING CARE
20|FH_F40690_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F40690_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|RADIOLOGY SVCS
20|FH_F40690_0_0|CSTM-ALL|CSTM-00|2020|PDM|1210.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40694_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|PROFESSIONAL SVCS
20|FH_F40694_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F40698_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40698_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F40698_0_0|SrvcGrp|13640|2022|PDM|90.00|99|0.00|CPT 99202
20|FH_F40702_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F40715_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.87|99|0.00|OP SVCS
20|FH_F40715_0_0|CSTM-ALL|CSTM-00|2020|PDM|1312.00|99|0.00|ACUTE IP MED SVCS
20|FH_F40736_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F40739_0_0|SrvcGrp|13551|2022|PDM|550.00|99|0.00|NEWBORN NURSERY
20|FH_F40765_0_0|CSTM-ALL|CSTM-00|2020|PDM|583.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F40765_0_0|CSTM-ALL|CSTM-00|2020|PDM|613.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40783_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F40783_0_0|SrvcGrp|26901|2022|PDM|988.00|99|0.00|VENTILATOR REHAB SERVICES
20|FH_F40784_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F40785_0_0|CSTM-ALL|CSTM-00|2020|PCT|57.00|99|0.00|OP SVCS
20|FH_F40797_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F40797_0_0|CSTM-ALL|CSTM-00|2020|PDM|675.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40797_0_0|SrvcGrp|109|2022|PDM|650.00|99|0.00|CD - DETOX
20|FH_F40797_0_0|SrvcGrp|110|2022|PDM|450.00|99|0.00|CD - REHABILITATION
20|FH_F40799_0_0|SrvcGrp|3499|2022|PCT|0.55|99|0.00|IMPLANTS
20|FH_F40800_0_0|CSTM-ALL|CSTM-00|2020|PDM|875.00|99|0.00|ACUTE IP MED SVCS
20|FH_F40812_0_0|CSTM-ALL|CSTM-00|2020|PDM|231.00|99|0.00|CD PARTIAL HOSPITALIZATION
20|FH_F40834_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|ACUTE PSYCH
20|FH_F40834_0_0|SrvcGrp|14067|2022|PCT|0.80|99|0.00|PROFESSIONAL FEES ON UB04
20|FH_F40834_0_0|SrvcGrp|360|2022|PDM|2146.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F40834_0_0|SrvcGrp|97|2022|PDM|4494.00|99|0.00|C-SECTION
20|FH_F40850_0_0|CSTM-ALL|CSTM-00|2020|PDM|828.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40853_0_0|CSTM-ALL|CSTM-00|2020|PDM|565.00|99|0.00|ACUTE PSYCH
20|FH_F40853_0_0|SrvcGrp|38|2022|PDM|2450.00|99|0.00|NORMAL DELIVERY
20|FH_F40853_0_0|SrvcGrp|592|2022|PDM|240.00|99|0.00|SUB-ACUTE CARE
20|FH_F40853_0_0|SrvcGrp|701|2022|PDM|1125.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F40885_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F40885_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|CPT 95805  MOD TC
20|FH_F40885_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|CPT 95810  MOD TC
20|FH_F40885_0_0|SrvcGrp|26427|2022|PDM|850.00|99|0.00|CPT 95811  MOD TC
20|FH_F40890_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F40903_0_0|CSTM-ALL|CSTM-00|2020|PDM|5.83|99|0.00|ADDITIONAL MILEAGE
20|FH_F40904_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F40906_0_0|SrvcGrp|13597|2022|PDM|174.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT
20|FH_F40906_0_0|SrvcGrp|13682|2022|PDM|265.00|99|0.00|ADVANCED LIFE SUPPORT (ALS) PARAMEDIC INTERCEPT
20|FH_F40906_0_0|SrvcGrp|25282|2022|PDM|5.83|99|0.00|GROUND MILEAGE, PER STATUTE MILE
20|FH_F40914_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F40914_0_0|CSTM-ALL|CSTM-00|2020|PDM|910.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40917_0_0|SrvcGrp|109|2022|PDM|505.00|99|0.00|CD - DETOX
20|FH_F40917_0_0|SrvcGrp|30941|2022|PDM|235.00|99|0.00|NEWBORN NURSERY
20|FH_F40919_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40943_0_0|SrvcGrp|472|2022|PDM|377.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F40943_0_0|SrvcGrp|473|2022|PDM|318.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F40943_0_0|SrvcGrp|474|2022|PDM|260.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F40953_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F40957_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F40972_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|HEAD INJURY REHABILITATION
20|FH_F40977_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE
20|FH_F40979_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE
20|FH_F40979_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F40979_0_0|SrvcGrp|10361|2022|PDM|80.00|99|0.00|CPT CODE 99281
20|FH_F40979_0_0|SrvcGrp|10363|2022|PDM|300.00|99|0.00|CPT CODE 99283
20|FH_F40979_0_0|SrvcGrp|10364|2022|PDM|350.00|99|0.00|CPT CODE 99284
20|FH_F40979_0_0|SrvcGrp|6|2022|PCT|0.80|99|0.00|OP SURGERY
20|FH_F40980_0_0|CSTM-ALL|CSTM-00|2020|PDM|20625.00|99|0.00|MS DRG 248
20|FH_F40980_0_0|CSTM-ALL|CSTM-00|2020|PDM|20625.00|99|0.00|MS DRG 249
20|FH_F40980_0_0|CSTM-ALL|CSTM-00|2020|PDM|25783.00|99|0.00|MS DRG 238
20|FH_F40980_0_0|CSTM-ALL|CSTM-00|2020|PDM|5768.00|99|0.00|BURN TRANSITIONAL
20|FH_F40980_0_0|CSTM-ALL|CSTM-00|2020|PDM|64454.00|99|0.00|MS DRG 226-227
20|FH_F40980_0_0|SrvcGrp|16679|2022|PDM|23404.00|99|0.00|LAPAROSCOPIC PROCEDURES
20|FH_F40980_0_0|SrvcGrp|3277|2022|PDM|2802.00|99|0.00|SKILLED NURSING CARE
20|FH_F40980_0_0|SrvcGrp|97|2022|PDM|17008.00|99|0.00|C-SECTION
20|FH_F40983_0_0|CSTM-ALL|CSTM-00|2020|PDM|1361.10|99|0.00|ASPG IX
20|FH_F40983_0_0|CSTM-ALL|CSTM-00|2020|PDM|518.42|99|0.00|ASPG III
20|FH_F40983_0_0|CSTM-ALL|CSTM-00|2020|PDM|837.16|99|0.00|ASPG VI
20|FH_F40983_0_0|SrvcGrp|28818|2022|PCT|1.00|99|0.00|SUPPLIES AND DEVICES
20|FH_F40993_0_0|CSTM-ALL|CSTM-00|2020|PDM|870.00|99|0.00|GENERAL ACUTE CARE
20|FH_F40994_0_0|SrvcGrp|701|2022|PDM|1600.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F41015_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41015_0_0|SrvcGrp|472|2022|PDM|395.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F41015_0_0|SrvcGrp|473|2022|PDM|375.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F41021_0_0|SrvcGrp|17069|2022|PDM|2763.00|99|0.00|ASPG III
20|FH_F41021_0_0|SrvcGrp|17075|2022|PDM|4474.00|99|0.00|ASPG VI
20|FH_F41021_0_0|SrvcGrp|17079|2022|PDM|6589.00|99|0.00|ASPG VIII
20|FH_F41033_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|IMPLANTS
20|FH_F41033_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F41033_0_0|SrvcGrp|17071|2022|PDM|693.00|99|0.00|ASPG IV
20|FH_F41033_0_0|SrvcGrp|17075|2022|PDM|826.00|99|0.00|ASPG VI
20|FH_F41033_0_0|SrvcGrp|17083|2022|PDM|561.00|99|0.00|ASPG X
20|FH_F41035_0_0|SrvcGrp|103570|2022|PDM|910.00|99|0.00|ARTHROSCOPIC FRACTURE
20|FH_F41035_0_0|SrvcGrp|107778|2022|PDM|910.00|99|0.00|ARTHROSCOPIC FRACTURE TX
20|FH_F41035_0_0|SrvcGrp|107779|2022|PDM|910.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F41035_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F41035_0_0|SrvcGrp|72990|2022|PDM|370.00|99|0.00|AEG 1
20|FH_F41035_0_0|SrvcGrp|72994|2022|PDM|565.00|99|0.00|AEG 3
20|FH_F41035_0_0|SrvcGrp|72996|2022|PDM|700.00|99|0.00|AEG 4
20|FH_F41035_0_0|SrvcGrp|73002|2022|PDM|1103.00|99|0.00|AEG 7
20|FH_F41053_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F41053_0_0|CSTM-ALL|CSTM-00|2020|PDM|281.00|99|0.00|CD PARTIAL HOSPITALIZATION
20|FH_F41053_0_0|CSTM-ALL|CSTM-00|2020|PDM|562.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41059_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F41059_0_0|CSTM-ALL|CSTM-00|2020|PDM|230.00|99|0.00|ADULT PARTIAL HOSPITALIZATION
20|FH_F41059_0_0|CSTM-ALL|CSTM-00|2020|PDM|332.00|99|0.00|CHILD RESIDENTIAL TREATMENT
20|FH_F41059_0_0|CSTM-ALL|CSTM-00|2020|PDM|332.00|99|0.00|RESIDENTIAL PSYCH / CD (ADOLESCENT)
20|FH_F41133_0_0|CSTM-ALL|CSTM-00|2020|PDM|686.00|99|0.00|ADULT PSYCHIATRIC
20|FH_F41135_0_0|SrvcGrp|17083|2022|PDM|492.54|99|0.00|ASPG X
20|FH_F41142_0_0|CSTM-ALL|CSTM-00|2020|PDM|281.00|99|0.00|CHILD PSYCH FULL DAY (8-12 HRS)
20|FH_F41142_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41142_0_0|SrvcGrp|167|2022|PDM|433.00|99|0.00|CD (ADULT) - REHABILITATION
20|FH_F41155_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|TISSUE PLASMINOGEN ACTIVATOR
20|FH_F41155_0_0|CSTM-ALL|CSTM-00|2020|PDM|468.00|99|0.00|SKILLED NURSING
20|FH_F41155_0_0|SrvcGrp|97|2022|PDM|2809.00|99|0.00|C-SECTION
20|FH_F41161_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F41161_0_0|CSTM-ALL|CSTM-00|2020|PDM|548.00|99|0.00|ACUTE PSYCH
20|FH_F41161_0_0|SrvcGrp|34207|2022|PDM|658.00|99|0.00|ELECTROCONVULSIVE THERAPY
20|FH_F41166_0_0|SrvcGrp|115|2022|PDM|350.00|99|0.00|SKILLED NURSING CARE
20|FH_F41167_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41167_0_0|SrvcGrp|3418|2022|PDM|1300.00|99|0.00|NEONATAL INTENSIVE CARE UNIT
20|FH_F41167_0_0|SrvcGrp|439|2022|PDM|1300.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F41173_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F41173_0_0|CSTM-ALL|CSTM-00|2020|PDM|364.00|99|0.00|ADOL PSYCH RESIDENTIAL CARE
20|FH_F41173_0_0|SrvcGrp|110|2022|PDM|598.00|99|0.00|CD - REHABILITATION
20|FH_F41178_0_0|CSTM-ALL|CSTM-00|2020|PDM|646.00|99|0.00|ACUTE PSYCH
20|FH_F41181_0_0|SrvcGrp|1306|2022|PDM|442.00|99|0.00|OP PSYCH PARTIAL HOSP
20|FH_F41181_0_0|SrvcGrp|13811|2022|PDM|442.00|99|0.00|PSYCH PARTIAL HOSP
20|FH_F41196_0_0|CSTM-ALL|CSTM-00|2020|PCT|67.00|99|0.00|OP SVCS
20|FH_F41201_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|MS DRG 216-221, 231-236 CV SURGERY
20|FH_F41201_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|TRAUMA CARE
20|FH_F41201_0_0|SrvcGrp|10400|2022|PDM|2200.00|99|0.00|IP SURGERY
20|FH_F41201_0_0|SrvcGrp|20012|2022|PCT|0.85|99|0.00|KIDNEY TRANSPLANT
20|FH_F41201_0_0|SrvcGrp|361|2022|PCT|0.73|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F41201_0_0|SrvcGrp|762|2022|PDM|5125.00|99|0.00|AIR AMBULANCE SVCS
20|FH_F41202_0_0|SrvcGrp|350|2022|PDM|1800.00|99|0.00|SURGICAL CARE
20|FH_F41236_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41254_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41263_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS
20|FH_F41273_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE
20|FH_F41273_0_0|SrvcGrp|11336|2022|PCT|0.70|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F41275_0_0|CSTM-ALL|CSTM-00|2020|PDM|140.00|99|0.00|IP ADOLESCENT PARTIAL HOSPITALIZATION HALF DAY (4-7 HOURS)
20|FH_F41275_0_0|CSTM-ALL|CSTM-00|2020|PDM|150.00|99|0.00|OP PARTIAL HOSPITALIZATION (4-7 HOURS)
20|FH_F41275_0_0|CSTM-ALL|CSTM-00|2020|PDM|85.00|99|0.00|OP ADULT PARTIAL HOSPITALIZATION HALF DAY (4-7 HOURS)
20|FH_F41275_0_0|SrvcGrp|34041|2022|PDM|625.00|99|0.00|ACUTE PSYCH
20|FH_F41279_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F41279_0_0|CSTM-ALL|CSTM-00|2020|PDM|372.00|99|0.00|ADOLESCENT PSYCH
20|FH_F41281_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F41313_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|BLOOD AND BLOOD PRODUCTS
20|FH_F41313_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41313_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|OP SVCS
20|FH_F41314_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OP SVCS
20|FH_F41317_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F41339_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41342_0_0|CSTM-ALL|CSTM-00|2020|PDM|625.00|99|0.00|ACUTE PSYCH
20|FH_F41347_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41348_0_0|CSTM-ALL|CSTM-00|2020|PDM|205.00|99|0.00|IP ADULT PARTIAL HOSPITALIZATION (CD)
20|FH_F41348_0_0|CSTM-ALL|CSTM-00|2020|PDM|213.00|99|0.00|IP ADOLESCENT PARTIAL HOSPITALIZATION (CD)
20|FH_F41348_0_0|CSTM-ALL|CSTM-00|2020|PDM|238.00|99|0.00|ADULT PSYCH PARTIAL HOSPITALIZATION
20|FH_F41348_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|ADOLESCENT PSYCHIATRIC
20|FH_F41374_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F41374_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|ADULT PSYCHIATRIC
20|FH_F41374_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41374_0_0|CSTM-ALL|CSTM-00|2020|PDM|536.00|99|0.00|CHEMICAL DEPENDENCY - ADOLESCENT
20|FH_F41374_0_0|CSTM-ALL|CSTM-00|2020|PDM|536.00|99|0.00|CHILD PSYCHIATRIC
20|FH_F41377_0_0|SrvcGrp|38|2022|PDM|1600.00|99|0.00|NORMAL DELIVERY
20|FH_F41429_0_0|SrvcGrp|109|2022|PDM|543.00|99|0.00|CD - DETOX
20|FH_F41433_0_0|SrvcGrp|11442|2022|PDM|623.00|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)
20|FH_F41433_0_0|SrvcGrp|22954|2022|PDM|140.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F77585_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F77585_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F77585_0_0|SrvcGrp|474|2022|PDM|675.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F77585_0_0|SrvcGrp|9861|2022|PDM|585.00|99|0.00|ACUTE REHABILITATION
20|FH_F77597_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F77625_0_0|SrvcGrp|42827|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY VISIT
20|FH_F77642_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F77642_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F77662_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F77662_0_0|SrvcGrp|42870|2022|PDM|65.00|99|0.00|OCCUPATIONAL THERAPY VISIT
20|FH_F77662_0_0|SrvcGrp|75545|2022|PDM|370.00|99|0.00|SUB-ACUTE - LEVEL I AND II
20|FH_F77663_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE
20|FH_F77663_0_0|CSTM-ALL|CSTM-00|2020|PDM|120.00|99|0.00|OP SVCS
20|FH_F77663_0_0|SrvcGrp|12591|2022|PDM|120.00|99|0.00|CD FULL DAY
20|FH_F77665_0_0|SrvcGrp|10517|2022|PDM|8.00|99|0.00|HOME HEALTH AIDE VISIT
20|FH_F77665_0_0|SrvcGrp|10537|2022|PDM|120.00|99|0.00|NURSING CARE
20|FH_F77665_0_0|SrvcGrp|10538|2022|PDM|60.00|99|0.00|NURSING CARE
20|FH_F77665_0_0|SrvcGrp|10539|2022|PDM|65.00|99|0.00|HOME HEALTH AIDE
20|FH_F77665_0_0|SrvcGrp|10541|2022|PDM|60.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F77665_0_0|SrvcGrp|10543|2022|PDM|60.00|99|0.00|SPEECH THERAPY SVCS
20|FH_F77665_0_0|SrvcGrp|10545|2022|PDM|60.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F77665_0_0|SrvcGrp|10623|2022|PDM|15.00|99|0.00|SPEECH THERAPY SERVICES
20|FH_F77665_0_0|SrvcGrp|74840|2022|PDM|6.00|99|0.00|PHYSICAL THERAPY SERVICES
20|FH_F77722_0_0|SrvcGrp|68846|2022|PDM|700.00|99|0.00|SKILLED NURSING
20|FH_F77762_0_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE
20|FH_F77762_0_0|SrvcGrp|42973|2022|PDM|135.00|99|0.00|SPEECH  THERAPIST
20|FH_F77762_0_0|SrvcGrp|42974|2022|PDM|135.00|99|0.00|OCCUPATIONAL THERAPIST
20|FH_F77762_0_0|SrvcGrp|42975|2022|PDM|135.00|99|0.00|PHYSICAL THERAPIST
20|FH_F77762_0_0|SrvcGrp|43955|2022|PDM|120.00|99|0.00|NURSING CARE
20|FH_F77763_0_0|SrvcGrp|100947|2022|PDM|85.00|99|0.00|HOME HEALTH RN SERVICE
20|FH_F77763_0_0|SrvcGrp|10541|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F77862_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F77862_0_0|SrvcGrp|26001|2022|PDM|156.39|99|0.00|HOSPICE RESPITE SVCS
20|FH_F77862_0_0|SrvcGrp|34865|2022|PDM|46.28|99|0.00|HOME HEALTH AIDE
20|FH_F77862_0_0|SrvcGrp|34868|2022|PDM|105.78|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F77862_0_0|SrvcGrp|45540|2022|PDM|105.78|99|0.00|PHYSICAL THERAPY
20|FH_F77883_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F77883_0_0|SrvcGrp|74922|2022|PDM|199.12|99|0.00|HOME INFUSION
20|FH_F77883_0_0|SrvcGrp|74924|2022|PDM|63.50|99|0.00|HOME HEALTH AID VISIT/LNA
20|FH_F77883_0_0|SrvcGrp|74926|2022|PDM|206.66|99|0.00|OCCUPATIONAL THERAPY
20|FH_F77883_0_0|SrvcGrp|74930|2022|PDM|385.33|99|0.00|HOSPICE LEVEL 2
20|FH_F77883_0_0|SrvcGrp|74934|2022|PDM|360.58|99|0.00|BASIC TELE-MONITORING
20|FH_F77903_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|COVENTRY ENHANCED GROUPER 6
20|FH_F77903_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|COVENTRY ENHANCED GROUPER 8
20|FH_F77903_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F77903_0_0|SrvcGrp|14651|2022|PDM|6500.00|99|0.00|LITHOTRIPSY SVCS
20|FH_F77903_0_0|SrvcGrp|19973|2022|PDM|2500.00|99|0.00|CAT SCAN
20|FH_F77923_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE
20|FH_F77923_0_0|SrvcGrp|46632|2022|PDM|45.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F77925_0_0|SrvcGrp|15763|2022|PCT|0.65|99|0.00|TRAUMA
20|FH_F77925_0_0|SrvcGrp|35560|2022|PCT|0.53|99|0.00|PHARMACY SVCS
20|FH_F77925_0_0|SrvcGrp|38648|2022|PDM|4968.00|99|0.00|ACUTE MEDICAL/SURGICAL SERVICES
20|FH_F77943_0_0|SrvcGrp|12886|2022|PCT|0.70|99|0.00|HOSPICE SVCS (HOME CARE)
20|FH_F77943_0_0|SrvcGrp|20252|2022|PDM|84768.89|99|0.00|MS DRG 224-225 ONLY
20|FH_F77943_0_0|SrvcGrp|20293|2022|PDM|74751.89|99|0.00|MS DRG 235-236 ONLY CV SURGERY
20|FH_F77943_0_0|SrvcGrp|20752|2022|PDM|27960.00|99|0.00|MSDRG 619-621 ONLY BARIATRIC SURGERY
20|FH_F77943_0_0|SrvcGrp|22106|2022|PCT|0.70|99|0.00|CAT SCAN
20|FH_F77943_0_0|SrvcGrp|26690|2022|PDM|120903.24|99|0.00|MS DRG 215 ONLY
20|FH_F77943_0_0|SrvcGrp|30623|2022|PDM|7872.50|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788
20|FH_F77943_0_0|SrvcGrp|37263|2022|PCT|0.70|99|0.00|MRI
20|FH_F77943_0_0|SrvcGrp|8950|2022|PDM|5906.72|99|0.00|INTERMEDIATE ICU/CCU
20|FH_F77943_0_0|SrvcGrp|89937|2022|PDM|73781.47|99|0.00|MS DRG 273-274 ONLY
20|FH_F77943_0_0|SrvcGrp|9511|2022|PCT|0.70|99|0.00|OBSERVATION SVCS
20|FH_F77943_0_0|SrvcGrp|9826|2022|PCT|0.70|99|0.00|OP SURGERY
20|FH_F78003_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F78003_0_0|SrvcGrp|471|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F78003_0_0|SrvcGrp|472|2022|PDM|360.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F78022_0_0|SrvcGrp|35142|2022|PDM|2400.00|99|0.00|DELIVERY
20|FH_F78023_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F78023_0_0|SrvcGrp|35964|2022|PDM|45.00|99|0.00|SPEECH THERAPY
20|FH_F78023_0_0|SrvcGrp|472|2022|PDM|360.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F78023_0_0|SrvcGrp|473|2022|PDM|245.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F78048_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F78048_0_0|SrvcGrp|30095|2022|PDM|45.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F78048_0_0|SrvcGrp|471|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F78165_0_0|SrvcGrp|471|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F78167_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F78167_0_0|SrvcGrp|35964|2022|PDM|45.00|99|0.00|SPEECH THERAPY
20|FH_F78167_0_0|SrvcGrp|471|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F78167_0_0|SrvcGrp|474|2022|PDM|245.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F78204_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F78204_0_0|CSTM-ALL|CSTM-00|2020|PDM|321.40|99|0.00|ASPG I
20|FH_F78204_0_0|CSTM-ALL|CSTM-00|2020|PDM|966.14|99|0.00|ASPG VII
20|FH_F78243_0_0|CSTM-ALL|CSTM-00|2020|PDM|515.00|99|0.00|DIGESTIVE SURGERY
20|FH_F78324_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE
20|FH_F78343_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE
20|FH_F78343_0_0|SrvcGrp|35964|2022|PDM|45.00|99|0.00|SPEECH THERAPY
20|FH_F78363_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F78385_0_0|SrvcGrp|471|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F78385_0_0|SrvcGrp|472|2022|PDM|360.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F78385_0_0|SrvcGrp|473|2022|PDM|245.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F78385_0_0|SrvcGrp|75501|2022|PDM|45.00|99|0.00|PHYSICAL THERAPY
20|FH_F78447_0_0|SrvcGrp|472|2022|PDM|360.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F78542_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS
20|FH_F78603_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F78603_0_0|CSTM-ALL|CSTM-00|2020|PDM|2025.92|99|0.00|ACUTE PSYCH
20|FH_F78603_0_0|CSTM-ALL|CSTM-00|2020|PDM|3132.85|99|0.00|ACUTE IP MED SVCS
20|FH_F78603_0_0|SrvcGrp|20910|2022|PDM|45910.92|99|0.00|MS DRG 234 ONLY
20|FH_F78603_0_0|SrvcGrp|20914|2022|PDM|69894.10|99|0.00|MS DRG 233 ONLY
20|FH_F78603_0_0|SrvcGrp|21104|2022|PDM|52610.43|99|0.00|MS DRG 220 ONLY
20|FH_F78603_0_0|SrvcGrp|21106|2022|PDM|29807.41|99|0.00|MS DRG 250 ONLY
20|FH_F78603_0_0|SrvcGrp|21108|2022|PDM|25793.82|99|0.00|MS DRG 243 ONLY
20|FH_F78603_0_0|SrvcGrp|26036|2022|PCT|0.73|99|0.00|DRUGS
20|FH_F78603_0_0|SrvcGrp|28161|2022|PDM|100581.15|99|0.00|MS DRG 216 ONLY
20|FH_F78603_0_0|SrvcGrp|28162|2022|PDM|69649.33|99|0.00|MS DRG 217 ONLY
20|FH_F78603_0_0|SrvcGrp|28163|2022|PDM|86157.15|99|0.00|MS DRG 222 ONLY
20|FH_F78603_0_0|SrvcGrp|29755|2022|PDM|39699.86|99|0.00|MS DRG 245 ONLY
20|FH_F78603_0_0|SrvcGrp|439|2022|PDM|4054.02|99|0.00|INTENSIVE CARE UNIT
20|FH_F78603_0_0|SrvcGrp|53152|2022|PDM|16838.92|99|0.00|MS DRG 259 ONLY
20|FH_F78706_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.22|99|0.00|OP SVCS
20|FH_F78706_0_0|CSTM-ALL|CSTM-00|2020|PDM|2278.00|99|0.00|GENERAL ACUTE CARE
20|FH_F78762_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.43|99|0.00|GENERAL ACUTE CARE
20|FH_F78762_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.43|99|0.00|OP SVCS
20|FH_F78852_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|GENERAL ACUTE CARE
20|FH_F78887_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE
20|FH_F78889_0_0|CSTM-ALL|CSTM-00|2020|PCT|81.00|99|0.00|GENERAL ACUTE CARE
20|FH_F78893_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F78894_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F78894_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F78903_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE
20|FH_F78903_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS
20|FH_F78922_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|GENERAL ACUTE CARE
20|FH_F78922_0_0|SrvcGrp|16|2022|PDM|950.00|99|0.00|ACUTE REHABILITATION
20|FH_F78922_0_0|SrvcGrp|42869|2022|PDM|95.00|99|0.00|PHYSICAL THERAPY VISIT
20|FH_F78922_0_0|SrvcGrp|76040|2022|PCT|0.20|99|0.00|HIGH COST DRUG
20|FH_F78922_0_0|SrvcGrp|76047|2022|PCT|0.20|99|0.00|ULTRAFILTRATION
20|FH_F78928_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE
20|FH_F79025_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F79025_0_0|SrvcGrp|75545|2022|PDM|540.00|99|0.00|SUB-ACUTE - LEVEL I AND II
20|FH_F79212_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F79212_0_0|SrvcGrp|76094|2022|PDM|146.41|99|0.00|HOSPICE ROUTINE HOME CARE
20|FH_F79231_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F79245_0_0|SrvcGrp|66481|2022|PDM|75.00|99|0.00|SOCIAL WORKER
20|FH_F79305_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE
20|FH_F79427_0_0|SrvcGrp|65421|2022|PCT|1.00|99|0.00|HAPA SEPA-- IMPLANTS
20|FH_F79429_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F79429_0_0|SrvcGrp|22954|2022|PDM|130.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F79429_0_0|SrvcGrp|59426|2022|PDM|75.00|99|0.00|PT
20|FH_F79429_0_0|SrvcGrp|66482|2022|PDM|35.00|99|0.00|HOME HEALTH AID
20|FH_F79443_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS
20|FH_F79483_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|OP SVCS
20|FH_F79542_0_0|CSTM-ALL|CSTM-00|2020|PCT|59.40|99|0.00|GENERAL ACUTE CARE
20|FH_F79551_0_0|CSTM-ALL|CSTM-00|2020|PDM|1672.00|99|0.00|AEG 9 (NO REV)
20|FH_F79551_0_0|CSTM-ALL|CSTM-00|2020|PDM|636.00|99|0.00|AEG 3 (NO REV)
20|FH_F79570_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|OP SVCS
20|FH_F79584_0_0|CSTM-ALL|CSTM-00|2020|PDM|538.00|99|0.00|COVENTRY ENHANCED GROUPER 2
20|FH_F79584_0_0|CSTM-ALL|CSTM-00|2020|PDM|864.00|99|0.00|COVENTRY ENHANCED GROUPER 10
20|FH_F79584_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|COVENTRY ENHANCED GROUPER 6
20|FH_F79587_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F79623_0_0|SrvcGrp|72992|2022|PDM|2283.00|99|0.00|AEG 2
20|FH_F79623_0_0|SrvcGrp|72994|2022|PDM|3511.00|99|0.00|AEG 3
20|FH_F79623_0_0|SrvcGrp|72998|2022|PDM|5262.00|99|0.00|AEG 5
20|FH_F79623_0_0|SrvcGrp|73006|2022|PDM|7959.00|99|0.00|AEG 9
20|FH_F79623_0_0|SrvcGrp|75497|2022|PCT|0.53|99|0.00|AEG 10
20|FH_F79625_0_0|SrvcGrp|472|2022|PDM|597.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F79645_0_0|SrvcGrp|62258|2022|PDM|85.00|99|0.00|PHYSICAL THERAY EVAL/RE-EVAL
20|FH_F79645_0_0|SrvcGrp|62259|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY
20|FH_F79645_0_0|SrvcGrp|62260|2022|PDM|85.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F79645_0_0|SrvcGrp|9882|2022|PCT|0.70|99|0.00|SUPPLIES
20|FH_F79704_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F79763_0_0|SrvcGrp|66480|2022|PDM|110.00|99|0.00|RN VISIT
20|FH_F79763_0_0|SrvcGrp|66481|2022|PDM|110.00|99|0.00|SOCIAL WORKER
20|FH_F79904_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F79923_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE
20|FH_F79923_0_0|SrvcGrp|46631|2022|PDM|45.00|99|0.00|PHYSICAL THERAPY
20|FH_F80083_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|GENERAL ACUTE CARE
20|FH_F80084_0_0|SrvcGrp|26001|2022|PDM|140.69|99|0.00|HOSPICE RESPITE SVCS
20|FH_F80084_0_0|SrvcGrp|76094|2022|PDM|135.76|99|0.00|HOSPICE ROUTINE HOME CARE
20|FH_F41433_0_0|SrvcGrp|9263|2022|PDM|145.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F41438_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41438_0_0|CSTM-ALL|CSTM-00|2020|PDM|25.00|99|0.00|HOSPICE PAIN MGMT COMFORT KIT
20|FH_F41441_0_0|CSTM-ALL|CSTM-00|2020|PDM|1167.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41441_0_0|SrvcGrp|38|2022|PDM|1273.00|99|0.00|NORMAL DELIVERY
20|FH_F41441_0_0|SrvcGrp|97|2022|PDM|1273.00|99|0.00|C-SECTION
20|FH_F41452_0_0|CSTM-ALL|CSTM-00|2020|PDM|363.00|99|0.00|ASPG 1- PROGRESSIVE SURG
20|FH_F41452_0_0|CSTM-ALL|CSTM-00|2020|PDM|486.20|99|0.00|ASPG 2- PROGRESSIVE SURG
20|FH_F41452_0_0|CSTM-ALL|CSTM-00|2020|PDM|556.60|99|0.00|ASPG 3- PROGRESSIVE SURG
20|FH_F41456_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F41456_0_0|CSTM-ALL|CSTM-00|2020|PDM|25.00|99|0.00|HOSPICE PAIN MGMT COMFORT KIT
20|FH_F41456_0_0|SrvcGrp|12403|2022|PDM|34.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F41456_0_0|SrvcGrp|22954|2022|PDM|140.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F41456_0_0|SrvcGrp|26001|2022|PDM|145.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F41457_0_0|CSTM-ALL|CSTM-00|2020|PDM|288.00|99|0.00|AMBULANCE SVC BASIC LIFE SUPPORT NON-EMERG TRANSPORT
20|FH_F41457_0_0|CSTM-ALL|CSTM-00|2020|PDM|345.00|99|0.00|AMBULANCE SVC, BASIC LIFE SUPPORT, EMERGENCY TRANSPORT
20|FH_F41457_0_0|CSTM-ALL|CSTM-00|2020|PDM|58.00|99|0.00|EXTRA AMBULANCE ATTENDANT
20|FH_F41457_0_0|CSTM-ALL|CSTM-00|2020|PDM|875.00|99|0.00|EMERGENCY ROOM LEVEL IV
20|FH_F41457_0_0|SrvcGrp|10956|2022|PDM|90.00|99|0.00|PT/OT/ST
20|FH_F41461_0_0|SrvcGrp|38|2022|PDM|1800.00|99|0.00|NORMAL DELIVERY
20|FH_F41481_0_0|SrvcGrp|17065|2022|PDM|366.00|99|0.00|ASPG I
20|FH_F41481_0_0|SrvcGrp|17077|2022|PDM|1092.00|99|0.00|ASPG VII
20|FH_F41481_0_0|SrvcGrp|17079|2022|PDM|1076.00|99|0.00|ASPG VIII
20|FH_F41481_0_0|SrvcGrp|17081|2022|PDM|1525.00|99|0.00|ASPG IX
20|FH_F41484_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41484_0_0|CSTM-ALL|CSTM-00|2020|PDM|492.54|99|0.00|ASPG III
20|FH_F41489_0_0|SrvcGrp|97|2022|PDM|2800.00|99|0.00|C-SECTION
20|FH_F41491_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F41494_0_0|CSTM-ALL|CSTM-00|2020|PDM|1910.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41494_0_0|SrvcGrp|115|2022|PDM|490.00|99|0.00|SKILLED NURSING CARE
20|FH_F41519_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41519_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|ACUTE PSYCH
20|FH_F41519_0_0|SrvcGrp|97|2022|PDM|3000.00|99|0.00|C-SECTION
20|FH_F41535_0_0|SrvcGrp|97|2022|PDM|2600.00|99|0.00|C-SECTION
20|FH_F41539_0_0|SrvcGrp|33827|2022|PDM|677.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG 5
20|FH_F41540_0_0|SrvcGrp|11000|2022|PCT|0.26|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F41540_0_0|SrvcGrp|33826|2022|PDM|1152.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG 4
20|FH_F41540_0_0|SrvcGrp|33828|2022|PDM|1480.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG 6
20|FH_F41594_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F41594_0_0|SrvcGrp|28570|2022|PDM|144.26|99|0.00|CPT 92610
20|FH_F41596_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE
20|FH_F41596_0_0|SrvcGrp|13551|2022|PDM|440.00|99|0.00|NEWBORN NURSERY
20|FH_F41602_0_0|SrvcGrp|3577|2022|PDM|334.00|99|0.00|PARTIAL HOSPITALIZATION
20|FH_F41605_0_0|SrvcGrp|97|2022|PDM|4327.00|99|0.00|C-SECTION
20|FH_F41608_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE
20|FH_F41617_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41652_0_0|CSTM-ALL|CSTM-00|2020|PDM|174.00|99|0.00|CD (ADULT) RESIDENTIAL CARE
20|FH_F41652_0_0|CSTM-ALL|CSTM-00|2020|PDM|212.00|99|0.00|CD PARTIAL HOSP (> 4 HOURS)
20|FH_F41652_0_0|SrvcGrp|110|2022|PDM|324.00|99|0.00|CD - REHABILITATION
20|FH_F41660_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|HOME HEALTH CARE
20|FH_F41660_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SURGERY
20|FH_F41660_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F41661_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41663_0_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|MS DRG 765-766 C-SECTION
20|FH_F41663_0_0|SrvcGrp|10400|2022|PDM|1750.00|99|0.00|IP SURGERY
20|FH_F41663_0_0|SrvcGrp|360|2022|PDM|900.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F41666_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F41670_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41670_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS
20|FH_F41675_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F41675_0_0|CSTM-ALL|CSTM-00|2020|PDM|1205.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41675_0_0|SrvcGrp|34666|2022|PDM|415.00|99|0.00|SUB ACUTE UNIT SERVICES
20|FH_F41675_0_0|SrvcGrp|34667|2022|PDM|1010.00|99|0.00|PROGRESSIVE SUB ACUTE UNIT SERVICES
20|FH_F41678_0_0|CSTM-ALL|CSTM-00|2020|PDM|250.00|99|0.00|PSYCH PARTIAL HOSPITALIZATION
20|FH_F41679_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F41679_0_0|CSTM-ALL|CSTM-00|2020|PDM|380.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41695_0_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F41696_0_0|CSTM-ALL|CSTM-00|2020|PDM|281.00|99|0.00|PSYCH PARTIAL HOSPITALIZATION
20|FH_F41696_0_0|CSTM-ALL|CSTM-00|2020|PDM|562.00|99|0.00|ACUTE PSYCH
20|FH_F41696_0_0|CSTM-ALL|CSTM-00|2020|PDM|562.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41696_0_0|SrvcGrp|109|2022|PDM|540.00|99|0.00|CD - DETOX
20|FH_F41699_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41738_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41738_0_0|CSTM-ALL|CSTM-00|2020|PDM|405.00|99|0.00|COVENTRY ENHANCED GROUPER 1
20|FH_F41738_0_0|CSTM-ALL|CSTM-00|2020|PDM|737.00|99|0.00|COVENTRY ENHANCED GROUPER 4
20|FH_F41738_0_0|CSTM-ALL|CSTM-00|2020|PDM|838.00|99|0.00|COVENTRY ENHANCED GROUPER 5
20|FH_F41739_0_0|CSTM-ALL|CSTM-00|2020|PDM|1872.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41739_0_0|CSTM-ALL|CSTM-00|2020|PDM|27499.00|99|0.00|DRG 003 ONLY CRANIOTOMY
20|FH_F41739_0_0|CSTM-ALL|CSTM-00|2020|PDM|35310.00|99|0.00|DRG 107 ONLY CRNRY BYPASS (DRG 547-548)
20|FH_F41739_0_0|CSTM-ALL|CSTM-00|2020|PDM|37450.00|99|0.00|DRG 108 ONLY OTHER CARDIOTHORACIC PROC
20|FH_F80102_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F80224_0_0|CSTM-ALL|CSTM-00|2020|PDM|1403.00|99|0.00|ACUTE PSYCH
20|FH_F80224_0_0|SrvcGrp|29387|2022|PDM|115906.00|99|0.00|MS DRG 008 ONLY - SIMULT-PANCREAS/KIDNEY TRANSPLANT
20|FH_F80224_0_0|SrvcGrp|3029|2022|PDM|856.00|99|0.00|NEWBORN NURSERY
20|FH_F80224_0_0|SrvcGrp|30595|2022|PCT|0.79|99|0.00|MS DRG 010 ONLY
20|FH_F80224_0_0|SrvcGrp|360|2022|PDM|1543.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F80224_0_0|SrvcGrp|453|2022|PDM|493.00|99|0.00|PSYCH PARTIAL HOSP
20|FH_F80269_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE
20|FH_F80283_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F80455_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F80455_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F80455_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 7 (NO REV)
20|FH_F80455_0_0|CSTM-ALL|CSTM-00|2020|PDM|563.20|99|0.00|AEG 10 (NO REV)
20|FH_F80455_0_0|CSTM-ALL|CSTM-00|2020|PDM|776.60|99|0.00|AEG 5  (NO REV)
20|FH_F80455_0_0|SrvcGrp|78045|2022|PDM|803.00|99|0.00|AETNA AMNIOTIC MEMBRANE
20|FH_F80511_0_0|SrvcGrp|3178|2022|PDM|781.00|99|0.00|ACUTE PSYCH
20|FH_F80511_0_0|SrvcGrp|78180|2022|PDM|781.00|99|0.00|AETNA RESIDENTIAL TREATMENT
20|FH_F80511_0_0|SrvcGrp|78181|2022|PDM|1215.00|99|0.00|AETNA CAT SCAN
20|FH_F80513_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.74|99|0.00|GENERAL ACUTE CARE
20|FH_F80513_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.74|99|0.00|OP SVCS
20|FH_F80513_0_0|CSTM-ALL|CSTM-00|2020|PDM|6678.00|99|0.00|MS DRG 491 ONLY
20|FH_F80513_0_0|SrvcGrp|12342|2022|PCT|0.74|99|0.00|IMPLANTS
20|FH_F80513_0_0|SrvcGrp|16162|2022|PDM|2003.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F80513_0_0|SrvcGrp|19671|2022|PDM|6678.00|99|0.00|MS DRG 286 ONLY CIRCULATORY DISORDERS W/CARD CATH COMPLEX DX
20|FH_F80513_0_0|SrvcGrp|21075|2022|PDM|25933.00|99|0.00|MS DRG 025 ONLY
20|FH_F80513_0_0|SrvcGrp|21106|2022|PDM|23487.00|99|0.00|MS DRG 250 ONLY
20|FH_F80513_0_0|SrvcGrp|21350|2022|PDM|6122.00|99|0.00|MS DRG 287 ONLY
20|FH_F80513_0_0|SrvcGrp|26692|2022|PDM|23808.00|99|0.00|MS DRG 026 ONLY
20|FH_F80513_0_0|SrvcGrp|28121|2022|PDM|24603.00|99|0.00|MS DRG 469 ONLY
20|FH_F80513_0_0|SrvcGrp|29294|2022|PDM|947.00|99|0.00|ACUTE REHAB
20|FH_F80513_0_0|SrvcGrp|29340|2022|PDM|9718.00|99|0.00|MS DRG 262 ONLY
20|FH_F80513_0_0|SrvcGrp|361|2022|PDM|2125.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F80513_0_0|SrvcGrp|53149|2022|PDM|14427.00|99|0.00|MS DRG 064 ONLY
20|FH_F80513_0_0|SrvcGrp|87305|2022|PDM|21718.00|99|0.00|MSDRG 268 ONLY
20|FH_F80513_0_0|SrvcGrp|87308|2022|PDM|19882.00|99|0.00|MSDRG 271 ONLY
20|FH_F80513_0_0|SrvcGrp|941|2022|PDM|2337.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F80592_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F80592_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS
20|FH_F80771_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F80771_0_0|CSTM-ALL|CSTM-00|2020|PDM|538.00|99|0.00|COVENTRY ENHANCED GROUPER 2
20|FH_F80771_0_0|CSTM-ALL|CSTM-00|2020|PDM|864.00|99|0.00|COVENTRY ENHANCED GROUPER 5
20|FH_F80776_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F80831_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F80831_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|99|0.00|OP SVCS
20|FH_F80855_0_0|SrvcGrp|44066|2022|PDM|1530.00|99|0.00|CPT 57288
20|FH_F80855_0_0|SrvcGrp|47142|2022|PDM|2625.00|99|0.00|CPT 49650
20|FH_F80855_0_0|SrvcGrp|65403|2022|PDM|1100.00|99|0.00|CPT 42830
20|FH_F80855_0_0|SrvcGrp|72998|2022|PDM|1025.00|99|0.00|AEG 5
20|FH_F80855_0_0|SrvcGrp|73000|2022|PDM|1025.00|99|0.00|AEG 6
20|FH_F80855_0_0|SrvcGrp|73002|2022|PDM|1200.00|99|0.00|AEG 7
20|FH_F80855_0_0|SrvcGrp|73004|2022|PDM|1100.00|99|0.00|AEG 8
20|FH_F80855_0_0|SrvcGrp|73006|2022|PDM|1400.00|99|0.00|AEG 9
20|FH_F80855_0_0|SrvcGrp|78282|2022|PDM|3375.00|99|0.00|CPT 47563
20|FH_F81033_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F81033_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F81033_0_0|SrvcGrp|78662|2022|PDM|892.50|99|0.00|AETNA ENDOMETRIAL THERMAL ABLTN
20|FH_F81033_0_0|SrvcGrp|78664|2022|PDM|892.50|99|0.00|AETNA HYSTEROSCOPY ABLATION
20|FH_F81037_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F81152_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F81172_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F81183_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F81294_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE
20|FH_F81297_0_0|CSTM-ALL|CSTM-00|2020|PCT|64.90|99|0.00|OP SVCS
20|FH_F81312_0_0|SrvcGrp|14046|2022|PCT|1.00|99|0.00|DRUGS
20|FH_F81377_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F81377_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F81377_0_0|CSTM-ALL|CSTM-00|2020|PDM|688.00|99|0.00|AEG 1 (NO REV)
20|FH_F81377_0_0|CSTM-ALL|CSTM-00|2020|PDM|710.00|99|0.00|AEG 3 (NO REV)
20|FH_F81377_0_0|CSTM-ALL|CSTM-00|2020|PDM|722.00|99|0.00|AEG 4 (NO REV)
20|FH_F81393_0_0|CSTM-ALL|CSTM-00|2020|PDM|349.00|99|0.00|AEG 1 (NO REV)
20|FH_F81456_0_0|SrvcGrp|55677|2022|PDM|3000.00|99|0.00|VAGINAL DELIVERY ONLY
20|FH_F81456_0_0|SrvcGrp|79238|2022|PDM|700.00|99|0.00|TRANSFER
20|FH_F81457_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F81457_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F81481_0_0|CSTM-ALL|CSTM-00|2020|PDM|892.00|99|0.00|AETNA AMBULATORY SURGERY (NO REV)
20|FH_F81494_0_0|CSTM-ALL|CSTM-00|2020|PDM|575.00|99|0.00|CT SCAN
20|FH_F81494_0_0|SrvcGrp|16616|2022|PDM|79.00|99|0.00|HOME HEALTH AIDE
20|FH_F81494_0_0|SrvcGrp|16619|2022|PDM|136.00|99|0.00|OT SVCS
20|FH_F81494_0_0|SrvcGrp|16620|2022|PDM|136.00|99|0.00|PT SVCS
20|FH_F81494_0_0|SrvcGrp|22954|2022|PDM|186.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F81494_0_0|SrvcGrp|30623|2022|PDM|7686.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788
20|FH_F81494_0_0|SrvcGrp|3809|2022|PDM|933.00|99|0.00|HOSPICE CARE
20|FH_F41739_0_0|CSTM-ALL|CSTM-00|2020|PDM|46010.00|99|0.00|DRG 104 ONLY CARDIAC VALVE PROCEDURE W/CARDIAC CATH
20|FH_F41739_0_0|CSTM-ALL|CSTM-00|2020|PDM|963.00|99|0.00|ACUTE PSYCH
20|FH_F41739_0_0|SrvcGrp|10059|2022|PDM|15943.00|99|0.00|DRG 124 ONLY CIRCULATORY DISORDERS W/CARDIAC CATH COMPLEX DX
20|FH_F41739_0_0|SrvcGrp|8968|2022|PDM|2514.00|99|0.00|NICU LEVEL III & IV
20|FH_F41739_0_0|SrvcGrp|97|2022|PDM|8025.00|99|0.00|C-SECTION
20|FH_F41749_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|EATING DISORDER PARTIAL DAY - CHILD
20|FH_F41773_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F41795_0_0|CSTM-ALL|CSTM-00|2020|PDM|60.00|99|0.00|PT & OT
20|FH_F41795_0_0|SrvcGrp|15403|2022|PDM|70.00|99|0.00|SPEECH THERAPY SVCS INITIAL EVAL
20|FH_F41795_0_0|SrvcGrp|16746|2022|PDM|70.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F41796_0_0|SrvcGrp|110|2022|PDM|440.00|99|0.00|CD - REHABILITATION
20|FH_F41798_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F41798_0_0|CSTM-ALL|CSTM-00|2020|PDM|192.00|99|0.00|CD PARTIAL HOSP - DAY TREATMENT
20|FH_F41798_0_0|SrvcGrp|109|2022|PDM|468.00|99|0.00|CD - DETOX
20|FH_F41799_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F41801_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|ADOLESCENT PSYCHIATRIC
20|FH_F41803_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F41803_0_0|SrvcGrp|34872|2022|PCT|0.80|99|0.00|INTRAOCULAR LENS
20|FH_F41803_0_0|SrvcGrp|34874|2022|PCT|0.50|99|0.00|COCHLEAR IMPLANT
20|FH_F41804_0_0|CSTM-ALL|CSTM-00|2020|PDM|1082.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41804_0_0|SrvcGrp|3029|2022|PDM|309.00|99|0.00|NEWBORN NURSERY
20|FH_F41808_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F41808_0_0|SrvcGrp|22954|2022|PDM|135.11|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F41809_0_0|SrvcGrp|3029|2022|PDM|300.00|99|0.00|NEWBORN NURSERY
20|FH_F41814_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.76|99|0.00|OP SVCS
20|FH_F41814_0_0|SrvcGrp|72|2022|PDM|478.00|99|0.00|NEWBORN NURSERY
20|FH_F41818_0_0|SrvcGrp|30941|2022|PDM|408.00|99|0.00|NEWBORN NURSERY
20|FH_F41845_0_0|SrvcGrp|109|2022|PDM|545.00|99|0.00|CD - DETOX
20|FH_F41874_0_0|SrvcGrp|3029|2022|PDM|235.00|99|0.00|NEWBORN NURSERY
20|FH_F41885_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|ACUTE PSYCH
20|FH_F41885_0_0|SrvcGrp|97|2022|PDM|2600.00|99|0.00|C-SECTION
20|FH_F41887_0_0|SrvcGrp|13631|2022|PDM|110.00|99|0.00|CPT 99213
20|FH_F41932_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE
20|FH_F41932_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS
20|FH_F41934_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F41934_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|ASPG IV - CPD 1281588
20|FH_F41934_0_0|SrvcGrp|35261|2022|PDM|1200.00|99|0.00|IOL PROCEDURES
20|FH_F41962_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F41976_0_0|CSTM-ALL|CSTM-00|2020|PDM|360.00|99|0.00|MARLBORO GASTRO GI PROCEDURES 360
20|FH_F41988_0_0|CSTM-ALL|CSTM-00|2020|PDM|442.00|99|0.00|ACUTE PSYCH
20|FH_F41992_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F41999_0_0|SrvcGrp|35143|2022|PDM|800.00|99|0.00|LABOR
20|FH_F42003_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F42005_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|COLORECTAL CANCER SCREENING
20|FH_F42012_0_0|CSTM-ALL|CSTM-00|2020|PDM|60.00|99|0.00|OP SVCS
20|FH_F42016_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42019_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F42019_0_0|SrvcGrp|177|2022|PDM|950.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F42019_0_0|SrvcGrp|701|2022|PDM|1600.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F42019_0_0|SrvcGrp|97|2022|PDM|2600.00|99|0.00|C-SECTION
20|FH_F42024_0_0|CSTM-ALL|CSTM-00|2020|PDM|17500.00|99|0.00|MS DRG 619-621
20|FH_F42024_0_0|CSTM-ALL|CSTM-00|2020|PDM|4900.00|99|0.00|MS DRG 242-245 OTHER PERMANENT CARDIAC PACEMAKER IMP W/O
20|FH_F42024_0_0|SrvcGrp|10927|2022|PDM|694.00|99|0.00|COMPUTED TOMOGRAPHY (CT)
20|FH_F42024_0_0|SrvcGrp|10944|2022|PCT|0.79|99|0.00|EMERGENCY ROOM
20|FH_F42024_0_0|SrvcGrp|15354|2022|PCT|0.75|99|0.00|OTHER DIAGNOSTIC TESTING
20|FH_F42024_0_0|SrvcGrp|35499|2022|PCT|0.79|99|0.00|OP SURGERY
20|FH_F42024_0_0|SrvcGrp|35558|2022|PCT|1.10|99|0.00|LITHOTRIPSY - OP
20|FH_F42024_0_0|SrvcGrp|35559|2022|PDM|4500.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY - OP
20|FH_F42024_0_0|SrvcGrp|35560|2022|PCT|0.74|99|0.00|PHARMACY SVCS
20|FH_F42026_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|INDIVIDUAL COUNSELING SERVICES
20|FH_F42028_0_0|CSTM-ALL|CSTM-00|2020|PCT|67.04|99|0.00|GENERAL ACUTE CARE
20|FH_F42028_0_0|CSTM-ALL|CSTM-00|2020|PCT|67.04|99|0.00|OP SVCS
20|FH_F42098_0_0|CSTM-ALL|CSTM-00|2020|PDM|60.00|99|0.00|PROFESSIONAL PHARMACY
20|FH_F42098_0_0|SrvcGrp|11085|2022|PDM|28.00|99|0.00|HOME HEALTH AIDE
20|FH_F42098_0_0|SrvcGrp|26694|2022|PDM|60.00|99|0.00|INITIAL SPECIALTY NURSING S9123 MOD TG
20|FH_F42105_0_0|SrvcGrp|16|2022|PDM|850.00|99|0.00|ACUTE REHABILITATION
20|FH_F42117_0_0|CSTM-ALL|CSTM-00|2020|PDM|125.00|99|0.00|RHO D IMMUNE GLOB
20|FH_F42117_0_0|SrvcGrp|38007|2022|PDM|700.00|99|0.00|CPT CODE 59425
20|FH_F42138_0_0|SrvcGrp|11442|2022|PDM|492.00|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)
20|FH_F42138_0_0|SrvcGrp|14494|2022|PDM|28.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F42138_0_0|SrvcGrp|9263|2022|PDM|125.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|117.00|99|0.00|HAPA EPA ASC 20
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|1359.00|99|0.00|HAPA EPA ASC 56
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|1370.00|99|0.00|HAPA EPA ASC 55
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|200.00|99|0.00|HAPA EPA ASC 30
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|268.00|99|0.00|HAPA EPA ASC 36
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|341.00|99|0.00|HAPA EPA ASC 41
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|363.00|99|0.00|HAPA EPA ASC 1
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|407.00|99|0.00|HAPA EPA ASC 46
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|427.00|99|0.00|HAPA EPA ASC 47
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|431.00|99|0.00|HAPA EPA ASC 48
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|461.00|99|0.00|HAPA EPA ASC 52
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|73.00|99|0.00|HAPA EPA ASC 12
20|FH_F42145_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|OP SVCS
20|FH_F42153_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.83|99|0.00|OP SVCS
20|FH_F42153_0_0|SrvcGrp|34557|2022|PDM|867.00|99|0.00|MS DRG 894-897 ONLY CHEM DEP
20|FH_F42159_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|LITHOTRIPSY
20|FH_F42160_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F42160_0_0|SrvcGrp|88|2022|PDM|4665.00|99|0.00|OP LITHOTRIPSY
20|FH_F42161_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|MS DRG 765-766 ONLY C-SECTION
20|FH_F42161_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|PEDIATRIC IP SVCS
20|FH_F42161_0_0|SrvcGrp|3349|2022|PCT|0.88|99|0.00|LITHOTRIPSY SVCS
20|FH_F42165_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|MS DRG 765-766 ONLY C-SECTION
20|FH_F42165_0_0|SrvcGrp|22461|2022|PCT|0.85|99|0.00|INPATIENT HOSPICE SVCS
20|FH_F42165_0_0|SrvcGrp|29817|2022|PDM|2000.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F42165_0_0|SrvcGrp|3660|2022|PCT|0.85|99|0.00|MAGNETIC RESONANCE IMAGING (MRI)
20|FH_F42168_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|GENERAL ACUTE CARE
20|FH_F42168_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|OP SVCS
20|FH_F42168_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F42168_0_0|SrvcGrp|12146|2022|PDM|1400.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F42169_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE
20|FH_F42169_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|ACUTE IP MED SVCS
20|FH_F42169_0_0|SrvcGrp|12146|2022|PDM|1700.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F42169_0_0|SrvcGrp|22461|2022|PCT|0.85|99|0.00|INPATIENT HOSPICE SVCS
20|FH_F42176_0_0|SrvcGrp|12117|2022|PCT|0.88|99|0.00|MAGNETIC RESONANCE IMAGING
20|FH_F42176_0_0|SrvcGrp|20534|2022|PCT|0.88|99|0.00|SKILLED NURSING
20|FH_F42176_0_0|SrvcGrp|22461|2022|PCT|0.88|99|0.00|INPATIENT HOSPICE SVCS
20|FH_F42176_0_0|SrvcGrp|29817|2022|PDM|2000.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F42177_0_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|MS DRG 765-766 ONLY C-SECTION
20|FH_F42177_0_0|SrvcGrp|12146|2022|PDM|1250.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F42177_0_0|SrvcGrp|31007|2022|PDM|210.00|99|0.00|MS DRG 795 ONLY & REV CODES 170-171 NORMAL NEWBORN
20|FH_F42244_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|CV SERVICES
20|FH_F42244_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|IMPLANTS
20|FH_F42244_0_0|SrvcGrp|269|2022|PCT|0.70|99|0.00|OP LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F42248_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|CD DAY TREATMENT
20|FH_F42248_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE
20|FH_F42248_0_0|SrvcGrp|110|2022|PDM|193.00|99|0.00|CD - REHABILITATION
20|FH_F42255_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42255_0_0|CSTM-ALL|CSTM-00|2020|PDM|321.40|99|0.00|ASPG I
20|FH_F42255_0_0|CSTM-ALL|CSTM-00|2020|PDM|608.96|99|0.00|ASPG IV
20|FH_F42255_0_0|CSTM-ALL|CSTM-00|2020|PDM|944.29|99|0.00|ASPG VIII
20|FH_F42260_0_0|CSTM-ALL|CSTM-00|2020|PDM|1004.00|99|0.00|COVENTRY ENHANCED GROUPER 5 MOD 50
20|FH_F42260_0_0|CSTM-ALL|CSTM-00|2020|PDM|1156.00|99|0.00|COVENTRY ENHANCED GROUPER 6 MOD 50
20|FH_F42260_0_0|CSTM-ALL|CSTM-00|2020|PDM|1393.00|99|0.00|COVENTRY ENHANCED GROUPER 7 MOD 50
20|FH_F42260_0_0|CSTM-ALL|CSTM-00|2020|PDM|1875.00|99|0.00|COVENTRY ENHANCED GROUPER 9
20|FH_F42260_0_0|CSTM-ALL|CSTM-00|2020|PDM|714.00|99|0.00|COVENTRY ENHANCED GROUPER 3
20|FH_F42272_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F42272_0_0|CSTM-ALL|CSTM-00|2020|PDM|1205.00|99|0.00|ASPG IX
20|FH_F42272_0_0|CSTM-ALL|CSTM-00|2020|PDM|645.00|99|0.00|ASPG V
20|FH_F42272_0_0|CSTM-ALL|CSTM-00|2020|PDM|743.00|99|0.00|ASPG VI
20|FH_F42272_0_0|CSTM-ALL|CSTM-00|2020|PDM|846.00|99|0.00|ASPG VIII
20|FH_F42272_0_0|CSTM-ALL|CSTM-00|2020|PDM|896.00|99|0.00|ASPG VII
20|FH_F42279_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS
20|FH_F42282_0_0|CSTM-ALL|CSTM-00|2020|PDM|598.00|99|0.00|ACUTE PSYCH
20|FH_F42294_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F42295_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42300_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42300_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F42312_0_0|CSTM-ALL|CSTM-00|2020|PDM|401.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F42312_0_0|CSTM-ALL|CSTM-00|2020|PDM|401.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42332_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F42333_0_0|CSTM-ALL|CSTM-00|2020|PDM|330.00|99|0.00|ACUTE PSYCH
20|FH_F42342_0_0|SrvcGrp|9832|2022|PDM|131.25|99|0.00|ST SVCS
20|FH_F42343_0_0|CSTM-ALL|CSTM-00|2020|PDM|255.00|99|0.00|PSYCH PARTIAL HOSPITALIZATION
20|FH_F42343_0_0|SrvcGrp|109|2022|PDM|517.00|99|0.00|CD - DETOX
20|FH_F42352_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F42352_0_0|SrvcGrp|13437|2022|PDM|3270.00|99|0.00|LITHOTRIPSY
20|FH_F42352_0_0|SrvcGrp|903|2022|PDM|4600.00|99|0.00|PTC ANGIOPLASTY
20|FH_F42355_0_0|CSTM-ALL|CSTM-00|2020|PDM|169.00|99|0.00|PSYCH PARTIAL HOSPITALIZATION
20|FH_F42363_0_0|CSTM-ALL|CSTM-00|2020|PDM|275.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42364_0_0|CSTM-ALL|CSTM-00|2020|PCT|52.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42368_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|OP SVCS
20|FH_F42377_0_0|CSTM-ALL|CSTM-00|2020|PDM|275.00|99|0.00|PSYCH PARTIAL HOSPITALIZATION
20|FH_F42395_0_0|CSTM-ALL|CSTM-00|2020|PDM|477.00|99|0.00|SKILLED NURSING
20|FH_F42395_0_0|CSTM-ALL|CSTM-00|2020|PDM|902.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42395_0_0|SrvcGrp|3029|2022|PDM|244.00|99|0.00|NEWBORN NURSERY
20|FH_F42395_0_0|SrvcGrp|38|2022|PDM|2016.00|99|0.00|NORMAL DELIVERY
20|FH_F42395_0_0|SrvcGrp|97|2022|PDM|2864.00|99|0.00|C-SECTION
20|FH_F42402_0_0|SrvcGrp|12117|2022|PCT|0.90|99|0.00|MAGNETIC RESONANCE IMAGING
20|FH_F42420_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42422_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.56|99|0.00|OP SVCS
20|FH_F42422_0_0|CSTM-ALL|CSTM-00|2020|PDM|1025.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42422_0_0|SrvcGrp|3277|2022|PDM|809.00|99|0.00|SKILLED NURSING CARE
20|FH_F42423_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F81563_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F81563_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F81771_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F81823_0_0|SrvcGrp|57968|2022|PDM|30.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F81835_0_0|SrvcGrp|74661|2022|PDM|589.23|99|0.00|AETNA SLEEP STUDIES
20|FH_F81835_0_0|SrvcGrp|75326|2022|PDM|77.46|99|0.00|SLEEP STUDY CPT 95801
20|FH_F81860_0_0|CSTM-ALL|CSTM-00|2020|PCT|61.20|99|0.00|GENERAL ACUTE CARE
20|FH_F81860_0_0|CSTM-ALL|CSTM-00|2020|PCT|61.20|99|0.00|OP SVCS
20|FH_F82033_0_0|CSTM-ALL|CSTM-00|2020|PDM|1260.00|99|0.00|AEG 10 (NO REV)
20|FH_F82033_0_0|CSTM-ALL|CSTM-00|2020|PDM|1260.00|99|0.00|AEG 2 (NO REV)
20|FH_F82033_0_0|CSTM-ALL|CSTM-00|2020|PDM|3150.00|99|0.00|AEG 4 (NO REV)
20|FH_F82033_0_0|CSTM-ALL|CSTM-00|2020|PDM|5250.00|99|0.00|AEG 7 (NO REV)
20|FH_F82033_0_0|CSTM-ALL|CSTM-00|2020|PDM|6300.00|99|0.00|AEG 3 (NO REV)
20|FH_F82033_0_0|CSTM-ALL|CSTM-00|2020|PDM|6300.00|99|0.00|AEG 5  (NO REV)
20|FH_F82033_0_0|CSTM-ALL|CSTM-00|2020|PDM|6300.00|99|0.00|AEG 6 (NO REV)
20|FH_F82114_0_0|SrvcGrp|74661|2022|PDM|350.58|99|0.00|AETNA SLEEP STUDIES
20|FH_F82114_0_0|SrvcGrp|75326|2022|PDM|86.06|99|0.00|SLEEP STUDY CPT 95801
20|FH_F82195_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F82196_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F82199_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F82234_0_0|SrvcGrp|80098|2022|PDM|857.79|99|0.00|AETNA HOSPICE CONTINUOUS HOME CARE
20|FH_F82234_0_0|SrvcGrp|80285|2022|PDM|146.97|99|0.00|HOSPICE ROUTINE HOME CARE
20|FH_F82235_0_0|SrvcGrp|72998|2022|PDM|788.70|99|0.00|AEG 5
20|FH_F82235_0_0|SrvcGrp|80126|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANICNG SUBSTANCE
20|FH_F82378_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F82378_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F82381_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F82382_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F82432_0_0|SrvcGrp|63297|2022|PDM|105.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F82432_0_0|SrvcGrp|65720|2022|PDM|105.00|99|0.00|RESPITE CARE
20|FH_F82452_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F82571_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F82571_0_0|CSTM-ALL|CSTM-00|2020|PDM|1030.00|99|0.00|COVENTRY ENHANCED GROUPER 8
20|FH_F82571_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|COVENTRY ENHANCED GROUPER 9
20|FH_F82571_0_0|CSTM-ALL|CSTM-00|2020|PDM|873.00|99|0.00|COVENTRY ENHANCED GROUPER 6
20|FH_F82572_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F82572_0_0|SrvcGrp|47995|2022|PDM|70.00|99|0.00|OCCUPATIONAL THERAPY SERVICES VISIT
20|FH_F82671_0_0|CSTM-ALL|CSTM-00|2020|PDM|698.00|99|0.00|COVENTRY ENHANCED GROUPER 3
20|FH_F82671_0_0|CSTM-ALL|CSTM-00|2020|PDM|982.00|99|0.00|COVENTRY ENHANCED GROUPER 5
20|FH_F82691_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F82691_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F82691_0_0|SrvcGrp|33164|2022|PDM|225.00|99|0.00|SKILLED NURSING - LEVEL I
20|FH_F82691_0_0|SrvcGrp|78537|2022|PDM|48.00|99|0.00|PHYSICAL THERAPY
20|FH_F82691_0_0|SrvcGrp|79177|2022|PDM|48.00|99|0.00|SPEECH THERAPY
20|FH_F82771_0_0|CSTM-ALL|CSTM-00|2020|PDM|1260.00|99|0.00|AEG 2 (NO REV)
20|FH_F82771_0_0|CSTM-ALL|CSTM-00|2020|PDM|2048.00|99|0.00|AEG 6 (NO REV)
20|FH_F82771_0_0|CSTM-ALL|CSTM-00|2020|PDM|893.00|99|0.00|AEG 10 (NO REV)
20|FH_F82771_0_0|SrvcGrp|79937|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F82779_0_0|CSTM-ALL|CSTM-00|2020|PDM|474.00|99|0.00|COVENTRY ENHANCED GROUPER 2
20|FH_F82779_0_0|CSTM-ALL|CSTM-00|2020|PDM|670.00|99|0.00|COVENTRY ENHANCED GROUPER 4
20|FH_F82813_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F82813_0_0|SrvcGrp|72994|2022|PDM|793.00|99|0.00|AEG 3
20|FH_F82813_0_0|SrvcGrp|73000|2022|PDM|1223.00|99|0.00|AEG 6
20|FH_F82894_0_0|SrvcGrp|80098|2022|PDM|31.60|99|0.00|AETNA HOSPICE CONTINUOUS HOME CARE
20|FH_F82973_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F82973_0_0|CSTM-ALL|CSTM-00|2020|PDM|523.00|99|0.00|AEG 3 (NO REV)
20|FH_F82973_0_0|CSTM-ALL|CSTM-00|2020|PDM|736.00|99|0.00|AEG 5  (NO REV)
20|FH_F82973_0_0|SrvcGrp|11663|2022|PCT|1.10|99|0.00|IMPLANTS
20|FH_F83053_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F83053_0_0|SrvcGrp|11000|2022|PCT|0.26|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F83053_0_0|SrvcGrp|72994|2022|PDM|3368.00|99|0.00|AEG 3
20|FH_F83053_0_0|SrvcGrp|73004|2022|PDM|4756.00|99|0.00|AEG 8
20|FH_F83053_0_0|SrvcGrp|73006|2022|PDM|7635.00|99|0.00|AEG 9
20|FH_F83053_0_0|SrvcGrp|77180|2022|PCT|0.53|99|0.00|AETNA UNGROUPABLE AEG
20|FH_F83196_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F83231_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F83313_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F83313_0_0|SrvcGrp|81297|2022|PDM|220.00|99|0.00|URGENT CARE
20|FH_F83431_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.46|99|0.00|OP SVCS
20|FH_F83451_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F83451_0_0|CSTM-ALL|CSTM-00|2020|PDM|436.00|99|0.00|AEG 1 (NO REV)
20|FH_F83451_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AEG 10 (NO REV)
20|FH_F83451_0_0|CSTM-ALL|CSTM-00|2020|PDM|931.00|99|0.00|AEG 5  (NO REV)
20|FH_F83451_0_0|SrvcGrp|112110|2022|PDM|1350.00|99|0.00|NSL / SINS NDSC TOTAL
20|FH_F83451_0_0|SrvcGrp|112111|2022|PDM|12500.00|99|0.00|TOTAL JOINT CODES
20|FH_F83451_0_0|SrvcGrp|14614|2022|PDM|3500.00|99|0.00|LITHOTRIPSY
20|FH_F83451_0_0|SrvcGrp|23585|2022|PCT|0.68|99|0.00|IMPLANTS
20|FH_F83451_0_0|SrvcGrp|81562|2022|PDM|1500.00|99|0.00|STEREOTACTIC COMPUTER
20|FH_F83451_0_0|SrvcGrp|88492|2022|PDM|1906.00|99|0.00|AETNA SPINAL BONE AUTOGRAFT
20|FH_F83472_0_0|CSTM-ALL|CSTM-00|2020|PDM|1025.52|99|0.00|AEG 8 (NO REV)
20|FH_F83472_0_0|CSTM-ALL|CSTM-00|2020|PDM|470.40|99|0.00|AEG 2 (NO REV)
20|FH_F83472_0_0|CSTM-ALL|CSTM-00|2020|PDM|664.45|99|0.00|AEG 4 (NO REV)
20|FH_F42423_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|COVENTRY ENHANCED GROUPER 1
20|FH_F42427_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F42429_0_0|SrvcGrp|13368|2022|PCT|0.70|99|0.00|OP SURGERY
20|FH_F42433_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42433_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F42433_0_0|SrvcGrp|473|2022|PDM|295.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F42438_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F42438_0_0|CSTM-ALL|CSTM-00|2020|PDM|1542.00|99|0.00|COVENTRY ENHANCED GROUPER 7
20|FH_F42438_0_0|CSTM-ALL|CSTM-00|2020|PDM|516.00|99|0.00|COVENTRY ENHANCED GROUPER 1
20|FH_F42438_0_0|CSTM-ALL|CSTM-00|2020|PDM|977.00|99|0.00|COVENTRY ENHANCED GROUPER 10
20|FH_F42438_0_0|SrvcGrp|16719|2022|PCT|1.05|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F42446_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42449_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F42452_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F42452_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42453_0_0|CSTM-ALL|CSTM-00|2020|PDM|775.00|99|0.00|SPINAL CORD REHABILITATION
20|FH_F42464_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42464_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.00|99|0.00|EMERGENCY ROOM
20|FH_F42467_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|ACUTE PSYCH
20|FH_F42467_0_0|SrvcGrp|177|2022|PDM|950.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F42467_0_0|SrvcGrp|97|2022|PDM|2600.00|99|0.00|C-SECTION
20|FH_F42500_0_0|CSTM-ALL|CSTM-00|2020|PDM|525.00|99|0.00|ACUTE PSYCH
20|FH_F42500_0_0|CSTM-ALL|CSTM-00|2020|PDM|525.00|99|0.00|SKILLED NURSING CARE
20|FH_F42538_0_0|SrvcGrp|3809|2022|PDM|657.00|99|0.00|HOSPICE CARE
20|FH_F42538_0_0|SrvcGrp|9483|2022|PDM|130.00|99|0.00|RESIDENTIAL HOSPICE SVCS
20|FH_F42539_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F42551_0_0|CSTM-ALL|CSTM-00|2020|PDM|205.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42551_0_0|CSTM-ALL|CSTM-00|2020|PDM|3465.00|99|0.00|OP SVCS
20|FH_F42577_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE
20|FH_F42581_0_0|SrvcGrp|6|2022|PCT|0.70|99|0.00|OP SURGERY
20|FH_F42622_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE
20|FH_F42626_0_0|CSTM-ALL|CSTM-00|2020|PDM|1061.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42633_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42633_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS
20|FH_F42640_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42646_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F42646_0_0|SrvcGrp|701|2022|PDM|1600.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F42646_0_0|SrvcGrp|97|2022|PDM|2600.00|99|0.00|C-SECTION
20|FH_F42706_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|TISSUE GRAFTS
20|FH_F42706_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|OP DIALYSIS
20|FH_F42706_0_0|CSTM-ALL|CSTM-00|2020|PDM|625.79|99|0.00|ASPG IV
20|FH_F42706_0_0|CSTM-ALL|CSTM-00|2020|PDM|967.50|99|0.00|ASPG VIII
20|FH_F42706_0_0|SrvcGrp|13854|2022|PDM|760.00|99|0.00|HYPERBARIC CHAMBER
20|FH_F42708_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F42708_0_0|SrvcGrp|109|2022|PDM|620.00|99|0.00|CD - DETOX
20|FH_F42708_0_0|SrvcGrp|110|2022|PDM|528.00|99|0.00|CD - REHABILITATION
20|FH_F42715_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42715_0_0|SrvcGrp|471|2022|PDM|618.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F42715_0_0|SrvcGrp|473|2022|PDM|374.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F42722_0_0|CSTM-ALL|CSTM-00|2020|PDM|72.00|99|0.00|PT / OT / ST
20|FH_F42722_0_0|SrvcGrp|28147|2022|PDM|506.00|99|0.00|SKILLED NURSING
20|FH_F42736_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F42746_0_0|SrvcGrp|15403|2022|PDM|55.00|99|0.00|SPEECH THERAPY SVCS INITIAL EVAL
20|FH_F42748_0_0|SrvcGrp|110|2022|PDM|500.00|99|0.00|CD - REHABILITATION
20|FH_F42754_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42775_0_0|SrvcGrp|24727|2022|PDM|500.00|99|0.00|ANESTHESIA SERVICES - OBSTETRIC
20|FH_F42799_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42803_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F42803_0_0|SrvcGrp|38|2022|PDM|1000.00|99|0.00|NORMAL DELIVERY
20|FH_F42803_0_0|SrvcGrp|97|2022|PDM|1000.00|99|0.00|C-SECTION
20|FH_F42807_0_0|CSTM-ALL|CSTM-00|2020|PDM|780.00|99|0.00|ACUTE PSYCH
20|FH_F42807_0_0|SrvcGrp|110|2022|PDM|728.00|99|0.00|CD - REHABILITATION
20|FH_F42807_0_0|SrvcGrp|12491|2022|PCT|0.75|99|0.00|PACEMAKER
20|FH_F42807_0_0|SrvcGrp|12837|2022|PCT|0.75|99|0.00|INTRAOCULAR LENSES
20|FH_F42807_0_0|SrvcGrp|12840|2022|PCT|0.75|99|0.00|PACEMAKER
20|FH_F42814_0_0|CSTM-ALL|CSTM-00|2020|PDM|55.00|99|0.00|OP SVCS
20|FH_F42822_0_0|CSTM-ALL|CSTM-00|2020|PDM|225.00|99|0.00|ADULT PARTIAL HOSPITALIZATION
20|FH_F42822_0_0|CSTM-ALL|CSTM-00|2020|PDM|595.00|99|0.00|CHILD PSYCHIATRIC
20|FH_F42822_0_0|SrvcGrp|33251|2022|PDM|350.00|99|0.00|CD (CHILD) - REHAB
20|FH_F42879_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42879_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F42897_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F42905_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F42906_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F42917_0_0|SrvcGrp|9500|2022|PDM|875.00|99|0.00|PSYCH INTENSIVE CARE UNIT
20|FH_F42923_0_0|CSTM-ALL|CSTM-00|2020|PCT|58.30|99|0.00|GENERAL ACUTE CARE
20|FH_F42929_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.70|99|0.00|OP SVCS
20|FH_F42937_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F42938_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42951_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.50|99|0.00|OP SVCS
20|FH_F42952_0_0|SrvcGrp|31931|2022|PDM|1156.00|99|0.00|SKILLED NURSING CARE
20|FH_F42964_0_0|CSTM-ALL|CSTM-00|2020|PDM|820.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42964_0_0|SrvcGrp|31134|2022|PDM|820.00|99|0.00|SURGICAL - ADULT/PEDIATRIC
20|FH_F42964_0_0|SrvcGrp|40820|2022|PDM|1000.00|99|0.00|ICU/CCU
20|FH_F42979_0_0|CSTM-ALL|CSTM-00|2020|PDM|133.00|99|0.00|CPT 90885 PSYCHIATRIC EVALUATION
20|FH_F42979_0_0|CSTM-ALL|CSTM-00|2020|PDM|557.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F42979_0_0|SrvcGrp|3390|2022|PDM|132.00|99|0.00|CPT 90801
20|FH_F42979_0_0|SrvcGrp|3392|2022|PDM|96.00|99|0.00|CPT 90806
20|FH_F42979_0_0|SrvcGrp|3404|2022|PDM|32.00|99|0.00|CPT 99211
20|FH_F42979_0_0|SrvcGrp|3406|2022|PDM|84.00|99|0.00|CPT 99214
20|FH_F42980_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42980_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F42980_0_0|SrvcGrp|50204|2022|PDM|125.00|99|0.00|OP OFFICE VISIT- ESTABLISHED PATIENT
20|FH_F42980_0_0|SrvcGrp|50205|2022|PDM|125.00|99|0.00|CPT 99211
20|FH_F42984_0_0|CSTM-ALL|CSTM-00|2020|PDM|373.00|99|0.00|RESIDENTIAL PSYCH / CD (ADOLESCENT)
20|FH_F42984_0_0|CSTM-ALL|CSTM-00|2020|PDM|584.00|99|0.00|ADOLESCENT PSYCHIATRIC
20|FH_F42984_0_0|CSTM-ALL|CSTM-00|2020|PDM|584.00|99|0.00|ADULT PSYCHIATRIC
20|FH_F42985_0_0|CSTM-ALL|CSTM-00|2020|PDM|360.00|99|0.00|GENERAL ACUTE CARE
20|FH_F42992_0_0|SrvcGrp|31134|2022|PDM|950.00|99|0.00|SURGICAL - ADULT/PEDIATRIC
20|FH_F43000_0_0|CSTM-ALL|CSTM-00|2020|PDM|35.00|99|0.00|HOME HEALTH AIDE
20|FH_F43007_0_0|SrvcGrp|170|2022|PDM|267.00|99|0.00|CD (ADOLESCENT) - REHAB
20|FH_F43008_0_0|SrvcGrp|31134|2022|PDM|1040.00|99|0.00|SURGICAL - ADULT/PEDIATRIC
20|FH_F43014_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43018_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE
20|FH_F43018_0_0|SrvcGrp|12342|2022|PCT|0.60|99|0.00|IMPLANTS
20|FH_F43018_0_0|SrvcGrp|36802|2022|PCT|0.75|99|0.00|MS DRG 215-238, 258-262  ONLY CV SURGERY
20|FH_F43018_0_0|SrvcGrp|36803|2022|PDM|731.00|99|0.00|MS DRG 876, 880-887, 894-897 ONLY - PSYCH/CD
20|FH_F43018_0_0|SrvcGrp|36812|2022|PDM|4515.00|99|0.00|ACUTE IP MEDICAL SVCS - ONE DAY STAY
20|FH_F43018_0_0|SrvcGrp|9793|2022|PDM|575.00|99|0.00|NEWBORN NURSERY
20|FH_F43027_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F43027_0_0|SrvcGrp|33164|2022|PDM|250.00|99|0.00|SKILLED NURSING - LEVEL I
20|FH_F43027_0_0|SrvcGrp|33165|2022|PDM|325.00|99|0.00|SKILLED NURSING - LEVEL II
20|FH_F43078_0_0|SrvcGrp|22954|2022|PDM|140.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F43078_0_0|SrvcGrp|3809|2022|PDM|580.00|99|0.00|HOSPICE CARE
20|FH_F43081_0_0|CSTM-ALL|CSTM-00|2020|PDM|399.00|99|0.00|ACUTE PSYCH
20|FH_F43113_0_0|SrvcGrp|12401|2022|PDM|71.50|99|0.00|RN VISIT
20|FH_F43120_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|EMERGENCY MEDICAL SERVICES (EMS)
20|FH_F43120_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43120_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F43135_0_0|CSTM-ALL|CSTM-00|2020|PDM|820.00|99|0.00|HEAD INJURY REHABILITATION
20|FH_F43139_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43147_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43154_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F43156_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|AMBULATORY SURGERY
20|FH_F43156_0_0|SrvcGrp|12834|2022|PDM|280.00|99|0.00|EMERGENCY ROOM
20|FH_F43156_0_0|SrvcGrp|675|2022|PDM|800.00|99|0.00|PEDIATRIC INPATIENT SVCS
20|FH_F43164_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F43164_0_0|CSTM-ALL|CSTM-00|2020|PDM|464.00|99|0.00|ACUTE PSYCH
20|FH_F43164_0_0|CSTM-ALL|CSTM-00|2020|PDM|773.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43164_0_0|SrvcGrp|37007|2022|PDM|876.00|99|0.00|VENTILATOR DEPENDENT CARE
20|FH_F43167_0_0|CSTM-ALL|CSTM-00|2020|PDM|125.00|99|0.00|CD INTENSIVE OUTPATIENT SVCS
20|FH_F43167_0_0|SrvcGrp|108568|2022|PDM|525.00|99|0.00|CHILD & ADOLESCENT PSYCH
20|FH_F43169_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F43169_0_0|SrvcGrp|12403|2022|PDM|580.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F43169_0_0|SrvcGrp|22954|2022|PDM|132.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F43169_0_0|SrvcGrp|26001|2022|PDM|141.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F43169_0_0|SrvcGrp|37016|2022|PDM|60.00|99|0.00|PT/OT/ST
20|FH_F43171_0_0|CSTM-ALL|CSTM-00|2020|PDM|100.00|99|0.00|CD SVCS (ADULT)
20|FH_F43192_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS
20|FH_F43199_0_0|SrvcGrp|12157|2022|PDM|131.25|99|0.00|RN VISIT
20|FH_F43199_0_0|SrvcGrp|12401|2022|PDM|105.00|99|0.00|RN VISIT
20|FH_F43236_0_0|CSTM-ALL|CSTM-00|2020|PDM|2600.00|99|0.00|MS DRG 765-766 C-SECTION
20|FH_F43236_0_0|SrvcGrp|40820|2022|PDM|1150.00|99|0.00|ICU/CCU
20|FH_F43237_0_0|CSTM-ALL|CSTM-00|2020|PDM|2315.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43237_0_0|SrvcGrp|40820|2022|PDM|1400.00|99|0.00|ICU/CCU
20|FH_F43244_0_0|SrvcGrp|31931|2022|PDM|1979.00|99|0.00|SKILLED NURSING CARE
20|FH_F43246_0_0|CSTM-ALL|CSTM-00|2020|PDM|820.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43246_0_0|SrvcGrp|40820|2022|PDM|1120.00|99|0.00|ICU/CCU
20|FH_F43249_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.54|99|0.00|CD SVCS (ADULT)
20|FH_F43249_0_0|CSTM-ALL|CSTM-00|2020|PDM|2888.00|99|0.00|CV SERVICES (MS DRG)
20|FH_F43260_0_0|CSTM-ALL|CSTM-00|2020|PDM|110.00|99|0.00|CD INTENSIVE OUTPATIENT SVCS
20|FH_F43260_0_0|CSTM-ALL|CSTM-00|2020|PDM|110.00|99|0.00|INTENSIVE PSYCH SVCS
20|FH_F43260_0_0|CSTM-ALL|CSTM-00|2020|PDM|325.00|99|0.00|ADOLESCENT RESIDENTIAL TREATMENT
20|FH_F43274_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F43293_0_0|SrvcGrp|31134|2022|PDM|950.00|99|0.00|SURGICAL - ADULT/PEDIATRIC
20|FH_F43294_0_0|SrvcGrp|3029|2022|PDM|440.00|99|0.00|NEWBORN NURSERY
20|FH_F43295_0_0|CSTM-ALL|CSTM-00|2020|PDM|929.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43295_0_0|SrvcGrp|360|2022|PDM|1499.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F43296_0_0|CSTM-ALL|CSTM-00|2020|PDM|1675.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43296_0_0|CSTM-ALL|CSTM-00|2020|PDM|2310.00|99|0.00|MS DRG 765-766 C-SECTION
20|FH_F43296_0_0|SrvcGrp|26228|2022|PCT|0.50|99|0.00|DME/ORTHOTICS/PROSTHETICS/IMPLANTS
20|FH_F43330_0_0|CSTM-ALL|CSTM-00|2020|PDM|26.00|99|0.00|NURSING CARE MOD TE
20|FH_F43330_0_0|SrvcGrp|11069|2022|PDM|90.00|99|0.00|OT SVCS
20|FH_F43330_0_0|SrvcGrp|11072|2022|PDM|100.00|99|0.00|SPEECH THERAPY SVCS
20|FH_F43330_0_0|SrvcGrp|11073|2022|PDM|100.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F43330_0_0|SrvcGrp|11074|2022|PDM|70.00|99|0.00|NURSING CARE
20|FH_F43330_0_0|SrvcGrp|11796|2022|PDM|65.00|99|0.00|DIETICIAN
20|FH_F83472_0_0|CSTM-ALL|CSTM-00|2020|PDM|756.22|99|0.00|AEG 5  (NO REV)
20|FH_F83472_0_0|CSTM-ALL|CSTM-00|2020|PDM|870.48|99|0.00|AEG 6 (NO REV)
20|FH_F83475_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.00|99|0.00|GENERAL ACUTE CARE
20|FH_F83514_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.20|99|0.00|GENERAL ACUTE CARE
20|FH_F83534_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F83621_0_0|CSTM-ALL|CSTM-00|2020|PDM|2796.00|99|0.00|AEG 4 (NO REV)
20|FH_F83621_0_0|CSTM-ALL|CSTM-00|2020|PDM|2802.00|99|0.00|AEG 7 (NO REV)
20|FH_F83635_0_0|CSTM-ALL|CSTM-00|2020|PCT|91.60|99|0.00|GENERAL ACUTE CARE
20|FH_F83672_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F83754_0_0|SrvcGrp|107733|2022|PDM|3940.00|99|0.00|CESAREAN SECTION
20|FH_F83754_0_0|SrvcGrp|16|2022|PDM|2067.00|99|0.00|ACUTE REHABILITATION
20|FH_F83754_0_0|SrvcGrp|16392|2022|PCT|0.86|99|0.00|AMBULANCE
20|FH_F83754_0_0|SrvcGrp|17378|2022|PCT|0.86|99|0.00|CAPD TRAINING
20|FH_F83754_0_0|SrvcGrp|17379|2022|PCT|0.86|99|0.00|CCPD TRAINING
20|FH_F83754_0_0|SrvcGrp|20077|2022|PCT|0.81|99|0.00|MS DRG 226-227 ONLY CARDIAC DEFIBRILLATOR
20|FH_F83754_0_0|SrvcGrp|21354|2022|PCT|0.81|99|0.00|MS DRG 250-251 ONLY
20|FH_F83754_0_0|SrvcGrp|21818|2022|PDM|20673.00|99|0.00|DIAGNOSTIC CARDIAC CATH
20|FH_F83754_0_0|SrvcGrp|22811|2022|PCT|0.86|99|0.00|TRAUMA CARE
20|FH_F83754_0_0|SrvcGrp|3224|2022|PCT|0.86|99|0.00|EMERGENCY ROOM SVCS
20|FH_F83754_0_0|SrvcGrp|38980|2022|PCT|0.81|99|0.00|MSDRG 246-249 ONLY
20|FH_F83754_0_0|SrvcGrp|4109|2022|PDM|1940.00|99|0.00|ACUTE PSYCH
20|FH_F83754_0_0|SrvcGrp|8950|2022|PDM|5429.00|99|0.00|INTERMEDIATE ICU/CCU
20|FH_F83792_0_0|SrvcGrp|73485|2022|PDM|1837.00|99|0.00|AETNA REHAB
20|FH_F83792_0_0|SrvcGrp|73601|2022|PDM|1837.00|99|0.00|AETNA INTERMEDIATE ICU/CCU
20|FH_F83792_0_0|SrvcGrp|73659|2022|PDM|1837.00|99|0.00|AETNA MED & SURG SVCS
20|FH_F83792_0_0|SrvcGrp|73806|2022|PDM|735.00|99|0.00|AETNA ER
20|FH_F83792_0_0|SrvcGrp|74585|2022|PCT|0.68|99|0.00|AETNA OP IMPLANTS
20|FH_F83792_0_0|SrvcGrp|78443|2022|PDM|2730.00|99|0.00|AETNA MATERNITY CARE (NORMAL DELIVERY)
20|FH_F83799_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F83853_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.80|99|0.00|GENERAL ACUTE CARE
20|FH_F83853_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.80|99|0.00|OP SVCS
20|FH_F83931_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F83931_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F83937_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE
20|FH_F83951_0_0|CSTM-ALL|CSTM-00|2020|PCT|58.00|99|0.00|GENERAL ACUTE CARE
20|FH_F84015_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F84057_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F84159_0_0|CSTM-ALL|CSTM-00|2020|PCT|41.80|99|0.00|OP SVCS
20|FH_F84175_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F84215_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F84215_0_0|SrvcGrp|72992|2022|PDM|546.00|99|0.00|AEG 2
20|FH_F84215_0_0|SrvcGrp|73000|2022|PDM|1005.00|99|0.00|AEG 6
20|FH_F84215_0_0|SrvcGrp|73002|2022|PDM|1233.00|99|0.00|AEG 7
20|FH_F84215_0_0|SrvcGrp|73008|2022|PDM|651.00|99|0.00|AEG 10
20|FH_F84215_0_0|SrvcGrp|82570|2022|PDM|961.00|99|0.00|REVISION EYELID/EXCESS SKIN
20|FH_F84215_0_0|SrvcGrp|82572|2022|PDM|961.00|99|0.00|CYSTOSCOPY/CYSTOURETHROSCOPY
20|FH_F84413_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F84413_0_0|SrvcGrp|26470|2022|PDM|150.00|99|0.00|SELF DIALYSIS TRAINING CAPD
20|FH_F84433_0_0|SrvcGrp|27968|2022|PDM|35.01|99|0.00|SKILLED NURSING LPN
20|FH_F84433_0_0|SrvcGrp|44884|2022|PDM|93.36|99|0.00|PT SVCS INITIAL EVAL 97001 VISIT LEVEL
20|FH_F84433_0_0|SrvcGrp|46605|2022|PDM|141.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES
20|FH_F84433_0_0|SrvcGrp|48396|2022|PDM|116.00|99|0.00|OT SERVICES
20|FH_F84433_0_0|SrvcGrp|48631|2022|PDM|93.36|99|0.00|OCCUPATIONAL THERAPY SVCS RE-EVAL
20|FH_F84433_0_0|SrvcGrp|52803|2022|PDM|93.36|99|0.00|OT SVCS INITIAL EVAL 97003 VISIT LEVEL
20|FH_F84446_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F84446_0_0|CSTM-ALL|CSTM-00|2020|PCT|41.00|99|0.00|OP SVCS
20|FH_F84454_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|GENERAL ACUTE CARE
20|FH_F84532_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F84532_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F84532_0_0|SrvcGrp|11663|2022|PCT|0.31|99|0.00|IMPLANTS
20|FH_F84532_0_0|SrvcGrp|14614|2022|PDM|6717.00|99|0.00|LITHOTRIPSY
20|FH_F84532_0_0|SrvcGrp|705|2022|PCT|0.31|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F84532_0_0|SrvcGrp|72992|2022|PDM|1240.00|99|0.00|AEG 2
20|FH_F84532_0_0|SrvcGrp|72998|2022|PDM|1986.00|99|0.00|AEG 5
20|FH_F84532_0_0|SrvcGrp|73008|2022|PCT|0.68|99|0.00|AEG 10
20|FH_F84532_0_0|SrvcGrp|82808|2022|PDM|9572.00|99|0.00|CARDIO CARVEOUTS
20|FH_F84535_0_0|CSTM-ALL|CSTM-00|2020|PCT|58.00|99|0.00|GENERAL ACUTE CARE
20|FH_F84591_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|GENERAL ACUTE CARE
20|FH_F84712_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.71|99|0.00|OP SVCS
20|FH_F84712_0_0|CSTM-ALL|CSTM-00|2020|PDM|2082.00|99|0.00|GENERAL ACUTE CARE
20|FH_F84712_0_0|SrvcGrp|73008|2022|PDM|3532.00|99|0.00|AEG 10
20|FH_F84712_0_0|SrvcGrp|73602|2022|PDM|630.00|99|0.00|AETNA NEWBORN NURSERY I
20|FH_F84712_0_0|SrvcGrp|73604|2022|PDM|662.00|99|0.00|AETNA DETOXIFICATION
20|FH_F84712_0_0|SrvcGrp|78647|2022|PDM|38.00|99|0.00|AETNA COMPUTER AIDED DETECTION CPT 77051
20|FH_F84712_0_0|SrvcGrp|79299|2022|PDM|128.00|99|0.00|AETNA X-RAY (CPT 77056)
20|FH_F84712_0_0|SrvcGrp|81406|2022|PDM|7.00|99|0.00|URINALYSIS
20|FH_F84712_0_0|SrvcGrp|82747|2022|PDM|52.00|99|0.00|THROMBOPLASTIN TIME PARTIAL
20|FH_F84712_0_0|SrvcGrp|82750|2022|PDM|26.00|99|0.00|CHORIONIC GONADOTROPIN ASSAY
20|FH_F84712_0_0|SrvcGrp|82761|2022|PDM|32.00|99|0.00|AUTOMATED WITHOUT MICRO
20|FH_F84712_0_0|SrvcGrp|82764|2022|PDM|52.00|99|0.00|HEPATIC FUNCTION PANEL
20|FH_F84712_0_0|SrvcGrp|82803|2022|PDM|3911.00|99|0.00|IP CARDIAC CATHETERIZATION
20|FH_F84712_0_0|SrvcGrp|87040|2022|PDM|5109.00|99|0.00|AETNA MATERNITY CARE (C-SECTION)
20|FH_F84712_0_0|SrvcGrp|87967|2022|PDM|8842.00|99|0.00|GASTRIC SLEEVE
20|FH_F43330_0_0|SrvcGrp|15520|2022|PDM|30.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY
20|FH_F43330_0_0|SrvcGrp|26694|2022|PDM|80.00|99|0.00|INITIAL SPECIALTY NURSING S9123 MOD TG
20|FH_F43330_0_0|SrvcGrp|28284|2022|PDM|75.00|99|0.00|SUBSEQUENT  SPECIALTY NURSING S9123 MOD TF
20|FH_F43330_0_0|SrvcGrp|28622|2022|PDM|40.00|99|0.00|NURSING CARE
20|FH_F43352_0_0|CSTM-ALL|CSTM-00|2020|PDM|1590.00|99|0.00|WELLPATH PROPIETARY ASC VII
20|FH_F43352_0_0|CSTM-ALL|CSTM-00|2020|PDM|2137.00|99|0.00|WELLPATH PROPRIETARY ASC IX
20|FH_F43352_0_0|CSTM-ALL|CSTM-00|2020|PDM|713.00|99|0.00|WELLPATH PROPRIERARY ASC II 731315
20|FH_F43411_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRA)
20|FH_F43411_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F43411_0_0|CSTM-ALL|CSTM-00|2020|PDM|910.00|99|0.00|ACUTE PSYCH
20|FH_F43411_0_0|SrvcGrp|11259|2022|PCT|0.60|99|0.00|DRUGS
20|FH_F43411_0_0|SrvcGrp|12290|2022|PDM|1225.00|99|0.00|DETOXIFICATION
20|FH_F43411_0_0|SrvcGrp|360|2022|PDM|2385.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F43411_0_0|SrvcGrp|40820|2022|PDM|2475.00|99|0.00|ICU/CCU
20|FH_F43411_0_0|SrvcGrp|9539|2022|PDM|725.00|99|0.00|SUBACUTE CARE
20|FH_F43412_0_0|CSTM-ALL|CSTM-00|2020|PDM|200.00|99|0.00|ADULT REHABILITATION HALF DAY
20|FH_F43412_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|PARTIAL HOSPITAL
20|FH_F43417_0_0|SrvcGrp|40820|2022|PDM|1280.00|99|0.00|ICU/CCU
20|FH_F43418_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F43418_0_0|CSTM-ALL|CSTM-00|2020|PDM|2334.00|99|0.00|MS DRG 765-766 C-SECTION
20|FH_F43418_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43421_0_0|CSTM-ALL|CSTM-00|2020|PDM|132.00|99|0.00|ADULT CD OUTPATIENT SVCS
20|FH_F43421_0_0|CSTM-ALL|CSTM-00|2020|PDM|276.00|99|0.00|ADULT PSYCH DAY TREATMENT
20|FH_F43436_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43450_0_0|CSTM-ALL|CSTM-00|2020|PDM|536.00|99|0.00|ACUTE PSYCH
20|FH_F43450_0_0|CSTM-ALL|CSTM-00|2020|PDM|536.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F43485_0_0|CSTM-ALL|CSTM-00|2020|PCT|57.00|99|0.00|OP SVCS
20|FH_F43503_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|99|0.00|MS DRG 216-227, 231-236 CV SURGERY
20|FH_F43503_0_0|SrvcGrp|13551|2022|PDM|407.00|99|0.00|NEWBORN NURSERY
20|FH_F43503_0_0|SrvcGrp|38|2022|PDM|2369.00|99|0.00|NORMAL DELIVERY
20|FH_F43536_0_0|SrvcGrp|13551|2022|PDM|436.00|99|0.00|NEWBORN NURSERY
20|FH_F43575_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F43612_0_0|SrvcGrp|1306|2022|PDM|250.00|99|0.00|OP PSYCH PARTIAL HOSP
20|FH_F43663_0_0|CSTM-ALL|CSTM-00|2020|PDM|729.00|99|0.00|ACUTE PSYCH
20|FH_F43663_0_0|SrvcGrp|10951|2022|PDM|293.00|99|0.00|PARTIAL HOSPITALIZATION PSYCH/CD
20|FH_F43663_0_0|SrvcGrp|14165|2022|PDM|293.00|99|0.00|PARTIAL HOSP PSYCH/CD
20|FH_F43663_0_0|SrvcGrp|3577|2022|PDM|221.00|99|0.00|PARTIAL HOSPITALIZATION
20|FH_F43665_0_0|CSTM-ALL|CSTM-00|2020|PDM|892.00|99|0.00|BRAIN INJURY REHAB
20|FH_F43665_0_0|SrvcGrp|37516|2022|PDM|331.00|99|0.00|VENTILATOR MANAGEMENT
20|FH_F43679_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F43679_0_0|CSTM-ALL|CSTM-00|2020|PDM|625.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43693_0_0|SrvcGrp|12682|2022|PDM|340.00|99|0.00|GROUP THERAPY
20|FH_F43693_0_0|SrvcGrp|1306|2022|PDM|257.00|99|0.00|OP PSYCH PARTIAL HOSP
20|FH_F43694_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE
20|FH_F43694_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F43694_0_0|SrvcGrp|3577|2022|PDM|300.00|99|0.00|PARTIAL HOSPITALIZATION
20|FH_F43694_0_0|SrvcGrp|37542|2022|PDM|500.00|99|0.00|RESIDENTIAL TREATMENT
20|FH_F43696_0_0|CSTM-ALL|CSTM-00|2020|PDM|2052.00|99|0.00|ACUTE PSYCH
20|FH_F43696_0_0|SrvcGrp|13811|2022|PDM|512.00|99|0.00|PSYCH PARTIAL HOSP
20|FH_F43696_0_0|SrvcGrp|6|2022|PCT|0.80|99|0.00|OP SURGERY
20|FH_F43717_0_0|SrvcGrp|30941|2022|PDM|280.00|99|0.00|NEWBORN NURSERY
20|FH_F43717_0_0|SrvcGrp|350|2022|PDM|918.00|99|0.00|SURGICAL CARE
20|FH_F43717_0_0|SrvcGrp|97|2022|PDM|3010.00|99|0.00|C-SECTION
20|FH_F43719_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F43719_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|ACUTE PSYCH
20|FH_F43774_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F43774_0_0|SrvcGrp|8962|2022|PDM|125.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F43774_0_0|SrvcGrp|9832|2022|PDM|115.00|99|0.00|ST SVCS
20|FH_F43779_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F43779_0_0|CSTM-ALL|CSTM-00|2020|PDM|890.00|99|0.00|ACUTE PSYCH
20|FH_F43779_0_0|SrvcGrp|360|2022|PDM|1128.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F43779_0_0|SrvcGrp|361|2022|PDM|2887.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F43779_0_0|SrvcGrp|411|2022|PCT|0.75|99|0.00|OP CARDIAC CATH
20|FH_F43779_0_0|SrvcGrp|413|2022|PCT|0.80|99|0.00|TRANSPLANT SVCS
20|FH_F43779_0_0|SrvcGrp|941|2022|PDM|2887.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F43779_0_0|SrvcGrp|9863|2022|PDM|2887.00|99|0.00|INTENSIVE CARE/CORONARY CARE UNIT
20|FH_F43786_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43793_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43800_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F43800_0_0|CSTM-ALL|CSTM-00|2020|PDM|961.00|99|0.00|SPINAL CORD REHABILITATION
20|FH_F43801_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F43832_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F43832_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F43832_0_0|SrvcGrp|10410|2022|PDM|74.00|99|0.00|SKILLED NURSING CARE
20|FH_F43832_0_0|SrvcGrp|42824|2022|PDM|152.00|99|0.00|SKILLED NURSING VISIT
20|FH_F43858_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE
20|FH_F43858_0_0|CSTM-ALL|CSTM-00|2020|PDM|25.00|99|0.00|SKILLED LPN HOURLY
20|FH_F43858_0_0|SrvcGrp|30958|2022|PDM|65.00|99|0.00|SKILLED LPN VISIT
20|FH_F43858_0_0|SrvcGrp|35468|2022|PDM|75.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F43859_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE
20|FH_F43859_0_0|SrvcGrp|30955|2022|PDM|115.00|99|0.00|SKILLED RN VISIT
20|FH_F43859_0_0|SrvcGrp|37403|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE
20|FH_F43860_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F43860_0_0|SrvcGrp|37403|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE
20|FH_F43860_0_0|SrvcGrp|37405|2022|PDM|90.00|99|0.00|OT SVCS
20|FH_F43861_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F43861_0_0|SrvcGrp|37403|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE
20|FH_F43861_0_0|SrvcGrp|37404|2022|PDM|90.00|99|0.00|PT SVCS
20|FH_F43862_0_0|CSTM-ALL|CSTM-00|2020|PDM|25.00|99|0.00|SKILLED LPN HOURLY
20|FH_F43862_0_0|SrvcGrp|37403|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE
20|FH_F43862_0_0|SrvcGrp|37405|2022|PDM|90.00|99|0.00|OT SVCS
20|FH_F43863_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE
20|FH_F43863_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F43863_0_0|CSTM-ALL|CSTM-00|2020|PDM|25.00|99|0.00|SKILLED LPN HOURLY
20|FH_F43863_0_0|SrvcGrp|27725|2022|PDM|40.00|99|0.00|SKILLED RN HOURLY
20|FH_F43863_0_0|SrvcGrp|35468|2022|PDM|75.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F43865_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE
20|FH_F43865_0_0|SrvcGrp|35468|2022|PDM|75.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F43867_0_0|CSTM-ALL|CSTM-00|2020|PDM|25.00|99|0.00|SKILLED LPN HOURLY
20|FH_F43867_0_0|SrvcGrp|37404|2022|PDM|90.00|99|0.00|PT SVCS
20|FH_F43867_0_0|SrvcGrp|37405|2022|PDM|90.00|99|0.00|OT SVCS
20|FH_F43872_0_0|SrvcGrp|474|2022|PDM|248.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F43895_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE
20|FH_F43913_0_0|SrvcGrp|16141|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F43913_0_0|SrvcGrp|37122|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F43953_0_0|SrvcGrp|10675|2022|PDM|4586.00|99|0.00|ICU/CCU
20|FH_F43953_0_0|SrvcGrp|361|2022|PDM|2354.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F43953_0_0|SrvcGrp|37990|2022|PDM|782.00|99|0.00|NEWBORN - WELL BABY
20|FH_F43953_0_0|SrvcGrp|9875|2022|PDM|3106.00|99|0.00|ACUTE IP MEDICAL SERVICES
20|FH_F43953_0_0|SrvcGrp|9889|2022|PDM|782.00|99|0.00|NICU LEVEL I & II
20|FH_F43974_0_0|CSTM-ALL|CSTM-00|2020|PDM|65.00|99|0.00|OP SVCS
20|FH_F44020_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F44023_0_0|SrvcGrp|3224|2022|PCT|0.71|99|0.00|EMERGENCY ROOM SVCS
20|FH_F44025_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F44025_0_0|CSTM-ALL|CSTM-00|2020|PDM|140.00|99|0.00|CD INTENSIVE OUTPATIENT SVCS
20|FH_F44048_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|ADOLESCENT RESIDENTIAL TREATMENT
20|FH_F44061_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44061_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS
20|FH_F44072_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.00|99|0.00|OP SVCS
20|FH_F44075_0_0|CSTM-ALL|CSTM-00|2020|PDM|1153.90|99|0.00|ASPG VII
20|FH_F44075_0_0|CSTM-ALL|CSTM-00|2020|PDM|386.10|99|0.00|ASPG I
20|FH_F44093_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44093_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F44097_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F44113_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F44113_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|ACUTE IP MED SVCS
20|FH_F44113_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|MS DRG 765-766 ONLY C-SECTION
20|FH_F44113_0_0|SrvcGrp|12119|2022|PCT|0.90|99|0.00|EMERGENCY ROOM
20|FH_F44113_0_0|SrvcGrp|12146|2022|PDM|1800.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F44113_0_0|SrvcGrp|12299|2022|PCT|0.60|99|0.00|PROSTHETICS/IMPLANTS/DEVICES
20|FH_F44113_0_0|SrvcGrp|20534|2022|PDM|600.00|99|0.00|SKILLED NURSING
20|FH_F44114_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44132_0_0|SrvcGrp|33164|2022|PDM|325.00|99|0.00|SKILLED NURSING - LEVEL I
20|FH_F44132_0_0|SrvcGrp|33165|2022|PDM|400.00|99|0.00|SKILLED NURSING - LEVEL II
20|FH_F44134_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44134_0_0|CSTM-ALL|CSTM-00|2020|PDM|457.30|99|0.00|COVENTRY ENHANCED GROUPER 1
20|FH_F44134_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.37|99|0.00|COVENTRY ENHANCED DEFAULT 10021-69990
20|FH_F44177_0_0|SrvcGrp|30160|2022|PDM|4355.00|99|0.00|MS DRG 216-238, 242-244  ONLY CV SURGERY
20|FH_F44177_0_0|SrvcGrp|3066|2022|PCT|0.55|99|0.00|HIGH-COST DRUGS
20|FH_F44194_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44195_0_0|CSTM-ALL|CSTM-00|2020|PDM|365.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44198_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F44198_0_0|CSTM-ALL|CSTM-00|2020|PDM|5.00|99|0.00|ADDITIONAL MILEAGE
20|FH_F44198_0_0|SrvcGrp|13681|2022|PDM|289.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT
20|FH_F44218_0_0|SrvcGrp|12591|2022|PDM|160.00|99|0.00|CD FULL DAY
20|FH_F44218_0_0|SrvcGrp|14210|2022|PDM|225.00|99|0.00|PSYCH INTENSIVE OUTPATIENT
20|FH_F44218_0_0|SrvcGrp|23587|2022|PDM|620.00|99|0.00|RESIDENTIAL TREATMENT - PSYCH
20|FH_F44225_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE
20|FH_F44241_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44241_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|RADIOLOGY - C-ARM
20|FH_F44241_0_0|CSTM-ALL|CSTM-00|2020|PDM|2034.00|99|0.00|ASPG IV
20|FH_F44241_0_0|CSTM-ALL|CSTM-00|2020|PDM|2075.00|99|0.00|ASPG V
20|FH_F44241_0_0|CSTM-ALL|CSTM-00|2020|PDM|4641.00|99|0.00|HYSTEROSCOPY
20|FH_F44241_0_0|SrvcGrp|16289|2022|PDM|3875.00|99|0.00|CARPAL TUNNEL RELEASE
20|FH_F44255_0_0|SrvcGrp|110|2022|PDM|530.00|99|0.00|CD - REHABILITATION
20|FH_F44255_0_0|SrvcGrp|13811|2022|PDM|265.00|99|0.00|PSYCH PARTIAL HOSP
20|FH_F44257_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F44258_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44258_0_0|CSTM-ALL|CSTM-00|2020|PDM|320.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F44272_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44278_0_0|CSTM-ALL|CSTM-00|2020|PDM|1575.00|99|0.00|ACUTE IP MED SVCS
20|FH_F44278_0_0|CSTM-ALL|CSTM-00|2020|PDM|1575.00|99|0.00|PEDIATRIC IP SVCS
20|FH_F44278_0_0|SrvcGrp|20534|2022|PCT|0.85|99|0.00|SKILLED NURSING
20|FH_F44278_0_0|SrvcGrp|29817|2022|PDM|3150.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F44279_0_0|CSTM-ALL|CSTM-00|2020|PDM|200.00|99|0.00|DIAGNOSTIC TESTING
20|FH_F44279_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|GENERAL ACUTE CARE
20|FH_F84712_0_0|SrvcGrp|87968|2022|PDM|10316.00|99|0.00|GASTRIC SLEEVE W/ HERINA REPAIR
20|FH_F84712_0_0|SrvcGrp|88142|2022|PDM|220.00|99|0.00|AETNA ULTRASOUND BREAST(S)
20|FH_F84755_0_0|SrvcGrp|471|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F84755_0_0|SrvcGrp|472|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F84755_0_0|SrvcGrp|75545|2022|PDM|320.00|99|0.00|SUB-ACUTE - LEVEL I AND II
20|FH_F84778_0_0|SrvcGrp|72996|2022|PDM|1890.00|99|0.00|AEG 4
20|FH_F84778_0_0|SrvcGrp|73002|2022|PDM|1927.00|99|0.00|AEG 7
20|FH_F84778_0_0|SrvcGrp|73004|2022|PDM|1995.00|99|0.00|AEG 8
20|FH_F84778_0_0|SrvcGrp|78680|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F84855_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|COVENTRY ENHANCED GROUPER 10
20|FH_F84855_0_0|CSTM-ALL|CSTM-00|2020|PDM|1072.00|99|0.00|COVENTRY ENHANCED GROUPER 3
20|FH_F84855_0_0|CSTM-ALL|CSTM-00|2020|PDM|1340.00|99|0.00|COVENTRY ENHANCED GROUPER 4
20|FH_F84855_0_0|CSTM-ALL|CSTM-00|2020|PDM|1527.00|99|0.00|COVENTRY ENHANCED GROUPER 5
20|FH_F84855_0_0|CSTM-ALL|CSTM-00|2020|PDM|976.00|99|0.00|COVENTRY ENHANCED GROUPER 2
20|FH_F84893_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F84911_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F84911_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F84912_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F84912_0_0|SrvcGrp|13640|2022|PDM|68.27|99|0.00|CPT 99202
20|FH_F84912_0_0|SrvcGrp|83177|2022|PDM|1800.00|99|0.00|DME
20|FH_F85001_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F85001_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F85002_0_0|CSTM-ALL|CSTM-00|2020|PCT|36500.00|99|0.00|TIMELY FILING
20|FH_F85002_0_0|CSTM-ALL|CSTM-00|2020|PCT|40.00|99|0.00|GENERAL ACUTE CARE
20|FH_F85002_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|IMPLANTS
20|FH_F85012_0_0|SrvcGrp|13927|2022|PCT|0.00|99|0.00|DAY HOSPITAL FULL DAY
20|FH_F85012_0_0|SrvcGrp|16|2022|PDM|945.00|99|0.00|ACUTE REHABILITATION
20|FH_F85012_0_0|SrvcGrp|79720|2022|PDM|1155.00|99|0.00|ACUTE REHAB II
20|FH_F85039_0_0|SrvcGrp|75481|2022|PDM|491.00|99|0.00|AEG 2
20|FH_F85039_0_0|SrvcGrp|75495|2022|PDM|1473.00|99|0.00|AEG 9
20|FH_F85055_0_0|SrvcGrp|72994|2022|PDM|780.00|99|0.00|AEG 3
20|FH_F85055_0_0|SrvcGrp|72998|2022|PDM|1500.00|99|0.00|AEG 5
20|FH_F85091_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F85115_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F85115_0_0|SrvcGrp|76421|2022|PDM|393.75|99|0.00|HEMODIALYSIS
20|FH_F85132_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F85211_0_0|SrvcGrp|49544|2022|PDM|11000.00|99|0.00|ARTHROPLASTY
20|FH_F85211_0_0|SrvcGrp|83625|2022|PDM|11000.00|99|0.00|RECONSTRUCT SHOULDER JOINT
20|FH_F85257_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F85257_0_0|SrvcGrp|2738|2022|PCT|0.55|99|0.00|IMPLANTS
20|FH_F85257_0_0|SrvcGrp|83544|2022|PCT|0.55|99|0.00|THERAPEUTIC RADIOPHARMACEUTICALS
20|FH_F85257_0_0|SrvcGrp|997|2022|PCT|0.55|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F85291_0_0|SrvcGrp|471|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F85295_0_0|SrvcGrp|75937|2022|PCT|0.00|99|0.00|AETNA CONTRAST AGENTS
20|FH_F85314_0_0|CSTM-ALL|CSTM-00|2020|PDM|640.00|99|0.00|AETNA SURGERY DEFAULT WITHOUT GROUPER 1 & 2
20|FH_F85314_0_0|SrvcGrp|64744|2022|PDM|409.00|99|0.00|CPT 45331
20|FH_F85314_0_0|SrvcGrp|83898|2022|PDM|640.00|99|0.00|AETNA HIGH RISK IND
20|FH_F85393_0_0|SrvcGrp|42975|2022|PDM|75.00|99|0.00|PHYSICAL THERAPIST
20|FH_F85393_0_0|SrvcGrp|42976|2022|PDM|75.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F85393_0_0|SrvcGrp|88621|2022|PDM|70.00|99|0.00|SKILLED NURSING LPN
20|FH_F85475_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F85492_0_0|SrvcGrp|22528|2022|PCT|0.00|99|0.00|DAY HOSPITAL FULL DAY
20|FH_F85492_0_0|SrvcGrp|9861|2022|PDM|1736.00|99|0.00|ACUTE REHABILITATION
20|FH_F85655_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F85674_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F85674_0_0|CSTM-ALL|CSTM-00|2020|PDM|272.02|99|0.00|AETNA SLEEP STUDIES
20|FH_F85674_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.58|99|0.00|AETNA SLEEP STUDY CPT 95805
20|FH_F85674_0_0|CSTM-ALL|CSTM-00|2020|PDM|487.96|99|0.00|AETNA POLYSOMNOGRAPHY
20|FH_F85674_0_0|CSTM-ALL|CSTM-00|2020|PDM|533.51|99|0.00|AETNA SLEEP STUDY CPT 95808
20|FH_F85674_0_0|SrvcGrp|83880|2022|PDM|52.17|99|0.00|AETNA SLEEP STUDY (MOD 26)
20|FH_F85674_0_0|SrvcGrp|83884|2022|PDM|110.63|99|0.00|AETNA POLYSOMNOGRAPHY (MOD 26)
20|FH_F85691_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|OP SVCS
20|FH_F85713_0_0|SrvcGrp|25688|2022|PDM|421.00|99|0.00|HOME HEMODIALYSIS
20|FH_F85753_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F85753_0_0|SrvcGrp|80284|2022|PDM|131.17|99|0.00|HOSPICE ROUTINE HOME CARE
20|FH_F85757_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F85757_0_0|SrvcGrp|73656|2022|PDM|480.00|99|0.00|AETNA HOSPICE SVCS
20|FH_F85757_0_0|SrvcGrp|82222|2022|PDM|105.00|99|0.00|HOSPICE CARE
20|FH_F85772_0_0|CSTM-ALL|CSTM-00|2020|PDM|1008.00|99|0.00|AEG 3 (NO REV)
20|FH_F85772_0_0|CSTM-ALL|CSTM-00|2020|PDM|1105.00|99|0.00|AEG 4 (NO REV)
20|FH_F85772_0_0|CSTM-ALL|CSTM-00|2020|PDM|1745.00|99|0.00|AEG 7 (NO REV)
20|FH_F85772_0_0|SrvcGrp|84182|2022|PDM|1639.00|99|0.00|AETNA REMOVAL OF BREAST CAPSULE
20|FH_F85772_0_0|SrvcGrp|84184|2022|PDM|1719.00|99|0.00|AETNA REMOVAL OF BREAST IMPLANT
20|FH_F85911_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.50|99|0.00|ACUTE REHAB II
20|FH_F86011_0_0|CSTM-ALL|CSTM-00|2020|PCT|86.50|99|0.00|GENERAL ACUTE CARE
20|FH_F86098_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F86137_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F86252_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F86293_0_0|CSTM-ALL|CSTM-00|2020|PDM|1312.00|99|0.00|AEG 3 (NO REV)
20|FH_F86293_0_0|CSTM-ALL|CSTM-00|2020|PDM|2684.00|99|0.00|AEG 9 (NO REV)
20|FH_F86293_0_0|SrvcGrp|26273|2022|PDM|2714.00|99|0.00|CPT 29880
20|FH_F44279_0_0|SrvcGrp|3378|2022|PDM|600.00|99|0.00|OBSERVATION SVCS
20|FH_F44299_0_0|SrvcGrp|10542|2022|PDM|65.00|99|0.00|OCCUPATIONAL THERAPY SVCS
20|FH_F44312_0_0|CSTM-ALL|CSTM-00|2020|PDM|575.00|99|0.00|CHILD PSYCHIATRIC
20|FH_F44314_0_0|SrvcGrp|33164|2022|PDM|275.00|99|0.00|SKILLED NURSING - LEVEL I
20|FH_F44341_0_0|CSTM-ALL|CSTM-00|2020|PDM|362.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44341_0_0|SrvcGrp|109|2022|PDM|425.00|99|0.00|CD - DETOX
20|FH_F44342_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F44342_0_0|CSTM-ALL|CSTM-00|2020|PDM|680.00|99|0.00|ADULT PSYCHIATRIC
20|FH_F44358_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F44358_0_0|CSTM-ALL|CSTM-00|2020|PDM|275.00|99|0.00|PSYCH PARTIAL HOSPITALIZATION
20|FH_F44383_0_0|CSTM-ALL|CSTM-00|2020|PDM|259.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44396_0_0|CSTM-ALL|CSTM-00|2020|PDM|359.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44396_0_0|SrvcGrp|38797|2022|PDM|260.00|99|0.00|PSYCHIATRIC PARTIAL HOSPITALIZATION - IP
20|FH_F44414_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44435_0_0|CSTM-ALL|CSTM-00|2020|PDM|2165.00|99|0.00|AEG 5  (NO REV)
20|FH_F44435_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|RIVERVIEW ASC CARVE OUT
20|FH_F44438_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|NUCLEAR MEDICINE
20|FH_F44449_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44455_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE
20|FH_F44459_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44459_0_0|SrvcGrp|16746|2022|PDM|45.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F44459_0_0|SrvcGrp|27173|2022|PDM|45.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F44495_0_0|CSTM-ALL|CSTM-00|2020|PDM|179.00|99|0.00|MEDICAL SOCIAL WORKER VISIT
20|FH_F44495_0_0|CSTM-ALL|CSTM-00|2020|PDM|20.00|99|0.00|HOME HEALTH AIDE (ADDITIONAL HOURS)
20|FH_F44495_0_0|SrvcGrp|9828|2022|PDM|49.00|99|0.00|HOME HEALTH AIDE
20|FH_F44540_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44557_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F44582_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|ASPG IV
20|FH_F44582_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|ASPG V
20|FH_F44582_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|ASPG VIII
20|FH_F44582_0_0|CSTM-ALL|CSTM-00|2020|PDM|3800.00|99|0.00|ORTHOPEDIC SHORT STAY
20|FH_F44582_0_0|CSTM-ALL|CSTM-00|2020|PDM|9000.00|99|0.00|PACEMAKER / AICD
20|FH_F44582_0_0|SrvcGrp|13152|2022|PDM|7000.00|99|0.00|RADIO FREQUENCY ABLATION
20|FH_F44582_0_0|SrvcGrp|30218|2022|PDM|6000.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F44582_0_0|SrvcGrp|3420|2022|PCT|0.70|99|0.00|OP LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F44582_0_0|SrvcGrp|38826|2022|PCT|0.70|99|0.00|ELECTROPHYSIOLOGY STUDIES
20|FH_F44582_0_0|SrvcGrp|39123|2022|PCT|0.70|99|0.00|CARDIAC ABLATION
20|FH_F44582_0_0|SrvcGrp|9774|2022|PDM|3300.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F44584_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44638_0_0|CSTM-ALL|CSTM-00|2020|PDM|190.00|99|0.00|ADULT CD PARTIAL HOSP
20|FH_F44638_0_0|CSTM-ALL|CSTM-00|2020|PDM|595.00|99|0.00|ADULT PSYCHIATRIC
20|FH_F44638_0_0|CSTM-ALL|CSTM-00|2020|PDM|595.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44638_0_0|SrvcGrp|166|2022|PDM|590.00|99|0.00|CD (ADULT) - DETOXIFICATION
20|FH_F44660_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F44660_0_0|CSTM-ALL|CSTM-00|2020|PDM|2250.00|99|0.00|MS DRG 767-768, 774-775 NORMAL DELIVERY
20|FH_F44660_0_0|SrvcGrp|360|2022|PDM|900.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F44701_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44701_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F44701_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|ASPG IV
20|FH_F44701_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|CPT 15821 - BLEPHAROPLASTY, LOWER EYELID
20|FH_F44701_0_0|CSTM-ALL|CSTM-00|2020|PDM|913.00|99|0.00|ASPG X
20|FH_F44701_0_0|CSTM-ALL|CSTM-00|2020|PDM|968.00|99|0.00|ASPG V
20|FH_F44701_0_0|SrvcGrp|13297|2022|PCT|1.10|99|0.00|IMPLANTS
20|FH_F44701_0_0|SrvcGrp|28547|2022|PDM|1550.00|99|0.00|VITRECTOMY
20|FH_F44724_0_0|SrvcGrp|26205|2022|PDM|48.00|99|0.00|ST
20|FH_F44724_0_0|SrvcGrp|26742|2022|PDM|48.00|99|0.00|PT
20|FH_F44724_0_0|SrvcGrp|26775|2022|PDM|48.00|99|0.00|OT
20|FH_F44754_0_0|SrvcGrp|10543|2022|PDM|70.00|99|0.00|SPEECH THERAPY SVCS
20|FH_F44813_0_0|CSTM-ALL|CSTM-00|2020|PDM|430.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44952_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F44952_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F44992_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F44992_0_0|SrvcGrp|9525|2022|PDM|425.00|99|0.00|DIALYSIS
20|FH_F44992_0_0|SrvcGrp|9526|2022|PDM|425.00|99|0.00|DIALYSIS
20|FH_F45113_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F45120_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F45120_0_0|CSTM-ALL|CSTM-00|2020|PDM|612.00|99|0.00|COVENTRY ENHANCED GROUPER 2
20|FH_F45120_0_0|CSTM-ALL|CSTM-00|2020|PDM|984.00|99|0.00|COVENTRY ENHANCED GROUPER 10
20|FH_F45120_0_0|SrvcGrp|13881|2022|PCT|0.21|99|0.00|PACEMAKER DEVICE
20|FH_F45120_0_0|SrvcGrp|30456|2022|PCT|0.21|99|0.00|DRUGS
20|FH_F45120_0_0|SrvcGrp|30458|2022|PCT|0.21|99|0.00|DRUGS
20|FH_F45121_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F45132_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F45132_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F45158_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F45158_0_0|CSTM-ALL|CSTM-00|2020|PDM|60.00|99|0.00|OP SVCS
20|FH_F45176_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F45176_0_0|CSTM-ALL|CSTM-00|2020|PDM|1042.00|99|0.00|ASPG III
20|FH_F45176_0_0|CSTM-ALL|CSTM-00|2020|PDM|1288.00|99|0.00|ASPG IV
20|FH_F45176_0_0|CSTM-ALL|CSTM-00|2020|PDM|1980.00|99|0.00|ASPG VIII
20|FH_F45176_0_0|SrvcGrp|39606|2022|PDM|2400.00|99|0.00|TONSILS & ADENOIDS
20|FH_F45200_0_0|SrvcGrp|39652|2022|PDM|264.00|99|0.00|SKILLED NURSING VENT SUPPORT
20|FH_F45212_0_0|CSTM-ALL|CSTM-00|2020|PDM|1727.00|99|0.00|GENERAL ACUTE CARE
20|FH_F45220_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE
20|FH_F86293_0_0|SrvcGrp|44068|2022|PDM|1995.00|99|0.00|CPT 52332
20|FH_F86293_0_0|SrvcGrp|58671|2022|PDM|1592.00|99|0.00|ASC CARVE OUT 64721
20|FH_F86293_0_0|SrvcGrp|70749|2022|PDM|2794.00|99|0.00|CPT 29823
20|FH_F86293_0_0|SrvcGrp|84704|2022|PDM|1995.00|99|0.00|CYSTOURETHROSCOPY W/ REMOVAL OF FOREIGN BODY
20|FH_F86294_0_0|CSTM-ALL|CSTM-00|2020|PDM|1198.00|99|0.00|2006 MEDICARE ASPG VI
20|FH_F86294_0_0|CSTM-ALL|CSTM-00|2020|PDM|1420.00|99|0.00|2006 MEDICARE ASPG VIII
20|FH_F86294_0_0|CSTM-ALL|CSTM-00|2020|PDM|495.00|99|0.00|2006 MEDICARE ASPG X
20|FH_F86294_0_0|SrvcGrp|84721|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F86315_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|COVENTRY ENHANCED GROUPER 1
20|FH_F86315_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|COVENTRY ENHANCED GROUPER 7
20|FH_F86375_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F86375_0_0|SrvcGrp|65720|2022|PDM|105.00|99|0.00|RESPITE CARE
20|FH_F86377_0_0|SrvcGrp|3809|2022|PDM|531.22|99|0.00|HOSPICE CARE
20|FH_F86434_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F86434_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 1 (NO REV)
20|FH_F86435_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F86452_0_0|CSTM-ALL|CSTM-00|2020|PDM|1446.00|99|0.00|2007 MEDICARE ASPG VI
20|FH_F86552_0_0|CSTM-ALL|CSTM-00|2020|PDM|1900.00|99|0.00|AEG 7 (NO REV)
20|FH_F86552_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|AEG 2 (NO REV)
20|FH_F86552_0_0|SrvcGrp|36591|2022|PDM|26000.00|99|0.00|CPT 63685
20|FH_F86655_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F86655_0_0|CSTM-ALL|CSTM-00|2020|PDM|1750.42|99|0.00|AEG 9 (NO REV)
20|FH_F86655_0_0|CSTM-ALL|CSTM-00|2020|PDM|434.91|99|0.00|AEG 1 (NO REV)
20|FH_F86655_0_0|SrvcGrp|78878|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F86660_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F86660_0_0|CSTM-ALL|CSTM-00|2020|PDM|2140.00|99|0.00|COVENTRY ENHANCED GROUPER 10
20|FH_F86660_0_0|CSTM-ALL|CSTM-00|2020|PDM|2976.00|99|0.00|COVENTRY ENHANCED GROUPER 6
20|FH_F86717_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F86717_0_0|CSTM-ALL|CSTM-00|2020|PDM|589.94|99|0.00|AEG 10 (NO REV)
20|FH_F86717_0_0|CSTM-ALL|CSTM-00|2020|PDM|707.94|99|0.00|AEG 2 (NO REV)
20|FH_F86733_0_0|CSTM-ALL|CSTM-00|2020|PCT|67.00|99|0.00|GENERAL ACUTE CARE
20|FH_F86733_0_0|CSTM-ALL|CSTM-00|2020|PCT|67.00|99|0.00|OP SVCS
20|FH_F86752_0_0|SrvcGrp|75481|2022|PDM|587.00|99|0.00|AEG 2
20|FH_F86752_0_0|SrvcGrp|75495|2022|PDM|821.00|99|0.00|AEG 9
20|FH_F86752_0_0|SrvcGrp|75497|2022|PDM|821.00|99|0.00|AEG 10
20|FH_F86815_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F86815_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 6 (NO REV)
20|FH_F86815_0_0|CSTM-ALL|CSTM-00|2020|PDM|455.00|99|0.00|AEG 1 (NO REV)
20|FH_F86815_0_0|CSTM-ALL|CSTM-00|2020|PDM|615.00|99|0.00|AEG 2 (NO REV)
20|FH_F86815_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|AEG 10 (NO REV)
20|FH_F86836_0_0|SrvcGrp|105569|2022|PDM|4750.00|99|0.00|PRIVATE MED/SURG/GYN
20|FH_F86836_0_0|SrvcGrp|11258|2022|PCT|0.65|99|0.00|DRUGS
20|FH_F86836_0_0|SrvcGrp|11336|2022|PCT|0.65|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F86836_0_0|SrvcGrp|1259|2022|PDM|4000.00|99|0.00|INTERMEDIATE INTENSIVE CARE UNIT
20|FH_F86836_0_0|SrvcGrp|184|2022|PDM|6650.00|99|0.00|MEDICAL INTENSIVE CARE
20|FH_F86836_0_0|SrvcGrp|9460|2022|PDM|3200.00|99|0.00|ACUTE REHABILITATION
20|FH_F87012_0_0|SrvcGrp|72990|2022|PDM|568.37|99|0.00|AEG 1
20|FH_F87012_0_0|SrvcGrp|72994|2022|PDM|869.25|99|0.00|AEG 3
20|FH_F87012_0_0|SrvcGrp|73000|2022|PDM|1396.69|99|0.00|AEG 6
20|FH_F87031_0_0|SrvcGrp|72990|2022|PDM|520.00|99|0.00|AEG 1
20|FH_F87031_0_0|SrvcGrp|73000|2022|PDM|1284.00|99|0.00|AEG 6
20|FH_F87031_0_0|SrvcGrp|73004|2022|PDM|1512.00|99|0.00|AEG 8
20|FH_F87031_0_0|SrvcGrp|73006|2022|PDM|2088.00|99|0.00|AEG 9
20|FH_F87031_0_0|SrvcGrp|73008|2022|PDM|983.00|99|0.00|AEG 10
20|FH_F87031_0_0|SrvcGrp|79937|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F87053_0_0|SrvcGrp|13990|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F87053_0_0|SrvcGrp|72994|2022|PDM|826.00|99|0.00|AEG 3
20|FH_F87053_0_0|SrvcGrp|72998|2022|PDM|1166.00|99|0.00|AEG 5
20|FH_F87053_0_0|SrvcGrp|73002|2022|PDM|1452.00|99|0.00|AEG 7
20|FH_F87053_0_0|SrvcGrp|73004|2022|PDM|1420.00|99|0.00|AEG 8
20|FH_F87053_0_0|SrvcGrp|73008|2022|PDM|770.00|99|0.00|AEG 10
20|FH_F87053_0_0|SrvcGrp|75181|2022|PCT|1.00|99|0.00|AETNA IMPLANTS
20|FH_F87053_0_0|SrvcGrp|83542|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F87054_0_0|SrvcGrp|11663|2022|PCT|0.70|99|0.00|IMPLANTS
20|FH_F87054_0_0|SrvcGrp|72996|2022|PDM|1024.00|99|0.00|AEG 4
20|FH_F87054_0_0|SrvcGrp|73006|2022|PDM|2109.00|99|0.00|AEG 9
20|FH_F87054_0_0|SrvcGrp|79561|2022|PDM|1313.00|99|0.00|AETNA CARDIAC CATH
20|FH_F87054_0_0|SrvcGrp|84858|2022|PDM|1533.00|99|0.00|AEG 7 W/O 93452-93461
20|FH_F87054_0_0|SrvcGrp|84933|2022|PDM|2100.00|99|0.00|TRANSLUMINAL DILATION OF CANAL
20|FH_F87114_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.30|99|0.00|OP SVCS
20|FH_F87117_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F87219_0_0|CSTM-ALL|CSTM-00|2020|PDM|129.45|99|0.00|AETNA SLEEP STUDIES
20|FH_F87219_0_0|CSTM-ALL|CSTM-00|2020|PDM|495.96|99|0.00|AETNA SLEEP STUDIES W/O MOD 26 & TC
20|FH_F87219_0_0|SrvcGrp|83881|2022|PDM|59.91|99|0.00|AETNA SLEEP STUDY (MOD 26)
20|FH_F87254_0_0|SrvcGrp|104617|2022|PDM|921.00|99|0.00|INCISION OF RECTAL ABSCESS
20|FH_F87254_0_0|SrvcGrp|63465|2022|PDM|1100.00|99|0.00|CPT 52214
20|FH_F87254_0_0|SrvcGrp|63471|2022|PDM|3200.00|99|0.00|CPT 64590
20|FH_F87254_0_0|SrvcGrp|72992|2022|PDM|693.00|99|0.00|AEG 2
20|FH_F87254_0_0|SrvcGrp|78284|2022|PDM|921.00|99|0.00|CPT 46200
20|FH_F87254_0_0|SrvcGrp|78285|2022|PDM|2200.00|99|0.00|CPT 58671
20|FH_F87333_0_0|SrvcGrp|16719|2022|PCT|0.84|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F87333_0_0|SrvcGrp|75182|2022|PCT|0.84|99|0.00|AETNA IMPLANTS
20|FH_F87411_0_0|CSTM-ALL|CSTM-00|2020|PDM|170.18|99|0.00|SLEEP STUDY CPT 95800
20|FH_F87411_0_0|CSTM-ALL|CSTM-00|2020|PDM|177.29|99|0.00|AETNA POLYSOMNOGRAPHY (MOD 26)
20|FH_F45303_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS
20|FH_F45312_0_0|SrvcGrp|8|2022|PCT|0.88|99|0.00|BURN INTENSIVE CARE
20|FH_F45317_0_0|CSTM-ALL|CSTM-00|2020|PCT|35.00|99|0.00|OP SVCS
20|FH_F45372_0_0|SrvcGrp|1306|2022|PDM|255.00|99|0.00|OP PSYCH PARTIAL HOSP
20|FH_F45392_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|GENERAL ACUTE CARE
20|FH_F45392_0_0|CSTM-ALL|CSTM-00|2020|PDM|2400.00|99|0.00|MS DRG 767-768, 774-775 NORMAL DELIVERY
20|FH_F45392_0_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|MS DRG 765-766 C-SECTION
20|FH_F45435_0_0|SrvcGrp|12263|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE- HOURLY
20|FH_F45435_0_0|SrvcGrp|12702|2022|PDM|45.00|99|0.00|RN, INTERMITTENT VISIT
20|FH_F45435_0_0|SrvcGrp|9828|2022|PDM|60.00|99|0.00|HOME HEALTH AIDE
20|FH_F45516_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F45519_0_0|CSTM-ALL|CSTM-00|2020|PCT|86.00|99|0.00|GENERAL ACUTE CARE
20|FH_F45535_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F45535_0_0|CSTM-ALL|CSTM-00|2020|PDM|1115.00|99|0.00|ASPG VII- GNADEN HUETTEN
20|FH_F45535_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|ASPG IX- GNADEN HUETTEN
20|FH_F45535_0_0|CSTM-ALL|CSTM-00|2020|PDM|638.00|99|0.00|ASPG XI- GNADEN HUETTEN (UNGROUPED)
20|FH_F45535_0_0|CSTM-ALL|CSTM-00|2020|PDM|706.00|99|0.00|ASPG IV - GNADEN HUETTEN
20|FH_F45653_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F45692_0_0|CSTM-ALL|CSTM-00|2020|PCT|49.16|99|0.00|OP SVCS
20|FH_F45692_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.74|99|0.00|GENERAL ACUTE CARE
20|FH_F45752_0_0|CSTM-ALL|CSTM-00|2020|PDM|1005.00|99|0.00|ASPG IV
20|FH_F45752_0_0|CSTM-ALL|CSTM-00|2020|PDM|1595.00|99|0.00|ASPG VII
20|FH_F45752_0_0|CSTM-ALL|CSTM-00|2020|PDM|760.00|99|0.00|ASPG II
20|FH_F45792_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F45792_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F45793_0_0|CSTM-ALL|CSTM-00|2020|PDM|80.00|99|0.00|OP SVCS
20|FH_F45795_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F45798_0_0|CSTM-ALL|CSTM-00|2020|PDM|26500.00|99|0.00|DRG 498 SPINAL FUSION EXCEPT CERVICAL
20|FH_F45798_0_0|SrvcGrp|10059|2022|PDM|12500.00|99|0.00|DRG 124 ONLY CIRCULATORY DISORDERS W/CARDIAC CATH COMPLEX DX
20|FH_F45798_0_0|SrvcGrp|11193|2022|PDM|20500.00|99|0.00|DRG 555 PERCUTANEOUS CARDIOVASCULAR PROCEDURE W/ MAJOR DX
20|FH_F45798_0_0|SrvcGrp|11212|2022|PDM|15800.00|99|0.00|DRG 556 PERCUTANEUS CV PX W/NON DRUG ELUTING STENT W/O MC DX
20|FH_F45798_0_0|SrvcGrp|11223|2022|PDM|18500.00|99|0.00|DRG 558 PERC CV PX W/DRUG-ELUTING STENT W/O MAJOR CV DX
20|FH_F45798_0_0|SrvcGrp|11227|2022|PDM|24500.00|99|0.00|DRG 557 PERCUTANEOUS CV PX W/DRUG-ELUTING STENT W/MAJ CV DX
20|FH_F45798_0_0|SrvcGrp|11659|2022|PDM|2933.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F45798_0_0|SrvcGrp|3029|2022|PDM|1043.00|99|0.00|NEWBORN NURSERY
20|FH_F45798_0_0|SrvcGrp|4109|2022|PDM|1224.00|99|0.00|ACUTE PSYCH
20|FH_F45798_0_0|SrvcGrp|9537|2022|PDM|2933.00|99|0.00|CARDIAC CARE UNIT
20|FH_F45798_0_0|SrvcGrp|9879|2022|PDM|964.00|99|0.00|SKILLED NURSING CARE- IP
20|FH_F45856_0_0|CSTM-ALL|CSTM-00|2020|PDM|100.00|99|0.00|OP SVCS
20|FH_F45873_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F45932_0_0|CSTM-ALL|CSTM-00|2020|PDM|605.00|99|0.00|ASPG I
20|FH_F45932_0_0|CSTM-ALL|CSTM-00|2020|PDM|795.00|99|0.00|ASPG II
20|FH_F45932_0_0|CSTM-ALL|CSTM-00|2020|PDM|795.00|99|0.00|ASPG X
20|FH_F45974_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F45974_0_0|SrvcGrp|17000|2022|PCT|0.75|99|0.00|OUTPATIENT SURGERY
20|FH_F46001_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F46158_0_0|SrvcGrp|17071|2022|PCT|0.65|99|0.00|ASPG IV
20|FH_F46158_0_0|SrvcGrp|17079|2022|PCT|0.65|99|0.00|ASPG VIII
20|FH_F46158_0_0|SrvcGrp|17081|2022|PCT|0.65|99|0.00|ASPG IX
20|FH_F46158_0_0|SrvcGrp|17083|2022|PCT|0.65|99|0.00|ASPG X
20|FH_F46192_0_0|SrvcGrp|10013|2022|PDM|463.00|99|0.00|NEWBORN NURSERY
20|FH_F46192_0_0|SrvcGrp|12674|2022|PCT|0.70|99|0.00|IMPLANTS
20|FH_F46192_0_0|SrvcGrp|9889|2022|PDM|868.00|99|0.00|NICU LEVEL I & II
20|FH_F46276_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F46281_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F46284_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE
20|FH_F46284_0_0|SrvcGrp|10410|2022|PDM|79.00|99|0.00|SKILLED NURSING CARE
20|FH_F46284_0_0|SrvcGrp|42762|2022|PDM|158.00|99|0.00|NURSING CARE
20|FH_F46284_0_0|SrvcGrp|9828|2022|PDM|63.00|99|0.00|HOME HEALTH AIDE
20|FH_F46286_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F46288_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F46290_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE
20|FH_F46352_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE
20|FH_F46352_0_0|SrvcGrp|11080|2022|PDM|158.00|99|0.00|NURSING CARE
20|FH_F46352_0_0|SrvcGrp|26001|2022|PDM|313.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F46352_0_0|SrvcGrp|9828|2022|PDM|63.00|99|0.00|HOME HEALTH AIDE
20|FH_F46354_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F46354_0_0|CSTM-ALL|CSTM-00|2020|PDM|1022.40|99|0.00|COVENTRY ENHANCED GROUPER 8
20|FH_F46354_0_0|CSTM-ALL|CSTM-00|2020|PDM|1036.58|99|0.00|COVENTRY ENHANCED GROUPER 7
20|FH_F46354_0_0|CSTM-ALL|CSTM-00|2020|PDM|531.31|99|0.00|COVENTRY ENHANCED GROUPER 3
20|FH_F46354_0_0|CSTM-ALL|CSTM-00|2020|PDM|746.97|99|0.00|COVENTRY ENHANCED GROUPER 5
20|FH_F46354_0_0|SrvcGrp|38925|2022|PCT|1.10|99|0.00|HCPC IMPLANTS
20|FH_F46357_0_0|CSTM-ALL|CSTM-00|2020|PDM|1487.07|99|0.00|COVENTRY ENHANCED GROUPER 8
20|FH_F46357_0_0|CSTM-ALL|CSTM-00|2020|PDM|1526.67|99|0.00|COVENTRY ENHANCED GROUPER 7
20|FH_F46357_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F46357_0_0|CSTM-ALL|CSTM-00|2020|PDM|520.57|99|0.00|COVENTRY ENHANCED GROUPER 1
20|FH_F46357_0_0|CSTM-ALL|CSTM-00|2020|PDM|681.09|99|0.00|COVENTRY ENHANCED GROUPER 2
20|FH_F46357_0_0|SrvcGrp|10986|2022|PDM|2300.00|99|0.00|ARTHROSCOPIC KNEE REPAIR
20|FH_F46359_0_0|SrvcGrp|10410|2022|PDM|79.00|99|0.00|SKILLED NURSING CARE
20|FH_F46359_0_0|SrvcGrp|42762|2022|PDM|158.00|99|0.00|NURSING CARE
20|FH_F87411_0_0|CSTM-ALL|CSTM-00|2020|PDM|37.51|99|0.00|AETNA SLEEP STUDIES (MOD TC)
20|FH_F87411_0_0|CSTM-ALL|CSTM-00|2020|PDM|541.95|99|0.00|AETNA POLYSOMNOGRAPHY
20|FH_F87411_0_0|SrvcGrp|77440|2022|PDM|189.00|99|0.00|HOME SLEEP TEST TYPE III
20|FH_F87411_0_0|SrvcGrp|83880|2022|PDM|49.10|99|0.00|AETNA SLEEP STUDY (MOD 26)
20|FH_F87411_0_0|SrvcGrp|85683|2022|PDM|107.79|99|0.00|POLYSOM (MOD 26)
20|FH_F87463_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F87463_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F87480_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F87480_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F87480_0_0|CSTM-ALL|CSTM-00|2020|PDM|1095.00|99|0.00|AEG 7 (NO REV) W/O HAND SURG CODES
20|FH_F87480_0_0|CSTM-ALL|CSTM-00|2020|PDM|1339.00|99|0.00|AEG 9 (NO REV)
20|FH_F87480_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|AEG 1 (NO REV)
20|FH_F87480_0_0|CSTM-ALL|CSTM-00|2020|PDM|475.00|99|0.00|AEG 2 (NO REV)
20|FH_F87480_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|AEG 3 (NO REV)
20|FH_F87480_0_0|SrvcGrp|80126|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANICNG SUBSTANCE
20|FH_F87480_0_0|SrvcGrp|86236|2022|PDM|2500.00|99|0.00|AETNA SPINAL SURGERY
20|FH_F87538_0_0|SrvcGrp|42826|2022|PDM|108.00|99|0.00|PHYSICAL THERAPY VISIT
20|FH_F87538_0_0|SrvcGrp|46390|2022|PDM|108.00|99|0.00|PHYSICAL THERAPY SVCS INITIAL EVAL
20|FH_F87541_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F87541_0_0|SrvcGrp|73008|2022|PDM|864.00|99|0.00|AEG 10
20|FH_F87559_0_0|CSTM-ALL|CSTM-00|2020|PDM|33.80|99|0.00|AETNA SLEEP STUDIES (MOD TC)
20|FH_F87559_0_0|CSTM-ALL|CSTM-00|2020|PDM|367.68|99|0.00|AETNA SLEEP STUDIES
20|FH_F87559_0_0|CSTM-ALL|CSTM-00|2020|PDM|624.35|99|0.00|POLYSOMNOGRAPHY
20|FH_F87559_0_0|CSTM-ALL|CSTM-00|2020|PDM|624.35|99|0.00|POLYSOMNOGRAPHY W/O MOD 26 & TC
20|FH_F87559_0_0|CSTM-ALL|CSTM-00|2020|PDM|77.46|99|0.00|AETNA SLEEP STUDY CPT 95801
20|FH_F87559_0_0|CSTM-ALL|CSTM-00|2020|PDM|96.87|99|0.00|AETNA SLEEP STUDIES
20|FH_F87571_0_0|SrvcGrp|10393|2022|PDM|1760.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F87571_0_0|SrvcGrp|10903|2022|PDM|350.00|99|0.00|EMERGENCY ROOM LEVEL I
20|FH_F87571_0_0|SrvcGrp|10906|2022|PCT|0.60|99|0.00|EMERGENCY ROOM LEVEL IV
20|FH_F87618_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|TRANSPLANT SVCS
20|FH_F87619_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F87619_0_0|SrvcGrp|72996|2022|PDM|791.00|99|0.00|AEG 4
20|FH_F87619_0_0|SrvcGrp|73000|2022|PDM|1043.00|99|0.00|AEG 6
20|FH_F87619_0_0|SrvcGrp|73002|2022|PDM|1247.00|99|0.00|AEG 7
20|FH_F87619_0_0|SrvcGrp|73008|2022|PDM|567.00|99|0.00|AEG 10
20|FH_F87716_0_0|SrvcGrp|29817|2022|PDM|4085.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F87815_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS
20|FH_F87816_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F87816_0_0|SrvcGrp|76421|2022|PDM|430.50|99|0.00|HEMODIALYSIS
20|FH_F87822_0_0|SrvcGrp|28787|2022|PDM|22.95|99|0.00|CPT CODE 90993
20|FH_F87822_0_0|SrvcGrp|37047|2022|PDM|481.95|99|0.00|HEMO/HOME DIALYSIS SVCS
20|FH_F87822_0_0|SrvcGrp|81023|2022|PDM|206.85|99|0.00|AETNA CAPD CCPD IPD DIALYSIS PROC
20|FH_F87856_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F87856_0_0|SrvcGrp|59705|2022|PDM|1000.00|99|0.00|SEPTOPLASTY
20|FH_F87856_0_0|SrvcGrp|64517|2022|PDM|2332.00|99|0.00|REDUCE MANMMAPLASTY
20|FH_F87856_0_0|SrvcGrp|75479|2022|PDM|432.00|99|0.00|AEG 1
20|FH_F87856_0_0|SrvcGrp|75481|2022|PDM|579.00|99|0.00|AEG 2
20|FH_F87856_0_0|SrvcGrp|75489|2022|PDM|1080.00|99|0.00|AEG 6
20|FH_F87856_0_0|SrvcGrp|75491|2022|PDM|1292.00|99|0.00|AEG 7
20|FH_F87856_0_0|SrvcGrp|78878|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F87856_0_0|SrvcGrp|81424|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F87856_0_0|SrvcGrp|86458|2022|PDM|791.00|99|0.00|SKIN TISSUE REARRANGEMENT
20|FH_F87856_0_0|SrvcGrp|86461|2022|PDM|1500.00|99|0.00|AREOLA RECONSTRUCTION
20|FH_F87915_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F87915_0_0|SrvcGrp|13630|2022|PDM|647.00|99|0.00|CPT 99204
20|FH_F87915_0_0|SrvcGrp|3404|2022|PDM|154.00|99|0.00|CPT 99211
20|FH_F87915_0_0|SrvcGrp|3406|2022|PDM|647.00|99|0.00|CPT 99214
20|FH_F87993_0_0|CSTM-ALL|CSTM-00|2020|PDM|1075.00|99|0.00|AEG 8 (NO REV)
20|FH_F87993_0_0|CSTM-ALL|CSTM-00|2020|PDM|1480.00|99|0.00|AEG 9 (NO REV)
20|FH_F87993_0_0|CSTM-ALL|CSTM-00|2020|PDM|369.00|99|0.00|AEG 1 (NO REV)
20|FH_F87993_0_0|CSTM-ALL|CSTM-00|2020|PDM|563.00|99|0.00|AEG 10 (NO REV)
20|FH_F87993_0_0|CSTM-ALL|CSTM-00|2020|PDM|793.00|99|0.00|AEG 5  (NO REV)
20|FH_F88057_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F88058_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F88096_0_0|CSTM-ALL|CSTM-00|2020|PDM|1450.00|99|0.00|AEG 4 (NO REV)
20|FH_F88096_0_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|AEG 8 (NO REV)
20|FH_F88096_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|AEG 7 (NO REV)
20|FH_F88096_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|AEG 9 (NO REV)
20|FH_F88096_0_0|SrvcGrp|70749|2022|PDM|2100.00|99|0.00|CPT 29823
20|FH_F88096_0_0|SrvcGrp|78504|2022|PDM|4000.00|99|0.00|AETNA CARDIAC CATHETERIZATION
20|FH_F88096_0_0|SrvcGrp|85540|2022|PDM|600.00|99|0.00|LOWER GI PROCEDURES
20|FH_F88096_0_0|SrvcGrp|86578|2022|PDM|1800.00|99|0.00|ARTHROSCOPY SVCS
20|FH_F88171_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F88274_0_0|SrvcGrp|75497|2022|PDM|650.00|99|0.00|AEG 10
20|FH_F88355_0_0|CSTM-ALL|CSTM-00|2020|PDM|1110.00|99|0.00|AEG 9 (NO REV)
20|FH_F88355_0_0|CSTM-ALL|CSTM-00|2020|PDM|645.00|99|0.00|AEG 10 (NO REV)
20|FH_F88355_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F88355_0_0|SrvcGrp|85022|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F88357_0_0|CSTM-ALL|CSTM-00|2020|PDM|432.00|99|0.00|AEG 2 (NO REV)
20|FH_F88357_0_0|CSTM-ALL|CSTM-00|2020|PDM|695.00|99|0.00|AEG 5  (NO REV)
20|FH_F88391_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F88391_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F88451_0_0|SrvcGrp|25665|2022|PCT|0.60|99|0.00|PHARMACY
20|FH_F88451_0_0|SrvcGrp|43283|2022|PDM|126.00|99|0.00|PHYSICAL THERAPY
20|FH_F88451_0_0|SrvcGrp|43284|2022|PDM|126.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F88451_0_0|SrvcGrp|56484|2022|PDM|126.00|99|0.00|SKILLED NURSING
20|FH_F88456_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F88456_0_0|SrvcGrp|111868|2022|PDM|897.00|99|0.00|LAPAROSCOPY
20|FH_F88456_0_0|SrvcGrp|55084|2022|PDM|4953.00|99|0.00|CPT 52648
20|FH_F88456_0_0|SrvcGrp|56462|2022|PDM|2440.00|99|0.00|CPT 53850
20|FH_F88456_0_0|SrvcGrp|63468|2022|PDM|897.00|99|0.00|CPT 52281
20|FH_F88456_0_0|SrvcGrp|63469|2022|PDM|952.00|99|0.00|CPT 55700
20|FH_F88456_0_0|SrvcGrp|77444|2022|PDM|1280.00|99|0.00|VASECTOMY
20|FH_F88456_0_0|SrvcGrp|77452|2022|PDM|13871.00|99|0.00|CPT 54405
20|FH_F88456_0_0|SrvcGrp|84704|2022|PDM|1003.00|99|0.00|CYSTOURETHROSCOPY W/ REMOVAL OF FOREIGN BODY
20|FH_F88456_0_0|SrvcGrp|87054|2022|PDM|2801.00|99|0.00|CYSTOSCOPY CHEMODENERVATION
20|FH_F88456_0_0|SrvcGrp|87421|2022|PDM|952.00|99|0.00|CYSTOURETHROSCOPY
20|FH_F88483_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F88483_0_0|CSTM-ALL|CSTM-00|2020|PDM|331.00|99|0.00|AEG 1 (NO REV)
20|FH_F88483_0_0|CSTM-ALL|CSTM-00|2020|PDM|443.00|99|0.00|AEG 2 (NO REV)
20|FH_F88483_0_0|CSTM-ALL|CSTM-00|2020|PDM|712.00|99|0.00|AEG 5  (NO REV)
20|FH_F88483_0_0|CSTM-ALL|CSTM-00|2020|PDM|967.00|99|0.00|AEG 8 (NO REV)
20|FH_F88483_0_0|CSTM-ALL|CSTM-00|2020|PDM|988.00|99|0.00|AEG 7 (NO REV)
20|FH_F88511_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F88616_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F88616_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F88616_0_0|CSTM-ALL|CSTM-00|2020|PDM|775.00|99|0.00|AEG 1 (NO REV)
20|FH_F88640_32935_0|CSTM-ALL|CSTM-00|2020|PCT|0.25|99|0.00|GENERAL ACUTE CARE
20|FH_F88640_32935_0|CSTM-ALL|CSTM-00|2020|PCT|0.25|99|0.00|OP SVCS
20|FH_F88672_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F88672_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F88672_0_0|CSTM-ALL|CSTM-00|2020|PDM|538.00|99|0.00|AEG 3 (NO REV)
20|FH_F88672_0_0|SrvcGrp|35669|2022|PDM|3992.00|99|0.00|CPT 63650
20|FH_F88672_0_0|SrvcGrp|87679|2022|PDM|819.00|99|0.00|LUMBAR OR SACRAL SURGERY
20|FH_F88733_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F88733_0_0|SrvcGrp|73483|2022|PDM|630.00|99|0.00|AETNA SUBACUTE III
20|FH_F88733_0_0|SrvcGrp|79720|2022|PDM|1050.00|99|0.00|ACUTE REHAB II
20|FH_F88740_0_0|CSTM-ALL|CSTM-00|2020|PDM|1750.00|99|0.00|AEG 7 (NO REV)
20|FH_F88740_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F88753_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F88753_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|OP SVCS
20|FH_F88797_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F88818_0_0|SrvcGrp|75489|2022|PDM|630.00|99|0.00|AEG 6
20|FH_F88818_0_0|SrvcGrp|75497|2022|PDM|365.00|99|0.00|AEG 10
20|FH_F88818_0_0|SrvcGrp|87818|2022|PDM|300.00|99|0.00|INTERMEDIATE WOUND REPAIR OF FACE/MM
20|FH_F88818_0_0|SrvcGrp|87820|2022|PDM|1000.00|99|0.00|REMOVAL OF PRESSURE SORE
20|FH_F88818_0_0|SrvcGrp|87840|2022|PDM|320.00|99|0.00|AEG 1 W/O 11442, 12051
20|FH_F88885_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|HSS ASC INVOICE
20|FH_F88893_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F88893_0_0|CSTM-ALL|CSTM-00|2020|PDM|856.55|99|0.00|AEG 5  (NO REV)
20|FH_F88893_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F88893_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F88893_0_0|SrvcGrp|113481|2022|PDM|1210.00|99|0.00|LAPAROSCOPY
20|FH_F88893_0_0|SrvcGrp|27345|2022|PDM|3520.00|99|0.00|OP SURGERY (CPT 49650)
20|FH_F88893_0_0|SrvcGrp|33967|2022|PDM|1430.00|99|0.00|CPT 47562
20|FH_F88893_0_0|SrvcGrp|67989|2022|PDM|3630.00|99|0.00|CPT 49320
20|FH_F88893_0_0|SrvcGrp|79589|2022|PDM|660.00|99|0.00|UPPER GI
20|FH_F88893_0_0|SrvcGrp|81904|2022|PDM|1836.00|99|0.00|LAP PARASOPHAG HERNIA REPAIR
20|FH_F88893_0_0|SrvcGrp|82298|2022|PDM|10112.00|99|0.00|AETNA LAP SLEEVE GASTRECTOMY
20|FH_F88893_0_0|SrvcGrp|87845|2022|PDM|957.00|99|0.00|GASTRIC RESTRICTIVE PROCEDURE
20|FH_F88893_0_0|SrvcGrp|97903|2022|PDM|3520.00|99|0.00|REMOVAL OF STOMACH PARTIAL
20|FH_F88933_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F88933_0_0|CSTM-ALL|CSTM-00|2020|PDM|1311.00|99|0.00|AEG 4 (NO REV)
20|FH_F88933_0_0|CSTM-ALL|CSTM-00|2020|PDM|1476.00|99|0.00|AEG 6 (NO REV)
20|FH_F88933_0_0|CSTM-ALL|CSTM-00|2020|PDM|1914.00|99|0.00|AEG 9 (NO REV)
20|FH_F88933_0_0|SrvcGrp|112940|2022|PDM|5065.00|99|0.00|SPINE SURGERY PROCEDURES
20|FH_F88933_0_0|SrvcGrp|16241|2022|PDM|1748.00|99|0.00|SHOULDER SCOPE
20|FH_F88933_0_0|SrvcGrp|38016|2022|PDM|2186.00|99|0.00|ROTATOR CUFF REPAIR
20|FH_F88933_0_0|SrvcGrp|40002|2022|PDM|11255.00|99|0.00|TOTAL HIP
20|FH_F88933_0_0|SrvcGrp|82289|2022|PDM|5065.00|99|0.00|KYPHOPLASTY
20|FH_F88933_0_0|SrvcGrp|87521|2022|PDM|2186.00|99|0.00|AETNA REPAIR OF KNEE LIGAMENT
20|FH_F88933_0_0|SrvcGrp|87525|2022|PDM|5065.00|99|0.00|AETNA NEUROSTIMULATOR TRIAL
20|FH_F88933_0_0|SrvcGrp|99073|2022|PDM|1.36|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F89037_0_0|SrvcGrp|72992|2022|PDM|537.57|99|0.00|AEG 2
20|FH_F89071_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F89111_0_0|SrvcGrp|471|2022|PDM|550.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F89173_0_0|CSTM-ALL|CSTM-00|2020|PDM|1208.00|99|0.00|AEG 8 (NO REV)
20|FH_F89173_0_0|CSTM-ALL|CSTM-00|2020|PDM|629.00|99|0.00|AEG 10 (NO REV)
20|FH_F89176_0_0|CSTM-ALL|CSTM-00|2020|PDM|1392.00|99|0.00|ASPG V
20|FH_F89176_0_0|CSTM-ALL|CSTM-00|2020|PDM|580.00|99|0.00|ASPG I
20|FH_F89176_0_0|CSTM-ALL|CSTM-00|2020|PDM|696.00|99|0.00|ASPG II
20|FH_F89176_0_0|CSTM-ALL|CSTM-00|2020|PDM|928.00|99|0.00|ASPG IV
20|FH_F89211_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F89233_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F89233_0_0|SrvcGrp|131|2022|PCT|0.76|99|0.00|PACEMAKER DEVICE
20|FH_F89273_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F89273_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 6 (NO REV)
20|FH_F89273_0_0|CSTM-ALL|CSTM-00|2020|PDM|1550.00|99|0.00|AEG 9 (NO REV)
20|FH_F89273_0_0|CSTM-ALL|CSTM-00|2020|PDM|425.00|99|0.00|AEG 1 (NO REV)
20|FH_F89273_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F89311_0_0|CSTM-ALL|CSTM-00|2020|PDM|1137.00|99|0.00|COVENTRY ENHANCED GROUPER 6
20|FH_F89311_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|COVENTRY ENHANCED GROUPER 7
20|FH_F89311_0_0|CSTM-ALL|CSTM-00|2020|PDM|638.00|99|0.00|COVENTRY ENHANCED GROUPER 10
20|FH_F89340_0_0|CSTM-ALL|CSTM-00|2020|PDM|1181.00|99|0.00|AEG 6 (NO REV)
20|FH_F89340_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|AEG 10 (NO REV)
20|FH_F89340_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F89340_0_0|SrvcGrp|38364|2022|PDM|3300.00|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F89340_0_0|SrvcGrp|44068|2022|PDM|1023.00|99|0.00|CPT 52332
20|FH_F89340_0_0|SrvcGrp|63462|2022|PDM|1210.00|99|0.00|CPT 64595
20|FH_F89340_0_0|SrvcGrp|63471|2022|PDM|1210.00|99|0.00|CPT 64590
20|FH_F89340_0_0|SrvcGrp|88137|2022|PDM|3850.00|99|0.00|PENILE PROSTHESIS
20|FH_F89363_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.64|99|0.00|OP SVCS
20|FH_F89372_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.51|99|0.00|AETNA OP SVCS
20|FH_F89372_0_0|SrvcGrp|107734|2022|PDM|5682.00|99|0.00|VAGINAL DELIVERY
20|FH_F89372_0_0|SrvcGrp|109120|2022|PDM|30240.00|99|0.00|GASTRIC BYPASS
20|FH_F89372_0_0|SrvcGrp|113447|2022|PDM|10547.00|99|0.00|CARDIAC SURGERY
20|FH_F89372_0_0|SrvcGrp|14514|2022|PDM|30240.00|99|0.00|LAP BANDS
20|FH_F89372_0_0|SrvcGrp|16392|2022|PCT|1.00|99|0.00|AMBULANCE
20|FH_F89372_0_0|SrvcGrp|20752|2022|PDM|2100.00|99|0.00|MSDRG 619-621 ONLY BARIATRIC SURGERY
20|FH_F89372_0_0|SrvcGrp|24006|2022|PCT|0.51|99|0.00|MRI CT SCANS
20|FH_F89372_0_0|SrvcGrp|4109|2022|PDM|2100.00|99|0.00|ACUTE PSYCH
20|FH_F89372_0_0|SrvcGrp|43|2022|PCT|0.51|99|0.00|IMPLANTS
20|FH_F89372_0_0|SrvcGrp|73463|2022|PDM|5606.00|99|0.00|AETNA NICU II
20|FH_F89372_0_0|SrvcGrp|79099|2022|PDM|5789.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS
20|FH_F89372_0_0|SrvcGrp|88428|2022|PDM|14106.00|99|0.00|AETNA IP SPINAL SURGERY
20|FH_F89372_0_0|SrvcGrp|88432|2022|PDM|2882.00|99|0.00|AETNA IP REHAB
20|FH_F89372_0_0|SrvcGrp|9866|2022|PDM|5789.00|99|0.00|IP OBSERVATION SVCS
20|FH_F89495_0_0|SrvcGrp|72992|2022|PDM|465.00|99|0.00|AEG 2
20|FH_F89495_0_0|SrvcGrp|73006|2022|PDM|1342.00|99|0.00|AEG 9
20|FH_F89495_0_0|SrvcGrp|87769|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F89538_0_0|CSTM-ALL|CSTM-00|2020|PDM|1084.86|99|0.00|AEG 5  (NO REV)
20|FH_F89538_0_0|CSTM-ALL|CSTM-00|2020|PDM|1261.32|99|0.00|AEG 6 (NO REV)
20|FH_F89538_0_0|CSTM-ALL|CSTM-00|2020|PDM|1505.48|99|0.00|AEG 10 (NO REV)
20|FH_F89538_0_0|CSTM-ALL|CSTM-00|2020|PDM|674.81|99|0.00|AEG 2 (NO REV)
20|FH_F89538_0_0|CSTM-ALL|CSTM-00|2020|PDM|953.22|99|0.00|AEG 4 (NO REV)
20|FH_F89551_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F89551_0_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F89551_0_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II
20|FH_F89574_0_0|SrvcGrp|73483|2022|PDM|630.00|99|0.00|AETNA SUBACUTE III
20|FH_F89574_0_0|SrvcGrp|73606|2022|PDM|525.00|99|0.00|AETNA SKILLED NURSING CARE
20|FH_F89580_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.46|99|0.00|IP DIAPHRAGMATIC PACEMAKER IMP
20|FH_F89580_0_0|SrvcGrp|16141|2022|PCT|0.46|99|0.00|PACEMAKER
20|FH_F89580_0_0|SrvcGrp|16719|2022|PCT|0.46|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F89580_0_0|SrvcGrp|17520|2022|PCT|0.46|99|0.00|IMPLANTS
20|FH_F89580_0_0|SrvcGrp|23585|2022|PCT|0.46|99|0.00|IMPLANTS
20|FH_F89580_0_0|SrvcGrp|85040|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH INCIDENTAL CODES
20|FH_F89580_0_0|SrvcGrp|88421|2022|PCT|0.46|99|0.00|OP DIAPHRAGMATIC PACEMAKER IMP
20|FH_F89582_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F89582_0_0|SrvcGrp|57968|2022|PDM|31.59|99|0.00|CONTINUOUS HOMECARE
20|FH_F89616_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.10|99|0.00|GENERAL ACUTE CARE
20|FH_F89645_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F89680_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.87|99|0.00|GENERAL ACUTE CARE
20|FH_F89734_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F89736_0_0|SrvcGrp|12674|2022|PCT|0.50|99|0.00|IMPLANTS
20|FH_F89760_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F89760_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|GENERAL ACUTE CARE
20|FH_F89778_0_0|CSTM-ALL|CSTM-00|2020|PDM|1306.00|99|0.00|AEG 6 (NO REV)
20|FH_F89778_0_0|CSTM-ALL|CSTM-00|2020|PDM|1558.00|99|0.00|AEG 7 (NO REV)
20|FH_F89778_0_0|CSTM-ALL|CSTM-00|2020|PDM|747.00|99|0.00|AEG 2 (NO REV)
20|FH_F89778_0_0|CSTM-ALL|CSTM-00|2020|PDM|997.00|99|0.00|AEG 4 (NO REV)
20|FH_F89778_0_0|SrvcGrp|16289|2022|PDM|782.06|99|0.00|CARPAL TUNNEL RELEASE
20|FH_F89778_0_0|SrvcGrp|23585|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F89778_0_0|SrvcGrp|33967|2022|PDM|2135.54|99|0.00|CPT 47562
20|FH_F89778_0_0|SrvcGrp|34606|2022|PDM|2455.44|99|0.00|CPT 29827
20|FH_F89778_0_0|SrvcGrp|76604|2022|PDM|1900.99|99|0.00|CPT 25447
20|FH_F89778_0_0|SrvcGrp|82109|2022|PDM|782.01|99|0.00|REVISE ULNAR NERVE ELBOW
20|FH_F89778_0_0|SrvcGrp|88820|2022|PDM|1470.32|99|0.00|CPT 24359
20|FH_F89779_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F89779_0_0|SrvcGrp|72998|2022|PDM|3300.00|99|0.00|AEG 5
20|FH_F89779_0_0|SrvcGrp|73004|2022|PDM|3000.00|99|0.00|AEG 8
20|FH_F89779_0_0|SrvcGrp|80617|2022|PDM|16000.00|99|0.00|ARTHOPLASTY
20|FH_F89779_0_0|SrvcGrp|86233|2022|PDM|19500.00|99|0.00|AETNA RECONSTRUCT ANKLE JOINT
20|FH_F89799_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F89952_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 1 (NO REV)
20|FH_F89952_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|AEG 6 (NO REV)
20|FH_F90136_0_0|SrvcGrp|33722|2022|PDM|23.00|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F90136_0_0|SrvcGrp|82223|2022|PDM|100.00|99|0.00|HOSPICE CARE
20|FH_F90136_0_0|SrvcGrp|84185|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F90157_0_0|SrvcGrp|22529|2022|PCT|0.00|99|0.00|DAY HOSPITAL HALF DAY
20|FH_F90157_0_0|SrvcGrp|79720|2022|PDM|1243.00|99|0.00|ACUTE REHAB II
20|FH_F90160_0_0|CSTM-ALL|CSTM-00|2020|PCT|44.90|99|0.00|OP SVCS
20|FH_F90173_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F90184_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|ASPG IX
20|FH_F90184_0_0|CSTM-ALL|CSTM-00|2020|PDM|1266.00|99|0.00|ASPG VIII
20|FH_F90184_0_0|CSTM-ALL|CSTM-00|2020|PDM|430.00|99|0.00|ASPG I
20|FH_F90354_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F90354_0_0|SrvcGrp|92502|2022|PDM|620.28|99|0.00|HOSPICE GENERAL IP CARE
20|FH_F90362_0_0|SrvcGrp|72994|2022|PDM|585.00|99|0.00|AEG 3
20|FH_F90362_0_0|SrvcGrp|84939|2022|PDM|11670.00|99|0.00|SHOULDER JOINT
20|FH_F90362_0_0|SrvcGrp|87558|2022|PDM|1948.00|99|0.00|SPINE SURGERY PROCEDURES
20|FH_F90362_0_0|SrvcGrp|89944|2022|PDM|2380.00|99|0.00|NEUROSTIMULATOR PERMANENT
20|FH_F90422_0_0|SrvcGrp|1168|2022|PDM|76.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F90422_0_0|SrvcGrp|3810|2022|PDM|85.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F90453_65203_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F90453_65203_0|SrvcGrp|79720|2022|PDM|941.00|99|0.00|ACUTE REHAB II
20|FH_F90455_0_0|SrvcGrp|14494|2022|PDM|31.81|99|0.00|CONTINUOUS HOMECARE
20|FH_F90455_0_0|SrvcGrp|3810|2022|PDM|151.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F90455_0_0|SrvcGrp|46605|2022|PDM|185.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES
20|FH_F90455_0_0|SrvcGrp|90065|2022|PDM|6.50|99|0.00|AETNA - ROUTINE VENIPUNCTURE
20|FH_F90559_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F90559_0_0|SrvcGrp|79757|2022|PDM|1040.00|99|0.00|ESOPHAGUS ENDOSCOPY REPAIR
20|FH_F90653_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F90653_0_0|SrvcGrp|15659|2022|PCT|0.70|99|0.00|CHEMOTHERAPY
20|FH_F90654_0_0|SrvcGrp|11199|2022|PCT|0.70|99|0.00|HYPERBARIC CHAMBER
20|FH_F90654_0_0|SrvcGrp|15659|2022|PCT|0.70|99|0.00|CHEMOTHERAPY
20|FH_F90654_0_0|SrvcGrp|16778|2022|PCT|0.70|99|0.00|DIALYSIS
20|FH_F90654_0_0|SrvcGrp|17990|2022|PCT|0.70|99|0.00|CT / MRI
20|FH_F90654_0_0|SrvcGrp|47260|2022|PCT|0.70|99|0.00|IMPLANTS 274-276, 278  LINE LEVEL
20|FH_F90691_0_0|SrvcGrp|72990|2022|PDM|382.00|99|0.00|AEG 1
20|FH_F90691_0_0|SrvcGrp|72992|2022|PDM|504.00|99|0.00|AEG 2
20|FH_F90691_0_0|SrvcGrp|73004|2022|PDM|1055.00|99|0.00|AEG 8
20|FH_F90691_0_0|SrvcGrp|73008|2022|PDM|761.00|99|0.00|AEG 10
20|FH_F90698_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F90698_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F90698_0_0|CSTM-ALL|CSTM-00|2020|PDM|840.00|99|0.00|AEG 2 (NO REV)
20|FH_F90700_0_0|SrvcGrp|22954|2022|PDM|208.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F90714_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|DEVICE INSERTION
20|FH_F90714_0_0|SrvcGrp|73002|2022|PDM|1033.00|99|0.00|AEG 7
20|FH_F90714_0_0|SrvcGrp|73006|2022|PDM|1040.00|99|0.00|AEG 9
20|FH_F90714_0_0|SrvcGrp|73008|2022|PDM|555.00|99|0.00|AEG 10
20|FH_F90811_0_0|CSTM-ALL|CSTM-00|2020|PDM|1161.00|99|0.00|AEG 6 (NO REV)
20|FH_F90811_0_0|CSTM-ALL|CSTM-00|2020|PDM|1233.00|99|0.00|AEG 8 (NO REV)
20|FH_F90811_0_0|CSTM-ALL|CSTM-00|2020|PDM|1413.00|99|0.00|AEG 7 (NO REV)
20|FH_F90811_0_0|CSTM-ALL|CSTM-00|2020|PDM|472.50|99|0.00|AEG 1 (NO REV)
20|FH_F90811_0_0|CSTM-ALL|CSTM-00|2020|PDM|643.50|99|0.00|AEG 2 (NO REV)
20|FH_F90811_0_0|CSTM-ALL|CSTM-00|2020|PDM|765.00|99|0.00|AEG 3 (NO REV)
20|FH_F90811_0_0|SrvcGrp|76604|2022|PDM|1800.00|99|0.00|CPT 25447
20|FH_F90811_0_0|SrvcGrp|90418|2022|PDM|2800.00|99|0.00|ENLARGE BREAST WITH IMPLANT
20|FH_F90811_0_0|SrvcGrp|90419|2022|PDM|4000.00|99|0.00|REPAIR HAND DISLOCATION
20|FH_F90811_0_0|SrvcGrp|90425|2022|PDM|2500.00|99|0.00|SHOULDER ARTHROSCOPY SURGERY
20|FH_F90811_0_0|SrvcGrp|90428|2022|PDM|4500.00|99|0.00|INSERT SPINE FIXATION DEVICE
20|FH_F90811_0_0|SrvcGrp|90431|2022|PDM|2500.00|99|0.00|HAND PROCEDURES
20|FH_F90811_0_0|SrvcGrp|90438|2022|PDM|2500.00|99|0.00|ARM SURGICAL PROCEDURES
20|FH_F90817_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 5  (NO REV)
20|FH_F90817_0_0|CSTM-ALL|CSTM-00|2020|PDM|1125.00|99|0.00|AEG 6 (NO REV)
20|FH_F90817_0_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|AEG 7 (NO REV)
20|FH_F90817_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 9 (NO REV)
20|FH_F90817_0_0|SrvcGrp|10986|2022|PDM|2914.00|99|0.00|ARTHROSCOPIC KNEE REPAIR
20|FH_F90817_0_0|SrvcGrp|16289|2022|PDM|1217.00|99|0.00|CARPAL TUNNEL RELEASE
20|FH_F90817_0_0|SrvcGrp|46906|2022|PDM|2350.00|99|0.00|CORNEAL TISSUE
20|FH_F90817_0_0|SrvcGrp|53703|2022|PDM|2256.00|99|0.00|REVISE AQUEOUS SHUNT TO EXTRAOCULAR RESIVOIR
20|FH_F90817_0_0|SrvcGrp|75182|2022|PCT|1.00|99|0.00|AETNA IMPLANTS
20|FH_F90817_0_0|SrvcGrp|83350|2022|PDM|2444.00|99|0.00|AETNA LAPAR HERNIA REPAIR
20|FH_F90817_0_0|SrvcGrp|88149|2022|PDM|1866.00|99|0.00|RELEASE OF EYE FLUID
20|FH_F90817_0_0|SrvcGrp|90358|2022|PDM|1692.00|99|0.00|EXPLORE/DRAIN EYE SOCKET
20|FH_F90817_0_0|SrvcGrp|90365|2022|PDM|1997.00|99|0.00|REPAIR METACARPAL FRACTURE
20|FH_F90817_0_0|SrvcGrp|90367|2022|PDM|1692.00|99|0.00|NASAL/SINUS ENDOSCOPY
20|FH_F90817_0_0|SrvcGrp|90371|2022|PDM|2096.00|99|0.00|REBUILD OUTER EAR CANAL
20|FH_F90817_0_0|SrvcGrp|90375|2022|PDM|1574.00|99|0.00|KNEE ARTHROSCOPY/SURGERY
20|FH_F90817_0_0|SrvcGrp|90377|2022|PDM|1198.00|99|0.00|FUSION OF FINGER JOINT
20|FH_F90817_0_0|SrvcGrp|90386|2022|PDM|2256.00|99|0.00|REPAIR EARDRUM STRUCTURES
20|FH_F90817_0_0|SrvcGrp|90997|2022|PDM|2096.00|99|0.00|REPAIR SHOULDER CAPSULE (HCFA)
20|FH_F90817_0_0|SrvcGrp|90998|2022|PDM|7520.00|99|0.00|RECONSTRUCT SHOULDER JOINT (HCFA)
20|FH_F90817_0_0|SrvcGrp|90999|2022|PDM|2162.00|99|0.00|REPAIR FRACTURE OF ULNA (HCFA)
20|FH_F90817_0_0|SrvcGrp|91001|2022|PDM|1433.00|99|0.00|REP FLX TEND ZONE 2 DIGT SEC (HCFA)
20|FH_F90817_0_0|SrvcGrp|91003|2022|PDM|2650.00|99|0.00|REVISE/IMPLANT FINGER JOINT (HCFA)
20|FH_F90817_0_0|SrvcGrp|91009|2022|PDM|2280.00|99|0.00|JAW ARTHROSCOPY/TMJ SURG (HCFA)
20|FH_F90817_0_0|SrvcGrp|91010|2022|PDM|2280.00|99|0.00|SHOULDER ARTHROSCOPY/SURGERY (HCFA)
20|FH_F90817_0_0|SrvcGrp|91011|2022|PDM|2280.00|99|0.00|SHOULDER ARTHROSCOPY/SURGERY (HCFA)
20|FH_F90817_0_0|SrvcGrp|91015|2022|PDM|2721.00|99|0.00|ANKLE ARTHROSCOPY SURGERY (HCFA)
20|FH_F90817_0_0|SrvcGrp|91021|2022|PDM|855.00|99|0.00|PROBE NASOLACRIMAL DUCT (HCFA)
20|FH_F90817_0_0|SrvcGrp|91027|2022|PDM|2444.00|99|0.00|AETNA LAPAR HERNIA REPAIR (HCFA)
20|FH_F90817_0_0|SrvcGrp|91028|2022|PDM|2444.00|99|0.00|KNEE ARTHROSCOPY/SURGERY (HCFA)
20|FH_F90817_0_0|SrvcGrp|91032|2022|PDM|2256.00|99|0.00|AQUEOUS SHUNT EYE W/GRAFT (HCFA)
20|FH_F90817_0_0|SrvcGrp|91035|2022|PDM|2096.00|99|0.00|REPAIR OF TENDON(S) (HCFA)
20|FH_F90817_0_0|SrvcGrp|91036|2022|PDM|2096.00|99|0.00|RECONSTRUCTION OF SHOULDER CUFF (ROTATOR) (HCFA)
20|FH_F90817_0_0|SrvcGrp|91044|2022|PDM|1574.00|99|0.00|KNEE ARTHROSCOPY/SURGERY (HCFA)
20|FH_F90818_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 4 (NO REV)
20|FH_F90818_0_0|CSTM-ALL|CSTM-00|2020|PDM|1515.00|99|0.00|AEG 6 (NO REV)
20|FH_F90818_0_0|CSTM-ALL|CSTM-00|2020|PDM|1815.00|99|0.00|AEG 7 (NO REV)
20|FH_F90818_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|AEG 2 (NO REV)
20|FH_F90818_0_0|SrvcGrp|57596|2022|PDM|3200.00|99|0.00|CIRCUMCISION
20|FH_F90818_0_0|SrvcGrp|72121|2022|PDM|6500.00|99|0.00|ARTHOSCOPY
20|FH_F90818_0_0|SrvcGrp|83351|2022|PDM|4100.00|99|0.00|AETNA LAPAR ORCHIOPEXY
20|FH_F90818_0_0|SrvcGrp|89882|2022|PDM|3125.00|99|0.00|AETNA REMOVAL OF TONSILS
20|FH_F90818_0_0|SrvcGrp|89887|2022|PDM|3750.00|99|0.00|AETNA CYSTOSCOPY AND TREATMENT
20|FH_F90840_0_0|CSTM-ALL|CSTM-00|2020|PDM|1305.00|99|0.00|AEG 6 (NO REV)
20|FH_F90840_0_0|CSTM-ALL|CSTM-00|2020|PDM|1535.00|99|0.00|AEG 8 (NO REV)
20|FH_F90840_0_0|CSTM-ALL|CSTM-00|2020|PDM|889.00|99|0.00|AEG 10 (NO REV)
20|FH_F90840_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS
20|FH_F90852_0_0|SrvcGrp|10391|2022|PDM|1260.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F90852_0_0|SrvcGrp|10393|2022|PDM|1627.50|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F90853_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|GENERAL ACUTE CARE
20|FH_F90853_0_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS
20|FH_F90853_0_0|SrvcGrp|75545|2022|PDM|551.00|99|0.00|SUB-ACUTE - LEVEL I AND II
20|FH_F90940_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F90958_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F90958_0_0|CSTM-ALL|CSTM-00|2020|PCT|36500.00|99|0.00|TIMELY FILING
20|FH_F91034_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F91034_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F91039_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F91039_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|AEG 10 (NO REV)
20|FH_F91039_0_0|CSTM-ALL|CSTM-00|2020|PDM|867.00|99|0.00|AEG 6 (NO REV)
20|FH_F91039_0_0|SrvcGrp|86863|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F91067_0_0|SrvcGrp|72992|2022|PDM|547.00|99|0.00|AEG 2
20|FH_F91067_0_0|SrvcGrp|72996|2022|PDM|779.00|99|0.00|AEG 4
20|FH_F91067_0_0|SrvcGrp|73008|2022|PDM|884.00|99|0.00|AEG 10
20|FH_F91111_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F91171_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F91171_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F91171_0_0|CSTM-ALL|CSTM-00|2020|PDM|1235.00|99|0.00|AEG 7 (NO REV)
20|FH_F91171_0_0|CSTM-ALL|CSTM-00|2020|PDM|507.00|99|0.00|AEG 2 (NO REV)
20|FH_F91171_0_0|SrvcGrp|36864|2022|PDM|5665.00|99|0.00|COCHLEAR IMPLANTS
20|FH_F91171_0_0|SrvcGrp|77582|2022|PDM|1242.00|99|0.00|CPT 31255
20|FH_F91171_0_0|SrvcGrp|79101|2022|PDM|783.00|99|0.00|AETNA NASAL ENDOSCOPY
20|FH_F91171_0_0|SrvcGrp|90822|2022|PDM|783.00|99|0.00|NASAL/SINUS ENDOSCOPY SURGERY
20|FH_F91216_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F91258_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F91258_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F91259_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F91259_0_0|CSTM-ALL|CSTM-00|2020|PDM|1364.00|99|0.00|AEG 2 (NO REV)
20|FH_F91259_0_0|CSTM-ALL|CSTM-00|2020|PDM|909.00|99|0.00|AEG 1 (NO REV)
20|FH_F91284_0_0|CSTM-ALL|CSTM-00|2020|PDM|1192.00|99|0.00|AEG 2 (NO REV)
20|FH_F91284_0_0|CSTM-ALL|CSTM-00|2020|PDM|1738.00|99|0.00|AEG 4 (NO REV)
20|FH_F91284_0_0|CSTM-ALL|CSTM-00|2020|PDM|2284.00|99|0.00|AEG 6 (NO REV)
20|FH_F91284_0_0|CSTM-ALL|CSTM-00|2020|PDM|2780.00|99|0.00|AEG 7 (NO REV)
20|FH_F91284_0_0|CSTM-ALL|CSTM-00|2020|PDM|3774.00|99|0.00|AEG 9 (NO REV)
20|FH_F91313_0_0|CSTM-ALL|CSTM-00|2020|PCT|99.00|99|0.00|GENERAL ACUTE CARE
20|FH_F91331_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F91331_0_0|CSTM-ALL|CSTM-00|2020|PDM|534.54|99|0.00|ASPG II
20|FH_F91331_0_0|CSTM-ALL|CSTM-00|2020|PDM|611.24|99|0.00|ASPG III
20|FH_F91331_0_0|CSTM-ALL|CSTM-00|2020|PDM|859.34|99|0.00|ASPG V
20|FH_F91332_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F91332_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|COVENTRY ENHANCED GROUPER 1
20|FH_F91332_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|COVENTRY ENHANCED GROUPER 10
20|FH_F91332_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|COVENTRY ENHANCED GROUPER 3
20|FH_F91332_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|COVENTRY ENHANCED GROUPER 6
20|FH_F91332_0_0|CSTM-ALL|CSTM-00|2020|PDM|973.00|99|0.00|COVENTRY ENHANCED GROUPER 8
20|FH_F91332_0_0|SrvcGrp|28818|2022|PCT|1.10|99|0.00|SUPPLIES AND DEVICES
20|FH_F91412_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F91412_0_0|CSTM-ALL|CSTM-00|2020|PDM|1149.00|99|0.00|AEG 4 (NO REV)
20|FH_F91412_0_0|CSTM-ALL|CSTM-00|2020|PDM|1534.30|99|0.00|AEG 9 (NO REV)
20|FH_F91412_0_0|CSTM-ALL|CSTM-00|2020|PDM|1724.18|99|0.00|AEG 10 (NO REV)
20|FH_F91412_0_0|CSTM-ALL|CSTM-00|2020|PDM|1790.71|99|0.00|AEG 8 (NO REV)
20|FH_F91412_0_0|SrvcGrp|84912|2022|PDM|3934.70|99|0.00|PERQ VERTEBRAL AUGMENTATION
20|FH_F91412_0_0|SrvcGrp|87062|2022|PDM|861.30|99|0.00|REVISE ULNAR NERVE AT ELBOW
20|FH_F91412_0_0|SrvcGrp|99073|2022|PDM|1.38|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F91575_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F91575_0_0|CSTM-ALL|CSTM-00|2020|PDM|1473.00|99|0.00|AEG 9 (NO REV)
20|FH_F91575_0_0|CSTM-ALL|CSTM-00|2020|PDM|366.00|99|0.00|AEG 1 (NO REV)
20|FH_F91575_0_0|CSTM-ALL|CSTM-00|2020|PDM|366.00|99|0.00|AEG 10 (NO REV)
20|FH_F91575_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|AEG 3 (NO REV)
20|FH_F91594_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F91617_0_0|SrvcGrp|82981|2022|PDM|240.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F91617_0_0|SrvcGrp|91418|2022|PDM|500.00|99|0.00|PROLONGED SERVICE (MOD 25)
20|FH_F91632_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F91632_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F91634_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F91634_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|AEG 6 (NO REV)
20|FH_F91634_0_0|CSTM-ALL|CSTM-00|2020|PDM|1560.00|99|0.00|AEG 8 (NO REV)
20|FH_F91634_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|AEG 10 (NO REV)
20|FH_F91634_0_0|SrvcGrp|44461|2022|PDM|17486.00|99|0.00|INSERTION / REPLACEMENT OF SPINAL NEUROSTIMULATOR GENERATOR
20|FH_F91634_0_0|SrvcGrp|93759|2022|PCT|0.00|99|0.00|CARDIAC CATH
20|FH_F91641_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|IMPLANTS CARVE OUT
20|FH_F91641_0_0|CSTM-ALL|CSTM-00|2020|PDM|1456.56|99|0.00|DEVICE INSERTION
20|FH_F91641_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F91641_0_0|SrvcGrp|26281|2022|PDM|3953.52|99|0.00|CPT 58353
20|FH_F91641_0_0|SrvcGrp|65623|2022|PDM|4785.84|99|0.00|HYSTEROSCOPY
20|FH_F91641_0_0|SrvcGrp|87201|2022|PDM|3121.20|99|0.00|AETNA HIGH COST SURGERY - CATARACT
20|FH_F91641_0_0|SrvcGrp|91454|2022|PDM|988.38|99|0.00|PLACEMENT OF AMNIOTIC MEMBRANE ON OCULAR SURFACE
20|FH_F91641_0_0|SrvcGrp|91458|2022|PDM|1872.72|99|0.00|OCULAR SURFACE RECONSTRUCTION
20|FH_F91641_0_0|SrvcGrp|91461|2022|PDM|2705.04|99|0.00|INTRAOCULAR LENS PROSTHESIS
20|FH_F91752_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE
20|FH_F91752_0_0|SrvcGrp|11442|2022|PDM|514.15|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)
20|FH_F91752_0_0|SrvcGrp|3327|2022|PDM|119.56|99|0.00|HOSPICE SERVICE - IP RESPITE
20|FH_F91752_0_0|SrvcGrp|80098|2022|PDM|28.11|99|0.00|AETNA HOSPICE CONTINUOUS HOME CARE
20|FH_F91772_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F91772_0_0|SrvcGrp|72992|2022|PDM|641.00|99|0.00|AEG 2
20|FH_F91787_0_0|CSTM-ALL|CSTM-00|2020|PDM|467.00|99|0.00|AEG 1 (NO REV)
20|FH_F91787_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AEG 2 (NO REV)
20|FH_F91819_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|COVENTRY ENHANCED GROUPER 7
20|FH_F91835_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|OP SVCS
20|FH_F91876_0_0|SrvcGrp|28549|2022|PDM|2100.00|99|0.00|VITRECTOMY
20|FH_F91876_0_0|SrvcGrp|33967|2022|PDM|2925.00|99|0.00|CPT 47562
20|FH_F91876_0_0|SrvcGrp|65403|2022|PDM|2645.00|99|0.00|CPT 42830
20|FH_F91876_0_0|SrvcGrp|72996|2022|PDM|1691.00|99|0.00|AEG 4
20|FH_F91876_0_0|SrvcGrp|83646|2022|PDM|2345.00|99|0.00|CPT 31276
20|FH_F91876_0_0|SrvcGrp|89569|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F91876_0_0|SrvcGrp|89882|2022|PDM|2645.00|99|0.00|AETNA REMOVAL OF TONSILS
20|FH_F91876_0_0|SrvcGrp|90822|2022|PDM|2345.00|99|0.00|NASAL/SINUS ENDOSCOPY SURGERY
20|FH_F91898_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F91898_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F91898_0_0|CSTM-ALL|CSTM-00|2020|PDM|14813.00|99|0.00|AEG 8 (NO REV)
20|FH_F91898_0_0|CSTM-ALL|CSTM-00|2020|PDM|6482.00|99|0.00|AEG 2 (NO REV)
20|FH_F91898_0_0|CSTM-ALL|CSTM-00|2020|PDM|7500.00|99|0.00|AETNA MEDICAL CARE MS DRG
20|FH_F91898_0_0|SrvcGrp|12670|2022|PCT|0.72|99|0.00|IMPLANTS/PROSTHETICS/DEVICES
20|FH_F91898_0_0|SrvcGrp|14727|2022|PCT|0.95|99|0.00|TRAUMA CARE
20|FH_F91898_0_0|SrvcGrp|3987|2022|PCT|0.95|99|0.00|TRAUMA CARE
20|FH_F91898_0_0|SrvcGrp|60112|2022|PDM|9662.00|99|0.00|ICU/CCU 200-203, 208-213, 219
20|FH_F91898_0_0|SrvcGrp|91657|2022|PDM|9373.00|99|0.00|AETNA MATERNITY CARE (C- SECTION)
20|FH_F91900_0_0|CSTM-ALL|CSTM-00|2020|PDM|675.00|99|0.00|COVENTRY ENHANCED GROUPER 4
20|FH_F91900_0_0|CSTM-ALL|CSTM-00|2020|PDM|770.00|99|0.00|COVENTRY ENHANCED GROUPER 5
20|FH_F91912_0_0|SrvcGrp|72602|2022|PDM|431.00|99|0.00|ECT
20|FH_F91913_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|DEVICE INSERTION
20|FH_F91913_0_0|SrvcGrp|72990|2022|PDM|333.00|99|0.00|AEG 1
20|FH_F91913_0_0|SrvcGrp|72992|2022|PDM|446.00|99|0.00|AEG 2
20|FH_F91913_0_0|SrvcGrp|72996|2022|PDM|630.00|99|0.00|AEG 4
20|FH_F91913_0_0|SrvcGrp|73004|2022|PDM|1200.00|99|0.00|AEG 8
20|FH_F91913_0_0|SrvcGrp|77507|2022|PCT|1.00|99|0.00|AETNA CORNEAL TISSUE HANDLING
20|FH_F91913_0_0|SrvcGrp|79937|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F91933_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F91933_0_0|SrvcGrp|10391|2022|PDM|1300.00|99|0.00|ACUTE MEDICAL & SURGICAL
20|FH_F91933_0_0|SrvcGrp|73483|2022|PDM|500.00|99|0.00|AETNA SUBACUTE III
20|FH_F91933_0_0|SrvcGrp|73606|2022|PDM|350.00|99|0.00|AETNA SKILLED NURSING CARE
20|FH_F91940_0_0|CSTM-ALL|CSTM-00|2020|PDM|1197.00|99|0.00|AEG 4 (NO REV)
20|FH_F91940_0_0|CSTM-ALL|CSTM-00|2020|PDM|1362.00|99|0.00|AEG 5  (NO REV)
20|FH_F91940_0_0|CSTM-ALL|CSTM-00|2020|PDM|2544.00|99|0.00|AEG 9 (NO REV)
20|FH_F91940_0_0|CSTM-ALL|CSTM-00|2020|PDM|969.00|99|0.00|AEG 3 (NO REV)
20|FH_F91940_0_0|SrvcGrp|86919|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH INCIDENTAL CODES
20|FH_F91940_0_0|SrvcGrp|91864|2022|PCT|1.25|99|0.00|IMPLANTS
20|FH_F91973_0_0|SrvcGrp|90376|2022|PDM|10197.00|99|0.00|REVISION OF KNEE JOINTLANT
20|FH_F91973_0_0|SrvcGrp|90436|2022|PDM|10197.00|99|0.00|TOTAL HIP ARTHROPLASTY
20|FH_F91973_0_0|SrvcGrp|91646|2022|PDM|4532.00|99|0.00|AETNA MACON SURGICAL CARVE-OUTS
20|FH_F91975_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F91975_0_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|AEG 9 (NO REV)
20|FH_F91975_0_0|SrvcGrp|91564|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F91975_0_0|SrvcGrp|91860|2022|PDM|611.00|99|0.00|ENDOSCOPY PROCEDURES
20|FH_F91975_0_0|SrvcGrp|91861|2022|PDM|452.00|99|0.00|COLONOSCOPY PROCEDURES
20|FH_F91994_0_0|SrvcGrp|55084|2022|PDM|4712.00|99|0.00|CPT 52648
20|FH_F91994_0_0|SrvcGrp|63472|2022|PDM|4800.00|99|0.00|CPT 64581
20|FH_F91994_0_0|SrvcGrp|72998|2022|PDM|1800.00|99|0.00|AEG 5
20|FH_F91994_0_0|SrvcGrp|73000|2022|PDM|2400.00|99|0.00|AEG 6
20|FH_F91994_0_0|SrvcGrp|73008|2022|PDM|1200.00|99|0.00|AEG 10
20|FH_F91994_0_0|SrvcGrp|77449|2022|PDM|1760.00|99|0.00|CPT 52352
20|FH_F91994_0_0|SrvcGrp|77452|2022|PDM|13245.00|99|0.00|CPT 54405
20|FH_F91994_0_0|SrvcGrp|77461|2022|PDM|2000.00|99|0.00|CPT 52356
20|FH_F91994_0_0|SrvcGrp|91866|2022|PDM|1360.00|99|0.00|AETNA CYSTOSCOPY/VASECTOMY
20|FH_F91998_0_0|SrvcGrp|72992|2022|PDM|481.00|99|0.00|AEG 2
20|FH_F91998_0_0|SrvcGrp|72994|2022|PDM|552.00|99|0.00|AEG 3
20|FH_F91998_0_0|SrvcGrp|72998|2022|PDM|774.00|99|0.00|AEG 5
20|FH_F91998_0_0|SrvcGrp|90427|2022|PDM|6500.00|99|0.00|CERVICAL SPINAL FUSION
20|FH_F91998_0_0|SrvcGrp|91887|2022|PDM|1000.00|99|0.00|SKELETAL FIXATION
20|FH_F91998_0_0|SrvcGrp|91889|2022|PDM|1530.00|99|0.00|ARTHROSCOPY TMJ
20|FH_F91998_0_0|SrvcGrp|91890|2022|PDM|1224.00|99|0.00|KNEE ARTHROSCOPY
20|FH_F92034_0_0|SrvcGrp|107347|2022|PDM|6000.00|99|0.00|IMPLT NEUROSTIM RADIOFQ REC
20|FH_F92034_0_0|SrvcGrp|73000|2022|PDM|1088.00|99|0.00|AEG 6
20|FH_F92034_0_0|SrvcGrp|73008|2022|PDM|831.00|99|0.00|AEG 10
20|FH_F92091_0_0|SrvcGrp|10985|2022|PDM|2800.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F92091_0_0|SrvcGrp|10986|2022|PDM|4200.00|99|0.00|ARTHROSCOPIC KNEE REPAIR
20|FH_F92091_0_0|SrvcGrp|11663|2022|PCT|0.50|99|0.00|IMPLANTS
20|FH_F92091_0_0|SrvcGrp|16289|2022|PDM|1600.00|99|0.00|CARPAL TUNNEL RELEASE
20|FH_F92091_0_0|SrvcGrp|67065|2022|PDM|7650.00|99|0.00|CERVICAL SURGERY
20|FH_F92091_0_0|SrvcGrp|67279|2022|PDM|7650.00|99|0.00|CERVICAL SURGERY
20|FH_F92091_0_0|SrvcGrp|72990|2022|PDM|645.00|99|0.00|AEG 1
20|FH_F92091_0_0|SrvcGrp|73004|2022|PDM|2062.00|99|0.00|AEG 8
20|FH_F92091_0_0|SrvcGrp|77021|2022|PDM|7800.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY
20|FH_F92091_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F92091_0_0|SrvcGrp|89983|2022|PDM|4000.00|99|0.00|KNEE ARTHROSCOPY / SURGERY
20|FH_F92091_0_0|SrvcGrp|89987|2022|PDM|1350.00|99|0.00|CORRECTION OF BUNION
20|FH_F92091_0_0|SrvcGrp|89989|2022|PDM|4000.00|99|0.00|FUSION OF BIG TOE JOINT
20|FH_F92119_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F92119_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F92119_0_0|CSTM-ALL|CSTM-00|2020|PDM|479.00|99|0.00|AEG 10 (NO REV)
20|FH_F92120_0_0|CSTM-ALL|CSTM-00|2020|PDM|1362.00|99|0.00|AEG 5  (NO REV)
20|FH_F92120_0_0|CSTM-ALL|CSTM-00|2020|PDM|1890.00|99|0.00|AEG 10 (NO REV)
20|FH_F92120_0_0|SrvcGrp|92021|2022|PCT|1.25|99|0.00|MISCELLANEOUS IMPLANTS
20|FH_F92129_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F92129_0_0|CSTM-ALL|CSTM-00|2020|PDM|625.00|99|0.00|AEG 2 (NO REV)
20|FH_F92129_0_0|SrvcGrp|74587|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F92174_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F92188_0_0|CSTM-ALL|CSTM-00|2020|PDM|542.00|99|0.00|AEG 1 (NO REV)
20|FH_F92212_0_0|CSTM-ALL|CSTM-00|2020|PDM|332.00|99|0.00|AEG 1 (NO REV)
20|FH_F92212_0_0|CSTM-ALL|CSTM-00|2020|PDM|714.00|99|0.00|AEG 5  (NO REV)
20|FH_F92212_0_0|CSTM-ALL|CSTM-00|2020|PDM|970.00|99|0.00|AEG 8 (NO REV)
20|FH_F92392_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F92392_0_0|SrvcGrp|73485|2022|PDM|3348.00|99|0.00|AETNA REHAB
20|FH_F92392_0_0|SrvcGrp|74581|2022|PCT|0.50|99|0.00|AETNA IP HIGH COST DRUGS
20|FH_F92411_0_0|SrvcGrp|26001|2022|PDM|138.95|99|0.00|HOSPICE RESPITE SVCS
20|FH_F92411_0_0|SrvcGrp|57968|2022|PDM|31.97|99|0.00|CONTINUOUS HOMECARE
20|FH_F92454_0_0|CSTM-ALL|CSTM-00|2020|PDM|1081.60|99|0.00|AEG 4 (NO REV)
20|FH_F92454_0_0|SrvcGrp|14188|2022|PCT|1.05|99|0.00|IMPLANTS
20|FH_F92454_0_0|SrvcGrp|14614|2022|PDM|5000.00|99|0.00|LITHOTRIPSY
20|FH_F92454_0_0|SrvcGrp|21978|2022|PDM|75.00|99|0.00|CPT 77003
20|FH_F92474_0_0|CSTM-ALL|CSTM-00|2020|PDM|504.00|99|0.00|AEG 2 (NO REV)
20|FH_F92474_0_0|CSTM-ALL|CSTM-00|2020|PDM|761.00|99|0.00|AEG 10 (NO REV)
20|FH_F92474_0_0|SrvcGrp|114519|2022|PDM|1050.00|99|0.00|INSERTION DRAINAGE DEVICE
20|FH_F92477_0_0|SrvcGrp|30089|2022|PDM|420.00|99|0.00|HEMODIALYSIS SERVICES
20|FH_F92493_0_0|CSTM-ALL|CSTM-00|2020|PDM|2146.10|99|0.00|AEG 7 (NO REV)
20|FH_F92493_0_0|SrvcGrp|103327|2022|PDM|18504.20|99|0.00|INSJ STABLJ DEV W/DCMPRN
20|FH_F92493_0_0|SrvcGrp|11669|2022|PDM|2989.14|99|0.00|OP SURG
20|FH_F92493_0_0|SrvcGrp|16289|2022|PDM|1949.64|99|0.00|CARPAL TUNNEL RELEASE
20|FH_F92493_0_0|SrvcGrp|26278|2022|PDM|1949.64|99|0.00|CPT 29881
20|FH_F92493_0_0|SrvcGrp|27261|2022|PDM|12999.53|99|0.00|CPT 27446
20|FH_F92493_0_0|SrvcGrp|27315|2022|PDM|2601.06|99|0.00|TENDON REPAIR
20|FH_F92493_0_0|SrvcGrp|33986|2022|PDM|1171.17|99|0.00|CPT 26055
20|FH_F92493_0_0|SrvcGrp|35672|2022|PDM|3640.56|99|0.00|CPT 23412
20|FH_F92493_0_0|SrvcGrp|67068|2022|PDM|23421.20|99|0.00|LUMBAR SPINE FUSION COMBINED
20|FH_F92493_0_0|SrvcGrp|71666|2022|PDM|8110.30|99|0.00|CPT 63655
20|FH_F92493_0_0|SrvcGrp|80617|2022|PDM|12999.53|99|0.00|ARTHOPLASTY
20|FH_F92493_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F92493_0_0|SrvcGrp|88065|2022|PDM|18504.20|99|0.00|TOTAL DISC ARTHROPLASTY
20|FH_F92493_0_0|SrvcGrp|88155|2022|PDM|12999.53|99|0.00|REVISE KNEECAP WITH IMPLANT
20|FH_F92493_0_0|SrvcGrp|89842|2022|PDM|21411.50|99|0.00|LUMBAR
20|FH_F92493_0_0|SrvcGrp|89989|2022|PDM|6239.20|99|0.00|FUSION OF BIG TOE JOINT
20|FH_F92493_0_0|SrvcGrp|92012|2022|PDM|1949.64|99|0.00|EXCISION OF HAND OR FINGER
20|FH_F92493_0_0|SrvcGrp|92358|2022|PDM|15599.43|99|0.00|REMOVAL OF KNEE PROSTHESIS
20|FH_F92493_0_0|SrvcGrp|92361|2022|PDM|12999.53|99|0.00|TREAT PELVIC RING FRACTURE
20|FH_F92493_0_0|SrvcGrp|92364|2022|PDM|12999.53|99|0.00|ARTHRODESIS SACROILIAC JOINT
20|FH_F92493_0_0|SrvcGrp|92367|2022|PDM|2601.06|99|0.00|TRANSPLANT HAND TENDON
20|FH_F92493_0_0|SrvcGrp|97741|2022|PDM|16193.10|99|0.00|REVISE KNEE
20|FH_F92493_0_0|SrvcGrp|99073|2022|PDM|1.42|99|0.00|INJ BUPIVACAINE LIPOSOME
20|FH_F92516_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F92516_0_0|SrvcGrp|72992|2022|PDM|475.00|99|0.00|AEG 2
20|FH_F92516_0_0|SrvcGrp|73000|2022|PDM|840.00|99|0.00|AEG 6
20|FH_F92516_0_0|SrvcGrp|73004|2022|PDM|989.00|99|0.00|AEG 8
20|FH_F92531_0_0|SrvcGrp|67065|2022|PDM|11275.00|99|0.00|CERVICAL SURGERY
20|FH_F92531_0_0|SrvcGrp|74585|2022|PCT|1.10|99|0.00|AETNA OP IMPLANTS
20|FH_F92531_0_0|SrvcGrp|89989|2022|PDM|3721.00|99|0.00|FUSION OF BIG TOE JOINT
20|FH_F92531_0_0|SrvcGrp|92193|2022|PDM|2199.00|99|0.00|CORRECTION OF BUNION - INCISION METATARSAL
20|FH_F92599_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F92600_0_0|CSTM-ALL|CSTM-00|2020|PDM|1270.00|99|0.00|AEG 2 (NO REV)
20|FH_F92600_0_0|CSTM-ALL|CSTM-00|2020|PDM|371.00|99|0.00|AEG 10 (NO REV)
20|FH_F92600_0_0|CSTM-ALL|CSTM-00|2020|PDM|588.00|99|0.00|AEG 1 (NO REV)
20|FH_F92618_0_0|SrvcGrp|26001|2022|PDM|143.06|99|0.00|HOSPICE RESPITE SVCS
20|FH_F92655_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F92655_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F92659_0_0|CSTM-ALL|CSTM-00|2020|PDM|1063.00|99|0.00|AEG 6 (NO REV)
20|FH_F92659_0_0|CSTM-ALL|CSTM-00|2020|PDM|1252.00|99|0.00|AEG 8 (NO REV)
20|FH_F92659_0_0|CSTM-ALL|CSTM-00|2020|PDM|1273.00|99|0.00|AEG 7 (NO REV)
20|FH_F92659_0_0|CSTM-ALL|CSTM-00|2020|PDM|806.00|99|0.00|AEG 4 (NO REV)
20|FH_F92659_0_0|CSTM-ALL|CSTM-00|2020|PDM|917.00|99|0.00|AEG 5  (NO REV)
20|FH_F92659_0_0|SrvcGrp|68282|2022|PDM|1485.00|99|0.00|CPT 67042
20|FH_F92659_0_0|SrvcGrp|68284|2022|PDM|1800.00|99|0.00|CPT 67113
20|FH_F92659_0_0|SrvcGrp|86863|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F92659_0_0|SrvcGrp|92542|2022|PDM|806.00|99|0.00|REVISION OF EYELID
20|FH_F92716_0_0|SrvcGrp|82301|2022|PDM|274.00|99|0.00|HEMORRHOIDECTOMY
20|FH_F92716_0_0|SrvcGrp|92561|2022|PDM|465.00|99|0.00|AETNA AEG 1 GASTROINTESTINAL INSTITUTE
20|FH_F92792_0_0|CSTM-ALL|CSTM-00|2020|PDM|1870.00|99|0.00|AEG 7 (NO REV)
20|FH_F92792_0_0|CSTM-ALL|CSTM-00|2020|PDM|557.70|99|0.00|AEG 1 (NO REV)
20|FH_F92792_0_0|SrvcGrp|28549|2022|PDM|2200.00|99|0.00|VITRECTOMY
20|FH_F92792_0_0|SrvcGrp|92659|2022|PDM|880.00|99|0.00|REPAIR OF RETINAL DETACHMENT
20|FH_F92833_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F92833_0_0|CSTM-ALL|CSTM-00|2020|PDM|1080.00|99|0.00|AEG 3 (NO REV)
20|FH_F92833_0_0|CSTM-ALL|CSTM-00|2020|PDM|2105.00|99|0.00|AEG 7 (NO REV)
20|FH_F92833_0_0|CSTM-ALL|CSTM-00|2020|PDM|2831.00|99|0.00|AEG 9 (NO REV)
20|FH_F92833_0_0|CSTM-ALL|CSTM-00|2020|PDM|705.00|99|0.00|AEG 1 (NO REV)
20|FH_F92833_0_0|CSTM-ALL|CSTM-00|2020|PDM|943.00|99|0.00|AEG 2 (NO REV)
20|FH_F92833_0_0|SrvcGrp|11673|2022|PDM|2215.00|99|0.00|CPT 29888
20|FH_F92833_0_0|SrvcGrp|26274|2022|PDM|2215.00|99|0.00|CPT 29877
20|FH_F92833_0_0|SrvcGrp|26275|2022|PDM|2215.00|99|0.00|CPT 29826
20|FH_F92833_0_0|SrvcGrp|26278|2022|PDM|2215.00|99|0.00|CPT 29881
20|FH_F92833_0_0|SrvcGrp|41336|2022|PDM|2215.00|99|0.00|VAGINAL HYSTERECTOMY
20|FH_F92833_0_0|SrvcGrp|84278|2022|PDM|2992.00|99|0.00|CORNEAL TRANSPLANT
20|FH_F92852_0_0|CSTM-ALL|CSTM-00|2020|PDM|1054.90|99|0.00|AETNA GLENNVILLE 2016 AEG 4
20|FH_F92852_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F92852_0_0|SrvcGrp|28548|2022|PDM|1320.00|99|0.00|VITRECTOMY
20|FH_F92852_0_0|SrvcGrp|28549|2022|PDM|2200.00|99|0.00|VITRECTOMY
20|FH_F92852_0_0|SrvcGrp|38907|2022|PDM|1320.00|99|0.00|CPT 66170 - FISTULIZATION OF SCLERA FOR GLAUCOMA
20|FH_F92852_0_0|SrvcGrp|45583|2022|PDM|2200.00|99|0.00|CPT 65730
20|FH_F92852_0_0|SrvcGrp|82570|2022|PDM|1045.00|99|0.00|REVISION EYELID/EXCESS SKIN
20|FH_F92852_0_0|SrvcGrp|92659|2022|PDM|880.00|99|0.00|REPAIR OF RETINAL DETACHMENT
20|FH_F92871_0_0|CSTM-ALL|CSTM-00|2020|PDM|1008.00|99|0.00|AEG 6 (NO REV)
20|FH_F92871_0_0|CSTM-ALL|CSTM-00|2020|PDM|1040.00|99|0.00|AEG 5  (NO REV)
20|FH_F92871_0_0|CSTM-ALL|CSTM-00|2020|PDM|763.00|99|0.00|AEG 10 (NO REV)
20|FH_F92871_0_0|SrvcGrp|89239|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F92912_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F92912_0_0|CSTM-ALL|CSTM-00|2020|PCT|76.00|99|0.00|GENERAL ACUTE CARE
20|FH_F92931_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F92935_0_0|CSTM-ALL|CSTM-00|2020|PDM|436.00|99|0.00|AEG 1 (NO REV)
20|FH_F92935_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F92959_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F92964_0_0|SrvcGrp|16|2022|PDM|1375.00|99|0.00|ACUTE REHABILITATION
20|FH_F92964_0_0|SrvcGrp|79720|2022|PDM|1375.00|99|0.00|ACUTE REHAB II
20|FH_F92972_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.63|99|0.00|OP SVCS
20|FH_F92972_0_0|SrvcGrp|78504|2022|PCT|0.63|99|0.00|AETNA CARDIAC CATHETERIZATION
20|FH_F92972_0_0|SrvcGrp|79699|2022|PCT|0.63|99|0.00|CARDIAC CATHETERIZATION INJECTIONS
20|FH_F92972_0_0|SrvcGrp|82137|2022|PCT|0.63|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F92993_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F92993_0_0|CSTM-ALL|CSTM-00|2020|PDM|134.32|99|0.00|SLEEP STUDY CPT 95806 W/O MOD 26 & TC
20|FH_F92993_0_0|CSTM-ALL|CSTM-00|2020|PDM|143.85|99|0.00|AETNA SLEEP STUDY
20|FH_F92993_0_0|CSTM-ALL|CSTM-00|2020|PDM|143.85|99|0.00|SLEEP STUDY CPT 95800
20|FH_F92993_0_0|CSTM-ALL|CSTM-00|2020|PDM|180.00|99|0.00|AETNA-HME SLP TEST/TYPE III (W/O MOD 26 & TC)
20|FH_F92993_0_0|CSTM-ALL|CSTM-00|2020|PDM|336.08|99|0.00|AETNA SLEEP STUDIES W/O MOD 26 & TC
20|FH_F92993_0_0|CSTM-ALL|CSTM-00|2020|PDM|481.86|99|0.00|AETNA SLEEP STUDIES W/O MOD 26 & TC
20|FH_F92993_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AETNA SLEEP STUDIES
20|FH_F92993_0_0|SrvcGrp|92838|2022|PDM|117.00|99|0.00|AETNA SLEEP STUDY (MOD TC)
20|FH_F93000_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE
20|FH_F93000_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS
20|FH_F93119_0_0|SrvcGrp|592|2022|PDM|1032.08|99|0.00|SUB-ACUTE CARE
20|FH_F93136_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F93136_0_0|SrvcGrp|72990|2022|PDM|333.00|99|0.00|AEG 1
20|FH_F93136_0_0|SrvcGrp|72994|2022|PDM|510.00|99|0.00|AEG 3
20|FH_F93136_0_0|SrvcGrp|73000|2022|PDM|826.00|99|0.00|AEG 6
20|FH_F93136_0_0|SrvcGrp|73002|2022|PDM|995.00|99|0.00|AEG 7
20|FH_F93136_0_0|SrvcGrp|78045|2022|PCT|1.00|99|0.00|AETNA AMNIOTIC MEMBRANE
20|FH_F93138_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F93138_0_0|SrvcGrp|87077|2022|PDM|105.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F93172_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F93212_0_0|CSTM-ALL|CSTM-00|2020|PDM|1073.00|99|0.00|AEG 2 (NO REV)
20|FH_F93212_0_0|CSTM-ALL|CSTM-00|2020|PDM|1461.00|99|0.00|AEG 4 (NO REV)
20|FH_F93212_0_0|CSTM-ALL|CSTM-00|2020|PDM|2384.00|99|0.00|AEG 10 (NO REV)
20|FH_F93212_0_0|CSTM-ALL|CSTM-00|2020|PDM|2384.00|99|0.00|AEG 5  (NO REV)
20|FH_F93212_0_0|CSTM-ALL|CSTM-00|2020|PDM|3098.00|99|0.00|AEG 9 (NO REV)
20|FH_F93232_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F93232_0_0|SrvcGrp|42782|2022|PDM|45.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F93232_0_0|SrvcGrp|474|2022|PDM|235.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F93237_0_0|SrvcGrp|82981|2022|PDM|184.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F93252_0_0|CSTM-ALL|CSTM-00|2020|PDM|1290.00|99|0.00|AEG 10 (NO REV) 2016 BRANDON ASC
20|FH_F93252_0_0|CSTM-ALL|CSTM-00|2020|PDM|2316.00|99|0.00|AEG 9 (NO REV) 2016 BRANDON ASC
20|FH_F93252_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 1 (NO REV) 2016 BRANDON ASC
20|FH_F93252_0_0|SrvcGrp|58636|2022|PDM|2500.00|99|0.00|CPT 62362
20|FH_F93252_0_0|SrvcGrp|89569|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F93252_0_0|SrvcGrp|93016|2022|PDM|2500.00|99|0.00|HIP ARTHRO W/ FEMOROPLASTY
20|FH_F93252_0_0|SrvcGrp|93021|2022|PDM|4700.00|99|0.00|CERVICAL LAMINECTOMY
20|FH_F93252_0_0|SrvcGrp|93029|2022|PDM|2000.00|99|0.00|GYN SURGICAL PROCEDURES
20|FH_F93268_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F93275_0_0|CSTM-ALL|CSTM-00|2020|PDM|1343.00|99|0.00|AEG 3 (NO REV)
20|FH_F93275_0_0|CSTM-ALL|CSTM-00|2020|PDM|2096.00|99|0.00|AEG 5  (NO REV)
20|FH_F93275_0_0|CSTM-ALL|CSTM-00|2020|PDM|8910.00|99|0.00|AEG 9 (NO REV)
20|FH_F93275_0_0|SrvcGrp|11663|2022|PCT|1.05|99|0.00|IMPLANTS
20|FH_F93275_0_0|SrvcGrp|89569|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F93279_0_0|CSTM-ALL|CSTM-00|2020|PDM|1125.00|99|0.00|AEG 8 (NO REV)
20|FH_F93279_0_0|CSTM-ALL|CSTM-00|2020|PDM|806.00|99|0.00|AEG 10 (NO REV)
20|FH_F93281_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F93281_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F93281_0_0|CSTM-ALL|CSTM-00|2020|PDM|430.00|99|0.00|AEG 1 (NO REV)
20|FH_F93281_0_0|CSTM-ALL|CSTM-00|2020|PDM|430.00|99|0.00|AEG 4 (NO REV)
20|FH_F93281_0_0|CSTM-ALL|CSTM-00|2020|PDM|430.00|99|0.00|AEG 6 (NO REV)
20|FH_F93281_0_0|CSTM-ALL|CSTM-00|2020|PDM|430.00|99|0.00|AEG 7 (NO REV)
20|FH_F93281_0_0|CSTM-ALL|CSTM-00|2020|PDM|430.00|99|0.00|AEG 8 (NO REV)
20|FH_F93331_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F93331_0_0|CSTM-ALL|CSTM-00|2020|PDM|1442.00|99|0.00|AEG 3 (NO REV)
20|FH_F93331_0_0|CSTM-ALL|CSTM-00|2020|PDM|1854.00|99|0.00|AEG 4 (NO REV)
20|FH_F93331_0_0|CSTM-ALL|CSTM-00|2020|PDM|927.00|99|0.00|AEG 1 (NO REV)
20|FH_F93331_0_0|CSTM-ALL|CSTM-00|2020|PDM|927.00|99|0.00|AEG 10 (NO REV)
20|FH_F93332_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F93332_0_0|CSTM-ALL|CSTM-00|2020|PDM|1030.00|99|0.00|AEG 5  (NO REV)
20|FH_F93332_0_0|CSTM-ALL|CSTM-00|2020|PDM|670.00|99|0.00|AEG 2 (NO REV)
20|FH_F93332_0_0|SrvcGrp|67072|2022|PDM|2295.00|99|0.00|CPT 22845
20|FH_F93332_0_0|SrvcGrp|67119|2022|PDM|7416.00|99|0.00|ARTHODESIS
20|FH_F93332_0_0|SrvcGrp|74039|2022|PDM|6695.00|99|0.00|LAMINECTOMY
20|FH_F93332_0_0|SrvcGrp|77021|2022|PDM|7725.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY
20|FH_F93332_0_0|SrvcGrp|88159|2022|PDM|6386.00|99|0.00|LOW BACK DISK SURGERY
20|FH_F93332_0_0|SrvcGrp|88164|2022|PDM|7416.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR
20|FH_F93332_0_0|SrvcGrp|88760|2022|PDM|7416.00|99|0.00|CERVICAL ARTHRODESIS
20|FH_F93332_0_0|SrvcGrp|91564|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F93332_0_0|SrvcGrp|93061|2022|PDM|3090.00|99|0.00|PERQ CERVICOTHORACIC INJECTION
20|FH_F93332_0_0|SrvcGrp|93074|2022|PDM|2295.00|99|0.00|INSERT SPINE FIXATION DEVICE (HCFA)
20|FH_F93332_0_0|SrvcGrp|93076|2022|PDM|2096.00|99|0.00|AETNA SPINAL BONE AUTOGRAFT (HCFA)
20|FH_F93332_0_0|SrvcGrp|93078|2022|PDM|7416.00|99|0.00|CERVICAL ARTHRODESIS (HCFA)
20|FH_F93332_0_0|SrvcGrp|93084|2022|PDM|6386.00|99|0.00|LOW BACK DISK SURGERY (HCFA)
20|FH_F93332_0_0|SrvcGrp|93088|2022|PDM|6695.00|99|0.00|LAMINECTOMY (HCFA)
20|FH_F93332_0_0|SrvcGrp|93091|2022|PDM|7416.00|99|0.00|AETNA TRANSPEDICULAR 1 SEGLUMBAR (HCFA)
20|FH_F93333_0_0|CSTM-ALL|CSTM-00|2020|PDM|1270.00|99|0.00|AEG 5  (NO REV)
20|FH_F93333_0_0|CSTM-ALL|CSTM-00|2020|PDM|1405.00|99|0.00|AEG 6 (NO REV)
20|FH_F93333_0_0|CSTM-ALL|CSTM-00|2020|PDM|1694.00|99|0.00|AEG 7 (NO REV)
20|FH_F93333_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F93371_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F93375_0_0|SrvcGrp|72990|2022|PDM|349.00|99|0.00|AEG 1
20|FH_F93375_0_0|SrvcGrp|72994|2022|PDM|535.00|99|0.00|AEG 3
20|FH_F93375_0_0|SrvcGrp|72996|2022|PDM|661.00|99|0.00|AEG 4
20|FH_F93375_0_0|SrvcGrp|73000|2022|PDM|945.00|99|0.00|AEG 6
20|FH_F93375_0_0|SrvcGrp|73002|2022|PDM|1044.00|99|0.00|AEG 7
20|FH_F93375_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F93377_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F93377_0_0|SrvcGrp|90478|2022|PDM|120.00|99|0.00|HOSPICE
20|FH_F93384_0_0|SrvcGrp|42782|2022|PDM|45.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F93413_0_0|SrvcGrp|3809|2022|PDM|531.96|99|0.00|HOSPICE CARE
20|FH_F93421_0_0|SrvcGrp|76094|2022|PDM|132.57|99|0.00|HOSPICE ROUTINE HOME CARE
20|FH_F93512_0_0|CSTM-ALL|CSTM-00|2020|PDM|1406.00|99|0.00|AEG 9 (NO REV)
20|FH_F93512_0_0|CSTM-ALL|CSTM-00|2020|PDM|662.00|99|0.00|AEG 4 (NO REV)
20|FH_F93512_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F93517_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.61|99|0.00|AEG 10 (NO REV)
20|FH_F93517_0_0|CSTM-ALL|CSTM-00|2020|PDM|1407.00|99|0.00|AEG 5  (NO REV)
20|FH_F93517_0_0|CSTM-ALL|CSTM-00|2020|PDM|935.00|99|0.00|AEG 2 (NO REV)
20|FH_F93561_0_0|SrvcGrp|82981|2022|PDM|90.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F93592_0_0|CSTM-ALL|CSTM-00|2020|PDM|693.00|99|0.00|AEG 4 (NO REV)
20|FH_F93592_0_0|CSTM-ALL|CSTM-00|2020|PDM|789.00|99|0.00|AEG 5  (NO REV)
20|FH_F93740_0_0|SrvcGrp|44664|2022|PDM|1700.00|99|0.00|CPT 93505
20|FH_F93740_0_0|SrvcGrp|79867|2022|PDM|2700.00|99|0.00|VENA CAVA FILTER INSERTION/ADJUSTMENT
20|FH_F93740_0_0|SrvcGrp|91578|2022|PDM|3000.00|99|0.00|CENTRAL VENOUS ACCESS
20|FH_F93740_0_0|SrvcGrp|91579|2022|PDM|2100.00|99|0.00|AV FISTULA / GRAFT
20|FH_F93740_0_0|SrvcGrp|91580|2022|PDM|2500.00|99|0.00|EVAT
20|FH_F93740_0_0|SrvcGrp|91584|2022|PDM|8800.00|99|0.00|PTCA W/ DRUG ELUDING STENT (DES)
20|FH_F93740_0_0|SrvcGrp|91589|2022|PDM|7500.00|99|0.00|INSERTION NEEDLE OR INTRACATHETER ARTERIAL
20|FH_F93740_0_0|SrvcGrp|91592|2022|PDM|15300.00|99|0.00|PACING IMPLANTABLE CARDIODEFIBRILLATOR
20|FH_F93786_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F93786_0_0|CSTM-ALL|CSTM-00|2020|PCT|76.00|99|0.00|OP SVCS
20|FH_F93791_0_0|CSTM-ALL|CSTM-00|2020|PDM|3675.00|99|0.00|AEG 6 (NO REV)
20|FH_F93791_0_0|SrvcGrp|36591|2022|PDM|1260.00|99|0.00|CPT 63685
20|FH_F93791_0_0|SrvcGrp|84939|2022|PDM|4200.00|99|0.00|SHOULDER JOINT
20|FH_F93791_0_0|SrvcGrp|93432|2022|PDM|4200.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT
20|FH_F93791_0_0|SrvcGrp|93596|2022|PDM|4200.00|99|0.00|SHOULDER JOINT(HCFA)
20|FH_F93791_0_0|SrvcGrp|93599|2022|PDM|4200.00|99|0.00|PARTIAL HIP REPLACEMENT(HCFA)
20|FH_F93791_0_0|SrvcGrp|93601|2022|PDM|4200.00|99|0.00|REVISON OF KNEE JOINT(HCFA)
20|FH_F93791_0_0|SrvcGrp|93603|2022|PDM|3675.00|99|0.00|CERVICAL SURGERY(HCFA)
20|FH_F93791_0_0|SrvcGrp|93605|2022|PDM|1050.00|99|0.00|CERVICAL SURGERY(HCFA)
20|FH_F93805_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F93946_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE
20|FH_F93946_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS
20|FH_F93948_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F93961_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F93961_0_0|CSTM-ALL|CSTM-00|2020|PDM|335.00|99|0.00|AEG 1 (NO REV)
20|FH_F93961_0_0|CSTM-ALL|CSTM-00|2020|PDM|780.00|99|0.00|AEG 6 (NO REV)
20|FH_F93961_0_0|SrvcGrp|86863|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F93961_0_0|SrvcGrp|91860|2022|PDM|611.00|99|0.00|ENDOSCOPY PROCEDURES
20|FH_F94100_0_0|CSTM-ALL|CSTM-00|2020|PCT|54.00|99|0.00|GENERAL ACUTE CARE
20|FH_F94102_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|PROFESSIONAL SERVICES (CMS-1500)
20|FH_F94165_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|AEG 1 (NO REV)
20|FH_F94165_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|AEG 4 (NO REV)
20|FH_F94165_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE
20|FH_F94165_0_0|SrvcGrp|73501|2022|PCT|0.85|99|0.00|AETNA OBSERVATION
20|FH_F94165_0_0|SrvcGrp|73601|2022|PCT|0.85|99|0.00|AETNA INTERMEDIATE ICU/CCU
20|FH_F94165_0_0|SrvcGrp|73605|2022|PCT|0.85|99|0.00|AETNA ACUTE PSYCH
20|FH_F94165_0_0|SrvcGrp|76257|2022|PCT|0.85|99|0.00|CARDIAC STUDIES
20|FH_F94165_0_0|SrvcGrp|78377|2022|PCT|0.85|99|0.00|AETNA IP DETOX (BHIPDETOX)
20|FH_F94165_0_0|SrvcGrp|80988|2022|PCT|0.85|99|0.00|AETNA MATERNITY DELIVERY
20|FH_F94165_0_0|SrvcGrp|84809|2022|PCT|0.85|99|0.00|AETNA OP RADIOLOGY (RADHCPC)
20|FH_F94165_0_0|SrvcGrp|85570|2022|PCT|0.85|99|0.00|AETNA HOSPITAL OP DIALYSIS
20|FH_F94165_0_0|SrvcGrp|85757|2022|PCT|0.85|99|0.00|PT OT ST
20|FH_F94280_0_0|CSTM-ALL|CSTM-00|2020|PDM|1925.00|99|0.00|AEG 9 (NO REV)
20|FH_F94300_0_0|CSTM-ALL|CSTM-00|2020|PDM|1995.00|99|0.00|AEG 3 (NO REV)
20|FH_F94300_0_0|CSTM-ALL|CSTM-00|2020|PDM|2205.00|99|0.00|AEG 4 (NO REV)
20|FH_F94300_0_0|SrvcGrp|11673|2022|PDM|3360.00|99|0.00|CPT 29888
20|FH_F94300_0_0|SrvcGrp|27261|2022|PDM|4200.00|99|0.00|CPT 27446
20|FH_F94300_0_0|SrvcGrp|88354|2022|PDM|1155.00|99|0.00|CPT 63685 (HCFA)
20|FH_F94300_0_0|SrvcGrp|93431|2022|PDM|4200.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT
20|FH_F94300_0_0|SrvcGrp|93433|2022|PDM|4200.00|99|0.00|PARTIAL HIP REPLACEMENT
20|FH_F94300_0_0|SrvcGrp|93597|2022|PDM|4200.00|99|0.00|REVISE RECONSTRUCT SHOULDER JOINT(HCFA)
20|FH_F94300_0_0|SrvcGrp|93598|2022|PDM|4200.00|99|0.00|REVISE RECONSTRUCT SHOULDER JOINT(HCFA)
20|FH_F94300_0_0|SrvcGrp|93600|2022|PDM|4200.00|99|0.00|TOTAL HIP ARTHOPLASTY(HCFA)
20|FH_F94300_0_0|SrvcGrp|93601|2022|PDM|4200.00|99|0.00|REVISON OF KNEE JOINT(HCFA)
20|FH_F94300_0_0|SrvcGrp|93603|2022|PDM|3675.00|99|0.00|CERVICAL SURGERY(HCFA)
20|FH_F94300_0_0|SrvcGrp|93604|2022|PDM|3360.00|99|0.00|KNEE ARTHO/ANT CRUCIATE LIG REPAIR(HCFA)
20|FH_F94303_0_0|SrvcGrp|73002|2022|PDM|2280.00|99|0.00|AEG 7
20|FH_F94303_0_0|SrvcGrp|73006|2022|PDM|1008.00|99|0.00|AEG 9
20|FH_F94303_0_0|SrvcGrp|76243|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F94402_0_0|CSTM-ALL|CSTM-00|2020|PDM|576.00|99|0.00|AEG 1 (NO REV)
20|FH_F94402_0_0|CSTM-ALL|CSTM-00|2020|PDM|588.00|99|0.00|AETNA AMBULATORY SURGERY (NO REV)
20|FH_F94403_0_0|CSTM-ALL|CSTM-00|2020|PDM|1040.00|99|0.00|AEG 5  (NO REV)
20|FH_F94403_0_0|CSTM-ALL|CSTM-00|2020|PDM|1942.00|99|0.00|AEG 9 (NO REV)
20|FH_F94403_0_0|CSTM-ALL|CSTM-00|2020|PDM|647.00|99|0.00|AEG 2 (NO REV)
20|FH_F94403_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 4 (NO REV)
20|FH_F94481_0_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F94481_0_0|SrvcGrp|76501|2022|PDM|235.00|99|0.00|SUB-ACUTE - LEVEL I
20|FH_F94502_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F94502_0_0|SrvcGrp|59291|2022|PDM|406.00|99|0.00|DAY HOSPITAL FULL DAY
20|FH_F94502_0_0|SrvcGrp|79720|2022|PDM|975.00|99|0.00|ACUTE REHAB II
20|FH_F94502_0_0|SrvcGrp|80258|2022|PCT|0.00|99|0.00|AETNA SKILLED CARE
20|FH_F94581_0_0|SrvcGrp|472|2022|PDM|552.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F94662_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F94662_0_0|SrvcGrp|47411|2022|PDM|199.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F94662_0_0|SrvcGrp|80317|2022|PDM|221.00|99|0.00|RESPITE CARE
20|FH_F94662_0_0|SrvcGrp|89822|2022|PDM|199.00|99|0.00|HOSPICE ROUTINE HOME CARE
20|FH_F94662_0_0|SrvcGrp|90477|2022|PDM|199.00|99|0.00|HOSPICE
20|FH_F94665_0_0|CSTM-ALL|CSTM-00|2020|PDM|1080.00|99|0.00|AEG 2 (NO REV)
20|FH_F94665_0_0|CSTM-ALL|CSTM-00|2020|PDM|1233.00|99|0.00|AEG 3 (NO REV)
20|FH_F94665_0_0|CSTM-ALL|CSTM-00|2020|PDM|1522.00|99|0.00|AEG 4 (NO REV)
20|FH_F94665_0_0|SrvcGrp|22383|2022|PCT|1.00|99|0.00|SUPPLIES
20|FH_F94862_0_0|SrvcGrp|72992|2022|PDM|575.00|99|0.00|AEG 2
20|FH_F94862_0_0|SrvcGrp|72994|2022|PDM|600.00|99|0.00|AEG 3
20|FH_F94862_0_0|SrvcGrp|73002|2022|PDM|1000.00|99|0.00|AEG 7
20|FH_F94942_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F94942_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F94942_0_0|SrvcGrp|114518|2022|PDM|3500.00|99|0.00|INSERTION DRAINAGE DEVICE
20|FH_F94942_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F94942_0_0|SrvcGrp|72990|2022|PDM|448.05|99|0.00|AEG 1
20|FH_F94942_0_0|SrvcGrp|72992|2022|PDM|602.55|99|0.00|AEG 2
20|FH_F94942_0_0|SrvcGrp|73006|2022|PDM|1807.63|99|0.00|AEG 9
20|FH_F94942_0_0|SrvcGrp|94159|2022|PDM|545.90|99|0.00|PROPHYLAXIS ADULT
20|FH_F95101_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F95101_0_0|SrvcGrp|42784|2022|PDM|45.00|99|0.00|OCCUPATIONAL THERAPY  SRVCS
20|FH_F95101_0_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F95221_0_0|SrvcGrp|72992|2022|PDM|478.00|99|0.00|AEG 2
20|FH_F95221_0_0|SrvcGrp|72994|2022|PDM|546.00|99|0.00|AEG 3
20|FH_F95221_0_0|SrvcGrp|72996|2022|PDM|675.00|99|0.00|AEG 4
20|FH_F95221_0_0|SrvcGrp|73002|2022|PDM|1066.00|99|0.00|AEG 7
20|FH_F95221_0_0|SrvcGrp|73006|2022|PDM|1406.00|99|0.00|AEG 9
20|FH_F95440_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F95440_0_0|SrvcGrp|33967|2022|PDM|3296.00|99|0.00|CPT 47562
20|FH_F95440_0_0|SrvcGrp|72992|2022|PDM|1169.00|99|0.00|AEG 2
20|FH_F95440_0_0|SrvcGrp|72998|2022|PDM|2730.00|99|0.00|AEG 5
20|FH_F95440_0_0|SrvcGrp|73000|2022|PDM|2755.00|99|0.00|AEG 6
20|FH_F95440_0_0|SrvcGrp|93722|2022|PDM|3605.00|99|0.00|LAMINECTOMIES
20|FH_F95482_0_0|CSTM-ALL|CSTM-00|2020|PDM|1217.00|99|0.00|AEG 3 (NO REV)
20|FH_F95482_0_0|CSTM-ALL|CSTM-00|2020|PDM|772.00|99|0.00|AEG 1 (NO REV)
20|FH_F95482_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS
20|FH_F95482_0_0|SrvcGrp|86919|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH INCIDENTAL CODES
20|FH_F95629_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F95629_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F95641_0_0|SrvcGrp|42782|2022|PDM|45.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F95641_0_0|SrvcGrp|471|2022|PDM|580.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F95800_0_0|CSTM-ALL|CSTM-00|2020|PDM|369.00|99|0.00|AEG 1 (NO REV)
20|FH_F95800_0_0|CSTM-ALL|CSTM-00|2020|PDM|565.00|99|0.00|AEG 3 (NO REV)
20|FH_F95800_0_0|CSTM-ALL|CSTM-00|2020|PDM|795.00|99|0.00|AEG 5  (NO REV)
20|FH_F95800_0_0|CSTM-ALL|CSTM-00|2020|PDM|911.00|99|0.00|AEG 6 (NO REV)
20|FH_F95900_0_0|CSTM-ALL|CSTM-00|2020|PDM|1102.00|99|0.00|AEG 8 (NO REV)
20|FH_F95900_0_0|CSTM-ALL|CSTM-00|2020|PDM|505.00|99|0.00|AEG 2 (NO REV)
20|FH_F95900_0_0|CSTM-ALL|CSTM-00|2020|PDM|578.00|99|0.00|AEG 3 (NO REV)
20|FH_F95962_0_0|CSTM-ALL|CSTM-00|2020|PDM|1972.00|99|0.00|GENERAL ACUTE CARE
20|FH_F96182_0_0|SrvcGrp|472|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F96182_0_0|SrvcGrp|474|2022|PDM|275.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F96321_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F96321_0_0|CSTM-ALL|CSTM-00|2020|PDM|463.61|99|0.00|AEG 1 (NO REV)
20|FH_F96321_0_0|CSTM-ALL|CSTM-00|2020|PDM|616.38|99|0.00|AEG 2 (NO REV)
20|FH_F96321_0_0|SrvcGrp|108771|2022|PDM|743.05|99|0.00|NEEDLE BIOPSY OF LIVER
20|FH_F96321_0_0|SrvcGrp|24095|2022|PDM|729.94|99|0.00|EGD W/BALLOON DIALATION CPT 43249
20|FH_F96780_0_0|CSTM-ALL|CSTM-00|2020|PDM|1128.00|99|0.00|AEG 5  (NO REV)
20|FH_F96780_0_0|CSTM-ALL|CSTM-00|2020|PDM|1268.00|99|0.00|AEG 8 (NO REV)
20|FH_F96780_0_0|CSTM-ALL|CSTM-00|2020|PDM|1796.00|99|0.00|AEG 7 (NO REV) DULANCEY EYE INSTITUTE
20|FH_F96780_0_0|SrvcGrp|28547|2022|PDM|1761.00|99|0.00|VITRECTOMY
20|FH_F96780_0_0|SrvcGrp|28549|2022|PDM|1761.00|99|0.00|VITRECTOMY
20|FH_F96780_0_0|SrvcGrp|28550|2022|PDM|1761.00|99|0.00|VITRECTOMY
20|FH_F96780_0_0|SrvcGrp|42428|2022|PDM|518.00|99|0.00|OP SURGERY CPT 65855
20|FH_F96780_0_0|SrvcGrp|46887|2022|PDM|1761.00|99|0.00|REPAIR DETACHED RETINA
20|FH_F96780_0_0|SrvcGrp|46890|2022|PDM|1605.00|99|0.00|IMPLANT EYE SHUNT
20|FH_F96780_0_0|SrvcGrp|84934|2022|PDM|1613.00|99|0.00|REMOVAL OF EYE LESION
20|FH_F96902_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F96902_0_0|SrvcGrp|87799|2022|PDM|165.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)
20|FH_F96902_0_0|SrvcGrp|93098|2022|PDM|165.00|99|0.00|HOSPICE CARE
20|FH_F96902_0_0|SrvcGrp|94781|2022|PDM|165.00|99|0.00|HOSPICE IN LTCH (HCFA)
20|FH_F97160_77436_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F97160_77436_0|SrvcGrp|89417|2022|PDM|584.00|99|0.00|PARTIAL HOSPITALIZATION
20|FH_F97161_0_0|CSTM-ALL|CSTM-00|2020|PDM|1263.00|99|0.00|AEG 8 (NO REV)
20|FH_F97161_0_0|CSTM-ALL|CSTM-00|2020|PDM|1753.00|99|0.00|AEG 9 (NO REV)
20|FH_F97161_0_0|CSTM-ALL|CSTM-00|2020|PDM|408.00|99|0.00|AEG 1 (NO REV)
20|FH_F97161_0_0|CSTM-ALL|CSTM-00|2020|PDM|729.00|99|0.00|AEG 3 (NO REV)
20|FH_F97161_0_0|CSTM-ALL|CSTM-00|2020|PDM|884.00|99|0.00|AEG 6 (NO REV)
20|FH_F97161_0_0|SrvcGrp|93121|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F97242_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F97242_0_0|SrvcGrp|42782|2022|PDM|45.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F97242_0_0|SrvcGrp|42784|2022|PDM|45.00|99|0.00|OCCUPATIONAL THERAPY  SRVCS
20|FH_F98161_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F98161_0_0|SrvcGrp|72990|2022|PDM|383.00|99|0.00|AEG 1
20|FH_F98161_0_0|SrvcGrp|72994|2022|PDM|587.00|99|0.00|AEG 3
20|FH_F98161_0_0|SrvcGrp|73002|2022|PDM|1144.00|99|0.00|AEG 7
20|FH_F98161_0_0|SrvcGrp|73008|2022|PDM|587.00|99|0.00|AEG 10
20|FH_F98161_0_0|SrvcGrp|84280|2022|PDM|1365.00|99|0.00|CORNEAL TRANSPLANT
20|FH_F98480_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F98640_0_0|CSTM-ALL|CSTM-00|2020|PDM|2548.00|99|0.00|AEG 8 (NO REV)
20|FH_F98640_0_0|CSTM-ALL|CSTM-00|2020|PDM|2744.00|99|0.00|AEG 9 (NO REV)
20|FH_F98640_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F98640_0_0|SrvcGrp|27316|2022|PDM|1818.00|99|0.00|TONSILS & ADENOIDS (42820)
20|FH_F99021_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F99021_0_0|CSTM-ALL|CSTM-00|2020|PDM|344.00|99|0.00|AEG 1 (NO REV)
20|FH_F99021_0_0|CSTM-ALL|CSTM-00|2020|PDM|512.00|99|0.00|AEG 3 (NO REV)
20|FH_F99021_0_0|CSTM-ALL|CSTM-00|2020|PDM|829.00|99|0.00|AEG 6 (NO REV)
20|FH_F99021_0_0|SrvcGrp|93759|2022|PCT|0.00|99|0.00|CARDIAC CATH
20|FH_F99100_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F99100_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F99100_0_0|CSTM-ALL|CSTM-00|2020|PDM|1410.00|99|0.00|AEG 8 (NO REV)
20|FH_F99100_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AEG 1 (NO REV)
20|FH_F99100_0_0|SrvcGrp|90973|2022|PDM|679.80|99|0.00|CERVICAL OR THORACIC INJECTION
20|FH_F99100_0_0|SrvcGrp|93121|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F99100_0_0|SrvcGrp|96103|2022|PDM|679.80|99|0.00|CERVICAL AND THORACIC INJECTION (HCFA)
20|FH_F99161_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F99161_0_0|SrvcGrp|75479|2022|PDM|700.00|99|0.00|AEG 1
20|FH_F99161_0_0|SrvcGrp|75483|2022|PDM|1250.00|99|0.00|AEG 3
20|FH_F99161_0_0|SrvcGrp|91564|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F99441_0_0|CSTM-ALL|CSTM-00|2020|PDM|531.00|99|0.00|AEG 3 (NO REV)
20|FH_F99441_0_0|CSTM-ALL|CSTM-00|2020|PDM|955.00|99|0.00|AEG 7 (NO REV)
20|FH_F99441_0_0|CSTM-ALL|CSTM-00|2020|PDM|988.00|99|0.00|AEG 8 (NO REV)
20|FH_F99442_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F99442_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.62|99|0.00|OP SVCS
20|FH_F99541_0_0|CSTM-ALL|CSTM-00|2020|PCT|47.00|99|0.00|OP SVCS
20|FH_F99720_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F99720_0_0|SrvcGrp|104739|2022|PDM|3174.00|99|0.00|REPAIR OF  TENDON(S)
20|FH_F99720_0_0|SrvcGrp|104740|2022|PDM|3584.00|99|0.00|HIP ARTHRO W/FEMOROPLASTY
20|FH_F99720_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F99720_0_0|SrvcGrp|33984|2022|PDM|1638.00|99|0.00|HAMMERTOE CORRECTION
20|FH_F99720_0_0|SrvcGrp|73004|2022|PDM|3067.00|99|0.00|AEG 8
20|FH_F99760_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|GENERAL ACUTE CARE
20|FH_F99960_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F99960_0_0|SrvcGrp|27345|2022|PDM|1760.00|99|0.00|OP SURGERY (CPT 49650)
20|FH_F99960_0_0|SrvcGrp|55071|2022|PDM|1174.00|99|0.00|ARTHROSCOPY SHOULDER
20|FH_F99960_0_0|SrvcGrp|72990|2022|PDM|502.00|99|0.00|AEG 1
20|FH_F99960_0_0|SrvcGrp|73008|2022|PDM|1124.00|99|0.00|AEG 10
20|FH_F99960_0_0|SrvcGrp|78911|2022|PDM|1760.00|99|0.00|LAPARO HERNIA REPAIR RECUR
20|FH_F46372_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|MS DRG 901-909, 913-923, 955-959, 963-965 TRAUMA CARE
20|FH_F46372_0_0|SrvcGrp|3499|2022|PCT|0.65|99|0.00|IMPLANTS
20|FH_F46373_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.84|99|0.00|OP SVCS
20|FH_F46473_0_0|CSTM-ALL|CSTM-00|2020|PDM|1512.00|99|0.00|ASPG VI
20|FH_F46473_0_0|CSTM-ALL|CSTM-00|2020|PDM|1780.00|99|0.00|ASPG VIII
20|FH_F46473_0_0|CSTM-ALL|CSTM-00|2020|PDM|611.00|99|0.00|ASPG I
20|FH_F46473_0_0|CSTM-ALL|CSTM-00|2020|PDM|820.00|99|0.00|ASPG II
20|FH_F46473_0_0|SrvcGrp|14997|2022|PCT|0.50|99|0.00|DRUGS
20|FH_F46473_0_0|SrvcGrp|3448|2022|PDM|1177.00|99|0.00|MRI
20|FH_F46492_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F46492_0_0|CSTM-ALL|CSTM-00|2020|PDM|1780.00|99|0.00|ASPG VIII
20|FH_F46492_0_0|CSTM-ALL|CSTM-00|2020|PDM|2460.00|99|0.00|ASPG IX
20|FH_F46492_0_0|CSTM-ALL|CSTM-00|2020|PDM|936.00|99|0.00|ASPG III
20|FH_F46492_0_0|SrvcGrp|12995|2022|PDM|485.00|99|0.00|DIALYSIS
20|FH_F46492_0_0|SrvcGrp|14997|2022|PCT|0.50|99|0.00|DRUGS
20|FH_F46612_0_0|SrvcGrp|22954|2022|PDM|310.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F46612_0_0|SrvcGrp|26742|2022|PDM|154.00|99|0.00|PT
20|FH_F46672_0_0|CSTM-ALL|CSTM-00|2020|PDM|45.00|99|0.00|SKILLED NURSING (ADDITIONAL HOURS)
20|FH_F46732_0_0|SrvcGrp|10519|2022|PDM|220.00|99|0.00|MEDICAL SOCIAL WORKER VISIT
20|FH_F46732_0_0|SrvcGrp|12702|2022|PDM|72.00|99|0.00|RN, INTERMITTENT VISIT
20|FH_F46732_0_0|SrvcGrp|22954|2022|PDM|140.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F46732_0_0|SrvcGrp|29303|2022|PDM|144.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F46857_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE
20|FH_F46874_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|ASPG IX
20|FH_F46874_0_0|CSTM-ALL|CSTM-00|2020|PDM|1740.00|99|0.00|ASPG VIII
20|FH_F46874_0_0|CSTM-ALL|CSTM-00|2020|PDM|585.00|99|0.00|ASPG I
20|FH_F46876_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.50|99|0.00|GENERAL ACUTE CARE
20|FH_F46914_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F46914_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F46914_0_0|SrvcGrp|9937|2022|PDM|147.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F46918_0_0|CSTM-ALL|CSTM-00|2020|PDM|73.00|99|0.00|LPN VISIT
20|FH_F46918_0_0|SrvcGrp|10545|2022|PDM|115.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F46918_0_0|SrvcGrp|10615|2022|PDM|120.00|99|0.00|HOME HEALTH AIDE
20|FH_F46918_0_0|SrvcGrp|10624|2022|PDM|68.00|99|0.00|CPT CODE 99347
20|FH_F46918_0_0|SrvcGrp|11798|2022|PDM|112.00|99|0.00|HOME INFUSION NURSING SVCS
20|FH_F46918_0_0|SrvcGrp|15846|2022|PDM|47.00|99|0.00|HOME VISIT
20|FH_F46938_0_0|SrvcGrp|42046|2022|PDM|595.00|99|0.00|HOSPICE CARE
20|FH_F46941_0_0|SrvcGrp|42046|2022|PDM|595.00|99|0.00|HOSPICE CARE
20|FH_F47037_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F47037_0_0|SrvcGrp|10518|2022|PDM|92.00|99|0.00|ENTEROSTOMAL VISIT F/U VISIT
20|FH_F47037_0_0|SrvcGrp|12157|2022|PDM|92.00|99|0.00|RN VISIT
20|FH_F47037_0_0|SrvcGrp|12401|2022|PDM|92.00|99|0.00|RN VISIT
20|FH_F47037_0_0|SrvcGrp|18025|2022|PDM|60.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F47037_0_0|SrvcGrp|3809|2022|PDM|525.00|99|0.00|HOSPICE CARE
20|FH_F47056_0_0|SrvcGrp|22954|2022|PDM|127.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F47097_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F47113_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F47113_0_0|CSTM-ALL|CSTM-00|2020|PDM|729.00|99|0.00|AEG 3 (NO REV)
20|FH_F47128_0_0|SrvcGrp|3142|2022|PDM|2121.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F47130_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F47130_0_0|SrvcGrp|8|2022|PDM|2270.00|99|0.00|BURN INTENSIVE CARE
20|FH_F47137_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F47140_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F47140_0_0|CSTM-ALL|CSTM-00|2020|PDM|122.30|99|0.00|SLEEP STUDIES CPT 95808 W/MODIFIER 26
20|FH_F47140_0_0|CSTM-ALL|CSTM-00|2020|PDM|161.53|99|0.00|SLEEP STUDIES CPT 95810 W/MODIFIER 26
20|FH_F47140_0_0|SrvcGrp|12044|2022|PDM|719.64|99|0.00|SLEEP STUDIES
20|FH_F47140_0_0|SrvcGrp|25038|2022|PDM|788.64|99|0.00|SLEEP STUDIES
20|FH_F47173_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE
20|FH_F47173_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F47233_0_0|CSTM-ALL|CSTM-00|2020|PDM|1080.00|99|0.00|WELLPATH PROPIETARY ASC VI
20|FH_F47233_0_0|CSTM-ALL|CSTM-00|2020|PDM|495.00|99|0.00|WELLPATH PROPRIERARY ASC II
20|FH_F47233_0_0|CSTM-ALL|CSTM-00|2020|PDM|90.00|99|0.00|WELLPATH PROPIETARY ASC X (MINOR PROCEDURE)
20|FH_F47421_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F47421_0_0|CSTM-ALL|CSTM-00|2020|PDM|1090.00|99|0.00|ASPG V
20|FH_F47421_0_0|CSTM-ALL|CSTM-00|2020|PDM|2010.00|99|0.00|ASPG IX
20|FH_F47424_0_0|SrvcGrp|3809|2022|PDM|730.00|99|0.00|HOSPICE CARE
20|FH_F47424_0_0|SrvcGrp|42782|2022|PDM|75.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F47462_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F47462_0_0|CSTM-ALL|CSTM-00|2020|PDM|110.00|99|0.00|PHYSICAL THERAPY
20|FH_F47473_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|GENERAL ACUTE CARE
20|FH_F47495_0_0|SrvcGrp|15488|2022|PCT|0.50|99|0.00|COMPUTED TOMOGRAPHY (CT SCAN)
20|FH_F47495_0_0|SrvcGrp|23132|2022|PDM|400.00|99|0.00|DIALYSIS/CHEMOTHERAPY/RADIATION
20|FH_F47495_0_0|SrvcGrp|28145|2022|PDM|1550.00|99|0.00|SKILLED NURSING
20|FH_F47495_0_0|SrvcGrp|30165|2022|PCT|0.70|99|0.00|BLOOD PRODUCTS
20|FH_F47499_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F47499_0_0|SrvcGrp|13928|2022|PDM|371.00|99|0.00|DAY HOSPITAL HALF DAY
20|FH_F47539_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F47552_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F47552_0_0|CSTM-ALL|CSTM-00|2020|PDM|1603.00|99|0.00|ASPG VI
20|FH_F47575_0_0|CSTM-ALL|CSTM-00|2020|PDM|90.00|99|0.00|OP SVCS
20|FH_F47605_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F47605_0_0|CSTM-ALL|CSTM-00|2020|PDM|975.00|99|0.00|GENERAL ACUTE CARE
20|FH_F47605_0_0|SrvcGrp|33165|2022|PDM|835.00|99|0.00|SKILLED NURSING - LEVEL II
20|FH_F47605_0_0|SrvcGrp|33166|2022|PDM|975.00|99|0.00|SKILLED NURSING - LEVEL III
20|FH_F47605_0_0|SrvcGrp|43322|2022|PDM|100.00|99|0.00|INDIVIDUAL THERAPY
20|FH_F47636_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F47636_0_0|SrvcGrp|11442|2022|PDM|589.27|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)
20|FH_F47636_0_0|SrvcGrp|3327|2022|PDM|135.99|99|0.00|HOSPICE SERVICE - IP RESPITE
20|FH_F47656_0_0|SrvcGrp|941|2022|PCT|0.80|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F47659_0_0|CSTM-ALL|CSTM-00|2020|PDM|2275.00|99|0.00|OBSTERICAL SERVICES MS DRGS 765-766, 774-775
20|FH_F47659_0_0|SrvcGrp|11336|2022|PCT|0.75|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F47659_0_0|SrvcGrp|941|2022|PCT|0.80|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F47679_0_0|SrvcGrp|42785|2022|PDM|40.12|99|0.00|SPEECH THERAPY  SRVCS
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|1264.00|99|0.00|GA RETINA SURG CTR ASC 28
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|1509.00|99|0.00|GA RETINA SURG CTR ASC 33
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|625.00|99|0.00|GA RETINA SURG CTR ASC 13
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|635.00|99|0.00|GA RETINA SURG CTR ASC 14
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|79.00|99|0.00|GA RETINA SURG CTR ASC 1
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|802.00|99|0.00|GA RETINA SURG CTR ASC 17
20|FH_F47694_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE
20|FH_F47694_0_0|SrvcGrp|3577|2022|PDM|615.00|99|0.00|PARTIAL HOSPITALIZATION
20|FH_F47694_0_0|SrvcGrp|40222|2022|PCT|0.50|99|0.00|OP SVCS
20|FH_F47717_0_0|SrvcGrp|4109|2022|PDM|692.00|99|0.00|ACUTE PSYCH
20|FH_F47773_0_0|CSTM-ALL|CSTM-00|2020|PDM|112.00|99|0.00|OP SVCS
20|FH_F47795_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F47812_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F47812_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F47812_0_0|SrvcGrp|42870|2022|PDM|40.12|99|0.00|OCCUPATIONAL THERAPY VISIT
20|FH_F47818_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F47836_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F47836_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|ENT SURG CTR -CVTY ENHANCED GROUP 4
20|FH_F47836_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|ENT SURG CTR -CVTY ENHANCED GROUP 5
20|FH_F47836_0_0|CSTM-ALL|CSTM-00|2020|PDM|1900.00|99|0.00|ENT SURGERY CTR CARVEOUT 2
20|FH_F47836_0_0|CSTM-ALL|CSTM-00|2020|PDM|2600.00|99|0.00|ENT SURGERY CENTER CARVEOUT
20|FH_F47836_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|ENT SURG CTR -CVTY ENHANCED GROUP 1
20|FH_F47836_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|ENT SURG CTR -CVTY ENHANCED GROUP 10
20|FH_F47836_0_0|CSTM-ALL|CSTM-00|2020|PDM|875.00|99|0.00|ENT SURG CTR -CVTY ENHANCED GROUP 2
20|FH_F47836_0_0|SrvcGrp|44144|2022|PDM|2000.00|99|0.00|CPT 42440
20|FH_F47857_0_0|CSTM-ALL|CSTM-00|2020|PDM|275.00|99|0.00|CHEMICAL DEPENDENCY - ADOLESCENT
20|FH_F47857_0_0|CSTM-ALL|CSTM-00|2020|PDM|275.00|99|0.00|GENERAL ACUTE CARE
20|FH_F47857_0_0|SrvcGrp|167|2022|PDM|275.00|99|0.00|CD (ADULT) - REHABILITATION
20|FH_F47884_0_0|SrvcGrp|701|2022|PDM|1732.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F47952_0_0|SrvcGrp|10527|2022|PDM|120.00|99|0.00|HOSPICE SVCS
20|FH_F47952_0_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE
20|FH_F47952_0_0|SrvcGrp|36068|2022|PDM|55.00|99|0.00|SKILLED NURSING NON IV RELATED
20|FH_F47952_0_0|SrvcGrp|42976|2022|PDM|95.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F47952_0_0|SrvcGrp|43958|2022|PDM|73.00|99|0.00|ENTEROSTOMAL THERAPY SERVICES
20|FH_F47969_0_0|SrvcGrp|3809|2022|PDM|460.00|99|0.00|HOSPICE CARE
20|FH_F47999_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F47999_0_0|SrvcGrp|12403|2022|PDM|33.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F47999_0_0|SrvcGrp|22954|2022|PDM|132.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F47999_0_0|SrvcGrp|42824|2022|PDM|104.50|99|0.00|SKILLED NURSING VISIT
20|FH_F47999_0_0|SrvcGrp|42826|2022|PDM|104.50|99|0.00|PHYSICAL THERAPY VISIT
20|FH_F48032_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F48032_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F48034_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F48034_0_0|CSTM-ALL|CSTM-00|2020|PDM|250.00|99|0.00|HALF-DAY PARTIAL PSYCH
20|FH_F48034_0_0|SrvcGrp|9493|2022|PDM|90.00|99|0.00|CPT 90804
20|FH_F48057_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F48092_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F48092_0_0|SrvcGrp|14997|2022|PDM|4000.00|99|0.00|DRUGS
20|FH_F48092_0_0|SrvcGrp|471|2022|PDM|1100.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F48133_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F48133_0_0|SrvcGrp|42870|2022|PDM|40.12|99|0.00|OCCUPATIONAL THERAPY VISIT
20|FH_F48192_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F48192_0_0|SrvcGrp|474|2022|PDM|295.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F48215_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F48215_0_0|SrvcGrp|13703|2022|PDM|26.75|99|0.00|LICENSED PRACTICAL NURSE- HOURLY
20|FH_F48215_0_0|SrvcGrp|26001|2022|PDM|94.50|99|0.00|HOSPICE RESPITE SVCS
20|FH_F48254_0_0|SrvcGrp|76207|2022|PDM|60.00|99|0.00|SPEECH THERAPY (VISIT LVL) MOD GN
20|FH_F48261_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F48261_0_0|CSTM-ALL|CSTM-00|2020|PDM|2282.00|99|0.00|GENERAL ACUTE CARE
20|FH_F48292_0_0|SrvcGrp|44244|2022|PDM|446.00|99|0.00|HEMODIALYSIS - HOME TRAINING
20|FH_F48292_0_0|SrvcGrp|44250|2022|PDM|192.00|99|0.00|CCPD TRAINING
20|FH_F48295_0_0|CSTM-ALL|CSTM-00|2020|PDM|52.00|99|0.00|NURSING CARE (VISIT LVL)
20|FH_F48295_0_0|SrvcGrp|27969|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE
20|FH_F48295_0_0|SrvcGrp|36068|2022|PDM|45.00|99|0.00|SKILLED NURSING NON IV RELATED
20|FH_F48295_0_0|SrvcGrp|42046|2022|PDM|595.00|99|0.00|HOSPICE CARE
20|FH_F48295_0_0|SrvcGrp|44423|2022|PDM|35.00|99|0.00|HOME HEALTH AIDE (VISIT LVL)
20|FH_F48295_0_0|SrvcGrp|44427|2022|PDM|90.00|99|0.00|PHYSICAL THERAPY SVCS (VISIT LVL)
20|FH_F48295_0_0|SrvcGrp|44430|2022|PDM|100.00|99|0.00|SPEECH THERAPY SVCS (VISIT LVL)
20|FH_F48355_0_0|CSTM-ALL|CSTM-00|2020|PDM|2282.00|99|0.00|GENERAL ACUTE CARE
20|FH_F48473_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F48473_0_0|SrvcGrp|12401|2022|PDM|93.50|99|0.00|RN VISIT
20|FH_F48473_0_0|SrvcGrp|9830|2022|PDM|93.50|99|0.00|OT SVCS
20|FH_F48475_0_0|SrvcGrp|14230|2022|PDM|418.00|99|0.00|SKILLED NURSING CARE
20|FH_F48475_0_0|SrvcGrp|473|2022|PDM|594.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F48476_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F48513_0_0|CSTM-ALL|CSTM-00|2020|PDM|60.00|99|0.00|SPEECH THERAPY (VISIT LVL)
20|FH_F48513_0_0|SrvcGrp|44347|2022|PDM|60.00|99|0.00|PT & OT (VISIT LVL)
20|FH_F48552_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F48581_0_0|CSTM-ALL|CSTM-00|2020|PDM|2600.00|99|0.00|MS DRG 765-766 C-SECTION
20|FH_F48581_0_0|SrvcGrp|10400|2022|PDM|1500.00|99|0.00|IP SURGERY
20|FH_F48581_0_0|SrvcGrp|15132|2022|PDM|1500.00|99|0.00|ACUTE IP MEDICAL SVCS
20|FH_F48581_0_0|SrvcGrp|9774|2022|PDM|1600.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F48617_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F48695_0_0|SrvcGrp|473|2022|PDM|1400.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F48752_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F48752_0_0|SrvcGrp|33165|2022|PDM|325.00|99|0.00|SKILLED NURSING - LEVEL II
20|FH_F48752_0_0|SrvcGrp|42870|2022|PDM|45.00|99|0.00|OCCUPATIONAL THERAPY VISIT
20|FH_F48752_0_0|SrvcGrp|42871|2022|PDM|45.00|99|0.00|SPEECH THERAPY VISIT
20|FH_F48855_0_0|SrvcGrp|44302|2022|PDM|70.00|99|0.00|PT & OT (VISIT LVL) PT MOD GP
20|FH_F48855_0_0|SrvcGrp|76207|2022|PDM|70.00|99|0.00|SPEECH THERAPY (VISIT LVL) MOD GN
20|FH_F48927_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F48927_0_0|SrvcGrp|12674|2022|PCT|0.50|99|0.00|IMPLANTS
20|FH_F48927_0_0|SrvcGrp|17739|2022|PDM|2400.00|99|0.00|ICU/CCU
20|FH_F48929_0_0|SrvcGrp|22954|2022|PDM|160.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F48935_0_0|SrvcGrp|44883|2022|PDM|18.00|99|0.00|RT/PT/ST/OT
20|FH_F48935_0_0|SrvcGrp|472|2022|PDM|460.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F48994_0_0|CSTM-ALL|CSTM-00|2020|PDM|1289.00|99|0.00|ASPG VI- MOD 50
20|FH_F48994_0_0|CSTM-ALL|CSTM-00|2020|PDM|1518.00|99|0.00|ASPG VIII- MOD 50
20|FH_F48994_0_0|CSTM-ALL|CSTM-00|2020|PDM|2089.00|99|0.00|ASPG IX
20|FH_F48994_0_0|CSTM-ALL|CSTM-00|2020|PDM|983.00|99|0.00|ASPG IV
20|FH_F48994_0_0|SrvcGrp|86340|2022|PCT|1.00|99|0.00|HCPC IMPLANT & PROSTHESIS
20|FH_F48997_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F48998_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F48998_0_0|SrvcGrp|43892|2022|PDM|18.00|99|0.00|PHYSICAL THERAPY VISIT
20|FH_F48998_0_0|SrvcGrp|44949|2022|PDM|18.00|99|0.00|RESPIRATORY THERAPY SVCS
20|FH_F48998_0_0|SrvcGrp|471|2022|PDM|660.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F48998_0_0|SrvcGrp|472|2022|PDM|460.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F48998_0_0|SrvcGrp|474|2022|PDM|360.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F49005_0_0|CSTM-ALL|CSTM-00|2020|PDM|70.00|99|0.00|DIETICIAN VISIT - IP
20|FH_F49005_0_0|CSTM-ALL|CSTM-00|2020|PDM|70.00|99|0.00|DIETICIAN VISIT - OP
20|FH_F49005_0_0|SrvcGrp|44709|2022|PDM|125.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F49016_0_0|SrvcGrp|9978|2022|PDM|1250.00|99|0.00|ACUTE INPATIENT MEDICAL SVCS
20|FH_F49026_0_0|CSTM-ALL|CSTM-00|2020|PCT|36500.00|99|0.00|TIMELY FILING
20|FH_F49027_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F49027_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F49029_0_0|SrvcGrp|45148|2022|PDM|90.00|99|0.00|SPEECH THERAPY
20|FH_F49031_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.10|99|0.00|OP SVCS
20|FH_F49033_0_0|SrvcGrp|43785|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY SERVICES
20|FH_F49033_0_0|SrvcGrp|45148|2022|PDM|90.00|99|0.00|SPEECH THERAPY
20|FH_F49033_0_0|SrvcGrp|45150|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY
20|FH_F49035_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F49035_0_0|SrvcGrp|43785|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY SERVICES
20|FH_F49035_0_0|SrvcGrp|44860|2022|PDM|600.00|99|0.00|SKILLED NURSING, BARIATRIC
20|FH_F49035_0_0|SrvcGrp|45148|2022|PDM|90.00|99|0.00|SPEECH THERAPY
20|FH_F49037_0_0|SrvcGrp|43785|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY SERVICES
20|FH_F49037_0_0|SrvcGrp|44860|2022|PDM|600.00|99|0.00|SKILLED NURSING, BARIATRIC
20|FH_F49039_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F49039_0_0|SrvcGrp|43785|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY SERVICES
20|FH_F49042_0_0|SrvcGrp|21594|2022|PDM|335.00|99|0.00|SKILLED NURSING
20|FH_F49042_0_0|SrvcGrp|45150|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY
20|FH_F49044_0_0|SrvcGrp|45148|2022|PDM|90.00|99|0.00|SPEECH THERAPY
20|FH_F49046_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F49046_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F49049_0_0|SrvcGrp|44860|2022|PDM|600.00|99|0.00|SKILLED NURSING, BARIATRIC
20|FH_F49049_0_0|SrvcGrp|45148|2022|PDM|90.00|99|0.00|SPEECH THERAPY
20|FH_F49049_0_0|SrvcGrp|45150|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY
20|FH_F49051_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F49051_0_0|SrvcGrp|45148|2022|PDM|90.00|99|0.00|SPEECH THERAPY
20|FH_F49054_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F49054_0_0|SrvcGrp|45148|2022|PDM|90.00|99|0.00|SPEECH THERAPY
20|FH_F49092_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.20|99|0.00|GENERAL ACUTE CARE
20|FH_F49092_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.20|99|0.00|OP SVCS
20|FH_F49197_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F49279_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F49279_0_0|CSTM-ALL|CSTM-00|2020|PDM|1422.00|99|0.00|ASPG VI
20|FH_F49279_0_0|CSTM-ALL|CSTM-00|2020|PDM|1625.00|99|0.00|ASPG VII
20|FH_F49279_0_0|CSTM-ALL|CSTM-00|2020|PDM|521.00|99|0.00|ASPG II
20|FH_F49279_0_0|CSTM-ALL|CSTM-00|2020|PDM|798.00|99|0.00|ASPG III
20|FH_F49279_0_0|CSTM-ALL|CSTM-00|2020|PDM|798.00|99|0.00|ASPG X
20|FH_F49279_0_0|SrvcGrp|26228|2022|PCT|0.55|99|0.00|DME/ORTHOTICS/PROSTHETICS/IMPLANTS
20|FH_F49300_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F49300_0_0|SrvcGrp|27969|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE
20|FH_F49300_0_0|SrvcGrp|42975|2022|PDM|90.00|99|0.00|PHYSICAL THERAPIST
20|FH_F49300_0_0|SrvcGrp|43955|2022|PDM|85.00|99|0.00|NURSING CARE
20|FH_F49329_0_0|CSTM-ALL|CSTM-00|2020|PDM|128.00|99|0.00|PT / OT / ST
20|FH_F49329_0_0|CSTM-ALL|CSTM-00|2020|PDM|140.00|99|0.00|DIETICIAN VISIT - IP
20|FH_F49329_0_0|CSTM-ALL|CSTM-00|2020|PDM|49.00|99|0.00|HOME HEALTH AIDE
20|FH_F49329_0_0|SrvcGrp|45334|2022|PDM|49.00|99|0.00|HOME HEALTH AIDE
20|FH_F49434_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE
20|FH_F49458_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE
20|FH_F49458_0_0|SrvcGrp|45567|2022|PDM|32.99|99|0.00|MASTECTOMY BRA
20|FH_F49458_0_0|SrvcGrp|45568|2022|PDM|247.29|99|0.00|MASTECTOMY PROSTHESIS
20|FH_F49459_0_0|SrvcGrp|11232|2022|PDM|384.00|99|0.00|PARTIAL HOSPITALIZATION
20|FH_F49459_0_0|SrvcGrp|3259|2022|PDM|762.00|99|0.00|ACUTE REHABILITATION
20|FH_F49478_0_0|CSTM-ALL|CSTM-00|2020|PDM|1074.00|99|0.00|COVENTRY ENHANCED GROUPER 8
20|FH_F49478_0_0|CSTM-ALL|CSTM-00|2020|PDM|493.00|99|0.00|COVENTRY ENHANCED GROUPER 2
20|FH_F49478_0_0|CSTM-ALL|CSTM-00|2020|PDM|696.00|99|0.00|COVENTRY ENHANCED GROUPER 10
20|FH_F49478_0_0|SrvcGrp|65284|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F49489_0_0|CSTM-ALL|CSTM-00|2020|PDM|2443.47|99|0.00|ASPG VII
20|FH_F49543_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|OP SVCS
20|FH_F49572_0_0|SrvcGrp|30623|2022|PDM|2600.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788
20|FH_F49572_0_0|SrvcGrp|360|2022|PDM|710.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F49573_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F49598_0_0|CSTM-ALL|CSTM-00|2020|PDM|1157.00|99|0.00|GENERAL ACUTE CARE
20|FH_F49598_0_0|CSTM-ALL|CSTM-00|2020|PDM|4244.00|99|0.00|CARDIAC CATH
20|FH_F49669_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F49732_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE
20|FH_F49776_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F49776_0_0|SrvcGrp|12403|2022|PDM|25.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F49776_0_0|SrvcGrp|22954|2022|PDM|120.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F49776_0_0|SrvcGrp|3809|2022|PDM|600.00|99|0.00|HOSPICE CARE
20|FH_F49776_0_0|SrvcGrp|42826|2022|PDM|102.00|99|0.00|PHYSICAL THERAPY VISIT
20|FH_F49776_0_0|SrvcGrp|42827|2022|PDM|102.00|99|0.00|OCCUPATIONAL THERAPY VISIT
20|FH_F49832_0_0|SrvcGrp|24028|2022|PDM|40.00|99|0.00|LICENSED PRACTICAL NURSE
20|FH_F49832_0_0|SrvcGrp|42826|2022|PDM|100.00|99|0.00|PHYSICAL THERAPY VISIT
20|FH_F49852_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F49853_0_0|SrvcGrp|473|2022|PDM|370.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F49913_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F49913_0_0|SrvcGrp|45150|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY
20|FH_F49914_0_0|SrvcGrp|45150|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY
20|FH_F49937_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F49937_0_0|SrvcGrp|44860|2022|PDM|600.00|99|0.00|SKILLED NURSING, BARIATRIC
20|FH_F49937_0_0|SrvcGrp|45150|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY
20|FH_F49943_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F49943_0_0|SrvcGrp|42973|2022|PDM|140.00|99|0.00|SPEECH  THERAPIST
20|FH_F49943_0_0|SrvcGrp|44042|2022|PDM|90.00|99|0.00|SKILLED NURSING - LPN
20|FH_F49943_0_0|SrvcGrp|45947|2022|PDM|90.00|99|0.00|LPN NURSING SVCS
20|FH_F49943_0_0|SrvcGrp|45948|2022|PDM|140.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F49943_0_0|SrvcGrp|45949|2022|PDM|140.00|99|0.00|OCCUPATIONAL THERAPY SVCS
20|FH_F49996_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F49996_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F49996_0_0|CSTM-ALL|CSTM-00|2020|PDM|1553.00|99|0.00|ASPG VII
20|FH_F49996_0_0|CSTM-ALL|CSTM-00|2020|PDM|1553.00|99|0.00|ASPG VII- MOD 50
20|FH_F49996_0_0|CSTM-ALL|CSTM-00|2020|PDM|2089.00|99|0.00|ASPG IX- MOD 50
20|FH_F49996_0_0|CSTM-ALL|CSTM-00|2020|PDM|696.00|99|0.00|ASPG II- MOD 50
20|FH_F49996_0_0|CSTM-ALL|CSTM-00|2020|PDM|955.00|99|0.00|ASPG III
20|FH_F49996_0_0|CSTM-ALL|CSTM-00|2020|PDM|955.00|99|0.00|ASPG III- MOD 50
20|FH_F49996_0_0|CSTM-ALL|CSTM-00|2020|PDM|983.00|99|0.00|ASPG IV
20|FH_F50013_0_0|CSTM-ALL|CSTM-00|2020|PDM|1212.00|99|0.00|GENERAL ACUTE CARE
20|FH_F50013_0_0|CSTM-ALL|CSTM-00|2020|PDM|714.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F50100_0_0|SrvcGrp|46107|2022|PDM|103.73|99|0.00|SKILLED NURSING
20|FH_F50100_0_0|SrvcGrp|46108|2022|PDM|55.32|99|0.00|SKILLED NURSING (ADDITIONAL HOUR)
20|FH_F50100_0_0|SrvcGrp|46117|2022|PDM|30.43|99|0.00|HOME HEALTH AIDE (PER HOUR)
20|FH_F50137_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|GENERAL ACUTE CARE
20|FH_F50137_0_0|CSTM-ALL|CSTM-00|2020|PDM|105.00|99|0.00|SKILLED NURSING HOME VISIT OR PROCEDURE
20|FH_F50137_0_0|CSTM-ALL|CSTM-00|2020|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES
20|FH_F50137_0_0|CSTM-ALL|CSTM-00|2020|PDM|115.00|99|0.00|OCCUPATIONAL THERAPY SERVICES
20|FH_F50137_0_0|CSTM-ALL|CSTM-00|2020|PDM|115.00|99|0.00|PHYSICAL THERAPY SERVICES
20|FH_F50137_0_0|SrvcGrp|10519|2022|PDM|115.00|99|0.00|MEDICAL SOCIAL WORKER VISIT
20|FH_F50137_0_0|SrvcGrp|10542|2022|PDM|115.00|99|0.00|OCCUPATIONAL THERAPY SVCS
20|FH_F50137_0_0|SrvcGrp|10543|2022|PDM|115.00|99|0.00|SPEECH THERAPY SVCS
20|FH_F50137_0_0|SrvcGrp|46248|2022|PDM|55.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F50163_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|OBSERVATION SVCS - UP TO 23 HRS
20|FH_F50163_0_0|CSTM-ALL|CSTM-00|2020|PDM|680.00|99|0.00|CHILD PSYCHIATRIC
20|FH_F50163_0_0|CSTM-ALL|CSTM-00|2020|PDM|715.00|99|0.00|ACUTE IP REHAB LEVEL B
20|FH_F50218_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|GENERAL ACUTE CARE
20|FH_F50218_0_0|CSTM-ALL|CSTM-00|2020|PDM|105.00|99|0.00|HIGH TECH SKILLED NURSING
20|FH_F50218_0_0|CSTM-ALL|CSTM-00|2020|PDM|120.00|99|0.00|HOME VISIT CATHETER CARE
20|FH_F50218_0_0|SrvcGrp|10518|2022|PDM|120.00|99|0.00|ENTEROSTOMAL VISIT F/U VISIT
20|FH_F50218_0_0|SrvcGrp|14081|2022|PDM|120.00|99|0.00|HOME VISIT - POSTNATAL
20|FH_F50218_0_0|SrvcGrp|28992|2022|PDM|120.00|99|0.00|RN HI-TECH VISIT
20|FH_F50237_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|GENERAL ACUTE CARE
20|FH_F50237_0_0|SrvcGrp|34086|2022|PDM|85.00|99|0.00|PT/OT/ST
20|FH_F50297_0_0|SrvcGrp|42974|2022|PDM|82.00|99|0.00|OCCUPATIONAL THERAPIST
20|FH_F50297_0_0|SrvcGrp|42976|2022|PDM|82.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F50334_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F50334_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F50334_0_0|SrvcGrp|22954|2022|PDM|130.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F50334_0_0|SrvcGrp|43893|2022|PDM|123.00|99|0.00|OCCUPATIONAL THERAPY VISIT
20|FH_F50334_0_0|SrvcGrp|45783|2022|PDM|115.00|99|0.00|SKILLED NURSING VISIT
20|FH_F50336_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F50432_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F50432_0_0|CSTM-ALL|CSTM-00|2020|PDM|2162.00|99|0.00|COVENTRY ENHANCED GROUPER 9
20|FH_F50432_0_0|CSTM-ALL|CSTM-00|2020|PDM|538.00|99|0.00|COVENTRY ENHANCED GROUPER 1
20|FH_F50432_0_0|CSTM-ALL|CSTM-00|2020|PDM|720.00|99|0.00|COVENTRY ENHANCED GROUPER 2
20|FH_F50459_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F50459_0_0|SrvcGrp|33166|2022|PDM|550.00|99|0.00|SKILLED NURSING - LEVEL III
20|FH_F50462_0_0|SrvcGrp|44427|2022|PDM|140.00|99|0.00|PHYSICAL THERAPY SVCS (VISIT LVL)
20|FH_F50462_0_0|SrvcGrp|46692|2022|PDM|105.00|99|0.00|RN NURSING SERVICES
20|FH_F50484_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS
20|FH_F50485_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F50490_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F50497_0_0|CSTM-ALL|CSTM-00|2020|PCT|74.00|99|0.00|GENERAL ACUTE CARE
20|FH_F50519_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F50519_0_0|SrvcGrp|46768|2022|PDM|80.00|99|0.00|CPT CODE 90847 PER VISIT
20|FH_F50535_0_0|CSTM-ALL|CSTM-00|2020|PDM|1199.00|99|0.00|COVENTRY ENHANCED GROUPER 7
20|FH_F50535_0_0|CSTM-ALL|CSTM-00|2020|PDM|759.00|99|0.00|COVENTRY ENHANCED GROUPER 4
20|FH_F50535_0_0|CSTM-ALL|CSTM-00|2020|PDM|864.00|99|0.00|COVENTRY ENHANCED GROUPER 5
20|FH_F50577_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F50635_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F50635_0_0|CSTM-ALL|CSTM-00|2020|PDM|365.00|99|0.00|GENERAL ACUTE CARE
20|FH_F50635_0_0|SrvcGrp|38223|2022|PDM|690.00|99|0.00|ADULT DETOX
20|FH_F50654_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|ASPG II
20|FH_F50654_0_0|SrvcGrp|46886|2022|PCT|1.00|99|0.00|REMOVAL OF EYELID LESION
20|FH_F50654_0_0|SrvcGrp|46888|2022|PCT|1.00|99|0.00|VITRECTOMY
20|FH_F50655_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|OP SVCS
20|FH_F50673_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|OP SVCS
20|FH_F50694_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F50715_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F50873_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F50879_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.20|99|0.00|GENERAL ACUTE CARE
20|FH_F50952_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|GENERAL ACUTE CARE
20|FH_F50958_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE
20|FH_F50976_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.00|99|0.00|OP SVCS
20|FH_F50994_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F50994_0_0|SrvcGrp|12403|2022|PDM|30.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F50994_0_0|SrvcGrp|22954|2022|PDM|75.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F51015_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|TRANSPLANT SVCS
20|FH_F51016_0_0|SrvcGrp|33165|2022|PDM|405.00|99|0.00|SKILLED NURSING - LEVEL II
20|FH_F51016_0_0|SrvcGrp|44131|2022|PDM|110.00|99|0.00|SPEECH THERAPY VISIT
20|FH_F51021_0_0|CSTM-ALL|CSTM-00|2020|PCT|67.00|99|0.00|GENERAL ACUTE CARE
20|FH_F51059_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE
20|FH_F51059_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F51074_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|99|0.00|OP SVCS
20|FH_F51074_0_0|SrvcGrp|11336|2022|PCT|0.55|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F51074_0_0|SrvcGrp|13215|2022|PCT|0.55|99|0.00|PHARMACY SVCS
20|FH_F51115_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F51115_0_0|SrvcGrp|42827|2022|PDM|108.24|99|0.00|OCCUPATIONAL THERAPY VISIT
20|FH_F51115_0_0|SrvcGrp|42830|2022|PDM|108.24|99|0.00|MEDICAL SOCIAL WORKER VISIT
20|FH_F51120_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F51120_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F51120_0_0|SrvcGrp|3809|2022|PDM|694.00|99|0.00|HOSPICE CARE
20|FH_F51121_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F51121_0_0|SrvcGrp|12403|2022|PDM|36.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F51123_0_0|CSTM-ALL|CSTM-00|2020|PDM|146.00|99|0.00|HI TECH NURSING
20|FH_F51124_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE
20|FH_F51124_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F51124_0_0|SrvcGrp|10618|2022|PDM|122.50|99|0.00|CPT CODE 99344
20|FH_F51124_0_0|SrvcGrp|12403|2022|PDM|40.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F51124_0_0|SrvcGrp|22954|2022|PDM|160.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F51129_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.94|99|0.00|BURN CARE SERVICES
20|FH_F51129_0_0|CSTM-ALL|CSTM-00|2020|PDM|3657.00|99|0.00|MS DRG 767-768, 774-775 NORMAL DELIVERY
20|FH_F51129_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|GENERAL ACUTE CARE
20|FH_F51129_0_0|SrvcGrp|12846|2022|PCT|0.55|99|0.00|PHARMACY SVCS
20|FH_F51129_0_0|SrvcGrp|38705|2022|PCT|0.75|99|0.00|CARDIAC ABLATION
20|FH_F51136_0_0|SrvcGrp|11606|2022|PDM|1475.00|99|0.00|ACUTE CARE (MEDICAL & SURGICAL)
20|FH_F51138_0_0|SrvcGrp|26001|2022|PDM|160.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F51197_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.77|99|0.00|OP SVCS
20|FH_F51232_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F51254_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F51258_0_0|SrvcGrp|43285|2022|PDM|81.00|99|0.00|SPEECH THERAPY
20|FH_F51258_0_0|SrvcGrp|471|2022|PDM|608.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F51258_0_0|SrvcGrp|472|2022|PDM|377.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F51272_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F51272_0_0|CSTM-ALL|CSTM-00|2020|PDM|12000.00|99|0.00|LITHOTRIPSY
20|FH_F51272_0_0|CSTM-ALL|CSTM-00|2020|PDM|51500.00|99|0.00|CV SURGERY (MS DRG 215-238)
20|FH_F51272_0_0|CSTM-ALL|CSTM-00|2020|PDM|5500.00|99|0.00|GENERAL ACUTE CARE
20|FH_F51272_0_0|SrvcGrp|11258|2022|PCT|0.50|99|0.00|DRUGS
20|FH_F51272_0_0|SrvcGrp|12670|2022|PCT|0.50|99|0.00|IMPLANTS/PROSTHETICS/DEVICES
20|FH_F51272_0_0|SrvcGrp|47591|2022|PDM|6000.00|99|0.00|OBSTETRICAL CARE VAGINAL DELIVERY
20|FH_F51318_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F51318_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|TRAUMA CARE
20|FH_F51352_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F51352_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F51356_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F51358_0_0|SrvcGrp|44427|2022|PDM|125.00|99|0.00|PHYSICAL THERAPY SVCS (VISIT LVL)
20|FH_F51358_0_0|SrvcGrp|44430|2022|PDM|125.00|99|0.00|SPEECH THERAPY SVCS (VISIT LVL)
20|FH_F51358_0_0|SrvcGrp|45944|2022|PDM|50.00|99|0.00|HOME HEALTH AIDE SVCS
20|FH_F51492_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F51492_0_0|SrvcGrp|43892|2022|PDM|75.00|99|0.00|PHYSICAL THERAPY VISIT
20|FH_F51492_0_0|SrvcGrp|46549|2022|PDM|35.00|99|0.00|HOME HEALTH AIDE
20|FH_F51518_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F51519_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F51548_0_0|SrvcGrp|10534|2022|PDM|125.00|99|0.00|NURSING CARE
20|FH_F51548_0_0|SrvcGrp|10542|2022|PDM|125.00|99|0.00|OCCUPATIONAL THERAPY SVCS
20|FH_F51548_0_0|SrvcGrp|10543|2022|PDM|125.00|99|0.00|SPEECH THERAPY SVCS
20|FH_F51548_0_0|SrvcGrp|14254|2022|PDM|45.00|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F51548_0_0|SrvcGrp|22933|2022|PDM|35.00|99|0.00|RESPITE CARE
20|FH_F51554_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F51555_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F51555_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F51557_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F51559_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F51559_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F51658_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F51658_0_0|SrvcGrp|44430|2022|PDM|105.00|99|0.00|SPEECH THERAPY SVCS (VISIT LVL)
20|FH_F51658_0_0|SrvcGrp|45950|2022|PDM|105.00|99|0.00|SPEECH THERAPY
20|FH_F51658_0_0|SrvcGrp|46234|2022|PDM|90.00|99|0.00|SKILLED NURSING
20|FH_F51733_0_0|SrvcGrp|45948|2022|PDM|105.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F51814_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS
20|FH_F51855_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS
20|FH_F51859_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F51934_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F51934_0_0|SrvcGrp|48385|2022|PDM|110.00|99|0.00|SPEECH THERAPY
20|FH_F51934_0_0|SrvcGrp|48393|2022|PDM|55.00|99|0.00|SKILLED NURSING SERVICES (PER HOUR)
20|FH_F51934_0_0|SrvcGrp|48398|2022|PDM|110.00|99|0.00|PT SERVICES
20|FH_F52112_0_0|SrvcGrp|48968|2022|PDM|5700.00|99|0.00|RENAL ABLATION
20|FH_F52172_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F52276_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F52278_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F52278_0_0|CSTM-ALL|CSTM-00|2020|PDM|598.00|99|0.00|ASPG I
20|FH_F52335_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F52393_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F52393_0_0|CSTM-ALL|CSTM-00|2020|PDM|1750.00|99|0.00|HEARING AID
20|FH_F52393_0_0|CSTM-ALL|CSTM-00|2020|PDM|2400.00|99|0.00|HEARING AID
20|FH_F52513_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F52516_0_0|SrvcGrp|1168|2022|PDM|788.55|99|0.00|CONTINUOUS HOMECARE
20|FH_F52617_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F52653_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F52713_0_0|SrvcGrp|14508|2022|PCT|0.60|99|0.00|PHARMACY SVCS
20|FH_F52713_0_0|SrvcGrp|14562|2022|PCT|0.60|99|0.00|OUTPATIENT SURGERY
20|FH_F52713_0_0|SrvcGrp|16|2022|PDM|3110.00|99|0.00|ACUTE REHABILITATION
20|FH_F52713_0_0|SrvcGrp|19961|2022|PDM|86584.00|99|0.00|MS DRG 231-232 ONLY CORONARY BYPASS W/ PTCA
20|FH_F52713_0_0|SrvcGrp|20077|2022|PDM|64398.00|99|0.00|MS DRG 226-227 ONLY CARDIAC DEFIBRILLATOR
20|FH_F52713_0_0|SrvcGrp|20252|2022|PDM|73969.00|99|0.00|MS DRG 224-225 ONLY
20|FH_F52713_0_0|SrvcGrp|23477|2022|PDM|15233.00|99|0.00|MSDRG 286-287 ONLY CARDIAC CATH
20|FH_F52713_0_0|SrvcGrp|49463|2022|PDM|68659.00|99|0.00|MS DRG 219 - 220 ONLY
20|FH_F52713_0_0|SrvcGrp|49522|2022|PDM|21188.00|99|0.00|PACEMAKER IMPLANT
20|FH_F52713_0_0|SrvcGrp|50085|2022|PDM|15661.00|99|0.00|OP PTCA
20|FH_F52713_0_0|SrvcGrp|70440|2022|PDM|1700.00|99|0.00|TCU
20|FH_F52713_0_0|SrvcGrp|9838|2022|PDM|4400.00|99|0.00|TRANSITIONAL CARE UNIT
20|FH_F52716_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F52733_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE
20|FH_F52733_0_0|SrvcGrp|42971|2022|PDM|85.00|99|0.00|SKN RN
20|FH_F52733_0_0|SrvcGrp|43569|2022|PDM|85.00|99|0.00|SKILLED NURSING - NEWBORN
20|FH_F52733_0_0|SrvcGrp|46104|2022|PDM|85.00|99|0.00|HOME VISIT - PRENATAL
20|FH_F52753_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F52753_0_0|CSTM-ALL|CSTM-00|2020|PDM|2010.00|99|0.00|ASPG IX
20|FH_F52754_0_0|CSTM-ALL|CSTM-00|2020|PDM|95.00|99|0.00|SPEECH PATHOLOGY VISIT
20|FH_F52754_0_0|SrvcGrp|29986|2022|PDM|450.00|99|0.00|REHAB THERAPY
20|FH_F52772_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F52801_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F52801_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F52805_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F52872_0_0|CSTM-ALL|CSTM-00|2020|PDM|1541.00|99|0.00|WILLS COMM SURG SVC ASC 6
20|FH_F52872_0_0|CSTM-ALL|CSTM-00|2020|PDM|2136.00|99|0.00|WILLS COMM SURG SVC ASC 10
20|FH_F52872_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F52872_0_0|SrvcGrp|49622|2022|PDM|1066.00|99|0.00|WILLS COMM SURG SVC UNGROUPED
20|FH_F53373_0_0|CSTM-ALL|CSTM-00|2020|PDM|1273.00|99|0.00|ASPG VIII
20|FH_F53373_0_0|CSTM-ALL|CSTM-00|2020|PDM|665.00|99|0.00|ASPG III
20|FH_F53872_0_0|SrvcGrp|10527|2022|PDM|100.00|99|0.00|HOSPICE SVCS
20|FH_F53872_0_0|SrvcGrp|42046|2022|PDM|595.00|99|0.00|HOSPICE CARE
20|FH_F54056_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F54056_0_0|SrvcGrp|12403|2022|PDM|788.55|99|0.00|CONTINUOUS HOMECARE
20|FH_F54172_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|ZERO ALLOWABLE - INPATIENT SERVICES
20|FH_F54272_0_0|CSTM-ALL|CSTM-00|2020|PDM|108000.00|99|0.00|MS DRG 004
20|FH_F54272_0_0|CSTM-ALL|CSTM-00|2020|PDM|1116.00|99|0.00|ACUTE PSYCH
20|FH_F54272_0_0|CSTM-ALL|CSTM-00|2020|PDM|148104.00|99|0.00|MS DRG 003
20|FH_F54272_0_0|SrvcGrp|27713|2022|PCT|0.45|99|0.00|PROSTHETICS / ORTHOTICS
20|FH_F54272_0_0|SrvcGrp|31213|2022|PCT|0.45|99|0.00|CHEMOTHERAPY DRUGS
20|FH_F54272_0_0|SrvcGrp|31214|2022|PCT|0.45|99|0.00|CHEMOTHERAPY DRUGS
20|FH_F54272_0_0|SrvcGrp|51323|2022|PDM|125.00|99|0.00|ST SERVICES
20|FH_F54272_0_0|SrvcGrp|51784|2022|PCT|0.45|99|0.00|OP PHARMACY
20|FH_F54272_0_0|SrvcGrp|9522|2022|PDM|5000.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F54512_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS
20|FH_F54513_0_0|SrvcGrp|10538|2022|PDM|42.00|99|0.00|NURSING CARE
20|FH_F54513_0_0|SrvcGrp|10541|2022|PDM|110.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F54532_0_0|SrvcGrp|14165|2022|PDM|487.00|99|0.00|PARTIAL HOSP PSYCH/CD
20|FH_F54532_0_0|SrvcGrp|16173|2022|PDM|270.00|99|0.00|PARTIAL HOSPITALIZATION
20|FH_F54535_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F54535_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F54572_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F54572_0_0|SrvcGrp|12118|2022|PDM|350.00|99|0.00|COMPUTED TOMOGRAPHY (CT)
20|FH_F54572_0_0|SrvcGrp|8950|2022|PDM|1730.00|99|0.00|INTERMEDIATE ICU/CCU
20|FH_F54614_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F54614_0_0|SrvcGrp|50905|2022|PDM|75.00|99|0.00|PHYSICAL THERAPY
20|FH_F54614_0_0|SrvcGrp|50906|2022|PDM|75.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F54652_0_0|CSTM-ALL|CSTM-00|2020|PDM|1023.23|99|0.00|ASPG VIII
20|FH_F54652_0_0|CSTM-ALL|CSTM-00|2020|PDM|349.79|99|0.00|ASPG I
20|FH_F54652_0_0|CSTM-ALL|CSTM-00|2020|PDM|468.93|99|0.00|ASPG II
20|FH_F54652_0_0|CSTM-ALL|CSTM-00|2020|PDM|662.40|99|0.00|ASPG IV
20|FH_F54752_0_0|CSTM-ALL|CSTM-00|2020|PDM|425.00|99|0.00|ASPG I
20|FH_F54752_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|ASPG III
20|FH_F54752_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|ASPG IV
20|FH_F54752_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|ASPG V
20|FH_F54793_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F55054_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F55054_0_0|SrvcGrp|16|2022|PDM|1170.00|99|0.00|ACUTE REHABILITATION
20|FH_F55054_0_0|SrvcGrp|23477|2022|PDM|4415.00|99|0.00|MSDRG 286-287 ONLY CARDIAC CATH
20|FH_F55054_0_0|SrvcGrp|29817|2022|PDM|2725.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F55054_0_0|SrvcGrp|30623|2022|PDM|3895.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788
20|FH_F55054_0_0|SrvcGrp|3388|2022|PDM|650.00|99|0.00|SUBACUTE CARE
20|FH_F55054_0_0|SrvcGrp|47250|2022|PDM|810.00|99|0.00|MS DRG 876, 880-887 ONLY
20|FH_F55054_0_0|SrvcGrp|51263|2022|PDM|4544.00|99|0.00|ANGIOPLASTY
20|FH_F55054_0_0|SrvcGrp|51265|2022|PDM|650.00|99|0.00|CD UNIT REHAB
20|FH_F55054_0_0|SrvcGrp|51269|2022|PDM|28000.00|99|0.00|GAMMA
20|FH_F55054_0_0|SrvcGrp|9774|2022|PDM|2143.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F55113_0_0|SrvcGrp|10400|2022|PDM|1500.00|99|0.00|IP SURGERY
20|FH_F55113_0_0|SrvcGrp|13854|2022|PDM|1086.00|99|0.00|HYPERBARIC CHAMBER
20|FH_F55113_0_0|SrvcGrp|16|2022|PDM|1230.00|99|0.00|ACUTE REHABILITATION
20|FH_F55113_0_0|SrvcGrp|20752|2022|PDM|27035.00|99|0.00|MSDRG 619-621 ONLY BARIATRIC SURGERY
20|FH_F55113_0_0|SrvcGrp|28074|2022|PCT|0.65|99|0.00|HIGH COST PHARMACEUTICALS
20|FH_F55113_0_0|SrvcGrp|360|2022|PDM|2590.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F55113_0_0|SrvcGrp|51267|2022|PDM|34080.00|99|0.00|CARDIOVASCULAR SURGERY
20|FH_F55113_0_0|SrvcGrp|941|2022|PDM|3405.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F55212_0_0|SrvcGrp|26350|2022|PDM|138.00|99|0.00|CPT 90802
20|FH_F55212_0_0|SrvcGrp|27252|2022|PDM|108.00|99|0.00|INDIVIDUAL PSYCHOTHERAPY
20|FH_F55212_0_0|SrvcGrp|3392|2022|PDM|87.00|99|0.00|CPT 90806
20|FH_F55212_0_0|SrvcGrp|46414|2022|PDM|52.00|99|0.00|INTERACTIVE GROUP PSYCHOTHERAPY
20|FH_F55212_0_0|SrvcGrp|51065|2022|PDM|173.00|99|0.00|HOSP DISCHARGE DAY MGMT 30 MINS OR LESS
20|FH_F55212_0_0|SrvcGrp|51123|2022|PDM|22.00|99|0.00|COMMUNITY PSYCH SUPPORTIVE TREATMENT
20|FH_F55212_0_0|SrvcGrp|9433|2022|PDM|104.00|99|0.00|CPT 90847 FAMILY PSYCHOTHERAPY
20|FH_F55255_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE
20|FH_F55453_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F55532_0_0|SrvcGrp|15887|2022|PCT|1.00|99|0.00|PHARMACY SERVICES
20|FH_F55532_0_0|SrvcGrp|3259|2022|PDM|950.00|99|0.00|ACUTE REHABILITATION
20|FH_F55532_0_0|SrvcGrp|9510|2022|PDM|675.00|99|0.00|SKILLED NURSING CARE
20|FH_F55532_0_0|SrvcGrp|9914|2022|PDM|850.00|99|0.00|PEDIATRIC REHABILITATION
20|FH_F55574_0_0|SrvcGrp|12834|2022|PCT|0.86|99|0.00|EMERGENCY ROOM
20|FH_F55577_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F55634_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE
20|FH_F55694_0_0|SrvcGrp|11336|2022|PCT|0.59|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F55694_0_0|SrvcGrp|12290|2022|PDM|1827.00|99|0.00|DETOXIFICATION
20|FH_F55694_0_0|SrvcGrp|3178|2022|PDM|844.00|99|0.00|ACUTE PSYCH
20|FH_F55694_0_0|SrvcGrp|81722|2022|PDM|3859.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F55713_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F55713_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F55794_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F55794_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F55812_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F55812_0_0|SrvcGrp|10534|2022|PDM|70.00|99|0.00|NURSING CARE
20|FH_F55812_0_0|SrvcGrp|10537|2022|PDM|52.00|99|0.00|NURSING CARE
20|FH_F55812_0_0|SrvcGrp|10544|2022|PDM|73.00|99|0.00|ENTEROSTOMAL THERAPY SERVICES
20|FH_F55812_0_0|SrvcGrp|53747|2022|PDM|35.00|99|0.00|RESPITE CARE
20|FH_F55854_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F55872_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F55876_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F56054_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|PROFESSIONAL FEES ON CMS 1500 (HCFA)
20|FH_F56136_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|PROCRIT/ERYTHROPOIETIN (EPOETIN)
20|FH_F56136_0_0|SrvcGrp|12659|2022|PCT|0.89|99|0.00|ELECTROSHOCK THERAPY TREATMENT
20|FH_F56136_0_0|SrvcGrp|20272|2022|PCT|0.85|99|0.00|MS DRG 219-221 ONLY CARDIAC VLV PROC W/O CA CAT
20|FH_F56136_0_0|SrvcGrp|22816|2022|PCT|0.92|99|0.00|ROTATOR CUFF
20|FH_F56136_0_0|SrvcGrp|22819|2022|PCT|0.92|99|0.00|PTCA
20|FH_F56136_0_0|SrvcGrp|22820|2022|PCT|0.92|99|0.00|DIALYSIS
20|FH_F56136_0_0|SrvcGrp|23477|2022|PCT|0.85|99|0.00|MSDRG 286-287 ONLY CARDIAC CATH
20|FH_F56136_0_0|SrvcGrp|3069|2022|PCT|0.67|99|0.00|IMPLANTS
20|FH_F56136_0_0|SrvcGrp|31101|2022|PDM|635.00|99|0.00|NORMAL NEWBORN VIA NORMAL DELIVERY
20|FH_F56136_0_0|SrvcGrp|3418|2022|PDM|3177.00|99|0.00|NEONATAL INTENSIVE CARE UNIT
20|FH_F56136_0_0|SrvcGrp|4109|2022|PDM|1004.00|99|0.00|ACUTE PSYCH
20|FH_F56136_0_0|SrvcGrp|9263|2022|PDM|803.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F56137_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F56137_0_0|SrvcGrp|36093|2022|PDM|1200.00|99|0.00|ACUTE REHABILITATION
20|FH_F56137_0_0|SrvcGrp|45883|2022|PDM|95.00|99|0.00|OT
20|FH_F56137_0_0|SrvcGrp|52247|2022|PDM|95.00|99|0.00|CARDIAC REHAB
20|FH_F56276_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F56276_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F56276_0_0|SrvcGrp|52945|2022|PDM|81.00|99|0.00|PSYCHIATRIC CPT 90805
20|FH_F56276_0_0|SrvcGrp|52948|2022|PDM|170.00|99|0.00|PSYCHIATRIC CPT 90809
20|FH_F56276_0_0|SrvcGrp|52949|2022|PDM|111.00|99|0.00|PSYCHIATRIC CPT 90812
20|FH_F56276_0_0|SrvcGrp|52950|2022|PDM|109.00|99|0.00|PSYCHIATRIC CPT 90818
20|FH_F56293_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F56472_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F56472_0_0|SrvcGrp|29303|2022|PDM|85.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F56512_0_0|SrvcGrp|42869|2022|PDM|60.00|99|0.00|PHYSICAL THERAPY VISIT
20|FH_F56512_0_0|SrvcGrp|42870|2022|PDM|60.00|99|0.00|OCCUPATIONAL THERAPY VISIT
20|FH_F56533_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE
20|FH_F56533_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS
20|FH_F56572_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F56572_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F56573_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F56573_0_0|SrvcGrp|13627|2022|PCT|0.00|99|0.00|SLEEP STUDY
20|FH_F56573_0_0|SrvcGrp|8960|2022|PDM|60.00|99|0.00|SPEECH THERAPY
20|FH_F56678_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F56712_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F56813_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F56832_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F56832_0_0|CSTM-ALL|CSTM-00|2020|PDM|1450.00|99|0.00|GENERAL ACUTE CARE
20|FH_F56832_0_0|SrvcGrp|2020|2022|PCT|0.75|99|0.00|PROFESSIONAL SVCS
20|FH_F56832_0_0|SrvcGrp|65|2022|PDM|1200.00|99|0.00|OBSTETRICAL CARE
20|FH_F57032_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE
20|FH_F57032_0_0|SrvcGrp|53484|2022|PDM|9.00|99|0.00|CONTROL SOLUTION
20|FH_F57032_0_0|SrvcGrp|53487|2022|PDM|134.00|99|0.00|DIBETIC SHOES
20|FH_F57032_0_0|SrvcGrp|53488|2022|PDM|244.00|99|0.00|INSERTS
20|FH_F57073_0_0|SrvcGrp|177|2022|PDM|1591.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F57073_0_0|SrvcGrp|3066|2022|PCT|0.75|99|0.00|HIGH-COST DRUGS
20|FH_F57073_0_0|SrvcGrp|3273|2022|PCT|0.75|99|0.00|IMPLANTS
20|FH_F57093_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F57114_0_0|CSTM-ALL|CSTM-00|2020|PCT|99.00|99|0.00|GENERAL ACUTE CARE
20|FH_F57312_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|OP SVCS
20|FH_F57372_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F57372_0_0|SrvcGrp|36968|2022|PDM|442.00|99|0.00|SKILLED NURSING LEVEL I & II
20|FH_F57396_0_0|CSTM-ALL|CSTM-00|2020|PDM|80.00|99|0.00|CPT 99201
20|FH_F57396_0_0|SrvcGrp|36669|2022|PDM|5.00|99|0.00|IMMUNIZATION ADMIN
20|FH_F57396_0_0|SrvcGrp|46584|2022|PDM|100.00|99|0.00|CPT 99203
20|FH_F57396_0_0|SrvcGrp|46585|2022|PDM|160.00|99|0.00|CPT 99204
20|FH_F57396_0_0|SrvcGrp|46592|2022|PDM|160.00|99|0.00|CPT 99214
20|FH_F57553_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F57553_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|CTR FOR DIGEST DIS $350  MOD SU
20|FH_F57592_0_0|SrvcGrp|10927|2022|PDM|1050.00|99|0.00|COMPUTED TOMOGRAPHY (CT)
20|FH_F57592_0_0|SrvcGrp|12523|2022|PCT|0.67|99|0.00|GAMMA KNIFE
20|FH_F57592_0_0|SrvcGrp|20910|2022|PDM|61000.00|99|0.00|MS DRG 234 ONLY
20|FH_F57592_0_0|SrvcGrp|20912|2022|PDM|34500.00|99|0.00|MS DRG 236 ONLY
20|FH_F57592_0_0|SrvcGrp|24598|2022|PDM|2250.00|99|0.00|MS DRG 945-946 ONLY
20|FH_F57592_0_0|SrvcGrp|26666|2022|PDM|33000.00|99|0.00|MS DRG 482 ONLY
20|FH_F57592_0_0|SrvcGrp|28161|2022|PDM|65000.00|99|0.00|MS DRG 216 ONLY
20|FH_F57592_0_0|SrvcGrp|28162|2022|PDM|72000.00|99|0.00|MS DRG 217 ONLY
20|FH_F57592_0_0|SrvcGrp|28167|2022|PDM|99000.00|99|0.00|MS DRG 231 ONLY
20|FH_F57592_0_0|SrvcGrp|29607|2022|PDM|48000.00|99|0.00|MS DRG 221 ONLY
20|FH_F57592_0_0|SrvcGrp|29609|2022|PDM|55000.00|99|0.00|MS DRG 232 ONLY
20|FH_F57592_0_0|SrvcGrp|30623|2022|PDM|9000.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788
20|FH_F57592_0_0|SrvcGrp|39871|2022|PCT|0.72|99|0.00|MS DRG 619-621 ONLY OTLR
20|FH_F57834_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE
20|FH_F57834_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F57834_0_0|SrvcGrp|41368|2022|PDM|1470.00|99|0.00|TELEMETRY
20|FH_F57854_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F57854_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F57912_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F58252_0_0|SrvcGrp|46350|2022|PDM|31.25|99|0.00|HI TECH SKILLED NURSING SERVICES
20|FH_F58252_0_0|SrvcGrp|46424|2022|PDM|31.25|99|0.00|HI TECH SKILLED NURSING SERVICES
20|FH_F58252_0_0|SrvcGrp|48397|2022|PDM|31.25|99|0.00|PT SERVICES
20|FH_F58272_0_0|SrvcGrp|76207|2022|PDM|60.00|99|0.00|SPEECH THERAPY (VISIT LVL) MOD GN
20|FH_F58313_0_0|CSTM-ALL|CSTM-00|2020|PCT|76.00|99|0.00|GENERAL ACUTE CARE
20|FH_F58592_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F58592_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|OP SURGERY (MOD SG)
20|FH_F58615_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F58636_0_0|CSTM-ALL|CSTM-00|2020|PCT|81.00|99|0.00|GENERAL ACUTE CARE
20|FH_F58692_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE
20|FH_F58692_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F58713_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F58713_0_0|CSTM-ALL|CSTM-00|2020|PDM|2186.00|99|0.00|ASPG IX
20|FH_F58713_0_0|CSTM-ALL|CSTM-00|2020|PDM|544.00|99|0.00|ASPG I
20|FH_F58713_0_0|SrvcGrp|14320|2022|PCT|1.10|99|0.00|OP IMPLANTS/PROSTHETICS/DEVICES
20|FH_F58714_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F58856_0_0|CSTM-ALL|CSTM-00|2020|PDM|1725.00|99|0.00|ACUTE PSYCHIATRIC SERVICES
20|FH_F58856_0_0|CSTM-ALL|CSTM-00|2020|PDM|2125.00|99|0.00|GENERAL ACUTE CARE
20|FH_F58856_0_0|CSTM-ALL|CSTM-00|2020|PDM|31750.00|99|0.00|MS DRG 230 ONLY
20|FH_F58856_0_0|SrvcGrp|16|2022|PDM|1100.00|99|0.00|ACUTE REHABILITATION
20|FH_F58856_0_0|SrvcGrp|20908|2022|PDM|17800.00|99|0.00|MS DRG 247 ONLY
20|FH_F58856_0_0|SrvcGrp|21350|2022|PDM|9000.00|99|0.00|MS DRG 287 ONLY
20|FH_F58856_0_0|SrvcGrp|22401|2022|PDM|956.00|99|0.00|ASPG I (REV CODE + CPT/HCPCS)
20|FH_F58856_0_0|SrvcGrp|22403|2022|PDM|1462.00|99|0.00|ASPG III (REV CODE + CPT)
20|FH_F58856_0_0|SrvcGrp|22404|2022|PDM|2000.00|99|0.00|ASPG IV (REV CODE + CPT)
20|FH_F58856_0_0|SrvcGrp|22405|2022|PDM|3219.00|99|0.00|ASPG V (REV CODE + CPT)
20|FH_F58856_0_0|SrvcGrp|22409|2022|PDM|4000.00|99|0.00|ASPG IX (REV CODE + CPT/HCPCS)
20|FH_F58856_0_0|SrvcGrp|28161|2022|PDM|40000.00|99|0.00|MS DRG 216 ONLY
20|FH_F58856_0_0|SrvcGrp|28163|2022|PDM|45000.00|99|0.00|MS DRG 222 ONLY
20|FH_F58856_0_0|SrvcGrp|29606|2022|PDM|37500.00|99|0.00|MS DRG 218 ONLY
20|FH_F58856_0_0|SrvcGrp|9529|2022|PDM|1100.00|99|0.00|HOSPICE SVCS
20|FH_F58972_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F58973_0_0|CSTM-ALL|CSTM-00|2020|PDM|1494.00|99|0.00|COVENTRY ENHANCED GROUPER 6
20|FH_F58973_0_0|CSTM-ALL|CSTM-00|2020|PDM|987.00|99|0.00|COVENTRY ENHANCED GROUPER 3
20|FH_F59093_0_0|SrvcGrp|42976|2022|PDM|85.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F59274_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F59274_0_0|SrvcGrp|3810|2022|PDM|132.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F59274_0_0|SrvcGrp|48395|2022|PDM|32.00|99|0.00|OT SERVICES
20|FH_F59274_0_0|SrvcGrp|48397|2022|PDM|32.00|99|0.00|PT SERVICES
20|FH_F59274_0_0|SrvcGrp|48398|2022|PDM|32.00|99|0.00|PT SERVICES
20|FH_F59312_0_0|SrvcGrp|12496|2022|PDM|717.00|99|0.00|ACUTE REHABILITATION
20|FH_F59312_0_0|SrvcGrp|43285|2022|PDM|74.00|99|0.00|SPEECH THERAPY
20|FH_F59312_0_0|SrvcGrp|471|2022|PDM|579.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F59333_0_0|SrvcGrp|22954|2022|PDM|135.11|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F59333_0_0|SrvcGrp|3809|2022|PDM|601.02|99|0.00|HOSPICE CARE
20|FH_F59652_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F59652_0_0|SrvcGrp|33812|2022|PDM|160.00|99|0.00|IOP / MENTAL HEALTH / SUBSTANCE ABUSE
20|FH_F59992_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F59992_0_0|SrvcGrp|56103|2022|PDM|2600.00|99|0.00|VAGINAL DELIVERY WITH POST PARTUM
20|FH_F60019_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F60072_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F60072_0_0|CSTM-ALL|CSTM-00|2020|PDM|18407.00|99|0.00|MS DRG 619-621
20|FH_F60072_0_0|SrvcGrp|3066|2022|PCT|0.60|99|0.00|HIGH-COST DRUGS
20|FH_F60072_0_0|SrvcGrp|3499|2022|PCT|0.60|99|0.00|IMPLANTS
20|FH_F60072_0_0|SrvcGrp|8950|2022|PDM|2650.00|99|0.00|INTERMEDIATE ICU/CCU
20|FH_F60072_0_0|SrvcGrp|941|2022|PDM|4225.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F60253_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F60253_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F60254_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F60254_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F60273_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F60273_0_0|CSTM-ALL|CSTM-00|2020|PDM|425.21|99|0.00|ASPG I
20|FH_F60273_0_0|CSTM-ALL|CSTM-00|2020|PDM|651.63|99|0.00|ASPG X
20|FH_F60273_0_0|SrvcGrp|16506|2022|PDM|3197.25|99|0.00|CPT 52647
20|FH_F60273_0_0|SrvcGrp|38364|2022|PDM|4189.50|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F60273_0_0|SrvcGrp|55084|2022|PDM|3210.48|99|0.00|CPT 52648
20|FH_F60273_0_0|SrvcGrp|56462|2022|PDM|4515.84|99|0.00|CPT 53850
20|FH_F60273_0_0|SrvcGrp|56464|2022|PDM|8379.00|99|0.00|CPT 55873
20|FH_F60275_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F60276_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|INTRAOCULAR LENS
20|FH_F60276_0_0|CSTM-ALL|CSTM-00|2020|PDM|595.00|99|0.00|ASPG IV
20|FH_F60276_0_0|CSTM-ALL|CSTM-00|2020|PDM|789.00|99|0.00|ASPG VI
20|FH_F60292_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE
20|FH_F60292_0_0|SrvcGrp|471|2022|PDM|625.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F60296_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F60296_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|TRACHEOSTOMY
20|FH_F60365_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|GENERAL ACUTE CARE
20|FH_F60365_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|TRANSPLANT SVCS
20|FH_F60812_0_0|SrvcGrp|11853|2022|PCT|0.45|99|0.00|DRUGS
20|FH_F60812_0_0|SrvcGrp|13365|2022|PDM|4883.00|99|0.00|INTENSIVE MEDICAL CARE
20|FH_F60836_0_0|CSTM-ALL|CSTM-00|2020|PDM|1387.82|99|0.00|ASPG VII
20|FH_F60836_0_0|CSTM-ALL|CSTM-00|2020|PDM|1867.63|99|0.00|ASPG IX
20|FH_F60836_0_0|CSTM-ALL|CSTM-00|2020|PDM|622.08|99|0.00|ASPG II
20|FH_F60836_0_0|SrvcGrp|11000|2022|PCT|1.00|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F61072_0_0|SrvcGrp|42827|2022|PDM|100.00|99|0.00|OCCUPATIONAL THERAPY VISIT
20|FH_F61292_0_0|CSTM-ALL|CSTM-00|2020|PDM|1117.00|99|0.00|ASPG I - FH SW CUSTOM GROUPERS
20|FH_F61292_0_0|SrvcGrp|11000|2022|PCT|0.44|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F61292_0_0|SrvcGrp|12587|2022|PDM|8720.00|99|0.00|PTCA W/ STENT
20|FH_F61292_0_0|SrvcGrp|14187|2022|PDM|959.00|99|0.00|MRI
20|FH_F61292_0_0|SrvcGrp|17324|2022|PDM|4071.00|99|0.00|ARTHROSCOPIC KNEE REPAIR
20|FH_F61292_0_0|SrvcGrp|20096|2022|PDM|46229.00|99|0.00|MS DRG 222-223 ONLY
20|FH_F61292_0_0|SrvcGrp|20297|2022|PDM|34795.00|99|0.00|MS DRG 219-221 ONLY CARDIAC VALVE PROC
20|FH_F61292_0_0|SrvcGrp|29098|2022|PDM|23802.00|99|0.00|GAMMA KNIFE
20|FH_F61292_0_0|SrvcGrp|29334|2022|PCT|0.49|99|0.00|EMERGENCY ROOM SRVCS
20|FH_F61292_0_0|SrvcGrp|31504|2022|PDM|23802.00|99|0.00|CYBER KNIFE
20|FH_F61292_0_0|SrvcGrp|39522|2022|PDM|47554.00|99|0.00|MS DRG 216-218 ONLY
20|FH_F61292_0_0|SrvcGrp|39871|2022|PCT|0.59|99|0.00|MS DRG 619-621 ONLY OTLR
20|FH_F61292_0_0|SrvcGrp|44564|2022|PDM|523.00|99|0.00|NEWBORN NURSERY
20|FH_F61292_0_0|SrvcGrp|57465|2022|PCT|0.68|99|0.00|MS DRG 001-002, 005-006, 008-010, 652, 981-983
20|FH_F61292_0_0|SrvcGrp|9774|2022|PDM|2790.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F61332_0_0|SrvcGrp|14609|2022|PCT|0.65|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F61332_0_0|SrvcGrp|14610|2022|PCT|0.65|99|0.00|SPEECH PATHOLOGY VISIT
20|FH_F61332_0_0|SrvcGrp|17520|2022|PCT|1.05|99|0.00|IMPLANTS
20|FH_F61673_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F62092_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS
20|FH_F62172_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F62252_0_0|SrvcGrp|472|2022|PDM|405.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F62252_0_0|SrvcGrp|474|2022|PDM|315.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F62333_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F62333_0_0|SrvcGrp|1168|2022|PDM|925.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F62373_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F62513_0_0|CSTM-ALL|CSTM-00|2020|PDM|1947.61|99|0.00|ASPG X
20|FH_F62513_0_0|CSTM-ALL|CSTM-00|2020|PDM|2703.41|99|0.00|ASPG VII
20|FH_F62532_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.00|99|0.00|GENERAL ACUTE CARE
20|FH_F62577_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F62577_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F62577_0_0|SrvcGrp|58458|2022|PDM|1408.00|99|0.00|ASPG V
20|FH_F62582_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS
20|FH_F62596_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F62596_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F62600_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE
20|FH_F62600_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F62600_0_0|CSTM-ALL|CSTM-00|2020|PDM|816.00|99|0.00|ASPG III
20|FH_F62601_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F62601_0_0|SrvcGrp|48398|2022|PDM|30.00|99|0.00|PT SERVICES
20|FH_F62614_0_0|SrvcGrp|46604|2022|PDM|30.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES
20|FH_F62614_0_0|SrvcGrp|48395|2022|PDM|30.00|99|0.00|OT SERVICES
20|FH_F62624_0_0|SrvcGrp|27160|2022|PDM|5440.00|99|0.00|MS DRG 242-243 ONLY
20|FH_F62624_0_0|SrvcGrp|29755|2022|PDM|11000.00|99|0.00|MS DRG 245 ONLY
20|FH_F62624_0_0|SrvcGrp|29817|2022|PDM|3400.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F62624_0_0|SrvcGrp|32539|2022|PDM|11000.00|99|0.00|MS DRG 222-227 ONLY
20|FH_F62624_0_0|SrvcGrp|3448|2022|PDM|550.00|99|0.00|MRI
20|FH_F62624_0_0|SrvcGrp|43871|2022|PDM|650.00|99|0.00|NEWBORN NURSERY
20|FH_F62624_0_0|SrvcGrp|51672|2022|PDM|5440.00|99|0.00|MS DRG 286-287 ONLY
20|FH_F62627_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SURG
20|FH_F62691_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F62694_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE
20|FH_F62697_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE
20|FH_F62697_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS
20|FH_F62713_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F62713_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F62719_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F62719_0_0|SrvcGrp|14494|2022|PDM|40.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F62719_0_0|SrvcGrp|30955|2022|PDM|108.00|99|0.00|SKILLED RN VISIT
20|FH_F62719_0_0|SrvcGrp|3810|2022|PDM|168.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F62719_0_0|SrvcGrp|44709|2022|PDM|108.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F62719_0_0|SrvcGrp|46183|2022|PCT|0.70|99|0.00|WOUND CARE / MEDICAL SUPPLIES
20|FH_F62719_0_0|SrvcGrp|59288|2022|PDM|56.70|99|0.00|PEDIATRIC RN ROUTING NURSING
20|FH_F62719_0_0|SrvcGrp|59289|2022|PDM|113.40|99|0.00|INITIAL SPECIALTY NURSING (MOD TG)
20|FH_F62719_0_0|SrvcGrp|59293|2022|PDM|54.00|99|0.00|NURSING CARE
20|FH_F62750_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F62761_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F62765_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F62773_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS
20|FH_F62797_0_0|CSTM-ALL|CSTM-00|2020|PCT|42.00|99|0.00|OP SVCS
20|FH_F62802_0_0|CSTM-ALL|CSTM-00|2020|PDM|545.00|99|0.00|ASPG I
20|FH_F62802_0_0|SrvcGrp|13297|2022|PCT|1.10|99|0.00|IMPLANTS
20|FH_F62864_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F62867_0_0|SrvcGrp|3934|2022|PDM|150.00|99|0.00|INTENSIVE ADULT DUAL DIAGNOSIS
20|FH_F62868_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F62869_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F62892_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F62892_0_0|SrvcGrp|10538|2022|PDM|27.50|99|0.00|NURSING CARE
20|FH_F62892_0_0|SrvcGrp|44423|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE (VISIT LVL)
20|FH_F62892_0_0|SrvcGrp|53746|2022|PDM|35.00|99|0.00|RESPITE CARE (HCFA)
20|FH_F62892_0_0|SrvcGrp|58848|2022|PDM|500.00|99|0.00|HOSPICE GENERAL CARE
20|FH_F62920_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F62922_0_0|SrvcGrp|23587|2022|PDM|475.00|99|0.00|RESIDENTIAL TREATMENT - PSYCH
20|FH_F62922_0_0|SrvcGrp|3934|2022|PDM|174.00|99|0.00|INTENSIVE ADULT DUAL DIAGNOSIS
20|FH_F62977_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F62978_0_0|CSTM-ALL|CSTM-00|2020|PDM|1194.00|99|0.00|ASPG VII
20|FH_F62978_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|ASPG I
20|FH_F62978_0_0|CSTM-ALL|CSTM-00|2020|PDM|612.00|99|0.00|ASPG X
20|FH_F62978_0_0|CSTM-ALL|CSTM-00|2020|PDM|756.00|99|0.00|ASPG IV
20|FH_F62980_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.90|99|0.00|GENERAL ACUTE CARE
20|FH_F62982_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F62995_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE
20|FH_F62995_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS
20|FH_F63020_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63049_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F63095_0_0|SrvcGrp|35419|2022|PCT|1.00|99|0.00|AIR AMBULANCE SVCS
20|FH_F63095_0_0|SrvcGrp|59290|2022|PDM|862.00|99|0.00|DAY HOSPITAL HALF DAY
20|FH_F63114_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F63114_0_0|SrvcGrp|46350|2022|PDM|25.00|99|0.00|HI TECH SKILLED NURSING SERVICES
20|FH_F63114_0_0|SrvcGrp|46605|2022|PDM|25.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES
20|FH_F63114_0_0|SrvcGrp|48397|2022|PDM|30.00|99|0.00|PT SERVICES
20|FH_F63117_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63124_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F63124_0_0|SrvcGrp|42974|2022|PDM|145.00|99|0.00|OCCUPATIONAL THERAPIST
20|FH_F63124_0_0|SrvcGrp|45944|2022|PDM|36.00|99|0.00|HOME HEALTH AIDE SVCS
20|FH_F63124_0_0|SrvcGrp|45948|2022|PDM|145.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F63124_0_0|SrvcGrp|45949|2022|PDM|145.00|99|0.00|OCCUPATIONAL THERAPY SVCS
20|FH_F63129_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE
20|FH_F63129_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F63129_0_0|SrvcGrp|46605|2022|PDM|25.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES
20|FH_F63129_0_0|SrvcGrp|48393|2022|PDM|8.50|99|0.00|SKILLED NURSING SERVICES (PER HOUR)
20|FH_F63129_0_0|SrvcGrp|48395|2022|PDM|30.00|99|0.00|OT SERVICES
20|FH_F63141_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE
20|FH_F63141_0_0|SrvcGrp|1306|2022|PDM|725.00|99|0.00|OP PSYCH PARTIAL HOSP
20|FH_F63141_0_0|SrvcGrp|14210|2022|PDM|370.00|99|0.00|PSYCH INTENSIVE OUTPATIENT
20|FH_F63178_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F63178_0_0|CSTM-ALL|CSTM-00|2020|PDM|1172.00|99|0.00|COVENTRY ENHANCED GROUPER 8
20|FH_F63178_0_0|CSTM-ALL|CSTM-00|2020|PDM|1199.00|99|0.00|COVENTRY ENHANCED GROUPER 7
20|FH_F63178_0_0|CSTM-ALL|CSTM-00|2020|PDM|759.00|99|0.00|COVENTRY ENHANCED GROUPER 4
20|FH_F63178_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|COVENTRY ENHANCED GROUPER 6
20|FH_F63182_0_0|SrvcGrp|9811|2022|PDM|435.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F63185_0_0|SrvcGrp|46424|2022|PDM|30.00|99|0.00|HI TECH SKILLED NURSING SERVICES
20|FH_F63195_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63229_0_0|SrvcGrp|44248|2022|PDM|160.00|99|0.00|CAPD/CCPD SUPPLEMENT
20|FH_F63229_0_0|SrvcGrp|59395|2022|PDM|290.00|99|0.00|CCPD
20|FH_F63231_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63231_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F63232_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63235_0_0|SrvcGrp|15472|2022|PDM|931.00|99|0.00|CPT CODE 62284
20|FH_F63235_0_0|SrvcGrp|29718|2022|PCT|0.40|99|0.00|SUPPLIES/DEVICES/IMPLANTABLES
20|FH_F63235_0_0|SrvcGrp|72994|2022|PDM|1426.00|99|0.00|AEG 3
20|FH_F63235_0_0|SrvcGrp|73004|2022|PDM|2722.00|99|0.00|AEG 8
20|FH_F63244_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63249_0_0|SrvcGrp|59415|2022|PDM|95.00|99|0.00|OCCUPATIONAL THERAPY SVCS EXCLD MOD GO
20|FH_F63250_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63250_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F63250_0_0|SrvcGrp|23683|2022|PDM|33.00|99|0.00|SKILLED NURSING RN
20|FH_F63250_0_0|SrvcGrp|27969|2022|PDM|44.00|99|0.00|HOME HEALTH AIDE
20|FH_F63250_0_0|SrvcGrp|42973|2022|PDM|105.00|99|0.00|SPEECH  THERAPIST
20|FH_F63250_0_0|SrvcGrp|46104|2022|PDM|99.00|99|0.00|HOME VISIT - PRENATAL
20|FH_F63250_0_0|SrvcGrp|46118|2022|PDM|72.00|99|0.00|NUTRITNAL CNSLNG/DIABETES EDU
20|FH_F63250_0_0|SrvcGrp|46424|2022|PDM|105.00|99|0.00|HI TECH SKILLED NURSING SERVICES
20|FH_F63297_0_0|SrvcGrp|59428|2022|PDM|75.00|99|0.00|ST
20|FH_F63312_0_0|SrvcGrp|10527|2022|PDM|103.00|99|0.00|HOSPICE SVCS
20|FH_F63312_0_0|SrvcGrp|10543|2022|PDM|79.00|99|0.00|SPEECH THERAPY SVCS
20|FH_F63312_0_0|SrvcGrp|12157|2022|PDM|85.00|99|0.00|RN VISIT
20|FH_F63317_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F63375_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63375_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F63385_0_0|CSTM-ALL|CSTM-00|2020|PDM|2288.00|99|0.00|ASPG IX
20|FH_F63385_0_0|SrvcGrp|58508|2022|PDM|1060.00|99|0.00|UNLISTED CODES OP SURGERY
20|FH_F63398_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F63403_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F63414_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F63417_0_0|SrvcGrp|44883|2022|PDM|18.00|99|0.00|RT/PT/ST/OT
20|FH_F63417_0_0|SrvcGrp|471|2022|PDM|660.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F63419_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63419_0_0|SrvcGrp|3259|2022|PDM|712.00|99|0.00|ACUTE REHABILITATION
20|FH_F63419_0_0|SrvcGrp|59714|2022|PDM|415.00|99|0.00|RESIDENTIAL TREATMENT
20|FH_F63422_0_0|SrvcGrp|33812|2022|PDM|300.00|99|0.00|IOP / MENTAL HEALTH / SUBSTANCE ABUSE
20|FH_F63459_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63462_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F63462_0_0|CSTM-ALL|CSTM-00|2020|PDM|1080.00|99|0.00|ASPG III
20|FH_F63462_0_0|CSTM-ALL|CSTM-00|2020|PDM|1463.00|99|0.00|ASPG V
20|FH_F63462_0_0|CSTM-ALL|CSTM-00|2020|PDM|1537.00|99|0.00|ASPG VI
20|FH_F63462_0_0|CSTM-ALL|CSTM-00|2020|PDM|823.00|99|0.00|ASPG II
20|FH_F63475_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63475_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F63481_0_0|SrvcGrp|26235|2022|PDM|900.00|99|0.00|SLEEP STUDIES
20|FH_F63494_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63516_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F63535_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F63556_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|GENERAL ACUTE CARE
20|FH_F63556_0_0|SrvcGrp|33793|2022|PDM|4000.00|99|0.00|MSDRG 246-251 ONLY ANGIOPLASTY
20|FH_F63618_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F63618_0_0|CSTM-ALL|CSTM-00|2020|PDM|12000.00|99|0.00|GHP CAPITAL REION MED MS DRG
20|FH_F63618_0_0|SrvcGrp|12787|2022|PCT|0.65|99|0.00|IMPLANTS
20|FH_F63618_0_0|SrvcGrp|360|2022|PDM|2000.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F63618_0_0|SrvcGrp|8950|2022|PDM|3500.00|99|0.00|INTERMEDIATE ICU/CCU
20|FH_F63625_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|HIGH COST DRUGS
20|FH_F63625_0_0|SrvcGrp|1259|2022|PDM|5145.00|99|0.00|INTERMEDIATE INTENSIVE CARE UNIT
20|FH_F63625_0_0|SrvcGrp|39870|2022|PDM|23476.00|99|0.00|MS DRG 619-621 ONLY
20|FH_F63625_0_0|SrvcGrp|60126|2022|PDM|37946.00|99|0.00|CARDIOVASCULAR SURGERY
20|FH_F63625_0_0|SrvcGrp|60128|2022|PDM|2620.00|99|0.00|GERIATRIC PSYCH SERVICES
20|FH_F63625_0_0|SrvcGrp|9911|2022|PCT|0.80|99|0.00|EMERGENCY ROOM SVCS
20|FH_F63881_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F63881_0_0|SrvcGrp|47999|2022|PDM|120.00|99|0.00|CAPD SUPPLEMENT DAY
20|FH_F63881_0_0|SrvcGrp|59358|2022|PDM|140.00|99|0.00|CCPD TRAINING
20|FH_F64160_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F64180_0_0|SrvcGrp|1168|2022|PDM|640.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F64440_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.72|99|0.00|GENERAL ACUTE CARE
20|FH_F64440_0_0|SrvcGrp|33843|2022|PDM|123.00|99|0.00|CPT CODE 94762
20|FH_F64441_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F64441_0_0|SrvcGrp|17139|2022|PDM|643.00|99|0.00|HOSPICE CARE
20|FH_F64441_0_0|SrvcGrp|42782|2022|PDM|68.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F64559_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F64579_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F64579_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F64739_0_0|SrvcGrp|14494|2022|PDM|37.40|99|0.00|CONTINUOUS HOMECARE
20|FH_F64739_0_0|SrvcGrp|60856|2022|PDM|132.00|99|0.00|HOSPICE SERVICE - ROUTINE HOME CARE
20|FH_F64779_0_0|SrvcGrp|42824|2022|PDM|163.00|99|0.00|SKILLED NURSING VISIT
20|FH_F64879_0_0|SrvcGrp|44302|2022|PDM|60.00|99|0.00|PT & OT (VISIT LVL) PT MOD GP
20|FH_F64879_0_0|SrvcGrp|76207|2022|PDM|60.00|99|0.00|SPEECH THERAPY (VISIT LVL) MOD GN
20|FH_F64940_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F64943_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE
20|FH_F64943_0_0|CSTM-ALL|CSTM-00|2020|PDM|598.00|99|0.00|ADULT SA PARTIAL HOSPITALIZATION
20|FH_F64943_0_0|CSTM-ALL|CSTM-00|2020|PDM|654.00|99|0.00|ADOLESCENT PARTIAL HOSPITALIZATION
20|FH_F64943_0_0|SrvcGrp|3087|2022|PDM|1850.00|99|0.00|CD - DETOX
20|FH_F64943_0_0|SrvcGrp|35966|2022|PDM|783.00|99|0.00|ECT
20|FH_F65100_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F65139_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F65182_0_0|SrvcGrp|33164|2022|PDM|315.00|99|0.00|SKILLED NURSING - LEVEL I
20|FH_F65182_0_0|SrvcGrp|43892|2022|PDM|80.00|99|0.00|PHYSICAL THERAPY VISIT
20|FH_F65182_0_0|SrvcGrp|49862|2022|PDM|80.00|99|0.00|SPEECH THERAPY
20|FH_F65200_0_0|SrvcGrp|44302|2022|PDM|60.00|99|0.00|PT & OT (VISIT LVL) PT MOD GP
20|FH_F65239_0_0|CSTM-ALL|CSTM-00|2020|PDM|1045.00|99|0.00|AEG 5  (NO REV)
20|FH_F65239_0_0|CSTM-ALL|CSTM-00|2020|PDM|1414.00|99|0.00|AEG 7 (NO REV)
20|FH_F65239_0_0|CSTM-ALL|CSTM-00|2020|PDM|487.00|99|0.00|AEG 1 (NO REV)
20|FH_F65239_0_0|CSTM-ALL|CSTM-00|2020|PDM|652.00|99|0.00|AEG 2 (NO REV)
20|FH_F65239_0_0|CSTM-ALL|CSTM-00|2020|PDM|811.00|99|0.00|AEG 3 (NO REV)
20|FH_F65239_0_0|SrvcGrp|61357|2022|PDM|1202.00|99|0.00|SURGICAL CARVEOUTS
20|FH_F65359_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F65440_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F65440_0_0|CSTM-ALL|CSTM-00|2020|PDM|1267.00|99|0.00|COVENTRY ENHANCED GROUPER 5
20|FH_F65440_0_0|CSTM-ALL|CSTM-00|2020|PDM|1758.00|99|0.00|COVENTRY ENHANCED GROUPER 7
20|FH_F65440_0_0|SrvcGrp|14614|2022|PDM|4285.00|99|0.00|LITHOTRIPSY
20|FH_F65444_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F65559_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F65559_0_0|CSTM-ALL|CSTM-00|2020|PDM|2395.00|99|0.00|ACUTE IP REHAB LEVEL A
20|FH_F65559_0_0|SrvcGrp|59291|2022|PDM|1296.00|99|0.00|DAY HOSPITAL FULL DAY
20|FH_F65681_0_0|SrvcGrp|473|2022|PDM|355.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F65719_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F65719_0_0|CSTM-ALL|CSTM-00|2020|PDM|1753.00|99|0.00|AEG 9 (NO REV)
20|FH_F65719_0_0|CSTM-ALL|CSTM-00|2020|PDM|729.00|99|0.00|AEG 3 (NO REV)
20|FH_F65719_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|AEG 10 (NO REV)
20|FH_F65979_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F65979_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|COVENTRY ENHANCED GROUPER 10
20|FH_F65979_0_0|CSTM-ALL|CSTM-00|2020|PDM|2750.00|99|0.00|COVENTRY ENHANCED GROUPER 8
20|FH_F65979_0_0|CSTM-ALL|CSTM-00|2020|PDM|3300.00|99|0.00|COVENTRY ENHANCED GROUPER 9
20|FH_F65979_0_0|CSTM-ALL|CSTM-00|2020|PDM|770.00|99|0.00|COVENTRY ENHANCED GROUPER 1
20|FH_F65979_0_0|SrvcGrp|12674|2022|PCT|1.10|99|0.00|IMPLANTS
20|FH_F66101_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F66220_0_0|SrvcGrp|33165|2022|PDM|425.00|99|0.00|SKILLED NURSING - LEVEL II
20|FH_F66220_0_0|SrvcGrp|33166|2022|PDM|500.00|99|0.00|SKILLED NURSING - LEVEL III
20|FH_F66403_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F66403_0_0|SrvcGrp|33166|2022|PDM|500.00|99|0.00|SKILLED NURSING - LEVEL III
20|FH_F66404_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F66404_0_0|SrvcGrp|33166|2022|PDM|500.00|99|0.00|SKILLED NURSING - LEVEL III
20|FH_F66406_0_0|SrvcGrp|33164|2022|PDM|350.00|99|0.00|SKILLED NURSING - LEVEL I
20|FH_F66408_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F66409_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F66409_0_0|SrvcGrp|33165|2022|PDM|425.00|99|0.00|SKILLED NURSING - LEVEL II
20|FH_F66410_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F66410_0_0|SrvcGrp|33164|2022|PDM|350.00|99|0.00|SKILLED NURSING - LEVEL I
20|FH_F66410_0_0|SrvcGrp|471|2022|PDM|625.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F66411_0_0|SrvcGrp|33164|2022|PDM|350.00|99|0.00|SKILLED NURSING - LEVEL I
20|FH_F66411_0_0|SrvcGrp|471|2022|PDM|625.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F66420_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F66420_0_0|SrvcGrp|33166|2022|PDM|500.00|99|0.00|SKILLED NURSING - LEVEL III
20|FH_F66465_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F66465_0_0|SrvcGrp|44302|2022|PDM|60.00|99|0.00|PT & OT (VISIT LVL) PT MOD GP
20|FH_F66465_0_0|SrvcGrp|76207|2022|PDM|60.00|99|0.00|SPEECH THERAPY (VISIT LVL) MOD GN
20|FH_F66469_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F66469_0_0|CSTM-ALL|CSTM-00|2020|PDM|1144.00|99|0.00|2006 MEDICARE ASPG VII
20|FH_F66469_0_0|CSTM-ALL|CSTM-00|2020|PDM|382.00|99|0.00|2006 MEDICARE ASPG I
20|FH_F66469_0_0|CSTM-ALL|CSTM-00|2020|PDM|825.00|99|0.00|2006 MEDICARE ASPG V
20|FH_F66480_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F66480_0_0|SrvcGrp|9828|2022|PDM|82.00|99|0.00|HOME HEALTH AIDE
20|FH_F66481_0_0|SrvcGrp|42971|2022|PDM|95.00|99|0.00|SKN RN
20|FH_F66541_0_0|CSTM-ALL|CSTM-00|2020|PCT|13500.00|99|0.00|DIALYSIS TRAINING
20|FH_F66545_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F66630_0_0|CSTM-ALL|CSTM-00|2020|PDM|250.00|99|0.00|INTENSIVE OP EATING DISORDERS
20|FH_F66630_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|EATING DISORDERS
20|FH_F66648_0_0|CSTM-ALL|CSTM-00|2020|PCT|50.90|99|0.00|OP SVCS
20|FH_F66687_0_0|SrvcGrp|17542|2022|PDM|11481.00|99|0.00|OP EP STUDY
20|FH_F66687_0_0|SrvcGrp|19961|2022|PCT|0.85|99|0.00|MS DRG 231-232 ONLY CORONARY BYPASS W/ PTCA
20|FH_F66687_0_0|SrvcGrp|20898|2022|PDM|58581.00|99|0.00|MS DRG 246 ONLY
20|FH_F66687_0_0|SrvcGrp|21356|2022|PCT|0.85|99|0.00|MS DRG 254 ONLY
20|FH_F66687_0_0|SrvcGrp|21358|2022|PCT|0.85|99|0.00|MS DRG 258-259 ONLY
20|FH_F66687_0_0|SrvcGrp|22781|2022|PDM|38159.00|99|0.00|MS DRG 244 ONLY
20|FH_F66687_0_0|SrvcGrp|28163|2022|PCT|0.85|99|0.00|MS DRG 222 ONLY
20|FH_F66687_0_0|SrvcGrp|28164|2022|PCT|0.85|99|0.00|MS DRG 224 ONLY
20|FH_F66687_0_0|SrvcGrp|29702|2022|PCT|0.85|99|0.00|CV SURGERY MS DRG 260-262 ONLY
20|FH_F66687_0_0|SrvcGrp|74020|2022|PDM|22871.00|99|0.00|CARDIAC ABLATION
20|FH_F66688_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F66688_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F66688_0_0|SrvcGrp|46283|2022|PDM|128.00|99|0.00|URGENT CARE
20|FH_F66712_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F66760_0_0|SrvcGrp|54670|2022|PDM|2500.00|99|0.00|NORMAL DELIVERY
20|FH_F66765_0_0|SrvcGrp|10410|2022|PDM|25.00|99|0.00|SKILLED NURSING CARE
20|FH_F66765_0_0|SrvcGrp|1168|2022|PDM|36.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F66835_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F66835_0_0|SrvcGrp|14210|2022|PDM|245.00|99|0.00|PSYCH INTENSIVE OUTPATIENT
20|FH_F66835_0_0|SrvcGrp|61039|2022|PDM|500.00|99|0.00|ELECTROCONVULSIVE THERAPY (ECT)
20|FH_F66900_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F66970_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|ASPG VII
20|FH_F66970_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|ASPG VIII
20|FH_F66991_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.20|99|0.00|GENERAL ACUTE CARE
20|FH_F67025_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F67025_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|ASPG VIII
20|FH_F67063_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|WELLPATH ASC IV
20|FH_F67063_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|WELLPATH ASC V
20|FH_F67063_0_0|CSTM-ALL|CSTM-00|2020|PDM|1660.00|99|0.00|WELLPATH ASC VIII
20|FH_F67063_0_0|SrvcGrp|23585|2022|PCT|1.10|99|0.00|IMPLANTS
20|FH_F67086_0_0|SrvcGrp|1168|2022|PDM|788.55|99|0.00|CONTINUOUS HOMECARE
20|FH_F67101_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F67101_0_0|SrvcGrp|112082|2022|PCT|1.00|99|0.00|CHILD DEVELOPMENT & REHAB
20|FH_F67101_0_0|SrvcGrp|11441|2022|PCT|0.75|99|0.00|PHARMACY SVCS
20|FH_F67101_0_0|SrvcGrp|62722|2022|PCT|0.90|99|0.00|TRAUMA WITH ER
20|FH_F67121_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F67121_0_0|SrvcGrp|471|2022|PDM|660.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F67121_0_0|SrvcGrp|472|2022|PDM|460.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F67121_0_0|SrvcGrp|473|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F67132_0_0|CSTM-ALL|CSTM-00|2020|PCT|44.50|99|0.00|OP SVCS
20|FH_F67136_0_0|CSTM-ALL|CSTM-00|2020|PDM|8427.00|99|0.00|GENERAL ACUTE CARE
20|FH_F67136_0_0|SrvcGrp|3354|2022|PCT|0.70|99|0.00|HIGH COST DRUGS
20|FH_F67136_0_0|SrvcGrp|38818|2022|PCT|0.70|99|0.00|ROBOTIC ASSISTED IP SURGERY
20|FH_F67136_0_0|SrvcGrp|60|2022|PDM|8427.00|99|0.00|NEWBORN NURSERY - LEVEL II
20|FH_F67173_0_0|CSTM-ALL|CSTM-00|2020|PDM|1395.00|99|0.00|ASPG VIII - FH SW CUSTOM GROUPERS
20|FH_F67173_0_0|CSTM-ALL|CSTM-00|2020|PDM|1680.00|99|0.00|ASPG IX - FH SW CUSTOM GROUPERS
20|FH_F67191_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|OP SVCS
20|FH_F67195_0_0|CSTM-ALL|CSTM-00|2020|PDM|714.00|99|0.00|COVENTRY ENHANCED GROUPER 3
20|FH_F67204_0_0|CSTM-ALL|CSTM-00|2020|PDM|5460.00|99|0.00|GENERAL ACUTE CARE
20|FH_F67207_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F67207_0_0|SrvcGrp|44106|2022|PDM|48.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F67265_0_0|CSTM-ALL|CSTM-00|2020|PDM|1075.00|99|0.00|IP DEVELOPMENTAL DISORDERS
20|FH_F67265_0_0|CSTM-ALL|CSTM-00|2020|PDM|830.00|99|0.00|ADULT PSYCHIATRIC SERVICES
20|FH_F67265_0_0|SrvcGrp|3259|2022|PDM|600.00|99|0.00|ACUTE REHABILITATION
20|FH_F67265_0_0|SrvcGrp|453|2022|PDM|472.00|99|0.00|PSYCH PARTIAL HOSP
20|FH_F67280_0_0|SrvcGrp|44106|2022|PDM|54.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F67280_0_0|SrvcGrp|44107|2022|PDM|54.00|99|0.00|SPEECH THERAPY
20|FH_F67281_0_0|SrvcGrp|46482|2022|PDM|159.00|99|0.00|S9083 PER VISIT
20|FH_F67288_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F67288_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|EMERGENCY ROOM SERVICES ON UB
20|FH_F67300_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE
20|FH_F67303_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE
20|FH_F67303_0_0|SrvcGrp|9518|2022|PCT|0.75|99|0.00|EMERGENCY ROOM
20|FH_F67305_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F67306_0_0|SrvcGrp|9518|2022|PCT|0.75|99|0.00|EMERGENCY ROOM
20|FH_F67319_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F67319_0_0|SrvcGrp|43956|2022|PDM|55.00|99|0.00|NURSING CARE
20|FH_F67339_0_0|SrvcGrp|9937|2022|PDM|65.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F67339_0_0|SrvcGrp|9938|2022|PDM|65.00|99|0.00|SPEECH THERAPY
20|FH_F67359_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F67379_0_0|CSTM-ALL|CSTM-00|2020|PDM|1270.00|99|0.00|GENERAL ACUTE CARE
20|FH_F67379_0_0|SrvcGrp|11336|2022|PCT|0.74|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F67379_0_0|SrvcGrp|13470|2022|PDM|1837.00|99|0.00|ACUTE SURGICAL SVCS
20|FH_F67379_0_0|SrvcGrp|1943|2022|PDM|1412.00|99|0.00|NEONATAL INTENSVE CARE II & III
20|FH_F67379_0_0|SrvcGrp|20900|2022|PDM|11300.00|99|0.00|MS DRG 248 ONLY
20|FH_F67379_0_0|SrvcGrp|20902|2022|PDM|11300.00|99|0.00|MS DRG 249 ONLY
20|FH_F67379_0_0|SrvcGrp|21354|2022|PDM|11300.00|99|0.00|MS DRG 250-251 ONLY
20|FH_F67379_0_0|SrvcGrp|27813|2022|PDM|11300.00|99|0.00|MS DRG 280 ONLY
20|FH_F67379_0_0|SrvcGrp|29817|2022|PDM|3533.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F67379_0_0|SrvcGrp|63157|2022|PDM|16952.00|99|0.00|CRANIOTOMY/NERVOUS SYSTEM
20|FH_F67379_0_0|SrvcGrp|63158|2022|PDM|3107.00|99|0.00|ORTHPEDIC SURGERY
20|FH_F67379_0_0|SrvcGrp|941|2022|PDM|2119.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV
20|FH_F67379_0_0|SrvcGrp|9774|2022|PDM|2119.00|99|0.00|INTENSIVE CARE UNIT
20|FH_F67381_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F67403_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F67403_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F67424_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|GENERAL ACUTE CARE
20|FH_F67424_0_0|SrvcGrp|472|2022|PDM|405.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F67424_0_0|SrvcGrp|474|2022|PDM|200.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F67424_0_0|SrvcGrp|63365|2022|PCT|1.00|99|0.00|DRUGS INVOICE
20|FH_F67425_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F67425_0_0|SrvcGrp|30135|2022|PDM|7165.00|99|0.00|LAP SURGERY
20|FH_F67425_0_0|SrvcGrp|3066|2022|PCT|0.55|99|0.00|HIGH-COST DRUGS
20|FH_F67425_0_0|SrvcGrp|9978|2022|PDM|2200.00|99|0.00|ACUTE INPATIENT MEDICAL SVCS
20|FH_F67504_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE
20|FH_F67504_0_0|SrvcGrp|43893|2022|PDM|93.00|99|0.00|OCCUPATIONAL THERAPY VISIT
20|FH_F67505_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F67505_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F67560_0_0|SrvcGrp|17067|2022|PCT|0.83|99|0.00|ASPG II
20|FH_F67560_0_0|SrvcGrp|17069|2022|PCT|0.83|99|0.00|ASPG III
20|FH_F67560_0_0|SrvcGrp|17073|2022|PCT|0.83|99|0.00|ASPG V
20|FH_F67639_0_0|CSTM-ALL|CSTM-00|2020|PDM|802.00|99|0.00|ASPG VI
20|FH_F67639_0_0|SrvcGrp|63463|2022|PDM|925.00|99|0.00|CPT 52204
20|FH_F67639_0_0|SrvcGrp|63464|2022|PDM|925.00|99|0.00|CPT 52276
20|FH_F67639_0_0|SrvcGrp|63466|2022|PDM|800.00|99|0.00|CPT 52005
20|FH_F67683_0_0|SrvcGrp|14165|2022|PDM|300.00|99|0.00|PARTIAL HOSP PSYCH/CD
20|FH_F67683_0_0|SrvcGrp|38223|2022|PDM|652.00|99|0.00|ADULT DETOX
20|FH_F67683_0_0|SrvcGrp|46903|2022|PDM|400.00|99|0.00|RESIDENTIAL TREATMENT
20|FH_F67699_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.00|99|0.00|GENERAL ACUTE CARE
20|FH_F67699_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.00|99|0.00|OP SVCS
20|FH_F67739_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F67742_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F67763_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F67763_0_0|SrvcGrp|44250|2022|PDM|375.00|99|0.00|CCPD TRAINING
20|FH_F67803_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F67803_0_0|SrvcGrp|29137|2022|PDM|23.00|99|0.00|HOME HEALTH AIDE
20|FH_F67803_0_0|SrvcGrp|42827|2022|PDM|120.00|99|0.00|OCCUPATIONAL THERAPY VISIT
20|FH_F67803_0_0|SrvcGrp|42828|2022|PDM|120.00|99|0.00|SPEECH THERAPY VISIT
20|FH_F67861_0_0|SrvcGrp|11000|2022|PCT|0.60|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F67861_0_0|SrvcGrp|229|2022|PCT|0.60|99|0.00|COMPUTED TOMOGRAPHY (CT SCAN)
20|FH_F67861_0_0|SrvcGrp|24805|2022|PCT|0.60|99|0.00|NUCLEAR MEDICINE
20|FH_F67861_0_0|SrvcGrp|24807|2022|PCT|0.60|99|0.00|OCCUPATIONAL THERAPY
20|FH_F67861_0_0|SrvcGrp|24808|2022|PCT|0.60|99|0.00|SPEECH PATHOLOGY VISIT
20|FH_F67861_0_0|SrvcGrp|3208|2022|PDM|1155.00|99|0.00|SUBACUTE CARE
20|FH_F67887_0_0|SrvcGrp|42827|2022|PDM|100.00|99|0.00|OCCUPATIONAL THERAPY VISIT
20|FH_F67887_0_0|SrvcGrp|42830|2022|PDM|114.00|99|0.00|MEDICAL SOCIAL WORKER VISIT
20|FH_F67887_0_0|SrvcGrp|43430|2022|PDM|66.00|99|0.00|LPN HOME VISIT
20|FH_F67888_0_0|SrvcGrp|22954|2022|PDM|138.78|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F67923_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|BURN INTENSIVE CARE
20|FH_F67923_0_0|CSTM-ALL|CSTM-00|2020|PCT|9000.00|99|0.00|TIMELY FILING
20|FH_F67924_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F67924_0_0|SrvcGrp|24029|2022|PDM|55.00|99|0.00|RN HOURLY
20|FH_F67924_0_0|SrvcGrp|42826|2022|PDM|125.00|99|0.00|PHYSICAL THERAPY VISIT
20|FH_F67984_0_0|SrvcGrp|3810|2022|PDM|130.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F67984_0_0|SrvcGrp|59424|2022|PDM|100.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F67984_0_0|SrvcGrp|59425|2022|PDM|45.00|99|0.00|HOME HEALTH AIDE
20|FH_F67984_0_0|SrvcGrp|64201|2022|PDM|100.00|99|0.00|SPEECH THERAPY
20|FH_F67986_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F68121_0_0|SrvcGrp|64320|2022|PDM|100.00|99|0.00|OCCUPATIONAL THERAPY EVAL/RE-EVAL
20|FH_F68121_0_0|SrvcGrp|64321|2022|PDM|100.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F68124_0_0|SrvcGrp|34923|2022|PDM|920.00|99|0.00|ACUTE PSYCH
20|FH_F68161_0_0|CSTM-ALL|CSTM-00|2020|PDM|1987.00|99|0.00|COVENTRY ENHANCED GROUPER 4
20|FH_F68161_0_0|CSTM-ALL|CSTM-00|2020|PDM|2537.00|99|0.00|COVENTRY ENHANCED GROUPER 5
20|FH_F68161_0_0|SrvcGrp|12491|2022|PCT|0.55|99|0.00|PACEMAKER
20|FH_F68161_0_0|SrvcGrp|705|2022|PCT|0.55|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F68251_0_0|SrvcGrp|33164|2022|PDM|305.00|99|0.00|SKILLED NURSING - LEVEL I
20|FH_F68309_0_0|CSTM-ALL|CSTM-00|2020|PDM|1170.00|99|0.00|AEG 8 (NO REV)
20|FH_F68309_0_0|CSTM-ALL|CSTM-00|2020|PDM|557.00|99|0.00|AEG 2 (NO REV)
20|FH_F68309_0_0|CSTM-ALL|CSTM-00|2020|PDM|637.00|99|0.00|AEG 3 (NO REV)
20|FH_F68309_0_0|CSTM-ALL|CSTM-00|2020|PDM|787.00|99|0.00|AEG 4 (NO REV)
20|FH_F68322_0_0|SrvcGrp|17073|2022|PDM|1265.00|99|0.00|ASPG V
20|FH_F68322_0_0|SrvcGrp|17075|2022|PDM|1480.00|99|0.00|ASPG VI
20|FH_F68322_0_0|SrvcGrp|17077|2022|PDM|1750.00|99|0.00|ASPG VII
20|FH_F68322_0_0|SrvcGrp|17079|2022|PDM|1740.00|99|0.00|ASPG VIII
20|FH_F68343_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F68363_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F68363_0_0|SrvcGrp|13640|2022|PDM|80.00|99|0.00|CPT 99202
20|FH_F68363_0_0|SrvcGrp|3405|2022|PDM|80.00|99|0.00|CPT 99212
20|FH_F68365_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F68365_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F68365_0_0|CSTM-ALL|CSTM-00|2020|PDM|584.00|99|0.00|COVENTRY ENHANCED GROUPER 2
20|FH_F68365_0_0|CSTM-ALL|CSTM-00|2020|PDM|884.00|99|0.00|COVENTRY ENHANCED GROUPER 6
20|FH_F68442_0_0|SrvcGrp|33165|2022|PDM|375.00|99|0.00|SKILLED NURSING - LEVEL II
20|FH_F68442_0_0|SrvcGrp|43892|2022|PDM|80.00|99|0.00|PHYSICAL THERAPY VISIT
20|FH_F68460_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F68460_0_0|SrvcGrp|3178|2022|PDM|887.00|99|0.00|ACUTE PSYCH
20|FH_F68481_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|ASPG X
20|FH_F68481_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F68481_0_0|CSTM-ALL|CSTM-00|2020|PDM|1265.00|99|0.00|ASPG V
20|FH_F68544_0_0|SrvcGrp|50842|2022|PDM|140.00|99|0.00|GENERAL ACUTE CARE
20|FH_F68622_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F68622_0_0|SrvcGrp|3259|2022|PDM|981.00|99|0.00|ACUTE REHABILITATION
20|FH_F68626_0_0|SrvcGrp|13188|2022|PCT|0.40|99|0.00|DRUGS
20|FH_F68660_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE
20|FH_F68699_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|OP SVCS
20|FH_F68782_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.40|99|0.00|GENERAL ACUTE CARE
20|FH_F68823_0_0|SrvcGrp|44303|2022|PDM|60.00|99|0.00|SPEECH THERAPY (VISIT LVL) MOD GN
20|FH_F68826_0_0|SrvcGrp|81058|2022|PDM|65.00|99|0.00|SPEECH THERAPY (VISIT LVL) MOD GN
20|FH_F68828_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F68831_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F68831_0_0|SrvcGrp|9832|2022|PDM|99.00|99|0.00|ST SVCS
20|FH_F68835_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS
20|FH_F68845_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS
20|FH_F68847_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F68848_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F68849_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F68850_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|AMBULANCE SERVICES
20|FH_F68868_0_0|CSTM-ALL|CSTM-00|2020|PDM|2460.00|99|0.00|GENERAL ACUTE CARE
20|FH_F68868_0_0|SrvcGrp|27761|2022|PDM|2836.00|99|0.00|ICU/CCU
20|FH_F68868_0_0|SrvcGrp|3029|2022|PDM|567.00|99|0.00|NEWBORN NURSERY
20|FH_F68888_0_0|SrvcGrp|44107|2022|PDM|48.00|99|0.00|SPEECH THERAPY
20|FH_F68888_0_0|SrvcGrp|474|2022|PDM|250.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F68943_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|GENERAL ACUTE CARE
20|FH_F68944_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F68944_0_0|SrvcGrp|12154|2022|PCT|0.70|99|0.00|LITHOTRIPSY
20|FH_F68944_0_0|SrvcGrp|21826|2022|PDM|4819.00|99|0.00|PTCA (MS DRG ONLY)
20|FH_F68944_0_0|SrvcGrp|3409|2022|PDM|893.00|99|0.00|NEWBORN NURSERY
20|FH_F68944_0_0|SrvcGrp|43985|2022|PCT|1.00|99|0.00|BLOOD AND BLOOD PRODUCTS
20|FH_F68944_0_0|SrvcGrp|6|2022|PCT|0.70|99|0.00|OP SURGERY
20|FH_F68944_0_0|SrvcGrp|65580|2022|PCT|0.70|99|0.00|PACEMAKER/AICD/REPAIR/REVISION
20|FH_F68947_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F68947_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|COVENTRY ENHANCED GROUPER 1
20|FH_F68947_0_0|CSTM-ALL|CSTM-00|2020|PDM|1950.00|99|0.00|COVENTRY ENHANCED GROUPER 5
20|FH_F68947_0_0|SrvcGrp|59841|2022|PDM|5367.60|99|0.00|SUBMUCOUS RESECTION
20|FH_F68950_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F68950_0_0|CSTM-ALL|CSTM-00|2020|PDM|1426.19|99|0.00|ASPG IV
20|FH_F68950_0_0|CSTM-ALL|CSTM-00|2020|PDM|1877.67|99|0.00|ASPG VI
20|FH_F68950_0_0|CSTM-ALL|CSTM-00|2020|PDM|2248.11|99|0.00|ASPG VII
20|FH_F68950_0_0|CSTM-ALL|CSTM-00|2020|PDM|2315.25|99|0.00|ASPG IX
20|FH_F68970_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|OP SVCS
20|FH_F68972_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|OP SVCS
20|FH_F68976_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|GENERAL ACUTE CARE
20|FH_F69063_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F69063_0_0|SrvcGrp|42976|2022|PDM|95.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F69071_0_0|SrvcGrp|13681|2022|PDM|488.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT
20|FH_F69071_0_0|SrvcGrp|2067|2022|PDM|1025.00|99|0.00|SPECIALTY CARE TRANSPORT
20|FH_F69084_0_0|CSTM-ALL|CSTM-00|2020|PDM|938.00|99|0.00|AEG 6 (NO REV)
20|FH_F69122_0_0|SrvcGrp|65622|2022|PDM|1589.00|99|0.00|REV CODE 724 & CPT CODE 59409
20|FH_F69202_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.90|99|0.00|ASPG I
20|FH_F69202_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.90|99|0.00|ASPG II
20|FH_F69202_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.90|99|0.00|ASPG V
20|FH_F69202_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.90|99|0.00|ASPG VI
20|FH_F69202_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|ACUTE PSYCH
20|FH_F69202_0_0|SrvcGrp|20293|2022|PDM|22000.00|99|0.00|MS DRG 235-236 ONLY CV SURGERY
20|FH_F69202_0_0|SrvcGrp|20299|2022|PDM|28500.00|99|0.00|MS DRG 228-230 ONLY OTHER CARDIOTHORACIC PROC
20|FH_F69202_0_0|SrvcGrp|31038|2022|PDM|29600.00|99|0.00|MS DRG 233-234 ONLY
20|FH_F69205_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F69205_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F69205_0_0|SrvcGrp|28973|2022|PCT|0.70|99|0.00|HOSPICE MEDICATIONS
20|FH_F69205_0_0|SrvcGrp|29303|2022|PDM|172.80|99|0.00|OCCUPATIONAL THERAPY
20|FH_F69205_0_0|SrvcGrp|29406|2022|PDM|172.80|99|0.00|PHYSICAL THERAPY
20|FH_F69205_0_0|SrvcGrp|35183|2022|PDM|74.04|99|0.00|SKILLED NURSING (ADDITIONAL HOURS)
20|FH_F69242_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F69242_0_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE
20|FH_F69242_0_0|SrvcGrp|46729|2022|PDM|35.00|99|0.00|RESPITE CARE
20|FH_F69249_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F69290_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F69322_0_0|SrvcGrp|167|2022|PDM|641.00|99|0.00|CD (ADULT) - REHABILITATION
20|FH_F69322_0_0|SrvcGrp|26835|2022|PDM|362.00|99|0.00|CD PARTIAL HOSP ADOLESCENT
20|FH_F69324_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F69423_0_0|CSTM-ALL|CSTM-00|2020|PDM|782.00|99|0.00|AEG 3 (NO REV)
20|FH_F69423_0_0|SrvcGrp|10989|2022|PDM|1561.00|99|0.00|ENDOSCOPIC LIGATION
20|FH_F69423_0_0|SrvcGrp|16732|2022|PDM|2965.00|99|0.00|HYSTEROSCOPY ABLATION
20|FH_F69423_0_0|SrvcGrp|35733|2022|PDM|2965.00|99|0.00|CPT 29819 29826
20|FH_F69504_0_0|SrvcGrp|46424|2022|PDM|27.00|99|0.00|HI TECH SKILLED NURSING SERVICES
20|FH_F69504_0_0|SrvcGrp|48398|2022|PDM|23.00|99|0.00|PT SERVICES
20|FH_F69604_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F69647_0_0|SrvcGrp|17065|2022|PDM|585.00|99|0.00|ASPG I
20|FH_F69647_0_0|SrvcGrp|17073|2022|PDM|1265.00|99|0.00|ASPG V
20|FH_F69647_0_0|SrvcGrp|17075|2022|PDM|1480.00|99|0.00|ASPG VI
20|FH_F69647_0_0|SrvcGrp|17077|2022|PDM|1750.00|99|0.00|ASPG VII
20|FH_F69647_0_0|SrvcGrp|17079|2022|PDM|1740.00|99|0.00|ASPG VIII
20|FH_F69648_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE
20|FH_F69648_0_0|SrvcGrp|48394|2022|PDM|7.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F69648_0_0|SrvcGrp|66264|2022|PDM|4.00|99|0.00|PHYSICAL THERAPY SERVICES
20|FH_F69648_0_0|SrvcGrp|66265|2022|PDM|4.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F69651_0_0|SrvcGrp|10543|2022|PDM|95.00|99|0.00|SPEECH THERAPY SVCS
20|FH_F69651_0_0|SrvcGrp|10545|2022|PDM|95.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F69651_0_0|SrvcGrp|22387|2022|PDM|55.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F69685_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.81|99|0.00|OP SVCS
20|FH_F69703_0_0|CSTM-ALL|CSTM-00|2020|PDM|825.00|99|0.00|COVENTRY ENHANCED GROUPER 3
20|FH_F69712_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F69723_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|GENERAL ACUTE CARE
20|FH_F69723_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|OP SVCS
20|FH_F69727_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS
20|FH_F69750_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F69764_0_0|CSTM-ALL|CSTM-00|2020|PCT|76.20|99|0.00|GENERAL ACUTE CARE
20|FH_F69764_0_0|CSTM-ALL|CSTM-00|2020|PCT|76.20|99|0.00|OP SVCS
20|FH_F69785_0_0|SrvcGrp|88621|2022|PDM|60.00|99|0.00|SKILLED NURSING LPN
20|FH_F69787_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F69804_0_0|CSTM-ALL|CSTM-00|2020|PCT|52.10|99|0.00|GENERAL ACUTE CARE
20|FH_F69805_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS
20|FH_F69807_0_0|CSTM-ALL|CSTM-00|2020|PCT|56.56|99|0.00|OP SVCS
20|FH_F69862_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS
20|FH_F69942_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F69965_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F69965_0_0|SrvcGrp|59428|2022|PDM|110.00|99|0.00|ST
20|FH_F69971_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F69971_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AEG 4 DUBUQUE ENDOSCOPY CENTER (NO REV)
20|FH_F69971_0_0|CSTM-ALL|CSTM-00|2020|PDM|1481.00|99|0.00|AEG 1 DUBUQUE ENDOSCOPY CENTER (NO REV)
20|FH_F69971_0_0|SrvcGrp|24951|2022|PDM|329.00|99|0.00|ESOPHOGEAL MOTILITY STUDY
20|FH_F69971_0_0|SrvcGrp|36608|2022|PDM|218.00|99|0.00|SIGMOIDOSCOPY
20|FH_F69982_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F70005_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F70005_0_0|CSTM-ALL|CSTM-00|2020|PDM|2136.00|99|0.00|AEG 8 (NO REV)
20|FH_F70005_0_0|CSTM-ALL|CSTM-00|2020|PDM|811.00|99|0.00|AEG 1 (NO REV)
20|FH_F70005_0_0|CSTM-ALL|CSTM-00|2020|PDM|972.00|99|0.00|AEG 2 (NO REV)
20|FH_F70026_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F70026_0_0|SrvcGrp|17139|2022|PDM|705.00|99|0.00|HOSPICE CARE
20|FH_F70043_0_0|CSTM-ALL|CSTM-00|2020|PCT|40.00|99|0.00|GENERAL ACUTE CARE
20|FH_F70104_0_0|SrvcGrp|46248|2022|PDM|48.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F70104_0_0|SrvcGrp|47183|2022|PDM|96.00|99|0.00|HOME INFUSION NURSING SVCS
20|FH_F70104_0_0|SrvcGrp|66264|2022|PDM|4.00|99|0.00|PHYSICAL THERAPY SERVICES
20|FH_F70126_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F70163_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F70182_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F70205_0_0|SrvcGrp|471|2022|PDM|660.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F70303_0_0|SrvcGrp|3810|2022|PDM|218.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F70303_0_0|SrvcGrp|9263|2022|PDM|211.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F70324_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F70324_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|GENERAL ACUTE CARE
20|FH_F70484_0_0|CSTM-ALL|CSTM-00|2020|PCT|53.80|99|0.00|GENERAL ACUTE CARE
20|FH_F70510_0_0|SrvcGrp|17140|2022|PDM|145.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F70603_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F70603_0_0|SrvcGrp|52842|2022|PDM|265.00|99|0.00|GI PROCEDURE GROUP A
20|FH_F70603_0_0|SrvcGrp|52843|2022|PDM|360.00|99|0.00|GI PROCEDURE GROUP B
20|FH_F71002_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F71043_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE
20|FH_F71047_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|GENERAL ACUTE CARE
20|FH_F71049_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.62|99|0.00|GENERAL ACUTE CARE
20|FH_F71049_0_0|SrvcGrp|3809|2022|PDM|1159.00|99|0.00|HOSPICE CARE
20|FH_F71067_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|GENERAL ACUTE CARE
20|FH_F71070_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|COVENTRY ENHANCED GROUPER 10
20|FH_F71070_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|COVENTRY ENHANCED GROUPER 4
20|FH_F71070_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|COVENTRY ENHANCED GROUPER 6
20|FH_F71070_0_0|SrvcGrp|22780|2022|PDM|3000.00|99|0.00|CPT 55875
20|FH_F71103_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F71145_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F71145_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F71268_0_0|SrvcGrp|15559|2022|PDM|3200.00|99|0.00|ACUTE MED & SURG SVCS
20|FH_F71268_0_0|SrvcGrp|30623|2022|PDM|7150.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788
20|FH_F71268_0_0|SrvcGrp|3499|2022|PCT|0.35|99|0.00|IMPLANTS
20|FH_F71268_0_0|SrvcGrp|8968|2022|PDM|4100.00|99|0.00|NICU LEVEL III & IV
20|FH_F71271_0_0|SrvcGrp|68259|2022|PDM|15.00|99|0.00|SKILLED NURSING
20|FH_F71271_0_0|SrvcGrp|68261|2022|PDM|12.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F71282_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|IMPLANTS
20|FH_F71342_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F71342_0_0|CSTM-ALL|CSTM-00|2020|PDM|1280.00|99|0.00|AEG 3 (NO REV)
20|FH_F71342_0_0|CSTM-ALL|CSTM-00|2020|PDM|1582.00|99|0.00|AEG 10 (NO REV)
20|FH_F71342_0_0|CSTM-ALL|CSTM-00|2020|PDM|2075.00|99|0.00|AEG 6 (NO REV)
20|FH_F71342_0_0|SrvcGrp|15473|2022|PDM|1801.00|99|0.00|CPT CODE 42820
20|FH_F71345_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F71345_0_0|SrvcGrp|12401|2022|PDM|105.37|99|0.00|RN VISIT
20|FH_F71345_0_0|SrvcGrp|9830|2022|PDM|105.37|99|0.00|OT SVCS
20|FH_F71346_0_0|SrvcGrp|17139|2022|PDM|565.00|99|0.00|HOSPICE CARE
20|FH_F71362_0_0|SrvcGrp|3810|2022|PDM|105.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F71365_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F71365_0_0|SrvcGrp|59428|2022|PDM|90.00|99|0.00|ST
20|FH_F71443_0_0|SrvcGrp|24290|2022|PDM|12.00|99|0.00|HOME HEALTH THERAPY VISITS
20|FH_F71523_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE
20|FH_F71585_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F71585_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F71628_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F71628_0_0|SrvcGrp|48385|2022|PDM|15.00|99|0.00|SPEECH THERAPY
20|FH_F71647_0_0|SrvcGrp|592|2022|PDM|550.00|99|0.00|SUB-ACUTE CARE
20|FH_F71686_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F71686_0_0|SrvcGrp|20801|2022|PCT|0.85|99|0.00|HOME HEALTH
20|FH_F71702_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F71702_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F71702_0_0|CSTM-ALL|CSTM-00|2020|PDM|321.40|99|0.00|ASPG I
20|FH_F71702_0_0|CSTM-ALL|CSTM-00|2020|PDM|944.29|99|0.00|ASPG VIII
20|FH_F71747_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F71748_0_0|SrvcGrp|1168|2022|PDM|40.96|99|0.00|CONTINUOUS HOMECARE
20|FH_F71786_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE
20|FH_F71829_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F71829_0_0|SrvcGrp|22954|2022|PDM|156.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F71848_0_0|SrvcGrp|31734|2022|PDM|882.00|99|0.00|OP SURGERY SERVICES (RC 490)
20|FH_F71848_0_0|SrvcGrp|68781|2022|PDM|149.73|99|0.00|SPECIAL STAINS GROUP 1
20|FH_F71863_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F71863_0_0|SrvcGrp|1168|2022|PDM|40.70|99|0.00|CONTINUOUS HOMECARE
20|FH_F71863_0_0|SrvcGrp|17140|2022|PDM|154.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F71905_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F71905_0_0|SrvcGrp|59427|2022|PDM|75.00|99|0.00|OT
20|FH_F71905_0_0|SrvcGrp|66482|2022|PDM|35.00|99|0.00|HOME HEALTH AID
20|FH_F71923_0_0|SrvcGrp|15265|2022|PDM|556.97|99|0.00|HEMODIALYSIS SVCS
20|FH_F71927_0_0|SrvcGrp|16274|2022|PCT|1.00|99|0.00|ORGAN ACQUISITION
20|FH_F71962_0_0|CSTM-ALL|CSTM-00|2020|PCT|81.00|99|0.00|GENERAL ACUTE CARE
20|FH_F71962_0_0|CSTM-ALL|CSTM-00|2020|PCT|81.00|99|0.00|OP SVCS
20|FH_F72024_0_0|SrvcGrp|12023|2022|PDM|147.00|99|0.00|HOSPICE RESPITE SERVICES
20|FH_F72024_0_0|SrvcGrp|17139|2022|PDM|643.00|99|0.00|HOSPICE CARE
20|FH_F72024_0_0|SrvcGrp|42782|2022|PDM|68.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F72024_0_0|SrvcGrp|42785|2022|PDM|68.00|99|0.00|SPEECH THERAPY  SRVCS
20|FH_F72047_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F72047_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SURGERY
20|FH_F72049_0_0|SrvcGrp|1168|2022|PDM|39.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F72051_0_0|SrvcGrp|59426|2022|PDM|75.00|99|0.00|PT
20|FH_F72051_0_0|SrvcGrp|59428|2022|PDM|75.00|99|0.00|ST
20|FH_F72051_0_0|SrvcGrp|66480|2022|PDM|75.00|99|0.00|RN VISIT
20|FH_F72051_0_0|SrvcGrp|66481|2022|PDM|75.00|99|0.00|SOCIAL WORKER
20|FH_F72065_0_0|SrvcGrp|17139|2022|PDM|841.00|99|0.00|HOSPICE CARE
20|FH_F72065_0_0|SrvcGrp|17140|2022|PDM|187.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F72085_0_0|SrvcGrp|44245|2022|PDM|168.00|99|0.00|CAPD/CCPD SUPPLEMENT
20|FH_F72085_0_0|SrvcGrp|44250|2022|PDM|420.00|99|0.00|CCPD TRAINING
20|FH_F72102_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72143_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F72143_0_0|SrvcGrp|15150|2022|PCT|0.50|99|0.00|DRUGS
20|FH_F72143_0_0|SrvcGrp|21459|2022|PDM|3400.00|99|0.00|MS DRG 774 ONLY REPLACEMENT MS DRG 805-806
20|FH_F72143_0_0|SrvcGrp|30623|2022|PDM|5400.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788
20|FH_F72143_0_0|SrvcGrp|3069|2022|PCT|0.50|99|0.00|IMPLANTS
20|FH_F72143_0_0|SrvcGrp|31134|2022|PDM|2300.00|99|0.00|SURGICAL - ADULT/PEDIATRIC
20|FH_F72206_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.66|99|0.00|GENERAL ACUTE CARE
20|FH_F72243_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72243_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F72244_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72244_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F72262_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE
20|FH_F72302_0_0|CSTM-ALL|CSTM-00|2020|PDM|1521.00|99|0.00|AEG 9 (NO REV)
20|FH_F72302_0_0|SrvcGrp|37706|2022|PCT|1.00|99|0.00|PROSTHETICS AND IMPLANTS
20|FH_F72306_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F72306_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|COVENTRY ENHANCED GROUPER 10
20|FH_F72306_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|COVENTRY ENHANCED GROUPER 6
20|FH_F72306_0_0|CSTM-ALL|CSTM-00|2020|PDM|1750.00|99|0.00|COVENTRY ENHANCED GROUPER 7
20|FH_F72387_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F72390_0_0|CSTM-ALL|CSTM-00|2020|PDM|1292.00|99|0.00|ASPG I
20|FH_F72390_0_0|CSTM-ALL|CSTM-00|2020|PDM|2746.00|99|0.00|ASPG X
20|FH_F72404_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F72404_0_0|CSTM-ALL|CSTM-00|2020|PDM|1042.00|99|0.00|AEG 3 (NO REV)
20|FH_F72404_0_0|CSTM-ALL|CSTM-00|2020|PDM|849.00|99|0.00|AEG 2 (NO REV)
20|FH_F72407_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SURGERY
20|FH_F72416_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.41|99|0.00|OP SVCS
20|FH_F72416_0_0|SrvcGrp|45882|2022|PDM|80.00|99|0.00|PT
20|FH_F72416_0_0|SrvcGrp|48085|2022|PDM|80.00|99|0.00|SPEECH PATHOLOGY VISIT
20|FH_F72427_0_0|SrvcGrp|11301|2022|PDM|470.00|99|0.00|MAGNETIC RESONANCE IMAGING
20|FH_F72431_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72431_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F72484_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72523_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72523_0_0|SrvcGrp|12403|2022|PDM|41.50|99|0.00|CONTINUOUS HOMECARE
20|FH_F72523_0_0|SrvcGrp|22954|2022|PDM|170.66|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F72542_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE
20|FH_F72542_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F72543_0_0|SrvcGrp|22954|2022|PDM|168.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F72543_0_0|SrvcGrp|46107|2022|PDM|108.00|99|0.00|SKILLED NURSING
20|FH_F72543_0_0|SrvcGrp|46108|2022|PDM|54.00|99|0.00|SKILLED NURSING (ADDITIONAL HOUR)
20|FH_F72543_0_0|SrvcGrp|46109|2022|PDM|113.40|99|0.00|HI-TECH NURSING (1 HOUR)
20|FH_F72543_0_0|SrvcGrp|46117|2022|PDM|40.50|99|0.00|HOME HEALTH AIDE (PER HOUR)
20|FH_F72543_0_0|SrvcGrp|68988|2022|PDM|108.00|99|0.00|ST VISIT
20|FH_F72543_0_0|SrvcGrp|69019|2022|PDM|47.25|99|0.00|LPN
20|FH_F72584_0_0|SrvcGrp|42825|2022|PDM|45.00|99|0.00|HOME HEALTH AIDE VISIT
20|FH_F72589_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72590_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72606_0_0|SrvcGrp|29817|2022|PDM|4600.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F72606_0_0|SrvcGrp|30475|2022|PDM|4300.00|99|0.00|INTENSIVE CARE SVCS
20|FH_F72606_0_0|SrvcGrp|31771|2022|PDM|9525.00|99|0.00|MS DRG 417-419 ONLY  LAP CHOLE
20|FH_F72606_0_0|SrvcGrp|73360|2022|PCT|0.80|99|0.00|OP SURGERY
20|FH_F72648_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72648_0_0|SrvcGrp|29428|2022|PDM|465.00|99|0.00|HOME/CHRONIC HEMODIALYSIS TREATMENT
20|FH_F72648_0_0|SrvcGrp|68641|2022|PDM|300.00|99|0.00|HOME HEMODIALYSIS
20|FH_F72662_0_0|SrvcGrp|11258|2022|PCT|0.35|99|0.00|DRUGS
20|FH_F72662_0_0|SrvcGrp|29977|2022|PDM|59.00|99|0.00|WOUND CARE CANISTER SET
20|FH_F72664_0_0|SrvcGrp|68383|2022|PDM|35.00|99|0.00|HOME HEALTH AID
20|FH_F72666_0_0|SrvcGrp|43|2022|PCT|0.80|99|0.00|IMPLANTS
20|FH_F72666_0_0|SrvcGrp|6|2022|PCT|0.75|99|0.00|OP SURGERY
20|FH_F72666_0_0|SrvcGrp|69681|2022|PDM|1680.00|99|0.00|TERTIARY ORTHOPEDIC PROCEDURES MS DRG ONLY
20|FH_F72666_0_0|SrvcGrp|69685|2022|PCT|0.75|99|0.00|OP ANGIOPLASTY
20|FH_F72666_0_0|SrvcGrp|69687|2022|PCT|0.65|99|0.00|OP DEEP BRAIN STIMULATION
20|FH_F72666_0_0|SrvcGrp|997|2022|PCT|0.80|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F72702_0_0|CSTM-ALL|CSTM-00|2020|PDM|485.00|99|0.00|AEG 1 (NO REV)
20|FH_F72702_0_0|CSTM-ALL|CSTM-00|2020|PDM|485.00|99|0.00|AEG 6 (NO REV)
20|FH_F72704_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE
20|FH_F72704_0_0|SrvcGrp|33165|2022|PDM|375.00|99|0.00|SKILLED NURSING - LEVEL II
20|FH_F72704_0_0|SrvcGrp|49862|2022|PDM|80.00|99|0.00|SPEECH THERAPY
20|FH_F72742_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72743_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72746_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72746_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F72764_0_0|SrvcGrp|21975|2022|PDM|1575.00|99|0.00|INPATIENT SERVICES
20|FH_F72765_0_0|SrvcGrp|21975|2022|PDM|1575.00|99|0.00|INPATIENT SERVICES
20|FH_F72765_0_0|SrvcGrp|29930|2022|PDM|400.00|99|0.00|DIALYSIS
20|FH_F72765_0_0|SrvcGrp|32703|2022|PDM|1900.00|99|0.00|ICU
20|FH_F72766_0_0|SrvcGrp|29930|2022|PDM|400.00|99|0.00|DIALYSIS
20|FH_F72766_0_0|SrvcGrp|8950|2022|PDM|1730.00|99|0.00|INTERMEDIATE ICU/CCU
20|FH_F72784_0_0|SrvcGrp|3271|2022|PDM|3262.11|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F72784_0_0|SrvcGrp|4109|2022|PDM|787.40|99|0.00|ACUTE PSYCH
20|FH_F72785_0_0|CSTM-ALL|CSTM-00|2020|PDM|1673.00|99|0.00|ACUTE PSYCH
20|FH_F72785_0_0|SrvcGrp|3271|2022|PDM|5227.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F72788_0_0|SrvcGrp|30623|2022|PDM|11282.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788
20|FH_F72788_0_0|SrvcGrp|3418|2022|PCT|0.68|99|0.00|NEONATAL INTENSIVE CARE UNIT
20|FH_F72828_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F72828_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F72828_0_0|SrvcGrp|33164|2022|PDM|350.00|99|0.00|SKILLED NURSING - LEVEL I
20|FH_F72828_0_0|SrvcGrp|33165|2022|PDM|425.00|99|0.00|SKILLED NURSING - LEVEL II
20|FH_F72828_0_0|SrvcGrp|33166|2022|PDM|500.00|99|0.00|SKILLED NURSING - LEVEL III
20|FH_F72830_0_0|CSTM-ALL|CSTM-00|2020|PDM|2100.00|99|0.00|ACUTE IP MED SVCS
20|FH_F72830_0_0|SrvcGrp|10675|2022|PDM|2500.00|99|0.00|ICU/CCU
20|FH_F72830_0_0|SrvcGrp|14404|2022|PCT|0.40|99|0.00|HOME HEALTH CARE MEDICAL SUPPLIES
20|FH_F72830_0_0|SrvcGrp|15325|2022|PDM|550.00|99|0.00|ER LEVEL III
20|FH_F72830_0_0|SrvcGrp|177|2022|PDM|2330.00|99|0.00|ACUTE IP SURGICAL SVCS
20|FH_F72830_0_0|SrvcGrp|20260|2022|PDM|1100.00|99|0.00|ER LEVEL V
20|FH_F72830_0_0|SrvcGrp|4109|2022|PDM|1000.00|99|0.00|ACUTE PSYCH
20|FH_F72830_0_0|SrvcGrp|70042|2022|PDM|1800.00|99|0.00|CVTY ENHANCED + REV CODE ASPG 2
20|FH_F72830_0_0|SrvcGrp|70049|2022|PDM|3300.00|99|0.00|CVTY ENHANCED + REV CODE ASPG 9
20|FH_F72842_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.74|99|0.00|OP SVCS
20|FH_F72842_0_0|CSTM-ALL|CSTM-00|2020|PDM|1475.00|99|0.00|ACUTE PSYCH
20|FH_F72845_0_0|CSTM-ALL|CSTM-00|2020|PDM|1475.00|99|0.00|CHEMICAL DEPENDENCY
20|FH_F72845_0_0|SrvcGrp|3418|2022|PCT|0.86|99|0.00|NEONATAL INTENSIVE CARE UNIT
20|FH_F72850_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F72850_0_0|CSTM-ALL|CSTM-00|2020|PDM|3411.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72850_0_0|SrvcGrp|3029|2022|PDM|755.00|99|0.00|NEWBORN NURSERY
20|FH_F72859_0_0|CSTM-ALL|CSTM-00|2020|PDM|194.56|99|0.00|TOTAL PARENTERAL NUTRITION
20|FH_F72859_0_0|CSTM-ALL|CSTM-00|2020|PDM|236.86|99|0.00|TOTAL PARENTERAL NUTRITION
20|FH_F72859_0_0|CSTM-ALL|CSTM-00|2020|PDM|3.93|99|0.00|TOTAL PARENTERAL NUTRITION
20|FH_F72859_0_0|CSTM-ALL|CSTM-00|2020|PDM|39.15|99|0.00|TOTAL PARENTERAL NUTRITION
20|FH_F72859_0_0|CSTM-ALL|CSTM-00|2020|PDM|48.74|99|0.00|TOTAL PARENTERAL NUTRITION
20|FH_F72859_0_0|CSTM-ALL|CSTM-00|2020|PDM|6.54|99|0.00|TOTAL PARENTERAL NUTRITION
20|FH_F72859_0_0|CSTM-ALL|CSTM-00|2020|PDM|6.78|99|0.00|TOTAL PARENTERAL NUTRITION
20|FH_F72859_0_0|CSTM-ALL|CSTM-00|2020|PDM|67.67|99|0.00|TOTAL PARENTERAL NUTRITION
20|FH_F72859_0_0|CSTM-ALL|CSTM-00|2020|PDM|8.06|99|0.00|TOTAL PARENTERAL NUTRITION
20|FH_F72859_0_0|CSTM-ALL|CSTM-00|2020|PDM|87.58|99|0.00|HOME INFUSION NURSING SVCS
20|FH_F72859_0_0|SrvcGrp|10522|2022|PDM|125.00|99|0.00|PICC LINE INSERT
20|FH_F72859_0_0|SrvcGrp|10565|2022|PDM|180.00|99|0.00|HOME INFUSION
20|FH_F72859_0_0|SrvcGrp|10567|2022|PDM|190.00|99|0.00|HOME INFUSION
20|FH_F72859_0_0|SrvcGrp|10582|2022|PDM|100.00|99|0.00|UNCLASSIFIED HOME INJECTABLES
20|FH_F72859_0_0|SrvcGrp|10644|2022|PDM|107.00|99|0.00|MIDLINE INSERTION NURSING
20|FH_F72859_0_0|SrvcGrp|11787|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY
20|FH_F72859_0_0|SrvcGrp|11789|2022|PDM|90.00|99|0.00|HOME INFUSION THERAPY
20|FH_F72859_0_0|SrvcGrp|11790|2022|PDM|110.00|99|0.00|HOME INFUSION THERAPY
20|FH_F72859_0_0|SrvcGrp|11793|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY
20|FH_F72859_0_0|SrvcGrp|12076|2022|PDM|100.00|99|0.00|HOME THERAPY
20|FH_F72859_0_0|SrvcGrp|15478|2022|PDM|117.63|99|0.00|OCCUPATIONAL THERAPY SVCS INITIAL EVAL
20|FH_F72859_0_0|SrvcGrp|15516|2022|PDM|70.00|99|0.00|HYDRATION THERAPY
20|FH_F72859_0_0|SrvcGrp|15517|2022|PDM|90.00|99|0.00|HYDRATION THERAPY
20|FH_F72859_0_0|SrvcGrp|15527|2022|PDM|100.00|99|0.00|HYDRATION THERAPY
20|FH_F72859_0_0|SrvcGrp|22018|2022|PDM|25.00|99|0.00|HOME INFUSION NURSING SVCS
20|FH_F72859_0_0|SrvcGrp|472|2022|PDM|320.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F72859_0_0|SrvcGrp|474|2022|PDM|190.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F72883_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72887_0_0|SrvcGrp|33164|2022|PDM|310.00|99|0.00|SKILLED NURSING - LEVEL I
20|FH_F72889_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.69|99|0.00|GENERAL ACUTE CARE
20|FH_F72890_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72907_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72909_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F72926_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72926_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F72930_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72934_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.71|99|0.00|GENERAL ACUTE CARE
20|FH_F72939_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F72941_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72944_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F72972_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72980_0_0|SrvcGrp|13597|2022|PDM|227.03|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT
20|FH_F72980_0_0|SrvcGrp|69961|2022|PCT|0.90|99|0.00|AIR AMBULANCE
20|FH_F72986_0_0|CSTM-ALL|CSTM-00|2020|PCT|71.00|99|0.00|GENERAL ACUTE CARE
20|FH_F72986_0_0|CSTM-ALL|CSTM-00|2020|PCT|71.00|99|0.00|OP SVCS
20|FH_F73024_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F73024_0_0|SrvcGrp|46424|2022|PDM|30.00|99|0.00|HI TECH SKILLED NURSING SERVICES
20|FH_F73024_0_0|SrvcGrp|48398|2022|PDM|30.00|99|0.00|PT SERVICES
20|FH_F73084_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.76|99|0.00|GENERAL ACUTE CARE
20|FH_F73084_0_0|SrvcGrp|46107|2022|PDM|72.00|99|0.00|SKILLED NURSING
20|FH_F73084_0_0|SrvcGrp|46109|2022|PDM|76.00|99|0.00|HI-TECH NURSING (1 HOUR)
20|FH_F73125_0_0|SrvcGrp|48396|2022|PDM|12.00|99|0.00|OT SERVICES
20|FH_F73125_0_0|SrvcGrp|48398|2022|PDM|12.00|99|0.00|PT SERVICES
20|FH_F73163_0_0|CSTM-ALL|CSTM-00|2020|PDM|2278.00|99|0.00|GENERAL ACUTE CARE
20|FH_F73202_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F73204_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F73204_0_0|SrvcGrp|22954|2022|PDM|145.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F73204_0_0|SrvcGrp|26001|2022|PDM|148.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F73209_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F73210_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F73228_0_0|SrvcGrp|11000|2022|PCT|0.55|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F73228_0_0|SrvcGrp|17069|2022|PDM|3516.00|99|0.00|ASPG III
20|FH_F73228_0_0|SrvcGrp|17073|2022|PDM|4942.00|99|0.00|ASPG V
20|FH_F73228_0_0|SrvcGrp|17077|2022|PDM|8575.00|99|0.00|ASPG VII
20|FH_F73228_0_0|SrvcGrp|17079|2022|PDM|8384.00|99|0.00|ASPG VIII
20|FH_F73228_0_0|SrvcGrp|17083|2022|PCT|0.74|99|0.00|ASPG X
20|FH_F73342_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F73403_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F73403_0_0|SrvcGrp|43432|2022|PDM|17.00|99|0.00|HOME HEALTH AIDE HOURLY
20|FH_F73403_0_0|SrvcGrp|45966|2022|PDM|140.00|99|0.00|SOCIAL WORKER
20|FH_F73442_0_0|SrvcGrp|44105|2022|PDM|50.00|99|0.00|PHYSICAL THERAPY
20|FH_F73442_0_0|SrvcGrp|44106|2022|PDM|50.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F73485_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F73485_0_0|SrvcGrp|48396|2022|PDM|15.00|99|0.00|OT SERVICES
20|FH_F73485_0_0|SrvcGrp|48398|2022|PDM|15.00|99|0.00|PT SERVICES
20|FH_F73502_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F73502_0_0|SrvcGrp|12403|2022|PDM|180.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F73505_0_0|CSTM-ALL|CSTM-00|2020|PDM|1115.00|99|0.00|ASPG 8 SURGICAL EYE CENTER
20|FH_F73505_0_0|CSTM-ALL|CSTM-00|2020|PDM|1516.00|99|0.00|ASPG 9 SURGICAL EYE CENTER
20|FH_F73505_0_0|CSTM-ALL|CSTM-00|2020|PDM|379.00|99|0.00|ASPG 1 SURGICAL EYE CENTER
20|FH_F73505_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|ASPG 4 SURGICAL EYE CENTER
20|FH_F73505_0_0|CSTM-ALL|CSTM-00|2020|PDM|817.00|99|0.00|ASPG 5 SURGICAL EYE CENTER
20|FH_F73505_0_0|SrvcGrp|17000|2022|PCT|0.60|99|0.00|OUTPATIENT SURGERY
20|FH_F73643_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F73643_0_0|SrvcGrp|3809|2022|PDM|600.00|99|0.00|HOSPICE CARE
20|FH_F73662_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F73662_0_0|CSTM-ALL|CSTM-00|2020|PDM|1039.00|99|0.00|ASPG IV
20|FH_F73662_0_0|CSTM-ALL|CSTM-00|2020|PDM|1362.00|99|0.00|ASPG VI
20|FH_F73662_0_0|CSTM-ALL|CSTM-00|2020|PDM|1641.00|99|0.00|ASPG VII
20|FH_F73705_0_0|CSTM-ALL|CSTM-00|2020|PDM|225.00|99|0.00|ASPG II
20|FH_F73705_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|ASPG V
20|FH_F73727_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F73730_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F73731_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS
20|FH_F73733_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F73733_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F73742_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F73743_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F73785_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE
20|FH_F73785_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS
20|FH_F73847_0_0|SrvcGrp|44330|2022|PDM|124.00|99|0.00|NEGATIVE PRESSURE WOUND THERAPY
20|FH_F73864_0_0|CSTM-ALL|CSTM-00|2020|PDM|12.00|99|0.00|SKILLED NURSING HCPC
20|FH_F73923_0_0|CSTM-ALL|CSTM-00|2020|PDM|952.00|99|0.00|AEG 6 (NO REV)
20|FH_F73923_0_0|SrvcGrp|71219|2022|PDM|796.00|99|0.00|COLONOSCOPY CPT 45382
20|FH_F73923_0_0|SrvcGrp|71221|2022|PDM|670.00|99|0.00|EGD W/BALLOON DIALATION CPT 43249
20|FH_F73967_0_0|SrvcGrp|3809|2022|PDM|643.00|99|0.00|HOSPICE CARE
20|FH_F73967_0_0|SrvcGrp|42785|2022|PDM|68.00|99|0.00|SPEECH THERAPY  SRVCS
20|FH_F74026_0_0|CSTM-ALL|CSTM-00|2020|PCT|50.00|99|0.00|GENERAL ACUTE CARE
20|FH_F74102_0_0|SrvcGrp|11068|2022|PDM|105.00|99|0.00|PT SVCS
20|FH_F74163_0_0|SrvcGrp|14112|2022|PDM|18.00|99|0.00|OCCUPATIONAL THERAPY SVCS
20|FH_F74163_0_0|SrvcGrp|472|2022|PDM|460.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F74187_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F74227_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|GENERAL ACUTE CARE
20|FH_F74263_0_0|CSTM-ALL|CSTM-00|2020|PDM|1550.00|99|0.00|SURGICAL SPECIALTY CENTER  ASC GROUPER 7
20|FH_F74263_0_0|CSTM-ALL|CSTM-00|2020|PDM|517.00|99|0.00|SURGICAL SPECIALTY CENTER  ASC GROUPER 1
20|FH_F74263_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|SURGICAL SPECIALTY CENTER  ASC GROUPER 2
20|FH_F74263_0_0|CSTM-ALL|CSTM-00|2020|PDM|794.00|99|0.00|SURGICAL SPECIALTY CENTER  ASC GROUPER 3
20|FH_F74263_0_0|CSTM-ALL|CSTM-00|2020|PDM|981.00|99|0.00|SURGICAL SPECIALTY CENTER  ASC GROUPER 4
20|FH_F74263_0_0|SrvcGrp|66168|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F74283_0_0|SrvcGrp|42784|2022|PDM|75.00|99|0.00|OCCUPATIONAL THERAPY  SRVCS
20|FH_F74283_0_0|SrvcGrp|42785|2022|PDM|75.00|99|0.00|SPEECH THERAPY  SRVCS
20|FH_F74283_0_0|SrvcGrp|68139|2022|PDM|75.00|99|0.00|RN VISIT
20|FH_F74283_0_0|SrvcGrp|68140|2022|PDM|35.00|99|0.00|HOME HEALTH AID
20|FH_F74305_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.66|99|0.00|OP SVCS
20|FH_F74305_0_0|CSTM-ALL|CSTM-00|2020|PDM|1473.00|99|0.00|ASPG IX
20|FH_F74305_0_0|SrvcGrp|15473|2022|PDM|789.00|99|0.00|CPT CODE 42820
20|FH_F74463_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|COVENTRY ENHANCED GROUPER 5
20|FH_F74463_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|COVENTRY ENHANCED GROUPER 1
20|FH_F74463_0_0|SrvcGrp|36591|2022|PDM|1000.00|99|0.00|CPT 63685
20|FH_F74467_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE
20|FH_F74507_0_0|SrvcGrp|72162|2022|PDM|1559.00|99|0.00|TRANSITIONAL CARE UNIT REV CODE 120
20|FH_F74509_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|GENERAL ACUTE CARE
20|FH_F74562_0_0|CSTM-ALL|CSTM-00|2020|PDM|1475.00|99|0.00|GENERAL ACUTE CARE
20|FH_F74562_0_0|CSTM-ALL|CSTM-00|2020|PDM|3115.00|99|0.00|MS DRG 216-221, 231-234 CV SURGERY
20|FH_F74562_0_0|CSTM-ALL|CSTM-00|2020|PDM|446.00|99|0.00|ACUTE PSYCH
20|FH_F74562_0_0|SrvcGrp|16|2022|PDM|940.00|99|0.00|ACUTE REHABILITATION
20|FH_F74562_0_0|SrvcGrp|269|2022|PCT|0.80|99|0.00|OP LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F74562_0_0|SrvcGrp|29900|2022|PCT|0.80|99|0.00|TRANSPLANT SVCS
20|FH_F74583_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F74583_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F74583_0_0|CSTM-ALL|CSTM-00|2020|PDM|14.00|99|0.00|SKILLED NURSING HCPC
20|FH_F74583_0_0|SrvcGrp|42976|2022|PDM|56.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F74583_0_0|SrvcGrp|48394|2022|PDM|8.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F74583_0_0|SrvcGrp|48398|2022|PDM|14.00|99|0.00|PT SERVICES
20|FH_F74622_0_0|CSTM-ALL|CSTM-00|2020|PDM|1036.00|99|0.00|COVENTRY ENHANCED GROUPER 6
20|FH_F74622_0_0|CSTM-ALL|CSTM-00|2020|PDM|791.00|99|0.00|COVENTRY ENHANCED GROUPER 4
20|FH_F74647_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F74648_0_0|CSTM-ALL|CSTM-00|2020|PCT|44.00|99|0.00|GENERAL ACUTE CARE
20|FH_F74663_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F74670_0_0|SrvcGrp|15478|2022|PDM|110.00|99|0.00|OCCUPATIONAL THERAPY SVCS INITIAL EVAL
20|FH_F74670_0_0|SrvcGrp|46723|2022|PDM|180.00|99|0.00|WORK HARDENING
20|FH_F74763_0_0|CSTM-ALL|CSTM-00|2020|PCT|59.80|99|0.00|GENERAL ACUTE CARE
20|FH_F74765_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F74765_0_0|CSTM-ALL|CSTM-00|2020|PDM|1056.00|99|0.00|COVENTRY ENHANCED GROUPER 6
20|FH_F74765_0_0|CSTM-ALL|CSTM-00|2020|PDM|981.00|99|0.00|COVENTRY ENHANCED GROUPER 5
20|FH_F74802_0_0|CSTM-ALL|CSTM-00|2020|PCT|57.30|99|0.00|OP SVCS
20|FH_F74825_0_0|SrvcGrp|471|2022|PDM|660.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F74825_0_0|SrvcGrp|474|2022|PDM|360.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F74845_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|CV SURGERY
20|FH_F74845_0_0|SrvcGrp|10427|2022|PCT|0.85|99|0.00|TRAUMA CARE
20|FH_F74845_0_0|SrvcGrp|13293|2022|PCT|1.15|99|0.00|HIGH-COST DRUGS
20|FH_F74845_0_0|SrvcGrp|58|2022|PCT|0.85|99|0.00|IP LITHOTRIPSY SVCS
20|FH_F74845_0_0|SrvcGrp|61197|2022|PCT|1.15|99|0.00|IVG
20|FH_F74883_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F74947_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F74947_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F74964_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F74964_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F75087_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|COVENTRY ENHANCED DEFAULT 10021-69990
20|FH_F75087_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|COVENTRY ENHANCED GROUPER 4
20|FH_F75087_0_0|CSTM-ALL|CSTM-00|2020|PDM|2700.00|99|0.00|COVENTRY ENHANCED GROUPER 9
20|FH_F75184_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F75185_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE
20|FH_F75185_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F75185_0_0|SrvcGrp|44883|2022|PDM|18.00|99|0.00|RT/PT/ST/OT
20|FH_F75185_0_0|SrvcGrp|471|2022|PDM|660.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F75205_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F75205_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F75207_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F75207_0_0|SrvcGrp|21815|2022|PDM|120.00|99|0.00|CAPD/CCPD SUPPLEMENT
20|FH_F75245_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.80|99|0.00|OP SVCS
20|FH_F75251_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F75307_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F75307_0_0|SrvcGrp|12403|2022|PDM|35.20|99|0.00|CONTINUOUS HOMECARE
20|FH_F75307_0_0|SrvcGrp|3809|2022|PDM|605.00|99|0.00|HOSPICE CARE
20|FH_F75307_0_0|SrvcGrp|46424|2022|PDM|105.00|99|0.00|HI TECH SKILLED NURSING SERVICES
20|FH_F75307_0_0|SrvcGrp|52782|2022|PDM|46.00|99|0.00|VENIPUNCTURE PER VISIT
20|FH_F75307_0_0|SrvcGrp|59414|2022|PDM|105.00|99|0.00|PHYSICAL THERAPY SVCS EXCLD MOD GP
20|FH_F75342_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F75344_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F75425_0_0|SrvcGrp|33164|2022|PDM|400.00|99|0.00|SKILLED NURSING - LEVEL I
20|FH_F75489_0_0|CSTM-ALL|CSTM-00|2020|PDM|693.00|99|0.00|GENERAL ACUTE CARE
20|FH_F75542_0_0|SrvcGrp|1168|2022|PDM|35.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F75595_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F75606_0_0|SrvcGrp|16|2022|PDM|1185.00|99|0.00|ACUTE REHABILITATION
20|FH_F75606_0_0|SrvcGrp|30623|2022|PDM|2720.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788
20|FH_F75643_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F75764_0_0|CSTM-ALL|CSTM-00|2020|PDM|105.00|99|0.00|GENERAL ACUTE CARE
20|FH_F75786_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F75786_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|COVENTRY ENHANCED GROUPER 2
20|FH_F75786_0_0|CSTM-ALL|CSTM-00|2020|PDM|615.00|99|0.00|COVENTRY ENHANCED GROUPER 4
20|FH_F75786_0_0|CSTM-ALL|CSTM-00|2020|PDM|705.00|99|0.00|COVENTRY ENHANCED GROUPER 5
20|FH_F75786_0_0|CSTM-ALL|CSTM-00|2020|PDM|954.00|99|0.00|COVENTRY ENHANCED GROUPER 8
20|FH_F75803_0_0|SrvcGrp|3932|2022|PCT|0.70|99|0.00|LITHOTRIPSY
20|FH_F75804_0_0|CSTM-ALL|CSTM-00|2020|PCT|36500.00|99|0.00|TIMELY FILING
20|FH_F75804_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE
20|FH_F75806_0_0|SrvcGrp|10542|2022|PDM|216.00|99|0.00|OCCUPATIONAL THERAPY SVCS
20|FH_F75826_0_0|SrvcGrp|40222|2022|PDM|100.00|99|0.00|OP SVCS
20|FH_F75944_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F75944_0_0|SrvcGrp|68188|2022|PDM|1214.00|99|0.00|CVTY ENHANCED + REV CODES ASPG 4
20|FH_F75944_0_0|SrvcGrp|68191|2022|PDM|1917.00|99|0.00|CVTY ENHANCED + REV CODES ASPG 7
20|FH_F75944_0_0|SrvcGrp|68362|2022|PDM|1084.00|99|0.00|COVENTRY ENHANCED GROUPER 10 WITH REV CODES
20|FH_F75963_0_0|CSTM-ALL|CSTM-00|2020|PDM|18.00|99|0.00|SKILLED NURSING HCPC
20|FH_F75963_0_0|SrvcGrp|48385|2022|PDM|18.00|99|0.00|SPEECH THERAPY
20|FH_F75963_0_0|SrvcGrp|73140|2022|PDM|18.00|99|0.00|OCCUPATIONAL THERAPY SERVICES
20|FH_F76022_0_0|SrvcGrp|11336|2022|PCT|0.85|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F76022_0_0|SrvcGrp|12290|2022|PDM|936.00|99|0.00|DETOXIFICATION
20|FH_F76028_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F76028_0_0|SrvcGrp|43428|2022|PDM|60.00|99|0.00|RN HOURLY
20|FH_F76028_0_0|SrvcGrp|43432|2022|PDM|17.00|99|0.00|HOME HEALTH AIDE HOURLY
20|FH_F76028_0_0|SrvcGrp|45967|2022|PDM|45.00|99|0.00|HOME HEALTH AIDE
20|FH_F76028_0_0|SrvcGrp|62539|2022|PDM|130.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F76124_0_0|SrvcGrp|56483|2022|PDM|71.00|99|0.00|PT/OT/ST
20|FH_F76146_0_0|SrvcGrp|68191|2022|PDM|1742.00|99|0.00|CVTY ENHANCED + REV CODES ASPG 7
20|FH_F76163_0_0|SrvcGrp|22954|2022|PDM|146.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F76163_0_0|SrvcGrp|3809|2022|PDM|646.00|99|0.00|HOSPICE CARE
20|FH_F76171_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F76171_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F76171_0_0|CSTM-ALL|CSTM-00|2020|PDM|16.00|99|0.00|RN HIGH TECH HOURLY
20|FH_F76171_0_0|SrvcGrp|48381|2022|PDM|250.00|99|0.00|ST SVCS INITIAL EVAL 92506 VISIT LEVEL
20|FH_F76171_0_0|SrvcGrp|48631|2022|PDM|154.00|99|0.00|OCCUPATIONAL THERAPY SVCS RE-EVAL
20|FH_F76171_0_0|SrvcGrp|52803|2022|PDM|172.00|99|0.00|OT SVCS INITIAL EVAL 97003 VISIT LEVEL
20|FH_F76171_0_0|SrvcGrp|53145|2022|PDM|80.00|99|0.00|SOCIAL WORKER
20|FH_F76222_0_0|SrvcGrp|29817|2022|PDM|6986.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F76222_0_0|SrvcGrp|3029|2022|PDM|1254.00|99|0.00|NEWBORN NURSERY
20|FH_F76222_0_0|SrvcGrp|3271|2022|PDM|5523.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F76222_0_0|SrvcGrp|3458|2022|PDM|2188.00|99|0.00|NEONATAL INTENSIVE CARE UNIT
20|FH_F76222_0_0|SrvcGrp|3499|2022|PCT|0.77|99|0.00|IMPLANTS
20|FH_F76222_0_0|SrvcGrp|6|2022|PCT|0.77|99|0.00|OP SURGERY
20|FH_F76284_0_0|SrvcGrp|22954|2022|PDM|167.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F76284_0_0|SrvcGrp|26001|2022|PDM|167.00|99|0.00|HOSPICE RESPITE SVCS
20|FH_F76285_0_0|CSTM-ALL|CSTM-00|2020|PDM|10.00|99|0.00|LVN HOURLY
20|FH_F76285_0_0|CSTM-ALL|CSTM-00|2020|PDM|11.00|99|0.00|LVN HIGH TECH HOURLY
20|FH_F76285_0_0|SrvcGrp|26160|2022|PDM|60.00|99|0.00|HOME HEALTH AIDE VISIT
20|FH_F76285_0_0|SrvcGrp|44884|2022|PDM|172.00|99|0.00|PT SVCS INITIAL EVAL 97001 VISIT LEVEL
20|FH_F76285_0_0|SrvcGrp|48382|2022|PDM|172.00|99|0.00|CPT 92507
20|FH_F76285_0_0|SrvcGrp|73300|2022|PDM|172.00|99|0.00|PHYSICAL THERAPY TREATMENT
20|FH_F76285_0_0|SrvcGrp|73521|2022|PDM|48.00|99|0.00|RESPIRATORY THERAPY HOURLY
20|FH_F76303_0_0|SrvcGrp|26160|2022|PDM|8.00|99|0.00|HOME HEALTH AIDE VISIT
20|FH_F76303_0_0|SrvcGrp|43568|2022|PDM|150.00|99|0.00|SKILLED NURSING - RN
20|FH_F76303_0_0|SrvcGrp|43956|2022|PDM|150.00|99|0.00|NURSING CARE
20|FH_F76303_0_0|SrvcGrp|46248|2022|PDM|72.00|99|0.00|SKILLED NURSING SERVICES
20|FH_F76303_0_0|SrvcGrp|73524|2022|PDM|18.00|99|0.00|PHYSICAL THERAPY
20|FH_F76382_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F76382_0_0|SrvcGrp|43893|2022|PDM|110.00|99|0.00|OCCUPATIONAL THERAPY VISIT
20|FH_F76522_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F76522_0_0|CSTM-ALL|CSTM-00|2020|PDM|1215.00|99|0.00|COVENTRY ENHANCED GROUPER 1
20|FH_F76522_0_0|CSTM-ALL|CSTM-00|2020|PDM|1626.00|99|0.00|COVENTRY ENHANCED GROUPER 2
20|FH_F76522_0_0|CSTM-ALL|CSTM-00|2020|PDM|2615.00|99|0.00|COVENTRY ENHANCED GROUPER 5
20|FH_F76522_0_0|CSTM-ALL|CSTM-00|2020|PDM|3549.00|99|0.00|COVENTRY ENHANCED GROUPER 8
20|FH_F76522_0_0|SrvcGrp|13990|2022|PCT|0.45|99|0.00|PACEMAKER
20|FH_F76522_0_0|SrvcGrp|24714|2022|PCT|0.45|99|0.00|INTRAOCULAR LENS
20|FH_F76544_0_0|CSTM-ALL|CSTM-00|2020|PDM|1031.00|99|0.00|REHABILITATION FULL DAY
20|FH_F76544_0_0|CSTM-ALL|CSTM-00|2020|PDM|1907.00|99|0.00|IP LEVEL A
20|FH_F76586_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|HOME HEALTH
20|FH_F76588_0_0|SrvcGrp|53144|2022|PDM|18.00|99|0.00|SPEECH THERAPY
20|FH_F76624_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.66|99|0.00|ASPG X - IOWA
20|FH_F76624_0_0|CSTM-ALL|CSTM-00|2020|PDM|1290.00|99|0.00|ASPG IV - IOWA
20|FH_F76662_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F76782_0_0|SrvcGrp|12403|2022|PDM|40.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F76782_0_0|SrvcGrp|3809|2022|PDM|698.00|99|0.00|HOSPICE CARE
20|FH_F76824_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F76887_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F77025_0_0|CSTM-ALL|CSTM-00|2020|PDM|1115.00|99|0.00|COVENTRY ENHANCED GROUPER 2
20|FH_F77025_0_0|CSTM-ALL|CSTM-00|2020|PDM|1275.00|99|0.00|COVENTRY ENHANCED GROUPER 3
20|FH_F77025_0_0|CSTM-ALL|CSTM-00|2020|PDM|1792.00|99|0.00|COVENTRY ENHANCED GROUPER 5
20|FH_F77025_0_0|CSTM-ALL|CSTM-00|2020|PDM|2487.00|99|0.00|COVENTRY ENHANCED GROUPER 7
20|FH_F77025_0_0|CSTM-ALL|CSTM-00|2020|PDM|3337.00|99|0.00|COVENTRY ENHANCED GROUPER 9
20|FH_F77025_0_0|CSTM-ALL|CSTM-00|2020|PDM|832.00|99|0.00|COVENTRY ENHANCED GROUPER 1
20|FH_F77025_0_0|SrvcGrp|38352|2022|PDM|2580.00|99|0.00|FOOT MUSCLOSKELETAL PROCEDURE
20|FH_F77025_0_0|SrvcGrp|74119|2022|PDM|2285.00|99|0.00|LAPAROSCOPY
20|FH_F77042_0_0|SrvcGrp|474|2022|PDM|360.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F77042_0_0|SrvcGrp|74383|2022|PDM|18.00|99|0.00|SPEECH THERAPY
20|FH_F77082_0_0|CSTM-ALL|CSTM-00|2020|PDM|10779.00|99|0.00|2007 MEDICARE ASPG VII
20|FH_F77082_0_0|CSTM-ALL|CSTM-00|2020|PDM|6740.00|99|0.00|2007 MEDICARE ASPG III
20|FH_F77082_0_0|SrvcGrp|14048|2022|PCT|0.95|99|0.00|EXTRA CORPOREAL MEMBRANE OXYGEN
20|FH_F77082_0_0|SrvcGrp|14221|2022|PCT|0.72|99|0.00|IMPLANTS/PROSTHETICS/DEVICES
20|FH_F77082_0_0|SrvcGrp|24598|2022|PDM|2793.00|99|0.00|MS DRG 945-946 ONLY
20|FH_F77082_0_0|SrvcGrp|361|2022|PDM|5129.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F77184_0_0|SrvcGrp|48396|2022|PDM|18.00|99|0.00|OT SERVICES
20|FH_F77232_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|OP SVCS
20|FH_F77234_0_0|SrvcGrp|17067|2022|PDM|1856.00|99|0.00|ASPG II
20|FH_F77234_0_0|SrvcGrp|17069|2022|PDM|1971.00|99|0.00|ASPG III
20|FH_F77234_0_0|SrvcGrp|17073|2022|PDM|2075.00|99|0.00|ASPG V
20|FH_F77234_0_0|SrvcGrp|17077|2022|PDM|2882.00|99|0.00|ASPG VII
20|FH_F77234_0_0|SrvcGrp|17083|2022|PDM|2379.00|99|0.00|ASPG X
20|FH_F77302_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F77404_0_0|SrvcGrp|22954|2022|PDM|138.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F77462_0_0|SrvcGrp|43957|2022|PDM|60.00|99|0.00|HOME HEALTH AIDE
20|FH_F77462_0_0|SrvcGrp|47764|2022|PDM|141.00|99|0.00|HOSPICE CARE/ IN HOME S9126 VISIT LEVEL
20|FH_F77463_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F77463_0_0|SrvcGrp|33165|2022|PDM|325.00|99|0.00|SKILLED NURSING - LEVEL II
20|FH_F77482_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.40|99|0.00|GENERAL ACUTE CARE
20|FH_F77484_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.67|99|0.00|GENERAL ACUTE CARE
20|FH_F77484_0_0|SrvcGrp|78378|2022|PCT|0.62|99|0.00|IMPLANTS
20|FH_F77504_0_0|CSTM-ALL|CSTM-00|2020|PDM|1150.00|99|0.00|GENERAL ACUTE CARE
20|FH_F77504_0_0|SrvcGrp|30451|2022|PCT|1.00|99|0.00|TISSUE PLASMINOGEN ACTIVATOR
20|FH_F77504_0_0|SrvcGrp|33236|2022|PCT|1.00|99|0.00|ORTHOTICS/PROSTHETICS/IMPLANTS
20|FH_F77504_0_0|SrvcGrp|38|2022|PDM|3200.00|99|0.00|NORMAL DELIVERY
20|FH_F77504_0_0|SrvcGrp|7|2022|PDM|1275.00|99|0.00|NEONATAL INTENSIVE
20|FH_F77544_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE
20|FH_F77544_0_0|SrvcGrp|3809|2022|PDM|575.00|99|0.00|HOSPICE CARE
20|FH_F77585_0_0|SrvcGrp|43323|2022|PDM|90.00|99|0.00|GROUP THERAPY
20|FH_F77597_0_0|CSTM-ALL|CSTM-00|2020|PCT|36500.00|99|0.00|TIMELY FILING
20|FH_F77597_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|AETNA CARDIAC CATHETERIZATION
20|FH_F77597_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F77625_0_0|SrvcGrp|9828|2022|PDM|39.00|99|0.00|HOME HEALTH AIDE
20|FH_F77662_0_0|SrvcGrp|471|2022|PDM|560.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F77662_0_0|SrvcGrp|472|2022|PDM|485.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F77663_0_0|SrvcGrp|3087|2022|PDM|630.00|99|0.00|CD - DETOX
20|FH_F77663_0_0|SrvcGrp|555|2022|PDM|350.00|99|0.00|INTENSIVE OP SVCS
20|FH_F77663_0_0|SrvcGrp|74859|2022|PDM|540.00|99|0.00|OBSERVATION
20|FH_F77665_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F77665_0_0|SrvcGrp|10519|2022|PDM|15.00|99|0.00|MEDICAL SOCIAL WORKER VISIT
20|FH_F77665_0_0|SrvcGrp|10540|2022|PDM|32.00|99|0.00|HOME HEALTH AIDE
20|FH_F77665_0_0|SrvcGrp|29303|2022|PDM|15.00|99|0.00|OCCUPATIONAL THERAPY
20|FH_F77665_0_0|SrvcGrp|74839|2022|PDM|15.00|99|0.00|SKILLED NURSING
20|FH_F77722_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F77762_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE
20|FH_F77762_0_0|SrvcGrp|43956|2022|PDM|120.00|99|0.00|NURSING CARE
20|FH_F77762_0_0|SrvcGrp|43957|2022|PDM|55.00|99|0.00|HOME HEALTH AIDE
20|FH_F77763_0_0|SrvcGrp|10545|2022|PDM|85.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F77822_0_0|SrvcGrp|471|2022|PDM|598.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F77862_0_0|SrvcGrp|3809|2022|PDM|623.54|99|0.00|HOSPICE CARE
20|FH_F77862_0_0|SrvcGrp|57968|2022|PDM|36.70|99|0.00|CONTINUOUS HOMECARE
20|FH_F77883_0_0|CSTM-ALL|CSTM-00|2020|PDM|462.83|99|0.00|ENHANCED TELE-MONITORING
20|FH_F77883_0_0|SrvcGrp|113846|2022|PDM|220.65|99|0.00|HOSPICE
20|FH_F77883_0_0|SrvcGrp|113847|2022|PDM|175.45|99|0.00|LACTATION SUPPORT
20|FH_F77883_0_0|SrvcGrp|114565|2022|PDM|175.45|99|0.00|SKILLED NURSING
20|FH_F77903_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|COVENTRY ENHANCED GROUPER 10
20|FH_F77903_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|COVENTRY ENHANCED GROUPER 9
20|FH_F77903_0_0|CSTM-ALL|CSTM-00|2020|PDM|1274.00|99|0.00|GENERAL ACUTE CARE
20|FH_F77903_0_0|SrvcGrp|131|2022|PCT|0.60|99|0.00|PACEMAKER DEVICE
20|FH_F77903_0_0|SrvcGrp|2738|2022|PCT|0.60|99|0.00|IMPLANTS
20|FH_F77903_0_0|SrvcGrp|3388|2022|PDM|1020.00|99|0.00|SUBACUTE CARE
20|FH_F77925_0_0|SrvcGrp|3358|2022|PDM|9100.00|99|0.00|CV SURGERY
20|FH_F77925_0_0|SrvcGrp|74999|2022|PCT|0.80|99|0.00|OUTPATIENT SURGERY
20|FH_F77925_0_0|SrvcGrp|9911|2022|PCT|0.74|99|0.00|EMERGENCY ROOM SVCS
20|FH_F77943_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F77943_0_0|SrvcGrp|105321|2022|PCT|0.70|99|0.00|PACEMAKER
20|FH_F77943_0_0|SrvcGrp|10944|2022|PCT|0.70|99|0.00|EMERGENCY ROOM
20|FH_F77943_0_0|SrvcGrp|19661|2022|PDM|93504.81|99|0.00|MS DRG 216-218 ONLY CARDIAC VALVE PROCEDURE W/CARDIAC CATH
20|FH_F77943_0_0|SrvcGrp|20096|2022|PDM|90606.00|99|0.00|MS DRG 222-223 ONLY
20|FH_F77943_0_0|SrvcGrp|20299|2022|PDM|73781.47|99|0.00|MS DRG 228-230 ONLY OTHER CARDIOTHORACIC PROC
20|FH_F77943_0_0|SrvcGrp|31782|2022|PDM|29508.64|99|0.00|MSDRG 258-262 ONLY PACEMAKER REVISION OR REPLACEMENT
20|FH_F77943_0_0|SrvcGrp|51643|2022|PCT|0.70|99|0.00|LABORATORY
20|FH_F77943_0_0|SrvcGrp|58521|2022|PCT|0.70|99|0.00|CARDIAC CATH
20|FH_F77943_0_0|SrvcGrp|62153|2022|PCT|0.70|99|0.00|RADIOLOGY SVCS
20|FH_F77943_0_0|SrvcGrp|62331|2022|PDM|39769.80|99|0.00|RADIOSURGERY
20|FH_F77943_0_0|SrvcGrp|62332|2022|PDM|5616.83|99|0.00|ACUTE MED/SURG
20|FH_F77943_0_0|SrvcGrp|62333|2022|PCT|0.70|99|0.00|HOME INFUSION
20|FH_F77943_0_0|SrvcGrp|71860|2022|PCT|0.70|99|0.00|PERCUTANEOUS PROCEDURES
20|FH_F77943_0_0|SrvcGrp|87307|2022|PDM|73781.47|99|0.00|MSDRG 270 ONLY
20|FH_F77943_0_0|SrvcGrp|87308|2022|PDM|73781.47|99|0.00|MSDRG 271 ONLY
20|FH_F77943_0_0|SrvcGrp|87309|2022|PDM|40060.72|99|0.00|MSDRG 272 ONLY
20|FH_F77943_0_0|SrvcGrp|9936|2022|PCT|0.70|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F77943_0_0|SrvcGrp|9938|2022|PCT|0.70|99|0.00|SPEECH THERAPY
20|FH_F78003_0_0|SrvcGrp|30094|2022|PDM|45.00|99|0.00|PHYSICAL THERAPY
20|FH_F78003_0_0|SrvcGrp|35964|2022|PDM|45.00|99|0.00|SPEECH THERAPY
20|FH_F78009_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F78022_0_0|SrvcGrp|35143|2022|PDM|975.00|99|0.00|LABOR
20|FH_F78023_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE
20|FH_F78042_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F78042_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F78048_0_0|SrvcGrp|35964|2022|PDM|45.00|99|0.00|SPEECH THERAPY
20|FH_F78165_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE
20|FH_F78165_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F78165_0_0|SrvcGrp|30094|2022|PDM|45.00|99|0.00|PHYSICAL THERAPY
20|FH_F78165_0_0|SrvcGrp|472|2022|PDM|360.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F78165_0_0|SrvcGrp|473|2022|PDM|245.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F78165_0_0|SrvcGrp|474|2022|PDM|245.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F78204_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F78204_0_0|CSTM-ALL|CSTM-00|2020|PDM|430.85|99|0.00|ASPG II
20|FH_F78204_0_0|CSTM-ALL|CSTM-00|2020|PDM|492.54|99|0.00|ASPG IX
20|FH_F78204_0_0|CSTM-ALL|CSTM-00|2020|PDM|692.55|99|0.00|ASPG V
20|FH_F78204_0_0|CSTM-ALL|CSTM-00|2020|PDM|802.00|99|0.00|ASPG VI
20|FH_F78243_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE
20|FH_F78324_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS
20|FH_F78343_0_0|SrvcGrp|30094|2022|PDM|45.00|99|0.00|PHYSICAL THERAPY
20|FH_F78343_0_0|SrvcGrp|471|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F78363_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F78385_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE
20|FH_F78385_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F78385_0_0|SrvcGrp|75503|2022|PDM|45.00|99|0.00|SPEECH THERAPY
20|FH_F78446_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F78446_0_0|SrvcGrp|472|2022|PDM|360.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F78446_0_0|SrvcGrp|474|2022|PDM|245.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F78447_0_0|SrvcGrp|473|2022|PDM|245.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F78447_0_0|SrvcGrp|474|2022|PDM|245.00|99|0.00|SUB-ACUTE REHAB - LEVEL I
20|FH_F78447_0_0|SrvcGrp|75503|2022|PDM|45.00|99|0.00|SPEECH THERAPY
20|FH_F78524_0_0|CSTM-ALL|CSTM-00|2020|PDM|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F78542_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING
20|FH_F78603_0_0|SrvcGrp|19846|2022|PDM|16337.36|99|0.00|MS DRG 249 ONLY
20|FH_F78603_0_0|SrvcGrp|20900|2022|PDM|27617.58|99|0.00|MS DRG 248 ONLY
20|FH_F78603_0_0|SrvcGrp|20908|2022|PDM|24827.85|99|0.00|MS DRG 247 ONLY
20|FH_F78603_0_0|SrvcGrp|27569|2022|PCT|0.53|99|0.00|MEDICAL/SURGICAL SUPPLIES
20|FH_F78603_0_0|SrvcGrp|28164|2022|PDM|79236.91|99|0.00|MS DRG 224 ONLY
20|FH_F78603_0_0|SrvcGrp|360|2022|PDM|2025.92|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F78603_0_0|SrvcGrp|6|2022|PCT|0.70|99|0.00|OP SURGERY
20|FH_F78705_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.23|99|0.00|OP SVCS
20|FH_F78705_0_0|CSTM-ALL|CSTM-00|2020|PDM|2278.00|99|0.00|GENERAL ACUTE CARE
20|FH_F78762_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F78922_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F78922_0_0|SrvcGrp|11258|2022|PCT|0.20|99|0.00|DRUGS
20|FH_F79025_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F79102_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F79212_0_0|SrvcGrp|3809|2022|PDM|652.80|99|0.00|HOSPICE CARE
20|FH_F79231_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS
20|FH_F79426_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F79427_0_0|CSTM-ALL|CSTM-00|2020|PDM|1113.00|99|0.00|ASPG IV
20|FH_F79427_0_0|CSTM-ALL|CSTM-00|2020|PDM|1760.00|99|0.00|ASPG VII
20|FH_F79427_0_0|CSTM-ALL|CSTM-00|2020|PDM|2112.00|99|0.00|LAP AND ARTH CARVE OUTS
20|FH_F79429_0_0|CSTM-ALL|CSTM-00|2020|PDM|20.59|99|0.00|VACCINE
20|FH_F79429_0_0|SrvcGrp|59427|2022|PDM|75.00|99|0.00|OT
20|FH_F79443_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE
20|FH_F79485_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE
20|FH_F79503_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F79503_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F79525_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.20|99|0.00|GENERAL ACUTE CARE
20|FH_F79551_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F79551_0_0|CSTM-ALL|CSTM-00|2020|PDM|1033.00|99|0.00|AEG 6 (NO REV)
20|FH_F79551_0_0|CSTM-ALL|CSTM-00|2020|PDM|1217.00|99|0.00|AEG 8 (NO REV)
20|FH_F79551_0_0|CSTM-ALL|CSTM-00|2020|PDM|786.00|99|0.00|AEG 4 (NO REV)
20|FH_F79584_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F79584_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F79584_0_0|CSTM-ALL|CSTM-00|2020|PDM|759.00|99|0.00|COVENTRY ENHANCED GROUPER 4
20|FH_F79584_0_0|CSTM-ALL|CSTM-00|2020|PDM|864.00|99|0.00|COVENTRY ENHANCED GROUPER 5
20|FH_F79587_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F79623_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F79623_0_0|SrvcGrp|73002|2022|PDM|6387.00|99|0.00|AEG 7
20|FH_F79623_0_0|SrvcGrp|73004|2022|PDM|4958.00|99|0.00|AEG 8
20|FH_F79623_0_0|SrvcGrp|73486|2022|PCT|0.00|99|0.00|AETNA CONTRAST AGENT
20|FH_F79624_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS
20|FH_F79625_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F79625_0_0|SrvcGrp|75185|2022|PCT|0.00|99|0.00|AETNA BLOOD PRODUCTS
20|FH_F79645_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F79645_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F79645_0_0|SrvcGrp|3140|2022|PCT|0.70|99|0.00|PHARMACY SERVICES
20|FH_F79645_0_0|SrvcGrp|471|2022|PDM|570.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F79645_0_0|SrvcGrp|47225|2022|PDM|85.00|99|0.00|OT RC434, CPT97003-97004
20|FH_F79645_0_0|SrvcGrp|62361|2022|PDM|85.00|99|0.00|SPEECH THERAPY EVAL AND RE-EVAL
20|FH_F79645_0_0|SrvcGrp|76928|2022|PCT|0.70|99|0.00|IV & IM DRUGS
20|FH_F79704_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F79704_0_0|SrvcGrp|10527|2022|PDM|160.00|99|0.00|HOSPICE SVCS
20|FH_F79704_0_0|SrvcGrp|22954|2022|PDM|160.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F79763_0_0|SrvcGrp|59427|2022|PDM|90.00|99|0.00|OT
20|FH_F79763_0_0|SrvcGrp|66482|2022|PDM|35.00|99|0.00|HOME HEALTH AID
20|FH_F79904_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F79904_0_0|SrvcGrp|12403|2022|PDM|28.73|99|0.00|CONTINUOUS HOMECARE
20|FH_F79904_0_0|SrvcGrp|3809|2022|PDM|531.25|99|0.00|HOSPICE CARE
20|FH_F79923_0_0|SrvcGrp|471|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F79923_0_0|SrvcGrp|472|2022|PDM|360.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F79923_0_0|SrvcGrp|473|2022|PDM|245.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F79927_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F80024_0_0|CSTM-ALL|CSTM-00|2020|PCT|99.00|99|0.00|GENERAL ACUTE CARE
20|FH_F80064_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.61|99|0.00|OP SVCS
20|FH_F80064_0_0|SrvcGrp|12118|2022|PDM|350.00|99|0.00|COMPUTED TOMOGRAPHY (CT)
20|FH_F80064_0_0|SrvcGrp|21975|2022|PDM|1575.00|99|0.00|INPATIENT SERVICES
20|FH_F80064_0_0|SrvcGrp|32703|2022|PDM|1900.00|99|0.00|ICU
20|FH_F80067_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F80067_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F80084_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F80084_0_0|SrvcGrp|3809|2022|PDM|604.30|99|0.00|HOSPICE CARE
20|FH_F80185_0_0|SrvcGrp|44105|2022|PDM|48.00|99|0.00|PHYSICAL THERAPY
20|FH_F80186_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F80186_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F80186_0_0|CSTM-ALL|CSTM-00|2020|PDM|518.10|99|0.00|AEG 10 (NO REV)
20|FH_F80224_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.76|99|0.00|MSDRG 216-238, 242-244, 246-251, 258, 261, 286-287 CV SURG
20|FH_F80224_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.76|99|0.00|OP SVCS
20|FH_F80224_0_0|SrvcGrp|26690|2022|PCT|0.76|99|0.00|MS DRG 215 ONLY
20|FH_F80224_0_0|SrvcGrp|701|2022|PDM|3667.00|99|0.00|INTENSIVE/CORONARY CARE UNIT
20|FH_F80269_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS
20|FH_F80283_0_0|SrvcGrp|12403|2022|PDM|57.62|99|0.00|CONTINUOUS HOMECARE
20|FH_F80363_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F80455_0_0|CSTM-ALL|CSTM-00|2020|PDM|1479.50|99|0.00|AEG 9 (NO REV)
20|FH_F80455_0_0|CSTM-ALL|CSTM-00|2020|PDM|368.50|99|0.00|AEG 1 (NO REV)
20|FH_F80455_0_0|CSTM-ALL|CSTM-00|2020|PDM|696.30|99|0.00|AEG 4 (NO REV)
20|FH_F80455_0_0|SrvcGrp|77507|2022|PDM|3520.00|99|0.00|AETNA CORNEAL TISSUE HANDLING
20|FH_F80511_0_0|SrvcGrp|17574|2022|PDM|176.00|99|0.00|BEHAVIORAL HEALTH INTENSIVE OUTPT
20|FH_F80511_0_0|SrvcGrp|3191|2022|PCT|0.57|99|0.00|OP SURGERY
20|FH_F80511_0_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS
20|FH_F80511_0_0|SrvcGrp|78184|2022|PDM|1643.00|99|0.00|AETNA OP MRI
20|FH_F80513_0_0|SrvcGrp|14174|2022|PDM|1012.00|99|0.00|MRI
20|FH_F80513_0_0|SrvcGrp|19846|2022|PDM|14061.00|99|0.00|MS DRG 249 ONLY
20|FH_F80513_0_0|SrvcGrp|20898|2022|PDM|26028.00|99|0.00|MS DRG 246 ONLY
20|FH_F80513_0_0|SrvcGrp|20908|2022|PDM|17066.00|99|0.00|MS DRG 247 ONLY
20|FH_F80513_0_0|SrvcGrp|22781|2022|PDM|11995.00|99|0.00|MS DRG 244 ONLY
20|FH_F80513_0_0|SrvcGrp|27815|2022|PDM|7346.00|99|0.00|MS DRG 281 ONLY
20|FH_F80513_0_0|SrvcGrp|28119|2022|PDM|34514.00|99|0.00|MS DRG 466 ONLY
20|FH_F80513_0_0|SrvcGrp|28203|2022|PDM|24359.00|99|0.00|MS DRG 260 ONLY
20|FH_F80513_0_0|SrvcGrp|29817|2022|PDM|3286.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F80513_0_0|SrvcGrp|3029|2022|PDM|445.00|99|0.00|NEWBORN NURSERY
20|FH_F80513_0_0|SrvcGrp|30458|2022|PCT|0.74|99|0.00|DRUGS
20|FH_F80513_0_0|SrvcGrp|31020|2022|PDM|14628.00|99|0.00|MS DRG 470 ONLY
20|FH_F80513_0_0|SrvcGrp|32539|2022|PDM|28120.00|99|0.00|MS DRG 222-227 ONLY
20|FH_F80513_0_0|SrvcGrp|33087|2022|PCT|0.74|99|0.00|ROBOTIC ASSISTED SURGERY
20|FH_F80513_0_0|SrvcGrp|53151|2022|PDM|24092.00|99|0.00|MS DRG 242 OR 245 ONLY
20|FH_F80513_0_0|SrvcGrp|53154|2022|PDM|1483.00|99|0.00|ACUTE MED/SURG SERVICES
20|FH_F80513_0_0|SrvcGrp|69801|2022|PCT|0.74|99|0.00|OP SURGERY
20|FH_F80513_0_0|SrvcGrp|87306|2022|PDM|21718.00|99|0.00|MSDRG 269 ONLY
20|FH_F80513_0_0|SrvcGrp|87307|2022|PDM|21718.00|99|0.00|MSDRG 270 ONLY
20|FH_F80532_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F80537_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.74|99|0.00|GENERAL ACUTE CARE
20|FH_F80537_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.74|99|0.00|OP SVCS
20|FH_F80694_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F80771_0_0|CSTM-ALL|CSTM-00|2020|PDM|1172.00|99|0.00|COVENTRY ENHANCED GROUPER 8
20|FH_F80771_0_0|CSTM-ALL|CSTM-00|2020|PDM|1614.00|99|0.00|COVENTRY ENHANCED GROUPER 9
20|FH_F80771_0_0|CSTM-ALL|CSTM-00|2020|PDM|615.00|99|0.00|COVENTRY ENHANCED GROUPER 3
20|FH_F80855_0_0|SrvcGrp|26278|2022|PDM|1200.00|99|0.00|CPT 29881
20|FH_F80855_0_0|SrvcGrp|33982|2022|PDM|2100.00|99|0.00|CPT 28296
20|FH_F80855_0_0|SrvcGrp|34606|2022|PDM|2200.00|99|0.00|CPT 29827
20|FH_F80855_0_0|SrvcGrp|35668|2022|PDM|2100.00|99|0.00|CPT 29824
20|FH_F80855_0_0|SrvcGrp|38707|2022|PDM|2650.00|99|0.00|HYSTEROSCOPY
20|FH_F80855_0_0|SrvcGrp|42550|2022|PDM|1250.00|99|0.00|OP SURGERY CPT 66984
20|FH_F80855_0_0|SrvcGrp|58671|2022|PDM|1300.00|99|0.00|ASC CARVE OUT 64721
20|FH_F80855_0_0|SrvcGrp|59840|2022|PDM|1135.00|99|0.00|TYMPANOSTOMY
20|FH_F80855_0_0|SrvcGrp|72996|2022|PDM|950.00|99|0.00|AEG 4
20|FH_F81033_0_0|SrvcGrp|78658|2022|PDM|892.50|99|0.00|AETNA CYSTOSCOPY AND TREATMENT
20|FH_F81033_0_0|SrvcGrp|78659|2022|PDM|892.50|99|0.00|AETNA HYMENOTOMY, SIMPLE INCISION
20|FH_F81033_0_0|SrvcGrp|78660|2022|PDM|892.50|99|0.00|AETNA PARTIAL REMOVAL OF HYMEN
20|FH_F81033_0_0|SrvcGrp|78661|2022|PDM|892.50|99|0.00|AETNA CONIZATION OF CERVIX
20|FH_F81033_0_0|SrvcGrp|78663|2022|PDM|892.50|99|0.00|AETNA HYSTEROSCOPY BIOPSY
20|FH_F81037_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F81152_0_0|SrvcGrp|473|2022|PDM|367.50|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F81172_0_0|SrvcGrp|33165|2022|PDM|425.00|99|0.00|SKILLED NURSING - LEVEL II
20|FH_F81172_0_0|SrvcGrp|33166|2022|PDM|500.00|99|0.00|SKILLED NURSING - LEVEL III
20|FH_F81183_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F81294_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F81297_0_0|CSTM-ALL|CSTM-00|2020|PCT|64.90|99|0.00|GENERAL ACUTE CARE
20|FH_F81312_0_0|SrvcGrp|29815|2022|PDM|5096.00|99|0.00|MS DRG 003-004, 207-208 ONLY
20|FH_F81312_0_0|SrvcGrp|59291|2022|PCT|1.00|99|0.00|DAY HOSPITAL FULL DAY
20|FH_F81313_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F81313_0_0|SrvcGrp|33165|2022|PDM|310.00|99|0.00|SKILLED NURSING - LEVEL II
20|FH_F81313_0_0|SrvcGrp|79177|2022|PDM|48.00|99|0.00|SPEECH THERAPY
20|FH_F81377_0_0|CSTM-ALL|CSTM-00|2020|PDM|1119.00|99|0.00|AEG 8 (NO REV)
20|FH_F81377_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AEG 10 (NO REV)
20|FH_F81377_0_0|CSTM-ALL|CSTM-00|2020|PDM|693.00|99|0.00|AEG 2 (NO REV)
20|FH_F81377_0_0|SrvcGrp|19891|2022|PDM|2604.00|99|0.00|LAPAROSCOPY SURGICAL CHOLECYSTECTOMY
20|FH_F81377_0_0|SrvcGrp|68048|2022|PDM|2750.00|99|0.00|CPT 64581
20|FH_F81393_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F81393_0_0|CSTM-ALL|CSTM-00|2020|PDM|1405.95|99|0.00|AEG 9 (NO REV)
20|FH_F81393_0_0|CSTM-ALL|CSTM-00|2020|PDM|661.50|99|0.00|AEG 10 (NO REV)
20|FH_F81393_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS
20|FH_F81456_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F81456_0_0|SrvcGrp|79237|2022|PDM|3000.00|99|0.00|VBAC DELIVERY
20|FH_F81481_0_0|SrvcGrp|75481|2022|PDM|1050.00|99|0.00|AEG 2
20|FH_F81494_0_0|SrvcGrp|10419|2022|PDM|827.00|99|0.00|SKILLED NURSING CARE
20|FH_F81494_0_0|SrvcGrp|12403|2022|PDM|43.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F81494_0_0|SrvcGrp|12981|2022|PDM|2875.00|99|0.00|ICU
20|FH_F81494_0_0|SrvcGrp|16617|2022|PDM|122.00|99|0.00|MEDICAL SOCIAL WORKER
20|FH_F81494_0_0|SrvcGrp|29817|2022|PDM|5745.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F81563_0_0|CSTM-ALL|CSTM-00|2020|PDM|546.43|99|0.00|AEG 1 (NO REV)
20|FH_F81657_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS
20|FH_F81761_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.50|99|0.00|GENERAL ACUTE CARE
20|FH_F81761_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.50|99|0.00|OP SVCS
20|FH_F81771_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE
20|FH_F81771_0_0|SrvcGrp|3809|2022|PDM|500.00|99|0.00|HOSPICE CARE
20|FH_F81823_0_0|SrvcGrp|22954|2022|PDM|130.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE
20|FH_F81823_0_0|SrvcGrp|59426|2022|PDM|75.00|99|0.00|PT
20|FH_F81823_0_0|SrvcGrp|59428|2022|PDM|75.00|99|0.00|ST
20|FH_F81823_0_0|SrvcGrp|66480|2022|PDM|75.00|99|0.00|RN VISIT
20|FH_F81835_0_0|SrvcGrp|74662|2022|PDM|465.18|99|0.00|AETNA SLEEP STUDIES
20|FH_F81835_0_0|SrvcGrp|75325|2022|PDM|142.66|99|0.00|SLEEP STUDY CPT 95800
20|FH_F82033_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F82033_0_0|SrvcGrp|79937|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F82114_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F82114_0_0|SrvcGrp|74663|2022|PDM|633.74|99|0.00|AETNA SLEEP STUDIES
20|FH_F82114_0_0|SrvcGrp|75325|2022|PDM|180.82|99|0.00|SLEEP STUDY CPT 95800
20|FH_F82136_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|GENERAL ACUTE CARE
20|FH_F82196_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F82215_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F82234_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F82234_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F82234_0_0|SrvcGrp|14412|2022|PDM|653.79|99|0.00|HOSPICE CARE
20|FH_F82235_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F82235_0_0|SrvcGrp|72990|2022|PDM|366.30|99|0.00|AEG 1
20|FH_F82235_0_0|SrvcGrp|72994|2022|PDM|560.00|99|0.00|AEG 3
20|FH_F82235_0_0|SrvcGrp|73002|2022|PDM|1094.50|99|0.00|AEG 7
20|FH_F82235_0_0|SrvcGrp|77507|2022|PCT|1.00|99|0.00|AETNA CORNEAL TISSUE HANDLING
20|FH_F82379_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F82380_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F82393_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|99|0.00|GENERAL ACUTE CARE
20|FH_F82432_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F82432_0_0|SrvcGrp|80920|2022|PDM|498.75|99|0.00|HOSPICE SERVICES
20|FH_F82571_0_0|CSTM-ALL|CSTM-00|2020|PDM|1064.00|99|0.00|COVENTRY ENHANCED GROUPER 7
20|FH_F82571_0_0|CSTM-ALL|CSTM-00|2020|PDM|477.00|99|0.00|COVENTRY ENHANCED GROUPER 2
20|FH_F82571_0_0|CSTM-ALL|CSTM-00|2020|PDM|546.00|99|0.00|COVENTRY ENHANCED GROUPER 3
20|FH_F82571_0_0|CSTM-ALL|CSTM-00|2020|PDM|676.00|99|0.00|COVENTRY ENHANCED GROUPER 4
20|FH_F82572_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F82591_0_0|SrvcGrp|75481|2022|PDM|1102.50|99|0.00|AEG 2
20|FH_F82671_0_0|CSTM-ALL|CSTM-00|2020|PDM|1832.00|99|0.00|COVENTRY ENHANCED GROUPER 9
20|FH_F82671_0_0|CSTM-ALL|CSTM-00|2020|PDM|611.00|99|0.00|COVENTRY ENHANCED GROUPER 2
20|FH_F82671_0_0|CSTM-ALL|CSTM-00|2020|PDM|862.00|99|0.00|COVENTRY ENHANCED GROUPER 4
20|FH_F82691_0_0|SrvcGrp|33166|2022|PDM|420.00|99|0.00|SKILLED NURSING - LEVEL III
20|FH_F82771_0_0|CSTM-ALL|CSTM-00|2020|PDM|866.00|99|0.00|AEG 1 (NO REV)
20|FH_F82771_0_0|SrvcGrp|58638|2022|PDM|1575.00|99|0.00|CPT 63688
20|FH_F82779_0_0|CSTM-ALL|CSTM-00|2020|PDM|1025.00|99|0.00|COVENTRY ENHANCED GROUPER 8
20|FH_F82779_0_0|SrvcGrp|68362|2022|PDM|1058.00|99|0.00|COVENTRY ENHANCED GROUPER 10 WITH REV CODES
20|FH_F82813_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F82894_0_0|SrvcGrp|14412|2022|PDM|561.75|99|0.00|HOSPICE CARE
20|FH_F82894_0_0|SrvcGrp|80284|2022|PDM|126.00|99|0.00|HOSPICE ROUTINE HOME CARE
20|FH_F82894_0_0|SrvcGrp|9263|2022|PDM|131.25|99|0.00|HOSPICE RESPITE SVCS
20|FH_F82973_0_0|CSTM-ALL|CSTM-00|2020|PDM|1009.00|99|0.00|AEG 8 (NO REV)
20|FH_F82973_0_0|CSTM-ALL|CSTM-00|2020|PDM|1021.00|99|0.00|AEG 7 (NO REV)
20|FH_F82973_0_0|CSTM-ALL|CSTM-00|2020|PDM|645.00|99|0.00|AEG 4 (NO REV)
20|FH_F83035_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F83035_0_0|SrvcGrp|3809|2022|PDM|531.22|99|0.00|HOSPICE CARE
20|FH_F83035_0_0|SrvcGrp|57968|2022|PDM|28.73|99|0.00|CONTINUOUS HOMECARE
20|FH_F83053_0_0|SrvcGrp|72990|2022|PDM|2158.00|99|0.00|AEG 1
20|FH_F83053_0_0|SrvcGrp|72992|2022|PDM|2190.00|99|0.00|AEG 2
20|FH_F83053_0_0|SrvcGrp|72996|2022|PDM|4224.00|99|0.00|AEG 4
20|FH_F83053_0_0|SrvcGrp|72998|2022|PDM|5047.00|99|0.00|AEG 5
20|FH_F83074_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F83074_0_0|SrvcGrp|76421|2022|PDM|525.00|99|0.00|HEMODIALYSIS
20|FH_F83196_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F83231_0_0|SrvcGrp|15488|2022|PDM|400.00|99|0.00|COMPUTED TOMOGRAPHY (CT SCAN)
20|FH_F83231_0_0|SrvcGrp|18076|2022|PDM|600.00|99|0.00|MRI
20|FH_F83231_0_0|SrvcGrp|69046|2022|PDM|1600.00|99|0.00|SUB-ACUTE REHAB II
20|FH_F83294_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F83313_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE
20|FH_F83420_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F83420_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F83451_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F83451_0_0|CSTM-ALL|CSTM-00|2020|PDM|1242.00|99|0.00|AEG 7 (NO REV)
20|FH_F83451_0_0|CSTM-ALL|CSTM-00|2020|PDM|1671.00|99|0.00|AEG 9 CENTER ONE
20|FH_F83451_0_0|CSTM-ALL|CSTM-00|2020|PDM|585.00|99|0.00|AEG 2 (NO REV)
20|FH_F83451_0_0|CSTM-ALL|CSTM-00|2020|PDM|682.00|99|0.00|AEG 3 (NO REV)
20|FH_F83451_0_0|CSTM-ALL|CSTM-00|2020|PDM|818.00|99|0.00|AEG 4 (NO REV)
20|FH_F83451_0_0|SrvcGrp|107695|2022|PDM|1575.00|99|0.00|LAPAROSCOPY SERVICES
20|FH_F83451_0_0|SrvcGrp|15473|2022|PDM|1350.00|99|0.00|CPT CODE 42820
20|FH_F83451_0_0|SrvcGrp|81567|2022|PDM|1625.00|99|0.00|SINUS ENDOSCOPY
20|FH_F83451_0_0|SrvcGrp|81570|2022|PDM|1705.00|99|0.00|PERCUTANEOUS ANNULOPLASTY
20|FH_F83472_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F83472_0_0|CSTM-ALL|CSTM-00|2020|PDM|1412.25|99|0.00|AEG 9 (NO REV)
20|FH_F83621_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F83621_0_0|CSTM-ALL|CSTM-00|2020|PDM|1541.00|99|0.00|AEG 8 (NO REV)
20|FH_F83621_0_0|CSTM-ALL|CSTM-00|2020|PDM|2423.00|99|0.00|AEG 3 (NO REV)
20|FH_F83621_0_0|CSTM-ALL|CSTM-00|2020|PDM|2700.00|99|0.00|AEG 10 (NO REV)
20|FH_F83621_0_0|CSTM-ALL|CSTM-00|2020|PDM|357.00|99|0.00|AEG 1 (NO REV)
20|FH_F83621_0_0|CSTM-ALL|CSTM-00|2020|PDM|753.00|99|0.00|AEG 2 (NO REV)
20|FH_F83754_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|OP SVCS
20|FH_F83754_0_0|CSTM-ALL|CSTM-00|2020|PDM|4006.00|99|0.00|GENERAL ACUTE CARE
20|FH_F83754_0_0|SrvcGrp|12290|2022|PDM|1940.00|99|0.00|DETOXIFICATION
20|FH_F83754_0_0|SrvcGrp|12659|2022|PCT|0.84|99|0.00|ELECTROSHOCK THERAPY TREATMENT
20|FH_F83754_0_0|SrvcGrp|13472|2022|PDM|6460.00|99|0.00|ICU/CCU
20|FH_F83754_0_0|SrvcGrp|20299|2022|PCT|0.81|99|0.00|MS DRG 228-230 ONLY OTHER CARDIOTHORACIC PROC
20|FH_F83754_0_0|SrvcGrp|20752|2022|PCT|0.81|99|0.00|MSDRG 619-621 ONLY BARIATRIC SURGERY
20|FH_F83754_0_0|SrvcGrp|22820|2022|PCT|0.86|99|0.00|DIALYSIS
20|FH_F83754_0_0|SrvcGrp|22822|2022|PCT|0.86|99|0.00|CPAP
20|FH_F83754_0_0|SrvcGrp|23477|2022|PCT|0.81|99|0.00|MSDRG 286-287 ONLY CARDIAC CATH
20|FH_F83754_0_0|SrvcGrp|24600|2022|PCT|0.86|99|0.00|CAPD TRAINING
20|FH_F83754_0_0|SrvcGrp|30608|2022|PCT|0.86|99|0.00|THERAPY SERVICES
20|FH_F83754_0_0|SrvcGrp|43939|2022|PCT|0.86|99|0.00|SLEEP STUDIES
20|FH_F83754_0_0|SrvcGrp|52742|2022|PCT|0.86|99|0.00|LAMINECTOMY
20|FH_F83772_0_0|CSTM-ALL|CSTM-00|2020|PCT|59.28|99|0.00|GENERAL ACUTE CARE
20|FH_F83792_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F83792_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|99|0.00|OP SVCS
20|FH_F83792_0_0|CSTM-ALL|CSTM-00|2020|PDM|1837.00|99|0.00|GENERAL ACUTE CARE
20|FH_F83792_0_0|SrvcGrp|73602|2022|PDM|630.00|99|0.00|AETNA NEWBORN NURSERY I
20|FH_F83792_0_0|SrvcGrp|73603|2022|PDM|1575.00|99|0.00|AETNA NEWBORN NURSERY II & III
20|FH_F83792_0_0|SrvcGrp|73605|2022|PDM|683.00|99|0.00|AETNA ACUTE PSYCH
20|FH_F83792_0_0|SrvcGrp|74580|2022|PCT|0.68|99|0.00|AETNA IP IMPLANTS
20|FH_F83792_0_0|SrvcGrp|74581|2022|PCT|0.68|99|0.00|AETNA IP HIGH COST DRUGS
20|FH_F83792_0_0|SrvcGrp|74586|2022|PCT|0.68|99|0.00|AETNA OP HIGH COST DRUGS
20|FH_F83792_0_0|SrvcGrp|78444|2022|PDM|3780.00|99|0.00|AETNA MATERNITY CARE (C-SECTION)
20|FH_F83799_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F83812_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE
20|FH_F83812_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS
20|FH_F84032_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE
20|FH_F84058_0_0|SrvcGrp|13262|2022|PDM|7.59|99|0.00|GROUND MILEAGE, PER STATUTE MILE
20|FH_F84058_0_0|SrvcGrp|13597|2022|PDM|209.56|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT
20|FH_F84135_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F84135_0_0|SrvcGrp|108041|2022|PDM|927.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME
20|FH_F84135_0_0|SrvcGrp|108081|2022|PDM|397.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS
20|FH_F84175_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F84193_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE
20|FH_F84193_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F84215_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F84215_0_0|SrvcGrp|26273|2022|PDM|1181.00|99|0.00|CPT 29880
20|FH_F84215_0_0|SrvcGrp|72990|2022|PDM|407.00|99|0.00|AEG 1
20|FH_F84215_0_0|SrvcGrp|72994|2022|PDM|625.00|99|0.00|AEG 3
20|FH_F84215_0_0|SrvcGrp|79420|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F84215_0_0|SrvcGrp|79937|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F84372_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F84413_0_0|SrvcGrp|28787|2022|PDM|25.00|99|0.00|CPT CODE 90993
20|FH_F84433_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F84433_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|99|0.00|OP SVCS
20|FH_F84433_0_0|SrvcGrp|23683|2022|PDM|46.68|99|0.00|SKILLED NURSING RN
20|FH_F84433_0_0|SrvcGrp|27969|2022|PDM|16.97|99|0.00|HOME HEALTH AIDE
20|FH_F84433_0_0|SrvcGrp|43569|2022|PDM|107.00|99|0.00|SKILLED NURSING - NEWBORN
20|FH_F84433_0_0|SrvcGrp|46104|2022|PDM|107.00|99|0.00|HOME VISIT - PRENATAL
20|FH_F84433_0_0|SrvcGrp|48385|2022|PDM|146.00|99|0.00|SPEECH THERAPY
20|FH_F84433_0_0|SrvcGrp|53987|2022|PDM|86.99|99|0.00|PHOTOTHERAPY
20|FH_F84433_0_0|SrvcGrp|73742|2022|PDM|11.14|99|0.00|AETNA - ROUTINE VENIPUNCTURE
20|FH_F84433_0_0|SrvcGrp|82773|2022|PDM|107.00|99|0.00|POST NATAL ASSESSMENT W/ NEWBORN
20|FH_F84532_0_0|SrvcGrp|72990|2022|PDM|924.00|99|0.00|AEG 1
20|FH_F84532_0_0|SrvcGrp|72996|2022|PDM|1746.00|99|0.00|AEG 4
20|FH_F84532_0_0|SrvcGrp|73006|2022|PDM|6346.00|99|0.00|AEG 9
20|FH_F84532_0_0|SrvcGrp|78878|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F84556_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS
20|FH_F84655_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F84672_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE
20|FH_F84712_0_0|SrvcGrp|12787|2022|PCT|0.63|99|0.00|IMPLANTS
20|FH_F84712_0_0|SrvcGrp|72990|2022|PDM|1640.00|99|0.00|AEG 1
20|FH_F84712_0_0|SrvcGrp|72992|2022|PDM|2177.00|99|0.00|AEG 2
20|FH_F84712_0_0|SrvcGrp|72996|2022|PDM|3091.00|99|0.00|AEG 4
20|FH_F84712_0_0|SrvcGrp|72998|2022|PDM|3532.00|99|0.00|AEG 5
20|FH_F84712_0_0|SrvcGrp|73000|2022|PDM|4037.00|99|0.00|AEG 6
20|FH_F84712_0_0|SrvcGrp|73462|2022|PDM|4415.00|99|0.00|AETNA NICU III
20|FH_F84712_0_0|SrvcGrp|73559|2022|PDM|4415.00|99|0.00|AETNA INTENSIVE CARE
20|FH_F84712_0_0|SrvcGrp|73806|2022|PCT|0.66|99|0.00|AETNA ER
20|FH_F84712_0_0|SrvcGrp|78645|2022|PDM|38.00|99|0.00|AETNA COMPUTER - AIDED DETECTION CPT 77052
20|FH_F84712_0_0|SrvcGrp|78807|2022|PDM|27753.00|99|0.00|AETNA CARDIAC VALVE & OTH MAJ CAR
20|FH_F84712_0_0|SrvcGrp|81402|2022|PDM|86.00|99|0.00|METABOLIC PANEL
20|FH_F84712_0_0|SrvcGrp|82738|2022|PDM|13.00|99|0.00|NON-AUTOMATED WITHOUT MICRO
20|FH_F84712_0_0|SrvcGrp|82742|2022|PDM|135.00|99|0.00|X-RAY EXAM CHEST SINGLE VIEW
20|FH_F84712_0_0|SrvcGrp|82745|2022|PDM|87.00|99|0.00|CULT BACT NO URINE/BLD/STOOL
20|FH_F84712_0_0|SrvcGrp|82746|2022|PDM|87.00|99|0.00|CULT BACT BLD AEROIC ISOLA
20|FH_F84712_0_0|SrvcGrp|82748|2022|PDM|37.00|99|0.00|HEMO/PLATELET CNT AUTOMATED
20|FH_F84712_0_0|SrvcGrp|82752|2022|PDM|18.00|99|0.00|ASSAY BUN
20|FH_F84712_0_0|SrvcGrp|82753|2022|PDM|58.00|99|0.00|TROPONIN QUANT
20|FH_F84712_0_0|SrvcGrp|82757|2022|PDM|15.00|99|0.00|ASSAY BLOOD CREATININE
20|FH_F84712_0_0|SrvcGrp|82759|2022|PDM|42.00|99|0.00|ASSAY CPK IN BLOOD
20|FH_F84712_0_0|SrvcGrp|82774|2022|PDM|13876.00|99|0.00|HIGH GASTRIC BYPASS ADDITIONAL
20|FH_F84712_0_0|SrvcGrp|87943|2022|PDM|6307.00|99|0.00|AETNA ANGIOPLASTY
20|FH_F84712_0_0|SrvcGrp|88101|2022|PDM|51.00|99|0.00|DRUG SCREEN SINGLE
20|FH_F84712_0_0|SrvcGrp|88782|2022|PCT|0.84|99|0.00|TRAUMA/BURN CARE
20|FH_F84774_0_0|SrvcGrp|16526|2022|PDM|169.05|99|0.00|DIALYSIS
20|FH_F84778_0_0|SrvcGrp|73000|2022|PDM|1759.00|99|0.00|AEG 6
20|FH_F84816_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.70|99|0.00|GENERAL ACUTE CARE
20|FH_F84855_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F84855_0_0|CSTM-ALL|CSTM-00|2020|PDM|2143.00|99|0.00|COVENTRY ENHANCED GROUPER 8
20|FH_F84855_0_0|CSTM-ALL|CSTM-00|2020|PDM|751.00|99|0.00|COVENTRY ENHANCED GROUPER 1
20|FH_F84911_0_0|CSTM-ALL|CSTM-00|2020|PCT|9500.00|99|0.00|TIMELY FILING
20|FH_F84912_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|MANDIBULAR ORTHOPEDIC
20|FH_F84912_0_0|SrvcGrp|13627|2022|PDM|154.17|99|0.00|SLEEP STUDY
20|FH_F84912_0_0|SrvcGrp|13630|2022|PDM|163.72|99|0.00|CPT 99204
20|FH_F84912_0_0|SrvcGrp|83180|2022|PDM|20.64|99|0.00|ORTHOPANTOGRAM
20|FH_F84994_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F85002_0_0|CSTM-ALL|CSTM-00|2020|PCT|40.00|99|0.00|OP SVCS
20|FH_F85012_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F85012_0_0|SrvcGrp|13928|2022|PCT|0.00|99|0.00|DAY HOSPITAL HALF DAY
20|FH_F85012_0_0|SrvcGrp|31931|2022|PCT|0.00|99|0.00|SKILLED NURSING CARE
20|FH_F85039_0_0|SrvcGrp|75483|2022|PDM|561.00|99|0.00|AEG 3
20|FH_F85039_0_0|SrvcGrp|75489|2022|PDM|909.00|99|0.00|AEG 6
20|FH_F85039_0_0|SrvcGrp|75491|2022|PDM|1095.00|99|0.00|AEG 7
20|FH_F85055_0_0|SrvcGrp|72990|2022|PDM|466.00|99|0.00|AEG 1
20|FH_F85055_0_0|SrvcGrp|72996|2022|PDM|850.00|99|0.00|AEG 4
20|FH_F85115_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F85132_0_0|CSTM-ALL|CSTM-00|2020|PCT|62.00|99|0.00|ACUTE REHAB II
20|FH_F85135_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F85211_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F85211_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F85211_0_0|SrvcGrp|72996|2022|PDM|864.60|99|0.00|AEG 4
20|FH_F85211_0_0|SrvcGrp|73004|2022|PDM|1337.60|99|0.00|AEG 8
20|FH_F85211_0_0|SrvcGrp|73006|2022|PDM|1839.20|99|0.00|AEG 9
20|FH_F85211_0_0|SrvcGrp|79937|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F85257_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE
20|FH_F85257_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS
20|FH_F85257_0_0|SrvcGrp|3066|2022|PCT|0.55|99|0.00|HIGH-COST DRUGS
20|FH_F85291_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F85295_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F85295_0_0|CSTM-ALL|CSTM-00|2020|PDM|2450.00|99|0.00|AEG 9 (NO REV)
20|FH_F85295_0_0|CSTM-ALL|CSTM-00|2020|PDM|575.00|99|0.00|AEG 1 (NO REV)
20|FH_F85295_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|AEG 2 (NO REV)
20|FH_F85393_0_0|SrvcGrp|42972|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE
20|FH_F85416_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.06|99|0.00|GENERAL ACUTE CARE
20|FH_F85416_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.06|99|0.00|OP SVCS
20|FH_F85444_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE
20|FH_F85444_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS
20|FH_F85492_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F85655_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.79|99|0.00|OP SVCS
20|FH_F85674_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F85674_0_0|CSTM-ALL|CSTM-00|2020|PDM|145.77|99|0.00|AETNA POLYSOMNOGRAPHY (MOD 26)
20|FH_F85674_0_0|CSTM-ALL|CSTM-00|2020|PDM|180.82|99|0.00|SLEEP STUDY CPT 95800
20|FH_F85674_0_0|CSTM-ALL|CSTM-00|2020|PDM|39.86|99|0.00|AETNA SLEEP STUDIES (MOD TC)
20|FH_F85674_0_0|CSTM-ALL|CSTM-00|2020|PDM|86.07|99|0.00|AETNA SLEEP STUDY CPT 95801
20|FH_F85674_0_0|SrvcGrp|83881|2022|PDM|46.21|99|0.00|AETNA SLEEP STUDY (MOD 26)
20|FH_F85691_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|GENERAL ACUTE CARE
20|FH_F85713_0_0|SrvcGrp|81023|2022|PDM|180.00|99|0.00|AETNA CAPD CCPD IPD DIALYSIS PROC
20|FH_F85757_0_0|SrvcGrp|33722|2022|PDM|23.00|99|0.00|CONTINUOUS HOSPICE CARE
20|FH_F85757_0_0|SrvcGrp|80918|2022|PDM|105.00|99|0.00|RESPITE CARE
20|FH_F85757_0_0|SrvcGrp|84185|2022|PDM|105.00|99|0.00|RESPITE CARE
20|FH_F85772_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F85772_0_0|CSTM-ALL|CSTM-00|2020|PDM|1479.00|99|0.00|AEG 6 (NO REV)
20|FH_F85772_0_0|CSTM-ALL|CSTM-00|2020|PDM|1832.00|99|0.00|AEG 8 (NO REV)
20|FH_F85772_0_0|SrvcGrp|83839|2022|PDM|2991.00|99|0.00|BREAST RECONSTRUCTION
20|FH_F85772_0_0|SrvcGrp|84180|2022|PDM|2991.00|99|0.00|AETNA DELAYED BREAST PROSTHESIS
20|FH_F85911_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.50|99|0.00|ACUTE REHABILITATION
20|FH_F85911_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.50|99|0.00|AETNA SKILLED NURSING CARE
20|FH_F85911_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.50|99|0.00|SKILLED NURSING
20|FH_F86031_0_0|CSTM-ALL|CSTM-00|2020|PCT|64.00|99|0.00|GENERAL ACUTE CARE
20|FH_F86031_0_0|CSTM-ALL|CSTM-00|2020|PCT|64.00|99|0.00|OP SVCS
20|FH_F86033_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE
20|FH_F86091_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|OP SVCS
20|FH_F86137_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS
20|FH_F86173_0_0|CSTM-ALL|CSTM-00|2020|PCT|61.35|99|0.00|GENERAL ACUTE CARE
20|FH_F86173_0_0|CSTM-ALL|CSTM-00|2020|PCT|61.35|99|0.00|OP SVCS
20|FH_F86293_0_0|CSTM-ALL|CSTM-00|2020|PDM|1599.00|99|0.00|AEG 5  (NO REV)
20|FH_F86293_0_0|CSTM-ALL|CSTM-00|2020|PDM|1950.00|99|0.00|AEG 8 (NO REV)
20|FH_F86293_0_0|SrvcGrp|13990|2022|PCT|0.33|99|0.00|PACEMAKER
20|FH_F86293_0_0|SrvcGrp|23585|2022|PCT|0.33|99|0.00|IMPLANTS
20|FH_F86293_0_0|SrvcGrp|26275|2022|PDM|2794.00|99|0.00|CPT 29826
20|FH_F86293_0_0|SrvcGrp|27348|2022|PDM|2794.00|99|0.00|OP SURGERY (CPT 58662)
20|FH_F86293_0_0|SrvcGrp|34606|2022|PDM|2794.00|99|0.00|CPT 29827
20|FH_F86293_0_0|SrvcGrp|41327|2022|PDM|1995.00|99|0.00|OP SURGERY CPT 28308
20|FH_F86293_0_0|SrvcGrp|44064|2022|PDM|1995.00|99|0.00|CPT 52351
20|FH_F86293_0_0|SrvcGrp|54943|2022|PDM|2048.00|99|0.00|REPAIR OF SLAP LESION
20|FH_F86293_0_0|SrvcGrp|77449|2022|PDM|1995.00|99|0.00|CPT 52352
20|FH_F86293_0_0|SrvcGrp|78878|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F86293_0_0|SrvcGrp|79937|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F86294_0_0|CSTM-ALL|CSTM-00|2020|PDM|1875.00|99|0.00|2006 MEDICARE ASPG IX
20|FH_F86294_0_0|CSTM-ALL|CSTM-00|2020|PDM|495.00|99|0.00|2006 MEDICARE ASPG I
20|FH_F86315_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F86315_0_0|CSTM-ALL|CSTM-00|2020|PDM|1339.00|99|0.00|COVENTRY ENHANCED GROUPER 9
20|FH_F86315_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|COVENTRY ENHANCED GROUPER 10
20|FH_F86315_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|COVENTRY ENHANCED GROUPER 4
20|FH_F86315_0_0|CSTM-ALL|CSTM-00|2020|PDM|973.00|99|0.00|COVENTRY ENHANCED GROUPER 8
20|FH_F86375_0_0|SrvcGrp|80918|2022|PDM|105.00|99|0.00|RESPITE CARE
20|FH_F86375_0_0|SrvcGrp|82223|2022|PDM|105.00|99|0.00|HOSPICE CARE
20|FH_F86377_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F86377_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F86394_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F86416_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS
20|FH_F86434_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F86434_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|AEG 4 (NO REV)
20|FH_F86434_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 5  (NO REV)
20|FH_F86434_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|AEG 2 (NO REV)
20|FH_F86434_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F86434_0_0|SrvcGrp|11663|2022|PCT|1.05|99|0.00|IMPLANTS
20|FH_F86452_0_0|CSTM-ALL|CSTM-00|2020|PDM|1703.00|99|0.00|2007 MEDICARE ASPG VIII
20|FH_F86452_0_0|CSTM-ALL|CSTM-00|2020|PDM|2343.00|99|0.00|2007 MEDICARE ASPG IX
20|FH_F86452_0_0|CSTM-ALL|CSTM-00|2020|PDM|893.00|99|0.00|2007 MEDICARE ASPG III
20|FH_F86452_0_0|SrvcGrp|15472|2022|PDM|583.00|99|0.00|CPT CODE 62284
20|FH_F86552_0_0|CSTM-ALL|CSTM-00|2020|PDM|2600.00|99|0.00|AEG 9 (NO REV)
20|FH_F86552_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 3 (NO REV)
20|FH_F86552_0_0|SrvcGrp|82881|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBTANCE
20|FH_F86655_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.70|99|0.00|AEG 7 (NO REV)
20|FH_F86655_0_0|CSTM-ALL|CSTM-00|2020|PDM|937.15|99|0.00|AEG 5  (NO REV)
20|FH_F86655_0_0|SrvcGrp|85159|2022|PCT|0.00|99|0.00|CARDIAC CATH
20|FH_F86658_0_0|SrvcGrp|20070|2022|PDM|90.00|99|0.00|HCPCS S9083
20|FH_F86660_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F86660_0_0|CSTM-ALL|CSTM-00|2020|PDM|2739.00|99|0.00|COVENTRY ENHANCED GROUPER 5
20|FH_F86717_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F86752_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F86752_0_0|SrvcGrp|75479|2022|PDM|443.00|99|0.00|AEG 1
20|FH_F86815_0_0|CSTM-ALL|CSTM-00|2020|PDM|870.00|99|0.00|AEG 4 (NO REV)
20|FH_F86815_0_0|SrvcGrp|78448|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F86836_0_0|SrvcGrp|105888|2022|PCT|0.65|99|0.00|WOUND CARE
20|FH_F86836_0_0|SrvcGrp|11000|2022|PCT|0.50|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS
20|FH_F86855_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE
20|FH_F86855_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS
20|FH_F86914_19605_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE
20|FH_F87012_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F87012_0_0|SrvcGrp|72996|2022|PDM|1074.86|99|0.00|AEG 4
20|FH_F87012_0_0|SrvcGrp|73008|2022|PDM|1149.32|99|0.00|AEG 10
20|FH_F87031_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F87031_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F87031_0_0|SrvcGrp|72996|2022|PDM|983.00|99|0.00|AEG 4
20|FH_F87031_0_0|SrvcGrp|72998|2022|PDM|1117.00|99|0.00|AEG 5
20|FH_F87053_0_0|SrvcGrp|72996|2022|PDM|1020.00|99|0.00|AEG 4
20|FH_F87053_0_0|SrvcGrp|78448|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F87054_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F87054_0_0|SrvcGrp|12491|2022|PCT|0.70|99|0.00|PACEMAKER
20|FH_F87054_0_0|SrvcGrp|38907|2022|PDM|1260.00|99|0.00|CPT 66170 - FISTULIZATION OF SCLERA FOR GLAUCOMA
20|FH_F87054_0_0|SrvcGrp|705|2022|PCT|0.70|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F87054_0_0|SrvcGrp|72992|2022|PDM|893.00|99|0.00|AEG 2
20|FH_F87054_0_0|SrvcGrp|72998|2022|PDM|1130.00|99|0.00|AEG 5
20|FH_F87054_0_0|SrvcGrp|73008|2022|PDM|992.00|99|0.00|AEG 10
20|FH_F87054_0_0|SrvcGrp|84123|2022|PDM|2100.00|99|0.00|INSERT ANT SEGMENT DRAIN EXT
20|FH_F87054_0_0|SrvcGrp|84931|2022|PDM|2132.00|99|0.00|KERATOPLASTY
20|FH_F87054_0_0|SrvcGrp|84935|2022|PDM|1260.00|99|0.00|REPAIR IRIS AND CILIARY BODY
20|FH_F87152_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE
20|FH_F87219_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F87219_0_0|CSTM-ALL|CSTM-00|2020|PDM|113.49|99|0.00|AETNA SLEEP STUDY CPT 95801
20|FH_F87219_0_0|CSTM-ALL|CSTM-00|2020|PDM|204.98|99|0.00|SLEEP STUDY CPT 95806 W/O MOD 26 & TC
20|FH_F87219_0_0|CSTM-ALL|CSTM-00|2020|PDM|581.02|99|0.00|AETNA POLYSOMNOGRAPHY
20|FH_F87219_0_0|CSTM-ALL|CSTM-00|2020|PDM|72.73|99|0.00|AETNA SLEEP STUDY (MOD 26)
20|FH_F87219_0_0|CSTM-ALL|CSTM-00|2020|PDM|749.66|99|0.00|AETNA SLEEP STUDIES W/O MOD 26 & TC
20|FH_F87219_0_0|CSTM-ALL|CSTM-00|2020|PDM|75.52|99|0.00|AETNA SLEEP STUDY (MOD 26)
20|FH_F87219_0_0|CSTM-ALL|CSTM-00|2020|PDM|767.03|99|0.00|POLYSOMNOGRAPHY W/O MOD 26 & TC
20|FH_F87219_0_0|SrvcGrp|83880|2022|PDM|63.75|99|0.00|AETNA SLEEP STUDY (MOD 26)
20|FH_F87254_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F87254_0_0|SrvcGrp|104614|2022|PDM|800.00|99|0.00|BIOPSY OF RECTUM
20|FH_F87254_0_0|SrvcGrp|104618|2022|PDM|850.00|99|0.00|EXCISION OF ANAL LESION(S)
20|FH_F87254_0_0|SrvcGrp|11306|2022|PCT|0.67|99|0.00|IMPLANTS
20|FH_F87254_0_0|SrvcGrp|42472|2022|PDM|2200.00|99|0.00|CPT 58670
20|FH_F87254_0_0|SrvcGrp|44064|2022|PDM|1100.00|99|0.00|CPT 52351
20|FH_F87254_0_0|SrvcGrp|68543|2022|PDM|1300.00|99|0.00|CPT 36561
20|FH_F87254_0_0|SrvcGrp|72998|2022|PDM|1040.00|99|0.00|AEG 5
20|FH_F87254_0_0|SrvcGrp|73000|2022|PDM|1092.00|99|0.00|AEG 6
20|FH_F87254_0_0|SrvcGrp|73004|2022|PDM|1640.00|99|0.00|AEG 8
20|FH_F87254_0_0|SrvcGrp|73008|2022|PDM|755.00|99|0.00|AEG 10
20|FH_F87254_0_0|SrvcGrp|82301|2022|PDM|610.00|99|0.00|HEMORRHOIDECTOMY
20|FH_F87254_0_0|SrvcGrp|84184|2022|PDM|1642.00|99|0.00|AETNA REMOVAL OF BREAST IMPLANT
20|FH_F87254_0_0|SrvcGrp|87053|2022|PDM|1100.00|99|0.00|CYSTOSCOPY AND TREATMENT
20|FH_F87272_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F87333_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F87333_0_0|SrvcGrp|13990|2022|PCT|0.84|99|0.00|PACEMAKER
20|FH_F87333_0_0|SrvcGrp|72994|2022|PDM|903.31|99|0.00|AEG 3
20|FH_F87333_0_0|SrvcGrp|73004|2022|PDM|1638.08|99|0.00|AEG 8
20|FH_F87374_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS
20|FH_F87411_0_0|CSTM-ALL|CSTM-00|2020|PDM|161.05|99|0.00|SLEEP STUDY CPT 95806 W/O MOD 26 & TC
20|FH_F87411_0_0|CSTM-ALL|CSTM-00|2020|PDM|191.14|99|0.00|AETNA POLYSOMNOGRAPHY (MOD 26)
20|FH_F87411_0_0|CSTM-ALL|CSTM-00|2020|PDM|428.82|99|0.00|AETNA SLEEP STUDIES
20|FH_F87411_0_0|CSTM-ALL|CSTM-00|2020|PDM|565.77|99|0.00|AETNA SLEEP STUDIES W/O MOD 26 & TC
20|FH_F87411_0_0|CSTM-ALL|CSTM-00|2020|PDM|566.19|99|0.00|AETNA SLEEP STUDIES W/O MOD 26 & TC
20|FH_F87411_0_0|CSTM-ALL|CSTM-00|2020|PDM|66.37|99|0.00|AETNA SLEEP STUDY (MOD 26)
20|FH_F87411_0_0|CSTM-ALL|CSTM-00|2020|PDM|788.22|99|0.00|POLYSOMNOGRAPHY W/O MOD 26 & TC
20|FH_F87411_0_0|SrvcGrp|85682|2022|PDM|797.21|99|0.00|POLYSOMNOGRAPHY (MOD TC)
20|FH_F87411_0_0|SrvcGrp|85684|2022|PDM|118.02|99|0.00|POLYSOMNOGRAPHY (MOD 26)
20|FH_F87480_0_0|CSTM-ALL|CSTM-00|2020|PDM|1070.00|99|0.00|AEG 8 (NO REV)
20|FH_F87480_0_0|CSTM-ALL|CSTM-00|2020|PDM|909.00|99|0.00|AEG 6 (NO REV)
20|FH_F87480_0_0|SrvcGrp|27261|2022|PDM|6500.00|99|0.00|CPT 27446
20|FH_F87480_0_0|SrvcGrp|41335|2022|PDM|7500.00|99|0.00|TOTAL HIP
20|FH_F87480_0_0|SrvcGrp|75182|2022|PCT|1.00|99|0.00|AETNA IMPLANTS
20|FH_F87480_0_0|SrvcGrp|86237|2022|PDM|1800.00|99|0.00|AETNA PODIATRY PROCEDURES
20|FH_F87482_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS
20|FH_F87538_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F87538_0_0|SrvcGrp|59290|2022|PDM|568.00|99|0.00|DAY HOSPITAL HALF DAY
20|FH_F87538_0_0|SrvcGrp|59291|2022|PDM|731.00|99|0.00|DAY HOSPITAL FULL DAY
20|FH_F87541_0_0|SrvcGrp|72996|2022|PDM|759.00|99|0.00|AEG 4
20|FH_F87541_0_0|SrvcGrp|72998|2022|PDM|864.00|99|0.00|AEG 5
20|FH_F87541_0_0|SrvcGrp|73006|2022|PDM|1615.00|99|0.00|AEG 9
20|FH_F87559_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F87559_0_0|CSTM-ALL|CSTM-00|2020|PDM|115.22|99|0.00|AETNA POLYSOMNOGRAPHY (MOD 26)
20|FH_F87559_0_0|CSTM-ALL|CSTM-00|2020|PDM|142.66|99|0.00|AETNA SLEEP STUDY
20|FH_F87559_0_0|CSTM-ALL|CSTM-00|2020|PDM|142.66|99|0.00|SLEEP STUDY CPT 95800
20|FH_F87559_0_0|CSTM-ALL|CSTM-00|2020|PDM|163.33|99|0.00|SLEEP STUDY CPT 95806 W/O MOD 26 & TC
20|FH_F87559_0_0|CSTM-ALL|CSTM-00|2020|PDM|475.04|99|0.00|CPT 95810 (W/MOD TC)
20|FH_F87559_0_0|CSTM-ALL|CSTM-00|2020|PDM|512.65|99|0.00|AETNA POLYSOMNOGRAPHY
20|FH_F87559_0_0|CSTM-ALL|CSTM-00|2020|PDM|77.45|99|0.00|AETNA SLEEP STUDY
20|FH_F87559_0_0|SrvcGrp|42722|2022|PDM|56.28|99|0.00|SLEEP STUDIES CPT 95806 W/MODIFIER 26
20|FH_F87559_0_0|SrvcGrp|86480|2022|PDM|79.14|99|0.00|AETNA POLYSOMNOGRAPHY (MOD 26)
20|FH_F87571_0_0|CSTM-ALL|CSTM-00|2020|PDM|1600.00|99|0.00|ACUTE IP MED SVCS
20|FH_F87571_0_0|SrvcGrp|29817|2022|PDM|2090.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY
20|FH_F87571_0_0|SrvcGrp|45882|2022|PDM|85.00|99|0.00|PT
20|FH_F87571_0_0|SrvcGrp|45884|2022|PDM|85.00|99|0.00|ST
20|FH_F87595_0_0|SrvcGrp|13724|2022|PCT|0.49|99|0.00|PHARMACY SVCS
20|FH_F87619_0_0|SrvcGrp|72992|2022|PDM|561.00|99|0.00|AEG 2
20|FH_F87619_0_0|SrvcGrp|73004|2022|PDM|1229.00|99|0.00|AEG 8
20|FH_F87619_0_0|SrvcGrp|73006|2022|PDM|1502.00|99|0.00|AEG 9
20|FH_F87716_0_0|SrvcGrp|12342|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F87716_0_0|SrvcGrp|37260|2022|PDM|5305.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY
20|FH_F87716_0_0|SrvcGrp|44564|2022|PDM|647.00|99|0.00|NEWBORN NURSERY
20|FH_F87816_0_0|SrvcGrp|16526|2022|PDM|183.75|99|0.00|DIALYSIS
20|FH_F87822_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F87822_0_0|SrvcGrp|26470|2022|PDM|138.60|99|0.00|SELF DIALYSIS TRAINING CAPD
20|FH_F87856_0_0|SrvcGrp|75483|2022|PDM|663.00|99|0.00|AEG 3
20|FH_F87856_0_0|SrvcGrp|75487|2022|PDM|932.00|99|0.00|AEG 5
20|FH_F87856_0_0|SrvcGrp|75493|2022|PDM|1272.00|99|0.00|AEG 8
20|FH_F87856_0_0|SrvcGrp|83644|2022|PDM|2000.00|99|0.00|CPT 30465
20|FH_F87856_0_0|SrvcGrp|83837|2022|PDM|2332.00|99|0.00|EXCISION EXCESSIVE SKIN
20|FH_F87856_0_0|SrvcGrp|84181|2022|PDM|2332.00|99|0.00|AETNA IMMEDIATE BREAST PROSTHESIS
20|FH_F87915_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F87915_0_0|CSTM-ALL|CSTM-00|2020|PDM|154.00|99|0.00|CPT 99201
20|FH_F87915_0_0|SrvcGrp|13632|2022|PDM|1187.00|99|0.00|CPT 99215
20|FH_F87915_0_0|SrvcGrp|3405|2022|PDM|154.00|99|0.00|CPT 99212
20|FH_F87993_0_0|CSTM-ALL|CSTM-00|2020|PDM|493.00|99|0.00|AEG 2 (NO REV)
20|FH_F88096_0_0|CSTM-ALL|CSTM-00|2020|PDM|1275.00|99|0.00|AEG 3 (NO REV)
20|FH_F88096_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|AEG 2 (NO REV)
20|FH_F88096_0_0|SrvcGrp|11663|2022|PCT|0.91|99|0.00|IMPLANTS
20|FH_F88096_0_0|SrvcGrp|11673|2022|PDM|2100.00|99|0.00|CPT 29888
20|FH_F88096_0_0|SrvcGrp|36591|2022|PDM|1500.00|99|0.00|CPT 63685
20|FH_F88096_0_0|SrvcGrp|76243|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F88096_0_0|SrvcGrp|86577|2022|PDM|1200.00|99|0.00|NEUROSTIMULATOR PROCEDURES
20|FH_F88274_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F88274_0_0|SrvcGrp|75479|2022|PDM|600.00|99|0.00|AEG 1
20|FH_F88355_0_0|CSTM-ALL|CSTM-00|2020|PDM|323.00|99|0.00|AEG 1 (NO REV)
20|FH_F88355_0_0|CSTM-ALL|CSTM-00|2020|PDM|494.00|99|0.00|AEG 3 (NO REV)
20|FH_F88355_0_0|CSTM-ALL|CSTM-00|2020|PDM|695.00|99|0.00|AEG 5  (NO REV)
20|FH_F88355_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS
20|FH_F88355_0_0|SrvcGrp|80126|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANICNG SUBSTANCE
20|FH_F88357_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F88357_0_0|CSTM-ALL|CSTM-00|2020|PDM|1110.00|99|0.00|AEG 8 (NO REV)
20|FH_F88357_0_0|CSTM-ALL|CSTM-00|2020|PDM|1110.00|99|0.00|AEG 9 (NO REV)
20|FH_F88357_0_0|CSTM-ALL|CSTM-00|2020|PDM|494.00|99|0.00|AEG 3 (NO REV)
20|FH_F88357_0_0|CSTM-ALL|CSTM-00|2020|PDM|611.00|99|0.00|AEG 4 (NO REV)
20|FH_F88357_0_0|CSTM-ALL|CSTM-00|2020|PDM|964.00|99|0.00|AEG 7 (NO REV)
20|FH_F88357_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F88357_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS
20|FH_F88357_0_0|SrvcGrp|78045|2022|PCT|1.00|99|0.00|AETNA AMNIOTIC MEMBRANE
20|FH_F88391_0_0|SrvcGrp|12403|2022|PDM|32.90|99|0.00|CONTINUOUS HOMECARE
20|FH_F88391_0_0|SrvcGrp|26001|2022|PDM|140.81|99|0.00|HOSPICE RESPITE SVCS
20|FH_F88451_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F88451_0_0|SrvcGrp|14404|2022|PCT|0.60|99|0.00|HOME HEALTH CARE MEDICAL SUPPLIES
20|FH_F88451_0_0|SrvcGrp|24029|2022|PDM|35.00|99|0.00|RN HOURLY
20|FH_F88451_0_0|SrvcGrp|29137|2022|PDM|28.00|99|0.00|HOME HEALTH AIDE
20|FH_F88456_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F88456_0_0|CSTM-ALL|CSTM-00|2020|PDM|2241.00|99|0.00|AEG 9 (NO REV)
20|FH_F88456_0_0|CSTM-ALL|CSTM-00|2020|PDM|587.00|99|0.00|AEG 1 (NO REV)
20|FH_F88456_0_0|CSTM-ALL|CSTM-00|2020|PDM|747.00|99|0.00|AEG 10 (NO REV)
20|FH_F88456_0_0|CSTM-ALL|CSTM-00|2020|PDM|784.00|99|0.00|AEG 2 (NO REV)
20|FH_F88456_0_0|SrvcGrp|44066|2022|PDM|2465.00|99|0.00|CPT 57288
20|FH_F88456_0_0|SrvcGrp|74670|2022|PCT|0.00|99|0.00|AETNA OP INTRAOCULAR LENS
20|FH_F88456_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F88616_0_0|CSTM-ALL|CSTM-00|2020|PDM|625.00|99|0.00|AMBULATORY SURGERY W/O AEG 1 & 2
20|FH_F88672_0_0|CSTM-ALL|CSTM-00|2020|PDM|1413.00|99|0.00|AEG 9 (NO REV)
20|FH_F88672_0_0|CSTM-ALL|CSTM-00|2020|PDM|399.00|99|0.00|AEG 1 (NO REV)
20|FH_F88672_0_0|CSTM-ALL|CSTM-00|2020|PDM|538.00|99|0.00|AEG 10 (NO REV)
20|FH_F88672_0_0|CSTM-ALL|CSTM-00|2020|PDM|665.00|99|0.00|AEG 4 (NO REV)
20|FH_F88672_0_0|CSTM-ALL|CSTM-00|2020|PDM|871.00|99|0.00|AEG 6 (NO REV)
20|FH_F88694_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS
20|FH_F88733_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F88733_0_0|SrvcGrp|73485|2022|PDM|840.00|99|0.00|AETNA REHAB
20|FH_F88740_0_0|CSTM-ALL|CSTM-00|2020|PDM|1494.00|99|0.00|AEG 6 (NO REV)
20|FH_F88740_0_0|CSTM-ALL|CSTM-00|2020|PDM|1758.00|99|0.00|AEG 8 (NO REV)
20|FH_F88740_0_0|CSTM-ALL|CSTM-00|2020|PDM|784.00|99|0.00|AEG 2 (NO REV)
20|FH_F88740_0_0|CSTM-ALL|CSTM-00|2020|PDM|987.00|99|0.00|AEG 3 (NO REV)
20|FH_F88816_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F88816_0_0|SrvcGrp|75545|2022|PDM|352.00|99|0.00|SUB-ACUTE - LEVEL I AND II
20|FH_F88818_0_0|SrvcGrp|75483|2022|PDM|470.00|99|0.00|AEG 3
20|FH_F88818_0_0|SrvcGrp|75495|2022|PDM|600.00|99|0.00|AEG 9
20|FH_F88818_0_0|SrvcGrp|87821|2022|PDM|1000.00|99|0.00|REPLACE TISSUE EXPANDER
20|FH_F88885_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.40|99|0.00|HSS ASC
20|FH_F88893_0_0|CSTM-ALL|CSTM-00|2020|PDM|1188.52|99|0.00|AEG 7 (NO REV)
20|FH_F88893_0_0|CSTM-ALL|CSTM-00|2020|PDM|532.51|99|0.00|AEG 2 (NO REV)
20|FH_F88893_0_0|CSTM-ALL|CSTM-00|2020|PDM|679.80|99|0.00|AEG 10 (NO REV)
20|FH_F88893_0_0|SrvcGrp|115846|2022|PDM|1210.00|99|0.00|BOWEL TO BOWEL FUSION
20|FH_F88893_0_0|SrvcGrp|13187|2022|PCT|0.00|99|0.00|INTRAOCULAR LENSES
20|FH_F88893_0_0|SrvcGrp|79588|2022|PDM|528.00|99|0.00|CPT 43235
20|FH_F88893_0_0|SrvcGrp|87842|2022|PDM|11897.00|99|0.00|LAPAROSCOPY - GASTRIC
20|FH_F88933_0_0|CSTM-ALL|CSTM-00|2020|PDM|1182.00|99|0.00|AEG 3 (NO REV)
20|FH_F88933_0_0|CSTM-ALL|CSTM-00|2020|PDM|1420.00|99|0.00|AEG 5  (NO REV)
20|FH_F88933_0_0|CSTM-ALL|CSTM-00|2020|PDM|676.00|99|0.00|AEG 1 (NO REV)
20|FH_F88933_0_0|CSTM-ALL|CSTM-00|2020|PDM|820.00|99|0.00|AEG 2 (NO REV)
20|FH_F88933_0_0|SrvcGrp|49544|2022|PDM|10927.00|99|0.00|ARTHROPLASTY
20|FH_F88933_0_0|SrvcGrp|87522|2022|PDM|3939.00|99|0.00|AETNA REPAIR OF KNEE LIGAMENT
20|FH_F88933_0_0|SrvcGrp|87524|2022|PDM|5065.00|99|0.00|AETNA HIP ARTHOSCOPY
20|FH_F88933_0_0|SrvcGrp|87528|2022|PDM|5065.00|99|0.00|AETNA GYN SURGICAL PROCEDURES
20|FH_F88935_0_0|SrvcGrp|26001|2022|PDM|135.22|99|0.00|HOSPICE RESPITE SVCS
20|FH_F89037_0_0|SrvcGrp|73000|2022|PDM|995.60|99|0.00|AEG 6
20|FH_F89037_0_0|SrvcGrp|73002|2022|PDM|1199.90|99|0.00|AEG 7
20|FH_F89037_0_0|SrvcGrp|73006|2022|PDM|1613.92|99|0.00|AEG 9
20|FH_F89037_0_0|SrvcGrp|73008|2022|PDM|749.80|99|0.00|AEG 10
20|FH_F89111_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F89173_0_0|CSTM-ALL|CSTM-00|2020|PDM|629.00|99|0.00|AEG 3 (NO REV)
20|FH_F89176_0_0|CSTM-ALL|CSTM-00|2020|PDM|812.00|99|0.00|ASPG III
20|FH_F89176_0_0|SrvcGrp|66168|2022|PCT|1.10|99|0.00|IMPLANTS
20|FH_F89233_0_0|SrvcGrp|2738|2022|PCT|0.76|99|0.00|IMPLANTS
20|FH_F89233_0_0|SrvcGrp|63|2022|PDM|979.00|99|0.00|SUBACUTE CARE
20|FH_F89273_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 8 (NO REV)
20|FH_F89273_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|AEG 7 (NO REV)
20|FH_F89273_0_0|CSTM-ALL|CSTM-00|2020|PDM|575.00|99|0.00|AEG 2 (NO REV)
20|FH_F89273_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|AEG 5  (NO REV)
20|FH_F89273_0_0|SrvcGrp|78045|2022|PDM|595.00|99|0.00|AETNA AMNIOTIC MEMBRANE
20|FH_F89273_0_0|SrvcGrp|78046|2022|PDM|795.00|99|0.00|AETNA AQUEOUS SHUNT
20|FH_F89273_0_0|SrvcGrp|88261|2022|PDM|275.00|99|0.00|OCULAR IMPLANTS (HCFA)
20|FH_F89273_0_0|SrvcGrp|88264|2022|PDM|4300.00|99|0.00|CORNEAL TISSUE SVCS (HCFA)
20|FH_F89273_0_0|SrvcGrp|88265|2022|PDM|595.00|99|0.00|CONNECTIVE TISSUE
20|FH_F89273_0_0|SrvcGrp|88266|2022|PDM|595.00|99|0.00|CONNECTIVE TISSUE (HCFA)
20|FH_F89273_0_0|SrvcGrp|88270|2022|PDM|400.00|99|0.00|RETINAL TAMPONADE DEVICE (HCFA)
20|FH_F89311_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F89311_0_0|CSTM-ALL|CSTM-00|2020|PDM|638.00|99|0.00|COVENTRY ENHANCED GROUPER 3
20|FH_F89340_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F89340_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F89340_0_0|CSTM-ALL|CSTM-00|2020|PDM|638.00|99|0.00|AEG 2 (NO REV)
20|FH_F89340_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|AEG 4 (NO REV)
20|FH_F89340_0_0|SrvcGrp|29830|2022|PDM|1936.00|99|0.00|PERCUT NEEDLE INSERTION
20|FH_F89340_0_0|SrvcGrp|56464|2022|PDM|5720.00|99|0.00|CPT 55873
20|FH_F89340_0_0|SrvcGrp|63472|2022|PDM|3300.00|99|0.00|CPT 64581
20|FH_F89340_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F89363_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F89372_0_0|SrvcGrp|107733|2022|PDM|6848.00|99|0.00|CESAREAN SECTION
20|FH_F89372_0_0|SrvcGrp|109151|2022|PDM|14288.00|99|0.00|IP SURGICAL SVCS
20|FH_F89372_0_0|SrvcGrp|111201|2022|PDM|324.00|99|0.00|TRANSCRANIAL MAGNETIC STIMULATION
20|FH_F89372_0_0|SrvcGrp|113456|2022|PDM|15750.00|99|0.00|JOINT REPLACEMENT
20|FH_F89372_0_0|SrvcGrp|73602|2022|PDM|1244.00|99|0.00|AETNA NEWBORN NURSERY I
20|FH_F89372_0_0|SrvcGrp|73653|2022|PDM|394.00|99|0.00|AETNA INTENSIVE OUTPATIENT
20|FH_F89372_0_0|SrvcGrp|88429|2022|PCT|0.51|99|0.00|AETNA SKIN SUBSTITUTCE PRODUCTS
20|FH_F89372_0_0|SrvcGrp|8968|2022|PDM|5606.00|99|0.00|NICU LEVEL III & IV
20|FH_F89495_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F89495_0_0|SrvcGrp|16719|2022|PCT|0.45|99|0.00|PROSTHETICS/ORTHOTICS
20|FH_F89495_0_0|SrvcGrp|71666|2022|PDM|1530.00|99|0.00|CPT 63655
20|FH_F89495_0_0|SrvcGrp|72990|2022|PDM|345.00|99|0.00|AEG 1
20|FH_F89495_0_0|SrvcGrp|73000|2022|PDM|854.00|99|0.00|AEG 6
20|FH_F89495_0_0|SrvcGrp|73004|2022|PDM|1006.00|99|0.00|AEG 8
20|FH_F89538_0_0|CSTM-ALL|CSTM-00|2020|PDM|771.64|99|0.00|AEG 3 (NO REV)
20|FH_F89551_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F89551_0_0|SrvcGrp|471|2022|PDM|550.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F89574_0_0|SrvcGrp|87536|2022|PDM|315.00|99|0.00|MED REHAB DAY PROGRAM (HALF)
20|FH_F89574_0_0|SrvcGrp|87537|2022|PDM|525.00|99|0.00|MED REHAB DAY PROGRAM (FULL)
20|FH_F89580_0_0|SrvcGrp|16|2022|PDM|3212.00|99|0.00|ACUTE REHABILITATION
20|FH_F89580_0_0|SrvcGrp|33096|2022|PCT|0.46|99|0.00|INTRAOCULAR LENS
20|FH_F89580_0_0|SrvcGrp|43985|2022|PCT|0.44|99|0.00|BLOOD AND BLOOD PRODUCTS
20|FH_F89580_0_0|SrvcGrp|778|2022|PDM|9421.00|99|0.00|OP TRAUMA
20|FH_F89580_0_0|SrvcGrp|82137|2022|PCT|0.66|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F89580_0_0|SrvcGrp|86663|2022|PDM|5869.00|99|0.00|AETNA MEDICAL/SURGICAL
20|FH_F89580_0_0|SrvcGrp|88419|2022|PCT|0.48|99|0.00|IP NITRIX OXIDE
20|FH_F89580_0_0|SrvcGrp|88423|2022|PCT|1.00|99|0.00|OP REFERENCE LABORATORY (MOD 90)
20|FH_F89580_0_0|SrvcGrp|88477|2022|PCT|0.47|99|0.00|IP HIGH COST DRUGS
20|FH_F89580_0_0|SrvcGrp|8968|2022|PDM|6485.00|99|0.00|NICU LEVEL III & IV
20|FH_F89616_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.70|99|0.00|OP SVCS
20|FH_F89680_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.87|99|0.00|OP SVCS
20|FH_F89732_0_0|SrvcGrp|88427|2022|PDM|2882.00|99|0.00|AETNA IP SERVICES
20|FH_F89736_0_0|SrvcGrp|105822|2022|PDM|910.00|99|0.00|AETNA OVERNIGHT STAYS
20|FH_F89736_0_0|SrvcGrp|111962|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES
20|FH_F89736_0_0|SrvcGrp|114930|2022|PDM|19905.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F89736_0_0|SrvcGrp|115054|2022|PDM|19542.00|99|0.00|TOTAL JOINT PROCEDURES
20|FH_F89736_0_0|SrvcGrp|82137|2022|PCT|0.78|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F89760_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F89778_0_0|CSTM-ALL|CSTM-00|2020|PDM|1122.00|99|0.00|AEG 5  (NO REV)
20|FH_F89778_0_0|CSTM-ALL|CSTM-00|2020|PDM|1549.00|99|0.00|AEG 8 (NO REV)
20|FH_F89778_0_0|CSTM-ALL|CSTM-00|2020|PDM|2097.00|99|0.00|AEG 9 (NO REV)
20|FH_F89778_0_0|CSTM-ALL|CSTM-00|2020|PDM|558.00|99|0.00|AEG 1 (NO REV)
20|FH_F89778_0_0|SrvcGrp|26278|2022|PDM|1215.74|99|0.00|CPT 29881
20|FH_F89778_0_0|SrvcGrp|28549|2022|PDM|1764.40|99|0.00|VITRECTOMY
20|FH_F89778_0_0|SrvcGrp|35668|2022|PDM|2455.44|99|0.00|CPT 29824
20|FH_F89778_0_0|SrvcGrp|64517|2022|PDM|2345.20|99|0.00|REDUCE MANMMAPLASTY
20|FH_F89778_0_0|SrvcGrp|82881|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBTANCE
20|FH_F89778_0_0|SrvcGrp|87053|2022|PDM|1178.04|99|0.00|CYSTOSCOPY AND TREATMENT
20|FH_F89778_0_0|SrvcGrp|88599|2022|PDM|1135.88|99|0.00|ENDOSCOPY MAXILLARY SINUS
20|FH_F89778_0_0|SrvcGrp|88823|2022|PDM|1099.69|99|0.00|REPAIR OF EARDRUM
20|FH_F89779_0_0|SrvcGrp|67065|2022|PDM|11000.00|99|0.00|CERVICAL SURGERY
20|FH_F89779_0_0|SrvcGrp|72994|2022|PDM|2700.00|99|0.00|AEG 3
20|FH_F89779_0_0|SrvcGrp|73000|2022|PDM|3000.00|99|0.00|AEG 6
20|FH_F89912_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.70|99|0.00|OP SVCS
20|FH_F89952_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F89952_0_0|CSTM-ALL|CSTM-00|2020|PDM|1339.00|99|0.00|AEG 9 (NO REV)
20|FH_F89952_0_0|CSTM-ALL|CSTM-00|2020|PDM|446.00|99|0.00|AEG 2 (NO REV)
20|FH_F89952_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|AEG 5  (NO REV)
20|FH_F89952_0_0|SrvcGrp|87297|2022|PCT|0.00|99|0.00|HCPCS CODES
20|FH_F90136_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F90136_0_0|SrvcGrp|73656|2022|PDM|475.00|99|0.00|AETNA HOSPICE SVCS
20|FH_F90136_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE
20|FH_F90157_0_0|SrvcGrp|80258|2022|PCT|0.00|99|0.00|AETNA SKILLED CARE
20|FH_F90160_0_0|CSTM-ALL|CSTM-00|2020|PCT|44.90|99|0.00|GENERAL ACUTE CARE
20|FH_F90173_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F90173_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING
20|FH_F90184_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE
20|FH_F90184_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS
20|FH_F90197_0_0|CSTM-ALL|CSTM-00|2020|PCT|66.00|99|0.00|GENERAL ACUTE CARE
20|FH_F90354_0_0|SrvcGrp|57968|2022|PDM|33.90|99|0.00|CONTINUOUS HOMECARE
20|FH_F90362_0_0|SrvcGrp|10986|2022|PDM|1667.00|99|0.00|ARTHROSCOPIC KNEE REPAIR
20|FH_F90362_0_0|SrvcGrp|16289|2022|PDM|1485.00|99|0.00|CARPAL TUNNEL RELEASE
20|FH_F90362_0_0|SrvcGrp|23585|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F90362_0_0|SrvcGrp|27261|2022|PDM|11670.00|99|0.00|CPT 27446
20|FH_F90362_0_0|SrvcGrp|72992|2022|PDM|520.00|99|0.00|AEG 2
20|FH_F90362_0_0|SrvcGrp|72996|2022|PDM|721.00|99|0.00|AEG 4
20|FH_F90362_0_0|SrvcGrp|73004|2022|PDM|1288.00|99|0.00|AEG 8
20|FH_F90362_0_0|SrvcGrp|73006|2022|PDM|1515.00|99|0.00|AEG 9
20|FH_F90362_0_0|SrvcGrp|80617|2022|PDM|11670.00|99|0.00|ARTHOPLASTY
20|FH_F90455_0_0|SrvcGrp|16304|2022|PDM|685.00|99|0.00|HOSPICE CARE
20|FH_F90455_0_0|SrvcGrp|43569|2022|PDM|128.00|99|0.00|SKILLED NURSING - NEWBORN
20|FH_F90455_0_0|SrvcGrp|48385|2022|PDM|152.00|99|0.00|SPEECH THERAPY
20|FH_F90455_0_0|SrvcGrp|48396|2022|PDM|140.00|99|0.00|OT SERVICES
20|FH_F90455_0_0|SrvcGrp|88834|2022|PDM|128.00|99|0.00|SKILLED NURSING SERVICES (15 MINS)
20|FH_F90653_0_0|SrvcGrp|11199|2022|PCT|0.70|99|0.00|HYPERBARIC CHAMBER
20|FH_F90653_0_0|SrvcGrp|25695|2022|PDM|1300.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F90653_0_0|SrvcGrp|47260|2022|PCT|0.70|99|0.00|IMPLANTS 274-276, 278  LINE LEVEL
20|FH_F90653_0_0|SrvcGrp|58763|2022|PCT|0.70|99|0.00|IMMUNE ENHANCING/SUPPRESSANT PHARMACY
20|FH_F90654_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE
20|FH_F90654_0_0|SrvcGrp|471|2022|PDM|1800.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F90691_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F90691_0_0|SrvcGrp|114518|2022|PDM|1050.00|99|0.00|INSERTION DRAINAGE DEVICE
20|FH_F90691_0_0|SrvcGrp|72998|2022|PDM|785.00|99|0.00|AEG 5
20|FH_F90691_0_0|SrvcGrp|73002|2022|PDM|1055.00|99|0.00|AEG 7
20|FH_F90691_0_0|SrvcGrp|73006|2022|PDM|1211.00|99|0.00|AEG 9
20|FH_F90691_0_0|SrvcGrp|75182|2022|PCT|1.00|99|0.00|AETNA IMPLANTS
20|FH_F90700_0_0|SrvcGrp|12403|2022|PDM|2165.00|99|0.00|CONTINUOUS HOMECARE
20|FH_F90714_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F90714_0_0|SrvcGrp|72992|2022|PDM|490.00|99|0.00|AEG 2
20|FH_F90714_0_0|SrvcGrp|72994|2022|PDM|555.00|99|0.00|AEG 3
20|FH_F90811_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F90811_0_0|CSTM-ALL|CSTM-00|2020|PDM|1071.00|99|0.00|AEG 5  (NO REV)
20|FH_F90811_0_0|SrvcGrp|10986|2022|PDM|2500.00|99|0.00|ARTHROSCOPIC KNEE REPAIR
20|FH_F90811_0_0|SrvcGrp|83839|2022|PDM|2800.00|99|0.00|BREAST RECONSTRUCTION
20|FH_F90811_0_0|SrvcGrp|84181|2022|PDM|2700.00|99|0.00|AETNA IMMEDIATE BREAST PROSTHESIS
20|FH_F90811_0_0|SrvcGrp|86460|2022|PDM|2700.00|99|0.00|REVISE BREAST RECONSTRUCTION
20|FH_F90811_0_0|SrvcGrp|86462|2022|PDM|1500.00|99|0.00|AREOLA RECONSTRUCTION
20|FH_F90811_0_0|SrvcGrp|87059|2022|PDM|2700.00|99|0.00|REPAIR OF TENDON
20|FH_F90811_0_0|SrvcGrp|88748|2022|PDM|2500.00|99|0.00|HIP ARTHROSCOPY
20|FH_F90811_0_0|SrvcGrp|90061|2022|PDM|10000.00|99|0.00|AETNA RECONSTRUCT SHOULDER JOINT
20|FH_F90811_0_0|SrvcGrp|90423|2022|PDM|3500.00|99|0.00|FUSION GRAFT OF WRIST JOINT
20|FH_F90811_0_0|SrvcGrp|90424|2022|PDM|2500.00|99|0.00|ANKLE ARTHROSCOPY SURGERY
20|FH_F90811_0_0|SrvcGrp|90426|2022|PDM|2500.00|99|0.00|SHOULDER ARTHROSCOPY SURGERY
20|FH_F90811_0_0|SrvcGrp|90439|2022|PDM|2500.00|99|0.00|SHOULDER ARTHROSCOPY SURGERY
20|FH_F90817_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F90817_0_0|CSTM-ALL|CSTM-00|2020|PDM|1340.00|99|0.00|AEG 8 (NO REV)
20|FH_F90817_0_0|SrvcGrp|26274|2022|PDM|1574.00|99|0.00|CPT 29877
20|FH_F90817_0_0|SrvcGrp|26432|2022|PDM|2444.00|99|0.00|OP SURGICAL SERVICES
20|FH_F90817_0_0|SrvcGrp|27343|2022|PDM|2914.00|99|0.00|OP SURGERY (CPT 25607 - 25609)
20|FH_F90817_0_0|SrvcGrp|33981|2022|PDM|1443.00|99|0.00|CPT 49505, 49585
20|FH_F90817_0_0|SrvcGrp|37642|2022|PDM|2068.00|99|0.00|LAP HERNIORRHAPY
20|FH_F90817_0_0|SrvcGrp|45583|2022|PDM|2350.00|99|0.00|CPT 65730
20|FH_F90817_0_0|SrvcGrp|46890|2022|PDM|2256.00|99|0.00|IMPLANT EYE SHUNT
20|FH_F90817_0_0|SrvcGrp|76604|2022|PDM|1692.00|99|0.00|CPT 25447
20|FH_F90817_0_0|SrvcGrp|77579|2022|PDM|2096.00|99|0.00|CPT 23410 - 23412
20|FH_F90817_0_0|SrvcGrp|88358|2022|PDM|2914.00|99|0.00|ARTHROSCOPIC KNEE REPAIR (HCFA)
20|FH_F90817_0_0|SrvcGrp|90361|2022|PDM|2914.00|99|0.00|REPAIR FRACTURE RADIUS/ULNA
20|FH_F90817_0_0|SrvcGrp|90362|2022|PDM|1433.00|99|0.00|RELEASE FOREARM/HAND TENDON
20|FH_F90817_0_0|SrvcGrp|90366|2022|PDM|1880.00|99|0.00|RHINOPLASTY COMPLETE EXT PRT
20|FH_F90817_0_0|SrvcGrp|90369|2022|PDM|855.00|99|0.00|PROBE NASOLACRIMAL DUCT
20|FH_F90817_0_0|SrvcGrp|90372|2022|PDM|1433.00|99|0.00|REP FLX TEND ZONE 2 DIGT SEC
20|FH_F90817_0_0|SrvcGrp|90378|2022|PDM|2280.00|99|0.00|JAW ARTHROSCOPY/TMJ SURG
20|FH_F90817_0_0|SrvcGrp|90380|2022|PDM|2280.00|99|0.00|ARTHROSCOPIC FRACTURE TX
20|FH_F90817_0_0|SrvcGrp|90382|2022|PDM|2721.00|99|0.00|ANKLE ARTHROSCOPY SURGERY
20|FH_F90817_0_0|SrvcGrp|90384|2022|PDM|7520.00|99|0.00|TOTAL HIP ARTHROPLASTY
20|FH_F90817_0_0|SrvcGrp|90398|2022|PDM|3008.00|99|0.00|LAPAROSCOPY CHOLECYSTECTOMY
20|FH_F90817_0_0|SrvcGrp|91000|2022|PDM|2914.00|99|0.00|REPAIR FRACTURE RADIUS/ULNA (HCFA)
20|FH_F90817_0_0|SrvcGrp|91006|2022|PDM|7520.00|99|0.00|TOTAL HIP ARTHROPLASTY (HCFA)
20|FH_F90817_0_0|SrvcGrp|91016|2022|PDM|1880.00|99|0.00|RHINOPLASTY COMPLETE EXT PRT (HCFA)
20|FH_F90817_0_0|SrvcGrp|91018|2022|PDM|1762.00|99|0.00|NASAL ENDOSCOPY SURGICAL (HCFA)
20|FH_F90817_0_0|SrvcGrp|91020|2022|PDM|1151.00|99|0.00|REMOVAL OF TEAR SAC (HCFA)
20|FH_F90817_0_0|SrvcGrp|91025|2022|PDM|2914.00|99|0.00|OPEN TREATMENT OF DISTAL (HCFA)
20|FH_F90817_0_0|SrvcGrp|91030|2022|PDM|2350.00|99|0.00|CORNEAL TISSUE (HCFA)
20|FH_F90817_0_0|SrvcGrp|91033|2022|PDM|2256.00|99|0.00|REVISE AQUEOUS SHUNT EYE (HCFA)
20|FH_F90817_0_0|SrvcGrp|91039|2022|PDM|1866.00|99|0.00|RELEASE OF EYE FLUID (HCFA)
20|FH_F90817_0_0|SrvcGrp|91047|2022|PDM|1217.00|99|0.00|REVISE MEDIAN NERVE AT WRIST (HCFA)
20|FH_F90818_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 10 (NO REV)
20|FH_F90818_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|AEG 1 (NO REV)
20|FH_F90818_0_0|SrvcGrp|11663|2022|PCT|0.50|99|0.00|IMPLANTS
20|FH_F90818_0_0|SrvcGrp|26278|2022|PDM|5500.00|99|0.00|CPT 29881
20|FH_F90818_0_0|SrvcGrp|77450|2022|PDM|3200.00|99|0.00|CPT 54161
20|FH_F90818_0_0|SrvcGrp|79594|2022|PDM|2880.00|99|0.00|CPT 45380
20|FH_F90831_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F90838_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE
20|FH_F90838_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS
20|FH_F90839_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F90840_0_0|CSTM-ALL|CSTM-00|2020|PDM|1126.00|99|0.00|AEG 5  (NO REV)
20|FH_F90840_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F90852_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F90852_0_0|SrvcGrp|16|2022|PDM|945.00|99|0.00|ACUTE REHABILITATION
20|FH_F90852_0_0|SrvcGrp|8950|2022|PDM|1470.00|99|0.00|INTERMEDIATE ICU/CCU
20|FH_F90853_0_0|SrvcGrp|73483|2022|PDM|850.00|99|0.00|AETNA SUBACUTE III
20|FH_F90940_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F91034_0_0|SrvcGrp|82981|2022|PDM|128.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS
20|FH_F91039_0_0|CSTM-ALL|CSTM-00|2020|PDM|1022.00|99|0.00|AEG 8 (NO REV)
20|FH_F91039_0_0|CSTM-ALL|CSTM-00|2020|PDM|468.00|99|0.00|AEG 2 (NO REV)
20|FH_F91039_0_0|CSTM-ALL|CSTM-00|2020|PDM|536.00|99|0.00|AEG 3 (NO REV)
20|FH_F91067_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F91067_0_0|SrvcGrp|84182|2022|PDM|2500.00|99|0.00|AETNA REMOVAL OF BREAST CAPSULE
20|FH_F91073_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.90|99|0.00|GENERAL ACUTE CARE
20|FH_F91077_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE
20|FH_F91171_0_0|CSTM-ALL|CSTM-00|2020|PDM|391.00|99|0.00|AEG 1 (NO REV)
20|FH_F91171_0_0|CSTM-ALL|CSTM-00|2020|PDM|688.00|99|0.00|AEG 4 (NO REV)
20|FH_F91171_0_0|SrvcGrp|23585|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F91171_0_0|SrvcGrp|83646|2022|PDM|783.00|99|0.00|CPT 31276
20|FH_F91263_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS
20|FH_F91275_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE
20|FH_F91284_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F91284_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F91331_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS
20|FH_F91331_0_0|CSTM-ALL|CSTM-00|2020|PDM|755.07|99|0.00|ASPG X
20|FH_F91331_0_0|SrvcGrp|90318|2022|PCT|1.10|99|0.00|IMPLANTS/PROSTHETICS
20|FH_F91332_0_0|CSTM-ALL|CSTM-00|2020|PDM|446.00|99|0.00|COVENTRY ENHANCED GROUPER 2
20|FH_F91332_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|COVENTRY ENHANCED GROUPER 5
20|FH_F91332_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|COVENTRY ENHANCED GROUPER 7
20|FH_F91412_0_0|CSTM-ALL|CSTM-00|2020|PDM|1811.50|99|0.00|AEG 7 (NO REV)
20|FH_F91412_0_0|CSTM-ALL|CSTM-00|2020|PDM|701.32|99|0.00|AEG 1 (NO REV)
20|FH_F91412_0_0|SrvcGrp|11663|2022|PCT|0.50|99|0.00|IMPLANTS
20|FH_F91451_0_0|SrvcGrp|3178|2022|PDM|1005.00|99|0.00|ACUTE PSYCH
20|FH_F91575_0_0|CSTM-ALL|CSTM-00|2020|PDM|1070.00|99|0.00|AEG 8 (NO REV)
20|FH_F91575_0_0|CSTM-ALL|CSTM-00|2020|PDM|1095.00|99|0.00|AEG 7 (NO REV)
20|FH_F91575_0_0|CSTM-ALL|CSTM-00|2020|PDM|491.00|99|0.00|AEG 2 (NO REV)
20|FH_F91575_0_0|CSTM-ALL|CSTM-00|2020|PDM|693.00|99|0.00|AEG 4 (NO REV)
20|FH_F91594_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F91594_0_0|SrvcGrp|14532|2022|PCT|0.85|99|0.00|OBSERVATION SVCS
20|FH_F91617_0_0|SrvcGrp|87077|2022|PDM|240.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F91617_0_0|SrvcGrp|91419|2022|PDM|500.00|99|0.00|PROLONGED SERVICE (HCFA MOD 25)
20|FH_F91634_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F91634_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 7 (NO REV)
20|FH_F91634_0_0|CSTM-ALL|CSTM-00|2020|PDM|474.00|99|0.00|AEG 1 (NO REV)
20|FH_F91634_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 3 (NO REV)
20|FH_F91634_0_0|SrvcGrp|108340|2022|PCT|0.00|99|0.00|IMPLANT NEURORECEIVER 23
20|FH_F91636_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS
20|FH_F91641_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F91641_0_0|CSTM-ALL|CSTM-00|2020|PDM|1560.60|99|0.00|AEG 4 (NO REV)
20|FH_F91641_0_0|CSTM-ALL|CSTM-00|2020|PDM|1948.67|99|0.00|AEG 6 (NO REV)
20|FH_F91641_0_0|CSTM-ALL|CSTM-00|2020|PDM|2296.16|99|0.00|AEG 8 (NO REV)
20|FH_F91641_0_0|CSTM-ALL|CSTM-00|2020|PDM|3161.78|99|0.00|AEG 9 (NO REV)
20|FH_F91641_0_0|SrvcGrp|111993|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES
20|FH_F91641_0_0|SrvcGrp|78285|2022|PDM|1976.76|99|0.00|CPT 58671
20|FH_F91641_0_0|SrvcGrp|91459|2022|PDM|1976.76|99|0.00|LAPAROSCOPY
20|FH_F91772_0_0|SrvcGrp|72990|2022|PDM|480.00|99|0.00|AEG 1
20|FH_F91772_0_0|SrvcGrp|82138|2022|PDM|480.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F91787_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F91819_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F91819_0_0|CSTM-ALL|CSTM-00|2020|PDM|1339.00|99|0.00|COVENTRY ENHANCED GROUPER 9
20|FH_F91819_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|COVENTRY ENHANCED GROUPER 10
20|FH_F91819_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|COVENTRY ENHANCED GROUPER 6
20|FH_F91819_0_0|SrvcGrp|78283|2022|PDM|1000.00|99|0.00|CPT 49505
20|FH_F91819_0_0|SrvcGrp|91686|2022|PDM|1500.00|99|0.00|ORTHOPEDIC SURGERY PROCEDURE
20|FH_F91876_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F91876_0_0|SrvcGrp|34606|2022|PDM|3525.00|99|0.00|CPT 29827
20|FH_F91876_0_0|SrvcGrp|73006|2022|PDM|3595.00|99|0.00|AEG 9
20|FH_F91876_0_0|SrvcGrp|73008|2022|PDM|1691.00|99|0.00|AEG 10
20|FH_F91876_0_0|SrvcGrp|88599|2022|PDM|2345.00|99|0.00|ENDOSCOPY MAXILLARY SINUS
20|FH_F91898_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.77|99|0.00|GENERAL ACUTE CARE
20|FH_F91898_0_0|CSTM-ALL|CSTM-00|2020|PDM|11837.00|99|0.00|AEG 5  (NO REV)
20|FH_F91898_0_0|CSTM-ALL|CSTM-00|2020|PDM|13984.00|99|0.00|AEG 4 (NO REV)
20|FH_F91898_0_0|SrvcGrp|360|2022|PDM|2723.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II
20|FH_F91898_0_0|SrvcGrp|361|2022|PDM|6780.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III
20|FH_F91898_0_0|SrvcGrp|91658|2022|PDM|6356.00|99|0.00|AETNA MATERNITY CARE (NORMAL DELIVERY)
20|FH_F91898_0_0|SrvcGrp|91753|2022|PDM|7500.00|99|0.00|AETNA MEDICAL MSDRG AND INTENSIVE CARE
20|FH_F91900_0_0|SrvcGrp|82957|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F91912_0_0|SrvcGrp|12659|2022|PDM|431.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT
20|FH_F91913_0_0|SrvcGrp|72994|2022|PDM|510.00|99|0.00|AEG 3
20|FH_F91913_0_0|SrvcGrp|91759|2022|PCT|1.00|99|0.00|OCULAR IMPLANT
20|FH_F91933_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F91933_0_0|SrvcGrp|16|2022|PDM|800.00|99|0.00|ACUTE REHABILITATION
20|FH_F91933_0_0|SrvcGrp|73559|2022|PDM|1500.00|99|0.00|AETNA INTENSIVE CARE
20|FH_F91940_0_0|CSTM-ALL|CSTM-00|2020|PDM|1849.00|99|0.00|AEG 8 (NO REV)
20|FH_F91940_0_0|CSTM-ALL|CSTM-00|2020|PDM|480.08|99|0.00|PHENYLEPHRINE KETOROLAC
20|FH_F91940_0_0|CSTM-ALL|CSTM-00|2020|PDM|847.00|99|0.00|AEG 2 (NO REV)
20|FH_F91973_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OP IMAGING ENHANC. SUBSTANCES (IMAGENHANCE)
20|FH_F91973_0_0|CSTM-ALL|CSTM-00|2020|PDM|2496.00|99|0.00|AEG 9 (NO REV)
20|FH_F91973_0_0|CSTM-ALL|CSTM-00|2020|PDM|2833.00|99|0.00|AEG 7 (NO REV)
20|FH_F91973_0_0|CSTM-ALL|CSTM-00|2020|PDM|692.00|99|0.00|AEG 1 (NO REV)
20|FH_F91973_0_0|SrvcGrp|91647|2022|PDM|6232.00|99|0.00|AETNA OTHER SPINAL SURGERIES
20|FH_F91975_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F91975_0_0|CSTM-ALL|CSTM-00|2020|PDM|448.00|99|0.00|AEG 2 (NO REV)
20|FH_F91975_0_0|CSTM-ALL|CSTM-00|2020|PDM|635.00|99|0.00|AEG 4 (NO REV)
20|FH_F91975_0_0|CSTM-ALL|CSTM-00|2020|PDM|987.00|99|0.00|AEG 8 (NO REV)
20|FH_F91975_0_0|SrvcGrp|91858|2022|PDM|611.00|99|0.00|SIGMOIDOSCOPY CODE W/ ULTRASOUND
20|FH_F91994_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F91994_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F91994_0_0|SrvcGrp|23585|2022|PCT|1.15|99|0.00|IMPLANTS
20|FH_F91994_0_0|SrvcGrp|38364|2022|PDM|4800.00|99|0.00|IMPLANT NEUROELECTRODES
20|FH_F91994_0_0|SrvcGrp|72992|2022|PDM|750.00|99|0.00|AEG 2
20|FH_F91994_0_0|SrvcGrp|72996|2022|PDM|1760.00|99|0.00|AEG 4
20|FH_F91994_0_0|SrvcGrp|73002|2022|PDM|2620.00|99|0.00|AEG 7
20|FH_F91994_0_0|SrvcGrp|73004|2022|PDM|3152.00|99|0.00|AEG 8
20|FH_F91994_0_0|SrvcGrp|73006|2022|PDM|4712.00|99|0.00|AEG 9
20|FH_F91998_0_0|SrvcGrp|16289|2022|PDM|895.00|99|0.00|CARPAL TUNNEL RELEASE
20|FH_F91998_0_0|SrvcGrp|27315|2022|PDM|1000.00|99|0.00|TENDON REPAIR
20|FH_F91998_0_0|SrvcGrp|35669|2022|PDM|1224.00|99|0.00|CPT 63650
20|FH_F91998_0_0|SrvcGrp|35672|2022|PDM|1530.00|99|0.00|CPT 23412
20|FH_F91998_0_0|SrvcGrp|36591|2022|PDM|1836.00|99|0.00|CPT 63685
20|FH_F91998_0_0|SrvcGrp|72996|2022|PDM|679.00|99|0.00|AEG 4
20|FH_F91998_0_0|SrvcGrp|73006|2022|PDM|1449.00|99|0.00|AEG 9
20|FH_F91998_0_0|SrvcGrp|75182|2022|PCT|1.00|99|0.00|AETNA IMPLANTS
20|FH_F91998_0_0|SrvcGrp|90061|2022|PDM|8500.00|99|0.00|AETNA RECONSTRUCT SHOULDER JOINT
20|FH_F91998_0_0|SrvcGrp|91888|2022|PDM|1800.00|99|0.00|SHOULDER ARTHROSCOPY
20|FH_F91998_0_0|SrvcGrp|91892|2022|PDM|8500.00|99|0.00|TOTAL HIP ARTHROPLASTY
20|FH_F92034_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F92034_0_0|SrvcGrp|35669|2022|PDM|5200.00|99|0.00|CPT 63650
20|FH_F92034_0_0|SrvcGrp|72990|2022|PDM|600.00|99|0.00|AEG 1
20|FH_F92034_0_0|SrvcGrp|72992|2022|PDM|588.00|99|0.00|AEG 2
20|FH_F92034_0_0|SrvcGrp|72994|2022|PDM|675.00|99|0.00|AEG 3
20|FH_F92091_0_0|SrvcGrp|26274|2022|PDM|3500.00|99|0.00|CPT 29877
20|FH_F92091_0_0|SrvcGrp|41335|2022|PDM|10000.00|99|0.00|TOTAL HIP
20|FH_F92091_0_0|SrvcGrp|73002|2022|PDM|3149.00|99|0.00|AEG 7
20|FH_F92091_0_0|SrvcGrp|73006|2022|PDM|2835.00|99|0.00|AEG 9
20|FH_F92091_0_0|SrvcGrp|73008|2022|PDM|2247.00|99|0.00|AEG 10
20|FH_F92091_0_0|SrvcGrp|80617|2022|PDM|6000.00|99|0.00|ARTHOPLASTY
20|FH_F92091_0_0|SrvcGrp|89984|2022|PDM|7800.00|99|0.00|LAMINECTOMY W/FACE-LUMBAR
20|FH_F92091_0_0|SrvcGrp|89986|2022|PDM|1350.00|99|0.00|CORRECTION OF BUNION
20|FH_F92119_0_0|CSTM-ALL|CSTM-00|2020|PDM|1257.00|99|0.00|AEG 9 (NO REV)
20|FH_F92119_0_0|CSTM-ALL|CSTM-00|2020|PDM|419.00|99|0.00|AEG 2 (NO REV)
20|FH_F92119_0_0|CSTM-ALL|CSTM-00|2020|PDM|479.00|99|0.00|AEG 3 (NO REV)
20|FH_F92119_0_0|CSTM-ALL|CSTM-00|2020|PDM|673.00|99|0.00|AEG 5  (NO REV)
20|FH_F92119_0_0|CSTM-ALL|CSTM-00|2020|PDM|923.00|99|0.00|AEG 8 (NO REV)
20|FH_F92120_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F92120_0_0|CSTM-ALL|CSTM-00|2020|PDM|633.00|99|0.00|AEG 1 (NO REV)
20|FH_F92129_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F92129_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|AEG 1 (NO REV)
20|FH_F92129_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|AEG 10 (NO REV)
20|FH_F92129_0_0|SrvcGrp|11663|2022|PCT|0.80|99|0.00|IMPLANTS
20|FH_F92188_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F92188_0_0|CSTM-ALL|CSTM-00|2020|PDM|726.00|99|0.00|AEG 2 (NO REV)
20|FH_F92188_0_0|CSTM-ALL|CSTM-00|2020|PDM|726.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F92212_0_0|CSTM-ALL|CSTM-00|2020|PDM|991.00|99|0.00|AEG 7 (NO REV)
20|FH_F92212_0_0|SrvcGrp|92084|2022|PDM|1737.00|99|0.00|CORNEAL TRANSPLANT
20|FH_F92411_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F92411_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F92411_0_0|SrvcGrp|76094|2022|PDM|131.46|99|0.00|HOSPICE ROUTINE HOME CARE
20|FH_F92454_0_0|CSTM-ALL|CSTM-00|2020|PDM|1206.40|99|0.00|AEG 5  (NO REV)
20|FH_F92454_0_0|CSTM-ALL|CSTM-00|2020|PDM|1716.00|99|0.00|AEG 7 (NO REV)
20|FH_F92454_0_0|CSTM-ALL|CSTM-00|2020|PDM|1820.00|99|0.00|AEG 8 (NO REV)
20|FH_F92454_0_0|SrvcGrp|36591|2022|PDM|9700.00|99|0.00|CPT 63685
20|FH_F92474_0_0|CSTM-ALL|CSTM-00|2020|PDM|1055.00|99|0.00|AEG 8 (NO REV)
20|FH_F92474_0_0|CSTM-ALL|CSTM-00|2020|PDM|383.00|99|0.00|AEG 1 (NO REV)
20|FH_F92474_0_0|CSTM-ALL|CSTM-00|2020|PDM|570.00|99|0.00|AEG 3 (NO REV)
20|FH_F92474_0_0|CSTM-ALL|CSTM-00|2020|PDM|699.00|99|0.00|AEG 4 (NO REV)
20|FH_F92477_0_0|SrvcGrp|73559|2022|PDM|1627.50|99|0.00|AETNA INTENSIVE CARE
20|FH_F92477_0_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE
20|FH_F92493_0_0|CSTM-ALL|CSTM-00|2020|PDM|1514.21|99|0.00|AEG 3 (NO REV)
20|FH_F92493_0_0|CSTM-ALL|CSTM-00|2020|PDM|2398.00|99|0.00|AEG 8 (NO REV)
20|FH_F92493_0_0|SrvcGrp|54943|2022|PDM|3250.17|99|0.00|REPAIR OF SLAP LESION
20|FH_F92493_0_0|SrvcGrp|70749|2022|PDM|3250.17|99|0.00|CPT 29823
20|FH_F92493_0_0|SrvcGrp|76604|2022|PDM|3119.66|99|0.00|CPT 25447
20|FH_F92493_0_0|SrvcGrp|82109|2022|PDM|2340.03|99|0.00|REVISE ULNAR NERVE ELBOW
20|FH_F92493_0_0|SrvcGrp|88163|2022|PDM|20241.10|99|0.00|LUMBAR SPINE FUSION
20|FH_F92493_0_0|SrvcGrp|89980|2022|PDM|3119.66|99|0.00|OPEN TREATMENT OF DISTAL
20|FH_F92493_0_0|SrvcGrp|92365|2022|PDM|12999.53|99|0.00|FUSION OF SACROILIAC JOINT
20|FH_F92493_0_0|SrvcGrp|92370|2022|PDM|2079.00|99|0.00|FUSION OF KNUCKLE JOINT
20|FH_F92493_0_0|SrvcGrp|92405|2022|PDM|8263.20|99|0.00|PERQ LUMBOSACRAL INJECTION
20|FH_F92496_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS
20|FH_F92513_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F92513_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS
20|FH_F92516_0_0|SrvcGrp|72990|2022|PDM|336.00|99|0.00|AEG 1
20|FH_F92516_0_0|SrvcGrp|86863|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F92516_0_0|SrvcGrp|89978|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F92531_0_0|CSTM-ALL|CSTM-00|2020|PDM|1241.00|99|0.00|AEG 2 (NO REV)
20|FH_F92531_0_0|CSTM-ALL|CSTM-00|2020|PDM|1409.00|99|0.00|AEG 3 (NO REV)
20|FH_F92531_0_0|CSTM-ALL|CSTM-00|2020|PDM|1748.00|99|0.00|AEG 5  (NO REV)
20|FH_F92531_0_0|CSTM-ALL|CSTM-00|2020|PDM|2300.00|99|0.00|AEG 6 (NO REV)
20|FH_F92531_0_0|CSTM-ALL|CSTM-00|2020|PDM|2424.00|99|0.00|AEG 8 (NO REV)
20|FH_F92531_0_0|CSTM-ALL|CSTM-00|2020|PDM|862.00|99|0.00|AEG 1 (NO REV)
20|FH_F92531_0_0|SrvcGrp|67066|2022|PDM|4510.00|99|0.00|CERVICAL SURGERY
20|FH_F92531_0_0|SrvcGrp|86919|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH INCIDENTAL CODES
20|FH_F92531_0_0|SrvcGrp|92011|2022|PDM|1522.00|99|0.00|REMOVAL OF IMPLANT
20|FH_F92531_0_0|SrvcGrp|92194|2022|PDM|5638.00|99|0.00|SPINE DISK SURGERY REMOVE LAMINA
20|FH_F92599_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F92599_0_0|SrvcGrp|75479|2022|PDM|479.00|99|0.00|AEG 1
20|FH_F92599_0_0|SrvcGrp|75481|2022|PDM|641.00|99|0.00|AEG 2
20|FH_F92599_0_0|SrvcGrp|75485|2022|PDM|906.00|99|0.00|AEG 4
20|FH_F92599_0_0|SrvcGrp|75489|2022|PDM|1194.00|99|0.00|AEG 6
20|FH_F92599_0_0|SrvcGrp|75497|2022|PDM|733.00|99|0.00|AEG 10
20|FH_F92600_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F92614_0_0|CSTM-ALL|CSTM-00|2020|PCT|71.20|99|0.00|GENERAL ACUTE CARE
20|FH_F92614_0_0|CSTM-ALL|CSTM-00|2020|PCT|71.20|99|0.00|OP SVCS
20|FH_F92618_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F92618_0_0|SrvcGrp|57968|2022|PDM|33.20|99|0.00|CONTINUOUS HOMECARE
20|FH_F92659_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F92659_0_0|CSTM-ALL|CSTM-00|2020|PDM|570.00|99|0.00|AEG 10 (NO REV)
20|FH_F92659_0_0|CSTM-ALL|CSTM-00|2020|PDM|652.00|99|0.00|AEG 3 (NO REV)
20|FH_F92659_0_0|SrvcGrp|23936|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS
20|FH_F92659_0_0|SrvcGrp|54086|2022|PDM|1500.00|99|0.00|VITRECTOMY, MECHANICAL, PARS PLANA APPROACH
20|FH_F92659_0_0|SrvcGrp|85563|2022|PDM|962.00|99|0.00|INCISION OF EYE
20|FH_F92659_0_0|SrvcGrp|86034|2022|PDM|1485.00|99|0.00|REPAIR DETACHED RETINA
20|FH_F92659_0_0|SrvcGrp|92552|2022|PCT|1.00|99|0.00|AMNIOTIC MEMBRANE
20|FH_F92716_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F92760_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F92792_0_0|CSTM-ALL|CSTM-00|2020|PDM|1393.70|99|0.00|AEG 6 (NO REV)
20|FH_F92792_0_0|CSTM-ALL|CSTM-00|2020|PDM|2242.90|99|0.00|GEORGIA EYE INSTITUTE AEG 10 (NO REV)
20|FH_F92792_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F92792_0_0|SrvcGrp|28550|2022|PDM|2200.00|99|0.00|VITRECTOMY
20|FH_F92792_0_0|SrvcGrp|28551|2022|PDM|2200.00|99|0.00|REPAIR OF COMPLEX RETINAL DETACHMENT
20|FH_F92792_0_0|SrvcGrp|46890|2022|PDM|2200.00|99|0.00|IMPLANT EYE SHUNT
20|FH_F92792_0_0|SrvcGrp|53702|2022|PDM|2200.00|99|0.00|PREP CORNEAL ENDOTHELIAL ALLOGRAFT
20|FH_F92792_0_0|SrvcGrp|53703|2022|PDM|1320.00|99|0.00|REVISE AQUEOUS SHUNT TO EXTRAOCULAR RESIVOIR
20|FH_F92792_0_0|SrvcGrp|82570|2022|PDM|1045.00|99|0.00|REVISION EYELID/EXCESS SKIN
20|FH_F92833_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F92833_0_0|CSTM-ALL|CSTM-00|2020|PDM|1517.00|99|0.00|AEG 5  (NO REV)
20|FH_F92833_0_0|CSTM-ALL|CSTM-00|2020|PDM|2063.00|99|0.00|AEG 8 (NO REV)
20|FH_F92833_0_0|SrvcGrp|13990|2022|PCT|1.00|99|0.00|PACEMAKER
20|FH_F92833_0_0|SrvcGrp|33967|2022|PDM|2215.00|99|0.00|CPT 47562
20|FH_F92833_0_0|SrvcGrp|84280|2022|PDM|2992.00|99|0.00|CORNEAL TRANSPLANT
20|FH_F92852_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F92852_0_0|CSTM-ALL|CSTM-00|2020|PDM|1645.60|99|0.00|AETNA GLENNVILLE 2016 AEG 8
20|FH_F92852_0_0|CSTM-ALL|CSTM-00|2020|PDM|2242.90|99|0.00|AETNA GLENNVILLE 2016 AEG 9
20|FH_F92852_0_0|CSTM-ALL|CSTM-00|2020|PDM|853.60|99|0.00|AETNA GLENNVILLE 2016 AEG 3
20|FH_F92852_0_0|SrvcGrp|28547|2022|PDM|2200.00|99|0.00|VITRECTOMY
20|FH_F92852_0_0|SrvcGrp|28550|2022|PDM|2200.00|99|0.00|VITRECTOMY
20|FH_F92852_0_0|SrvcGrp|46890|2022|PDM|2200.00|99|0.00|IMPLANT EYE SHUNT
20|FH_F92852_0_0|SrvcGrp|53702|2022|PDM|2200.00|99|0.00|PREP CORNEAL ENDOTHELIAL ALLOGRAFT
20|FH_F92852_0_0|SrvcGrp|53703|2022|PDM|1320.00|99|0.00|REVISE AQUEOUS SHUNT TO EXTRAOCULAR RESIVOIR
20|FH_F92852_0_0|SrvcGrp|84280|2022|PDM|2200.00|99|0.00|CORNEAL TRANSPLANT
20|FH_F92852_0_0|SrvcGrp|87759|2022|PDM|1320.00|99|0.00|REINFORCE/GRAFT EYE WALL
20|FH_F92871_0_0|CSTM-ALL|CSTM-00|2020|PDM|525.00|99|0.00|AEG 2 (NO REV)
20|FH_F92871_0_0|CSTM-ALL|CSTM-00|2020|PDM|741.00|99|0.00|AEG 4 (NO REV)
20|FH_F92871_0_0|SrvcGrp|114519|2022|PDM|1275.00|99|0.00|INSERTION DRAINAGE DEVICE
20|FH_F92931_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F92935_0_0|CSTM-ALL|CSTM-00|2020|PDM|1753.00|99|0.00|AEG 9 (NO REV)
20|FH_F92935_0_0|CSTM-ALL|CSTM-00|2020|PDM|668.00|99|0.00|AEG 3 (NO REV)
20|FH_F92959_0_0|SrvcGrp|57968|2022|PDM|31.94|99|0.00|CONTINUOUS HOMECARE
20|FH_F92964_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F92971_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F92971_0_0|CSTM-ALL|CSTM-00|2020|PCT|76.00|99|0.00|OP SVCS
20|FH_F92993_0_0|CSTM-ALL|CSTM-00|2020|PDM|102.27|99|0.00|AETNA SLEEP STUDIES
20|FH_F92993_0_0|CSTM-ALL|CSTM-00|2020|PDM|134.32|99|0.00|AETNA SLEEP STUDY
20|FH_F92993_0_0|CSTM-ALL|CSTM-00|2020|PDM|180.00|99|0.00|AETNA-HME SLP TEST/TYPE III (MOD TC, 26)
20|FH_F92993_0_0|CSTM-ALL|CSTM-00|2020|PDM|33.93|99|0.00|AETNA SLEEP STUDIES (MOD TC)
20|FH_F92993_0_0|CSTM-ALL|CSTM-00|2020|PDM|336.08|99|0.00|AETNA SLEEP STUDIES
20|FH_F92993_0_0|CSTM-ALL|CSTM-00|2020|PDM|607.90|99|0.00|CPT 95811 (W/MOD TC)
20|FH_F92993_0_0|CSTM-ALL|CSTM-00|2020|PDM|73.56|99|0.00|AETNA SLEEP STUDY
20|FH_F92993_0_0|SrvcGrp|42723|2022|PDM|85.83|99|0.00|SLEEP STUDIES CPT 95806 W/MODIFIER TC
20|FH_F92993_0_0|SrvcGrp|86474|2022|PDM|39.63|99|0.00|AETNA SLEEP STUDY (MOD 26)
20|FH_F92993_0_0|SrvcGrp|86476|2022|PDM|41.57|99|0.00|AETNA SLEEP STUDY (MOD 26)
20|FH_F93136_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS
20|FH_F93138_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F93171_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)
20|FH_F93171_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F93172_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE
20|FH_F93212_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F93212_0_0|CSTM-ALL|CSTM-00|2020|PDM|1818.00|99|0.00|AEG 6 (NO REV)
20|FH_F93212_0_0|CSTM-ALL|CSTM-00|2020|PDM|2744.00|99|0.00|AEG 8 (NO REV)
20|FH_F93212_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F93212_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F93232_0_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F93252_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F93252_0_0|CSTM-ALL|CSTM-00|2020|PDM|1104.00|99|0.00|AEG 4 (NO REV) 2016 BRANDON ASC
20|FH_F93252_0_0|CSTM-ALL|CSTM-00|2020|PDM|1284.00|99|0.00|AEG 5 (NO REV) 2016 BRANDON ASC
20|FH_F93252_0_0|SrvcGrp|80617|2022|PDM|7000.00|99|0.00|ARTHOPLASTY
20|FH_F93252_0_0|SrvcGrp|87026|2022|PDM|1200.00|99|0.00|CYSTOSCOPY AND TREATMENT
20|FH_F93252_0_0|SrvcGrp|91564|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE
20|FH_F93252_0_0|SrvcGrp|93006|2022|PDM|1500.00|99|0.00|PAIN MANAGEMENT SURGICAL PROCEDURES
20|FH_F93252_0_0|SrvcGrp|93011|2022|PDM|1500.00|99|0.00|PAIN MANAGEMENT SURGICAL PROCEDURES
20|FH_F93252_0_0|SrvcGrp|93019|2022|PDM|8000.00|99|0.00|TOTAL KNEE REPLACEMENT
20|FH_F93252_0_0|SrvcGrp|93020|2022|PDM|4000.00|99|0.00|KYPHOPLASTY-VERTEBROPLASTY LUMBAR
20|FH_F93252_0_0|SrvcGrp|93026|2022|PDM|2700.00|99|0.00|ROTATOR CUFF REPAIR
20|FH_F93252_0_0|SrvcGrp|93027|2022|PDM|8000.00|99|0.00|TOTAL SHOULDER REPLACEMENT
20|FH_F93254_0_0|SrvcGrp|26001|2022|PDM|125.55|99|0.00|HOSPICE RESPITE SVCS
20|FH_F93254_0_0|SrvcGrp|3809|2022|PDM|539.93|99|0.00|HOSPICE CARE
20|FH_F93254_0_0|SrvcGrp|57968|2022|PDM|29.52|99|0.00|CONTINUOUS HOMECARE
20|FH_F93268_0_0|SrvcGrp|473|2022|PDM|426.40|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F93268_0_0|SrvcGrp|76501|2022|PDM|329.68|99|0.00|SUB-ACUTE - LEVEL I
20|FH_F93275_0_0|CSTM-ALL|CSTM-00|2020|PDM|431.00|99|0.00|AEG 1 (NO REV)
20|FH_F93275_0_0|CSTM-ALL|CSTM-00|2020|PDM|5500.00|99|0.00|AEG 7 (NO REV)
20|FH_F93279_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F93279_0_0|CSTM-ALL|CSTM-00|2020|PDM|1122.00|99|0.00|AEG 7 (NO REV)
20|FH_F93279_0_0|CSTM-ALL|CSTM-00|2020|PDM|577.00|99|0.00|AEG 1 (NO REV)
20|FH_F93279_0_0|CSTM-ALL|CSTM-00|2020|PDM|691.00|99|0.00|AEG 2 (NO REV)
20|FH_F93279_0_0|CSTM-ALL|CSTM-00|2020|PDM|746.00|99|0.00|AEG 3 (NO REV)
20|FH_F93279_0_0|CSTM-ALL|CSTM-00|2020|PDM|806.00|99|0.00|AEG 5  (NO REV)
20|FH_F93279_0_0|SrvcGrp|93759|2022|PCT|0.00|99|0.00|CARDIAC CATH
20|FH_F93281_0_0|CSTM-ALL|CSTM-00|2020|PDM|430.00|99|0.00|AEG 3 (NO REV)
20|FH_F93281_0_0|CSTM-ALL|CSTM-00|2020|PDM|430.00|99|0.00|AEG 5  (NO REV)
20|FH_F93281_0_0|CSTM-ALL|CSTM-00|2020|PDM|575.00|99|0.00|AEG 2 (NO REV)
20|FH_F93281_0_0|SrvcGrp|89569|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F93287_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F93331_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F93331_0_0|CSTM-ALL|CSTM-00|2020|PDM|2266.00|99|0.00|AEG 6 (NO REV)
20|FH_F93332_0_0|SrvcGrp|67073|2022|PDM|2295.00|99|0.00|CPT 22851
20|FH_F93332_0_0|SrvcGrp|87448|2022|PDM|4120.00|99|0.00|AETNA KYPHOPLASTY (2015 HIPPA)
20|FH_F93332_0_0|SrvcGrp|88492|2022|PDM|2096.00|99|0.00|AETNA SPINAL BONE AUTOGRAFT
20|FH_F93332_0_0|SrvcGrp|89860|2022|PDM|7416.00|99|0.00|SPINAL DISK SURGERY ADD-ON
20|FH_F93332_0_0|SrvcGrp|91047|2022|PDM|3090.00|99|0.00|REVISE MEDIAN NERVE AT WRIST (HCFA)
20|FH_F93332_0_0|SrvcGrp|93059|2022|PDM|2096.00|99|0.00|SPINAL BONE AUTOGRAFT
20|FH_F93332_0_0|SrvcGrp|93063|2022|PDM|7416.00|99|0.00|LUMBAR ARTIF DISKECTOMY
20|FH_F93332_0_0|SrvcGrp|93064|2022|PDM|7416.00|99|0.00|LUMBAR ARTIF DISKECTOMY (HCFA)
20|FH_F93332_0_0|SrvcGrp|93065|2022|PDM|7416.00|99|0.00|LUMB ARTIF DISKECTOMY ADDL
20|FH_F93332_0_0|SrvcGrp|93068|2022|PDM|7416.00|99|0.00|SPINE FUSION EXTRA SEGMENT (HCFA)
20|FH_F93332_0_0|SrvcGrp|93075|2022|PDM|2295.00|99|0.00|APPLY SPINE PROSTH DEVICE (HCFA)
20|FH_F93332_0_0|SrvcGrp|93077|2022|PDM|4120.00|99|0.00|AETNA KYPHOPLASTY (HCFA)
20|FH_F93332_0_0|SrvcGrp|93086|2022|PDM|6386.00|99|0.00|REMOVAL OF SPINAL LAMINA (HCFA)
20|FH_F93332_0_0|SrvcGrp|93087|2022|PDM|6386.00|99|0.00|LAMINECTOMY W/FACE-THORACIC (HFCA)
20|FH_F93332_0_0|SrvcGrp|93089|2022|PDM|7025.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON (HCFA)
20|FH_F93333_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F93333_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 10 (NO REV)
20|FH_F93333_0_0|CSTM-ALL|CSTM-00|2020|PDM|2488.00|99|0.00|AEG 9 (NO REV)
20|FH_F93333_0_0|CSTM-ALL|CSTM-00|2020|PDM|757.00|99|0.00|AEG 2 (NO REV)
20|FH_F93371_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS
20|FH_F93375_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F93375_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F93375_0_0|SrvcGrp|72992|2022|PDM|468.00|99|0.00|AEG 2
20|FH_F93375_0_0|SrvcGrp|72998|2022|PDM|752.00|99|0.00|AEG 5
20|FH_F93377_0_0|SrvcGrp|82222|2022|PDM|27.00|99|0.00|HOSPICE CARE
20|FH_F93381_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F93384_0_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III
20|FH_F93392_0_0|SrvcGrp|87077|2022|PDM|110.00|99|0.00|AETNA URGENT CARE CENTERS
20|FH_F93413_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F93413_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F93421_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F93512_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F93512_0_0|CSTM-ALL|CSTM-00|2020|PDM|468.00|99|0.00|AEG 2 (NO REV)
20|FH_F93512_0_0|CSTM-ALL|CSTM-00|2020|PDM|536.00|99|0.00|AEG 3 (NO REV)
20|FH_F93512_0_0|CSTM-ALL|CSTM-00|2020|PDM|867.00|99|0.00|AEG 6 (NO REV)
20|FH_F93517_0_0|CSTM-ALL|CSTM-00|2020|PDM|1313.00|99|0.00|AEG 4 (NO REV)
20|FH_F93517_0_0|CSTM-ALL|CSTM-00|2020|PDM|1885.00|99|0.00|AEG 7 (NO REV)
20|FH_F93517_0_0|CSTM-ALL|CSTM-00|2020|PDM|2100.00|99|0.00|AEG 9 (NO REV)
20|FH_F93561_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F93561_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F93592_0_0|CSTM-ALL|CSTM-00|2020|PDM|1473.00|99|0.00|AEG 9 (NO REV)
20|FH_F93592_0_0|CSTM-ALL|CSTM-00|2020|PDM|491.00|99|0.00|AEG 2 (NO REV)
20|FH_F93592_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F93592_0_0|SrvcGrp|82110|2022|PDM|1278.00|99|0.00|KNEE ARTHROSCOPY DIAGNOSTIC
20|FH_F93740_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F93740_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F93740_0_0|SrvcGrp|73008|2022|PDM|500.00|99|0.00|AEG 10
20|FH_F93740_0_0|SrvcGrp|91577|2022|PDM|10500.00|99|0.00|FEM/POPL REVASC STNT & ATHER
20|FH_F93740_0_0|SrvcGrp|91583|2022|PDM|5300.00|99|0.00|CAROTID DIAGNOSTIC
20|FH_F93740_0_0|SrvcGrp|91588|2022|PDM|10000.00|99|0.00|DIAGNOSTIC ELECTROPHYSIOLOGY (EP) STUDY
20|FH_F93791_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F93791_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F93791_0_0|CSTM-ALL|CSTM-00|2020|PDM|2730.00|99|0.00|AEG 9 (NO REV)
20|FH_F93791_0_0|CSTM-ALL|CSTM-00|2020|PDM|3150.00|99|0.00|AEG 7 (NO REV)
20|FH_F93791_0_0|CSTM-ALL|CSTM-00|2020|PDM|788.00|99|0.00|AEG 10 (NO REV)
20|FH_F93791_0_0|SrvcGrp|27261|2022|PDM|4200.00|99|0.00|CPT 27446
20|FH_F93791_0_0|SrvcGrp|67065|2022|PDM|3675.00|99|0.00|CERVICAL SURGERY
20|FH_F93791_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE
20|FH_F93791_0_0|SrvcGrp|88354|2022|PDM|1260.00|99|0.00|CPT 63685 (HCFA)
20|FH_F93791_0_0|SrvcGrp|93431|2022|PDM|4200.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT
20|FH_F93791_0_0|SrvcGrp|93433|2022|PDM|4200.00|99|0.00|PARTIAL HIP REPLACEMENT
20|FH_F93791_0_0|SrvcGrp|93595|2022|PDM|4200.00|99|0.00|ARTHROPLASTY(HCFA)
20|FH_F93791_0_0|SrvcGrp|93600|2022|PDM|4200.00|99|0.00|TOTAL HIP ARTHOPLASTY(HCFA)
20|FH_F93805_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F93906_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS
20|FH_F93909_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|GENERAL ACUTE CARE
20|FH_F93961_0_0|CSTM-ALL|CSTM-00|2020|PDM|335.00|99|0.00|AEG 10 (NO REV)
20|FH_F93961_0_0|CSTM-ALL|CSTM-00|2020|PDM|514.00|99|0.00|AEG 3 (NO REV)
20|FH_F93961_0_0|SrvcGrp|91858|2022|PDM|611.00|99|0.00|SIGMOIDOSCOPY CODE W/ ULTRASOUND
20|FH_F93961_0_0|SrvcGrp|91861|2022|PDM|452.00|99|0.00|COLONOSCOPY PROCEDURES
20|FH_F93961_0_0|SrvcGrp|91862|2022|PDM|452.00|99|0.00|COLONOSCOPY PROCEDURES 2
20|FH_F93961_0_0|SrvcGrp|93749|2022|PDM|1654.00|99|0.00|ERCP DUCT STENT PLACEMENT
20|FH_F93961_0_0|SrvcGrp|93751|2022|PDM|1654.00|99|0.00|ERCP STENT EXCHANGE W/DILATE
20|FH_F94061_0_0|CSTM-ALL|CSTM-00|2020|PCT|50.00|99|0.00|GENERAL ACUTE CARE
20|FH_F94101_0_0|CSTM-ALL|CSTM-00|2020|PCT|52.00|99|0.00|GENERAL ACUTE CARE
20|FH_F94102_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.54|99|0.00|GENERAL ACUTE CARE
20|FH_F94103_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F94165_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|AEG 3 (NO REV)
20|FH_F94165_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|AEG 5  (NO REV)
20|FH_F94165_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS
20|FH_F94165_0_0|SrvcGrp|73806|2022|PCT|0.85|99|0.00|AETNA ER
20|FH_F94165_0_0|SrvcGrp|74470|2022|PCT|0.85|99|0.00|AETNA SLEEP STUDIES
20|FH_F94280_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F94280_0_0|CSTM-ALL|CSTM-00|2020|PDM|1482.00|99|0.00|AEG 3 (NO REV)
20|FH_F94280_0_0|CSTM-ALL|CSTM-00|2020|PDM|1717.00|99|0.00|AEG 5  (NO REV)
20|FH_F94280_0_0|CSTM-ALL|CSTM-00|2020|PDM|1769.00|99|0.00|AEG 6 (NO REV)
20|FH_F94280_0_0|CSTM-ALL|CSTM-00|2020|PDM|1821.00|99|0.00|AEG 7 (NO REV)
20|FH_F94280_0_0|CSTM-ALL|CSTM-00|2020|PDM|1873.00|99|0.00|AEG 8 (NO REV)
20|FH_F94280_0_0|SrvcGrp|85022|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F94300_0_0|CSTM-ALL|CSTM-00|2020|PDM|2457.00|99|0.00|AEG 9 (NO REV)
20|FH_F94300_0_0|CSTM-ALL|CSTM-00|2020|PDM|788.00|99|0.00|AEG 10 (NO REV)
20|FH_F94300_0_0|CSTM-ALL|CSTM-00|2020|PDM|945.00|99|0.00|AEG 2 (NO REV)
20|FH_F94300_0_0|SrvcGrp|67065|2022|PDM|3675.00|99|0.00|CERVICAL SURGERY
20|FH_F94300_0_0|SrvcGrp|89404|2022|PDM|4200.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY
20|FH_F94300_0_0|SrvcGrp|93432|2022|PDM|4200.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT
20|FH_F94300_0_0|SrvcGrp|93602|2022|PDM|4200.00|99|0.00|TOTAL KNEE(HCFA)
20|FH_F94303_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F94303_0_0|SrvcGrp|72992|2022|PDM|1154.00|99|0.00|AEG 2
20|FH_F94303_0_0|SrvcGrp|72994|2022|PDM|1423.00|99|0.00|AEG 3
20|FH_F94303_0_0|SrvcGrp|72998|2022|PDM|1892.00|99|0.00|AEG 5
20|FH_F94303_0_0|SrvcGrp|83379|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH INCIDENTAL CODES
20|FH_F94340_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS
20|FH_F94403_0_0|CSTM-ALL|CSTM-00|2020|PDM|1410.00|99|0.00|AEG 8 (NO REV)
20|FH_F94403_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AEG 1 (NO REV)
20|FH_F94481_0_0|SrvcGrp|42782|2022|PDM|45.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F94502_0_0|SrvcGrp|73485|2022|PDM|713.00|99|0.00|AETNA REHAB
20|FH_F94581_0_0|SrvcGrp|473|2022|PDM|405.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F94662_0_0|SrvcGrp|73656|2022|PDM|726.00|99|0.00|AETNA HOSPICE SVCS
20|FH_F94662_0_0|SrvcGrp|90707|2022|PDM|199.00|99|0.00|AETNA HOSPICE CARE
20|FH_F94662_0_0|SrvcGrp|93098|2022|PDM|199.00|99|0.00|HOSPICE CARE
20|FH_F94665_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F94665_0_0|CSTM-ALL|CSTM-00|2020|PDM|2018.00|99|0.00|AEG 9 (NO REV)
20|FH_F94665_0_0|CSTM-ALL|CSTM-00|2020|PDM|2375.00|99|0.00|AEG 10 (NO REV)
20|FH_F94665_0_0|CSTM-ALL|CSTM-00|2020|PDM|902.00|99|0.00|AEG 1 (NO REV)
20|FH_F94665_0_0|SrvcGrp|13187|2022|PCT|1.00|99|0.00|INTRAOCULAR LENSES
20|FH_F94665_0_0|SrvcGrp|21803|2022|PDM|5562.00|99|0.00|LITHOTRIPSY
20|FH_F94862_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F94862_0_0|SrvcGrp|73006|2022|PDM|1000.00|99|0.00|AEG 9
20|FH_F94942_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION
20|FH_F94942_0_0|SrvcGrp|72994|2022|PDM|846.66|99|0.00|AEG 3
20|FH_F94942_0_0|SrvcGrp|73000|2022|PDM|1122.70|99|0.00|AEG 6
20|FH_F94942_0_0|SrvcGrp|73004|2022|PDM|1257.63|99|0.00|AEG 8
20|FH_F94942_0_0|SrvcGrp|75497|2022|PDM|924.94|99|0.00|AEG 10
20|FH_F95021_0_0|SrvcGrp|471|2022|PDM|580.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F95021_0_0|SrvcGrp|76501|2022|PDM|235.00|99|0.00|SUB-ACUTE - LEVEL I
20|FH_F95101_0_0|SrvcGrp|42782|2022|PDM|45.00|99|0.00|PHYSICAL THERAPY SVCS
20|FH_F95101_0_0|SrvcGrp|473|2022|PDM|315.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F95221_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F95221_0_0|SrvcGrp|73000|2022|PDM|919.00|99|0.00|AEG 6
20|FH_F95221_0_0|SrvcGrp|73004|2022|PDM|1066.00|99|0.00|AEG 8
20|FH_F95284_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F95340_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE
20|FH_F95440_0_0|SrvcGrp|11663|2022|PCT|1.03|99|0.00|IMPLANTS
20|FH_F95440_0_0|SrvcGrp|35669|2022|PDM|5600.00|99|0.00|CPT 63650
20|FH_F95440_0_0|SrvcGrp|36591|2022|PDM|5700.00|99|0.00|CPT 63685
20|FH_F95440_0_0|SrvcGrp|58638|2022|PDM|4900.00|99|0.00|CPT 63688
20|FH_F95440_0_0|SrvcGrp|63471|2022|PDM|5400.00|99|0.00|CPT 64590
20|FH_F95440_0_0|SrvcGrp|93807|2022|PDM|6000.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY
20|FH_F95482_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F95482_0_0|CSTM-ALL|CSTM-00|2020|PDM|1356.00|99|0.00|AEG 4 (NO REV)
20|FH_F95482_0_0|CSTM-ALL|CSTM-00|2020|PDM|4174.00|99|0.00|AEG 9 (NO REV)
20|FH_F95482_0_0|SrvcGrp|86582|2022|PDM|1217.00|99|0.00|AETNA CARDIAC CATHERTERIZATION
20|FH_F95629_0_0|CSTM-ALL|CSTM-00|2020|PDM|1714.00|99|0.00|AEG 7 (NO REV)
20|FH_F95629_0_0|CSTM-ALL|CSTM-00|2020|PDM|1738.00|99|0.00|AEG 8 (NO REV)
20|FH_F95629_0_0|CSTM-ALL|CSTM-00|2020|PDM|2533.00|99|0.00|AEG 9 (NO REV)
20|FH_F95629_0_0|CSTM-ALL|CSTM-00|2020|PDM|665.00|99|0.00|AEG 2 (NO REV)
20|FH_F95641_0_0|SrvcGrp|76501|2022|PDM|235.00|99|0.00|SUB-ACUTE - LEVEL I
20|FH_F95800_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F95800_0_0|CSTM-ALL|CSTM-00|2020|PDM|1102.00|99|0.00|AEG 7 (NO REV)
20|FH_F95800_0_0|CSTM-ALL|CSTM-00|2020|PDM|698.00|99|0.00|AEG 4 (NO REV)
20|FH_F95800_0_0|SrvcGrp|87679|2022|PDM|884.00|99|0.00|LUMBAR OR SACRAL SURGERY
20|FH_F95900_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F95962_0_0|SrvcGrp|3208|2022|PDM|1378.00|99|0.00|SUBACUTE CARE
20|FH_F95962_0_0|SrvcGrp|94886|2022|PDM|1972.00|99|0.00|MEDICAL SVERVICES
20|FH_F96182_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE
20|FH_F96182_0_0|SrvcGrp|471|2022|PDM|550.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F96321_0_0|CSTM-ALL|CSTM-00|2020|PDM|1017.00|99|0.00|AEG 7 (NO REV)
20|FH_F96321_0_0|CSTM-ALL|CSTM-00|2020|PDM|1286.00|99|0.00|AEG 9 (NO REV)
20|FH_F96780_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F96780_0_0|CSTM-ALL|CSTM-00|2020|PDM|384.00|99|0.00|AEG 1 (NO REV)
20|FH_F96780_0_0|CSTM-ALL|CSTM-00|2020|PDM|603.00|99|0.00|AEG 3 (NO REV)
20|FH_F96780_0_0|CSTM-ALL|CSTM-00|2020|PDM|728.00|99|0.00|AEG 4 (NO REV)
20|FH_F96780_0_0|SrvcGrp|28548|2022|PDM|1786.00|99|0.00|VITRECTOMY
20|FH_F96780_0_0|SrvcGrp|42429|2022|PDM|516.00|99|0.00|OP SURGERY CPT 66761
20|FH_F96780_0_0|SrvcGrp|46906|2022|PDM|1786.00|99|0.00|CORNEAL TISSUE
20|FH_F96780_0_0|SrvcGrp|62737|2022|PDM|1761.00|99|0.00|SURGERY CARVE OUTS
20|FH_F96902_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F96902_0_0|SrvcGrp|47411|2022|PDM|165.00|99|0.00|HOSPICE CARE/ IN HOME S9126
20|FH_F96902_0_0|SrvcGrp|94780|2022|PDM|165.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)
20|FH_F97160_77436_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS
20|FH_F97160_77436_0|SrvcGrp|86723|2022|PDM|584.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)
20|FH_F97161_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|AEG 4 (NO REV)
20|FH_F97242_0_0|SrvcGrp|473|2022|PDM|315.00|99|0.00|SUB-ACUTE REHAB - LEVEL II
20|FH_F97700_0_0|SrvcGrp|33166|2022|PDM|550.00|99|0.00|SKILLED NURSING - LEVEL III
20|FH_F97700_0_0|SrvcGrp|471|2022|PDM|660.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV
20|FH_F98101_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB
20|FH_F98101_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.49|99|0.00|GENERAL ACUTE CARE
20|FH_F98101_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.49|99|0.00|OP SVCS
20|FH_F98161_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F98161_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS
20|FH_F98161_0_0|SrvcGrp|73006|2022|PDM|1540.00|99|0.00|AEG 9
20|FH_F98161_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH
20|FH_F98480_0_0|CSTM-ALL|CSTM-00|2020|PDM|475.00|99|0.00|AEG 1 (NO REV)
20|FH_F98480_0_0|CSTM-ALL|CSTM-00|2020|PDM|530.00|99|0.00|AETNA AMBULATORY DEFAULT
20|FH_F98480_0_0|CSTM-ALL|CSTM-00|2020|PDM|637.00|99|0.00|AEG 2 (NO REV)
20|FH_F98640_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE
20|FH_F98640_0_0|CSTM-ALL|CSTM-00|2020|PDM|1140.00|99|0.00|AEG 2 (NO REV)
20|FH_F98640_0_0|CSTM-ALL|CSTM-00|2020|PDM|812.00|99|0.00|AEG 1 (NO REV)
20|FH_F98640_0_0|SrvcGrp|109017|2022|PDM|1818.00|99|0.00|REMOVAL OF ADENOIDS
20|FH_F98640_0_0|SrvcGrp|42550|2022|PDM|2826.00|99|0.00|OP SURGERY CPT 66984
20|FH_F98640_0_0|SrvcGrp|59840|2022|PDM|1818.00|99|0.00|TYMPANOSTOMY
20|FH_F98640_0_0|SrvcGrp|88613|2022|PDM|1818.00|99|0.00|REMOVAL OF TONSILS
20|FH_F98741_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F99021_0_0|CSTM-ALL|CSTM-00|2020|PDM|633.00|99|0.00|AEG 4 (NO REV)
20|FH_F99021_0_0|CSTM-ALL|CSTM-00|2020|PDM|720.00|99|0.00|AEG 5  (NO REV)
20|FH_F99100_0_0|CSTM-ALL|CSTM-00|2020|PDM|1040.00|99|0.00|AEG 5  (NO REV)
20|FH_F99100_0_0|CSTM-ALL|CSTM-00|2020|PDM|1442.00|99|0.00|AEG 7 (NO REV)
20|FH_F99100_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 4 (NO REV)
20|FH_F99100_0_0|SrvcGrp|88495|2022|PDM|669.80|99|0.00|AETNA PERCUTANEOUS INTRADISCAL
20|FH_F99100_0_0|SrvcGrp|96060|2022|PDM|1801.47|99|0.00|DISECTOMY
20|FH_F99100_0_0|SrvcGrp|96102|2022|PDM|566.50|99|0.00|LUMBAR INJECTION (HCFA)
20|FH_F99161_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F99161_0_0|SrvcGrp|75487|2022|PDM|1529.09|99|0.00|AEG 5
20|FH_F99161_0_0|SrvcGrp|75489|2022|PDM|1619.09|99|0.00|AEG 6
20|FH_F99161_0_0|SrvcGrp|75497|2022|PDM|700.00|99|0.00|AEG 10
20|FH_F99161_0_0|SrvcGrp|85022|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F99320_0_0|CSTM-ALL|CSTM-00|2020|PCT|46.00|99|0.00|GENERAL ACUTE CARE
20|FH_F99320_0_0|CSTM-ALL|CSTM-00|2020|PCT|46.00|99|0.00|OP SVCS
20|FH_F99441_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F99441_0_0|CSTM-ALL|CSTM-00|2020|PDM|531.00|99|0.00|AEG 10 (NO REV)
20|FH_F99441_0_0|CSTM-ALL|CSTM-00|2020|PDM|832.00|99|0.00|AEG 6 (NO REV)
20|FH_F99441_0_0|SrvcGrp|104003|2022|PDM|2601.00|99|0.00|INSERT AQUEOUS DRAIN DEVICES
20|FH_F99441_0_0|SrvcGrp|111136|2022|PDM|467.00|99|0.00|PHENYLEPHRINE KETOROLAC INJECTION
20|FH_F99441_0_0|SrvcGrp|112581|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION
20|FH_F99441_0_0|SrvcGrp|42550|2022|PDM|1380.00|99|0.00|OP SURGERY CPT 66984
20|FH_F99522_0_0|CSTM-ALL|CSTM-00|2020|PCT|47.00|99|0.00|OP SVCS
20|FH_F99528_0_0|CSTM-ALL|CSTM-00|2020|PCT|48.00|99|0.00|OP SVCS
20|FH_F99720_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)
20|FH_F99720_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2
20|FH_F99720_0_0|SrvcGrp|104735|2022|PDM|2048.00|99|0.00|NERVE REPAIR WITH SYNTHETIC
20|FH_F99720_0_0|SrvcGrp|104741|2022|PDM|4096.00|99|0.00|HIP ARTHRO W/ LABRAL REPAIR
20|FH_F99720_0_0|SrvcGrp|104742|2022|PDM|4301.00|99|0.00|TOTAL HIP ARTHROPLASTY
20|FH_F99720_0_0|SrvcGrp|72994|2022|PDM|1595.00|99|0.00|AEG 3
20|FH_F99720_0_0|SrvcGrp|72996|2022|PDM|1967.00|99|0.00|AEG 4
20|FH_F99720_0_0|SrvcGrp|73006|2022|PDM|2608.00|99|0.00|AEG 9
20|FH_F99760_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|OP SVCS
20|FH_F99960_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS
20|FH_F99960_0_0|SrvcGrp|27348|2022|PDM|1760.00|99|0.00|OP SURGERY (CPT 58662)
20|FH_F99960_0_0|SrvcGrp|67989|2022|PDM|1760.00|99|0.00|CPT 49320
20|FH_F99960_0_0|SrvcGrp|72996|2022|PDM|986.00|99|0.00|AEG 4
20|FH_F99960_0_0|SrvcGrp|72998|2022|PDM|1124.00|99|0.00|AEG 5
20|FH_F99960_0_0|SrvcGrp|73006|2022|PDM|2097.00|99|0.00|AEG 9
99|5626|49832|55460